The primary aim of this ACE is to be a world-wide leading center for HPB diseases in the three pillars of academic medicine: patient care, research, and teaching. Patient care involves expert multidisciplinary decision making as well as innovative diagnostic and therapeutic modalities. Research involves both epidemiological, translational and clinical research. Education involves teaching knowledge, judgment, and skills covering the complete spectrum from medical students to specialists.
Research Activities
The focus of research of the ACE is both epidemiological, translational and clinical research. Translational studies involve close collaborations between clinicians and scientists, for example: organoids of biliary tumors for personalized treatment, genomics of chronic HBV infection, and the innate immune response in viral hepatitis. Clinical research includes the initiation of several international registries (e.g., for PBC and pancreatic cysts), multi-center phase II trials (e.g., LAPC), and nation-wide phase III trials (e.g., PREOPANC and APEC).
Most of the studies in our ACE are multidisciplinary, for example: pancreatitis studies (e.g., APEC trial) comparing endoscopic with surgical management, and oncological studies (e.g. PREOPANC trial) comparing combinations of surgery and systemic treatment. Future multidisciplinary phase 3 trials include: PUMP trial and the PREOPANC-2 trial, Typically, each PhD student is supervised by professors of two or more disciplines.
The ACE has many long-term international collaborations, including: Johns Hopkins University (surveillance of patients at risk for pancreatic cancer; prognostic models for cholangiocarcinoma), Mayo Clinic (PSC, NASH, and liver transplantation), Memorial Sloan Kettering Cancer Center (cholangiocarcinoma and regional chemotherapy), and a world-wide registry for pancreatic cysts. In addition, the Erasmus MC participates in a international network on cholangiocarcinoma and liver adenomas (EURACAN)
Collaborations
The ACE has many long-term international collaborations, including: Johns Hopkins University (surveillance of patients at risk for pancreatic cancer; prognostic models for cholangiocarcinoma), Mayo Clinic (PSC, NASH, and liver transplantation), Memorial Sloan Kettering Cancer Center (cholangiocarcinoma and regional chemotherapy), and a world-wide registry for pancreatic cysts.
Contributions
Education within this ACE involves teaching knowledge, judgment, and skills. The ACE contributes to education for all degrees: BA, MSc, PhD, medical specialization (AIOS), sub-specialization (clinical fellows), nurse practitioners, and physician assistants. The liver transplantation fellowship program is accredited by the UEMS (European Union of Medical Specialist); the HPB program is scheduled for European accreditation this year. We offer competitive international fellowships, including a 6-months fellowship for advanced endoscopic skills (ERCP and EUS), a 4-month fellowship for liver transplantation and ultrasound of the liver, and a two-year surgical fellowship for HPB and transplantation. Fellows come from all over the world including UK, Iltaly,Poland, Georgia, Turkey and Japan. Several postgraduate courses are organized by the ACE for an international audience, for example: the basic course in liver transplantation and the annual Liver day. We have a close collaboration with International Organisation for Professionals (IASGO)
Evaluations including SETQ and audits allow for continuous improvement of our teaching programs. Moreover, we develop novel educational programs. For example, we developed and validated a novel teaching model to ensure safe training in ERCP.
Care Activities
Most interventions within the ACE are not offered outside academic hospitals, including: liver transplantation, complex interventional endoscopy, management of hilar cholangiocarcinoma, management of benign and malignent liver tumors and liver resection in cirrhotic patients.
The ACE is recognized by the Netherlands Federation of University Hospitals (NFU) as a center of expertise for a nearly all rare HPB diseases, including: hepatocellular adenoma, cholangiocarcinoma, hepatocellular carcinoma, hereditary chronic pancreatitis, recurrent acute pancreatitis, autoimmune pancreatitis, and congenital pancreatic cysts. Further increase in patient volume for these rare diseases is reassured by the new regional cancer network (EMBRAZE).
Transmural multidisciplinary clinical pathways have been implemented to reassure effective and efficient patient care. Value-based health care programs are near completion for cholangiocarcinoma, liver tumors, and liver transplantation. Moreover, the ACE played a central role in the development of several national guidelines (e.g., pancreatic cancer), international guidelines (e.g., benign liver tumors), and nationwide clinical audits (e.g., pancreatic resection).
The ACE has contributed significantly to innovations in patient care, including: interventional endoscopy for pancreatic necrosis, management of pancreatic cysts, and imaging in the modern operating roomand Ytrium treatment of malignant liver tumors.
Societal Relevance to Research, Education and Patient Care
Involvement in public health is exemplified by the international leading role in surveillance of individuals at high-risk for pancreatic cancer, and patients with pancreatic cysts; both in collaboration with the ACE Prevention. Moreover, members of the ACE co-authored the appraisal on early detection of pancreatic cancer of the Dutch Cancer Society. The ACE has developed curricula for all levels of training, for example, an HPB and liver transplantation curriculum for medical students that covers the same diseases as the ACE. The ACE continuous to innovate education, for example, with the recent development of a teaching model for ERCP and a robotic HPB surgery training program that is being developed.
The ACE wrote educational material for patients that is available on the website of the Dutch Cancer Society: kanker.nl. The ACE has played a leading role in the development of national guidelines (e.g., pancreatic cancer, hepatocellular carcinoma, liver transplantation, organ donation after euthanasia, and viral hepatitis), and international guidelines (e.g., chronic pancreatitis and liver adenoma). The ACE has authored and edited many medical textbooks. The ACE is also highly visible in the lay press and media (e.g. in the past few months, Volkskrant, NRC, and RTL Late night).
Viability of Research, Education and Patient Care
Knowledge sharing is a key part of daily practice within the ACE; for example, between consultants and residents in clinic or in the OR, or between disciplines in the many weekly multidisciplinary meetings within the ACE. Several PhD students were trained during their curriculum at collaborating international leading centers.
The ACE is represented at all international meetings by PhD students presenting their original work and by consultants invited as lecturers or moderators. Many publications are the result of international collaborations involving both original research and consensus guidelines. To improve the quality of our work we focus on governance and leadership skills of our the various units in our ACE in close collaboration with our network. A bibliometric network analysis is currently not available; however, the list of ten key publications in the next section demonstrates that the ACE participates in the international top.
Key and relevant publications of the last five years
- First Comparison of Hypothermic Oxygenated PErfusion Versus Static Cold Storage of Human Donation After Cardiac Death Liver Transplants: An International-matched Case Analysis.Dutkowski P, Polak WG, Muiesan P, Schlegel A, Verhoeven CJ, Scalera I, DeOliveira ML, Kron P, Clavien PA. Ann Surg. 2015
- Systematic review and meta-analysis of the impact of computed tomography assessed skeletal muscle mass on outcome in patients awaiting or undergoing liver transplantation.van Vugt JL, Levolger S, de Bruin RW, van Rosmalen J, Metselaar HJ, IJzermans JN.
- Long-term culture of genome-stable bipotent stem cells from adult human liver.Huch M, Gehart H, van Boxtel R, Hamer K, Blokzijl F, Verstegen MM, Ellis E, van Wenum M, Fuchs SA, de Ligt J, van de Wetering M, Sasaki N, Boers SJ, Kemperman H, de Jonge J, Ijzermans JN, Nieuwenhuis EE, Hoekstra R, Strom S, Vries RR, van der Laan LJ, Cuppen E, Clevers H.
- FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis.Suker M, Beumer BR, Sadot E, Marthey L, Faris JE, Mellon EA, El-Rayes BF, Wang-Gillam A, Lacy J, Hosein PJ, Moorcraft SY, Conroy T, Hohla F, Allen P, Taieb J, Hong TS, Shridhar R, Chau I, van Eijck CH, Groot Koerkamp B.
- EASL Clinical Practice Guidelines on the management of benign liver tumours.European Association for the Study of the Liver (EASL). J Hepatol. 2016 Apr 11. IJzermans JNM
- Recurrence Rate and Pattern of Perihilar Cholangiocarcinoma after Curative Intent Resection.Groot Koerkamp B, Wiggers JK, Allen PJ, Besselink MG, Blumgart LH, Busch OR, Coelen RJ, D'Angelica MI, DeMatteo RP, Gouma DJ, Kingham TP, Jarnagin WR, van Gulik TM.
- Early versus on-demand nasoenteric feeding in acute pancreatitis.Bakker OJ, van Brunschot S, van Santvoort HC, Besselink MG, Bollen TL, Boermeester MA, Dejong CH, van Goor H, Bosscha K, Ali UA, Bouwense S, van Grevenstein WM Heisterkamp J, Houdijk AP, Jansen JM, Karsten TM, Manusama ER, Nieuwenhuijs VB, Schaapherder AF, van der Schelling GP, Schwartz MP, Spanier BWM, Tan A, Vecht J, Weusten BL, Witteman BJ, Akkermans LM, Bruno MJ, Dijkgraaf MG, van Ramshorst B, Gooszen HG. N Engl J Med 2014; 371:1983-93.
- Same-admission versus Interval Cholecystectomy for Mild Gallstone Pancreatitis.da Costa DW, Bouwense SA, Schepers NJ, Besselink MG, van Brunschot S, van Santvoort HC, Bakker OJ, Bollen TL, Dejong CH, van Goor H, Boermeester MA, Bruno MJ, van Eijck CH, Timmer R, Weusten BL, Consten EC, Brink MA Spanier MB, Spillenaar Bilgen EJ, Nieuwenhuijs VB, Hofker HS, Rosman C, Voorburg A, Bosscha K, van Duijvendijk P, Gerritsen JJ, Heisterkamp J, de Hingh IH, Witteman BJ, Kruyt PM, Scheepers JJ, Molenaar IQ, Schaapherder AF, Manusama ER, van der Waaij LA, van Unen J, Dijkgraaf MG, van Ramshorst B, Gooszen HG, Boerma D, or the Dutch Pancreatitis Study Group. Lancet 2015; 386: 1261-8.
- International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer.Canto MI, Harinck F, Hruban RH, Offerhaus GJ, Poley JW, Kamel I, Nio Y, Schulick RS, Bassi C, Kluijt I, Levy MJ, Chak A, Fockens P, Goggins M, Bruno MJ; on behalf of the International Cancer of the Pancreas Screening (CAPS) Consortium. Gut. 2013; 62: 339-47.
- Treatment of HCV infection by targeting microRNA (2013)Janssen, H.L.A., Reesink, H.W., Lawitz, E.J., Zeuzem, S., Rodriguez-Torres, M., Patel, K., Van Der Meer, A.J., Patick, A.K., Chen, A., Zhou, Y., Persson, R., King, B.D., Kauppinen, S., Levin, A.A., Hodges, M.R. New England Journal of Medicine, 368 (18), pp. 1685-1694.
PhD theses of the last five years
- Harinck F. The impact of surveillance of individuals at high risk for developing pancreatic cancer by EUS and MRI. Promotores: Bruno MJ, dept. of Gastroenterology & Hepatology, Erasmus MC, Rotterdam, Netherlands & Fockens P, dept. of Gastroenterology & He
- Edith Koehler. Non-alcoholic fatty liver disease: from patient to population. Promotor: H.L.A. Janssen. Copromotor: J.N.L. Schouten. June 2013
- Emmeloes de Mare-Bredemeijer: Determintants of complications in liver transplant patients. Promotor: H.J. Metselaar. Copromotor: J. Kwekkeboom. September 2015.
- V.E. de Meijer: Fatty liver-Risks, Regulation and Reversibility. Promotor: J.N.M. Ijzermans. Co-promotor; M. Puder, juni 2011.
- S.M. van Aalten: Hepatocellular Adenoma ‘A new Perspective. Promotor: J.N.M. IJzermans. Co-promotor: R.A. de Man; maart 2012
- C.D.M. Witjes: New Insights in Hepatocellular Carcinoma. Promotor; J.N.M. IJzermans. Co-promotor: R.A. de Man, C. Verhoef, oktober 2012
- M.G. van Vledder, Liver Surgery: Imaging and Image Guided Therapies. Promotor; J.N.M. IJzermans, co-promotor: M.A. Choti, November 2012.
- J. Buijs: Autoimmunne pancreatitus; Promotor M.J. Bruno, co-promotor H. van Buuren, December 2015.
- P.R.A. Buijs; Oncolytic Newcastle Disease Virus as Treatment for Pancreatic Cancer. Promotor: C.H.J. van Eijck, R.A.M. Fouchier, co-promotor: B.G. van den Hoogen, September 2015
- J.I. Erdmann; Classification and Treatment of Pancreatic and Non-Pancreatic Periampullary Cancers. Promotor: C.H.J. van Eijck, co-promotor: N.F.M. Kok, November 2015