Zoe Garoufalia interviews Christianne Buskens, specialised IBD-surgeon in Amsterdam University Medical Hospitals, Netherlands. Christianne is a strong believer that daily practice should be connected to research work, to constantly improve patient care.
In 2015, she was awarded an innovative research incentive grant from The Netherlands organisation for health research and development which has been the basis for the current translational IBD research lines: the role of the appendix in ulcerative colitis, the role of the mesentery in Crohn’s disease, and the fundamental characterisation of perianal fistulas in Crohn’s patients.
Christianne will speak at ESCP’s 20th annual congress on how surgeons change the natural course of IBD. Zoe Garoufalia spoke to her about what delegates can expect from her talk.
Zoe Garoufalia: Dr Buskens thank you for agreeing to speak with us about your upcoming speech in ESCP’s upcoming event.
Christianne Buskens: Thank you for the invitation.
ZG: Can you tell us a few things about yourself, your training and your main areas of interest?
CB: First and foremost, I am a clinical doctor with an intense joy in my surgical job and taking care of patients. However, I strongly believe that daily practice should be connected to research work, to constantly improve patient care. Therefore, I have always combined clinical work with research projects. During the first years of surgical training, I developed an enthusiasm for translational research projects. I have defended my PhD-dissertation with distinction in October 2004 (Title: The development of new treatment strategies for oesophageal carcinoma). Since qualitative research can only be performed with the correct background knowledge, I have completed a masters program in clinical epidemiology.
After finishing my surgical training in 2009, I have been working as a colorectal fellow specialising in proctology and laparoscopic surgery at the Oxford Radcliffe Hospitals under supervision of Professor Dr N. Mortensen, funded by the KWF (Koningin Wilhelmina Fonds). This Dutch organisation on medical oncology supports medical specialists by providing a two-year budget for clinical specialisation, and stimulates the development of collaborative research programs.
Since January 2012, I am working as a staff surgeon at the Amsterdam University Medical Hospitals (location AMC), The Netherlands. In the AMC, my field of interest changed from oncology to IBD. Nowadays, I am a specialised IBD-surgeon treating this fascinating disease in all its complexity, in a multidisciplinary setting. In 2015, I was awarded an innovative research incentive grant from The Netherlands organization for health research and development. This grant enabled me to spend dedicated research time in the laboratory, and was the basis for the current translational IBD research lines: the role of the appendix in ulcerative colitis, the role of the mesentery in Crohn’s disease, and the fundamental characterisation of perianal fistulas in Crohn’s patients.
ZG: Ahead of your upcoming speech, can you give us some advice how can a surgeon change the natural course of IBD?
CB: Management of patients with IBD has traditionally been an area for the gastroenterologist. Surgery has often been considered as a 'last-resort treatment'. However, times are changing. Only this last decade it has become clear that surgery can sometimes be considered as an alternative to medical treatment and can sometimes be more effective.
ZG: Is there a new role for surgical treatment in IBD management?
CB: Medical treatment generally remains the first choice for the majority of patients with IBD. It is, however, still discussed whether the expanding medical armamentarium does change the natural course of the disease. Epidemiological studies have suggested a reduced incidence of surgical interventions and hospitalisation after the introduction of anti-tumour necrosis factor (TNF). Other studies have demonstrated that surgery is merely just postponed. Moreover, several reports suggest increasing numbers of postoperative complications related to a higher incidence of concomitant fistulas and/or abscesses and patients in more deplorable condition when on medical treatment.
ZG: Can you tell us what your speech is about?
CB: In my talk at ESCP 2020 I will discuss new surgical treatment options and strategies that are emerging to change the natural course of ulcerative colitis (UC) and Crohn's disease (CD). I will address the role of an appendectomy for patients with UC, both to ameliorate active disease activity and prevent flares. For CD, the focus will be on the ileocoecal resection, as this is the most frequently performed procedure. Various surgical possibilities to decrease the incidence of (surgical) recurrences, varying from the role of the mesentery (and whether or not to perform an 'oncological' resection) to the advantages of inflammation-free resection margins, will be discussed.
ZG: What will be the key points of interest?
CJB:
- Appendectomy mitigates UC disease activity
- Response to appendectomy is related to inflammation of the appendix
- The incidence of CD recurrence after ileocoecal resection has decreased over time
- Active inflammation at the distal colonic resection margin after ileocecal resection is a strong predictive parameter for postoperative recurrence
- The mesentery is involved in CD. Whether this organ can be considered as a friend, foe, or an innocent bystander is dependent on location and the phenotype of the disease
- The bowel-mesentery-axis is at least bi-directional
ZG: Thank you for your time and insight. Looking forward to your presentation.
Don’t miss Dr Buskens’ speech on how surgeons change the natural course of IBD on Monday 21 September at 17:45-17:55.
