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Brouquet A, Bachet JB, Huguet F, Karoui M, Artru P, Sabbagh C, Lefèvre JH, Vernerey D, Mariette C, Vicaut E, Benoist S. NORAD01-GRECCAR16 multicenter phase III non-inferiority randomized trial comparing preoperative modified FOLFIRINOX without irradiation to radiochemotherapy for resectable locally advanced rectal cancer (intergroup FRENCH-GRECCAR- PRODIGE trial). BMC Cancer 2020; 20:485. [PMID: 32471382 PMCID: PMC7257230 DOI: 10.1186/s12885-020-06968-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Preoperative radiochemotherapy (RCT) is recommended in France prior to total mesorectal excision in patients with mid or low locally advanced rectal cancer (LARC) (cT3/T4 and/or N+) because it has been shown to improve local control. Preoperative RCT has also disadvantages including the absence of proven impact on metastatic recurrence and the risk of late side effects on bowel and genitourinary function. In patients with primarily resectable LARC, preoperative systemic chemotherapy without pelvic irradiation could be used as an alternative to RCT. METHODS This study is a multicenter, open-label randomized, 2-arm phase III non-inferiority trial. Patients with mid or low resectable LARC (cT3N0 or cT1-T3N+ with circumferential resection margin [CRM] > 2 mm on pretreatment MRI) will be randomized to either modified FOLFIRINOX for 3 months or RCT (Cap50 intensified-modulated radiotherapy). All patients have restaging MRI after preoperative treatment. The primary endpoint is 3-year progression-free survival (PFS) from the time to randomization including progression during preoperative treatment. Secondary endpoints are treatment related toxicity, treatment compliance, R0 resection rate, sphincter saving surgery rate, postoperative morbidity and mortality rates, loco-regional recurrence free survival, overall survival, bowel and sexual functions at diagnosis, quality of life, radiologic and pathologic response after preoperative treatment. The number of patients required is 574. DISCUSSION The choice of modified FOLFIRINOX for preoperative chemotherapy is supported by recent and consistent data on safety and efficacy of this regimen on rectal cancer. The use of preoperative chemotherapy instead of RCT could be associated with pronounced advantages in terms of functional results and quality of life in cancer survivors. However and first of all, the non-inferiority of preoperative chemotherapy compared to RCT on oncologic outcome has to be validated. If this study demonstrates the non-inferiority of chemotherapy compared to RCT, this can lead to a crucial change in clinical practice in a large subset of rectal cancer patients. TRIAL REGISTRATION ClinicalTrials.gov NCT03875781 (March 15, 2019). Version 1.1.
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Affiliation(s)
- Antoine Brouquet
- Service de Chirurgie Digestive et Oncologique, Hôpital Bicêtre, Groupe Hospitalier Universitaire Paris Sud, Assistance Publique, Hôpitaux de Paris, 63, rue Gabriel Péri, Le Kremlin Bicetre, 94275, France. .,Faculté de Médecine Paris Sud, Université Paris Saclay, Lrekmlin Bicêtre, 94275, France.
| | - Jean-Baptiste Bachet
- Service d'Oncologie Digestive, Hôpital de la Pitié Salpétrière, Assistance Publique, Hôpitaux de Paris, Paris, 75013, France
| | - Florence Huguet
- Service de Radiothérapie, Hôpital Tenon, Assistance Publique, Hôpitaux de Paris, Paris, 75020, France
| | - Mehdi Karoui
- Service de Chirurgie Digestive, Hôpital Européen Georges Pompidou, Assistance Publique, Hôpitaux de Paris, Paris, 75015, France
| | | | - Charles Sabbagh
- Service de Chirurgie Digestive, CHU Amiens, Amiens, 60000, France
| | - Jérémie H Lefèvre
- Service de Chirurgie Générale et Digestive, Hôpital Saint Antoine, Assistance Publique, Hôpitaux de Paris, Paris, 75012, France
| | | | - Christophe Mariette
- Service de Chirurgie Digestive et Oncologique, CHU Lille, Lille, 59000, France
| | - Eric Vicaut
- Unité de Recherche Clinique Paris VII, Assistance Publique, Hôpitaux de Paris, Paris, 75010, France
| | - Stephane Benoist
- Service de Chirurgie Digestive et Oncologique, Hôpital Bicêtre, Groupe Hospitalier Universitaire Paris Sud, Assistance Publique, Hôpitaux de Paris, 63, rue Gabriel Péri, Le Kremlin Bicetre, 94275, France.,Faculté de Médecine Paris Sud, Université Paris Saclay, Lrekmlin Bicêtre, 94275, France
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Manceau G, Eveno C, Sabbagh C. What are the Particularities of Colorectal Surgery in Cirrhotic Patients. Chirurgia (Bucur) 2020; 115:148-154. [PMID: 32369718 DOI: 10.21614/chirurgia.115.2.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
This work's objective was to review the entire literature on colorectal surgery in order to best define the surgical indications and their management specificities. The literature analysis was carried out according to High Authority for Health (HAS) methodology, by consulting the PubMed database (Medline), from the beginning of January 1995 until the end of June 2015.
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van Hooft JE, Veld JV, Arnold D, Beets-Tan RGH, Everett S, Götz M, van Halsema EE, Hill J, Manes G, Meisner S, Rodrigues-Pinto E, Sabbagh C, Vandervoort J, Tanis PJ, Vanbiervliet G, Arezzo A. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020. Endoscopy 2020; 52:389-407. [PMID: 32259849 DOI: 10.1055/a-1140-3017] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 : ESGE recommends colonic stenting to be reserved for patients with clinical symptoms and radiological signs of malignant large-bowel obstruction, without signs of perforation. ESGE does not recommend prophylactic stent placement.Strong recommendation, low quality evidence. 2 : ESGE recommends stenting as a bridge to surgery to be discussed, within a shared decision-making process, as a treatment option in patients with potentially curable left-sided obstructing colon cancer as an alternative to emergency resection.Strong recommendation, high quality evidence. 3 : ESGE recommends colonic stenting as the preferred treatment for palliation of malignant colonic obstruction.Strong recommendation, high quality evidence. 4 : ESGE suggests consideration of colonic stenting for malignant obstruction of the proximal colon either as a bridge to surgery or in a palliative setting.Weak recommendation, low quality evidence. 5 : ESGE suggests a time interval of approximately 2 weeks until resection when colonic stenting is performed as a bridge to elective surgery in patients with curable left-sided colon cancer.Weak recommendation, low quality evidence. 6 : ESGE recommends that colonic stenting should be performed or directly supervised by an operator who can demonstrate competence in both colonoscopy and fluoroscopic techniques and who performs colonic stenting on a regular basis.Strong recommendation, low quality evidence. 7 : ESGE suggests that a decompressing stoma as a bridge to elective surgery is a valid option if the patient is not a candidate for colonic stenting or when stenting expertise is not available.Weak recommendation, low quality evidence.
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Affiliation(s)
- Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Joyce V Veld
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands.,Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Dirk Arnold
- Department of Oncology, Hematology and Palliative Care, Asklepios Tumourzentrum Hamburg, Hamburg, Germany
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Everett
- Department of Gastroenterology and Hepatology, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Martin Götz
- Department of Gastroenterology/Oncology, Klinikum Sindelfingen-Böblingen, Kliniken Böblingen, Böblingen, Germany
| | - Emo E van Halsema
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - James Hill
- Department of Surgery, Manchester University NHS FT, Manchester, United Kingdom
| | - Gianpiero Manes
- Department of Gastroenterology and Endoscopy, Guido Salvini Hospital, Garbagnate Milanese/Rho, Milan, Italy
| | - Soren Meisner
- Endoscopy Unit, Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | - Charles Sabbagh
- Department of Digestive and Oncological Surgery, University Hospital of Amiens, France
| | - Jo Vandervoort
- Department of Gastroenterology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, The Netherlands
| | - Geoffroy Vanbiervliet
- Department of Gastroenterology, Centre Hospitalier Universitaire de l'Archet, Pôle digestif, Nice, France
| | - Alberto Arezzo
- Department of Surgical Sciences, Università di Torino, Torino, Italy
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Collard M, Lakkis Z, Loriau J, Mege D, Sabbagh C, Lefevre JH, Maggiori L. [Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis]. ACTA ACUST UNITED AC 2020; 157:S33-S43. [PMID: 32355509 PMCID: PMC7190476 DOI: 10.1016/j.jchirv.2020.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
La saturation intrahospitalière liée à l’arrivée massive de patients atteints du COVID-19 nécessitant une prise en charge urgente conduit à reconsidérer la prise en charge des autres patients. Différer au maximum les hospitalisations et les opérations chirurgicales non urgentes est un des objectifs des chirurgiens afin de désengorger autant que possible le système de soins. Alors que la majorité des opérations programmées sont annulées, la réduction de la chirurgie d’urgence est évidemment compliquée à proposer sans altérer la qualité de la prise en charge et conduire à une perte de chance pour le patient. Cependant, l’appendicite aiguë constitue une situation spécifique bien particulière et la fréquence de cette pathologie conduit à considérer ce cas particulier. En effet, tandis que le traitement recommandé de l’appendicite aiguë non compliquée est chirurgical, l’alternative non chirurgicale par antibiothérapie seule a été largement évaluée dans la littérature au cours de travaux de qualité. Dans la mesure où la limite principale du traitement médical exclusif de l’appendicite aiguë non compliquée est le risque de récidive à distance, cette option thérapeutique représente une alternative de choix pour réduire la surcharge intrahospitalière dans ce contexte de crise sanitaire. L’objectif de ce travail est donc de mettre à disposition des médecins et des chirurgiens un guide pratique issu d’une analyse de la littérature sur le traitement médical de l’appendicite aiguë non compliquée de l’adulte afin de pouvoir proposer ce traitement alternatif aux bons patients et dans des bonnes conditions, notamment lorsque l’accès au bloc opératoire est impossible.
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Affiliation(s)
- M Collard
- Service de chirurgie digestive, Sorbonne université, hôpital Saint-Antoine, AP-HP, 75012, Paris, France
| | - Z Lakkis
- Service de chirurgie digestive et oncologique , et de transplantation hépatique, CHU de Besançon, 2, boulevard Alexander-Fleming, 25000, Besançon, France
| | - J Loriau
- Service de chirurgie viscérale, groupe hospitalier Paris Saint-Joseph, 75014, Paris, France
| | - D Mege
- Service de chirurgie digestive, assistance publique hôpitaux de Marseille, hôpital de la Timone, CHU de Marseille, France
| | - C Sabbagh
- Service de chirurgie digestive, CHU Amiens-Picardie, 8000 Amiens, France.,Unité de recherche SSPC (simplification des soins des patients chirurgicaux complexes), université de Picardie Jules-Verne, 80025 Amiens, France
| | - J H Lefevre
- Service de chirurgie digestive, Sorbonne université, hôpital Saint-Antoine, AP-HP, 75012, Paris, France
| | - L Maggiori
- Service de chirurgie colorectale, hôpital Beaujon, université de Paris, AP-HP, 92110 Clichy, France
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Collard M, Lakkis Z, Loriau J, Mege D, Sabbagh C, Lefevre JH, Maggiori L. Antibiotics alone as an alternative to appendectomy for uncomplicated acute appendicitis in adults: Changes in treatment modalities related to the COVID-19 health crisis. J Visc Surg 2020; 157:S33-S42. [PMID: 32362368 PMCID: PMC7181971 DOI: 10.1016/j.jviscsurg.2020.04.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The massive inflow of patients with COVID-19 requiring urgent care has overloaded hospitals in France and impacts the management of other patients. Deferring hospitalization and non-urgent surgeries has become a priority for surgeons today in order to relieve the health care system. It is obviously not simple to reduce emergency surgery without altering the quality of care or leading to a loss of chance for the patient. Acute appendicitis is a very specific situation and the prevalence of this disease leads us to reconsider this particular disease in the context of the COVID-19 crisis. Indeed, while the currently recommended treatment for uncomplicated acute appendicitis is surgical appendectomy, the non-surgical alternative of medical management by antibiotic therapy alone has been widely evaluated by high-quality studies in the literature. Insofar as the main limitation of exclusively medical treatment of uncomplicated acute appendicitis is the risk of recurrent appendicitis, this treatment option represents an alternative of choice to reduce the intra-hospital overload in this context of health crisis. The aim of this work is therefore to provide physicians and surgeons with a practical guide based on a review of the literature on the medical treatment of uncomplicated acute appendicitis in adults, to offer this alternative treatment to the right patients and under good conditions, especially when access to the operating room is limited or impossible.
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Affiliation(s)
- M Collard
- Digestive Surgery Department, Sorbonne University, Saint-Antoine Hospital, AP-HP, 75012 Paris, France
| | - Z Lakkis
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, University Hospital of Besançon, 2, boulevard Alexander Fleming, 25000, Besançon, France
| | - J Loriau
- Department of Visceral Surgery, Groupe Hospitalier Paris Saint Joseph, 75014, Paris, France
| | - D Mege
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - C Sabbagh
- Digestive surgery department, CHU Amiens-Picardie, 80000 Amiens, France; Research Unit SSPC (simplification des soins des patients chirurgicaux complexes), université de Picardie Jules Verne, 80025 Amiens, France
| | - J H Lefevre
- Digestive Surgery Department, Sorbonne University, Saint-Antoine Hospital, AP-HP, 75012 Paris, France
| | - L Maggiori
- Department of Colorectal surgery, Beaujon Hospital, Paris University, AP-HP, 92110, Clichy, France.
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Hammoudi N, Cazals-Hatem D, Auzolle C, Gardair C, Ngollo M, Bottois H, Nancey S, Pariente B, Buisson A, Treton X, Fumery M, Bezault M, Seksik P, Le Bourhis L, Flejou JF, Allez M, Chirica M, Munoz-Bongrand N, Corte H, Beaupel N, Catry J, Gornet JM, Baudry C, Lourenco N, Maillet M, Tran-Minh ML, Chardiny V, Grand C, Gergaud B, Bonnet J, Chedouba L, Nisard A, Beaugerie L, Sokol H, Bourrier A, Nion-Larmurier I, Kirchgesner J, Quevrain E, Brot L, Chafai N, Lefevre JH, Tiret E, Svrcek M, Guedj N, Panis Y, Magiorri L, Ferron M, Bouhnik Y, Corcos O, Stefanescu C, Marteau P, Dray X, Chaput U, Kaci R, Dubois A, Bommelaer G, Goutte M, Barnich N, Coban D, Godfraind C, Zakeyh JJ, Desreumaux P, Nachury M, Sommeville C, Renaud F, Dupas JL, Loreau J, Brazier F, Chatelain D, Attencourt C, Sabbagh C, Leconte M, Boschetti G, Flourié B, François Y, Cotte E, Charlois AL, Falgon P, Hadjisavvas H, Moussata D, Chauvenet M, Boyer S, Traverse-Glehen A, Hebuterne X, Filippi J, Hofmann P, Rahili A, Patouraux S, Jouven X. Association Between Microscopic Lesions at Ileal Resection Margin and Recurrence After Surgery in Patients With Crohn's Disease. Clin Gastroenterol Hepatol 2020; 18:141-149.e2. [PMID: 31042575 DOI: 10.1016/j.cgh.2019.04.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/04/2019] [Accepted: 04/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Different types of histologic lesions at the ileal margin, detected by histology, have been associated with increased rates of recurrence after ileocaecal surgery in patients with Crohn's disease (CD). We aimed to characterize histologic features of the ileal margin and to evaluate their association with disease recurrence. METHODS We collected histologic data from 211 patients with ileal or ileocolonic CD who underwent ileocolonic resections at hospitals in France from September 2010 through December 2016. Ileal margins were analyzed. Early endoscopic recurrence was defined by a Rutgeerts score of i2 or more, 6 months after surgery. We also collected data from 10 adults with healthy ileum who underwent ileocecal resection for colonic tumors (controls). Clinical relapse was defined by CD-related symptoms confirmed by imaging, endoscopy, therapy intensification, CD-related complication, or subsequent surgery. RESULTS Six months after surgery, 49% of patients had endoscopic recurrence; 5 years after surgery, 57% of patients had clinical relapse. Ileal margins were macroscopically affected in 20.9% of patients. CD transmural lesions at the margin (defined by mucosal ulceration or cryptitis, submucosal fibrosis and lymphoplasmacytic infiltrate of the subserosa) were observed in 13.6% of patients. Endoscopic recurrence was observed in 75% of patients with CD transmural lesions vs 46% of patients without (P =.005). In multivariate analysis, CD transmural lesions at the margin were independently associated with early endoscopic recurrence (OR, 3.83; 95% CI, 1.47-11.05; P =.008) and clinical recurrence (OR 2.04; 95% CI, 1.09-3.99; P =.026). CONCLUSION In patients with CD, transmural lesions at the ileal margin were associated with an increased risk of post-operative recurrence. Histologic features of the ileal margin should be included in making decisions about post-operative therapy.
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Affiliation(s)
- Nassim Hammoudi
- Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France; Departement de Gastroentérologie, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | | | - Claire Auzolle
- Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France; Departement de Gastroentérologie, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France
| | | | - Marjolaine Ngollo
- Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France
| | - Hugo Bottois
- Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France
| | - Stéphane Nancey
- Gastroenterology Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Pariente
- Gastroenterology Department, Hôpital Claude Huriez, University of Lille 2, Lille, France
| | - Anthony Buisson
- Service de Médecine de l'Appareil Digestif, CHU Clermont-Ferrand, 3iHP, M2iSH, Inserm U1071, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Xavier Treton
- Service de Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon, Clichy, France
| | - Mathurin Fumery
- Hepatogastroenterology Department, Amiens University Hospital, Amiens, France
| | - Madeleine Bezault
- Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France
| | - Philippe Seksik
- Laboratoire des Biomolécules, INSERM, CNRS, PSL Research University, Ecole normale supérieure, AP-HP, Department of Gastroenterology, Saint Antoine Hospital, Sorbonne Universités, Paris, France
| | - Lionel Le Bourhis
- Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France
| | | | - Jean-François Flejou
- Pathology Department, AP-HP, Hôpital Saint-Antoine, Faculté de Médecine Sorbonne Université, Paris, France
| | - Matthieu Allez
- Université de Paris, Institut de Recherche Saint Louis, EMiLy, Inserm U1160, F-75010 Paris, France; Departement de Gastroentérologie, AP-HP, Hôpital Saint-Louis, F-75010 Paris, France.
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Manceau G, Mege D, Bridoux V, Lakkis Z, Venara A, Voron T, De Angelis N, Ouaissi M, Sielezneff I, Karoui M, Dazza M, Gagnat G, Hamel S, Mallet L, Martre P, Philouze G, Roussel E, Tortajada P, Dumaine AS, Heyd B, Paquette B, Brunetti F, Esposito F, Lizzi V, Michot N, Denost Q, Tresallet C, Tetard O, Regimbeau JM, Sabbagh C, Rivier P, Fayssal E, Collard M, Moszkowicz D, Peschaud F, Etienne JC, loge L, Beyer L, Bege T, Corte H, D'Annunzio E, Humeau M, Issard J, Munoz N, Abba J, Jafar Y, Lacaze L, Sage PY, Susoko L, Trilling B, Arvieux C, Mauvais F, Ulloa‐Severino B, Lefevre JH, Pitel S, Vauchaussade de Chaumont A, Badic B, Blanc B, Bert M, Rat P, Ortega‐Deballon P, Chau A, Dejeante C, Piessen G, Grégoire E, Alfarai A, Cabau M, David A, Kadoche D, Dufour F, Goin G, Goudard Y, Pauleau G, Sockeel P, De la Villeon B, Pautrat K, Eveno C, Brouquet A, Couchard AC, Balbo G, Mabrut JY, Bellinger J, Bertrand M, Aumont A, Duchalais E, Messière AS, Tranchart A, Cazauran JB, Pichot‐Delahaye V, Dubuisson V, Maggiori L, Djawad‐Boumediene B, Fuks D, Kahn X, Huart E, Catheline JM, Lailler G, Baraket O, Baque P, Diaz de Cerio JM, Mariol P, Maes B, Fernoux P, Guillem P, Chatelain E, de Saint Roman C, Fixot K. Thirty-day mortality after emergency surgery for obstructing colon cancer: survey and dedicated score from the French Surgical Association. Colorectal Dis 2019; 21:782-790. [PMID: 30884089 DOI: 10.1111/codi.14614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/27/2019] [Indexed: 02/08/2023]
Abstract
AIM The aim was to define risk factors for postoperative mortality in patients undergoing emergency surgery for obstructing colon cancer (OCC) and to propose a dedicated score. METHOD From 2000 to 2015, 2325 patients were treated for OCC in French surgical centres by members of the French National Surgical Association. A multivariate analysis was performed for variables with P value ≤ 0.20 in the univariate analysis for 30-day mortality. Predictive performance was assessed by the area under the receiver operating characteristic curve. RESULTS A total of 1983 patients were included. Thirty-day postoperative mortality was 7%. Multivariate analysis found five significant independent risk factors: age ≥ 75 (P = 0.013), American Society of Anesthesiologists (ASA) score ≥ III (P = 0.027), pulmonary comorbidity (P = 0.0002), right-sided cancer (P = 0.047) and haemodynamic failure (P < 0.0001). The odds ratio for risk of postoperative death was 3.42 with one factor, 5.80 with two factors, 15.73 with three factors, 29.23 with four factors and 77.25 with five factors. The discriminating capacity in predicting 30-day postoperative mortality was 0.80. CONCLUSION Thirty-day postoperative mortality after emergency surgery for OCC is correlated with age, ASA score, pulmonary comorbidity, site of tumour and haemodynamic failure, with a specific score ranging from 0 to 5.
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Affiliation(s)
- G Manceau
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - D Mege
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - V Bridoux
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Z Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - A Venara
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - T Voron
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Saint Antoine Hospital, Sorbonne Université, Paris, France
| | - N De Angelis
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Université Paris-Est (UEP), Créteil, France
| | - M Ouaissi
- Department of Digestive Surgery, Tours University Hospital, Tours, France
| | - I Sielezneff
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - M Karoui
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
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Mege D, Manceau G, Bridoux V, Voron T, Sabbagh C, Lakkis Z, Venara A, Ouaissi M, Denost Q, Kepenekian V, Sielezneff I, Karoui M. Surgical management of obstructive left colon cancer at a national level: Results of a multicentre study of the French Surgical Association in 1500 patients. J Visc Surg 2019; 156:197-208. [DOI: 10.1016/j.jviscsurg.2018.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Sabbagh C, Masseline L, Grelpois G, Ntouba A, Dembinski J, Regimbeau JM. Management of Uncomplicated Acute Appendicitis as Day Case Surgery: Can Outcomes of a Prospective Study Be Reproduced in Real Life? J Am Coll Surg 2019; 229:277-285. [PMID: 31096041 DOI: 10.1016/j.jamcollsurg.2019.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The feasibility of day case surgery (DCS) appendectomy for uncomplicated acute appendicitis (UCAA) was evaluated by the prospective AppendAmbu (Feasibility of Outpatient Appendectomy for Acute Appendicitis) study (ClinicalTrials.gov ID NCT01839435). The aim of this study was to evaluate the real-life feasibility of DCS for UCAA. STUDY DESIGN This single-center, retrospective, non-interventional study was conducted after the AppendAmbu study and included UCAA only. The primary end point was DCS success rate (ie length of stay <12 hours) in the intention-to-treat population (all patients with UCAA) and in the per-protocol population (population with UCAA and no preoperative and intraoperative exclusion criteria). The secondary end points were to determine the DCS quality criteria to evaluate and compare the morbidity and mortality of DCS and conventional hospitalization for UCAA (Clavien, Comprehensive Complication Index) and to externally validate the St Antoine criteria for the selection of patients for DCS. RESULTS From January 2016 to September 2017, two hundred and ninety-six patients underwent operations for acute appendicitis. The proportion of patients with successful DCS management was 27% in the intention-to-treat population and 95% in the per-protocol population. The unplanned consultation rate was 15%, the unplanned hospitalization rate was 4%, and the unplanned reoperation rate was 0%. The postoperative morbidity of patients managed by DCS was not different from that of patients managed in conventional hospitalization. The DCS success rate was 0%, with a St Antoine score of 0, and 80% of patients had a St Antoine score of 5 (p < 0.0001). CONCLUSIONS Day case surgery constitutes progress in surgery as a result of enhanced recovery programs. It avoids unnecessary prolonged hospitalization.
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Affiliation(s)
- Charles Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens Picardie, Jules Verne University of Picardie, Amiens, France; Simplification of Surgical Patients Care Research Unit, Jules Verne University of Picardie, Amiens, France; Jules Verne University of Picardie, Amiens, France
| | - Loréna Masseline
- Simplification of Surgical Patients Care Research Unit, Jules Verne University of Picardie, Amiens, France
| | - Gérard Grelpois
- Simplification of Surgical Patients Care Research Unit, Jules Verne University of Picardie, Amiens, France
| | - Alexandre Ntouba
- Department of Anesthesia, University Hospital of Amiens Picardie, Jules Verne University of Picardie, Amiens, France; Jules Verne University of Picardie, Amiens, France
| | - Jeanne Dembinski
- Department of Digestive Surgery, University Hospital of Amiens Picardie, Jules Verne University of Picardie, Amiens, France; Simplification of Surgical Patients Care Research Unit, Jules Verne University of Picardie, Amiens, France; Jules Verne University of Picardie, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, University Hospital of Amiens Picardie, Jules Verne University of Picardie, Amiens, France; Simplification of Surgical Patients Care Research Unit, Jules Verne University of Picardie, Amiens, France; Jules Verne University of Picardie, Amiens, France.
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Mege D, Sabbagh C, Manceau G, Karoui M. Response to Dr. Veld et al. Regarding the Manuscript Titled "What is the Best Option Between Primary Diverting Stoma or Endoscopic Stent as a Bridge to Surgery with a Curative Intent for Obstructed Left Colon Cancer? Results from a Propensity Score Analysis of the French Surgical Association Multicenter Cohort of 518 patients". Ann Surg Oncol 2019; 26:1954-1955. [PMID: 30843158 DOI: 10.1245/s10434-019-07281-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Diane Mege
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Gilles Manceau
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Sorbonne University, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Paris, France
| | - Mehdi Karoui
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Sorbonne University, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Paris, France.
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Mege D, Sabbagh C, Manceau G, Bridoux V, Lakkis Z, Momar D, Sielezneff I, Karoui M. What is the Best Option Between Primary Diverting Stoma or Endoscopic Stent as a Bridge to Surgery with a Curative Intent for Obstructed Left Colon Cancer? Results from a Propensity Score Analysis of the French Surgical Association Multicenter Cohort of 518 Patients. Ann Surg Oncol 2019; 26:756-764. [PMID: 30623342 DOI: 10.1245/s10434-018-07139-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic stent (ES) as a bridge to surgery in obstructed left colon cancer (OLCC) is controversial. Our goal was to compare the operative and oncological results of primary diverting colostomy (PDC) and ES for the curative treatment of OLCC. METHODS Between 2000 and 2015, patients who underwent PDC or ES in a curative intent for OLCC at member centers of the French Surgical Association were included. Patients with unresectable tumors and/or synchronous metastases were excluded. Comparisons between the two groups were performed after ponderation with propensity score for: demographic and tumor characteristics, operative, and oncological results. RESULTS A total of 518 patients were included: PDC (n = 327); ES (n = 191). The demographic characteristics were similar between the groups. ES failed in 23% of the patients (11% perforation). Cumulative tumor resection rates were 80% and 86% after PDC and ES, respectively (p = 0.049). The rates of primary anastomosis were 57% in the PDC group and 40% in the ES group (p < 0.0001). The permanent stoma rates were similar between the two groups (29% vs. 28%, p = 0.0586). Cumulative overall, surgical, and medical complications were significantly higher in PDC group. The resected tumors were significantly smaller and less frequently perforated and metastatic in the PDC group. The median overall survival was significantly higher after PDC (123.6 vs. 58.5 months, p = 0.046), whereas the median disease-free survival was similar between the two groups (54.1 vs. 53.6 months, p = 0.646). CONCLUSIONS Although endoscopic stenting is associated with better surgical outcomes than diverting stoma, it may negatively impact histological features and overall survival.
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Affiliation(s)
- Diane Mege
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Gilles Manceau
- Sorbonne University, Assistance Publique Hôpitaux de Paris, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - Valérie Bridoux
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Zaher Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - Diouf Momar
- Department of Clinical Research and Innovation, Amiens University Hospital, Amiens, France
| | - Igor Sielezneff
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - Mehdi Karoui
- Sorbonne University, Assistance Publique Hôpitaux de Paris, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, Paris, France.
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Abstract
Aim Definition of the type of appendicitis is based on examination of the peritoneum and appendix. Gomes et al. proposed a laparoscopic grading system of acute appendicitis (grades 1 and 2, noncomplicated appendicitis, grade 3-5 complicated appendicitis). The aim of this study was to evaluate the reproducibility of this score. Patients and methods All patients managed for acute appendicitis between January 2016 and June 2016 were included in this single-center prospective study. Laparoscopic appendectomy procedures were filmed by analogy to Sugerbaker's peritoneal carcinomatosis score (9 quadrants, all of the abdomen was filmed). The videos were then analyzed by seven staff surgeons blinded to each other and the operative report. The primary endpoint was to determine the concordance between staff surgeons for grading of appendicitis using the laparoscopic grading system of acute appendicitis described by Gomes et al. Results A total of 40 patients were included in this study. A concordance was observed between the seven staff surgeons in 85% of cases. For regional peritonitis, the mean ± (SD) number of quadrants in which the staff surgeons reported signs of peritonitis was 1.44 ± 0.63. For diffuse peritonitis, the mean (SD) number of quadrants in which the staff surgeons reported signs of peritonitis was 2.59 ± 0.51. On ROC curve analysis, two quadrants was the best cut-off between grade 4B (local peritonitis) and five (diffuse peritonitis) acute appendicitis (AUC = 0.92, Se = 100%, Sp = 92%, p = 0.005). Conclusion The classification used to determine the type of appendicitis is reproducible. Clinical significance To give a definition of complicated appendicitis. How to cite this article Mariage M, Sabbagh C, et al. Surgeon's Definition of Complicated Appendicitis: A Prospective Video Survey Study. Euroasian J Hepatogastroenterol 2019;9(1):1-4.
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Affiliation(s)
- Maxime Mariage
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, Hautsde France, France
| | - Charles Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, Hautsde France, France
| | - Gerard Grelpois
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, Hautsde France, France
| | - Flavien Prevot
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, Hautsde France, France
| | - Ilan Darmon
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, Hautsde France, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, Hautsde France, France
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Abstract
Pseudomyxoma peritonei is a rare tumor characterized by the presence of mucous disseminated throughout the peritoneal cavity generally arising from the rupture of an appendicular mucocele. Liver scalloping is a highly suggestive image of pseudomyxoma and corresponds to the indentation of the liver compressed by the gelatinous mucin.
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Affiliation(s)
- K Allart
- Service de chirurgie digestive, centre hospitalier universtaire Amiens, avenue René-Laennec, 80054 Amiens cedex 01, France; Université Picardie-Jules-Verne, 1, chemin du Thil, 80000 Amiens cedex 01, France
| | - C Sabbagh
- Service de chirurgie digestive, centre hospitalier universtaire Amiens, avenue René-Laennec, 80054 Amiens cedex 01, France; Université Picardie-Jules-Verne, 1, chemin du Thil, 80000 Amiens cedex 01, France
| | - J-M Regimbeau
- Service de chirurgie digestive, centre hospitalier universtaire Amiens, avenue René-Laennec, 80054 Amiens cedex 01, France; Université Picardie-Jules-Verne, 1, chemin du Thil, 80000 Amiens cedex 01, France; Simplifications des soins patients chirurgicaux complexes, or Simplication of care of complex surgical patients (SSPC), unité de recherché clinique, université Picardie-Jules-Vernes, 80000 Amiens, France.
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Ammar-Khodja N, Sabbagh C, Regimbeau JM. Laparoscopic right colectomy for adenocarcinoma (with video). J Visc Surg 2018; 155:505-506. [PMID: 30429102 DOI: 10.1016/j.jviscsurg.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- N Ammar-Khodja
- Service de chirurgie digestive, CHU Amiens Picardie, Avenue René Laënnec-Salouël, 80054 Amiens, France; Unité de recherche SSPC (simplification des soins des patients chirurgicaux complexes), Université de Picardie Jules Verne, Amiens, France
| | - C Sabbagh
- Service de chirurgie digestive, CHU Amiens Picardie, Avenue René Laënnec-Salouël, 80054 Amiens, France; Unité de recherche SSPC (simplification des soins des patients chirurgicaux complexes), Université de Picardie Jules Verne, Amiens, France
| | - J-M Regimbeau
- Service de chirurgie digestive, CHU Amiens Picardie, Avenue René Laënnec-Salouël, 80054 Amiens, France; Unité de recherche SSPC (simplification des soins des patients chirurgicaux complexes), Université de Picardie Jules Verne, Amiens, France.
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Sabbagh C, Siembida N, Yzet T, Robert B, Chivot C, Browet F, Mauvais F, Regimbeau JM. What are the predictive factors of caecal perforation in patients with obstructing distal colon cancer? Colorectal Dis 2018; 20:688-695. [PMID: 29495118 DOI: 10.1111/codi.14056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 02/05/2018] [Indexed: 02/08/2023]
Abstract
AIM In the presence of large bowel obstruction, the choice of treatment is determined by the patient's general status, the tumour characteristics and the perceived risk of caecal perforation. This study was designed to evaluate the predictive factors of impending caecal perforation, and also investigated the use of caecal volumetry. METHOD From January 2011 to June 2016, patients with obstructive distal colon cancer undergoing emergency laparotomy, for whom a pretreatment CT scan was available, were included in this retrospective, case-control, two-centre study. Two patient groups were defined: patients with and without impending caecal perforation. The primary end-point of the study was a determination of predictive factors for caecal perforation. RESULTS A total of 72 patients (45 men, 62.5%) were included. Univariate analysis revealed that the presence of pericaecal fluid (P < 0.0001), caecal pneumatosis (P < 0.0001), mean maximum caecal diameter (P = 0.001), mean caecal diameter at the ileocaecal junction (P = 0.0001) and mean caecal volume (P = 0.001) were associated with caecal perforation. Receiver operating characteristic curve analysis revealed that a caecal volume greater than 400 cm3 (P < 0.0001), a maximum caecal diameter > 9 cm (P = 0.002) and a caecal diameter at the ileocaecal junction > 7.5 cm (P = 0.001) were associated with impending caecal perforation. In multivariate analysis, only caecal volume > 400 cm3 (P = 0.001) was correlated with the risk of impending caecal perforation. CONCLUSION Caecal volumetry is an easy and useful tool to predict impending caecal perforation in patients with large bowel obstruction.
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France.,Jules Verne University of Picardie, Amiens, France
| | - N Siembida
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - T Yzet
- Department of Radiology, Amiens University Medical Center, Amiens, France
| | - B Robert
- Department of Radiology, Amiens University Medical Center, Amiens, France
| | - C Chivot
- Department of Radiology, Amiens University Medical Center, Amiens, France
| | - F Browet
- Department of Digestive Surgery, Department of Digestive Surgery, Amiens, France
| | - F Mauvais
- Department of Digestive Surgery, Department of Digestive Surgery, Amiens, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France.,Jules Verne University of Picardie, Amiens, France
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Mariage M, Sabbagh C, Yzet T, Dupont H, NTouba A, Regimbeau JM. Distinguishing fecal appendicular peritonitis from purulent appendicular peritonitis. Am J Emerg Med 2018; 36:2232-2235. [PMID: 29779677 DOI: 10.1016/j.ajem.2018.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Fecal appendicular peritonitis (FAP) is a poorly studied, rare form of acute appendicitis, corresponding to peritoneal inflammation with the presence of feces secondary to ruptured appendix. The purpose of this study was to describe FAP and to compare FAP with purulent appendicular peritonitis (PAP). PATIENTS AND METHODS This single-center, retrospective study was conducted in consecutive patients to compare the FAP group and the PAP group. The primary endpoint was the 30-day postoperative morbidity and mortality according to the Clavien-Dindo classification. The secondary endpoints were description and comparison of intraoperative data (laparoscopy rate, conversion rate, type of procedure and the mean operating time), and short-term outcomes (types of complications, length of stay, readmission rate, and reoperation rate), comparison of intraoperative bacteriological samples of FAP and PAP as well as the rate of resistance to amoxicillin and clavulanic acid, used as routine postoperative antibiotic therapy. RESULTS Between January 2006 and January 2016, 2.2% of appendectomies were performed for FAP. Patients of the FAP group reported a longer history of pain than patients of the PAP group (mean: 58 h [range: 24-120] vs 24 h [range: 6-504], p = 0.0001) and hyperthermia was more frequent in the FAP group than in the PAP group (72% vs 26%, p = 0.0001). Mean preoperative CRP was also higher in the FAP group than in the PAP group (110 mg/L [range: 67-468] vs 37.5 mg/L [range: 3.1-560], p = 0.007). Significantly less patients were operated by laparoscopy in the FAP group (89.7% vs 96.6%, p < 0.0001). Mean length of stay was significantly longer in the FAP group than in the PAP group (10 days [range: 3-24] vs 5 days [range: 1-32], p = 0.001). The overall 30-day complication rate was significantly higher in the FAP group than in the PAP group (62.1% vs 24.7%, p = 0.0005). The readmission rate was not significantly different between the two groups (14% vs 11.2%, p = 0.2), but the reoperation rate was higher in the FAP group than in the PAP group (31% vs 11%, p = 0.01). No significant difference was observed between the FAP and PAP groups in terms of the positive culture rate (75.9% vs 65.6%, p = 0.3). No significant difference was observed between the two groups in terms of resistance to amoxicillin and clavulanic acid (18.2% vs 20.5%, p = 0.8). CONCLUSION FAP is associated with significantly more severe morbidity compared to PAP. Clinicians must be familiar with this form of appendicitis in order to adequately inform their patients.
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Affiliation(s)
- M Mariage
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Jules Verne University of Picardie, Amiens, France
| | - C Sabbagh
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Jules Verne University of Picardie, Amiens, France; SSPC (simplification des soins des patients chirurgicaux complexes) research unit, Jules Verne University of PIcardie, Amiens, France
| | - T Yzet
- Department of Radiology, Amiens University Medical Center, Amiens, France
| | - H Dupont
- Intensive Care Unit, Amiens University Medical Center, Amiens, France; SSPC (simplification des soins des patients chirurgicaux complexes) research unit, Jules Verne University of PIcardie, Amiens, France
| | - A NTouba
- Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens University Medical Center, Amiens, France; Jules Verne University of Picardie, Amiens, France; SSPC (simplification des soins des patients chirurgicaux complexes) research unit, Jules Verne University of PIcardie, Amiens, France.
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Passot G, Dumont F, Goéré D, Arvieux C, Rousset P, Regimbeau JM, Elias D, Villeneuve L, Glehen O, Abba J, Abboud K, Carere S, Durand-Fontanier S, Eveno C, Facy O, Gelli M, Gilly FN, Karoui M, Lo Dico R, Ortega-Deballon P, Pocard M, Quenet F, Rat P, Sabbagh C, Sgarbura O, Thibaudeau E, Vaudoyer D, Wernert R. Multicentre study of laparoscopic or open assessment of the peritoneal cancer index (BIG-RENAPE). Br J Surg 2018; 105:663-667. [DOI: 10.1002/bjs.10723] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/01/2017] [Accepted: 09/06/2017] [Indexed: 02/04/2023]
Abstract
Abstract
Background
The peritoneal cancer index (PCI) is a comparative prognostic factor for colorectal peritoneal metastasis (CRPM). The ability of laparoscopy to determine the PCI in consideration of cytoreductive surgery remains undetermined, and this study was designed to compare it with laparotomy.
Methods
A prospective multicentre study was conducted for patients with no known CRPM, but at risk of peritoneal disease. Surgery began with laparoscopic exploration followed by open exploration to determine the PCI. Concordance between laparoscopic and open assessment was evaluated for the diagnosis of CRPM and for the PCI.
Results
Among 50 patients evaluated, CRPM recurrence was found in 29 (58 per cent) and 34 (68 per cent) at laparoscopic and open surgery respectively. Laparoscopy was feasible in 88 per cent (44 of 50) and deemed satisfactory by the surgeon in 52 per cent (26 of 50). Among the 25 evaluable patients with satisfactory laparoscopy, there was concordance of 96 per cent (24 of 25 patients) and 38 per cent (10 of 25) for laparoscopic and open assessment of CRPM and the PCI respectively. Where there were discrepancies, it was laparoscopy that underestimated the PCI.
Conclusion
Laparoscopy may underestimate the extent of CRPM.
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Affiliation(s)
- G Passot
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
| | - F Dumont
- Department of Surgery, Institut de Cancérologie de l'Ouest (René Gauducheau), Site Hospitalier Nord, Saint-Herblain, France
| | - D Goéré
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Villejuif, France
| | - C Arvieux
- Department of Visceral Surgery, Grenoble University Hospital, Hôpital Albert Michallon, Grenoble, France
| | - P Rousset
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
| | - J-M Regimbeau
- Department of Digestive Surgery, Amiens-Picardie University Medical Centre, Amiens, France
| | - D Elias
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Villejuif, France
| | - L Villeneuve
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
| | - O Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
| | - J Abba
- Department of Digestive Surgery, Grenoble University Hospital, Grenoble, France
| | - K Abboud
- Department of General Surgery, St Etienne University Hospital, St Etienne, France
| | - S Carere
- Department of Surgical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - S Durand-Fontanier
- Department of Visceral Surgery and Transplantation, Dupuytren University Hospital, Limoges, France
| | - C Eveno
- Surgical Oncological and Digestive Unit, Lariboisiere University Hospital, Paris, France
| | - O Facy
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - M Gelli
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - F-N Gilly
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France
| | - M Karoui
- Department of Digestive Surgery, La Pitié-Salpétriêre University Hospital, Paris, France
| | - R Lo Dico
- Surgical Oncological and Digestive Unit, Lariboisiere University Hospital, Paris, France
| | - P Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - M Pocard
- Surgical Oncological and Digestive Unit, Lariboisiere University Hospital, Paris, France
| | - F Quenet
- Department of Surgical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - P Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - C Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - O Sgarbura
- Department of Surgical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - E Thibaudeau
- Department of Surgery, lnstitut de Cancerologie de l'Ouest (Rene Gauducheau), Saint-Herblain, France
| | - D Vaudoyer
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France
| | - R Wernert
- Department of Surgical Oncology, Institut de Cancerologie de l'Ouest, Paul Papin Cancer Center, Angers, France
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Sabbagh C, Chatelain D, Attencourt C, Joly JP, Chauffert B, Cosse C, Regimbeau JM. Impact of homogeneous pathologic response to preoperative chemotherapy in patients with multiple colorectal liver metastases. World J Gastroenterol 2017; 23:8027-8034. [PMID: 29259378 PMCID: PMC5725297 DOI: 10.3748/wjg.v23.i45.8027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 07/28/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze the homogeneity of pathologic response to preoperative chemotherapy (PRPC) after chemotherapy in patients with multiple liver metastases (LM).
METHODS From September 2011 to August 2014, patients with at least two LM undergoing preoperative chemotherapy prior to resection were included in this retrospective, single-center study. The endpoints were PRPC homogeneity (according to both the Rubbia-Brandt and MD Anderson classifications), the impact of PRPC on the MDT decision, factors associated with homogeneous PRPC and overall survival of patients with vs. without homogeneous PRPC.
RESULTS seventy-three patients with a total of 88 liver resections (including 15 two-stage procedures) were included in the study. The homogeneous PRPC rate was 55% according to the Rubbia-Brandt classification and 53% according to the MD Anderson classification. The MDT decision was modified by the PRPC in only 2.7% of patients (n = 2).
CONCLUSION The PRPC was homogeneous in only one half of patients and had very little influence on the MDT decision.
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Affiliation(s)
- Charles Sabbagh
- Department of Digestive and Oncologic Surgery, Amiens University Medical Center, 80054 Amiens, France
- INSERM U1088, Jules Verne University of Picardie, 80054 Amiens, France
- University of Picardie, 80054 Amiens, France
| | - Denis Chatelain
- University of Picardie, 80054 Amiens, France
- Department of Anatomic Pathology, Amiens University Medical Center, 80054 Amiens, France
| | - Christophe Attencourt
- Department of Anatomic Pathology, Amiens University Medical Center, 80054 Amiens, France
| | - Jean-Paul Joly
- Department of Hepatogastroenterology, Amiens University Medical Center, 80054 Amiens, France
| | - Bruno Chauffert
- University of Picardie, 80054 Amiens, France
- Department of Medical Oncology, Amiens University Medical Center, 80054 Amiens, France
| | - Cyril Cosse
- Department of Digestive and Oncologic Surgery, Amiens University Medical Center, 80054 Amiens, France
- INSERM U1088, Jules Verne University of Picardie, 80054 Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive and Oncologic Surgery, Amiens University Medical Center, 80054 Amiens, France
- University of Picardie, 80054 Amiens, France
- EA4294, Jules Verne University of Picardie, 80054 Amiens, France
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Sabbagh C, Cosse C, Regimbeau JM. Re: Outcome of bridge to surgery stenting for obstructive left colon cancer. ANZ J Surg 2017; 87:744-745. [PMID: 28876542 DOI: 10.1111/ans.14130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 05/28/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Charles Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - Cyril Cosse
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
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Fumery M, Kohut M, Gower-Rousseau C, Duhamel A, Brazier F, Thelu F, Nagorniewicz F, Lamarche F, Nguyen-Khac E, Sabbagh C, Loreau J, Colombel JF, Savoye G, Chatelain D, Dupas JL. Incidence, Clinical Presentation, and Associated Factors of Microscopic Colitis in Northern France: A Population-Based Study. Dig Dis Sci 2017; 62:1571-1579. [PMID: 27659673 DOI: 10.1007/s10620-016-4306-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/07/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To date, there are no epidemiological data on microscopic colitis (MC) in France. The aim of this study was to determine the incidence of MC in the Somme department in Northern France, to evaluate clinical characteristics, and to search for risk factors for both collagenous colitis (CC) and lymphocytic colitis (LC). DESIGN Between January 1, 2005, and December 31, 2007, four pathology units in the Somme department recorded all new cases of MC diagnosed in patients living in the area. Colonic biopsies were reviewed by 4 pathologists together. For each incident case, demographic, clinical, endoscopic, and biological data were collected according to methodology of the EPIMAD registry. RESULTS One hundred and thirty cases of MC, including 87 CC and 43 LC, were recorded during the three-year study. The mean annual incidence for MC was 7.9/105 inhabitants, 5.3/105 inhabitants for CC, and 2.6/105 inhabitants for LC. Annual standardized incidence of Crohn's disease and ulcerative colitis in the EPIMAD registry during the same period (2005-2007) were 7.4/105 and 4.9/105, respectively. Median age at diagnosis was 63 years for MC, 70 for CC, and 48 for LC. The female-to-male gender ratio was 3.5 for MC, 4.1 for CC, and 2.6 for LC. Median time to diagnosis was 8 weeks. Chronic diarrhea and abdominal pain were, respectively, present in 93 and 47 % of the cases. An autoimmune disease was associated in 28 % of MC cases. At diagnosis, proton pump inhibitor treatment was more often reported in CC than in LC (46 vs 16 %; p = 0.003). Budesonide was effective on diarrhea in 77 % of patients, and thirteen percent of patients became steroid dependent. CONCLUSION This population-based study shows that the incidence of MC in France is high and similar to Crohn's disease incidence and confirms that this condition is associated with female gender, autoimmune diseases, and medications.
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Affiliation(s)
- Mathurin Fumery
- Service d'hepatogastroenterologie, Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Avenue Laennec-Salouel, 80000, Amiens, France. .,EPIMAD registry, Amiens, France.
| | - Mathieu Kohut
- Gastroenterology, St. Isabelle Clinic, Abbeville, France
| | - Corinne Gower-Rousseau
- LIRIC-UMR 995 INSERM, IBD team and Environmental Factors: Epidemiology and Functional Analyses, Lille University, Lille, France.,Public Health, Epidemiology and Economic Health, EPIMAD registry, Regional Clinical Research Center, Lille University and Hospital, Cedex, France
| | - Alain Duhamel
- Biostatistics Unit, CERIM, EA2694, Lille University and Hospital, Lille, France
| | - Franck Brazier
- Service d'hepatogastroenterologie, Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Avenue Laennec-Salouel, 80000, Amiens, France.,EPIMAD registry, Amiens, France
| | - Francoise Thelu
- Pathology Laboratory, 40 rue Andre Chenier, 80000, Amiens, France
| | | | - Francois Lamarche
- Pathology Laboratory, 13 Rue Sainte-Catherine, 80100, Abbeville, France
| | - Eric Nguyen-Khac
- Service d'hepatogastroenterologie, Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Avenue Laennec-Salouel, 80000, Amiens, France
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Julien Loreau
- Service d'hepatogastroenterologie, Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Avenue Laennec-Salouel, 80000, Amiens, France
| | - Jean-Frederic Colombel
- Dr. Henry D Janowitz, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guillaume Savoye
- Gastroenterology Unit, EPIMAD registry, Rouen University and Hospital, Rouen, France
| | - Denis Chatelain
- Pathology Unit, Amiens University and Hospital, Picardie University Jules Verne, Amiens, France
| | - Jean-Louis Dupas
- Service d'hepatogastroenterologie, Gastroenterology Unit, Amiens University and Hospital, Université de Picardie Jules Verne, Avenue Laennec-Salouel, 80000, Amiens, France.,EPIMAD registry, Amiens, France
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Abstract
INTRODUCTION The implementation of enhanced recovery programmes after elective colorectal surgery has dramatically reduced the length of stay. The objective of this study was to assess the selection of good candidates for short post-operative stay (GCSS) in the context of stoma closure. METHODS Between January 2011 and December 2014, 222 patients were included in the present retrospective, single-center study. The primary endpoint was the proportion of GCSS. We also identified factors associated with GCSS status and built a predictive score. RESULTS The study population was predominantly male (n = 122, 55%). 60% of the patients had undergone ileostomy and 85% had undergone hand-sewn anastomosis. The postoperative ileus rate was 5% and the readmission rate was 3.5%. 41% (n = 92) of the study population were considered to be GCSS. In a multivariate analysis, age under 50 (odds ratio (OR) [95% confidence interval (CI)] = 2.8 [1.2-5.6], p = 0.008), the absence of vascular comorbidities (OR [95%CI] = 3.2 [1.3-12.3]; p = 0.006) and stapled anastomosis (OR: 4.2, 95%CI: 1.1-17.3, p = 0.03) were associated with GCSS status. Predictive scores of 0, 1, 2, and 3 were associated with GCSS rates of 20%, 18%, 44%, and 62%, respectively (p < 0.001). CONCLUSION In the context of stoma closure, 41% of patients were GCSS.
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Affiliation(s)
- Charles Sabbagh
- a Department of Digestive and Oncological Surgery , Amiens University Hospital , Amiens , France.,b INSERM U1088 , Amiens , France.,c Jules Verne University of Picardie , Amiens , France
| | - Cyril Cosse
- a Department of Digestive and Oncological Surgery , Amiens University Hospital , Amiens , France.,b INSERM U1088 , Amiens , France
| | - Lionel Rebibo
- a Department of Digestive and Oncological Surgery , Amiens University Hospital , Amiens , France
| | - Hanane Hariz
- a Department of Digestive and Oncological Surgery , Amiens University Hospital , Amiens , France
| | - Abdennaceur Dhahri
- a Department of Digestive and Oncological Surgery , Amiens University Hospital , Amiens , France.,c Jules Verne University of Picardie , Amiens , France.,d EA4294, Jules Verne University of Picardie , Amiens , France.,e Clinical Research Centre , Amiens University Hospital , Amiens , France
| | - Jean Marc Regimbeau
- a Department of Digestive and Oncological Surgery , Amiens University Hospital , Amiens , France.,c Jules Verne University of Picardie , Amiens , France.,d EA4294, Jules Verne University of Picardie , Amiens , France.,e Clinical Research Centre , Amiens University Hospital , Amiens , France
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Cossé C, Sabbagh C, Fumery M, Zogheib E, Mauvais F, Browet F, Rebibo L, Regimbeau JM. Serum procalcitonin correlates with colonoscopy findings and can guide therapeutic decisions in postoperative ischemic colitis. Dig Liver Dis 2017; 49:286-290. [PMID: 28089622 DOI: 10.1016/j.dld.2016.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 12/02/2016] [Accepted: 12/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postoperative ischaemic colitis (POIC) is a life-threatening vascular gastrointestinal condition. Serum procalcitonin (PCT) levels be of value in the detection of necrosis. AIMS To evaluate the correlation between serum PCT levels and the colonoscopic assessment of the severity of POIC. METHODS Between January 2007 and November 2014, 150 patients with POIC and PCT data were included in the study. The main outcome measure was the correlation between serum PCT and the colonoscopy-based assessment of the severity of POIC (according to Favier's classification: stage 1/2 without multi-organ failure vs. stage 2/3 with multi-organ failure). RESULTS Eighty-five percent of the stage 1 cases (n=22) had a serum PCT level ≤2μg/L; 63% (n=19) of the stage 2 cases with multi-organ failure had a PCT level between 4 and 8μg/L, and 70% (n=52) of the stage 3 cases had a PCT level ≥8μg/L. The PCT level was strongly correlated with the Favier stage (Spearman's rho: 0.701; p<0.0001). PCT levels were similar in stage 2 cases with multi-organ failure and in stage 3 cases (16.06μg/L vs. 7.79μg/L, respectively; p=0.35). CONCLUSION AND RELEVANCE Serum PCT is correlated with stage 2/3 POIC requiring surgery. If PCT ≥5μg/L, surgery should be considered.
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Affiliation(s)
- C Cossé
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France; INSERM U1088, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France
| | - C Sabbagh
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France; INSERM U1088, Jules Verne University of Picardie, Amiens, France
| | - M Fumery
- Department of Gastroenterology, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France
| | - E Zogheib
- Department of Anaesthesiology and Cardiovascular Intensive Care, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France
| | - F Mauvais
- Department of Visceral Surgery, Beauvais General Hospital, Beauvais, France
| | - F Browet
- Department of Visceral Surgery, Beauvais General Hospital, Beauvais, France
| | - L Rebibo
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France
| | - J M Regimbeau
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France.
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Fumery M, Seksik P, Auzolle C, Munoz-Bongrand N, Gornet JM, Boschetti G, Cotte E, Buisson A, Dubois A, Pariente B, Zerbib P, Chafai N, Stefanescu C, Panis Y, Marteau P, Pautrat K, Sabbagh C, Filippi J, Chevrier M, Houze P, Jouven X, Treton X, Allez M. Postoperative Complications after Ileocecal Resection in Crohn's Disease: A Prospective Study From the REMIND Group. Am J Gastroenterol 2017; 112:337-345. [PMID: 27958285 DOI: 10.1038/ajg.2016.541] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/21/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We sought to determine the frequency of and risk factors for early (30-day) postoperative complications after ileocecal resection in a well-characterized, prospective cohort of Crohn's disease patients. METHODS The REMIND group performed a nationwide study in 9 French university medical centers. Clinical-, biological-, surgical-, and treatment-related data on the 3 months before surgery were collected prospectively. Patients operated on between 1 September 2010 and 30 August 2014 were included. RESULTS A total of 209 patients were included. The indication for ileocecal resection was stricturing disease in 109 (52%) cases, penetrating complications in 88 (42%), and medication-refractory inflammatory disease in 12 (6%). A two-stage procedure was performed in 33 (16%) patients. There were no postoperative deaths. Forty-three (21%) patients (23% of the patients with a one-stage procedure vs. 9% of those with a two-stage procedure, P=0.28) experienced a total of 54 early postoperative complications after a median time interval of 5 days (interquartile range, 4-12): intra-abdominal septic complications (n=38), extra-intestinal infections (n=10), and hemorrhage (n=6). Eighteen complications (33%) were severe (Dindo-Clavien III-IV). Reoperation was necessary in 14 (7%) patients, and secondary stomy was performed in 8 (4.5%). In a multivariate analysis, corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate (odds ratio (95% confidence interval)=2.69 (1.15-6.29); P=0.022). Neither preoperative exposure to anti-tumor necrosis factor (TNF) agents (n=93, 44%) nor trough serum anti-TNF levels were significant risk factors for postoperative complications. CONCLUSIONS In this large, nationwide, prospective cohort, postoperative complications were observed after 21% of the ileocecal resections. Corticosteroid treatment in the 4 weeks before surgery was significantly associated with an elevated postoperative complication rate. In contrast, preoperative anti-TNF therapy (regardless of the serum level or the time interval between last administration and surgery) was not associated with an elevated risk of postoperative complications.
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Affiliation(s)
- Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, University Picardie Jules Verne, Amiens, France
| | - Philippe Seksik
- Sorbonne Universites, UPMC Univ Paris 06, Ecole Normale Superieure, CNRS, INSERM, ERL 1157, LBM, APHP, Gastroenterology Unit, Saint Antoine Hospital, Paris, France
| | - Claire Auzolle
- Department of Gastroenterology, Saint-Louis Hospital, APHP, INSERM U1160, University Denis Diderot, Paris, France.,INSERM U970, Paris, France
| | | | - Jean-Marc Gornet
- Department of Gastroenterology, Saint-Louis Hospital, APHP, INSERM U1160, University Denis Diderot, Paris, France
| | - Gilles Boschetti
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Eddy Cotte
- Department of Digestive Surgery, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Anthony Buisson
- Departmernt of Gastroenterology, Estaing University Hospital, M2iSH, UMR 1071 INSERM/Université d'Auvergne, USC-INRA 2018, Clermont-Ferrand, France
| | - Anne Dubois
- Department of Digestive Surgery, Estaing University Hospital, Auvergne University, Clermont-Ferrand, France
| | - Benjamin Pariente
- Department of Gastroenterology, Huriez Hospital, Lille 2 University, Lille, France
| | - Philippe Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Université Lille Nord de France, Lille, France
| | - Najim Chafai
- Department of Digestive Surgery, Saint Antoine Hospital, APHP, Paris, France
| | - Carmen Stefanescu
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, APHP, University Paris 7 Denis Diderot, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, APHP, University Paris 7 Denis Diderot, Clichy, France
| | - Philippe Marteau
- Department of Gastroenterology, Lariboisiere Hospital, APHP, University Paris 7 Denis Diderot, Paris, France
| | - Karine Pautrat
- Department of Digestive Surgery, Lariboisiere Hospital, APHP, Paris, France
| | - Charles Sabbagh
- Department of Digestive and Oncologic Surgery, Amiens University Hospital, University Picardie Jules Verne, Amiens, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Marc Chevrier
- Biochimie, Saint-Louis Hospital, APHP, Paris, France
| | - Pascal Houze
- Biochimie, Saint-Louis Hospital, APHP, Paris, France
| | | | - Xavier Treton
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, APHP, University Paris 7 Denis Diderot, Clichy, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis Hospital, APHP, INSERM U1160, University Denis Diderot, Paris, France
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Cossé C, Sabbagh C, Carroni V, Galmiche A, Rebibo L, Regimbeau JM. Impact of a procalcitonin-based algorithm on the management of adhesion-related small bowel obstruction. J Visc Surg 2017; 154:231-237. [PMID: 28153520 DOI: 10.1016/j.jviscsurg.2017.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Adhesion-related small bowel obstruction (ASBO) management is difficult if there are no signs of strangulation or peritonitis when intestinal transit has not been restored. The aim of the present study was to determine the impact of combining a procalcitonin (PCT)-based algorithm with clinical signs on the management of uncomplicated ASBO. METHOD We performed a pilot, retrospective, single-center "before-after" study. During the "before" period (2007 to 2012), patients with uncomplicated ASBO (n=93, the Gastrografin® group) underwent a clinical examination and a Gastrografin® index. During the "after" period (2013 to 2016), patients with uncomplicated ASBO (n=70, the algorithm group) underwent a clinical examination and were assessed with the PCT-based algorithm. The study's primary outcome was the appropriateness of ASBO management. The secondary outcomes were the need for surgery and the time to surgery, the LOS, the morbidity and mortality rates, and the recurrence rate. RESULTS The proportion of well-managed patients was higher in the algorithm group than in the Gastrografin® group (86% vs. 47%; P<0.001). The time to surgery (48h vs 72h; P=0.02) and the LOS (4 vs. 6days, P=0.02) were significantly lower in the algorithm group. The need for surgery was similar in both groups (31% vs. 37%, P=0.49). The morbidity (P=0.69), mortality (P=0.82) and recurrence rates (P=0.57) were similar in the two groups. CONCLUSION The use of a PCT-based algorithm is of value in the routine clinical management of ASBO; it reduces the LOS and the time to surgery without increasing the need for surgery.
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Affiliation(s)
- C Cossé
- Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France; INSERM U1088, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France
| | - C Sabbagh
- Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France; INSERM U1088, Jules Verne University of Picardie, Amiens, France
| | - V Carroni
- Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - A Galmiche
- Department of Biochemistry, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France
| | - L Rebibo
- Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France
| | - J-M Regimbeau
- Department of Digestive and Oncological Surgery, Amiens University Medical Center, Jules Verne University of Picardie, Amiens, France; Clinical Research Centre, Amiens University Medical Center and Jules Verne University of Picardie, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France.
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Grelpois G, Sabbagh C, Cosse C, Robert B, Chapuis-Roux E, Ntouba A, Lion T, Regimbeau JM. Management of Uncomplicated Acute Appendicitis as Day Case Surgery: Feasibility and a Critical Analysis of Exclusion Criteria and Treatment Failure. J Am Coll Surg 2016; 223:694-703. [DOI: 10.1016/j.jamcollsurg.2016.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 01/07/2023]
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Sabbagh C, Cosse C, Fournier R, Carola E, Chauffert B, Dumesnil R, Regimbeau JM. [The use of the G8 score for the patient of more than 75years old in digestive surgery for cancer]. Bull Cancer 2016; 103:896-897. [PMID: 27712831 DOI: 10.1016/j.bulcan.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/31/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Charles Sabbagh
- CHU d'Amiens-Picardie, service de chirurgie digestive, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, chemin du Thil, 80000 Amiens, France; UPJV, unité Inserm U 1088, chemin du Thil, 80000 Amiens, France; Unité de recherche clinique Ikebana, 80054 Amiens, France
| | - Cyril Cosse
- CHU d'Amiens-Picardie, service de chirurgie digestive, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; UPJV, unité Inserm U 1088, chemin du Thil, 80000 Amiens, France; Unité de recherche clinique Ikebana, 80054 Amiens, France
| | - Roxana Fournier
- CHU d'Amiens-Picardie, service de gériatrie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France
| | - Elisabeth Carola
- Groupe hospitalier public du Sud-de-L'Oise, 4, avenue Paul-Rouge, 60300 Senlis, France
| | - Bruno Chauffert
- CHU d'Amiens-Picardie, service d'oncologie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France
| | - Romain Dumesnil
- CHU d'Amiens-Picardie, service de chirurgie digestive, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France
| | - Jean-Marc Regimbeau
- CHU d'Amiens-Picardie, service de chirurgie digestive, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, chemin du Thil, 80000 Amiens, France; Unité de recherche clinique Ikebana, 80054 Amiens, France; UPJV, unité Inserm EA 4294, chemin du Thil, 80000 Amiens, France.
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Hanes A, Rebibo L, Sabbagh C, Badaoui R, Hubert V, Cosse C, Regimbeau JM. A critical analysis of factors leading to next-day discharge in ambulatory surgery patients. J Visc Surg 2016; 153:433-437. [PMID: 27318584 DOI: 10.1016/j.jviscsurg.2016.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ambulatory surgery (AS) is becoming the rule. However, some patients do not have AS despite correct indications. The purpose of this retrospective study of prospectively collected data was to analyze why these patients do not have AS and evaluate their immediate post-operative course, in order to broaden the indications for AS. MATERIAL AND METHODS Between January and December 2013, the reasons why patients who had appropriate indications for ambulatory cholecystectomy or hernia repair but later had conventional hospital management were recorded. The primary endpoint was early post-operative morbidity. Secondary endpoints were demographic, surgical, anesthetic, post-operative data as well as analysis of criteria leading to conventional hospital stay. RESULTS Among 410 patients undergoing surgery for accepted AS indications, 158 (39%) did not have AS; 113 out of these patients (72%) were discharged the day following surgery. Of the 69 patients (43.6%) who did not have AS for medical reasons (50 by the surgeon's decision alone), 60 patients could have undergone AS since their outcome was uneventful in 96% of cases; only three patients (2.5%) had post-operative complications. CONCLUSION The AS rate could have been increased by 15% through better surgical and anesthetic collaboration.
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Affiliation(s)
- A Hanes
- Service de Chirurgie Digestive, CHU d'Amiens, Avenue René-Laennec, 80054 Amiens Cedex 01, France
| | - L Rebibo
- Service de Chirurgie Digestive, CHU d'Amiens, Avenue René-Laennec, 80054 Amiens Cedex 01, France; EA4294, Université de Picardie Jules-Verne, 80054 Amiens, France
| | - C Sabbagh
- Service de Chirurgie Digestive, CHU d'Amiens, Avenue René-Laennec, 80054 Amiens Cedex 01, France; EA4294, Université de Picardie Jules-Verne, 80054 Amiens, France
| | - R Badaoui
- Service d'Anesthésie et de Réanimation, CHU d'Amiens, Avenue René-Laennec, 80054 Amiens Cedex 01, France
| | - V Hubert
- Service d'Anesthésie et de Réanimation, CHU d'Amiens, Avenue René-Laennec, 80054 Amiens Cedex 01, France
| | - C Cosse
- Service de Chirurgie Digestive, CHU d'Amiens, Avenue René-Laennec, 80054 Amiens Cedex 01, France; EA4294, Université de Picardie Jules-Verne, 80054 Amiens, France
| | - J-M Regimbeau
- Service de Chirurgie Digestive, CHU d'Amiens, Avenue René-Laennec, 80054 Amiens Cedex 01, France; EA4294, Université de Picardie Jules-Verne, 80054 Amiens, France; Centre de Recherche Clinique, CHU d'Amiens, Avenue René-Laennec, 80054 Amiens Cedex 01, France.
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Villeneuve L, Thivolet A, Bakrin N, Mohamed F, Isaac S, Valette PJ, Glehen O, Rousset P, Abba J, Abboud K, Arvieux C, Balagué G, Barrau V, Rejeb H, Bereder JM, Bibeau F, Bouzard D, Brigand C, Carrère S, Carretier M, de Chaisemartin C, Chassang M, Chevallier A, Courvoisier T, Dartigues P, Delroeux D, Desolneux G, Dohan A, Dromain C, Dumont F, Durand-Fontanier S, Elias D, Eveno C, Evrard S, Fay O, Ferron G, Geffroy D, Gilly FN, Fontaine J, Goasguen N, Ghouti L, Goéré D, Guilloit JM, Guyon F, Heyd B, Kaci R, Karoui M, Kianmanesh R, Labbé C, Lacroix J, Lang-Averous G, Laverriere MH, Lefevre J, Lelong B, Leroux A, Dico R, Loi V, Lorimier G, Marchal F, Mariani A, Mariani P, Mariette C, Meeus P, Mery E, Messager M, Msika S, Nadeau C, Ortega-Deballon P, Passot G, Petorin C, Peyrat P, Pezet D, Piessen G, Pirro N, Pocard M, Poizat F, Porcheron J, Pourcher G, Quenet F, Rat P, Regimbeau JM, Rousselot P, Sabbagh C, Svrcek M, Tetreau R, Thibaudeau E, Tuech JJ, Valmary-Degano S, Vaudoyer D, Velasco S, Verriele-Beurrier V, Wernert R, Zinzindohoue F. A new internet tool to report peritoneal malignancy extent. PeRitOneal MalIgnancy Stage Evaluation (PROMISE) application. Eur J Surg Oncol 2016; 42:877-82. [DOI: 10.1016/j.ejso.2016.03.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/12/2016] [Accepted: 03/16/2016] [Indexed: 11/17/2022] Open
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Sabbagh C, Chatelain D, Nguyen-Khac E, Rebibo L, Joly JP, Regimbeau JM. Management of colorectal cancer in patients with cirrhosis: A retrospective, case-matched study of short- and long-term outcomes. Dig Liver Dis 2016; 48:429-34. [PMID: 26776878 DOI: 10.1016/j.dld.2015.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 11/23/2015] [Accepted: 12/04/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few studies have assessed access to postoperative chemotherapy and survival in cirrhotic patients with colorectal cancer. Aim of this study was to analyse short and long-term outcomes in these patients compared to non-cirrhotics. METHODS A retrospective, single-centre, comparative, case-matched study comparing 40 cirrhotic patients who had undergone colorectal resection between January 2006 and January 2014, and a matched cohort of 80 non-cirrhotic patients. Data collection included rate of postoperative outcomes, chemotherapy regimen, overall and disease-free 3-year survival. RESULTS Cirrhotics had more major postoperative complications than non-cirrhotics (57.5% vs. 26.5%, respectively; p=0.002) but no difference in anastomotic leakage (p=0.1); a higher mortality rate (p=0.0006) was observed in Child-Pugh class B patients. Cirrhotics had no difference in adjuvant chemotherapy rate compared to non-cirrhotics (55% vs. 65%, respectively p=0.8); 3-year overall survival was 71% in the Child A group vs. 92% in non-cirrhotics (p=0.03). CONCLUSION Despite a higher postoperative complication rate and a lower overall survival of cirrhotic patients compared to non-cirrhotics, cirrhosis had no impact on oncological outcomes and access/tolerance to postoperative chemotherapy. Thus cirrhosis should not be considered as a contraindication to curative treatment of colon cancer.
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Affiliation(s)
- Charles Sabbagh
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Amiens Cedex 01, France; Jules Verne University of Picardie, France; INSERM Unit U1088, Jules Verne University of Picardie, France
| | - Denis Chatelain
- Jules Verne University of Picardie, France; Department of Pathology, Amiens University Hospital, France
| | - Eric Nguyen-Khac
- Jules Verne University of Picardie, France; Department of Hepatology and Gastroenterology, Amiens University Hospital, France
| | - Lionel Rebibo
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Amiens Cedex 01, France
| | - Jean-Paul Joly
- Department of Hepatology and Gastroenterology, Amiens University Hospital, France
| | - Jean-Marc Regimbeau
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Amiens Cedex 01, France; Jules Verne University of Picardie, France; EA4294, Jules Verne University of Picardie, France; Clinical Research Centre, Amiens University Hospital, France.
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Abstract
Two principal branches from the aorta provide the colonic blood supply: the superior and inferior mesenteric arteries. There are numerous anatomical variations, which the surgeon must fully understand before embarking on any colonic surgery. A good knowledge of these variations is particularly important when the patient has already undergone colectomy or presents with occlusive vascular disease. The aim of this review is to summarize the standard anatomy and the main variations of the colonic blood supply as they apply to colorectal surgery in this setting.
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Affiliation(s)
- F Prevot
- Service de chirurgie digestive, centre hospitalier universitaire Amiens-Picardie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, 80000 Amiens, France
| | - C Sabbagh
- Service de chirurgie digestive, centre hospitalier universitaire Amiens-Picardie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, 80000 Amiens, France
| | - F Mauvais
- Service de chirurgie viscérale et digestive, centre hospitalier de Beauvais, avenue Léon-Blum, BP 40319, 60021 Beauvais cedex, France
| | - J-M Regimbeau
- Service de chirurgie digestive, centre hospitalier universitaire Amiens-Picardie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Unité Inserm EA4294, université de Picardie-Jules-Verne, 80000 Amiens, France; Centre de recherche clinique, centre hospitalier universitaire Amiens-Picardie, avenue René-Laënnec-Salouël, 80054 Amiens cedex 1, France; Université de Picardie-Jules-Verne, 80000 Amiens, France.
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84
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Sabbagh C, Dhahri A, Mariage M, Ntouba A, Yzet T, Regimbeau JM. Outcomes of duodenojejunostomy (the Grégoire procedure) for obstruction or perforation of the third and fourth portions of the duodenum. Surgical Practice 2016. [DOI: 10.1111/1744-1633.12158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Charles Sabbagh
- Department of Digestive, Oncological and Metabolic Surgery; Amiens University Hospital; Amiens France
| | - Abdennaceur Dhahri
- Department of Digestive, Oncological and Metabolic Surgery; Amiens University Hospital; Amiens France
| | - Maxime Mariage
- Department of Digestive, Oncological and Metabolic Surgery; Amiens University Hospital; Amiens France
| | - Alexandre Ntouba
- Department of Anaesthesiology and Critical Care Medicine; Amiens University Hospital; Amiens France
| | - Thierry Yzet
- Department of Radiology; Amiens University Hospital; Amiens France
| | - Jean-Marc Regimbeau
- Department of Digestive, Oncological and Metabolic Surgery; Amiens University Hospital; Amiens France
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Sabbagh C, Khazzaka A, Rizkallah J, El Kary N, Chaddad M, El Rassy E. Value of electrocardiograms ordered by junior medical officers in the emergency department. Intern Med J 2016; 46:105-8. [DOI: 10.1111/imj.12958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/26/2015] [Accepted: 11/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- C. Sabbagh
- Emergency Department; Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University; Beirut Lebanon
| | - A. Khazzaka
- Emergency Department; Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University; Beirut Lebanon
| | - J. Rizkallah
- Emergency Department; Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University; Beirut Lebanon
| | - N. El Kary
- Emergency Department; Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University; Beirut Lebanon
| | - M. Chaddad
- Emergency Department; Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University; Beirut Lebanon
| | - E. El Rassy
- Emergency Department; Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University; Beirut Lebanon
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Sabbagh C, Cosse C, Ravololoniaina T, Chauffert B, Joly JP, Mauvais F, Regimbeau JM. Oncological strategies for middle and low rectal cancer with synchronous liver metastases. Int J Surg 2015; 23:186-93. [DOI: 10.1016/j.ijsu.2015.08.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/03/2015] [Accepted: 08/22/2015] [Indexed: 01/20/2023]
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Messager M, Sabbagh C, Denost Q, Regimbeau JM, Laurent C, Rullier E, Sa Cunha A, Mariette C. Is there still a need for prophylactic intra-abdominal drainage in elective major gastro-intestinal surgery? J Visc Surg 2015; 152:305-13. [PMID: 26481067 DOI: 10.1016/j.jviscsurg.2015.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Prophylactic drainage of the abdominal cavity after gastro-intestinal surgery is widely used. The rationale is that intra-abdominal drainage enhances early detection of complications (gastro-intestinal leakage, hemorrhage, bile leak), prevents collection of fluid or pus, reduces morbidity and mortality, and decreases the duration of hospital stay. However, dogmatic attitudes favoring systematic drain placement should be questioned. The aim of this review was to evaluate the evidence supporting systematic use of prophylactic abdominal drainage following gastrectomy, pancreatectomy, liver resection, and rectal resection. Based on this review of the literature: (i) there was no evidence in favor of intra-peritoneal drainage following total or sub-total gastrectomy with respect to morbidity-mortality, nor was it helpful in the diagnosis or management of leakage, however the level of evidence is low, (ii) following pancreatic resection, data are conflicting but, overall, suggest that the absence of drainage is prejudicial, and support the notion that short-term drainage is better than long-term drainage, (iii) after liver resection without hepatico-intestinal anastomosis, high level evidence supports that there is no need for abdominal drainage, and (iv) following rectal resection, data are insufficient to establish recommendations. However, results from the French multicenter randomized controlled trial GRECCAR5 (NCT01269567) should provide new evidence this coming year. Accumulating data support that systematic drainage of the abdominal cavity in digestive surgery is a non-beneficial and obsolete practice, except following pancreatectomy where the consensus appears to indicate the usefulness of short-term drainage. While the level of evidence is high for liver resections, new randomized controlled trials are awaited regarding gastric, pancreatic and rectal surgery.
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Affiliation(s)
- M Messager
- Service de Chirurgie Digestive et Générale, Centre Hospitalier Régional Universitaire de Lille, Hôpital Claude-Huriez, Place de Verdun, 59037 Lille cedex, France
| | - C Sabbagh
- Service de Chirurgie Digestive et Oncologique, CHU d'Amiens, Amiens, France
| | - Q Denost
- Service de Chirurgie Colorectale, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - J M Regimbeau
- Service de Chirurgie Digestive et Oncologique, CHU d'Amiens, Amiens, France
| | - C Laurent
- Service de Chirurgie Colorectale, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - E Rullier
- Service de Chirurgie Colorectale, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - A Sa Cunha
- Service de Chirurgie Digestive, Hôpital Paul-Brousse, Villejuif, France
| | - C Mariette
- Service de Chirurgie Digestive et Générale, Centre Hospitalier Régional Universitaire de Lille, Hôpital Claude-Huriez, Place de Verdun, 59037 Lille cedex, France.
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Le Roux F, Sabbagh C, Robert B, Yzet T, Dugue L, Joly JP, Regimbeau JM. Multidisciplinary management of Mirizzi syndrome with cholecystobiliary fistula: the value of minimally invasive endoscopic surgery. Hepatobiliary Pancreat Dis Int 2015; 14:543-7. [PMID: 26459732 DOI: 10.1016/s1499-3872(15)60380-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mirizzi syndrome, a rare complication of gallstones, is defined by obstruction of the main bile duct. This obstruction may worsen and thus result in cholecystobiliary fistula. Surgical management of Mirizzi syndrome is complicated by the presence of inflamed tissue around the hepatic pedicle, making it impossible to distinguish between the main bile duct and the gallbladder. The surgeon's first task is to perform subtotal cholecystotomy (from the fundus of the gallbladder to the neck) without trying to locate the cystic duct. In a second step, the gallstones are extracted and the main bile duct is then repaired. In most cases, a T-tube is used to drain the main bile duct, and abdominal drainage is left in place (in case a bile fistula forms). This study concluded that preoperative drainage of the main bile duct in the treatment of Mirizzi syndrome types II and III is feasible and might help to decrease the postoperative complication rate.
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Affiliation(s)
- Fabien Le Roux
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Jules Verne University of Picardie, Amiens, France.
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Abstract
Pseudomyxoma peritonei (PMP) is a rare diagnosis with an incidence of 1-2 per million. Most cases originate from an appendix which ruptures and releases mucin into the peritoneal cavity. The progression of the disease results in obstruction and cutaneous leak. Abdominal compartment syndrome is an uncommon complication of peritoneal pseudomyxoma. In the present article, we report the case of a patient with PMP and abdominal compartment syndrome. A laparotomy to decrease the abdominal pressure was performed. Three months later, a peritonectomy with hyperthermic intraperitoneal chemotherapy was performed. The patient was still alive 1 year after the procedure without any recurrence. In conclusion, acute abdominal pain and respiratory failure in patients with peritoneal PMP should lead to the measurement of the abdominal pressure but are not a contra indication for curative treatment of PMP.
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Affiliation(s)
- Charles Sabbagh
- Department of Digestive and Metabolic Surgery, Amiens University Hospital, University of Picardie Jules Verne, Amiens, France
| | - Colette Vaillandet
- Department of Digestive and Metabolic Surgery, Amiens University Hospital, University of Picardie Jules Verne, Amiens, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen, France
| | - Jean-Marc Regimbeau
- Department of Digestive and Metabolic Surgery, Amiens University Hospital, University of Picardie Jules Verne, Amiens, France
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90
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Sabbagh C, Cosse C, Chauffert B, Nguyen-Khac E, Joly JP, Yzet T, Regimbeau J. Management of colon cancer in patients with cirrhosis: A review. Surg Oncol 2015; 24:187-93. [DOI: 10.1016/j.suronc.2015.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 12/29/2014] [Accepted: 06/08/2015] [Indexed: 01/22/2023]
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Ferron G, Simon L, Guyon F, Glehen O, Goere D, Elias D, Pocard M, Gladieff L, Bereder JM, Brigand C, Classe JM, Guilloit JM, Quenet F, Abboud K, Arvieux C, Bibeau F, De Chaisemartin C, Delroeux D, Durand-Fontanier S, Goasguen N, Gouthi L, Heyd B, Kianmanesh R, Leblanc E, Loi V, Lorimier G, Marchal F, Mariani P, Mariette C, Meeus P, Msika S, Ortega-Deballon P, Paineau J, Pezet D, Piessen G, Pirro N, Pomel C, Porcheron J, Pourcher G, Rat P, Regimbeau JM, Sabbagh C, Thibaudeau E, Torrent JJ, Tougeron D, Tuech JJ, Zinzindohoue F, Lundberg P, Herin F, Villeneuve L. Professional risks when carrying out cytoreductive surgery for peritoneal malignancy with hyperthermic intraperitoneal chemotherapy (HIPEC): A French multicentric survey. Eur J Surg Oncol 2015; 41:1361-7. [PMID: 26263848 DOI: 10.1016/j.ejso.2015.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/10/2015] [Accepted: 07/15/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over the last two decades, many surgical teams have developed programs to treat peritoneal carcinomatosis with extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, there are no specific recommendations for HIPEC procedures concerning environmental contamination risk management, personal protective equipment (PPE), or occupational health supervision. METHODS A survey of the institutional practices among all French teams currently performing HIPEC procedures was carried out via the French network for the treatment of rare peritoneal malignancies (RENAPE). RESULTS Thirty three surgical teams responded, 14 (42.4%) which reported more than 10 years of HIPEC experience. Some practices were widespread, such as using HIPEC machine approved by the European Community (100%), individualized or centralized smoke evacuation (81.8%), "open" abdominal coverage during perfusion (75.8%), and maintaining the same surgeon throughout the procedure (69.7%). Others were more heterogeneous, including laminar flow air circulation (54.5%) and the provision of safety protocols in the event of perfusate spills (51.5%). The use of specialized personal protective equipment is ubiquitous (93.9%) but widely variable between programs. CONCLUSION Protocols regarding cytoreductive surgery/HIPEC and the associated professional risks in France lack standardization and should be established.
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Affiliation(s)
- G Ferron
- Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France.
| | - L Simon
- Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France
| | - F Guyon
- Department of Surgical Oncology, Bergonie Institute, Bordeaux, France
| | - O Glehen
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - D Goere
- Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - D Elias
- Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - M Pocard
- Surgical Oncologic & Digestive Unit, Lariboisière University Hospital, Paris, France; INSERM, U 965, Paris, France
| | - L Gladieff
- Department of Medical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France
| | - J M Bereder
- Department of General Surgery, Archet 2 University Hospital, Nice, France
| | - C Brigand
- Department of General Surgery, Hautepierre University Hospital, Strasbourg, France
| | - J M Classe
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - J M Guilloit
- Department of Surgical Oncology, Francois Baclesse Comprehensive Cancer Center, Caen, France
| | - F Quenet
- Department of Surgical Oncology, Val d'Aurelle Montpellier Cancer Center, Montpellier, France
| | - K Abboud
- Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - C Arvieux
- Department of Digestive Surgery, Michallon University Hospital, Grenoble, France
| | - F Bibeau
- Department of Pathology, Val d'Aurelle Montpellier Cancer Center, Montpellier, France
| | - C De Chaisemartin
- Department of Surgical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - D Delroeux
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - S Durand-Fontanier
- Department of Visceral Surgery and Transplantation, Dupuytren University Hospital, Limoges, France
| | - N Goasguen
- Department of General Surgery, Diaconesses Croix Saint Simon Group Hospital, Paris, France
| | - L Gouthi
- Department of Digestive Surgery, Purpan University Hospital, Toulouse, France
| | - B Heyd
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - R Kianmanesh
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - E Leblanc
- Department of Gynaecological Surgery, Oscar Lambret Cancer Center, Lille, France
| | - V Loi
- Department of Digestive Surgery, Tenon University Hospital, Paris, France
| | - G Lorimier
- Department of Surgical Oncology, Paul Papin Cancer Center, Angers, France
| | - F Marchal
- Department of Surgical Oncology, Lorraine Institute of Oncology, Vandoeuvre-les-Nancy, France
| | - P Mariani
- Department of Surgical Oncology, Curie Institute, Paris, France
| | - C Mariette
- Department of Digestive and Oncological Surgery, Claude-Huriez University Hospital, Lille, France
| | - P Meeus
- Department of Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France
| | - S Msika
- Department of Surgery, Louis Mourier University Hospital, Colombes, France
| | - P Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - J Paineau
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - D Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, Claude-Huriez University Hospital, Lille, France
| | - N Pirro
- Department of Digestive Surgery, Timône University Hospital, Marseille, France
| | - C Pomel
- Department of Surgical Oncology, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France
| | - J Porcheron
- Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - G Pourcher
- Department of General Surgery, Antoine-Béclère University Hospital, Clamart, France
| | - P Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - J M Regimbeau
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - C Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - E Thibaudeau
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - J J Torrent
- Department of Gynecology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - D Tougeron
- Department of Hepato-Gastroenterology, University Hospital, Poitiers, France
| | - J J Tuech
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - F Zinzindohoue
- Department of Digestive and General Surgery, G. Pompidou European Hospital, Paris, France
| | - P Lundberg
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - F Herin
- Department of Occupational Medicine, University Hospital, Toulouse, France
| | - L Villeneuve
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
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Blot C, Sabbagh C, Rebibo L, Brazier F, Chivot C, Fumery M, Regimbeau JM. Use of transanastomotic double-pigtail stents in the management of grade B colorectal leakage: a pilot feasibility study. Surg Endosc 2015; 30:1869-75. [PMID: 26183957 DOI: 10.1007/s00464-015-4404-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/02/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Anastomotic leakage (AL) is a major complication of colorectal surgery. The leakage is classified as grade B when the patient's clinical condition requires an active therapeutic intervention but does not require further surgery. The management of grade B AL commonly includes administration of antibiotics and/or the placement of a pelvic drainage performed under radiological guidance or transanal drain. The objective of this study was to evaluate the feasibility and the efficacy of endoscopic transanastomotic drainage using double-pigtail stents (DPSs) in the management of grade B AL in colorectal surgery. PATIENTS AND METHODS Between September 2011 and December 2014, 650 patients underwent a colorectal procedure in our university hospital; 8.7 % presented with AL, including 42.8 % with grade B. Fourteen patients required endoscopic management and constituted the study population. The study's primary objective was to assess the feasibility and efficacy of DPS placement for the treatment of grade B AL after colorectal surgery. The secondary endpoints were the requirement for radiological drainage, the DPS placement failure rate, the rate of stoma closure and, lastly, feasibility of chemotherapy (if indicated). RESULTS DPS placement was feasible in 92.8 % of the 14 patients (n = 13). The overall success rate for endoscopic management was 78.5 % (n = 11). The median length of hospitalization after DPS placement was 5 days (3-17). The average duration of drainage through a DPS was 62 days (28-181). Five patients (35.7 %) also underwent drainage with radiological guidance. Of the 10 patients with stoma, closure occurred in 80 %. All patients that required adjuvant chemotherapy were able to receive it. CONCLUSION The treatment of AL requires multidisciplinary collaboration to save the anastomosis. DPS placement under endoscopic control is associated with AL healing, good clinical tolerance and the ability to undergo chemotherapy and is an alternative to repeat laparotomy when radiological drainage is unfeasible or inefficient.
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Affiliation(s)
- Christelle Blot
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.,Jules Verne University of Picardie, Amiens Cedex 01, France
| | - Charles Sabbagh
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.,Jules Verne University of Picardie, Amiens Cedex 01, France.,INSERM Unit 1088, Amiens Cedex 01, France
| | - Lionel Rebibo
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.,Jules Verne University of Picardie, Amiens Cedex 01, France
| | - Franck Brazier
- Department of Hepatogastroenterology, Amiens University Hospital, Amiens Cedex 01, France
| | - Cyril Chivot
- Department of Radiology, Amiens University Hospital, Amiens Cedex 01, France
| | - Mathurin Fumery
- Jules Verne University of Picardie, Amiens Cedex 01, France.,Department of Hepatogastroenterology, Amiens University Hospital, Amiens Cedex 01, France
| | - Jean-Marc Regimbeau
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France. .,Jules Verne University of Picardie, Amiens Cedex 01, France. .,EA4294, Jules Verne University of Picardie, Amiens Cedex 01, France. .,Clinical Research Centre, Amiens University Hospital, Amiens Cedex 01, France.
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93
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Sabbagh C, Chaddad M, El Rassy E. Experience of morning reports in the emergency department. Intern Med J 2015; 45:780-3. [PMID: 26134698 DOI: 10.1111/imj.12809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
Morning report in the emergency medicine departments is an emerging teaching modality in the medicine curriculum. Our institution, Hotel-Dieu de France hospital, a multidisciplinary tertiary care university hospital affiliated to the Saint Joseph University of Medical Sciences, is the only hospital in Middle East to hold morning reports in the emergency department (ED). We evaluate the usefulness of the morning report as a pedagogic tool as it assesses the content, quality of the discussions, professionalism, leadership, participation and duration of the morning report. The particularity of this paper is that it takes into consideration the interns' input often under-recognised in the studies. An anonymous questionnaire was diffused to the residents and interns that rotated in the ED during the previous year. It consisted of seven multiple-choice questions to evaluate the quality of the presentations, targeted discussions, ethics and professionalism, evidence-based medicine, clinical reasoning, relation of cases to discussions and implication of the ED physician. Overall, of the 63 patients who answered the survey, 65.1% were satisfied by the content. The majority considered the quality of the discussions acceptable and the leadership and participation satisfactory, professionalism was judged poor. Both residents and interns were satisfied of the teaching point of the morning reports. The only fail back observed was professionalism and pathophysiological discussions that require to be added to the sessions, whereas clinical management, teaching points, leadership and time management were completely satisfactory.
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Affiliation(s)
- C Sabbagh
- Emergency Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - M Chaddad
- Emergency Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - E El Rassy
- Emergency Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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94
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Tartar L, Sabbagh C, Chivot C, Cosse C, Regimbeau JM. Does radiotherapy have an impact on the thickness of the puborectal muscle? Colorectal Dis 2015; 17:542-3. [PMID: 25827604 DOI: 10.1111/codi.12966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 02/26/2015] [Indexed: 02/08/2023]
Affiliation(s)
- L Tartar
- Department of Digestive and Oncological surgery, Amiens University Hospital, Amiens, France
| | - C Sabbagh
- Department of Digestive and Oncological surgery, Amiens University Hospital, Amiens, France.,Jules Verne University of Picardie, Amiens, France.,INSERM unit U1088, Jules Verne University of Picardie, Amiens, France
| | - C Chivot
- Department of Radiology, Amiens University Hospital, Amiens, France
| | - C Cosse
- Department of Digestive and Oncological surgery, Amiens University Hospital, Amiens, France.,Jules Verne University of Picardie, Amiens, France.,INSERM unit U1088, Jules Verne University of Picardie, Amiens, France.,Clinical Research Centre, Amiens University Hospital, Amiens, France
| | - J M Regimbeau
- Department of Digestive and Oncological surgery, Amiens University Hospital, Amiens, France. .,Jules Verne University of Picardie, Amiens, France. .,Clinical Research Centre, Amiens University Hospital, Amiens, France. .,EA4294, Jules Verne University of Picardie, Amiens, France.
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95
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Affiliation(s)
- E Chapuis-Roux
- Department of oncologic and digestive surgery, Amiens University Center, place Victor-Pauchet, 80054 Amiens, France
| | - C Sabbagh
- Department of oncologic and digestive surgery, Amiens University Center, place Victor-Pauchet, 80054 Amiens, France
| | - J-M Regimbeau
- Department of oncologic and digestive surgery, Amiens University Center, place Victor-Pauchet, 80054 Amiens, France.
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96
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Cosse C, Sabbagh C, Browet F, Mauvais F, Rebibo L, Zogheib E, Chatelain D, Kamel S, Regimbeau JM. Serum value of procalcitonin as a marker of intestinal damages: type, extension, and prognosis. Surg Endosc 2015; 29:3132-9. [PMID: 25701059 DOI: 10.1007/s00464-014-4038-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/09/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Ischemic and necrotic damages are complications of digestive diseases and require emergency management. Nevertheless, the decision to surgically manage could be delayed because of no sufficiently preoperative accurate marker of ischemia diagnosis, extension, and prognosis. METHODS The aim of this study was to assess the predictive value of serum procalcitonin (PCT) levels for diagnosing intestinal necrotic damages, their extension, and their prognosis in patients with ischemic disease including ischemic colitis and mesenteric infarction by a gray zone approach. Between January 2007 to June 2014, 128 patients with ischemic colitis and mesenteric infarction (codes K55.0 and K51.9) were operated, for whom data on PCT were available. We perform a retrospective, multicenter review of their medical records. Patients were divided into subgroups: ischemia (ID group) versus necrosis (ND group); the extension [focal (FD) vs. extended (ED)] and the vital status [deceased (D) vs. alive (A)]. RESULTS PCT levels were higher in the ND (n = 94; p = 0.009); ED (n = 100; p = 0.02); and D (n = 70; p = 0.0003) groups. With a gray zone approach, the predictive thresholds were (i) for necrosis 2.473 ng/mL, (ii) for extension 3.884 ng/mL, and (iii) for mortality 7.87 ng/mL. CONCLUSION In our population, PCT could be used as a marker of necrosis; especially in case of extended damages and reflects the patient's prognosis.
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Affiliation(s)
- C Cosse
- Department of Digestive and Oncological Surgery, Amiens North Hospital, University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France.,INSERM U1088, Jules Verne University of Picardie, Amiens, France
| | - C Sabbagh
- Department of Digestive and Oncological Surgery, Amiens North Hospital, University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France
| | - F Browet
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - L Rebibo
- Department of Digestive and Oncological Surgery, Amiens North Hospital, University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France
| | - E Zogheib
- Department of Anesthesiology, Amiens South Hospital, University of Picardie, 80054, Amiens Cedex 01, France
| | - D Chatelain
- Department of Pathology, Amiens North Hospital, University of Picardie, 80054, Amiens Cedex 01, France
| | - S Kamel
- INSERM U1088, Jules Verne University of Picardie, Amiens, France.,Department of Biochemistry, Amiens South Hospital, University of Picardie, 80054, Amiens Cedex 01, France
| | - J M Regimbeau
- Department of Digestive and Oncological Surgery, Amiens North Hospital, University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France. .,EA4294, Jules Verne University of Picardie, Amiens, France. .,Department of Digestive and Oncological Surgery, CHU Nord Amiens and University of Picardie, Place Victor Pauchet, 80054, Amiens Cedex 01, France. .,Clinical Research Center, Amiens University Hospital, Amiens, France.
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97
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Cosse C, Sabbagh C, Kamel S, Galmiche A, Regimbeau JM. Procalcitonin and intestinal ischemia: A review of the literature. World J Gastroenterol 2014; 20:17773-17778. [PMID: 25548475 PMCID: PMC4273127 DOI: 10.3748/wjg.v20.i47.17773] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/07/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023] Open
Abstract
Intestinal ischemia is common after emergency gastrointestinal or cardiovascular surgery. At present, there are no diagnostic tools for the early diagnosis of intestinal ischemia. In the last decade, procalcitonin (PCT) has been suggested as a marker of this condition. Here, we review the use of PCT as a diagnostic tool for intestinal ischemia. Two reviewers independently searched the PubMed and EMBASE databases for articles on intestinal ischemia and PCT. They then considered (1) the criteria applicable to preclinical and clinical data; and (2) PCT’s predictive value in the diagnosis of intestinal ischemia. Article quality was rated according to the STAndards for Reporting of Diagnostic accuracy. Between 1993 and 2014, seven studies (including two preclinical studies and five clinical studies) dealt with the use of PCT to diagnose intestinal ischemia. Procalcitonin’s sensitivity, specificity, positive predictive value and negative predictive value ranged between 72% and 100%; 68% and 91%; 27% and 90% and 81% and 100%, respectively. The area under the receiver operating characteristic curve ranged from 0.77 to 0.92. In view of the preclinical and clinical data, we consider that PCT can be used in daily practice as a tool for diagnosing intestinal ischemia.
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98
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Sabbagh C, Mauvais F, Vecten A, Ainseba N, Cosse C, Diouf M, Regimbeau JM. What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? a randomized, controlled study in men. Dig Liver Dis 2014; 46:1082-5. [PMID: 25245464 DOI: 10.1016/j.dld.2014.08.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/18/2014] [Accepted: 08/25/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Digital rectal examination is an essential tool in the evaluation of the rectum. The aim of this trial was to determine the best position for performing a digital rectal examination. METHODS A total of 321 patients were randomized into "dorsal" or "lateral" groups in this multicentre randomized controlled trial performed in an outpatient setting. The primary endpoint was the proportion of patients with a complete digital rectal examination, defined as the examination of the rectum (upper border of the prostate), the entire circumference, and the assessment of the sphincter tone. RESULTS The dorsal group included a total of 161 patients (mean age: 62.3 ± 13.04 years), while the lateral group included 160 patients (mean age: 62.7 ± 14.4 years). The proportion of patients with a complete digital rectal examination was 44% (n=71) in the dorsal group and 49% (n=79) in the lateral group (p=0.3). The entire circumference of the rectum could be examined in 66% of the patients (n=106) in the dorsal group and in 79.5% of the patients (n=128) in the lateral group (p=0.007). CONCLUSION The intergroup difference in terms of digital rectal examination completion rate was not significant. In the lateral position, however, the entire circumference of the rectum could be examined more thoroughly.
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Affiliation(s)
- Charles Sabbagh
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France; INSERM U1088, Amiens, France
| | - François Mauvais
- Department of Digestive Surgery, Beauvais General Hospital, Beauvais, France
| | - Amaury Vecten
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Amiens, France
| | - Najib Ainseba
- Department of Digestive Surgery, Beauvais General Hospital, Beauvais, France
| | - Cyril Cosse
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France; INSERM U1088, Amiens, France
| | - Momar Diouf
- Clinical Research Directorate, Jules Verne University of Picardie, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Amiens, France; Jules Verne University of Picardie, Amiens, France.
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99
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van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RGH, DeWitt JM, Donnellan F, Dumonceau JM, Glynne-Jones RGT, Hassan C, Jiménez-Perez J, Meisner S, Muthusamy VR, Parker MC, Regimbeau JM, Sabbagh C, Sagar J, Tanis PJ, Vandervoort J, Webster GJ, Manes G, Barthet MA, Repici A. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Gastrointest Endosc 2014; 80:747-61.e1-75. [PMID: 25436393 DOI: 10.1016/j.gie.2014.09.018] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Emo E van Halsema
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - John M DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Fergal Donnellan
- UBC Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada
| | | | | | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Javier Jiménez-Perez
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Søren Meisner
- Endoscopy Unit, Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | - V Raman Muthusamy
- Division of Gastroenterology and Hepatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | | | - Jean-Marc Regimbeau
- Department of Digestive and Oncological Surgery, University Hospital of Amiens, France
| | - Charles Sabbagh
- Department of Digestive and Oncological Surgery, University Hospital of Amiens, France
| | - Jayesh Sagar
- Department of Colorectal Surgery, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Pieter J Tanis
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jo Vandervoort
- Department of Gastroenterology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - George J Webster
- Department of Gastroenterology, University College Hospital, London, United Kingdom
| | - Gianpiero Manes
- Department of Gastroenterology and Endoscopy, Guido Salvini Hospital, Garbagnate Milanese/Rho, Milan, Italy
| | - Marc A Barthet
- Department of Gastroenterology, Hôpital Nord, Aix Marseille Université, Marseille, France
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100
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van Hooft JE, van Halsema EE, Vanbiervliet G, Beets-Tan RGH, DeWitt JM, Donnellan F, Dumonceau JM, Glynne-Jones RGT, Hassan C, Jiménez-Perez J, Meisner S, Muthusamy VR, Parker MC, Regimbeau JM, Sabbagh C, Sagar J, Tanis PJ, Vandervoort J, Webster GJ, Manes G, Barthet MA, Repici A. Self-expandable metal stents for obstructing colonic and extracolonic cancer: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2014; 46:990-1053. [PMID: 25325682 DOI: 10.1055/s-0034-1390700] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). This Guideline was also reviewed and endorsed by the Governing Board of the American Society for Gastrointestinal Endoscopy (ASGE). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations The following recommendations should only be applied after a thorough diagnostic evaluation including a contrast-enhanced computed tomography (CT) scan. 1 Prophylactic colonic stent placement is not recommended. Colonic stenting should be reserved for patients with clinical symptoms and imaging evidence of malignant large-bowel obstruction, without signs of perforation (strong recommendation, low quality evidence). 2 Colonic self-expandable metal stent (SEMS) placement as a bridge to elective surgery is not recommended as a standard treatment of symptomatic left-sided malignant colonic obstruction (strong recommendation, high quality evidence). 3 For patients with potentially curable but obstructing left-sided colonic cancer, stent placement may be considered as an alternative to emergency surgery in those who have an increased risk of postoperative mortality, I. e. American Society of Anesthesiologists (ASA) Physical Status ≥ III and/or age > 70 years (weak recommendation, low quality evidence). 4 SEMS placement is recommended as the preferred treatment for palliation of malignant colonic obstruction (strong recommendation, high quality evidence), except in patients treated or considered for treatment with antiangiogenic drugs (e. g. bevacizumab) (strong recommendation, low quality evidence).
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Affiliation(s)
- Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Emo E van Halsema
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - John M DeWitt
- Department of Gastroenterology and Hepatology, Indiana University Medical Center, Indianapolis, Indiana, United States
| | - Fergal Donnellan
- UBC Division of Gastroenterology, Vancouver General Hospital, Vancouver, Canada
| | | | | | - Cesare Hassan
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | - Javier Jiménez-Perez
- Endoscopy Unit, Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Søren Meisner
- Endoscopy Unit, Digestive Disease Center, Bispebjerg University Hospital, Copenhagen, Denmark
| | - V Raman Muthusamy
- Division of Gastroenterology and Hepatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States
| | | | - Jean-Marc Regimbeau
- Department of Digestive and Oncological Surgery, University Hospital of Amiens, France
| | - Charles Sabbagh
- Department of Digestive and Oncological Surgery, University Hospital of Amiens, France
| | - Jayesh Sagar
- Department of Colorectal Surgery, Royal Surrey County Hospital, Guildford, UK
| | - Pieter J Tanis
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jo Vandervoort
- Department of Gastroenterology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - George J Webster
- Department of Gastroenterology, University College Hospital, London, UK
| | - Gianpiero Manes
- Department of Gastroenterology and Endoscopy, Guido Salvini Hospital, Garbagnate Milanese/Rho, Milan, Italy
| | - Marc A Barthet
- Department of Gastroenterology, Hôpital Nord, Aix Marseille Université, Marseille, France
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