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Yamaguchi T, Cristaudi A, Kokudo T, Uldry E, Demartines N, Halkic N. Surgical treatment for monolobular Caroli's disease ‒ Report of a 30-year single center case series. Biosci Trends 2018; 12:426-431. [DOI: 10.5582/bst.2018.01162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Takamune Yamaguchi
- Department of Visceral Surgery, University Hospital of Lausanne
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division Department of Surgery Graduate School of Medicine, The University of Tokyo
| | | | - Takashi Kokudo
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division Department of Surgery Graduate School of Medicine, The University of Tokyo
| | - Emilie Uldry
- Department of Visceral Surgery, University Hospital of Lausanne
| | | | - Nermin Halkic
- Department of Visceral Surgery, University Hospital of Lausanne
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Abstract
Few data exist on risk factors (RF) for surgical site infections (SSI) among patients treated in an enhanced recovery after surgery (ERAS) pathway. This study aimed to assess RF for SSI after pancreas surgery in a non-ERAS group and an ERAS cohort.An exploratory retrospective analysis of all pancreas surgeries prospectively collected (01/2000-12/2015) was performed. RF for SSI were calculated using uni- and multivariable binary logistic regressions in non-ERAS and ERAS patients.Pancreas surgery was performed in 549 patients. Among them, 144 presented a SSI (26%). In the non-ERAS group (n = 377), SSI incidence was 27% (99/377), and RF for SSI were male gender and preoperative biliary stenting. Since 2012, 172 consecutive patients were managed within an ERAS pathway. Forty-five patients (26%) had SSI. On multivariable analysis no RF for SSI in the ERAS cohort was found. In the ERAS group, patients with a pathway compliance ≤70% had higher occurrence of SSI (30/45 = 67% vs. 7/127 = 6%, p < 0.001) and patients with and without SSI had similar median overall compliances (77%, IQR 71-80 vs. 80%, IQR 73-83, p = 0.097).In the non-ERAS cohort, male gender and preoperative biliary stenting were RF for SSI, whereas in the ERAS group no RF for SSI was found. In an ERAS pathway, having an overall compliance >70% might diminish the SSI rate.
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Affiliation(s)
| | | | - David Petermann
- Department of Visceral Surgery, University Hospital CHUV, Lausanne
- Department of Surgery, Morges Hospital, Morges, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital CHUV, Lausanne
| | | | - Markus Schäfer
- Department of Visceral Surgery, University Hospital CHUV, Lausanne
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Abstract
OBJECTIVE Hepatocellular carcinomas (HCC) can infrequently rupture and cause hemorrhage. Little is known on recurrence rate (RR) and overall survival (OS) in case of ruptured HCC. This study aimed to assess RR, time to recurrence, and OS of operated ruptured HCC. PATIENTS AND METHODS All operated patients with HCC (1999-2015) were reviewed. Patient demographics, perioperative details, and postoperative outcomes of ruptured HCC were recorded. RR, time to recurrence, and OS were calculated. RR and OS of ruptured and non-ruptured HCC were compared. RESULTS Among the 140 consecutive patients with HCC operated during the study period, 14 presented with rupture. Eleven patients had cirrhosis (all Child-Pugh A). At presentation, median α-fetoprotein and hemoglobin levels were 23 µg/l (interquartile range: 5-883) and 127 g/l (118-148), respectively. All but one patient felt abdominal pain, and two were in hemorrhagic shock. Preoperative embolization with staged hepatectomy was performed in seven patients. Five patients were first treated conservatively and then had an elective hepatectomy, whereas two patients had upfront surgery (one packing and one segmentectomy). Major hepatectomy was performed in eight cases. Median intraoperative blood loss was 1000 ml (500-2100). Overall complication rate was 36%. Eight patients presented a recurrence (57%; median time to recurrence: 8 months; interquartile range: 6-19). Median OS was 44 months, and 5-year OS was 41%. The 126 operated patients with non-ruptured HCC had a RR of 59/126 (47%; P=0.576) and a 5-year OS of 61% (P=0.448). CONCLUSION RR between ruptured and non-ruptured HCC were similar. Moreover, HCC rupture did not impair OS compared with HCC without rupture.
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Roulin D, Gilgien J, Hübner M, Halkic N, Demartines N. Fluid overload increases complications following duodenopancreatectomy within an enhanced recovery program: A cohort study. Clin Nutr ESPEN 2018. [DOI: 10.1016/j.clnesp.2018.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Joliat GR, Petermann D, Demartines N, Halkic N, Schäfer M. Tumoral Venous Invasion after Distal Pancreatectomy: A Risk Factor for Recurrence. Dig Surg 2018; 36:317-322. [PMID: 29852496 DOI: 10.1159/000489276] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/05/2017] [Accepted: 04/12/2018] [Indexed: 12/10/2022]
Abstract
BACKGROUND Few data exist on postoperative outcomes of patients with pancreatic body-tail malignancies and tumoral venous invasion (VI). This study aimed at comparing survival and recurrence rate (RR) after distal pancreatectomy for adenocarcinoma in patients with and without tumoral VI. METHODS All consecutive distal pancreatectomies (2000-2015) were collected. Demographics and peri- and postoperative data were recorded. Survivals were calculated using Kaplan-Meier curves. RESULTS A total of 45 patients underwent distal pancreatectomies for malignancies, of which 33 patients had ductal adenocarcinomas and 2 had cystadenocarcinomas. Among these 35 adenocarcinomas, histological VI was found in 28 patients (80%). Characteristics and intraoperative data of patients with and without VI were similar. Complication rates were 15 of 28 (54%) in the VI group and 3 of 7 (43%) in the group without VI (p = 0.612). Five-year survival for the group with and without VI were 19 and 39% (p = 0.232), respectively. RR was 16 of 28 (57%) for the VI group and 1 of 7 (14%) for the group without VI (p = 0.042). CONCLUSION VI did not have an effect on postoperative -complications. Survivals were similar in case of VI or not. On the contrary, RR was higher in the VI group.
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Affiliation(s)
- Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - David Petermann
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland,
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
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Vietti Violi N, Duran R, Demartines N, Sempoux C, Guiu B, Bize PE, Sala N, Halkic N, Knebel JF, Denys A. Local recurrence rate in patients with colorectal cancer liver metastasis after wedge resection or percutaneous radiofrequency ablation. Int J Hyperthermia 2018; 34:1020-1028. [PMID: 29506424 DOI: 10.1080/02656736.2017.1372644] [Citation(s) in RCA: 16] [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] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare local recurrence (LR) rate in patients with colorectal cancer liver metastasis (CRCLM) after surgical wedge resection (WR) or radiofrequency ablation (RFA) and to investigate predictive factors of LR. MATERIALS AND METHODS This single-centre, retrospective, institutional review board-approved study including 43 consecutive patients with 121 metastases treated by WR and 60 patients with 110 metastases treated by RFA between 2007 and 2014 with 23 and 18.5 months of follow-up, respectively. Demographics and tumour characteristics were compared using the unpaired t-test and chi-square test. Predictive factors for LR (lesion size, depth, relation to hepatic vessels, intervention, margin status) were investigated in uni- and multivariate analyses. RESULTS Patient and CRCLM characteristics were similar in both groups. Mean lesion size and depth in the WR and RFA groups were 18 mm and 15 mm (p = 0.03), and 19 mm and 26 mm (p < 0.001), respectively. LR showed a trend towards difference in favour of RFA (19% and 10% in the WR and RFA groups, respectively, p = 0.06). Positive margins and lesion depth were predictive factors of LR in the WR group (p = 0.03 and p = 0.02, respectively, on uni- and multivariable analyses). Lesion depth and proximity to a vein increased the risk of positive margins on pathology after WR (p = 0.04 and p < 0.001, respectively). Our analysis did not identify any predictive factors of LR following RFA. CONCLUSION Our study showed a trend towards a lower LR rate with RFA compared to WR. Lesions located deep in the liver and/or close to large vessels are at high risk of LR following WR, while curative treatment can be obtained with RFA.
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Affiliation(s)
- Naïk Vietti Violi
- a Department of Radiology and Interventional Radiology , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland
| | - Rafael Duran
- a Department of Radiology and Interventional Radiology , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland
| | - Nicolas Demartines
- b Department of Surgery , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland
| | - Christine Sempoux
- c Department of Pathology , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland
| | - Boris Guiu
- a Department of Radiology and Interventional Radiology , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland
| | - Pierre E Bize
- a Department of Radiology and Interventional Radiology , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland
| | - Nathalie Sala
- c Department of Pathology , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland
| | - Nermin Halkic
- b Department of Surgery , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland
| | - Jean-Francois Knebel
- a Department of Radiology and Interventional Radiology , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland.,d Department of Clinical Neurosciences , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland
| | - Alban Denys
- a Department of Radiology and Interventional Radiology , Lausanne University Hospital and University of Lausanne , Lausanne , Switzerland
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Roulin D, Girardet R, Duran R, Hajdu S, Denys A, Halkic N, Demartines N, Melloul E. Outcome of elderly patients after acute biliary pancreatitis. Biosci Trends 2018; 12:54-59. [DOI: 10.5582/bst.2017.01303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Didier Roulin
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV)
| | - Raphaël Girardet
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV)
| | - Rafael Duran
- Department of Radiology, University Hospital of Lausanne (CHUV)
| | - Steven Hajdu
- Department of Radiology, University Hospital of Lausanne (CHUV)
| | - Alban Denys
- Department of Radiology, University Hospital of Lausanne (CHUV)
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV)
| | | | - Emmanuel Melloul
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV)
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Joliat GR, Halkic N, Pantet O, Ben-Hamouda N. Ischemic stroke and ST-elevation myocardial infarction revealing infective endocarditis. Eur Rev Med Pharmacol Sci 2017; 21:4640-4641. [PMID: 29131251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this clinical scenario, we report the case of a patient who presented multiple embolic complications due to mitral infective endocarditis (IE). A 68-year-old woman had extended right hepatectomy for hilar cholangiocarcinoma. Unfortunately, she had multiple postoperative complications and had to be transferred to the Intensive Care Unit. During this stay, we have diagnosed an Enterococcus faecium IE after the occurrence of multiple embolic complications (myocardial infarction, ischemic stroke, digital emboli, splenic emboli, and renal emboli). The case is presented hereunder with illustrative imagings. While embolism is a known complication of IE, the presence of multiple emboli in various organs is rare.
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Affiliation(s)
- G-R Joliat
- Division of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Sciarra A, Hessler R, Godat S, Fraga M, Dromain C, Duran R, Halkic N, Sempoux C. Heterotopic Gastric Mucosa in a Duplication Cyst of the Common Hepatic Duct Mimicking Cholangiocarcinoma. Int J Surg Pathol 2017; 26:84-88. [PMID: 28830294 DOI: 10.1177/1066896917727101] [Citation(s) in RCA: 4] [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] [Indexed: 01/01/2023]
Abstract
Heterotopic gastric mucosa in biliary tract is a congenital anomaly that can prove significant clinical dilemmas. Here we report the case of a 28-year-old female patient presenting with jaundice, pruritus, and altered liver tests, with predominant cholestasis. Liver biopsy revealed histological changes suggesting large bile duct obstruction with advanced fibrosis. At imaging, common hepatic duct stricture due to an intraluminal enhancing mass was observed. Endoscopic retrograde cholangiopancreatography and upper echoendoscopy revealed a firm mass of the common hepatic duct with a complete obstruction, suspicious for cholangiocarcinoma. Fine-needle aspiration biopsy performed under echoendoscopic guidance revealed fundic type gastric mucosa. Despite histological result, radiological suspicion of malignancy together with advanced fibrosis prompted a segmental resection of biliary tract. At macroscopic examination, the common hepatic duct presented a focal pseudocystic appearance with a firm zone of subtotal stenosis. Histology revealed a duplication cyst lined by heterotopic fundic gastric mucosa. Heterotopic gastric mucosa of the biliary tract should be suspected in young patients without know risk factors for hepatobiliary malignancies. Imaging and careful histological examination are mandatory for optimal management. Liver fibrosis, secondary to chronic biliary obstruction may be a significant late complication.
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Affiliation(s)
- Amedeo Sciarra
- 1 Lausanne University Hospital, Lausanne, Switzerland.,2 Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | | | - Rafael Duran
- 1 Lausanne University Hospital, Lausanne, Switzerland
| | - Nermin Halkic
- 1 Lausanne University Hospital, Lausanne, Switzerland
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Joliat GR, Allemann P, Labgaa I, Demartines N, Halkic N. Treatment and outcomes of recurrent hepatocellular carcinomas. Langenbecks Arch Surg 2017; 402:737-744. [PMID: 28497194 DOI: 10.1007/s00423-017-1582-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 11/08/2016] [Accepted: 04/24/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Surgery is one of the best options for curative treatment of hepatocellular carcinomas (HCC). Recurrences are nevertheless common (45-75%). This study aimed to compare overall survival (OS) of patients with recurrent HCC after primary resection to OS of patients without recurrence. METHODS A retrospective review of all HCC patients operated between 1993 and 2015 was performed. Median and 5-year OS were calculated. RESULTS This study included 147 HCC patients. Sixty-seven patients presented a recurrence (46%). Patients with recurrence had a worse prognosis than those without recurrence (median OS 63 vs. 82 months, 5-year OS 47 vs. 54%, p = 0.036). First-line performed treatments were radiofrequency ablation (18, RFA), chemo-embolization (16, TACE), repeat hepatectomy (10), systemic chemotherapy (4), radio-embolization (1), and alcoholization (1). Palliative care was performed in 17 patients. Median OS of patients treated by RFA, TACE, or repeat hepatectomy were similar (77, 71, and 84 months, p = 0.735). Patients treated with chemotherapy/palliative care had lower median OS compared to interventional treatments (20 vs. 77 months, p < 0.0001). CONCLUSIONS Recurrence after surgical HCC resection is frequent and negatively impacts OS. Interventional treatments of recurrences offered improved outcomes compared to medical care. In selected patients, RFA, TACE, and repeat hepatectomy allowed similar OS as non-recurrent cases.
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Affiliation(s)
- Gaëtan-Romain Joliat
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pierre Allemann
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Ismail Labgaa
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Joliat GR, Perentes JY, Ris HB, Halkic N. Pulmonary sequestration mimicking a pancreas herniation in a case of recurrent Bochdalek hernia. J Thorac Dis 2017; 9:E14-E16. [PMID: 28203431 DOI: 10.21037/jtd.2017.01.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/06/2022]
Abstract
In the reported scenario, the patient known for a history of operated Bochdalek hernia or congenital diaphragmatic hernia (CDH) presented with new abdominal pain. The CT-scan suspected the presence of pancreas herniation through a recurrent CDH. Intraoperatively, the patient was found to have a recurrent CDH containing greater omentum concomitantly with a pulmonary sequestration (PS). This case report highlights the fact that intraoperative findings can be different from preoperative radiological diagnosis. In this patient the unusual diaphragmatic hernia content was not identified on preoperative CT.
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Affiliation(s)
- Gaëtan-Romain Joliat
- Division of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland; Division of Thoracic Surgery, University Hospital CHUV, Lausanne, Switzerland
| | | | - Hans-Beat Ris
- Division of Thoracic Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - Nermin Halkic
- Division of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
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Joliat GR, Labgaa I, Demartines N, Halkic N. Preoperative albumin level is a marker of alveolar echinococcosis recurrence after hepatectomy. World J Gastroenterol 2017; 23:853-858. [PMID: 28223729 PMCID: PMC5296201 DOI: 10.3748/wjg.v23.i5.853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/30/2016] [Revised: 11/06/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To identify a preoperative blood marker predictive of alveolar echinococcosis (AE) recurrence after hepatectomy.
METHODS All consecutive patients who underwent operation for liver AE at the Lausanne University Hospital (CHUV) between January 1992 and December 2015 were included in this retrospective study. Preoperative laboratory values of leukocytes, mean corpuscular volume (MCV), red blood cell distribution width (RDW), thrombocytes, C-reactive protein (CRP) and albumin were collected and analyzed. Univariate and multivariate Cox regression analyses were performed to determine the risk factors for AE recurrence after liver resection. A receiver operating characteristic (ROC) curve was used to define the best discrimination threshold of the blood marker. Moreover, recurrence-free survival curves were calculated using the Kaplan-Meier method.
RESULTS The cohort included 68 adult patients (37 females) with median age of 61 years [interquartile range (IQR): 46-71]. Eight of the patients (12%) presented a recurrence over a median follow-up time of 76 mo (IQR: 34-128). Median time to recurrence was 10 mo (IQR: 6-11). Median preoperative leukocyte, MCV, RDW, thrombocyte and CRP levels were similar between recurrent and non-recurrent cases. Median preoperative albumin level was 43 g/L (IQR: 41-45) for non-recurrent cases and 36 g/L (IQR: 33-42) for recurrent cases (P = 0.005). The area under the ROC curve for preoperative albumin level to predict recurrence was 0.840 (95%CI: 0.642-1, P = 0.002). The cut-off albumin level value was 37.5 g/L for sensitivity of 94.5% and specificity of 75%. In multivariate analysis, preoperative albumin and surgical resection margins were independent predictors of AE recurrence (HR = 0.099, P = 0.007 and HR = 0.182, P = 0.045 respectively).
CONCLUSION Low preoperative albumin level was associated with AE recurrence in the present cohort. Thus, preoperative albumin may be a useful biomarker to guide follow-up.
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Fournier P, Allemann P, Hubner M, Halkic N, Schäfer M, Demartines N. [Novelties in surgery in 2016]. Rev Med Suisse 2017; 13:33-36. [PMID: 28703532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The year 2016 allowed further implementation of previous years innovations with the PIPAC treatment for peritoneal carcinomatosis, the development of new surgical technologies and procedures and challenging general principles in general and digestive surgery, including cholecystectomy and appendectomy. Prevention, improved general and perioperative care (ERAS program) become an integral part of our standard surgical activity.
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Abstract
Non-invasive ampullary tumors, may be treated with endoscopic (EA) or surgical ampullectomy (SA). However, evidence on the morbidity of these techniques remains limited. This pilot study aimed to assess and compare morbidity of EA and SA. Patients undergoing EA or SA for non-invasive ampullary tumors were retrospectively analyzed and compared. Outcomes were postoperative complications graded with Clavien Classification and Comprehensive Complication Index (CCI), and length of stay (LoS). A review of the literature was performed to propose an evidence-based algorithm to treat ampullary tumors. A total of 11 EA and 19 SA were identified and analyzed. EA was associated with shorter intervention (51 vs. 191 min, p < 0.001) and decreased blood loss (0 vs. 100 mL, p < 0.001). Postoperative complications were more frequent after surgery compared to endoscopy (9% vs. 68%, p = 0.002). Surgical patients showed a higher CCI (0 vs. 8.7, p < 0.001). LoS was reduced in patients undergoing endoscopy (0 vs. 14 days, p < 0.001), with comparable readmissions rates (p = 0.126). Necessity of subsequent treatment was more frequent after endoscopic, compared to SA (5 vs. 1, p = 0.016). EA was associated with lower morbidity than SA and appeared as an appropriate first-line treatment for non-invasive ampullary tumors. SA remains a valuable alternative after EA failure.
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Affiliation(s)
- Margaux Dubois
- Department of Visceral Surgery, Lausanne University Hospital (CHUV)
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Joliat GR, Demartines N, Halkic N, Petermann D, Schäfer M. Short-term outcomes after distal pancreatectomy: Laparotomy vs. laparoscopy - A single-center series. Ann Med Surg (Lond) 2016; 13:1-5. [PMID: 27994871 PMCID: PMC5153441 DOI: 10.1016/j.amsu.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 12/01/2016] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic distal pancreatectomy was introduced 15 years ago, but it is still not widely used. The aim of the study was to compare the postoperative complications and length of stay between open and laparoscopic distal pancreatectomy. Materials and methods A search of our institutional pancreas database was performed. All consecutive distal pancreatectomy patients from 2000 to 2015 were identified. Demographics, peri- and postoperative outcomes were reviewed. Postoperative complications were graded using Clavien classification. Standard statistical analyses were performed. Results One hundred and five patients underwent distal pancreatectomy (45 women, 60 men, median age of 63 years). Seventy-nine cases were performed open and 26 by laparoscopy (conversion rate from laparoscopy to laparotomy: 7/26). Characteristics of both groups were similar. The tumor proportion was similar in both groups (56/79 and 23/26, p = 0.114). Overall complication rate was 41/79 (52%) in the open group and 9/26 (36%) in the laparoscopy group (p = 0.175). Two patients died during hospital stay in the open group compared to 0 in the laparoscopy group (p = 1). The fistula rates were comparable (17/79 and 5/26, p = 1). Median length of stay was shorter for the laparoscopy group (8 vs. 12 days, p < 0.001), as well as the median intermediate care stay (1 vs. 3 days, p = 0.004). Conclusion Short-term outcomes after open and laparoscopic distal pancreatectomy regarding postoperative complications and mortality were similar, but length of stay was significantly shorter for the laparoscopic approach. Hence, laparoscopic distal pancreatectomy should be offered to all suitable patients. Laparoscopy has been recently used more frequently for distal pancreatectomy. Postoperative complications and oncologic outcomes were similar in this study. Length of stay was shorter for the patients operated by laparoscopy. Laparoscopy should be offered when technically feasible.
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Affiliation(s)
| | - Nicolas Demartines
- Corresponding author. Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.Department of Visceral SurgeryUniversity Hospital CHUVRue du Bugnon 46Lausanne1011Switzerland
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Grass F, Cachemaille M, Blanc C, Fournier N, Halkic N, Demartines N, Hübner M. Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy. BMC Surg 2016; 16:78. [PMID: 27905910 PMCID: PMC5131530 DOI: 10.1186/s12893-016-0194-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/05/2016] [Accepted: 11/25/2016] [Indexed: 01/06/2023] Open
Abstract
Background Immediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute cholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored care maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and emergent laparoscopic cholecystectomy. Methods From January 2014 until April 2015, data on pain and nausea management were prospectively recorded for all elective and emergency procedures in the department of visceral surgery. This prospective observational study compared consecutive laparoscopic elective vs. emergency cholecystectomies. Visual analogue scales (VAS) were used to measure pain, nausea, and satisfaction from recovery room until 96 hours postoperatively. Results Final analysis included 168 (79%) elective cholecystectomies and 44 (21%) emergent procedures. Demographics (Age, gender, BMI and ASA-scores) were comparable between the 2 groups. In the emergency group, patients did not receive anxiolytic medication (0% vs.13%, p = 0.009) and less postoperative nausea and vomiting (PONV) prophylaxis (77% vs. 97% p = <0.001). Perioperative pain management was similar in terms of opioid consumption (median amount of fentanyl 450ug [IQR 350-500] vs. 450ug [375-550], p = 0.456) and wound infiltration rates (24% vs. 25%, p = 0.799). Postoperative consumption of paracetamol, metamizole and opiod medications were similar between the 2 groups. VAS scores for pain (p = 0.191) and nausea (p = 0.392) were low for both groups. Patient satisfaction was equally high in both clinical settings (VAS 8.5 ± 1.1 vs. 8.6 ± 1.1, p = 0.68). Conclusions A standardized pathway allows equally successful control of pain and nausea after both elective and emergency laparoscopic cholecystectomy. This study was retrospectively registered by March 01, 2016 in the following trial register: www.researchregistry.com (UIN researchregistry993) Electronic supplementary material The online version of this article (doi:10.1186/s12893-016-0194-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fabian Grass
- Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | | | - Catherine Blanc
- Department of Anaesthesiology, University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas Fournier
- Institute for Social and Preventive Medicine, University Hospital CHUV, Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
| | - Martin Hübner
- Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
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67
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Flattet Y, Yamaguchi T, Andrejevic-Blant S, Halkic N. Pancreatic adenocarcinoma: the impact of preneoplastic lesion pattern on survival. Biosci Trends 2016; 9:402-6. [PMID: 26781798 DOI: 10.5582/bst.2015.01163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pancreatic adenocarcinoma is associated with a very poor prognosis, characterized with a 5-year survival rate of only 5%. Surgery is the only curative treatment for selected patients. Nevertheless, recurrence is very frequent. Identifying prognostic factors is thus warranted. Like numerous other tumors, adenocarcinomas are preceded by preneoplastic lesions. The role and the impact of these lesions remain unclear. This study aimed to assess the impact of the preneoplastic lesion pattern and histo-morphological features, on survival after pancreatic resection. Thirty-five patients who underwent pancreatic resection for pancreatic adenocarcinoma were identified from a prospective database of a single center, between 2003 and 2008. We considered demographics, tumor characteristics and type of treatment. The major outcome was survival. Analyzes were separated into two groups, according to the preneoplastic lesions: Pancreatic intraepithelial neoplasia (PanIN)-related carcinomas and intracanalar papillary mucinous neoplasia (IPMN)-related carcinomas. The former were more frequent, accounting for 63% (22/35). Moreover, they displayed more aggressive features, with a higher tumor stage (p = 0.01) and higher rate of positive lymph nodes (p = 0.019). Lymphatic (p = 0.009) and perinervous (p = 0.019) invasions were also more frequent. Survival was negatively influenced by PanIN preneoplastic lesions (p = 0.015), T3-4 tumor stage (p = 0.038), positive lymph nodes (p = 0.044), lymphatic (p = 0.019) and vascular (p = 0.029) invasions. Pancreatic adenocarcinoma displays different behavior according to its preneoplastic lesion. Indeed, PanIN-related adenocarcinoma showed more aggressive features and lower survival rate. Preneoplastic lesions may represent predictive factors for survival. Their role and predictive value should be investigated more thoroughly.
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Affiliation(s)
- Yves Flattet
- Department of Pathology, University Hospital CHUV
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68
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Tarabay AW, Rocca A, Martin D, Zingg T, Halkic N, Leviver M, Daniel RT. Post-traumatic pancreatico-dural fistula: Case report and management challenges. Trauma Case Rep 2016; 5:7-12. [PMID: 29942848 PMCID: PMC6013006 DOI: 10.1016/j.tcr.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 09/02/2016] [Indexed: 11/29/2022] Open
Abstract
Pancreatic injury can occur following high-energy blunt trauma to the torso. Although several types of pancreatic fistulas have been described in literature, we report to our knowledge, the first case of a pancreatico-dural fistula of traumatic origin. A 20-year-old male sustained a severe blow to the thoraco-abdominal region in the setting of a motorcycle accident. A total body scan revealed an AAST (American Association for the Surgery of Trauma) grade 4 splenic injury. A laparotomy with splenectomy and abdominal packing was performed. This was later followed by thoracolumbar instrumentation for posterior fixation of a T11–T12 transdiscal type C fracture with anterior subluxation of T11, according to the AO classification. Subsequent management was complicated by the persistence of a pseudomeningocele despite multiple surgical drainage procedures and a concomitant increase in retroperitoneal fluid collections. High levels of amylase and lipase in the pseudomeningocele fluid confirmed the presence of a pancreatico-dural fistula, due to a Wirsung duct rupture. This case report illiustrates the challenges in the management of this rare condition.
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Affiliation(s)
- Antonio W Tarabay
- Neurosurgery Division, Neurosciences Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - Alda Rocca
- Neurosurgery Division, Neurosciences Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - David Martin
- Visceral Surgery Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - Tobias Zingg
- Visceral Surgery Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - Nermin Halkic
- Visceral Surgery Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - Marc Leviver
- Neurosurgery Division, Neurosciences Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - Roy T Daniel
- Neurosurgery Division, Neurosciences Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
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Martin D, Uldry E, Demartines N, Halkic N. Bile duct injuries after laparoscopic cholecystectomy: 11-year experience in a tertiary center. Biosci Trends 2016; 10:197-201. [PMID: 27319974 DOI: 10.5582/bst.2016.01065] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Incidence of bile duct injuries (BDI) is low but remains a dramatic complication after laparoscopic cholecystectomy (LC). This study aimed to assess BDI incidence and management strategies. All patients treated in our institution for BDI after LC between 2000 and 2011 were retrospectively analyzed. Patients referred from others centers were excluded. Strasberg classification was used to determine the type of lesion. Thirteen patients presented iatrogenic BDI among 2,840 consecutive cholecystectomies performed (0.46%). Four cases were classified Strasberg type A, 4 type D, and 5 type E. Injury was recognized intraoperatively in 6 cases (46%). Three of these 6 required conversions to open surgery and all but one were primary sutured on a drain; the remaining patient required immediate biliodigestive anastomosis. In 7 patients, the injury was discovered postoperatively (54%). Among them, one was treated by direct closure of a cystic leak through immediate re-laparoscopy. Six underwent initially main bile duct stenting, but 4 required delayed secondary surgery (mean time 115 days), 2 to improve bile duct drainage and 2 for biliodigestive derivation. BDI incidence remains low but management depends on the time of diagnosis. BDI are complex and require tailored treatment usually in a tertiary center for a multidisciplinary approach.
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Affiliation(s)
- David Martin
- Department of Visceral Surgery, University Hospital CHUV
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Martin D, Roulin D, Takamune Y, Demartines N, Halkic N. [Preoperative assessment for extended hepatic resection]. Rev Med Suisse 2016; 12:1180-1184. [PMID: 27487623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The number of major hepatectomy performed for the treatment of primary or secondary liver cancer has increased over the past two decades. By definition, a major hepatectomy includes the resection of at least three liversegments. Advances in anesthesiology, surgical and radiological techniques and perioperative management allowed a broad patient selection with increased security. Every case must be discussed in multidisciplinary tumor board, and preoperative assessment should include biological, volumetric and functional hepatic parameters. In case of preoperative insufficient liver volume, portal vein embolization allows increasing the size of liver remnant. This paper aims describing preoperative work-up.
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Kokudo T, Hasegawa K, Amikura K, Uldry E, Shirata C, Yamaguchi T, Arita J, Kaneko J, Akamatsu N, Sakamoto Y, Takahashi A, Sakamoto H, Makuuchi M, Matsuyama Y, Demartines N, Malago M, Halkic N, Kokudo N. Assessment of preoperative liver function in patients with hepatocellular carcinoma: The albumin-indocyanine green evaluation (ALICE) grade. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.4066] [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: 11/20/2022] Open
Affiliation(s)
- Takashi Kokudo
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Katsumi Amikura
- Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - Emilie Uldry
- Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Chikara Shirata
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takamune Yamaguchi
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Arita
- Hepatobiliary-pancreatic Surgery Division, University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Sakamoto
- Hepato-Biliary-Pancreatic Surgery Division, The University of Tokyo, Tokyo, Japan
| | - Amane Takahashi
- Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - Hirohiko Sakamoto
- Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - Masatoshi Makuuchi
- Department of Hepato-Biliary-Pancreatic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health University of Tokyo, Tokyo, Japan
| | | | - Massimo Malago
- Department of Surgery-UCL Division of Surgical and Interventional Sciences, University College London, London, United Kingdom
| | | | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Pezzetta E, Kokudo T, Uldry E, Yamaguchi T, Kudo H, Ris HB, Christodoulou M, Vuilleumier H, Halkic N. The surgical management of spontaneous esophageal perforation (Boerhaave's syndrome) ‒ 20 years of experience. Biosci Trends 2016; 10:120-4. [PMID: 27052150 DOI: 10.5582/bst.2016.01009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Spontaneous esophageal perforation (Boerhaave's syndrome) is an uncommon and challenging condition with significant morbidity and mortality. Surgical treatment is indicated in the large majority of cases and different procedures have been described in this respect. We present the results of a mono-institutional evaluation of the management of spontaneous esophageal perforation over a 20-year period. The charts of 25 patients with spontaneous esophageal perforation treated at the Surgical Department of the University Hospital of Lausanne were retrospectively studied. In the 25 patients, 24 patients were surgically treated and one was managed with conservative treatment. Primary buttressed esophageal repair was performed in 23 cases. Nine postoperative complications were recorded, and the overall mortality was 32%. Despite prompt treatment postoperative morbidity and mortality are still relevant. Early diagnosis and definitive surgical management are the keys for successful outcome in the management of spontaneous esophageal perforation. Primary suture with buttressing should be considered as the procedure of choice. Conservative approach may be applied in very selected cases.
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73
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Vietti-Violi N, Bize PE, Duran R, Demartines N, Halkic N, Knebel JF, Denys A. Metastasectomy or radiofrequency ablation for treatment for colorectal cancer liver metastasis: Comparison of recurrence rates and identification of risk factors for local recurrence. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
769 Background: Metastasectomy and radiofrequency ablation (RFA) are currently use for treatment of colorectal cancer (CRC) liver metastasis aiming for total tumor ablation with sparing liver parenchyma. Literature is lacking of studies comparing results and risk of recurrence between both techniques. We aim to compare recurrence rate after RFA and metastasectomy for CRC liver metastasis and to define which lesion is the best candidate for each treatment. Methods: By a lesion-by-lesion analysis, we reviewed 121 metastases treated by metastasectomy (43 patients, median follow up 798 days) and 110 metastases treated by RFA (60 patients, median follow up 590 days). Rate of local recurrence (LR) and hepatic recurrence (HR) were compared. We analyzed patients and primary tumor characteristics, looked for predictive factors for recurrence in metastasis data: size, deepness in liver, distance to hepatic veins, pathological resection margins in case of surgery. Analysis were performed using Chi Square and logistic regression in uni and multivariate analysis. Results: Patients and primary tumor characteristics were similar. Metastasis size was larger in metastasectomy group (18mm, range 2-90mm and 15mm, range 3-55mm; p = 0.03). Lesions were located deeper in the liver parenchyma in RFA group (20mm, range 3-51mm and 26mm, range 6-59mm; p < 0.001). Rate of LR and HR were nearly statistically different in favor of RFA: LR was 19% for metastasectomy group and 10% for RFA group (p = 0.06, delay: 245 and 289 days, p = 0.56), HR were 78% for metastasectomy and 66% for RFA (p = 0.054, delay: 226 and 235 days, p = 0.81). Predictive factors for recurrence in metastasectomy group: R1 status (p = 0.03) and metastasis deepness (p = 0.02). Metastasis deepness and proximity to hepatic veins increased risk for R1 (p = 0.04 and p < 0.001 respectively). We found no predictive factor for recurrence in RFA group. Conclusions: Pending proper selection (small lesions visible under imaging guidance), RFA tends to have a lower recurrence rate than metastasectomy. Lesions localized in depth in the liver parenchyma, close to hepatic veins are at risk of LR after metastasectomy.
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Affiliation(s)
| | | | - Rafael Duran
- Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Alban Denys
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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74
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Labgaa I, Uldry E, Doerig C, Schmidt S, Demartines N, Halkic N. Loperamide-induced recurrent acute pancreatitis. Clin Res Hepatol Gastroenterol 2016; 40:e13-4. [PMID: 26184348 DOI: 10.1016/j.clinre.2015.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/04/2015] [Accepted: 06/11/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Ismaïl Labgaa
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
| | - Emilie Uldry
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Christopher Doerig
- Division of Gastroenterology and Hepatology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Radiology and Interventional Radiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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75
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Affiliation(s)
- Takamune Yamaguchi
- Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Takashi Kokudo
- Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Tobias Zingg
- Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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76
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Affiliation(s)
- Ismail Labgaa
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Nathan Huerzeler
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Radiology and Interventional Radiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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77
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Kokudo T, Bonard E, Gillet M, Kokudo N, Halkic N. Reappraisal of shunt surgery for extrahepatic portal vein obstruction in adults: Report of a single-center case series. Hepatol Res 2015; 45:1307-11. [PMID: 25731583 DOI: 10.1111/hepr.12512] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 10/11/2014] [Revised: 02/12/2015] [Accepted: 02/25/2015] [Indexed: 12/15/2022]
Abstract
AIM Extrahepatic portal venous obstruction (EHPVO) is a relatively rare disease in adults. The clinical significance of shunt surgery for EHPVO in adult cases remains unclear. METHODS We retrospectively analyzed the patient characteristics and the results of shunt surgery in 13 adult cases of EHPVO treated between March 1995 and March 2013 at a tertiary care hospital in Switzerland. The indication for shunt surgery was recurrent bleeding after endoscopic treatment. To update the outcomes of shunt surgery in adult cases of EHPVO, we performed a systematic review of published work to examine this issue. RESULTS The mean age of the 13 patients in the present case series was 41.8 years (range, 20-68), and the mean follow-up duration after surgery was 4.4 years (range, 1-16). The types of shunt surgery performed were mesocaval shunt (n = 8), portacaval shunt (n = 2), splenorenal shunt (n = 1) and mesorenal shunt (n = 2). Two patients (15%) developed postoperative rebleeding, which was successfully treated by endoscopic treatment. None of the patients developed postoperative hepatic encephalopathy. No operative-related deaths occurred in this series. Six studies, including our own, were identified in the published work. The overall mortality rate was 0-3.7%, and no cases of encephalopathy were observed. The rebleeding rate ranged 2.5-23%. CONCLUSION Shunt surgery for EHPVO in adults after the failure of endoscopic treatment is feasible, with acceptable outcomes at specialized centers. This surgical procedure should always be taken into consideration when managing adult cases of EHPVO.
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Affiliation(s)
- Takashi Kokudo
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.,Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Estelle Bonard
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Michel Gillet
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland
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78
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Kokudo T, Hasegawa K, Uldry E, Matsuyama Y, Kaneko J, Akamatsu N, Aoki T, Sakamoto Y, Demartines N, Sugawara Y, Kokudo N, Halkic N. A new formula for calculating standard liver volume for living donor liver transplantation without using body weight. J Hepatol 2015; 63:848-54. [PMID: 26057995 DOI: 10.1016/j.jhep.2015.05.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 08/21/2014] [Revised: 04/17/2015] [Accepted: 05/19/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The standard liver volume (SLV) is widely used in liver surgery, especially for living donor liver transplantation (LDLT). All the reported formulas for SLV use body surface area or body weight, which can be influenced strongly by the general condition of the patient. METHODS We analyzed the liver volumes of 180 Japanese donor candidates and 160 Swiss patients with normal livers to develop a new formula. The dataset was randomly divided into two subsets, the test and validation sample, stratified by race. The new formula was validated using 50 LDLT recipients. RESULTS Without using body weight-related variables, age, thoracic width measured using computed tomography, and race independently predicted the total liver volume (TLV). A new formula: 203.3-(3.61×age)+(58.7×thoracic width)-(463.7×race [1=Asian, 0=Caucasian]), most accurately predicted the TLV in the validation dataset as compared with any other formulas. The graft volume for LDLT was correlated with the postoperative prothrombin time, and the graft volume/SLV ratio calculated using the new formula was significantly better correlated with the postoperative prothrombin time than the graft volume/SLV ratio calculated using the other formulas or the graft volume/body weight ratio. CONCLUSIONS The new formula derived using the age, thoracic width and race predicted both the TLV in the healthy patient group and the SLV in LDLT recipients more accurately than any other previously reported formulas.
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Affiliation(s)
- Takashi Kokudo
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Emilie Uldry
- Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yutaka Matsuyama
- Department of Biostatistics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taku Aoki
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Sakamoto
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yasuhiko Sugawara
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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79
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Kokudo T, Uldry E, Demartines N, Halkic N. Risk factors for incisional and organ space surgical site infections after liver resection are different. World J Surg 2015; 39:1185-92. [PMID: 25561190 DOI: 10.1007/s00268-014-2922-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical site infection (SSI) is a common cause of major morbidity after liver resection. This study aimed to identify the risk factors for incisional and organ/space SSIs after liver resection. METHODS Our liver surgery database was retrospectively analyzed for patients treated between January 2009 and November 2012 in a tertiary care Swiss hospital. Univariate and multivariate analyses were conducted on preoperative, intraoperative, and postoperative variables to identify risk factors for incisional and organ/space SSIs. RESULTS In a total of 226 patients, SSI incidences were 12.8 % (incisional), 4.0 % (organ/space), and 1.8 % (both). Univariate analysis showed that incisional SSIs were associated with high American Society of Anesthesiologists (ASA) scores, preoperative anemia, hypoalbuminemia, low prothrombin time, viral or alcoholic chronic hepatitis, liver cirrhosis, and prolonged operation times. Organ/space SSIs were associated with high rates of red blood cell transfusions, concomitant bowel surgery, and prolonged operation times. Multivariate analysis revealed that risk factors for incisional SSIs were anemia [odds ratio (OR) 2.82], high ASA scores (OR 2.88), presence of hepatitis or cirrhosis (OR 5.07), and prolonged operation times (OR 9.61). The only risk factor for organ/space SSIs was concomitant bowel surgery (OR 5.53). Hospital stays were similar in organ/space and incisional SSI groups, but significantly longer for those with both organ/space and incisional SSIs. CONCLUSIONS High ASA scores, anemia, chronic hepatitis or liver cirrhosis, and prolonged operations increased the risk of incisional SSIs; concomitant bowel surgery increased the risk of organ/space SSI. Specific precautions to prevent organ/space and incisional SSIs may shorten hospital stays.
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Affiliation(s)
- Takashi Kokudo
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland,
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80
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Petermann D, Halkic N, Demartines N. [Surgery for pancreatic adenocarcinoma: from established facts to changes in strategy?]. Rev Med Suisse 2015; 11:1335-1338. [PMID: 26255494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pancreatic adenocarcinoma is still an aggressive disease with low survival. Apparently little changes have been made during the last years in the management of this disease, but knowledge and practices are evolving in many fields. Better understanding of the particular biology and genetics of this tumor will probably lead to more efficient targeted therapy. Surgical management with standardized "Enhanced Recovery After Surgery, ERAS" program diminishes postoperative medical morbidity, hospital length of stay and costs. Oncological treatment with more efficient chemotherapy is promising, with the emergence of strategy to perform more neoadjuvant treatments.
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81
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Kokudo T, Petermann D, Demartines N, Halkic N. Laparoscopic Pancreatic Enucleation With End-to-End Pancreatic Duct Reconstruction. Ann Surg Oncol 2015; 22:1190. [PMID: 28084604 DOI: 10.1245/s10434-014-4188-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Laparoscopic enucleation for neuroendocrine pancreatic tumors has become a feasible technique, with a reported incidence of pancreatic fistula ranging from 13 to 29 %.1 - 3 This report describes the first successful case of laparoscopic pancreatic enucleation with resection of the main pancreatic duct followed by end-to-end anastomosis. METHODS A 41-year-old woman was admitted to the authors' hospital for repeated syncope. Hypoglycemia also was noted. A contrast-enhanced computed tomography examination showed a highly enhanced tumor measuring 22 mm in diameter on the ventral side of the pancreatic body adjacent to the main pancreatic duct. The patient's blood insulin level was elevated, and her diagnosis was determined to be pancreatic insulinoma. Laparoscopic pancreatic enucleation was performed. Approximately 2 cm of the main pancreatic duct was segmentally resected, and a short stent (Silicone tube: Silastic, Dow Corning Corporation, Midland, MI) was inserted. The direct anastomosis of the main pancreatic duct was performed using four separate sutures with an absorbable monofilament (6-0 PDS). RESULTS The operation time was 166 min, and the estimated blood loss was 100 mL. The postoperative course was uneventful, and the patient was discharged from hospital on postoperative day 7. The pathologic findings showed a well-differentiated insulinoma and a negative surgical margin. A computed tomography examination performed 1 month after the operation showed a successful anastomosis with a patent main pancreatic duct. CONCLUSIONS Laparoscopic segmental resection of the main pancreatic duct and end-to-end anastomosis can be performed safely with the insertion of a short stent. This technique also can be used for a central pancreatectomy.
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Affiliation(s)
- Takashi Kokudo
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - David Petermann
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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82
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Joliat GR, Melloul E, Djafarrian R, Schmidt S, Fontanella S, Yan P, Demartines N, Halkic N. Cystic lymphangioma of the adrenal gland: report of a case and review of the literature. World J Surg Oncol 2015; 13:58. [PMID: 25889625 PMCID: PMC4335415 DOI: 10.1186/s12957-015-0490-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 01/26/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cystic lymphangioma is a rare tumor of the lymphatic vessels that occurs more frequently in women. Location of this pathology can be diverse but most commonly occurs in the neck or axilla. Cystic lymphangioma originating from the adrenal tissue represents a very rare entity. CASE PRESENTATION We report here the case of a 38-year-old woman who was diagnosed with a cystic retroperitoneal mass. After further investigations, the patient was suspected to have a left adrenal cystic lymphangioma. She underwent successful open left adrenalectomy as curative treatment, and the diagnosis of cystic lymphangioma of the left adrenal gland was confirmed at histology. The postoperative course was uneventful. CONCLUSION This case report and review of the literature bring new insights into the diagnostic difficulty and management of cystic lymphangioma of the adrenal gland.
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Affiliation(s)
- Gaëtan-Romain Joliat
- Division of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Vaud, CH, Switzerland.
| | - Emmanuel Melloul
- Division of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Vaud, CH, Switzerland.
| | - Reza Djafarrian
- Division of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Vaud, CH, Switzerland.
| | - Sabine Schmidt
- Department of Radiology, University Hospital CHUV, Lausanne, Switzerland.
| | - Sara Fontanella
- Department of Pathology, University Hospital CHUV, Lausanne, Switzerland.
| | - Pu Yan
- Department of Pathology, University Hospital CHUV, Lausanne, Switzerland.
| | - Nicolas Demartines
- Division of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Vaud, CH, Switzerland.
| | - Nermin Halkic
- Division of Visceral Surgery, University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Vaud, CH, Switzerland.
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83
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Du Pasquier C, Uldry E, Halkic N, Demartines N, Schäfer M. 372. Reverse treatment for patients with colorectal cancer and synchronous liver metastasis. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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84
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Kokudo T, Uldry E, Degrauwe S, Demartines N, Halkic N. A successful case of right hepatectomy in a patient with von Willebrand disease. Haemophilia 2014; 20:e191-2. [PMID: 24533961 DOI: 10.1111/hae.12378] [Citation(s) in RCA: 3] [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] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
Affiliation(s)
- T Kokudo
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
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85
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Becce F, Pomoni A, Uldry E, Halkic N, Yan P, Meuli R, Schmidt S. Alveolar echinococcosis of the liver: diffusion-weighted MRI findings and potential role in lesion characterisation. Eur J Radiol 2014; 83:625-31. [PMID: 24457140 DOI: 10.1016/j.ejrad.2013.12.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 10/31/2013] [Revised: 12/23/2013] [Accepted: 12/27/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To report the diffusion-weighted MRI findings in alveolar echinococcosis (AE) of the liver and evaluate the potential role of apparent diffusion coefficients (ADCs) in the characterisation of lesions. MATERIALS AND METHODS We retrospectively included 22 patients with 63 AE liver lesions (≥1 cm), examined with 3-T liver MRI, including a free-breathing diffusion-weighted single-shot echo-planar imaging sequence (b-values=50, 300 and 600 s/mm(2)). Two radiologists jointly assessed the following lesion features: size, location, presence of cystic and/or solid components (according to Kodama's classification system), relative contrast enhancement, and calcifications (on CT). The ADC(total), ADC(min) and ADC(max) were measured in each lesion and the surrounding liver parenchyma. RESULTS Three type 1, 19 type 2, 17 type 3, three type 4 and 21 type 5 lesions were identified. The mean (±SD) ADC(total), ADC(min) and ADC(max) for all lesions were 1.73 ± 0.50, 0.76 ± 0.38 and 2.63 ± 0.76 × 10(-3)mm(2)/s, respectively. The mean ADC(total) for type 1, type 2, type 3, type 4 and type 5 lesions were 1.97 ± 1.01, 1.76 ± 0.53, 1.73 ± 0.41, 1.15 ± 0.42 and 1.76 ± 0.44 × 10(-3)mm(2)/s, respectively. No significant differences were found between the five lesion types, except for type 4 (p=0.0363). There was a significant correlation between the presence of a solid component and low ADCmin (r=0.39, p=0.0016), whereas an inverse correlation was found between the relative contrast enhancement and ADCtotal (r=-0.34, p=0.0072). CONCLUSION The ADCs of AE lesions are relatively low compared to other cystic liver lesions, which may help in the differential diagnosis. Although ADCs are of little use to distinguish between the five lesion types, their low value reflects the underlying solid component.
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Affiliation(s)
- Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Anastasia Pomoni
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Emilie Uldry
- Department of Visceral Surgery, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Pu Yan
- University Institute of Pathology, Lausanne University Hospital, Rue du Bugnon 25, 1011 Lausanne, Switzerland
| | - Reto Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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86
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Kokudo T, Uldry E, Halkic N. An uncommon cause of right hepatic duct stenosis. Gastroenterology 2013; 145:1208, 1502. [PMID: 24409487 DOI: 10.1053/j.gastro.2013.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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87
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Venara A, Pittet O, Lu TL, Demartines N, Halkic N. Aberrant right hepatic artery with a prepancreatic course visualized prior to pancreaticoduodenectomy. J Gastrointest Surg 2013; 17:1024-6. [PMID: 23288717 DOI: 10.1007/s11605-012-2127-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 10/31/2012] [Accepted: 12/10/2012] [Indexed: 01/31/2023]
Abstract
Liver vascularization is known to present with several different variations. Generally, a normal vascular anatomy is reported in up to 50-80 % of cases. For this reason, a precise preoperative mapping of the hepatic vascularization prior to pancreatic surgery is essential to avoid injuries and subsequent complications. We report here a case of a young patient scheduled for Whipple procedure, who presented an arterial pattern type Michels IV, variation reported in 0.6 to 3 % in the literature. Another interesting particularity of this case was the fact that the right hepatic artery had a prepancreatic course. We think that every surgeon performing hepatopancreatic surgery should have heard of this special and rare situation.
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Affiliation(s)
- A Venara
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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88
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Guiu B, Bize P, Gunthern D, Demartines N, Halkic N, Denys A. Portal Vein Embolization before Right Hepatectomy: Improved Results Using n-Butyl-Cyanoacrylate Compared to Microparticles Plus Coils. Cardiovasc Intervent Radiol 2013; 36:1306-12. [DOI: 10.1007/s00270-013-0565-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 12/26/2012] [Indexed: 01/13/2023]
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89
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Melloul E, Halkic N, Raptis DA, Tempia A, Demartines N. Right Hepatectomy in Patients over 70 Years of Age: An Analysis of Liver Function and Outcome. World J Surg 2012; 36:2161-70. [DOI: 10.1007/s00268-012-1621-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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90
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Labgaa I, Pasche O, Halkic N, Cornuz J. [Hiking and useful advices to patients: part II]. Rev Med Suisse 2011; 7:2356-2361. [PMID: 22232858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The attraction of walking as a pastime has grown enormously in Switzerland over the past few years. Synonym of health and wellbeing, this activity carries some risks which more and more patients are questioning; answering these questions is not always obvious, so we wanted to tackle the subject. This second section concerns risks linked to food which can be found in the forest. Echinococcosis is an underestimated parasite which affects a large proportion of foxes in Switzerland. This infectious disease can also affect man following contamination which usually occurs through eating berries. Prevention is the most effective way to avoid poisoning by mushrooms. In case of poisoning, the physician must try and determine the toxidrome. The key element is the length of time before symptoms develop. Treatment is always symptomatic, using activated charcoal.
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91
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Pache I, Bize P, Halkic N, Montemurro M, Giostra E, Majno P, Moradpour D. [Management of hepatocellular carcinoma]. Rev Med Suisse 2010; 6:198-202. [PMID: 20214192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors worldwide and its incidence has increased over the last years in most developed countries. The majority of HCCs occur in the context of liver cirrhosis. Therefore, patients with cirrhosis and those with hepatitis B virus infection should enter a surveillance program. Detection of a focal liver lesion by ultrasound should be followed by further investigations to confirm the diagnosis and to permit staging. A number of curative and palliative treatment options are available today. The choice of treatment will depend on the tumor stage, liver function and the presence of portal hypertension as well as the general condition of the patient. A multidisciplinary approach is mandatory to offer to each patient the best treatment.
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Affiliation(s)
- I Pache
- Service de gastro-entérologie et d'hépatologie, CHUV, Lausanne.
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92
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Zingg T, Halkic N, Givel JC, Demartines N. [The management of an incidental liver lesion]. Rev Med Suisse 2009; 5:1408-1411. [PMID: 19715016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The widespread use of abdominal imaging technologies has led to an increase in the incidental finding of liver tumors. Most of these lesions are asymptomatic and will not require any treatment. With the use of contrast-enhanced radiological studies, most of the tumors can be reliably diagnosed by non-invasive means. In case of diagnostic uncertainty, patients should not undergo percutaneous biopsy but rather complete resection of the lesion for an unequivocal diagnosis. Such pathologies must be taken charge of in centers with expertise by interdisciplinary teams.
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Affiliation(s)
- T Zingg
- Service de chirurgie viscérale, CHUV, 1011 Lausanne.
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93
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Bricard G, Cesson V, Devevre E, Bouzourene H, Barbey C, Rufer N, Im JS, Alves PM, Martinet O, Halkic N, Cerottini JC, Romero P, Porcelli SA, Macdonald HR, Speiser DE. Enrichment of human CD4+ V(alpha)24/Vbeta11 invariant NKT cells in intrahepatic malignant tumors. J Immunol 2009; 182:5140-51. [PMID: 19342695 DOI: 10.4049/jimmunol.0711086] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Invariant NKT cells (iNKT cells) recognize glycolipid Ags via an invariant TCR alpha-chain and play a central role in various immune responses. Although human CD4(+) and CD4(-) iNKT cell subsets both produce Th1 cytokines, the CD4(+) subset displays an enhanced ability to secrete Th2 cytokines and shows regulatory activity. We performed an ex vivo analysis of blood, liver, and tumor iNKT cells from patients with hepatocellular carcinoma and metastases from uveal melanoma or colon carcinoma. Frequencies of Valpha24/Vbeta11 iNKT cells were increased in tumors, especially in patients with hepatocellular carcinoma. The proportions of CD4(+), double negative, and CD8alpha(+) iNKT cell subsets in the blood of patients were similar to those of healthy donors. However, we consistently found that the proportion of CD4(+) iNKT cells increased gradually from blood to liver to tumor. Furthermore, CD4(+) iNKT cell clones generated from healthy donors were functionally distinct from their CD4(-) counterparts, exhibiting higher Th2 cytokine production and lower cytolytic activity. Thus, in the tumor microenvironment the iNKT cell repertoire is modified by the enrichment of CD4(+) iNKT cells, a subset able to generate Th2 cytokines that can inhibit the expansion of tumor Ag-specific CD8(+) T cells. Because CD4(+) iNKT cells appear inefficient in tumor defense and may even favor tumor growth and recurrence, novel iNKT-targeted therapies should restore CD4(-) iNKT cells at the tumor site and specifically induce Th1 cytokine production from all iNKT cell subsets.
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Affiliation(s)
- Gabriel Bricard
- Division of Clinical Onco-Immunology, Ludwig Institute for Cancer Research, Lausanne Branch, Lausanne, Switzerland
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94
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Cerantola Y, Christoforidis D, Halkic N, Matter M, Romy S, Suter M, Tempia-Caliera A, Demartines N, Givel JC. [Trends in surgery]. Rev Med Suisse 2009; 5:210-214. [PMID: 19271432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
More than the number of real novelties, trends and preliminary results characterise the annual development in surgery. The wealth and diversity of topics to be covered require arbitrary choices, therefore not necessarily complete. The constant development of choledocolithiasis management, dominated by minimal invasive technology, treatments of unusual nature of two frequent proctological conditions, fistulae and haemorrhoids, the increasing importance of metabolic bariatric surgery, as well as the strict rules of effective melanoma treatment, represent as many directions in which the operating procedure, although unseen, continue to gain quality and security.
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Affiliation(s)
- Y Cerantola
- Service de chirurgie viscérale, CHUV, 1011 Lausanne
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95
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Petermann D, Ksontini R, Halkic N, Demartines N. [Pancreaticoduodenectomy: indications, results and management of complications]. Rev Med Suisse 2008; 4:1563-1566. [PMID: 18672546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pancreaticoduodenectomy is a major procedure in visceral surgery. Post-operative mortality is around 5% in high-volume hospitals, thanks to improvement in global patients care. Morbidity remains high though. The treatment of complications most often require a multidisciplinary approach. Delayed gastric emptying, intraabdominal abscesses and pancreatic fistulas are the most frequent complications. Post-pancreatectomy hemorrhage, although more rare, is a severe and dreadful event. Despite its morbidity, duodenopancreatectomy significantly improves survival of patients with biliopancreatic cancer. Early recognition of these complications and a prompt treatment increase the safety of this procedure.
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Affiliation(s)
- D Petermann
- Service de chirurgie viscérale, CHUV, 1011 Lausanne.
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96
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Montemurro M, Achtari L, Röth A, Halkic N, Luthi F, Ozsahin M, Denys A, Bauer J, Demartines N, Leyvraz S. [Systemic treatment of metastatic colorectal cancer]. Rev Med Suisse 2008; 4:1254-1257. [PMID: 18616207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Colorectal cancer is the 2nd cause of cancer related death in industrialised countries. 20% of all patients present with metastatic disease at diagnosis and need systemic treatment. Since the introduction of irinotecan and oxaliplatin as part of standard chemotherapy, and recently the new targeted agents bevacizumab, cetuximab and panitumumab, the overall survival for patients suffering from metastatic colorectal cancer (mCRC) has increased significantly and nearly reaches 2 years nowadays. Surgery or radiofrequency ablation has become central in the care of metastatic disease. This article resumes recent therapeutic advances in the field and emphasizes the multidisciplinary concertation between specialists to obtain the best outcome.
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Affiliation(s)
- M Montemurro
- Centre pluridisciplinaire d'oncologie, CHUV, Lausanne.
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97
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Guex E, Cheseaux M, Bertrand PC, Piquet MA, Bouvry S, Pilon N, Halkic N, Pascual M, Roulet M. [Prevalence of undernutrition in 143 patients before liver transplantation. The Lausanne experience between 1997 and 2005]. Rev Med Suisse 2008; 4:927-930. [PMID: 18578434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The prevalence of undernutrition was prospectively studied in 143 patients before liver transplantation between 1997 and 2005. Nutritional assessment is a particularly tricky problem in cirrhosis and mid-arm muscle circumference is considered as the best reliable anthropometric tool. In this prospective study, prevalence rate is very high (61%) and undernutrition is more frequent in alcoholic cirrhotic patients. In conclusion, these patients should benefit from an early dietician intervention before liver transplantation.
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Affiliation(s)
- E Guex
- Unité de nutrition clinique, CHUV, 1011 Lausanne.
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98
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Richert L, Tuschl G, Viollon-Abadie C, Blanchard N, Bonet A, Heyd B, Halkic N, Wimmer E, Dolgos H, Mueller SO. Species Differences in the Response of Liver Drug-Metabolizing Enzymes to (S)-4-O-Tolylsulfanyl-2-(4-trifluormethyl-phenoxy)-butyric Acid (EMD 392949) in Vivo and in Vitro. Drug Metab Dispos 2008; 36:702-14. [DOI: 10.1124/dmd.107.018358] [Citation(s) in RCA: 22] [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: 11/22/2022] Open
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99
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100
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Prot T, Halkic N, Demartines N. [Surgical managment of colorectal liver metastasis]. Rev Med Suisse 2007; 3:1638-42. [PMID: 17708232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Surgery offer the only curative treatment for colorectal hepatic metastasis. Nowadays, five-year survival increases up to 58% in selected cases, due to the improvement and combination of chemotherapy, surgery and ablative treatment like embolisation, radio-frequency or cryoablation. Surgery should be integrated in a multi disciplinary approach and initial work-up must take in account patient general conditions, tumor location, and possible extra hepatic extension. Thus, a surgical resection may be performed immediately or after preparation with chemotherapy or selective portal embolization. Management of liver metastasis should be carried out in oncological hepato-biliary centre.
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Affiliation(s)
- Thomas Prot
- Service de chirurgie viscérale, CHUV, 1005 Lausanne.
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