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Voron T, Karoui M, Lo Dico R, Malicot KL, Espin E, Cianchi F, Jürgen W, Buggenhout A, Bruzzi M, Denimal F, Cazelles A, Douard R, Lepage C, Taieb J. Impact of laparoscopy on oncological outcomes after colectomy for stage III colon cancer: A post-hoc multivariate analysis from PETACC8 European randomized clinical trial. Dig Liver Dis 2021; 53:1034-1040. [PMID: 34112615 DOI: 10.1016/j.dld.2021.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/20/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND In colon cancer (CC), surgery remains the mainstay of treatment with curative intent. Despite several clinical trials comparing open and laparoscopic approaches, data on long-term outcomes for stage III CC are lacking. METHODS This post-hoc analysis of the European PETACC8 randomized phase 3 trial included patients from 340 sites between December 2005 and November 2009, with long follow-up (median 7.56 years). Patients were randomly assigned to FOLFOX or FOLFOX+cetuximab after colonic resection. The surgical approach was left to the referring surgeon's discretion. RESULTS Among 2555 patients included, 1796 (70.29%) were operated on by open surgery and 759 (29.71%) by laparoscopy. The 5-year OS rate was better after laparoscopic resection (85.4%, 95%CI 82.5-87.7) than after open surgery (80.2%, 95%CI 78.2-82.0; p = 0.002). The 5-year DFS rate was also better after laparoscopy (p = 0.016). However, in multivariate analysis using a propensity matching, the surgical approach was not found to be an independent prognostic factor for OS or DFS. OS (p = 0.0243) and DFS (p = 0.035) were increased after laparoscopic surgery in KRAS/BRAF WT sub-group CONCLUSION: We showed that laparoscopic resection has comparable long-term outcomes to open surgery in patients with stage III CC. For those with RAS and BRAF WT CC, laparoscopic colectomy may favorably impact survival.
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Affiliation(s)
- Thibault Voron
- Sorbonne Université, Department of Digestive and General Surgery, Saint Antoine Hospital, Paris, France
| | - Mehdi Karoui
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France.
| | - Réa Lo Dico
- Université de Paris, Department of Digestive Surgery, Saint Louis Hospital, AP-HP, Paris, France
| | - Karine Le Malicot
- Fédération Francophone de Cancérologie Digestive, Faculty of Medecine, Dijon, France; EPICAD INSERM UMR LNC 1231, University of Burgundy Franche Comté, Dijon France
| | - Eloy Espin
- Department of General Surgery, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Weitz Jürgen
- Department of Visceral, Thoracic and Vascular surgery, University Hospital Carl Gustav Carus of the Technical University Dresden, Germany
| | - Alexis Buggenhout
- Department of surgical gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Matthieu Bruzzi
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Fabrice Denimal
- Department of Digestive Surgery, Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | - Antoine Cazelles
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Richard Douard
- Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Come Lepage
- EPICAD INSERM UMR LNC 1231, University of Burgundy Franche Comté, Dijon France; HepatoGastroenterology and Digestive oncology department, University hospital Dijon, University of Burgundy and Franche Comté, FFCD, EPICAD INSERM LNC-UMR 1231, Dijon, France
| | - Julien Taieb
- Université de Paris, Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
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Bregni G, Trevisi E, Senti C, Pretta A, Vandeputte C, Kehagias P, Reina EA, Deleporte A, Gkolfakis P, Van Laethem JL, Vergauwe P, Van den Eynde M, Deboever G, Janssens J, Demolin G, Holbrechts S, Clausse M, De Grez T, Peeters M, D'Hondt L, Geboes K, Besse-Hammer T, Buggenhout A, Rothé F, Flamen P, Hendlisz A, Sclafani F. Abstract 28: Prognostic value of baseline and early changes of circulating cell-free (cf)DNA in the neoadjuvant setting of early stage colon cancer (CC). Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-28] [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: 11/16/2022]
Abstract
Abstract
Introduction Circulating tumour (ct)DNA is an indicator of minimal residual disease and negative prognostic factor in stage II-III CC treated with surgery +/- adjuvant chemotherapy. No study, however, has ever analysed the prognostic value of this biomarker in CC patients (pts) treated with neoadjuvant chemotherapy. We sought to evaluate the prognostic value of baseline and early, on-treatment changes of cfDNA and ctDNA in stage II-III CC pts who were treated with one cycle of neoadjuvant FOLFOX chemotherapy followed by surgery +/- adjuvant FOLFOX chemotherapy in the PePiTA trial.
Methods PePITA was a multicentre, single-arm, prospective phase II trial aiming to test in vivo tumour chemosensitivity as assessd by metabolic response using 18F-FDG PET/CT scan of early stage CC and to evaluate its association with survival outcome (NCT00994864). Plasma samples were prospectively collected at baseline and 2 weeks (ie, after one cycle of neoadjuvant FOLFOX chemotherapy). cfDNA was isolated with the QIAmp circulating nucleic acid kit (Qiagen), and quantified with the Qubit fluorometer (Life-Technologies). cfDNA samples were bisulfite converted using the EZ DNA Methylation-Gold™ Kit (Zymo Research), with NPY and WIF1 being selected as universal methylation markers for ctDNA and analysed with digital droplet (dd)PCR technology. Data from ddPCR were processed with the QuantaSoft V1.6 software (BioRad). The primary outcome measure was 3-year disease-free survival (DFS). Receiver operating characteristics curve analyses, Kaplan-Meier method, cox proportional hazards models and log-rank tests were used. Statistical analyses were carried out with the SPSS for MacOS version 25.0 (SPSS Inc).
Results 80 pts were included (ypStage I-II 56%, ypStage III 44%). After a median follow-up of 52.5 months, 3-year DFS was 80% (95%CI 71.2-90.8) and 5-year OS 84% (95%CI 75.2-94.9). Pts with high (≥1.2 ng/µl) baseline cfDNA level had worse 3-year DFS (48% vs 80%; HR 2.72, 95%CI 1.02-7.25; p=0.036) and 5-year OS (71% vs 90%; HR 5.36, 95%CI 1.14-25.28; p=0.017) than those with low baseline cfDNA level. In a multivariable analysis (including sex, ypStage and CEA), baseline cfDNA was the only factor showing a trend towards statistical significance (HR DFS 2.6, 95%CI 0.96-7.01; p=0.059; HR OS 4.65, 95%CI 0.97-22.32; p=0.055). Early changes of cfDNA (Δ ≥11%) after one cycle of neoadjuvant FOLFOX chemotherapy failed to predict survival (HR DFS 1.08, 95%CI 0.42-2.81; p=0.873; HR OS 0.68, 95%CI 0.19-2.39; p=0.543). ctDNA analyses are ongoing and will be presented at the meeting.
Conclusions For the first time, we have shown that baseline cfDNA may predict survival outcome in early stage CC pts treated with neoadjuvant chemotherapy. Pending confirmation in larger series, testing for cfDNA at baseline could help select high-risk pts who may benefit from neoadjuvant, FOXTROT-like, treatment strategies.
Citation Format: Giacomo Bregni, Elena Trevisi, Chiara Senti, Andrea Pretta, Caroline Vandeputte, Pashalina Kehagias, Elena Acedo Reina, Amélie Deleporte, Paraskevas Gkolfakis, Jean-Luc Van Laethem, Philippe Vergauwe, Marc Van den Eynde, Guido Deboever, Jos Janssens, Gauthier Demolin, Stephane Holbrechts, Marylene Clausse, Thierry De Grez, Marc Peeters, Lionel D'Hondt, Karen Geboes, Tatiana Besse-Hammer, Alexis Buggenhout, Françoise Rothé, Patrick Flamen, Alain Hendlisz, Francesco Sclafani. Prognostic value of baseline and early changes of circulating cell-free (cf)DNA in the neoadjuvant setting of early stage colon cancer (CC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 28.
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Affiliation(s)
- Giacomo Bregni
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Elena Trevisi
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Chiara Senti
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Andrea Pretta
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Caroline Vandeputte
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pashalina Kehagias
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Elena Acedo Reina
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Amélie Deleporte
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alexis Buggenhout
- 2Hôpital Erasme - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Françoise Rothé
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Flamen
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alain Hendlisz
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Francesco Sclafani
- 1Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
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Bruzzi M, Auclin E, Lo Dico R, Voron T, Karoui M, Espin E, Cianchi F, Weitz J, Buggenhout A, Malafosse R, Denimal F, Le Malicot K, Vernerey D, Douard R, Emile JF, Lepage C, Laurent-Puig P, Taieb J. Influence of Molecular Status on Recurrence Site in Patients Treated for a Stage III Colon Cancer: a Post Hoc Analysis of the PETACC-8 Trial. Ann Surg Oncol 2019; 26:3561-3567. [PMID: 31209667 DOI: 10.1245/s10434-019-07513-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recurrence patterns in stage III colon cancer (CC) patients according to molecular markers remain unclear. The objective of the study was to assess recurrence patterns according to microsatellite instability (MSI), RAS and BRAFV600E status in stage III CC patients. METHODS All stage III CC patients from the PETACC-8 randomized trial tested for MSI, RAS and BRAFV600E status were included. The site and characteristics of recurrence were analyzed according to molecular status. Survival after recurrence (SAR) was analyzed. RESULTS A total of 1650 patients were included. Recurrence occurred in 434 patients (26.3%). Microsatellite stable (MSS) patients had a significantly higher recurrence rate (27.2% vs. 18.7%, P = 0.02) with a trend to more pulmonary recurrence (28.8% vs. 12.9%, P = 0.06) when compared to MSI patients. MSI patients experienced more regional lymph nodes compared to MSS (12.9% vs. 4%, P = 0.046). In the MSS population, the recurrence rate was significantly higher in RAS (32.2%) or BRAF (32.3%) patients when compared to double wild-type patients (19.9%) (p < 0.001); no preferential site of recurrence was observed according to RAS and BRAFV600E mutations. Finally, decreased SAR was observed in the case of peritoneal recurrence or more than two recurrence sites. CONCLUSIONS Microsatellite, RAS and BRAFV600E status influences recurrence rates in stage III CC patients. However, only microsatellite status seems to be associated with specific recurrence patterns. More than two recurrence sites and recurrence in the peritoneum were associated with poorer SAR.
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Affiliation(s)
- M Bruzzi
- Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France.
| | - E Auclin
- Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France.,Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital of Besançon, Besançon, France
| | - R Lo Dico
- Department of Digestive and Oncological Surgery, Lariboisière Hospital, AP-HP, Paris, France
| | - T Voron
- Department of Digestive and General Surgery, Saint Antoine Hospital, AP-HP, Sorbonne Université, Paris, France
| | - M Karoui
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié-Salpêtrière University Hospital, AP-HP, Paris VI University Institute of Cancerology, Paris, France
| | - E Espin
- Department of General Surgery, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - F Cianchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - J Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus of the Technical University Dresden, Dresden, Germany
| | - A Buggenhout
- Department of Surgical Gastroenterology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - R Malafosse
- Department of Digestive Surgery, Ambroise-Paré Hospital, AP-HP, Boulogne, France
| | - F Denimal
- Department of Digestive Surgery, Centre Hospitalier Départemental Vendée, La Roche Sur Yon, France
| | - K Le Malicot
- Statistical Department, Fédération Francophone de Cancérologie Digestive, EPICAD, INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, Dijon, France
| | - D Vernerey
- Methodological and Quality of Life in Oncology Unit, EA 3181, University Hospital of Besançon, Besançon, France
| | - R Douard
- Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - J F Emile
- Pathology Department, Ambroise-Paré Hospital, AP-HP, Boulogne, France
| | - C Lepage
- Hepato-Gastroenterology Department, Dijon University Hospital and EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - P Laurent-Puig
- Department of Biology, European Georges Pompidou Hospital, AP-HP, INSERM-UMR-S1147, Paris, France
| | - J Taieb
- Department of Digestive Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
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Hendlisz A, Caparica R, Deleporte A, Van Laethem JL, Vergauwe P, Van Den Eynde M, Deboever G, Janssens J, Demolin G, Holbrechts S, Clausse M, De Grez T, Vermeij J, D'Hondt LA, Geboes KP, Besse-Hammer T, Buggenhout A, Paesmans M, Piccart M, Flamen P. Preoperative chemosensitivity testing as predictor of treatment benefit in adjuvant stage III colon cancer: Preliminary analysis of the PePiTA study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3610 Background: Although being the standard-of-care for stage III colon cancer, no biomarkers can identify patients (pts) who benefit from adjuvant chemotherapy. In metastatic pts, the lack of metabolic response (mR) in FDG-PET/CT after 1 chemotherapy cycle predicts the absence of treatment benefit. The PePiTA study aims to evaluate if the absence of mR after 1 cycle of pre-operative chemotherapy is predictive of recurrence in non-metastatic colon cancer pts. Herein, we report a preliminary analysis on surgical outcomes, adverse events and mR assessment after 1 cycle of pre-operative chemotherapy after completing the study accrual objective. Methods: Colon cancer pts eligible for curative resection and ECOG ≤1 received 1 cycle of mFOLFOX followed by surgery in this prospective, multicentre, non-randomized trial. FDG-PET/CT was performed at baseline and after 1 cycle of mFOLFOX. Adjuvant mFOLFOX was administered for up to 12 cycles for stage III pts, whereas for stage II pts the decision to pursue adjuvant chemotherapy was at investigator’s discretion. A decrease ≥15% in SUVmax after 1 cycle of chemotherapy was defined as mR (EORTC criteria) at central review. Results: mR was assessable on the primary tumor in 204/240 pts (85%). In 11 pts (4.6%), staging was modified by the baseline FDG-PET/CT, which detected metastatic disease or other tumors. Pre-operative mFOLFOX was administered to 218 pts, of which 14 (6%) had a grade ≥3 adverse event. Surgery was performed in 218 pts, with a median delay of 20 days (6 to 59) after chemotherapy. Surgical complications occurred in 28 (13%) pts, however no deaths occurred. The median SUVmax decrease between baseline and 2nd FDG-PET/CT was 24%. A mR was observed in 65.2% of the pts, whereas 34.8% showed no mR, including 3% who had progressive disease. Conclusions: One cycle of pre-operative mFOLFOX followed by a mR assessment has shown to be a feasible and safe strategy, raising interest on the potential of neoadjuvant chemotherapy in colon cancer. The early mR assessment identified pts that may not benefit from chemotherapy and might have a worse prognosis. The substantiation of this hypothesis is expected with the study’s long-term results. Clinical trial information: NCT00994864.
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Affiliation(s)
- Alain Hendlisz
- Medical Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | | | | | - Marc Van Den Eynde
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | | | | | | | - Stephane Holbrechts
- Service of Medical Oncology, Centre Hospitalier Universitaire Ambroise Paré, Mons, Belgium
| | | | | | | | | | | | | | | | - Marianne Paesmans
- Data Centre, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
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Joosten A, Hafiane R, Pustetto M, Van Obbergh L, Quackels T, Buggenhout A, Vincent JL, Ickx B, Rinehart J. Practical impact of a decision support for goal-directed fluid therapy on protocol adherence: a clinical implementation study in patients undergoing major abdominal surgery. J Clin Monit Comput 2018; 33:15-24. [PMID: 29779129 DOI: 10.1007/s10877-018-0156-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/15/2018] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to assess the effects of using a real time clinical decision-support system, "Assisted Fluid Management" (AFM), to guide goal-directed fluid therapy (GDFT) during major abdominal surgery. We compared a group of patients managed using the AFM system with a historical cohort of patients (control group) who had been managed using a manual GDFT strategy. Adherence to the protocol was defined as the relative intraoperative time spent with a stroke volume variation (SVV) < 13%. We hypothesised that patients in the AFM group would have more time during surgery with a SVV < 13% compared to the control group. All patients had a radial arterial line connected to a pulse contour analysis monitor and received a 2 ml/kg/h maintenance crystalloid infusion. Additional 250 ml crystalloid boluses were administered whenever measured SVV ≥ 13% in the control group, and when the software suggested a fluid bolus in the AFM group. We compared 46 AFM-guided patients to 38 controls. Patients in the AFM group spent significantly more time during surgery with a SVV < 13% compared to the control group (median 92% [82, 96] vs. 76% [54, 86]; P < 0.0005), and received less fluid overall (1775 ml [1225, 2425] vs. 2350 ml [1825, 3250]; P = 0.010). The incidence of postoperative complications was comparable in the two groups. Implementation of a decision support system for GDFT guidance resulted in a significantly longer period during surgery with a SVV < 13% with a reduced total amount of fluid administered. Trial registration: Clinical Trials.gov (NCT03141411).
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Affiliation(s)
- Alexandre Joosten
- Department of Anesthesiology, CUB Erasme, Hopital ERASME, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium.
| | - Reda Hafiane
- Department of Anesthesiology, CUB Erasme, Hopital ERASME, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Marco Pustetto
- Department of Anesthesiology, CUB Erasme, Hopital ERASME, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Luc Van Obbergh
- Department of Anesthesiology, CUB Erasme, Hopital ERASME, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Thierry Quackels
- Department of Urology, CUB Erasme, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Alexis Buggenhout
- Department of Colorectal Surgery, CUB Erasme, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, CUB Erasme, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Brigitte Ickx
- Department of Anesthesiology, CUB Erasme, Hopital ERASME, Université Libre de Bruxelles, 808, route de Lennik, 1070, Brussels, Belgium
| | - Joseph Rinehart
- Department of Anesthesiology & Perioperative Care, University of California Irvine, 101 the City Drive South, Orange, CA, USA
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Anaf V, Gocevska S, Lemoine O, El Nakadi I, Buggenhout A, Zalcman M, Noël JC. The Problem of Anastomotic Stricture After Rectosigmoid Resection in Deep Infiltrating Endometriosis. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2015.0061] [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: 11/13/2022] Open
Affiliation(s)
- Vincent Anaf
- Department of Gynecology, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sashka Gocevska
- Department of Gynecology, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Lemoine
- Department of Gastroenterology, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Issam El Nakadi
- Department of Digestive Surgery, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexis Buggenhout
- Department of Digestive Surgery, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Zalcman
- Department of Radiology, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Christophe Noël
- Department of Pathology, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Farinella E, Buggenhout A, Van de Stadt J. Modified H-pouch as an alternative to the J-pouch for anorectal reconstruction. Colorectal Dis 2014; 16:O332-4. [PMID: 24980779 DOI: 10.1111/codi.12701] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 04/06/2014] [Indexed: 02/08/2023]
Abstract
AIM A modification is described of the J-pouch to facilitate ileoanal anastomosis in the presence of an anal or anovaginal fistula. METHOD The bowel is divided at the level of the apex of the J-pouch, the distal limb is advanced to project beyond the proximal limb by 3-5 cm. The pouch is constructed by a side-to-side anastomosis to form the H-pouch with a distal ileal segment, which is passed through the anal canal to form an ileoanal anastomosis. RESULTS The modification allows the treatment of anal and rectal disorders not resolvable by a usual J-pouch construction, as in cases where a rectal resection is needed for concomitant fistulation or destruction of the anal mucosa. The functional results are similar to those of the J-pouch, with no added postoperative morbidity. This technique helps to avoid permanent stoma in selected cases. CONCLUSION The modified pouch is relatively simple to perform and can help the surgeon to address complex anorectal disorders.
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Affiliation(s)
- E Farinella
- Clinic of Colorectal Surgery, Department of Digestive Surgery, ULB-Hopital Erasme, Brussels, Belgium
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Hendlisz A, Deleporte A, Van Laethem JL, Vergauwe P, Van Den Eynde M, Deboever G, Janssens J, Demolin G, Holbrechts S, Clausse M, Vermeij J, D'Hondt LA, Laurent S, Efira A, Gomez Galdon M, Buggenhout A, Paesmans M, Garcia C, Piccart-Gebhart MJ, Flamen P. Preoperative (preop) chemosensitivity testing as predictor of treatment benefit in adjuvant stage III colon cancer (CC): Interim analysis of the PEPITA study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.385] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
385 Background: Adjuvant chemotherapy (CT) improves stage III CC outcome but is not effective for all patients (pts). PePiTA’s main hypothesis is that absence of metabolic response (MR) of the primary tumor after 1 preop CT course predicts absence of benefit from adjuvant CT (at 3-year DFS). This strategy's aim is to spare pts from useless toxicities, improve healthcare resource allocation, and guide translational research. This interim analysis was performed for safety and feasibility of MR assessment (MRA). Methods: Pts ≥ 18 years, with PS ≤ 1, diagnosed with CC considered for curative resection are eligible, after signed consent. Baseline PET is repeated after 1 CT cycle, followed by surgery. PET quality insurance and MRA are performed centrally and the result is blinded for investigators. Results: From 2010 to 2013, 114 pts—M/F (55%/45%), median age 66 (26-81), ECOG 0/1(92%/8%)—were included in 15 Belgian centers. 11 pts were excluded from analysis: 2 hyperglycemia at baseline PET; 2 withdrew consent; 6 PET-revealed stage IV CC; and 1 second cancer. Preop CT was associated with 5% grade (gr) 3-4 neutropenia, 1% gr 3 diarrhea, 1% gr 3 hypokaliemia, 1% peritonitis and 1% gr 3 thromboembolic events. Colectomies were performed in all pts after a median of 20 days (interquartile interval 18-21): 32 right (31%), 69 left (67%), and 2 procedures not detailed. Pathology showed stages 0 (1%), I (13%), II (34%), III (47%), IV (7%), without lymph node downstaging. Postoperative morbidity is 9% (95%CI 5-16%) and includes fistulas (4%), transient ischemic attack (1%), ileus (2%), and evisceration (1%), but no death. Technical or methodological reasons prevented MRA in 19/103 pts. Median SUVmax was 14.4 (4.9-47.8) at baseline, and 10.9 (0-39.3) on day 14. 2 pts presented with complete MR. For the others, median delta SUVmax was -22% (-60 to +31%). MR was observed in 60% of pts, and was absent in 40%, with equal distribution for stages II and III (p = 1.00). Conclusions: 1 course of CT is feasible before curative surgery for CC, without inducing excessive toxicity, delay or surgical morbidity. MRA indicated metabolic signs of chemoresistance in 40% of the primary tumors. Clinical trial information: NCT00994864.
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Affiliation(s)
| | | | | | | | | | | | - Jos Janssens
- AZ Turnhout - Campus Sint-Elisabeth, Turnhout, Belgium
| | | | | | | | | | | | - Stéphanie Laurent
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Marianne Paesmans
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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9
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Agrafiotis AC, Corbeau M, Buggenhout A, Katsanos G, Ickx B, Van de Stadt J. Enhanced recovery after elective colorectal resection outside a strict fast-track protocol. A single centre experience. Int J Colorectal Dis 2014; 29:99-104. [PMID: 23982426 DOI: 10.1007/s00384-013-1767-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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] [Accepted: 08/20/2013] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Optimising the management of hospitalised patients is a major concern. In colorectal surgery, the concept of enhanced recovery has been popularised by means of "fast-track" protocols, aiming at patient's discharge on the second postoperative day. Nevertheless, a strict fast-track protocol has several limitations. It is very demanding for the patient and therefore applicable only to a limited number of patients. AIM In order to optimise, in every aspect, the postoperative recovery of each patient undergoing an elective colorectal resection inside our institution, we set up a "soft" enhanced recovery programme. MATERIAL-METHODS A retrospective analysis was conducted in 92 patients evaluating the respective impact of protocol application throughout the duration of the hospital stay. RESULTS When all the required measures of our protocol were correctly implemented, the median discharge day was postoperative day 3 (range 3-5 days). On the contrary, when deviations occurred, they resulted in longer hospital stay (p < 0.001). Patients operated by laparoscopy were discharged earlier than patients operated by laparotomy (p < 0.001). The use of nasogastric tube and postoperative drainage prolonged significantly the length of stay (p = 0.001 and p < 0.001 respectively). When the urinary catheter was not removed or oral feeding not resumed on postoperative day 1, the patients were discharged later (p < 0.001). CONCLUSIONS There are substantial possibilities of optimising the recovery process after an elective colorectal resection, outside a strict fast-track protocol.
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Affiliation(s)
- A C Agrafiotis
- Clinic of Colorectal Surgery, Department of Digestive Surgery, Erasme University Hospital-Université Libre de Bruxelles, Brussels, Belgium,
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10
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Lucidi V, Katsanos G, Buggenhout A, Moreno C, Gustot T, Boon N, Degré D, Bourgeois N, Brisbois D, Bali MA, Demetter P, Van Laethem JL, Donckier V. [Multidisciplinary management of hepatocellular carcinoma in cirrhotic patients]. Rev Med Brux 2012; 33:229-236. [PMID: 23091926] [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: 06/01/2023]
Abstract
The treatment of hepatocellular carcinoma (HCC) in cirrhotic patients is challenging: the incidence is increasing, the cirrhosis dramatically limits the tolerance to treatment possibilities, there are many therapeutic modalities but resources are limited, namely in the context of organ shortage for transplantation. Liver transplantation (LT) is the optimal treatment as it combines the largest tumor resection possible and the correction of the underlying liver disease. Due to organ shortage however, LT is reserved for early-stages HCC. Surgical resection and radiofrequency destruction represent potentially curative options in highly selected patients. Arterial embolizations, chemo- or radio-embolizations, allow local tumor control but are not curative. These techniques could be performed before surgical resection or LT, to downstage the tumor and/or to control tumor progression while waiting for a graft. Finally, sorafenib is the only systemic treatment which has shown a survival benefit in advanced HCC. The benefit of combination of sorafenib and surgical treatments remains undetermined. The challenge in the management of HCC in cirrhotic patients is to integrate both individual (age, comorbidities, cirrhosis stage, tumor stage, specific contraindications to LT, etc.) and collective variables (expected waiting time before LT) to determine the best therapeutic option for each patient. In this process, multidisciplinarity is a key for success.
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Affiliation(s)
- V Lucidi
- Service de Chirurgie Digestive, Hôpital Erasme, Bruxelles
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11
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Germanova D, Lucidi V, Buggenhout A, Boon N, Bourgeois N, Degré D, Gustot T, Moreno C, Bali M, Brisbois D, Donckier V. Liver Transplantation in Cases of Portal Vein Thrombosis in the Recipient: A Case Report and Review of the Various Options. Transplant Proc 2011; 43:3490-2. [DOI: 10.1016/j.transproceed.2011.09.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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12
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Donckier V, Sanchez-Fueyo A, Craciun L, Lucidi V, Buggenhout A, Troisi R, Rogiers X, Bourgeois N, Boon N, Moreno C, Colle I, Van Vlierberghe H, de Hemptinne B, Goldman M. Induction of tolerance in solid organ transplantation: the rationale to develop clinical protocols in liver transplantation. Transplant Proc 2009; 41:603-6. [PMID: 19328936 DOI: 10.1016/j.transproceed.2009.01.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Minimization or withdrawal of immunosuppressive treatments after organ transplantation represents a major objective for improving quality of life and long-term survival of grafted patients. Such a goal may be reached under some clinical conditions, particularly in liver transplantation, making these patients good candidates for tolerance trials. In this context in liver transplantation, the central questions are (1) how to promote the natural propensity of the liver graft to be accepted, (2) which type of immunosuppressive drug should be used for induction and maintenance, and (3) which biomarkers could be used to discriminate tolerant patients from those requiring long-term immunosuppression. Induction therapies using aggressive T-cell-depleting agents may favor graft acceptance. However, persistent and/or rapidly reemerging cell lines, such as memory-type cells or CD8(+) T cells, could represent a significant barrier for induction of tolerance. The type of maintenance drugs also remains questionable. Calcineurin inhibitors may be eventually deleterious in the context of tolerance protocols, through inhibitory effects on regulatory T cells, that are not observed with rapamycin. In conclusion, significant efforts must be made to achieve reliable strategies for immunosuppression minimization or withdrawal after organ transplantation into the clinics.
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Affiliation(s)
- V Donckier
- Medicosurgical Department of Gastroenterology, Clinic of Abdominal Transplantation, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
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13
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Abstract
Cholecystectomy in cirrhotic patients remains a high risk procedure. The recent literature was reviewed in the objective to elaborate (evidence-based) recommendations for therapeutic decision. In patients with Child Pugh A or B cirrhosis, the laparoscopic approach should be preferred as it is associated with reduced morbidity and mortality as compared with open surgery (level B). In patients with decompensated Child Pugh C cirrhosis, the scarcity of literature data renders much more hazardous the definition of robust recommendations. In these patients, two options have to be considered beyond early laparoscopic cholecystectomy: first, a delayed surgery, in order to improve the preoperative patient's general condition and namely the coagulation, and second, a percutaneous drainage in very severe cases (level C).
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14
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Donckier V, Buggenhout A, Troisi R, Lucidi V, Rogiers X, Nagy N, Craciun L, Bourgeois N, de Hemptinne B, Goldman M. EARLY IMMUNOSUPPRESSION WEANING AFTER CADAVER LIVER TRANSPLANTATION USING ATG INDUCTION AND RAPAMYCIN. Transplantation 2008. [DOI: 10.1097/01.tp.0000332466.38335.37] [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: 11/25/2022]
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15
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Lucidi V, Buggenhout A, Boon N, Moreno C, Bourgeois N, Donckier V. Liver transplantation for acute liver failure in adults. MINERVA GASTROENTERO 2008; 54:49-55. [PMID: 18299667] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Acute liver failure is a challenging clinical condition, associated with high morbidity and mortality. In well-selected patients, LT (LT) is the only therapeutic which has been demonstrated to improve patient survival. Clichy and King's College criteria are the two mains scoring systems used to select the patients for liver transplantation. Both models achieve high specificity but remain associated with limited negative predictive value. Several other predictive factors have been evaluated, but none of them have been strongly validated so far. Globally, whole LT appears as the procedure of choice for patients within Clichy and/or King's College criteria. Due to the severity of the disease and its multisystemic consequences, the results of LT for fulminant liver failure remain inferior to those obtained in elective indications. Accord-ing to local conditions, namely expected waiting time before urgent transplantation and surgical expertise, living donor transplantation and auxiliary transplantations appear as valuable alternatives. These techniques have the respective potential advantages to limit the waiting period before transplantation and to avoid the need for lifelong immunosuppression when native liver recovers, but overall results remain inferior to those obtained with whole LT.
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Affiliation(s)
- V Lucidi
- Medicosurgical Unit of Liver Transplantation, Erasme Hospital Free University of Brussels, Brussels, Belgium
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16
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Lucidi V, Lemyé A, Baire L, Buggenhout A, Hoang A, Loi P, Mboti F, Mikhailski D, Closset J, Gelin M, Boon N, Degré D, Bourgeois N, Adler M, Donckier V. Use of Marginal Donors for Liver Transplantation: A Single-Center Experience Within the Eurotransplant Patient-Driven Allocation System. Transplant Proc 2007; 39:2668-71. [DOI: 10.1016/j.transproceed.2007.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Mansour Z, Kochetkova EA, Ducrocq X, Vasilescu MD, Maxant G, Buggenhout A, Wihlm JM, Massard G. Induction chemotherapy does not increase the operative risk of pneumonectomy! Eur J Cardiothorac Surg 2007; 31:181-5. [PMID: 17141515 DOI: 10.1016/j.ejcts.2006.11.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 10/27/2006] [Accepted: 11/07/2006] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There is an ongoing debate whether induction therapy increases post-operative mortality and morbidity, especially when performing pneumonectomy. We therefore reviewed a consecutive series of patients having undergone pneumonectomy in a single center. METHODS The charts of 298 patients operated on between January 1999 and July 2005 were reviewed. Patients were divided into two groups: group 1 included those who received induction chemotherapy (60 patients, 20.1%), and group 2 included those who underwent surgery alone (238 patients, 79.9%). Endpoints were operative mortality at 30 and at 90 days, and major complications such as empyema, bronchial fistula and acute respiratory distress syndrome. Statistical analyses were performed using SPSS 11.0 software. RESULTS Demographic data were similar for both groups when considering side of operation, comorbidity and weaning from tobacco; patients were older in group 2 (61.83+/-9.58 years vs 57.75+/-8.94 years; p=0.003) and there were more female patients in group 2 (17.2% vs 5.0%; p=0.010). Post-operative mortality at 30 days was 6.7% in group 1 and 5.5% in group 2 (p=0.458), and 11.7% for group 1 and 10.9% in group 2 at 90 days (p=0.512). Incidence of empyema was 1.7% in group 1 and 2.1% in group 2 (p=0.652); incidence of bronchopleural fistulas was 1.7% in group 1 and 5.5% in group 2 (p=0.188); incidence of acute respiratory distress syndrome was 3.3% in group 1 and 3.4% in group 2 (p=0.675). CONCLUSION In opposition to previous reports, induction chemotherapy did not significantly jeopardize post-operative outcome following pneumonectomy in our experience.
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Affiliation(s)
- Ziad Mansour
- Service de Chirurgie Thoracique, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
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18
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Gris M, Van Nieuwenhove O, Buggenhout A, Burny F. Surgical treatment of ankle fractures by pneumatic stapling: clinical experience and review of the literature. Acta Orthop Belg 2005; 71:452-8. [PMID: 16185001] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Between June 1987 and December 2002, 237 cases of malleolar fractures were treated at Erasme Hospital using pneumatic stapling, alone or combined with another type of fixation. This retrospective study addresses 176 well-documented cases. The mean follow-up period was 36 months. The results indicate that pneumatic stapling is an effective technique with a very low rate of failure. Comminuted fractures are not a contraindication.
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Affiliation(s)
- Mireille Gris
- Department of Orthopaedics and Traumatology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Brussels, Belgium.
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19
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Buggenhout A, Hoang AD, Hut F, Lekeufack JB, Bali MA, De Pauw L. Pediatric en bloc dual kidney-pancreas transplantation into an adult recipient: a simplified technique. Benefits of the en bloc kidney-pancreas transplantation technique in pediatric donors. Am J Transplant 2004; 4:663-5. [PMID: 15023161 DOI: 10.1111/j.1600-6143.2004.00371.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The lower age limit for pancreas donors is not well defined. Fear of inadequate islet beta-cell mass and of technical complications has hampered the use of pediatric donors. A surgical technique of 'en bloc' kidney-pancreas is described. Both kidneys and pancreas were removed en bloc from a 13-kg, 31-month-old child. During bench preparation, one anastomosis was performed between the portal vein and the inferior vena cava. The proximal end of the aorta was closed. The bloc was transplanted into a 36-year-old type I diabetic patient intraperitoneally in the right iliac fossa. The kidneys functioned immediately. Pancreatic graft function resumed after POD 15 but insulin therapy was maintained until POD 112. Currently, the patient retains excellent kidney and pancreas graft functions. Very young donors can be accepted as pancreas donors for adult recipients, although slow recovery of pancreatic function can be expected. Use of the en bloc technique is well suited for very small children, as it prevents potential vascular complications.
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Affiliation(s)
- Alexis Buggenhout
- Clinique de Néphrologie Chirurgicale, Hôpital Erasme, Cliniques Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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20
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Gotlieb L, Kaufman L, Leclercq G, Nogaret JM, Buggenhout A, Larsimont D. Comparison of immunohistochemical and biochemical measurement of steroid receptors in breast cancer: are both still necessary? Breast 2004; 10:470-5. [PMID: 14965626 DOI: 10.1054/brst.2000.0283] [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] [Received: 02/22/2000] [Revised: 11/28/2000] [Accepted: 12/22/2000] [Indexed: 11/18/2022] Open
Abstract
In our institute, the oestrogen and progesterone receptors of breast cancer samples are analyzed by biochemistry and immunohistochemistry. The purpose of this study is to evaluate and compare both techniques and establish whether one of them should be used in preference to the other. The probability of getting a positive or negative result with each technique was the same regardless of the method used as reference. The biochemical method uses a larger volume of tissue to determine the receptor status than immunohistochemistry. In some cases, this means a loss of valuable information. If we only use one technique, there is the potential to misclassify +/- 11% of patients. According to these results and in the knowledge that the major interest of steroid receptors' status remains in the domain of therapeutic decisions, we advise using immunohistochemistry first and biochemistry if there is a negative result. This would spare tumour tissue for new research studies.
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Affiliation(s)
- Emmanuel Chasse
- Department of Digestive Surgery and Radiology, Erasme Hospital, 808 route de Lennik, 1070 Brussels, Belgium
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