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Rousset P, Buisson G, Lega JC, Charlot M, Gallice C, Cotte E, Milot L, Golfier F. Rectal endometriosis: predictive MRI signs for segmental bowel resection. Eur Radiol 2020; 31:884-894. [PMID: 32851441 DOI: 10.1007/s00330-020-07170-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/08/2020] [Revised: 05/31/2020] [Accepted: 08/07/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To retrospectively determine the accuracy of MRI rectal and pararectal signs in predicting the necessity for segmental resection in the case of lesions located in the rectum. METHODS MR images of consecutive patients treated for rectal endometriosis over a 5-year period were reviewed in consensus by two blinded readers. A systematic analysis of 7 rectal (lesion length, transverse axis, thickness and circumference, and presence of a convex base, submucosal oedema and hyperintense cystic areas) and 4 pararectal (posterior vaginal fornix, parametrial, ureteral and sacro-recto-genital septum involvements) signs was performed for each lesion. MRI results were compared to the surgical procedure performed (shaving versus segmental resection). RESULTS Among 61 patients studied, 32 received a segmental resection and 29, a shaving. Receiver operating characteristic curve analysis allowed determining cut-off values for length (≥ 32 mm), transverse axis (≥ 22 mm), thickness (≥ 14 mm) and circumference (≥ 3/8 radii). The 7 rectal signs, and only the sacro-recto-genital septum pararectal sign, were significantly associated with segmental resection in univariate analysis, nodular thickness ≥ 14 mm and circumference ≥ 3/8 radii being the most predictive signs (odds ratio 94.5 and 60.4, respectively). These 2 signs remained positively associated with segmental resection in multivariate analysis and, when combined, were predictive of segmental resection with an accuracy of 90.2%. CONCLUSION Assessing MRI rectal and pararectal signs may accurately predict the need for segmental resection versus a more conservative approach such as shaving for rectal lesion management. KEY POINTS • MRI analysis of rectal endometriosis, taking into account rectal and pararectal signs, may assist surgeons in the decision-making process, in counselling patients regarding the surgical procedure and in adequately allocating resources. • Among rectal signs, nodular thickness ≥ 14 mm and a circumference ≥ 38% were the most predictive signs of segmental resection. • Among pararectal signs, only the sacro-recto-genital septum involvement was significantly associated with segmental resection.
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Affiliation(s)
- Pascal Rousset
- Lyon 1 Claude Bernard University, Villeurbanne, France. .,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France. .,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France.
| | - Guillaume Buisson
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Jean-Christophe Lega
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Internal and Vascular Medicine Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Mathilde Charlot
- Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Colin Gallice
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Gynecological Oncological and Obstetrics Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Eddy Cotte
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Oncologic and General Surgery Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - Laurent Milot
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Radiology Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
| | - François Golfier
- Lyon 1 Claude Bernard University, Villeurbanne, France.,Hospices Civils de Lyon, Lyon Sud University Hospital, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Gynecological Oncological and Obstetrics Department, Hospices Civils de Lyon, Lyon Sud University Hospital, Pierre Bénite, France
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Siebert M, Alyami M, Mercier F, Gallice C, Villeneuve L, Laplace N, Passot G, Bakrin N, Glehen O, Kepenekian V. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in association with systemic chemotherapy and bevacizumab, evaluation of safety and feasibility. A single center comparative study. Eur J Surg Oncol 2019; 47:139-142. [PMID: 30914289 DOI: 10.1016/j.ejso.2019.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising technic for unresectable peritoneal metastasis (PM). Targeted therapies such as bevacizumab have demonstrated their efficacy in advanced colorectal and ovarian cancer. We aimed to evaluate the feasibility and safety of this bidimensional therapeutic association. METHODS A prospectively maintained PIPAC database was retrospectively analyzed from December 2015 to March 2018. All patients who underwent PIPAC for unresectable PM were selected. Patients with systemic chemotherapy including bevacizumab (BEVA group) were compared with patients with systemic chemotherapy without bevacizumab (NON-BEVA group). Major morbidity and mortality were analyzed. RESULTS 134 patients underwent 397 PIPAC in Lyon Sud University Hospital. 26 Patients had 88 PIPAC in the BEVA group were compared to 108 patients who had 309 PIPAC in the NON-BEVA group. Patients in the BEVA group demonstrated a higher Peritoneal Cancer Index (PCI 20 vs. 16, p < 0.001). There was no statistical difference in overall 30-day morbidity (BEVA: 13 (14.8%) vs NON-BEVA: 29 (9.4%); p = 0.147). There was no statistical difference for grade III-IV complications (BEVA: 4 (4.5%) vs NON-BEVA 10 (3.2%); P = 0.521). Major complications from BEVA group were as follow, 2 bowel obstructions, one hematoma and one severe hypersensitivity reaction to platinum compound. There was no 30-day mortality in the BEVA group compared to 6 (5.5%) mortality in the NON-BEVA group. CONCLUSION PIPAC associated with bevacizumab is feasible, safe and well tolerated. The potential oncologic benefit of the concomitant use of bevacizumab and PIPAC remains to be evaluated.
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Affiliation(s)
- Matthieu Siebert
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Mohammad Alyami
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France; Department of General Surgery and Surgical Oncology, King Khalid Hospital, Najran, Saudi Arabia.
| | - Frederic Mercier
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Surgical Oncology, Centre Hospitalo-Universitaire de Montreal, Montreal, Canada
| | - Colin Gallice
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Laurent Villeneuve
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Public Health, Clinical Research & Epidemiology, Lyon University Hospital, Lyon, France
| | - Nathalie Laplace
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Guillaume Passot
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Naoual Bakrin
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Vahan Kepenekian
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
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Siebert M, Alyami M, Mercier F, Gallice C, Villeneuve L, Bérard F, Glehen O, Bakrin N, Kepenekian V. Severe hypersensitivity reactions to platinum compounds post-pressurized intraperitoneal aerosol chemotherapy (PIPAC): first literature report. Cancer Chemother Pharmacol 2018; 83:425-430. [PMID: 30511218 DOI: 10.1007/s00280-018-3740-3] [Citation(s) in RCA: 19] [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] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pressurized intraperitoneal aerosol chemotherapy (PIPAC) shows encouraging results for patients with unresectable peritoneal metastasis. Several reports demonstrated the safety of the procedure combined with systemic chemotherapy, with a low rate of complication. The aim of this study is to report severe hypersensitivity reactions to platinum compounds (SHRPC) during PIPAC procedures. METHODS All patients who underwent PIPAC for non-resectable PC in Lyon Sud University hospital were included in a prospective institutional database. All patients who presented a SHRPC after PIPAC were included in our analysis. RESULTS One hundred and thirty-two patients underwent 383 PIPAC procedures between December 2015 and December 2017. oxaliplatin's and cisplatin-doxorubicin's protocols were used in 71 and 312 PIPAC, respectively. Four patients (3%) developed SHRPC; two patients (2.8%) after oxaliplatin and two patients (0.6%) after cisplatin-doxorubicin protocols. SHRPC occurred during the 6th PIPAC with cisplatin-doxorubicin protocol and during 2nd and 3rd PIPAC of the oxaliplatin protocol. Three events appeared within 15 min and one event occurred 50 min following nebulization. All the SHRPC have been managed successfully without any complication. CONCLUSIONS This is the first report of SHRPC after PIPAC. The physician must constantly keep this rare but life-threatening complication in mind, especially after repeated PIPAC administration or previous platinum-based systemic chemotherapy.
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Affiliation(s)
- Matthieu Siebert
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Mohammad Alyami
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France. .,EMR 3738, Lyon 1 University, Lyon, France. .,Department of General Surgery and Surgical Oncology, King Faisal Specialist Hospital and research center, Riyadh, Saudi Arabia. .,Département de Chirurgie Générale, Digestive et Endocrinienne, CHU Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.
| | - Frederic Mercier
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Colin Gallice
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Laurent Villeneuve
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Frédéric Bérard
- Service d'Allergologie et Immunologie Clinique, INSERM U851, Dufourt-5F. CHU Lyon-Sud, Pierre-Bénite, France
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Naoual Bakrin
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Vahan Kepenekian
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
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Lamblin G, Gallice C, Bournaud C, Nadaud B, Lebail-Carval K, Chene G. [Benign struma ovarii: Report of 7 cases and review of the literature]. ACTA ACUST UNITED AC 2016; 44:263-8. [PMID: 26997461 DOI: 10.1016/j.gyobfe.2016.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/04/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Struma ovarii is a monodermal teratoma composed of thyroid tissue, representing 0.85 to 1.3% of ovarian tumors. The objective of the present study is to report a continuous series of struma ovarii, with a comprehensive analysis of the literature. METHODS A retrospective study in the gynecological surgery department of Hôpital Femme-Mère-Enfant (Hospices Civils de Lyon, Lyon, France) assessed a continuous series of struma ovarii from the Lyon East Pathology Center database. Clinical and biological, imaging and pathological aspects were analyzed and the various forms of treatment described. RESULTS We identified 7 patients with struma ovarii from March 2008 to April 2015. Mean patient age was 49.7 years (28-70years). Three patients had a history of thyroid disease. CA-125 was elevated (51IU/mL) in only 1 patient. MRI and ultrasound imaging did not enable diagnosis of struma ovarii, which depended on pathologic examination. Conservative surgery for cystectomy or oophorectomy was performed for patients wishing to become pregnant (71%); nonconservative hysterectomy was performed in postmenopausal women (29%). CONCLUSIONS Struma ovarii is a rare, often asymptomatic condition in which diagnosis is difficult. Few series are described in the literature. Here we propose a management model for struma ovarii. Revision surgery and adjuvant therapy is indicated in case of malignant struma ovarii.
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Affiliation(s)
- G Lamblin
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France.
| | - C Gallice
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - C Bournaud
- Service de médecine nucléaire, groupement hospitalier Est, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - B Nadaud
- Service de pathologie Est (CPE), groupement hospitalier Est, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - K Lebail-Carval
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France
| | - G Chene
- Service de chirurgie gynécologique, université Claude Bernard-Lyon 1, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69677 Lyon-Bron, France
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