1
|
Guilbaud T, Faust C, Picaud O, Baumstarck K, Vicenty T, Farvacque G, Vanbrugghe C, Berdah S, Moutardier V, Birnbaum DJ. The falciform/round ligament "flooring," an effective method to reduce life-threatening post-pancreatectomy hemorrhage occurrence. Langenbecks Arch Surg 2023; 408:192. [PMID: 37171647 DOI: 10.1007/s00423-023-02915-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Late post-pancreatectomy hemorrhage (PPH) represents the most severe complication after pancreatic surgery. We have measured the efficacy of major vessels "flooring" with falciform/round ligament to prevent life-threatening grade C late PPH after pancreaticoduodenectomy (PD) and distal pancreatectomy (DP). METHODS All consecutive patients who underwent PD and DP between 2013 and 2021 were retrospectively reviewed on a prospectively maintained database. The cohort was divided in two groups: "flooring" vs. "no flooring" method group. The "no flooring" group had omental flap interposition. Patient characteristics and operative and postoperative data including clinically relevant postoperative pancreatic fistula (CR-POPF), late PPH (grade B and C), and 90-day mortality were compared between the two groups. RESULTS Two hundred and forty patients underwent pancreatic resections, including 143 PD and 97 DP. The "flooring" method was performed in 61 patients (39 PD and 22 DP). No difference was found between the two groups concerning severe morbidity, CR-POPF, delayed PPH, and mortality rate. The rate of patients requiring postoperative intensive care unit was lower in the "flooring" than in the "no flooring" method group (11.5% vs. 25.1%, p = 0.030). Among patients with grade B/C late PPH (n = 30), the rate of life-threatening grade C late PPH was lower in the "flooring" than in the "no flooring" method group (28.6% (n = 2/7) vs. 82.6% (n = 19/24), p = 0.014). Risk factor analysis showed that the "flooring" method was the only protective factor against grade C late PPH occurrence (p = 0.013). CONCLUSION The "flooring" method using the falciform/round ligament should be considered during pancreatectomies to reduce the occurrence of life-threatening grade C late PPH.
Collapse
Affiliation(s)
- Théophile Guilbaud
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Cindy Faust
- Center of Epidemiology and Health Economy, Direction de La Recherche en Santé, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Olivier Picaud
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Karine Baumstarck
- Center of Epidemiology and Health Economy, Direction de La Recherche en Santé, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Thibaud Vicenty
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Georges Farvacque
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Charles Vanbrugghe
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Stéphane Berdah
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - Vincent Moutardier
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France.
| |
Collapse
|
2
|
Champavier PG, Beyer-Berjot L, Arnoux PJ, Py M, Casanova R, Berdah S, Birnbaum DJ, Guilbaud T. An Ex Situ Cadaver Liver Training Model Continuously Pressurized to Simulate Specific Skills Involved in Laparoscopic Liver Resection: the Lap-Liver Trainer. J Gastrointest Surg 2023; 27:521-533. [PMID: 36624325 DOI: 10.1007/s11605-022-05566-9] [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: 08/03/2022] [Accepted: 12/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) requires delicate skills. The aim of the study was to develop a training model mimicking as much as possible intraoperative bleeding and bile leakage during LLR. We also assessed the educational value of the training model. METHODS The Lap-liver trainer (LLT) combined a continuously pressurized ex situ cadaver liver and a customized mannequin. The customized mannequin was designed by computer-aided design and manufactured by 3D printing. The left lateral sectionectomy (LLS) was chosen to assess the feasibility of a LLR with the LLT. Eighteen volunteers were recruited to perform LLS and to assess the educational value of the LLT using a Likert scale. RESULTS The customized mannequin consisted of a close laparoscopic training device based on a simplified reconstruction of the abdominal cavity in laparoscopic conditions. Ex situ cadaver livers were pressurized to simulate blood and bile supplies. Each expert surgeon (n = 3) performed two LLS. They were highly satisfied of simulation conditions (4.80 ± 0.45) and strongly recommended that the LLT should be incorporated into a teaching program (5.00 ± 0.0). Eight novice and 4 intermediate surgeons completed a teaching program and performed a LLS. Overall, the level of satisfaction was high (4.92 ± 0.29), and performing such a procedure under simulation conditions benefited their learning and clinical practice (4.92 ± 0.29). CONCLUSIONS The LLT could provide better opportunities for trainees to acquire and practice LLR skills in a more realistic environment and to improve their ability to deal with specific events related to LLR.
Collapse
Affiliation(s)
| | - Laura Beyer-Berjot
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.,Aix-Marseille Univ, Center for Surgical Teaching and Research (CERC), Marseille, France.,Aix-Marseille Univ, APHM, Hôpital Nord, Department of Digestive Surgery, Marseille, France
| | | | - Max Py
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France
| | | | - Stéphane Berdah
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.,Aix-Marseille Univ, Center for Surgical Teaching and Research (CERC), Marseille, France.,Aix-Marseille Univ, APHM, Hôpital Nord, Department of Digestive Surgery, Marseille, France
| | - David Jérémie Birnbaum
- Aix-Marseille Univ, Center for Surgical Teaching and Research (CERC), Marseille, France.,Aix-Marseille Univ, APHM, Hôpital Nord, Department of Digestive Surgery, Marseille, France
| | - Théophile Guilbaud
- Aix-Marseille Univ, Univ Gustave Eiffel, LBA, Marseille, France.,Aix-Marseille Univ, Center for Surgical Teaching and Research (CERC), Marseille, France.,Aix-Marseille Univ, APHM, Hôpital Nord, Department of Digestive Surgery, Marseille, France
| |
Collapse
|
3
|
de Rauglaudre B, Finetti P, Birnbaum DJ, Lopez M, Bertucci F, Mamessier E. First-in-Human, Phase I Study of PCA062 in Solid Tumors—Letter. Mol Cancer Ther 2022; 21:1742-1743. [DOI: 10.1158/1535-7163.mct-22-0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/14/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Bernadette de Rauglaudre
- 1Laboratory of Predictive Oncology, Centre de Recherche en Cancerologie de Marseille, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, “Equipe labellisee Ligue Contre le Cancer”, Marseille, France
- 2Departement d'Oncologie Digestive, Hopital de la Timone, Assistance Publique – Hopitaux de Marseille (APHM), Marseille, France
- 3Aix-Marseille University, France
| | - Pascal Finetti
- 1Laboratory of Predictive Oncology, Centre de Recherche en Cancerologie de Marseille, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, “Equipe labellisee Ligue Contre le Cancer”, Marseille, France
- 3Aix-Marseille University, France
| | - David Jérémie Birnbaum
- 1Laboratory of Predictive Oncology, Centre de Recherche en Cancerologie de Marseille, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, “Equipe labellisee Ligue Contre le Cancer”, Marseille, France
- 3Aix-Marseille University, France
- 4Departement de Chirurgie digestive, Hopital Nord, APHM, Marseille, France
| | - Marc Lopez
- 1Laboratory of Predictive Oncology, Centre de Recherche en Cancerologie de Marseille, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, “Equipe labellisee Ligue Contre le Cancer”, Marseille, France
- 3Aix-Marseille University, France
| | - François Bertucci
- 1Laboratory of Predictive Oncology, Centre de Recherche en Cancerologie de Marseille, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, “Equipe labellisee Ligue Contre le Cancer”, Marseille, France
- 3Aix-Marseille University, France
- 5Departement d'Oncologie Medicale, Institut Paoli-Calmettes, Marseille, France
| | - Emilie Mamessier
- 1Laboratory of Predictive Oncology, Centre de Recherche en Cancerologie de Marseille, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR725, “Equipe labellisee Ligue Contre le Cancer”, Marseille, France
- 3Aix-Marseille University, France
| |
Collapse
|
4
|
Vicenty T, Zoratti V, Ravaud S, Birnbaum DJ. Small bowel obstruction after laparoscopic adjustable gastric band: The gastric band is not always the one involved. Surgery 2022; 172:e37-e38. [PMID: 35501196 DOI: 10.1016/j.surg.2022.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Thibaud Vicenty
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, France
| | - Valentina Zoratti
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, France
| | - Simon Ravaud
- Department of Radiology, Hôpital Nord, Aix-Marseille Université, France
| | | |
Collapse
|
5
|
Guilbaud T, Cermolacce A, Berdah S, Birnbaum DJ. New 5-mm laparoscopic pneumodissector device to improve laparoscopic dissection: an experimental study of its safety in a swine model. Surg Endosc 2022; 36:2712-2720. [PMID: 34981235 DOI: 10.1007/s00464-021-08953-6] [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] [Received: 07/11/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To improve the laparoscopic surgical dissection, the aim of the study was to assess the safety of burst of high-pressure CO2 using a 5-mm laparoscopic pneumodissector (PD) operating at different flow rates and for different operating times regarding the risk of gas embolism (GE) in a swine model. METHODS The first step was to define the settings use of the PD device ensuring no GE. Successive procedures were conducted by laparotomy: cholecystectomy, the PD was placed 10 mm deep in the liver and the PD was directly introduced into the lumen of the inferior vena cava. Different PD flow rates of 5, 10, and 15 mL/s were used. The second step was to assess the safety of the device (PD group) during a laparoscopic dissection task (cystic and hepatic pedicles dissection, cholecystectomy and right nephrectomy) in comparison with the use of a standard laparoscopic hook device (control group). PD flow rate was 10 mL/s and consecutive burst of high-pressure CO2 was delivered for 3-5 s. RESULTS In the first step (n = 17 swine), no GE occurred during cholecystectomy regardless of the PD flow rate used. When the PD was placed in the liver or into the inferior vena cava, no severe or fatal GE occurred when a burst of high-pressure CO2 was applied for 3 or 5 s with PD flow rates of 5 and 10 mL/s. In the second step (PD group, n = 10; control group, n = 10), no GE occurred in the PD group. The use of the PD did not increase operative time or blood loss. The quality of the dissection was significantly improved compared to the control group. CONCLUSIONS The 5-mm laparoscopic PD appears to be free from CO2 GE risk when consecutive bursts of high-pressure CO2 are delivered for 3-5 s with a flow rate of 10 mL/s.
Collapse
Affiliation(s)
- Théophile Guilbaud
- Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France. .,Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France.
| | - Alexia Cermolacce
- Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France
| | - Stéphane Berdah
- Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France.,Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - David Jérémie Birnbaum
- Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France.,Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| |
Collapse
|
6
|
Gantois D, Guilbaud T, Scemama U, Girard E, Picaud O, Lefevre M, Elgani M, Hamidou Z, Moutardier V, Balandraud P, Chirica M, Barbier L, Fuks D, Birnbaum DJ. Prognostic impact of splenic vessel involvement and tumor size in distal pancreatectomy for adenocarcinoma: a retrospective multicentric cohort study. Langenbecks Arch Surg 2021; 407:153-165. [PMID: 34373941 DOI: 10.1007/s00423-021-02291-w] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Splenic vessel involvement occurs frequently in pancreatic ductal adenocarcinoma (PDAC) of the body and the tail (B/T) but the impact on survival is unknown. We assessed the influence of radiological and pathologic involvement of splenic artery (p-SA +) and vein (p-SV +) on patient outcomes after distal pancreatectomy (DP) for PDAC. METHODS From 2013 to 2019, all DP for PDAC in five centers were included. Factors associated with overall (OS) and disease-free (DFS) survival were identified. RESULTS Among the 76 patients included, 5 (6.6%) had p-SA + only, 11 (14.5%) had p-SV + only, and 24 (31.6%) had both p-SA + and p-SV + . The preoperative CT-scan accuracy to predict p-SV + and p-SA + was high (sensitivity: 91.4% and 82.8%, respectively; negative predictive value: 89.7% and 88.3%, respectively). The 5-year OS and DFS rates were 3.9% and 8.3%, respectively. Multivariate analysis identified splenic vessel involvement (i.e., p-SA + or p-SV + , or both p-SA + and p-SV +) as the only independent factor influencing DFS (HR 4.04; 95% CI [1.22-13.44], p = 0.023). Tumor size ≥ 30 mm was the only independent factor influencing OS (HR 4.04; 95% CI [1.26-12.95], p = 0.019) and was associated with a high risk of p-SA + (p = 0.001) and p-SV + (p < 0.001). CONCLUSION Tumor size ≥ 30 mm and splenic vessel involvement occurred in more than half of the patients who underwent DP for PDAC and had negative impact on long-term survival. Preoperative CT-scan was reliable to identify splenic vessel involvement in B/T PDAC. Large tumor size and radiological splenic vessel involvement could be taken into account to propose a neoadjuvant treatment.
Collapse
Affiliation(s)
- Dominique Gantois
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Théophile Guilbaud
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Ugo Scemama
- Department of Radiology, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Edouard Girard
- Department of Digestive Surgery and Liver Transplantation, Hôpital Michalon, Grenoble University, Grenoble, France
| | - Olivier Picaud
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Marine Lefevre
- Department of Anatomopathology, Institut Mutualiste Montsouris, Paris, France
| | - Myriam Elgani
- Department of Anatomopathology, Hôpital Trousseau, Tours, France
| | - Zeinab Hamidou
- Self Perceived Health Assessment Research Unit and Department of Public Health, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille cedex 20, France
| | - Vincent Moutardier
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Paul Balandraud
- Department of Digestive and Oncologic Surgery, Hôpital D'Instruction des Armées St-Anne, Toulon, France
| | - Mircea Chirica
- Department of Digestive Surgery and Liver Transplantation, Hôpital Michalon, Grenoble University, Grenoble, France
| | - Louise Barbier
- Department of Digestive, Oncologic, Metabolic Surgery and Liver Transplantation, Hôpital Trousseau, Tours, France
| | - David Fuks
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France.
| |
Collapse
|
7
|
Malissen N, Farvacque G, Duconseil P, Birnbaum DJ, Falque C, Macagno N, Grob JJ, Gaudy-Marqueste C, Moutardier V. Surgery of small bowel melanoma metastases in the era of efficient medical therapies: a retrospective cohort study. Melanoma Res 2021; 31:358-365. [PMID: 34039940 DOI: 10.1097/cmr.0000000000000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Surgery of small bowel melanoma metastases has to be reconsidered in the era of targeted treatments and immunotherapy. To retrospectively assess context and outcomes of small bowel melanoma metastases resections. All consecutive melanoma patients who underwent resection of small bowel metastases between 2011 and 2017, in a single referral center, were retrospectively analyzed through melanoma-specific survival (MSS). A total of 20 patients were included with a 47.8 months median follow-up. Before small bowel surgery, eight patients (40%) were asymptomatic while seven had anemia and five patients had abdominal pain. All resections were decided on tumor boards except for three surgeries performed in the emergency setting. In the whole cohort, MSS was 89.5 months with 50% of patients alive at the study endpoint. We classified surgical indications in three groups: (1) surgery as a pivotal treatment for mono- or oligo-metastases limited to the small bowel (n = 6); (2) salvage surgery for symptomatic patients in order to preserve their chances to switch to an active line of medical treatment (n = 8); and (3) surgery of small bowel dissociated metastatic progression for patients otherwise controlled (n = 6), aiming at keeping patients with the same treatment or active follow-up. In these three situations, the objective of surgery was usually met, and most patients had a long median MSS after surgery: 70.3 months, 89.5 months and 72.4 months, respectively. Although medical treatments have dramatically improved survival in metastatic melanoma, surgical control of life-threatening localization like small bowel metastases is often a condition for long survival.
Collapse
Affiliation(s)
| | - Georges Farvacque
- Department of Digestive Surgery, INSERM, CRCM, APHM, CHU Nord, Hôpital Nord
| | - Pauline Duconseil
- Department of Digestive Surgery, INSERM, CRCM, APHM, CHU Nord, Hôpital Nord
| | | | | | - Nicolas Macagno
- Department of Pathology, Aix Marseille University, INSERM, MMG, APHM, CHU Timone, CHU la Timone, Marseille, France
| | | | | | - Vincent Moutardier
- Department of Digestive Surgery, INSERM, CRCM, APHM, CHU Nord, Hôpital Nord
| |
Collapse
|
8
|
Guilbaud T, Garnier J, Girard E, Ewald J, Risse O, Moutardier V, Chirica M, Birnbaum DJ, Turrini O. Postoperative day 1 combination of serum C-reactive protein and drain amylase values predicts risks of clinically relevant pancreatic fistula. The "90-1000" score. Surgery 2021; 170:1508-1516. [PMID: 34092376 DOI: 10.1016/j.surg.2021.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/20/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several scoring systems predict risks of clinically relevant postoperative pancreatic fistula after pancreatectomy, but none have emerged as the gold standard. This study aimed to evaluate the accuracy of postoperative day 1 drain amylase and serum C-reactive protein levels in predicting clinically relevant postoperative pancreatic fistula compared with intraoperative pancreatic characteristics. METHODS Patients who underwent pancreatectomy between 2017 and 2019 were included prospectively. Cutoff values were determined using receiver operating characteristic curves, and a score combining postoperative day 1 drain amylase and serum C-reactive protein was tested in a multivariate logistic regression model to evaluate clinically relevant postoperative pancreatic fistula risk. RESULTS A total of 274 pancreatic resections (182 pancreaticoduodenectomies and 92 distal pancreatectomies) were included. The pancreatic gland texture was "soft" in 47.8% (n = 131), and 55.8% (n = 153) had a small size main pancreatic duct (≤3 mm). Clinically relevant postoperative pancreatic fistula occurred in 58 patients (21.2%). Drain amylase ≥1,000 UI/L and serum C-reactive protein ≥90 mg/L were identified as the optimal cutoffs to predict clinically relevant postoperative pancreatic fistula. On multivariate analysis these cutoffs were independent predictors of clinically relevant postoperative pancreatic fistula after both pancreaticoduodenectomies (drain amylase: P < .001, serum C-reactive protein: P = .006) and distal pancreatectomies (drain amylase: P = .009, serum C-reactive protein: P = .001). The postoperative day 1 "90-1000" model, a 2-value score relying on these cutoffs, significantly (P < .001) outperformed intraoperative pancreatic parenchymal characteristics in predicting clinically relevant postoperative pancreatic fistula after both pancreaticoduodenectomies and distal pancreatectomies. A postoperative day 1 "90-1000" score = 0 had a negative predictive value of 97% and 94%, respectively, after pancreaticoduodenectomy and distal pancreatectomies. CONCLUSION A combined score relying on postoperative day 1 values of drain amylase and serum C-reactive protein levels was accurate in predicting risks of clinically relevant postoperative pancreatic fistula after pancreatectomy.
Collapse
Affiliation(s)
- Théophile Guilbaud
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France.
| | - Jonathan Garnier
- Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| | - Edouard Girard
- Department of Digestive Surgery and Liver Transplantation, Hôpital Michalon, Grenoble University, France
| | - Jacques Ewald
- Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| | - Olivier Risse
- Department of Digestive Surgery and Liver Transplantation, Hôpital Michalon, Grenoble University, France
| | - Vincent Moutardier
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Mircea Chirica
- Department of Digestive Surgery and Liver Transplantation, Hôpital Michalon, Grenoble University, France
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Marseille, France
| | - Olivier Turrini
- Department of Surgical Oncology, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| |
Collapse
|
9
|
Guilbaud T, Fuks D, Berdah S, Birnbaum DJ, Beyer Berjot L. Development of a novel educational tool to assess skills in laparoscopic liver surgery using the Delphi methodology: the laparoscopic liver skills scale (LLSS). Surg Endosc 2021; 36:2321-2333. [PMID: 33871719 DOI: 10.1007/s00464-021-08507-w] [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] [Received: 12/02/2020] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND No specific performance assessment scales have been reported in laparoscopic liver resection. This study aimed at developing an objective scale specific for the assessment of technical skills for wedge resection in anterior segments (WRAS) and left lateral sectionectomy (LLS). METHODS A laparoscopic liver skills scale (LLSS) was developed using a hierarchical task analysis. A Delphi method obtained consensus among five international experts on relevant steps that should be included into the LLSS for assessment of operative performances. The consensus was predefined using Cronbach's alpha > 0.80. RESULTS A semi-structured review extracted 15 essential subtasks for full laparoscopic WRAS and LLS for evaluation in the Delphi survey. Two rounds of the survey were conducted. Three over 15 subtasks did not reach the predefined level of consensus. Based on the expert's comments, 13 subtasks were reformulated, 4 subtasks were added, and a revised skills scale was developed. After the 2nd round survey (Cronbach's alpha 0.84), 19 subtasks were adopted. The LLSS was composed of three main parts: patient positioning and intraoperative preparation (task 1 to 8), the core part of the WRAS and LLS procedure (tasks 9 to 14), and completion of procedure (task 15 to 19). CONCLUSIONS The LLSS was developed for measuring the skill set for the education of safe and secure laparoscopic WRAS and LLS procedures in a dedicated training program. After validation, this scale could be also used as an assessment tool in the operating room and extrapolated as an operative roadmap to other complex procedures.
Collapse
Affiliation(s)
- Théophile Guilbaud
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France. .,Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France.
| | - David Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France
| | - Stéphane Berdah
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France.,Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France.,Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France
| | - Laura Beyer Berjot
- Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin Des Bourrely, 13015, Marseille, France.,Center for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France
| |
Collapse
|
10
|
Guilbaud T, Girard E, Lemoine C, Schlienger G, Alao O, Risse O, Berdah S, Chirica M, Moutardier V, Birnbaum DJ. Intra-pancreatic distal cholangiocarcinoma and pancreatic ductal adenocarcinoma: a common short and long-term prognosis? Updates Surg 2021; 73:439-450. [PMID: 33486711 DOI: 10.1007/s13304-021-00981-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/12/2021] [Indexed: 01/04/2023]
Abstract
The aim of the study was to compare histological features, postoperative outcomes, and long-term prognostic factors after pancreaticoduodenectomy for distal cholangiocarcinoma and pancreatic ductal adenocarcinoma. From 2005 to 2017, 188 pancreaticoduodenectomies (pancreatic ductal adenocarcinoma n = 151, distal cholangiocarcinoma n = 37) were included. Postoperative outcomes were compared after matching on pancreatic gland texture and main pancreatic duct size. Matching according to tumor size, lymph node invasion and resection margin was used to compare overall and disease-free survival. Distal cholangiocarcinoma patients had more often "soft" pancreatic gland (P = 0.002) and small size main pancreatic duct (P = 0.001). Pancreatic ductal adenocarcinoma patients had larger tumors (P = 0.009), and higher lymph node ratio (P = 0.017). Severe morbidity (P = 0.023) and clinically relevant pancreatic fistula (P = 0.018) were higher in distal cholangiocarcinoma patients. After matching on gland texture and main pancreatic duct diameter, clinically relevant postoperative pancreatic fistula was still more frequent in distal cholangiocarcinoma patients (P = 0.007). Tumor size > 20 mm was predictive of impaired overall survival (P = 0.024) and disease-free survival (P = 0.003), tumor differentiation (P = 0.027) was predictive of impaired overall survival. Survival outcomes for distal cholangiocarcinoma and pancreatic ductal cholangiocarcinoma were similar after matching patients according to tumor size, lymph node invasion and resection margin. Long-term outcomes after pancreaticoduodenectomy for distal cholangiocarcinoma and pancreatic ductal adenocarcinoma patients are similar. Postoperative course is more complicated after pancreaticoduodenectomy for distal cholangiocarcinoma than pancreatic ductal adenocarcinoma. After pancreaticoduodenectomy, patients with distal cholangiocarcinoma and pancreatic ductal adenocarcinoma have similar long-term oncological outcomes.
Collapse
Affiliation(s)
- Théophile Guilbaud
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
| | - Edouard Girard
- Department of Digestive Surgery and Liver Transplantation, Hôpital Michallon, Grenoble University, Grenoble, France
| | - Coralie Lemoine
- Self Perceived Health Assessment Research Unit and Department of Public Health, Aix-Marseille University, Marseille, France
| | - Ghislain Schlienger
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - Oyekashopefoluw Alao
- Department of Digestive Surgery and Liver Transplantation, Hôpital Michallon, Grenoble University, Grenoble, France
| | - Olivier Risse
- Department of Digestive Surgery and Liver Transplantation, Hôpital Michallon, Grenoble University, Grenoble, France
| | - Stéphane Berdah
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - Mircea Chirica
- Department of Digestive Surgery and Liver Transplantation, Hôpital Michallon, Grenoble University, Grenoble, France
| | - Vincent Moutardier
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| |
Collapse
|
11
|
Vanbrugghe C, Bège T, Julien C, Birnbaum DJ. Small bowel obstruction secondary to gallstone migration from duodenal diverticulum after gastric bypass. Surg Obes Relat Dis 2020; 16:2127-2128. [PMID: 33127322 DOI: 10.1016/j.soard.2020.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Charles Vanbrugghe
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Marseille, France
| | - Thierry Bège
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Marseille, France
| | - Clément Julien
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Marseille, France
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Marseille, France.
| |
Collapse
|
12
|
Vanbrugghe C, Birnbaum DJ, Boucekine M, Ewald J, Marchese U, Guilbaud T, Berdah SV, Moutardier V. Prospective study on predictability of complications by pancreatic surgeons. Langenbecks Arch Surg 2020; 405:155-163. [PMID: 32285190 DOI: 10.1007/s00423-020-01866-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/20/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE We evaluated the intuition of expert pancreatic surgeons, in predicting the associated risk of pancreatic resection and compared this "intuition" to actual operative follow-up. The objective was to avoid major complications following pancreatic resection, which remains a challenge. METHODS From January 2015 to February 2018, all patients who were 18 years old or more undergoing a pancreatic resection (pancreaticoduodenectomy [PD], distal pancreatectomy [DP], or central pancreatectomy [CP]) for pancreatic lesions were included. Preoperatively and postoperatively, all surgeons completed a form assessing the expected potential occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF: grade B or C), postoperative hemorrhage, and length of stay. RESULTS Preoperative intuition was assessed for 101 patients for 52 PD, 44 DP, and 5 CP cases. Overall mortality and morbidity rates were 6.9% (n = 7) and 67.3% (n = 68), respectively, and 38 patients (37.6%) developed a POPF, including 27 (26.7%) CR-POPF. Concordance between preoperative intuition of CR-POPF occurrence and reality was minimal, with a Cohen's kappa coefficient (κ) of 0.175 (P value = 0.009), and the same result was obtained between postoperative intuition and reality (κ = 0.351; P < 0.001). When the pancreatic parenchyma was hard, surgeons predicted the absence of CR-POPF with a negative predictive value of 91.3%. However, they were not able to predict the occurrence of CR-POPF when the pancreas was soft (positive predictive value 48%). CONCLUSIONS This study assessed for the first time the surgeon's intuition in pancreatic surgery, and demonstrated that pancreatic surgeons cannot accurately assess outcomes except when the pancreatic parenchyma is hard.
Collapse
Affiliation(s)
- Charles Vanbrugghe
- Department of Digestive Surgery, Hospital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France.
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hospital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Mohamed Boucekine
- EA 3279 - Self-perceived Health Assessment Research Unit, Aix-Marseille University, 13005, Marseille, France
| | - Jacques Ewald
- Department of Digestive Surgery and Oncology, Institut Paoli Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France
| | - Ugo Marchese
- Department of Digestive Surgery and Oncology, Institut Paoli Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France
| | - Théophile Guilbaud
- Department of Digestive Surgery, Hospital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Stéphane Victor Berdah
- Department of Digestive Surgery, Hospital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| | - Vincent Moutardier
- Department of Digestive Surgery, Hospital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France
| |
Collapse
|
13
|
Guilbaud T, Berbis P, Birnbaum DJ. Glucagonoma with Paraneoplasic Dermatitis: Diagnosis and Management. J Gastrointest Surg 2020; 24:701-703. [PMID: 31152349 DOI: 10.1007/s11605-019-04267-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/10/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Théophile Guilbaud
- Department of Digestive surgery, Hôpital Nord, Université Aix-Marseille, France, Hôpital Nord, Chemin des Bourrely 13915, cedex 20, Marseille, France.
| | - Philippe Berbis
- Department of Dermatology, Hôpital Nord, Université Aix-Marseille, France, Hôpital Nord, Chemin des Bourrely 13915, cedex 20, Marseille, France
| | - David Jérémie Birnbaum
- Department of Digestive surgery, Hôpital Nord, Université Aix-Marseille, France, Hôpital Nord, Chemin des Bourrely 13915, cedex 20, Marseille, France
| |
Collapse
|
14
|
Delayre T, Guilbaud T, Resseguier N, Mamessier E, Rubis M, Moutardier V, Fara R, Berdah SV, Garcia S, Birnbaum DJ. Prognostic impact of tumour-infiltrating lymphocytes and cancer-associated fibroblasts in patients with pancreatic adenocarcinoma of the body and tail undergoing resection. Br J Surg 2020; 107:720-733. [PMID: 31960955 DOI: 10.1002/bjs.11434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/20/2019] [Accepted: 10/28/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The prognosis of patients with pancreatic cancer remains poor and novel therapeutic targets are required urgently. Treatment resistance could be due to the tumour microenvironment, a desmoplastic stroma consisting of cancer-associated fibroblasts and tumour-infiltrating lymphocytes (TILs). The aim of the study was to evaluate the prognostic value of TILs and cancer-associated fibroblasts (CAFs) in pancreatic cancer of the body and tail. METHODS Using tissue microarray from resected left-sided pancreatic cancer specimens, the immunohistochemistry of TILs (cluster of differentiation (CD) 45, CD3, CD4, FoxP3 and CD8), CAFs (vimentin and α-smooth muscle actin (αSMA)) and functional markers (PD-L1 and Ki-67) was examined, and the association with disease-free (DFS) and overall (OS) survival investigated using a computer-assisted quantitative analysis. Patients were classified into two groups, with low or high levels or ratios, using the 75th percentile value as the cut-off. RESULTS Forty-three patients were included in the study. Their median DFS and OS were 9 and 27 months respectively. A high CD4/CD3 lymphocyte ratio was associated with poorer DFS (8 months versus 11 months for a low ratio) (hazard ratio (HR) 2·23, 95 per cent c.i. 1·04 to 4·61; P = 0·041) and OS (13 versus 27 months respectively) (HR 2·62, 1·11 to 5·88; P = 0·028). A low αSMA/vimentin ratio together with a high CD4/CD3 ratio was correlated with poorer outcomes. No significant association was found between Ki-67, PD-L1 and survival. CONCLUSION In patients with resected left-sided pancreatic cancer, a tumour microenvironment characterized by a high CD4/CD3 lymphocyte ratio along with a low αSMA/vimentin ratio is correlated with poorer survival.
Collapse
Affiliation(s)
- T Delayre
- Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Faculté de Médecine de Marseille, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - T Guilbaud
- Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Faculté de Médecine de Marseille, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - N Resseguier
- Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Faculté de Médecine de Marseille, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - E Mamessier
- Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Faculté de Médecine de Marseille, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - M Rubis
- Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Faculté de Médecine de Marseille, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - V Moutardier
- Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Faculté de Médecine de Marseille, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - R Fara
- Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Faculté de Médecine de Marseille, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - S V Berdah
- Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Faculté de Médecine de Marseille, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - S Garcia
- Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Faculté de Médecine de Marseille, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - D J Birnbaum
- Digestive and Oncological Surgery Unit, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Faculté de Médecine de Marseille, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| |
Collapse
|
15
|
Abstract
Purpose. Anastomotic leak is the main complication after low colorectal anastomosis. Defunctioning ileostomy is therefore recommended, which carries its own morbidity. The aim of this study was to assess the technical feasibility, safety, and preliminary efficacy of a vacuum-based intra-colonic diverting device (Colovac) to reduce the impact of anastomotic leak. Methods. This prospective preclinical study was conducted on living swine. The device was surgically inserted transanally, proximal to a colorectal anastomosis, and removed endoscopically at day 14. Then, open surgery was performed to look for deep sepsis and/or anastomotic leak, and the remaining colorectal anastomosis was resected for histopathological analysis. The endpoints were successful insertion and delivery of the device, postoperative morbidity, successful maintaining of the device, and absence of feces spillage and/or abscess in the abdominal cavity. Results. The Colovac was inserted in 22 swine. Stent migration occurred in 7 of the first 8 specimens, leading to natural expulsion of the device. After diet adaptation, a subsequent group of 14 swine was undertaken, of which 13 did not show any sign of migration post-implantation. Disconnection of the suction drain occurred in 1 case, leading to device expulsion on day 10. Colovac retrieval was achieved successfully in 13 cases. The endoscopic assessment of the anchorage site showed limited mucosal injury, whereas histopathological findings revealed mild hyperplasia. One swine died prematurely of postoperative colonic ischemia. Conclusion. This new device appears to be safe in the swine model and may prevent peritonitis or abscess due to colorectal anastomotic leak.
Collapse
Affiliation(s)
- Charam Khosrovani
- 1 Department of Digestive Surgery, Capio-Fontvert Clinic, Sorgues, France
| | - David Jérémie Birnbaum
- 2 Centre for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France.,3 Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Stéphane Berdah
- 2 Centre for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France.,3 Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Laura Beyer-Berjot
- 2 Centre for Surgical Teaching and Research (CERC), Aix-Marseille University, Marseille, France.,3 Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| |
Collapse
|
16
|
Birnbaum DJ, Finetti P, Birnbaum D, Mamessier E, Bertucci F. XPO1 Expression Is a Poor-Prognosis Marker in Pancreatic Adenocarcinoma. J Clin Med 2019; 8:E596. [PMID: 31052304 PMCID: PMC6572621 DOI: 10.3390/jcm8050596] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/26/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022] Open
Abstract
Pancreatic adenocarcinoma (PAC) is one of the most aggressive human cancers and new systemic therapies are urgently needed. Exportin-1 (XPO1), which is a member of the importin-β superfamily of karyopherins, is the major exporter of many tumor suppressor proteins that are involved in the progression of PAC. Promising pre-clinical data using XPO1 inhibitors have been reported in PAC, but very few data are available regarding XPO1 expression in clinical samples. Retrospectively, we analyzed XPO1 mRNA expression in 741 pancreatic samples, including 95 normal, 73 metastatic and 573 primary cancers samples, and searched for correlations with clinicopathological and molecular data, including overall survival. XPO1 expression was heterogeneous across the samples, higher in metastatic samples than in the primary tumors, and higher in primaries than in the normal samples. "XPO1-high" tumors were associated with positive pathological lymph node status and aggressive molecular subtypes. They were also associated with shorter overall survival in both uni- and multivariate analyses. Supervised analysis between the "XPO1-high" and "XPO1-low" tumors identified a robust 268-gene signature, whereby ontology analysis suggested increased XPO1 activity in the "XPO1-high" tumors. XPO1 expression refines the prognostication in PAC and higher expression exists in secondary versus primary tumors, which supports the development of XPO1 inhibitors in this so-lethal disease.
Collapse
Affiliation(s)
- David Jérémie Birnbaum
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, F-13273 Marseille, France.
- Département d'Oncologie Médicale, Institut Paoli-Calmettes, F-13273 Marseille, France.
- Département de Chirurgie Générale et Viscérale, AP-HM, F-13000 Marseille, France.
| | - Pascal Finetti
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, F-13273 Marseille, France.
| | - Daniel Birnbaum
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, F-13273 Marseille, France.
| | - Emilie Mamessier
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, F-13273 Marseille, France.
| | - François Bertucci
- Laboratoire d'Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, Aix-Marseille Université, INSERM UMR1068, CNRS UMR725, F-13273 Marseille, France.
- Département d'Oncologie Médicale, Institut Paoli-Calmettes, F-13273 Marseille, France.
| |
Collapse
|
17
|
Guilbaud T, Birnbaum DJ. Reply to: The cystic duct syndrome is still actual. Surgery 2019; 166:1198-1199. [PMID: 30979426 DOI: 10.1016/j.surg.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Théophile Guilbaud
- Department of Digestive Surgery, Hôpital Nord, Aix Marseille University, France.
| | | |
Collapse
|
18
|
Birnbaum DJ, Bertucci F, Finetti P, Birnbaum D, Mamessier E. Head and Body/Tail Pancreatic Carcinomas Are Not the Same Tumors. Cancers (Basel) 2019; 11:cancers11040497. [PMID: 30965637 PMCID: PMC6520848 DOI: 10.3390/cancers11040497] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [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: 02/07/2019] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 12/23/2022] Open
Abstract
The association between pancreatic ductal adenocarcinoma (PDAC) location (head vs. Body/Tail (B/T)) and clinical outcome remains controversial. We collected clinicopathological and gene expression data from 249 resected PDAC samples from public data sets, and we compared data between 208 head and 41 B/T samples. The 2-year overall survival (OS) was better for the head than for the B/T PDACs (44 vs. 27%, p = 0.043), especially when comparing tumors with similar TNM classification (T3/4N0M0: 67% vs. 17%, p = 0.002) or from the same molecular class (squamous subtype: 31% vs. 0%, p < 0.0001). Bailey's molecular subtypes were differentially distributed within the two groups, with the immunogenic subtype being underrepresented in the "B/T" group (p = 0.005). Uni- and multivariate analyses indicated that PDAC anatomic location was an independent prognostic factor. Finally, the supervised analysis identified 334 genes differentially expressed. Genes upregulated in the "head" group suggested lymphocyte activation and pancreas exocrine functions. Genes upregulated in the "B/T" group were related to keratinocyte differentiation, in line with the enrichment for squamous phenotype. We identified a robust gene expression signature (GES) associated with B/T PDAC location, suggesting that head and B/T PDAC are different. This GES could serve as an indicator for differential therapeutic management based on PDAC location.
Collapse
Affiliation(s)
- David Jérémie Birnbaum
- Laboratoire Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR725, Aix-Marseille Université, 13273 Marseille, France.
- Faculté de Médecine, Aix-Marseille Université, 13385 Marseille, France.
- Département de Chirurgie Générale et Viscérale, AP-HM, 13015 Marseille, France.
| | - François Bertucci
- Laboratoire Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR725, Aix-Marseille Université, 13273 Marseille, France.
- Faculté de Médecine, Aix-Marseille Université, 13385 Marseille, France.
- Département d'Oncologie Médicale, Institut Paoli-Calmettes, 13009 Marseille, France.
| | - Pascal Finetti
- Laboratoire Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR725, Aix-Marseille Université, 13273 Marseille, France.
| | - Daniel Birnbaum
- Laboratoire Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR725, Aix-Marseille Université, 13273 Marseille, France.
| | - Emilie Mamessier
- Laboratoire Oncologie Prédictive, Centre de Recherche en Cancérologie de Marseille, INSERM UMR1068, CNRS UMR725, Aix-Marseille Université, 13273 Marseille, France.
| |
Collapse
|
19
|
Guilbaud T, Scemama U, Lestelle V, Orsoni PC, Birnbaum DJ. Unfortunate adverse event resulting from clip migration after cholecystectomy. Surgery 2019. [DOI: 10.1016/j.surg.2018.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
20
|
Guilbaud T, Birnbaum DJ, Loubière S, Bonnet J, Chopinet S, Grégoire E, Berdah S, Hardwigsen J, Moutardier V. Comparison of different feeding regimes after pancreatoduodenectomy - a retrospective cohort analysis. Nutr J 2017; 16:42. [PMID: 28676052 PMCID: PMC5496601 DOI: 10.1186/s12937-017-0265-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/25/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Delayed gastric emptying (DGE) is the most frequent pancreatic specific complication (PSC) after pancreaticoduodenectomy (PD). Several gastric decompression systems exist to manage DGE. Patients with a pancreatic tumor require prolonged nutrition; however, controversies exist concerning nutrition protocol after PD. The aim of the study was to assess the safety and efficacy of nasogastric (NG), gastrostomy (GT), and gastrojejunostomy (GJ) tubes with different feeding systems on postoperative courses. METHODS Between January 2013 and March 2016, 86 patients underwent PD with pancreaticogastrostomy. Patients were divided into three groups: GJ group with enteral nutrition (EN, n = 12, 14%), NG (n = 31, 36%) and GT groups (n = 43, 50%), both with total parenteral nutrition (TPN). RESULTS Patients in the GJ (n = 9, 75%) and GT (n = 18, 42%) groups had an American Society of Anesthesiologists (ASA) score of 3 more often than those in the NG group (n = 5, 16%, p ≤ 0.01). Multivariate analysis identified the GT tube with TPN as an independent risk factor of severe morbidity (p = 0.02) and DGE (p < 0.01). An ASA score of 3, jaundice, common pancreatic duct size ≤3 mm and soft pancreatic gland texture (p < 0.05) were found as independent risk factors of PSCs. Use of a GJ tube with EN, GT tube with TPN, jaundice, and PSCs were identified as independent risk factors for greater postoperative length of hospital stay (p < 0.01). Mean global hospitalization cost did not differ between groups. CONCLUSION GT tube insertion with TPN was associated with increased severe postoperative morbidity and DGE and should not be recommended. EN through a GJ tube after PD is feasible but does not have clear advantages on postoperative courses compared to an NG tube.
Collapse
Affiliation(s)
- Théophile Guilbaud
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely 13915, cedex 20, Marseille, France.
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely 13915, cedex 20, Marseille, France
| | - Sandrine Loubière
- Self perceived Health Assessment Research Unit and Department of Public health, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, cedex 20, Marseille, France
| | - Julien Bonnet
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely 13915, cedex 20, Marseille, France
| | - Sophie Chopinet
- Department of Digestive Surgery and Liver Transplantation, Hôpital La Timone, Aix-Marseille University, 264 Rue Saint-Pierre 13385, cedex 20, Marseille, France
| | - Emilie Grégoire
- Department of Digestive Surgery and Liver Transplantation, Hôpital La Timone, Aix-Marseille University, 264 Rue Saint-Pierre 13385, cedex 20, Marseille, France
| | - Stéphane Berdah
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely 13915, cedex 20, Marseille, France
| | - Jean Hardwigsen
- Department of Digestive Surgery and Liver Transplantation, Hôpital La Timone, Aix-Marseille University, 264 Rue Saint-Pierre 13385, cedex 20, Marseille, France
| | - Vincent Moutardier
- Department of Digestive Surgery, Hôpital Nord, Aix-Marseille University, Chemin des Bourrely 13915, cedex 20, Marseille, France
| |
Collapse
|
21
|
Vanbrugghe C, Birnbaum DJ, Berdah SV. Experimental Procedure of Compression Anastomosis Using Fragmented Rings: A Porcine Model. Surg Innov 2017; 24:233-239. [PMID: 28492355 DOI: 10.1177/1553350617693125] [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: 11/15/2022]
Abstract
BACKGROUND Compression anastomosis has been recently abandoned because of a nonsuperiority compared to stapling anastomosis. Nonremoval of the rings has frequently been reported and this technique does not support a routine use. The aim of this experimental study was to assess the feasibility of anastomosis using compression with a device consisting of fragmented rings. METHODS A new compression device, the "Anastocom," was compared to standard double-stapled colocolonic anastomosis in 2 groups of 8 pigs. In each group, colocolonic anastomosis was performed with a circular stapler (DST Series EEA Staplers) in 4 pigs and with the Anastocom device for the other 4 pigs. RESULTS The anastomotic rings were expelled between postoperative day 7 and day 13 from the 4 animals sacrificed at day 30. The anastomosis was clean and intact in all pigs. After sacrifice, there was no difference in the bursting pressure at day 7 ( P = .226) or at day 30 ( P = .885) between the 2 types of anastomosis. After sacrifice at day 7, the mean bursting pressure values for the Anastocom and EEA anastomoses were 128.6 mm Hg (range 119-143 mm Hg) and 218.9 mm Hg (range 84-240 mm Hg), respectively. After sacrifice at day 30, the mean bursting pressure values for the Anastocom and EEA anastomoses were 111 mm Hg (range 59-234 mm Hg) and 105 mm Hg (range 81-130 mmHg), respectively. CONCLUSION No bowel obstruction was observed with Anastocom. This fragmentation mechanism should better prevent nonexpulsion compared to basic compression anastomosis.
Collapse
|
22
|
Guilbaud T, Birnbaum DJ, Duconseil P, Soussan J, Moutardier V. Portal vein aneurysm incidentaloma. Surgery 2016; 162:1177-1178. [PMID: 27871687 DOI: 10.1016/j.surg.2016.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 02/08/2023]
Affiliation(s)
- Théophile Guilbaud
- Department of Digestive Surgery, Hôpital Nord, Aix Marseille University, Marseille, France.
| | - David Jérémie Birnbaum
- Department of Digestive Surgery, Hôpital Nord, Aix Marseille University, Marseille, France
| | - Pauline Duconseil
- Department of Digestive Surgery, Hôpital Nord, Aix Marseille University, Marseille, France
| | - Jérôme Soussan
- Department of Radiology, Hôpital Nord, Aix Marseille University, Marseille, France
| | - Vincent Moutardier
- Department of Digestive Surgery, Hôpital Nord, Aix Marseille University, Marseille, France
| |
Collapse
|
23
|
Ajandouz EH, Berdah S, Moutardier V, Bege T, Birnbaum DJ, Perrier J, Di Pasquale E, Maresca M. Hydrolytic Fate of 3/15-Acetyldeoxynivalenol in Humans: Specific Deacetylation by the Small Intestine and Liver Revealed Using in Vitro and ex Vivo Approaches. Toxins (Basel) 2016; 8:toxins8080232. [PMID: 27483321 PMCID: PMC4999848 DOI: 10.3390/toxins8080232] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 07/19/2016] [Indexed: 12/26/2022] Open
Abstract
In addition to deoxynivalenol (DON), acetylated derivatives, i.e., 3-acetyl and 15-acetyldexynivalenol (or 3/15ADON), are present in cereals leading to exposure to these mycotoxins. Animal and human studies suggest that 3/15ADON are converted into DON after their ingestion through hydrolysis of the acetyl moiety, the site(s) of such deacetylation being still uncharacterized. We used in vitro and ex vivo approaches to study the deacetylation of 3/15ADON by enzymes and cells/tissues present on their way from the food matrix to the blood in humans. We found that luminal deacetylation by digestive enzymes and bacteria is limited. Using human cells, tissues and S9 fractions, we were able to demonstrate that small intestine and liver possess strong deacetylation capacity compared to colon and kidneys. Interestingly, in most cases, deacetylation was more efficient for 3ADON than 15ADON. Although we initially thought that carboxylesterases (CES) could be responsible for the deacetylation of 3/15ADON, the use of pure human CES1/2 and of CES inhibitor demonstrated that CES are not involved. Taken together, our original model system allowed us to identify the small intestine and the liver as the main site of deacetylation of ingested 3/15ADON in humans.
Collapse
Affiliation(s)
| | - Stéphane Berdah
- Aix Marseille Univ, Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR, Faculté de médecine secteur Nord, Boulevard Pierre Dramard, F-13916 Marseille Cedex 20, France.
| | - Vincent Moutardier
- Aix Marseille Univ, Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR, Faculté de médecine secteur Nord, Boulevard Pierre Dramard, F-13916 Marseille Cedex 20, France.
| | - Thierry Bege
- Aix Marseille Univ, Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR, Faculté de médecine secteur Nord, Boulevard Pierre Dramard, F-13916 Marseille Cedex 20, France.
| | - David Jérémie Birnbaum
- Aix Marseille Univ, Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR, Faculté de médecine secteur Nord, Boulevard Pierre Dramard, F-13916 Marseille Cedex 20, France.
| | - Josette Perrier
- Aix Marseille Univ, CNRS, Centrale Marseille, iSm2, Marseille, France.
| | - Eric Di Pasquale
- Aix Marseille Univ, CNRS, CRN2M, Marseille, France & CSO@MyEnterix, Marseille, France.
| | - Marc Maresca
- Aix Marseille Univ, CNRS, Centrale Marseille, iSm2, Marseille, France.
| |
Collapse
|
24
|
Vanbrugghe C, Birnbaum DJ, Bege T. Use of a self-adherent parietal traction mesh to close laparostomy (with video). J Visc Surg 2016; 153:73-4. [PMID: 26750631 DOI: 10.1016/j.jviscsurg.2015.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- C Vanbrugghe
- Department of digestive surgery, Hôpital Nord, university Aix-Marseille, chemin des Bourrely, 13015 Marseille, France.
| | - D J Birnbaum
- Department of digestive surgery, Hôpital Nord, university Aix-Marseille, chemin des Bourrely, 13015 Marseille, France
| | - T Bege
- Department of digestive surgery, Hôpital Nord, university Aix-Marseille, chemin des Bourrely, 13015 Marseille, France
| |
Collapse
|
25
|
Viganò L, Birnbaum DJ. Reply to: "Gallbladder cancer: Nihilism abates, optimism prevails". Eur J Surg Oncol 2015; 41:1444-5. [PMID: 26233820 DOI: 10.1016/j.ejso.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/03/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- L Viganò
- Department of Hepatobiliary & General Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, MI, Italy.
| | - D J Birnbaum
- AP-HM, Hôpital Nord, Department of Digestive Surgery, Marseille, France
| |
Collapse
|
26
|
Meillat H, Birnbaum DJ, Fara R, Mancini J, Berdah S, Bège T. Do height and weight affect the feasibility of single-incision laparoscopic cholecystectomy? Surg Endosc 2015; 29:3594-9. [PMID: 25759236 DOI: 10.1007/s00464-015-4115-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 11/09/2014] [Accepted: 02/13/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the gold standard for gallbladder removal and the most common laparoscopic procedure worldwide. Single-incision laparoscopic surgery has recently emerged as a less invasive potential alternative to conventional three- or four-port laparoscopy. However, the feasibility of single-incision laparoscopic cholecystectomy (SILC) remains unclear, and there are no rigorous criteria in the literature. Identifying patients at risk of failure of this new technique is essential. The aim of our study was to determine risk factors that may predict failure of the procedure. METHODS From May 2010 to March 2012, 110 consecutive patients underwent SILC and were reviewed retrospectively. The main feasibility criterion was the procedure failure rate, defined as addition of supplementary port(s) and prolonged (>60 min) operative time. The factors evaluated were age, gender, height, weight, body mass index, previous abdominal surgery, indication for surgery and gallbladder suspension. RESULTS There was conversion in 16 patients (14.5%), and the operative time exceeded 60 min for 20 patients (30.9%). Univariate analysis showed a significant independent association between additional port requirement and each of weight as a continuous value, weight ≥80 kg, BMI >26.5 kg/m(2) and height >172 cm. Univariate analysis also showed a significant independent association between prolonged operative duration (>60 min) and each of height and weight as continuous values, height >172 cm and previous abdominal surgery. In the multivariate analysis, only weight remained independently associated with additional port requirement, and height remained independently associated with prolonged operative duration. CONCLUSION Preoperative identification of the factors increasing the risk of conversion may assist surgeons in making decisions concerning the management of patients, including appropriate use of SILC.
Collapse
Affiliation(s)
- Hélène Meillat
- Departments of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
| | - David Jérémie Birnbaum
- Departments of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - Régis Fara
- Department of Digestive Surgery and Liver Transplantation, Hôpital La Conception, Aix-Marseille Université, Marseille, France
| | - Julien Mancini
- Inserm, IRD, UM 62 SESSTIM, Aix Marseille Université, 13385, Marseille, France
- Public Health Department, APHM, BiosTIC, Hôpital de la Timone, 13385, Marseille, France
| | - Stéphane Berdah
- Departments of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - Thierry Bège
- Departments of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
| |
Collapse
|
27
|
Birnbaum DJ, Viganò L, Russolillo N, Langella S, Ferrero A, Capussotti L. Lymph node metastases in patients undergoing surgery for a gallbladder cancer. Extension of the lymph node dissection and prognostic value of the lymph node ratio. Ann Surg Oncol 2014; 22:811-8. [PMID: 25201500 DOI: 10.1245/s10434-014-4044-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Lymph node (LN) status is one of the strongest prognostic factors after gallbladder cancer (GBC) resection. The adequate extension of LN dissection and the stratification of the prognosis in N+ patients have been debated. The present study aims to clarify these issues. METHODS A total of 112 consecutive patients who underwent operations for GBC with LN dissection were analyzed. Twenty-five patients (22.3%) had D1 dissection (hepatic pedicle), and 87 (77.7%) had D2 dissection (hepatic pedicle, celiac and retro-pancreatic area). The LN ratio (LNR) was computed as follows: number of metastatic LNs/number of retrieved LNs. RESULTS The median number of retrieved LNs was 7 (1-35). Fifty-nine patients (52.7%) had LN metastases (22 N2). D2 dissection allowed the retrieval of more LNs (8 vs. 3, p = 0.0007), with similar short-term outcomes. Common bile duct (CBD) resection (n = 41) did not increase the number of retrieved LNs. In five patients, D2 dissection identified skip LN metastases that otherwise would have been missed. LN metastases negatively impacted survival (5-years survival 57.2% if N0 vs. 12.4% if N+, p < 0.0001), but N1 and N2 patients had similar survival rates. The number of LN+ (1-3 vs. ≥4) did not impact prognosis. An LNR = 0.15 stratified the prognosis of N+ patients: 5-years survival 32.7% if LNR ≤ 0.15 vs. 10.3% if LNR > 0.15 (multivariate analysis p = 0.007). CONCLUSIONS A D2 LN dissection is recommended in all patients, because it allows for better staging. CBD resection does not improve LN dissection. An LNR = 0.15, not the site of metastatic LNs, stratified the prognoses of N+ patients.
Collapse
Affiliation(s)
- David Jérémie Birnbaum
- Department of HPB and Digestive Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| | | | | | | | | | | |
Collapse
|
28
|
Birnbaum DJ, Turrini O, Vigano L, Russolillo N, Autret A, Moutardier V, Capussotti L, Le Treut YP, Delpero JR, Hardwigsen J. Surgical management of advanced pancreatic neuroendocrine tumors: short-term and long-term results from an international multi-institutional study. Ann Surg Oncol 2014; 22:1000-7. [PMID: 25190116 DOI: 10.1245/s10434-014-4016-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The role of extended resections in the management of advanced pancreatic neuroendocrine tumors (PNETs) is not well defined. METHODS Between 1995 and 2012, 134 patients with PNET underwent isolated (isoPNET group: 91 patients) or extended pancreatic resection (synchronous liver metastases and/or adjacent organs) (advPNET group: 43 patients). RESULTS The associated resections included 27 hepatectomies, 9 vascular resections, 12 colectomies, 10 gastrectomies, 4 nephrectomies, 4 adrenalectomies, and 3 duodenojejunal resections. R0 was achieved in 41 patients (95%) in the advPNET. The rates of T3-T4 (73 vs 16%; p < .0001) and N+ (35 vs 13%; p = .007) were higher in the advPNET group. Mortality (5 vs 2%) and major morbidity (21 vs 19%) rates were similar between the 2 groups. The 5-year overall survival (OS) of the series was 87% in the isoPNET group and 66% in the advPNET group (p = .006). Only patients with both locally advanced disease and liver metastases showed worse survival (p = .0003). The advPNET group developed recurrence earlier [disease-free survival (DFS) at 5 years: 26 vs 81%; p < .001]. In univariate analysis, negative prognostic factors of survival were: poor degree of differentiation (p < .001), liver metastasis (p = .011), NE carcinoma (p < .001), and resection of adjacent organs (p = .013). The multivariate analysis did not highlight any factor that influenced OS. In multivariate analysis independent DFS factors were a poor degree of differentiation (p = .03) and the European Neuroendocrine Tumor Society stage (p = .01). CONCLUSIONS An aggressive surgical approach for locally advanced or metastatic tumors is safe and offers long-term survival.
Collapse
|
29
|
Abstract
Isolated pancreatic metastasis from malignant melanoma (IPMMM) is rare because most melanoma patients already have a widespread disease at diagnosis. No adjuvant systemic treatment is known to be efficient in this setting. Experience with pancreatic resection for IPMMM is limited and controversial. We report here the case of an IPMMM patient successfully treated by pancreaticoduodenectomy with a prolonged survival of 6 years.
Collapse
Affiliation(s)
- David Jérémie Birnbaum
- Department of Surgical Oncology, Institute Paoli-Calmettes and University of the Mediterranée, Marseille, France
| | - Vincent Moutardier
- Department of Surgical Oncology, Institute Paoli-Calmettes and University of the Mediterranée, Marseille, France
| | - Olivier Turrini
- Department of Surgical Oncology, Institute Paoli-Calmettes and University of the Mediterranée, Marseille, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institute Paoli-Calmettes and University of the Mediterranée, Marseille, France
| | - Jean Robert Delpero
- Department of Surgical Oncology, Institute Paoli-Calmettes and University of the Mediterranée, Marseille, France
| |
Collapse
|
30
|
Abstract
Midgut malrotation (MMR) is a congenital anomaly referring to either nonrotation or incomplete rotation of the primitive intestinal loop around the axis of the superior mesenteric artery during fetal development. Adult MMR is rare and majority of MMR in adults remains asymptomatic throughout life. The increasing use of diagnostic imaging for acute abdominal pain will lead to more incidental recognitions of MMR. Up to now, surgical treatment has been guided by the experience from pediatric surgery, and Ladd's procedure has been the treatment of choice in adults with MMR. However, a major dilemma arises when patients are essentially asymptomatic and incidentally diagnosed with MMR during another abdominal affection like acute appendicitis. The surgeon has to decide whether it is necessary to also treat the MMR. Here, we report a rare case of a 37-year-old patient with acute left side appendicitis in association with asymptomatic MMR. We discuss whether correction of the asymptomatic malrotation was indicated.
Collapse
Affiliation(s)
- David Jérémie Birnbaum
- Department of Visceral and Thoracic Surgery, Hôpital d'Instruction des Armées A. Laveran, Marseille Armées, France
| | - Yann Geffroy
- Department of Radiology, Hôpital d'Instruction des Armées A. Laveran, Marseille Armées, France
| | - Géraldine Goin
- Department of Visceral and Thoracic Surgery, Hôpital d'Instruction des Armées A. Laveran, Marseille Armées, France
| | - Paul Balandraud
- Department of Visceral and Thoracic Surgery, Hôpital d'Instruction des Armées A. Laveran, Marseille Armées, France
| |
Collapse
|
31
|
Birnbaum DJ, Gaujoux S, Cherif R, Dokmak S, Fuks D, Couvelard A, Vullierme MP, Ronot M, Ruszniewski P, Belghiti J, Sauvanet A. Sporadic nonfunctioning pancreatic neuroendocrine tumors: prognostic significance of incidental diagnosis. Surgery 2013; 155:13-21. [PMID: 24238123 DOI: 10.1016/j.surg.2013.08.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 08/12/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sporadic nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) are increasingly diagnosed as incidentalomas, and their resection is usually recommended. The prognostic significance of this diagnosis feature is poorly studied, and management of these tumors remains controversial. Clinical, pathologic characteristics and outcome of resected incidentally diagnosed NF-PNET (Inc) were compared with resected symptomatic NF-PNET (Symp) to better assess their biologic behavior and tailor their management. METHODS From 1994 to 2010, 108 patients underwent resection for sporadic nonmetastatic NF-PNET. Diagnosis was considered as incidental in patients with no abdominal symptoms or symptoms unlikely to be related to tumor mass. Patients with Inc were compared with patients with Symp, regarding demographics, postoperative course, pathology, and disease-free survival (DFS). RESULTS Of the 108 patients, 65 (61%) had incidentally diagnosed tumors. Pancreas-sparing pancreatectomies (enucleation/central pancreatectomy) were performed more frequently in Inc (62% vs 30%, P = .001). Inc tumors were more frequently <20 mm (65% vs 42%, P = .019), staged T1 (62% vs 33%, P = .0001), node negative (85% vs 60%; P = .005), and grade 1 (66% vs 33%, P = .0001). One postoperative death occurred in the Inc group, and postoperative morbidity was similar between the two groups (60% vs 65%, P = .59). DFS was substantially better in the Inc group (5-year DFS = 92% vs 82%, P = .0016). CONCLUSION Incidentally diagnosed NF-PNETs are associated with less aggressive features compared with symptomatic lesions but cannot always be considered to be benign. Operative resection remains recommended for most. Incidentally diagnosed NF-PNET may be good candidates for pancreas-sparing pancreatectomies.
Collapse
Affiliation(s)
- David Jérémie Birnbaum
- Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France
| | - Sébastien Gaujoux
- Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France; Université Paris Diderot, Paris, France; Centre de Recherche Biomédicale Bichat Beaujon (CRB3)/INSERM U773, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Rim Cherif
- Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France
| | - Safi Dokmak
- Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France
| | - David Fuks
- Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France; Université Paris Diderot, Paris, France
| | - Anne Couvelard
- Université Paris Diderot, Paris, France; Centre de Recherche Biomédicale Bichat Beaujon (CRB3)/INSERM U773, Institut National de la Santé et de la Recherche Médicale, Paris, France; Département of Pathology, AP-HP, hôpital Beaujon, Clichy, France
| | | | - Maxime Ronot
- Université Paris Diderot, Paris, France; Département of Pathology, AP-HP, hôpital Beaujon, Clichy, France; Department of Radiology, AP-HP, hôpital Beaujon, Clichy, France
| | - Philippe Ruszniewski
- Université Paris Diderot, Paris, France; Centre de Recherche Biomédicale Bichat Beaujon (CRB3)/INSERM U773, Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Gastroenterology, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France
| | - Jacques Belghiti
- Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France; Université Paris Diderot, Paris, France
| | - Alain Sauvanet
- Department of Hepato-Pancreato-Biliary Surgery - Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, Clichy, France; Université Paris Diderot, Paris, France.
| |
Collapse
|
32
|
Birnbaum DJ, Viganò L, Ferrero A, Langella S, Russolillo N, Capussotti L. Locally advanced gallbladder cancer: which patients benefit from resection? Eur J Surg Oncol 2013; 40:1008-15. [PMID: 24246608 DOI: 10.1016/j.ejso.2013.10.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/16/2013] [Accepted: 10/19/2013] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Patients with T3-4 gallbladder cancers (GBCs) often require extended surgical procedures, and up to 30% of patients have N2 metastases. This study investigated which patients with T3-4 GBC benefit from resection. METHODS Consecutive patients (n = 78) with T3-4 GBC who underwent resection between 1990 and 2011 were analysed (38 before 2003, 40 in 2003-2011). Forty patients required common bile duct (CBD) resection, 10 pancreatoduodenectomy, 4 right colectomy and 2 gastric resection. Fifty-two (67%) patients had LN metastases, including 22 with N2 metastases. RESULTS The in-hospital mortality rate was 8%, 11% before 2003 vs. 5% in 2003-2011. The morbidity rate (47%) remained stable during the study. Undergoing liver and pancreatic resection did not increase severe morbidity (0%) or mortality (10%). Sixty-seven (86%) patients had R0 resection. The 5-year survival rate was 17% (median follow-up, 65 months). Survival improved after 2002 (26% vs. 9%, p = 0.04). R1 patients had poor 3-year survival (0% vs. 32%, p = 0.001). N+ patients also had low survival (5-year survival, 10% vs. 32% in N0, p = 0.019), but N1 and N2 patients had similar outcomes. CBD resection and major hepatectomy did not worsen prognosis. Patients requiring pancreatoduodenectomy, gastric or colonic resection had 0% 3-year survival (p = 0.036 in multivariate analysis). CONCLUSIONS Resection of T3-4 GBC is worthwhile only if R0 surgery is achievable. Outcomes improved in most recent years. N2 metastases should not preclude surgery. Good results are possible even with CBD resection or major hepatectomy, while benefits from surgery are doubtful if pancreatoduodenectomy or other organ resection is needed.
Collapse
Affiliation(s)
- D J Birnbaum
- Dept. of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128 Torino, Italy
| | - L Viganò
- Dept. of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128 Torino, Italy.
| | - A Ferrero
- Dept. of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128 Torino, Italy
| | - S Langella
- Dept. of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128 Torino, Italy
| | - N Russolillo
- Dept. of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128 Torino, Italy
| | - L Capussotti
- Dept. of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128 Torino, Italy
| |
Collapse
|
33
|
Birnbaum DJ, Grègoire E, Campan P, Hardwigsen J, Le Treut YP. Primary small bowel volvulus in adult. J Emerg Med 2012; 44:e329-30. [PMID: 23062598 DOI: 10.1016/j.jemermed.2012.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 02/19/2012] [Accepted: 08/24/2012] [Indexed: 11/28/2022]
Affiliation(s)
- David Jérémie Birnbaum
- University de la Mediterranée and Assistance-Publique Hôpitaux de Marseille, Department of General Surgery and Liver Transplantation, Hospital la Conception, Marseille, France
| | | | | | | | | |
Collapse
|
34
|
Birnbaum DJ, Grégoire E, Hardwigsen J, Le Treut YP. Salvage liver transplantation for hepatic gas gangrene. J Gastrointest Surg 2012; 16:1802-4. [PMID: 22669442 DOI: 10.1007/s11605-012-1917-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/15/2012] [Indexed: 01/31/2023]
Abstract
Hepatic gas gangrene is an uncommon situation mainly due to bacterial infection by Clostridium perfringens. It remains a life-threatening condition associated with a high mortality rate. Quick diagnosis and aggressive therapy including liver transplantation should be proposed to improve the outcome. This report describes a rare case of hepatic gas gangrene on native liver, secondary to iatrogenic hepatic artery thrombosis and instrumental biliary tree infection, which was successfully treated by liver transplantation.
Collapse
Affiliation(s)
- David Jérémie Birnbaum
- Aix-Marseille Univ 13284 Marseille, & Assistance-Publique Hôpitaux de Marseille, Department of Digestive Surgery and Liver Transplantation, Hopital de La Conception, 13005 Marseille, France.
| | | | | | | |
Collapse
|
35
|
Cornen S, Adelaide J, Bertucci F, Finetti P, Guille A, Birnbaum DJ, Birnbaum D, Chaffanet M. Mutations and deletions of ARID1A in breast tumors. Oncogene 2012; 31:4255-6. [PMID: 22249247 DOI: 10.1038/onc.2011.598] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
36
|
Cazalas G, Mattei S, Birnbaum DJ, Wikberg-Lafont E, Bastide C, Marciano-Chagnaud S, Moutardier V, Chaumoitre K. [Splenogonadal fusion in an adult with intra-abdominal cryptorchidism]. J Radiol 2010; 91:726-728. [PMID: 20808277 DOI: 10.1016/s0221-0363(10)70106-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|