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Espinel Y, Rabbani N, Bui TB, Ribeiro M, Buc E, Bartoli A. Keyhole-aware laparoscopic augmented reality. Med Image Anal 2024; 94:103161. [PMID: 38574543 DOI: 10.1016/j.media.2024.103161] [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: 04/30/2023] [Revised: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
Augmented Reality (AR) from preoperative data is a promising approach to improve intraoperative tumour localisation in Laparoscopic Liver Resection (LLR). Existing systems register the preoperative tumour model with the laparoscopic images and render it by direct camera projection, as if the organ were transparent. However, a simple geometric reasoning shows that this may induce serious surgeon misguidance. This is because the tools enter in a different keyhole than the laparoscope. As AR is particularly important for deep tumours, this problem potentially hinders the whole interest of AR guidance. A remedy to this issue is to project the tumour from its internal position to the liver surface towards the tool keyhole, and only then to the camera. This raises the problem of estimating the tool keyhole position in laparoscope coordinates. We propose a keyhole-aware pipeline which resolves the problem by using the observed tool to probe the keyhole position and by showing a keyhole-aware visualisation of the tumour. We assess the benefits of our pipeline quantitatively on a geometric in silico model and on a liver phantom model, as well as qualitatively on three patient data.
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Affiliation(s)
- Yamid Espinel
- Université Clermont Auvergne, 28 place Henri Dunant, 63000 Clermont-Ferrand, France; Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Navid Rabbani
- Université Clermont Auvergne, 28 place Henri Dunant, 63000 Clermont-Ferrand, France; Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Thien Bao Bui
- SURGAR Surgery, 22 allée Alan Turing, 63000 Clermont-Ferrand, France.
| | - Mathieu Ribeiro
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Emmanuel Buc
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Adrien Bartoli
- Université Clermont Auvergne, 28 place Henri Dunant, 63000 Clermont-Ferrand, France; Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
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Laroche S, Lim C, Goumard C, Rayar M, Cherqui D, Chiche L, Barbier L, Salamé E, Mabrut JY, Lesurtel M, Truant S, Boleslawski E, Muscari F, Hobeika C, Chirica M, Buc E, Hardwigsen J, Herrero A, Navarro F, Faitot F, Bachellier P, Regimbeau JM, Laurent A, Fuks D, Soubrane O, Azoulay D, Vibert E, Scatton O. Comparing indications, complexity and outcomes of laparoscopic liver resection between centers with and without a liver transplant program: a French nationwide study. HPB (Oxford) 2024; 26:586-593. [PMID: 38341287 DOI: 10.1016/j.hpb.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND There are no data to evaluate the difference in populations and impact of centers with liver transplant programs in performing laparoscopic liver resection (LLR). METHODS This was a multicenter study including patients undergoing LLR for benign and malignant tumors at 27 French centers from 1996 to 2018. The main outcomes were postoperative severe morbidity and mortality. RESULTS A total of 3154 patients were included, and 14 centers were classified as transplant centers (N = 2167 patients, 68.7 %). The transplant centers performed more difficult LLRs and more resections for hepatocellular carcinoma (HCC) in patients who more frequently had cirrhosis. A higher rate of performing the Pringle maneuver, a lower rate of blood loss and a higher rate of open conversion (all p < 0.05) were observed in the transplant centers. There was no association between the presence of a liver transplant program and either postoperative severe morbidity (<10 % in each group; p = 0.228) or mortality (1 % in each group; p = 0.915). CONCLUSIONS Most HCCs, difficult LLRs, and cirrhotic patients are treated in transplant centers. We show that all centers can achieve comparable safety and quality of care in LLR independent of the presence of a liver transplant program.
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Affiliation(s)
- Sophie Laroche
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Chetana Lim
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Research Unit, Université de Picardie-Jules Verne, UR UPJV 7518 SSPC, Amiens, France
| | - Claire Goumard
- Sorbonne University, Paris, France; Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France
| | - Michel Rayar
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Claude Huriez Hospital, Rennes, France
| | - Daniel Cherqui
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Laurence Chiche
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Bordeaux University Hospital-Magellan Centre, Bordeaux, France
| | - Louise Barbier
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Bordeaux University Hospital-Magellan Centre, Bordeaux, France
| | - Ephrem Salamé
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Trousseau Hospital, Tours Regional University Hospital, Tours, France
| | - Jean-Yves Mabrut
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, La Croix Rousse Hospital, Lyon, France
| | - Mickael Lesurtel
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Beaujon Hospital, Clichy, France
| | - Stéphanie Truant
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Beaujon Hospital, Clichy, France
| | - Emmanuel Boleslawski
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Claude Huriez Hospital, Lille, France
| | - Fabrice Muscari
- Department of Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Rangueil Hospital, Toulouse, France
| | - Christian Hobeika
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Beaujon Hospital, Clichy, France
| | - Mircea Chirica
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Grenoble Alpes Hospital, Grenoble, France
| | - Emmanuel Buc
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Estaing Hospital, Clermont-Ferrand, France
| | - Jean Hardwigsen
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, La Timone Hospital, Marseille, France
| | - Astrid Herrero
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Saint-Eloi Hospital, Montpellier, France
| | - Francis Navarro
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Saint-Eloi Hospital, Montpellier, France
| | - François Faitot
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, Hautepierre Hospital, Strasbourg, France
| | - Philippe Bachellier
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, Hautepierre Hospital, Strasbourg, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Research Unit, Université de Picardie-Jules Verne, UR UPJV 7518 SSPC, Amiens, France
| | - Alexis Laurent
- Department of Hepato-Pancreato-Biliary Surgery, APHP Henri Mondor Hospital, Creteil, France
| | - David Fuks
- Department of Hepato-Pancreato-Biliary Surgery, APHP Cochin Hospital, Paris, France
| | - Olivier Soubrane
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris France
| | - Daniel Azoulay
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Eric Vibert
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Olivier Scatton
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France.
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Ribeiro M, Espinel Y, Rabbani N, Pereira B, Bartoli A, Buc E. Augmented Reality Guided Laparoscopic Liver Resection: A Phantom Study With Intraparenchymal Tumors. J Surg Res 2024; 296:612-620. [PMID: 38354617 DOI: 10.1016/j.jss.2023.12.014] [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: 04/24/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Augmented reality (AR) in laparoscopic liver resection (LLR) can improve intrahepatic navigation by creating a virtual liver transparency. Our team has recently developed Hepataug, an AR software that projects the invisible intrahepatic tumors onto the laparoscopic images and allows the surgeon to localize them precisely. However, the accuracy of registration according to the location and size of the tumors, as well as the influence of the projection axis, have never been measured. The aim of this work was to measure the three-dimensional (3D) tumor prediction error of Hepataug. METHODS Eight 3D virtual livers were created from the computed tomography scan of a healthy human liver. Reference markers with known coordinates were virtually placed on the anterior surface. The virtual livers were then deformed and 3D printed, forming 3D liver phantoms. After placing each 3D phantom inside a pelvitrainer, registration allowed Hepataug to project virtual tumors along two axes: the laparoscope axis and the operator port axis. The surgeons had to point the center of eight virtual tumors per liver with a pointing tool whose coordinates were precisely calculated. RESULTS We obtained 128 pointing experiments. The average pointing error was 29.4 ± 17.1 mm and 9.2 ± 5.1 mm for the laparoscope and operator port axes respectively (P = 0.001). The pointing errors tended to increase with tumor depth (correlation coefficients greater than 0.5 with P < 0.001). There was no significant dependency of the pointing error on the tumor size for both projection axes. CONCLUSIONS Tumor visualization by projection toward the operating port improves the accuracy of AR guidance and partially solves the problem of the two-dimensional visual interface of monocular laparoscopy. Despite a lower precision of AR for tumors located in the posterior part of the liver, it could allow the surgeons to access these lesions without completely mobilizing the liver, hence decreasing the surgical trauma.
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Affiliation(s)
- Mathieu Ribeiro
- Department of Digestive and Hepatobiliary Surgery, Hospital Estaing, CHU de Clermont-Ferrand, Clermont-Ferrand, France; UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Institut Pascal, Clermont-Ferrand, France
| | - Yamid Espinel
- UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Institut Pascal, Clermont-Ferrand, France
| | - Navid Rabbani
- UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Institut Pascal, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Adrien Bartoli
- UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Institut Pascal, Clermont-Ferrand, France
| | - Emmanuel Buc
- Department of Digestive and Hepatobiliary Surgery, Hospital Estaing, CHU de Clermont-Ferrand, Clermont-Ferrand, France; UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Institut Pascal, Clermont-Ferrand, France.
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Janet J, Albouys J, Napoleon B, Jacques J, Mathonnet M, Magne J, Fontaine M, de Ponthaud C, Durand Fontanier S, Bardet SSM, Bourdariat R, Sulpice L, Lesurtel M, Legros R, Truant S, Robin F, Prat F, Palazzo M, Schwarz L, Buc E, Sauvanet A, Gaujoux S, Taibi A. Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicenter Comparative Cohort Study of the ACHBT-FRENCH-SFED Intergroup. Ann Surg Oncol 2023; 30:5036-5046. [PMID: 37069476 DOI: 10.1245/s10434-023-13466-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND It is unclear whether preoperative biliary drainage (PBD) by endoscopic retrograde cholangiopancreatography (ERCP) is equivalent to electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) before pancreatoduodenectomy (PD). METHODS Patients who underwent PBD for distal malignant biliary obstruction (DMBO) followed by PD were retrospectively included in nine expert centers between 2015 and 2022. ERCP or endoscopic ultrasound-guided choledochoduodenostomy with ECE-LAMS were performed. In intent-to-treat analysis, patients drained with ECE-LAMS were considered the study group (first-LAMS group) and those drained with conventional transpapillary stent the control group (first-cannulation group). The rates of technical success, clinical success, drainage-related complications, surgical complications, and oncological outcomes were analyzed. RESULTS Among 156 patients, 128 underwent ERCP and 28 ECE-LAMS in first intent. The technical and clinical success rates were 83.5% and 70.2% in the first-cannulation group versus 100% and 89.3% in the first-LAMS group (p = 0.02 and p = 0.05, respectively). The overall complication rate over the entire patient journey was 93.7% in first-cannulation group versus 92.0% in first-LAMS group (p = 0.04). The overall endoscopic complication rate was 30.5% in first-cannulation group versus 17.9% in first-LAMS group (p = 0.25). The overall complication rate after PD was higher in the first-cannulation group than in the first-LAMS group (92.2% versus 75.0%, p = 0.016). Overall survival and progression-free survival did not differ between the groups. CONCLUSIONS PBD with ECE-LAMS is easier to deploy and more efficient than ERCP in patients with DMBO. It is associated with less surgical complications after pancreatoduodenectomy without compromising the oncological outcome.
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Affiliation(s)
- Julien Janet
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
| | - Jeremie Albouys
- Hepato-Gastroenterology Department, CHU Dupuytren, Limoges, France
- Faculté de Médecine de Limoges, Limoges, France
- CNRS, XLIM, UMR 7252, University of Limoges, Limoges, France
| | - Bertrand Napoleon
- Gastroenterology Department, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Jeremie Jacques
- Hepato-Gastroenterology Department, CHU Dupuytren, Limoges, France
- Faculté de Médecine de Limoges, Limoges, France
| | - Muriel Mathonnet
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
| | | | - Marie Fontaine
- Gastroenterology Department, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Charles de Ponthaud
- Department of HPB and Endocrine Surgery, Hôpital la pitié salpêtrière, APHP, Paris, France
| | - Sylvaine Durand Fontanier
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
- CNRS, XLIM, UMR 7252, University of Limoges, Limoges, France
| | | | - Raphael Bourdariat
- Digestive Surgery Department, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Laurent Sulpice
- Department of Digestive Surgery, CHU de Rennes, Rennes, France
- Faculté de Médecine de Rennes, Rennes, France
| | - Mickael Lesurtel
- Department of HPB Surgery, Beaujon Hospital, APHP, Clichy, France
| | - Romain Legros
- Hepato-Gastroenterology Department, CHU Dupuytren, Limoges, France
- Faculté de Médecine de Limoges, Limoges, France
- CNRS, XLIM, UMR 7252, University of Limoges, Limoges, France
| | - Stephanie Truant
- Depatment of Digestive Surgery and Transplantation, Hôpital Huriez - CHRU de Lille, Lille, France
| | - Fabien Robin
- Department of Digestive Surgery, CHU de Rennes, Rennes, France
- Faculté de Médecine de Rennes, Rennes, France
| | - Frédéric Prat
- Department of Endoscopy, Beaujon Hospital, APHP, Clichy, France
| | | | - Lilian Schwarz
- Digestive Surgery Department, CHU de Rouen, Rouen, France
| | - Emmanuel Buc
- Digestive Surgery Department, CHU de Clermont, Ferrand, France
| | - Alain Sauvanet
- Department of HPB Surgery, Beaujon Hospital, APHP, Clichy, France
| | - Sebastien Gaujoux
- Department of HPB and Endocrine Surgery, Hôpital la pitié salpêtrière, APHP, Paris, France
| | - Abdelkader Taibi
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France.
- CNRS, XLIM, UMR 7252, University of Limoges, Limoges, France.
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Janet J, Albouys J, Napoleon B, Jacques J, Mathonnet M, Magne J, Fontaine M, De Ponthaud C, Durand Fontanier S, Bardet SM, Bourdariat R, Sulpice L, Lesurtel M, Legros R, Truant S, Robin F, Prat F, Palazzo M, Schwarz L, Buc E, Sauvanet A, Gaujoux S, Taibi A. ASO Visual Abstract: Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicentre Comparative Cohort Study of the ACHBT-FRENCH-SFED Intergroup. Ann Surg Oncol 2023; 30:5049-5050. [PMID: 37208568 DOI: 10.1245/s10434-023-13598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Julien Janet
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
| | - Jeremie Albouys
- Hepato-Gastroenterology Department, CHU Dupuytren, Limoges, France
- Faculté de Médecine de Limoges, Limoges, France
- University of Limoges, CNRS, XLIM, UMR 7252, 87000, Limoges, France
| | - Bertrand Napoleon
- Gastroenterology Department, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Jeremie Jacques
- Hepato-Gastroenterology Department, CHU Dupuytren, Limoges, France
- Faculté de Médecine de Limoges, Limoges, France
| | - Muriel Mathonnet
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
| | | | - Marie Fontaine
- Gastroenterology Department, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Charles De Ponthaud
- Department of HPB and Endocrine Surgery, Hôpital la Pitié Salpêtrière, APHP, Paris, France
| | - Sylvaine Durand Fontanier
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
- University of Limoges, CNRS, XLIM, UMR 7252, 87000, Limoges, France
| | - Sylvia M Bardet
- University of Limoges, CNRS, XLIM, UMR 7252, 87000, Limoges, France
| | - Raphael Bourdariat
- Digestive Surgery Department, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Laurent Sulpice
- Department of Digestive Surgery, CHU de Rennes, Rennes, France
- Faculté de Médecine de Rennes, Rennes, France
| | - Mickael Lesurtel
- Department of HPB Surgery, Beaujon Hospital, APHP, Clichy, France
| | - Romain Legros
- Hepato-Gastroenterology Department, CHU Dupuytren, Limoges, France
- Faculté de Médecine de Limoges, Limoges, France
- University of Limoges, CNRS, XLIM, UMR 7252, 87000, Limoges, France
| | - Stephanie Truant
- Depatment of Digestive Surgery and Transplantation, Hôpital Huriez - CHRU de Lille, Lille, France
| | - Fabien Robin
- Department of Digestive Surgery, CHU de Rennes, Rennes, France
- Faculté de Médecine de Rennes, Rennes, France
| | - Frédéric Prat
- Department of Endoscopy, Beaujon Hospital, APHP, Clichy, France
| | | | - Lilian Schwarz
- Digestive Surgery Department, CHU de Rouen, Rouen, France
| | - Emmanuel Buc
- Digestive Surgery Department, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - Alain Sauvanet
- Department of HPB Surgery, Beaujon Hospital, APHP, Clichy, France
| | - Sebastien Gaujoux
- Department of HPB and Endocrine Surgery, Hôpital la Pitié Salpêtrière, APHP, Paris, France
| | - Abdelkader Taibi
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France.
- University of Limoges, CNRS, XLIM, UMR 7252, 87000, Limoges, France.
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Saleh NB, Golse N, Abdallah M, Véziant J, Pereira B, Le Roy B, Magnin B, Adam R, Buc E. OUP accepted manuscript. Br J Surg 2022; 109:554-555. [PMID: 35576388 DOI: 10.1093/bjs/znac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 01/02/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Nour Bou Saleh
- Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Department of Hepatobiliary Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France
| | - Nicolas Golse
- Department of Hepatobiliary Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France
| | - Mourad Abdallah
- Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, Clermont-Ferrand, France
- UMR Auvergne CNRS 6284, Clermont-Ferrand Faculty of Medicine, Clermont-Ferrand, France
| | - Julie Véziant
- Department of Digestive, Pancreatic, Hepatobiliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France
| | - Bruno Pereira
- Biostatistics unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Bertrand Le Roy
- Department of Digestive and Oncologic Surgery, Saint-Priest-en-Jarret, France
| | - Benoît Magnin
- Department of Radiology, Estaing Hospital, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - René Adam
- Department of Hepatobiliary Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France
| | - Emmanuel Buc
- Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, Clermont-Ferrand, France
- UMR Auvergne CNRS 6284, Clermont-Ferrand Faculty of Medicine, Clermont-Ferrand, France
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Rabbani N, Calvet L, Espinel Y, Le Roy B, Ribeiro M, Buc E, Bartoli A. A methodology and clinical dataset with ground-truth to evaluate registration accuracy quantitatively in computer-assisted Laparoscopic Liver Resection. Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization 2021. [DOI: 10.1080/21681163.2021.1997642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- N. Rabbani
- EnCoV, Institut Pascal, Clermont-Ferrand, France
| | - L. Calvet
- EnCoV, Institut Pascal, Clermont-Ferrand, France
- CHU, Clermont-Ferrand, France
- IRIT, University of Toulouse
| | - Y. Espinel
- EnCoV, Institut Pascal, Clermont-Ferrand, France
| | - B. Le Roy
- EnCoV, Institut Pascal, Clermont-Ferrand, France
- CHU, Saint-Etienne, France
| | - M. Ribeiro
- EnCoV, Institut Pascal, Clermont-Ferrand, France
- CHU, Clermont-Ferrand, France
| | - E. Buc
- EnCoV, Institut Pascal, Clermont-Ferrand, France
- CHU, Clermont-Ferrand, France
| | - A. Bartoli
- EnCoV, Institut Pascal, Clermont-Ferrand, France
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Adballah M, Espinel Y, Calvet L, Pereira B, Le Roy B, Bartoli A, Buc E. Augmented reality in laparoscopic liver resection evaluated on an ex-vivo animal model with pseudo-tumours. Surg Endosc 2021; 36:833-843. [PMID: 34734305 DOI: 10.1007/s00464-021-08798-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/17/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to assess the performance of our augmented reality (AR) software (Hepataug) during laparoscopic resection of liver tumours and compare it to standard ultrasonography (US). MATERIALS AND METHODS Ninety pseudo-tumours ranging from 10 to 20 mm were created in sheep cadaveric livers by injection of alginate. CT-scans were then performed and 3D models reconstructed using a medical image segmentation software (MITK). The livers were placed in a pelvi-trainer on an inclined plane, approximately perpendicular to the laparoscope. The aim was to obtain free resection margins, as close as possible to 1 cm. Laparoscopic resection was performed using US alone (n = 30, US group), AR alone (n = 30, AR group) and both US and AR (n = 30, ARUS group). R0 resection, maximal margins, minimal margins and mean margins were assessed after histopathologic examination, adjusted to the tumour depth and to a liver zone-wise difficulty level. RESULTS The minimal margins were not different between the three groups (8.8, 8.0 and 6.9 mm in the US, AR and ARUS groups, respectively). The maximal margins were larger in the US group compared to the AR and ARUS groups after adjustment on depth and zone difficulty (21 vs. 18 mm, p = 0.001 and 21 vs. 19.5 mm, p = 0.037, respectively). The mean margins, which reflect the variability of the measurements, were larger in the US group than in the ARUS group after adjustment on depth and zone difficulty (15.2 vs. 12.8 mm, p < 0.001). When considering only the most difficult zone (difficulty 3), there were more R1/R2 resections in the US group than in the AR + ARUS group (50% vs. 21%, p = 0.019). CONCLUSION Laparoscopic liver resection using AR seems to provide more accurate resection margins with less variability than the gold standard US navigation, particularly in difficult to access liver zones with deep tumours.
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Affiliation(s)
- Mourad Adballah
- Institut Pascal, UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Bâtiment 3C, 28 place Henri Dunant, 63000, Clermont-Ferrand, France
- Department of Digestive and Hepatobiliary Surgery, University Hospital Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex, France
| | - Yamid Espinel
- Institut Pascal, UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Bâtiment 3C, 28 place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Lilian Calvet
- Institut Pascal, UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Bâtiment 3C, 28 place Henri Dunant, 63000, Clermont-Ferrand, France
- Biostatistics Department (DRCI), University Hospital Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Department (DRCI), University Hospital Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bertrand Le Roy
- Institut Pascal, UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Bâtiment 3C, 28 place Henri Dunant, 63000, Clermont-Ferrand, France
- Department of Digestive and Oncologic Surgery, University Hospital Nord St-Etienne, Avenue Albert Raimond, 42270, Saint-Priest en Jarez, France
| | - Adrien Bartoli
- Institut Pascal, UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Bâtiment 3C, 28 place Henri Dunant, 63000, Clermont-Ferrand, France
- Biostatistics Department (DRCI), University Hospital Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Emmanuel Buc
- Institut Pascal, UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Bâtiment 3C, 28 place Henri Dunant, 63000, Clermont-Ferrand, France.
- Department of Digestive and Hepatobiliary Surgery, University Hospital Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex, France.
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9
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Hain E, Challine A, Tzedakis S, Mare A, Martinino A, Fuks D, Adham M, Piessen G, Regimbeau JM, Buc E, Barbier L, Vaillant JC, Jeune F, Sulpice L, Muscari F, Schwarz L, Deguelte S, Sa Cunha A, Truant S, Dousset B, Sauvanet A, Gaujoux S. Study Protocol of the PreFiPS Study: Prevention of Postoperative Pancreatic Fistula by Somatostatin Compared With Octreotide, a Prospective Randomized Controlled Trial. Front Med (Lausanne) 2021; 7:488. [PMID: 33521003 PMCID: PMC7844059 DOI: 10.3389/fmed.2020.00488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 07/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Pancreatic fistula (PF), i. e., a failure of the pancreatic anastomosis or closure of the remnant pancreas after distal pancreatectomy, is one of the most feared complications after pancreatic surgery. PF is also one of the most common complications after pancreatic surgery, occurring in about 30% of patients. Prevention of a PF is still a major challenge for surgeons, and various technical and pharmacological interventions have been investigated, with conflicting results. Pancreatic exocrine secretion has been proposed as one of the mechanisms by which PF occurs. Pharmacological prevention using somatostatin or its analogs to inhibit pancreatic exocrine secretion has shown promising results. We can hypothesize that continuous intravenous infusion of somatostatin-14, the natural peptide hormone, associated with 10–50 times stronger affinity with all somatostatin receptor compared with somatostatin analogs, will be associated with an improved PF prevention. Methods: A French comparative randomized open multicentric study comparing somatostatin vs. octreotide in adult patients undergoing pancreaticoduodenectomy (PD) or distal pancreatectomy with or without splenectomy. Patients with neoadjuvant radiation therapy and/or neoadjuvant chemotherapy within 4 weeks before surgery are excluded from the study. The main objective of this study is to compare 90-day grade B or C postoperative PF as defined by the last ISGPF (International Study Group on Pancreatic Fistula) classification between patients who receive perioperative somatostatin and octreotide. In addition, we analyze overall length of stay, readmission rate, cost-effectiveness, and postoperative quality of life after pancreatic surgery in patients undergoing PD. Conclusion: The PreFiPS study aims to evaluate somatostatin vs. octreotide for the prevention of postoperative PF.
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Affiliation(s)
- Elisabeth Hain
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
| | - Alexandre Challine
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
| | - Stylianos Tzedakis
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
| | - Alexandru Mare
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
| | - Alessandro Martinino
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
| | - David Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Mustapha Adham
- Chirurgie digestive, HCL-Hôpital Edouard Herriot, Lyon, France
| | - Guillaume Piessen
- Chirurgie digestive et oncologique, Hôpital Claude Huriez, Lille, France
| | | | - Emmanuel Buc
- Chirurgie digestive et oncologie digestive, CHU Estaing, Clermont-Ferrand, France
| | - Louise Barbier
- Chirurgie digestive, Hôpital Trousseau, Chambray-Lès-Tours, France
| | - Jean-Christophe Vaillant
- Chirurgie Digestive et Hépatobiliaire-Transplantation Hépatique, Hôpital La pitié Salpêtrière, Paris, France
| | - Florence Jeune
- Chirurgie Digestive et Hépatobiliaire-Transplantation Hépatique, Hôpital La pitié Salpêtrière, Paris, France
| | - Laurent Sulpice
- Chirurgie Hépatobiliaire et Digestive, Hôpital Universitaire Pontchaillou, Rennes, France
| | - Fabrice Muscari
- Chirurgie Digestive et Transplantation Hépatique, CHU Rangueil, Toulouse, France
| | - Lilian Schwarz
- Chirurgie Digestive, Hôpital Charles Nicolle, Rouen, France
| | - Sophie Deguelte
- Chirurgie Viscérale, Digestive et Endocrinienne, CHU de Reims, Reims, France
| | | | - Stephanie Truant
- Chirurgie digestive et Transplantation, Hôpital Claude Huriez, Lille, France
| | - Bertrand Dousset
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
| | - Alain Sauvanet
- Chirurgie hépatobiliaire et transplantation hépatique, Hôpital Beaujon, Clichy, France
| | - Sébastien Gaujoux
- Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France
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10
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Abstract
Pancreatic fistula is the most common and dreaded complication after pancreatic resection, responsible for high morbidity and mortality (2 to 30%). Prophylactic drainage of the operative site is usually put in place to decrease and/or detect postoperative pancreatic fistula (POPF) early. However, this policy is currently debated and the data from the literature are unclear. The goal of this update is to analyze the most recent evidence-based data with regard to prophylactic abdominal drainage after pancreatic resection (pancreatoduodenectomy [PD] or distal pancreatectomy [PD]). This systematic review of the literature between 1990 and 2020 sought to answer the following questions: should drainage of the operative site after pancreatectomy be routine or adapted to the risk of POPF? If a drainage is used, how long should it remain in the abdomen, what criteria should be used to decide to remove it, and what type of drainage should be preferred? Has the introduction of laparoscopy changed our practice? The literature seems to indicate that it is not possible to recommend the omission of routine drainage after pancreatic resection. By contrast, an approach based on the risk of POPF using the fistula risk score seems beneficial. When a drain is placed, early removal (within 5 days) seems feasible based on clinical, laboratory (C-reactive protein, leukocyte count, neutrophile/lymphocyte ratio, dosage and dynamic of amylase in the drains on D1, D3±D5) and radiological findings. This is in line with the development of enhanced recovery programs after pancreatic surgery. Finally, this literature review did not find any specific data relative to mini-invasive pancreatic surgery.
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Affiliation(s)
- J Veziant
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France.
| | - M Selvy
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Buc
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France
| | - K Slim
- Department of digestive and hepato-biliary surgery, university hospital center of Clermont-Ferrand, Clermont-Ferrand, France; Groupe francophone de réhabilitation améliorée après chirurgie (GRACE), Beaumont, France
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11
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Gaujoux S, Jacques J, Bourdariat R, Sulpice L, Lesurtel M, Truant S, Robin F, Prat F, Palazzo M, Schwarz L, Buc E, Sauvanet A, Taibi A, Napoleon B. Pancreaticoduodenectomy following endoscopic ultrasound-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing stents an ACHBT - SFED study. HPB (Oxford) 2021; 23:154-160. [PMID: 32646808 DOI: 10.1016/j.hpb.2020.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND After ERCP failure or if ERCP is declined for preoperative biliary drainage before pancreaticoduodenectomy, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with electrocautery-enhanced lumen-apposing stents (ECE-LAMS) might be needed. The aim of the present study was to assess the technical feasibility and short-term outcomes of pancreaticoduodenectomy (PD) following endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with electrocautery-enhanced lumen-apposing stents (ECE-LAMS). METHODS A retrospective study of all EUS-CDS procedures with ECE-LAMS followed by PD performed in France since the availability of the device in 2016. RESULTS 21 patients underwent PD in 9 departments of surgery following EUS-CDS with ECE-LAMS. The median bilirubin level at endoscopic procedure was 292 μmol/L. A 6 mm diameter stent was used in 20 cases. No complications occurred during the procedure. During the waiting time, 1 patient had an acute pancreatitis post ERCP and 3 patients developed cholangitis, treated by either an additional percutaneous biliary drainage, or an endoscopic procedure to extract a bezoar occluding the stent, or antibiotics, respectively. PD with a curative intent was performed in all cases. Overall, postoperative mortality was nil and postoperative morbidity occurred in 17 patients (81%), including 3 with severe complications (14%). No patient developed postoperative biliary fistula. In the 21 patients followed at least 6 months, no biliary complications occurred, and no tumor recurrence developed on the hepaticojejunostomy/hepatic pedicle. CONCLUSION Pancreaticoduodenectomy following EUS-CDS with ECE-LAMS is technically feasible with acceptable short-term postoperative outcome, including healing of biliary anastomosis.
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Affiliation(s)
- Sébastien Gaujoux
- Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Paris, France; Paris Descartes University, Paris, France.
| | - Jérémie Jacques
- Service D'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France; Faculté de Médecine de Limoges, Limoges, France
| | - Raphael Bourdariat
- Service de Chirurgie Digestive, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Laurent Sulpice
- Department of Digestive Surgery, CHU de Rennes, Rennes, France; Faculté de Médecine de Rennes, Rennes, France
| | - Mickael Lesurtel
- Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Universitaire Croix Rousse, Hospices Civils de Lyon, France; University Lyon 1, France
| | - Stéphanie Truant
- Service de Chirurgie Digestive & Transplantations, Hôpital Huriez - CHRU de Lille, France
| | - Fabien Robin
- Department of Digestive Surgery, CHU de Rennes, Rennes, France; Faculté de Médecine de Rennes, Rennes, France
| | - Frédéric Prat
- Paris Descartes University, Paris, France; Department of Gastroenterology and Endoscopy, Cochin Hospital, APHP, Paris, France
| | - Maxime Palazzo
- Department of Endoscopy, Beaujon Hospital, APHP, Clichy, France
| | | | - Emmanuel Buc
- Service de Chirurgie Digestive, CHU de Rouen, France
| | - Alain Sauvanet
- Service de Chirurgie Digestive, CHU de Clermont Ferrand, France; Department of HPB Surgery, Beaujon Hospital, APHP, Clichy, France
| | - Abdelkader Taibi
- Faculté de Médecine de Limoges, Limoges, France; Service de Chirurgie Digestive et Endocrinienne, CHU Dupuytren, Limoges, France
| | - Bertrand Napoleon
- Service de Gastroentérologie, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
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12
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Bertrand LR, Abdallah M, Espinel Y, Calvet L, Pereira B, Ozgur E, Pezet D, Buc E, Bartoli A. A case series study of augmented reality in laparoscopic liver resection with a deformable preoperative model. Surg Endosc 2020; 34:5642-5648. [DOI: 10.1007/s00464-020-07815-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022]
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13
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Maulat C, Regimbeau JM, Buc E, Boleslawski E, Belghiti J, Hardwigsen J, Vibert E, Delpero JR, Tournay E, Arnaud C, Suc B, Pessaux P, Muscari F. Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial. Br J Surg 2020; 107:824-831. [DOI: 10.1002/bjs.11405] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/22/2019] [Accepted: 09/27/2019] [Indexed: 01/15/2023]
Abstract
Abstract
Background
Biliary fistula is one of the most common complications after hepatectomy. This study evaluated the effect of transcystic biliary drainage during hepatectomy on the occurrence of postoperative biliary fistula.
Methods
This multicentre RCT was carried out from 2009 to 2016 in nine centres. Patients were randomized to transcystic biliary drainage or no transcystic drainage (control). Patients underwent hepatectomy (more than 2 segments) of non-cirrhotic livers. The primary endpoint was the occurrence of biliary fistula after surgery. Secondary endpoints were morbidity, postoperative mortality, duration of hospital stay, reoperation, readmission to hospital, and complications caused by catheters. Intention-to-treat and per-protocol analyses were performed.
Results
A total of 310 patients were randomized. In intention-to-treat analysis, there were 158 patients in the transcystic group and 149 in the control group. Seven patients were removed from the per-protocol analysis owing to protocol deviations. The biliary fistula rate was 5·9 per cent in intention-to-treat and 6·0 per cent in per-protocol analyses. The rate was similar in the transcystic and control groups (5·7 versus 6·0 per cent; P = 1·000). There were no differences in terms of morbidity (49·4 versus 46·3 per cent; P = 0·731), mortality (2·5 versus 4·7 per cent; P = 0·367) and reoperations (4·4 versus 10·1 per cent; P = 1·000). Median duration of hospital stay was longer in the transcystic group (11 versus 10 days; P = 0·042). The biliary fistula risk was associated with the width and length of the hepatic cut surface.
Conclusion
This randomized trial did not demonstrate superiority of transcystic drainage during hepatectomy in preventing biliary fistula. The use of transcystic drainage during hepatectomy to prevent postoperative biliary fistula is not recommended. Registration number: NCT01469442 ( http://www.clinicaltrials.gov).
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Affiliation(s)
- C Maulat
- Department of Digestive Surgery and Liver Transplantation, Toulouse University Hospital, Toulouse, France
| | - J-M Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
- Simplifications des Soins Patients Chirurgicaux Complexes (SSPC), Unit of Clinical Research, University of Picardie Jules Verne, Amiens, France
| | - E Buc
- Department of Digestive Surgery and Liver Transplantation, Hôtel Dieu, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - E Boleslawski
- Department of Digestive Surgery and Liver Transplantation, Claude Huriez Hospital, Lille, France
| | - J Belghiti
- Department of Digestive Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - J Hardwigsen
- Department of Digestive Surgery, La Conception University Hospital, Marseille, France
| | - E Vibert
- Department of Digestive Surgery and Liver Transplantation, Centre Hépato-Biliaire, Paul Brousse Hospital, Villejuif, France
| | - J-R Delpero
- Department of Digestive Surgery, Paoli Calmettes Institute, Marseille, France
| | - E Tournay
- Department of Epidemiology and Clinical Research, Toulouse University Hospital, Toulouse, France
| | - C Arnaud
- Department of Epidemiology and Clinical Research, Toulouse University Hospital, Toulouse, France
| | - B Suc
- Department of Digestive Surgery and Liver Transplantation, Toulouse University Hospital, Toulouse, France
| | - P Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France
| | - F Muscari
- Department of Digestive Surgery and Liver Transplantation, Toulouse University Hospital, Toulouse, France
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14
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Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, Patrice D. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg 2020; 107:268-277. [PMID: 31916594 DOI: 10.1002/bjs.11406] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - F Cauchy
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - C Goumard
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - O Soubrane
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - E Salamé
- Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Tours University, Tours, France
| | - D Cherqui
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - E Vibert
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - O Scatton
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | | | - T Nomi
- Nara Medical University, Nara, Japan
| | - N Oudafal
- Institut Mutualiste Montsouris, Paris, France
| | - T Kawai
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Komatsu
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Okumura
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | | | - A Laurent
- Hôpital Henri Mondor, APHP, Creteil, France
| | - P Bucur
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - L Barbier
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - B Trechot
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - J Nunèz
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M Tedeschi
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M-A Allard
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - N Golse
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - O Ciacio
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - G Pittau
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - R Adam
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - C Laurent
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - L Chiche
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - P Leourier
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Rebibo
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - J-M Regimbeau
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Ferre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F R Souche
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J Chauvat
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J-M Fabre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F Jehaes
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Mohkam
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Lesurtel
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Ducerf
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-Y Mabrut
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - T Hor
- St Antoine Hospital, APHP, Paris, France
| | - F Paye
- St Antoine Hospital, APHP, Paris, France
| | - P Balladur
- St Antoine Hospital, APHP, Paris, France
| | - B Suc
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - F Muscari
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - G Millet
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - M El Amrani
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - C Ratajczak
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - K Lecolle
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - E Boleslawski
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - S Truant
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - F-R Pruvot
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - A-R Kianmanesh
- Robert Debré Hospital, Hospital University Centre of Reims, Reims, France
| | - T Codjia
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - L Schwarz
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - E Girard
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - J Abba
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - C Letoublon
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - M Chirica
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | | | | | - Z Cherkaoui
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - X Unterteiner
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - R Memeo
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - P Pessaux
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - E Buc
- Hospital University Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Lermite
- Hospital University Centre of Angers, Angers, France
| | - J Barbieux
- Hospital University Centre of Angers, Angers, France
| | - M Bougard
- Hospital University Centre of Angers, Angers, France
| | - U Marchese
- Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Institut Paoli-Calmettes, Marseille, France
| | - O Turini
- Institut Paoli-Calmettes, Marseille, France
| | - A Thobie
- Hospital University Centre of Caen Normandie, Caen, France
| | - B Menahem
- Hospital University Centre of Caen Normandie, Caen, France
| | - A Mulliri
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Lubrano
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Zemour
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - H Fagot
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - G Passot
- Hospital University Centre of Lyon Sud, Lyon, France
| | - E Gregoire
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - J Hardwigsen
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - Y-P le Treut
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - D Patrice
- Louis Pasteur Hospital, Colmar, France
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Gagnière J, Le Roy B, Veziant J, Pereira B, Narayan RR, Pezet D, Buc E, Dupré A. Pancreaticoduodenectomy with right gastric vessels preservation: impact on intraoperative and postoperative outcomes. ANZ J Surg 2018; 89:E147-E152. [PMID: 30497109 DOI: 10.1111/ans.14956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/27/2018] [Accepted: 10/07/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sympathetic denervation of the antropyloric area combined with relative devascularization from division of the right gastric vessels (RGV) during pancreaticoduodenectomy (PD) could predispose to delayed gastric emptying (DGE). Therefore, some authors advocated for RGV preservation (RGVP), where feasibility and utility for the prevention of post-operative DGE have never been investigated. METHODS From 2011 to 2014, patients who underwent classic Whipple PD (CWPD, n = 34), standard pylorus-preserving PD (PPPD, n = 44) or PPPD with RGVP (n = 22) were retrospectively analysed. RESULTS RGVP was not possible in 12% of the cases because of an intraoperative injury of the RGV. There was no difference between CWPD, standard PPPD and PPPD with RGVP in terms of intraoperative blood loss, operative time, number of lymph node harvested and resection margins. Post-operative morbidity and mortality were comparable between the three groups, including rate (27%, 34% and 32%, P = 0.77) and severity of DGE, delay in removing nasogastric tube and use of prokinetics. Hospital stay was similar in all the compared groups. CONCLUSION This is the first study comparing post-operative outcomes after PPPD with RGVP, standard PPPD and CWPD. Although feasible and safe, RGVP during PPPD appeared to offer no obvious clinical benefit in terms of preventing post-operative complications, especially DGE.
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Affiliation(s)
- Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,U1071 Inserm/Clermont Auvergne University, Clermont-Ferrand, France
| | - Bertrand Le Roy
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Julie Veziant
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics, Délégation à la Recherche Clinique et à l'Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Raja R Narayan
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,U1071 Inserm/Clermont Auvergne University, Clermont-Ferrand, France
| | - Emmanuel Buc
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélien Dupré
- Department of Surgery, Léon Bérard Cancer Center, Lyon, France
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16
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Le Roy B, Dupré A, Gallon A, Chabrot P, Gagnière J, Buc E. Liver hypertrophy: Underlying mechanisms and promoting procedures before major hepatectomy. J Visc Surg 2018; 155:393-401. [PMID: 30126801 DOI: 10.1016/j.jviscsurg.2018.03.005] [Citation(s) in RCA: 11] [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] [Indexed: 12/12/2022]
Abstract
Various procedures can promote hypertrophy of the future liver remnant (FLR) before major hepatectomy to prevent postoperative liver failure. The pathophysiological situation following portal vein embolization (PVE), hepatic artery ligation/embolization or hepatectomy remains unclear. On one hand, the main mechanisms of hepatic regeneration appear to be driven by hepatic hypoxia (involving the hepatic arterial buffer response), an increased portal blood flow inducing shear stress and the involvement of several mediators (inflammatory cytokines, vasoregulators, growth factors, eicosanoids and several hormones). On the other hand, several factors are associated with impaired liver regeneration, such as biliary obstruction, malnutrition, diabetes mellitus, male gender, age, ethanol and viral infection. All these mechanisms may explain the varying degrees of hypertrophy observed following a surgical or radiological procedure promoting hypertrophy the FLR. Radiological procedures include left and right portal vein embolization (extended or not to segment 4), sequential PVE and hepatic vein embolization (HVE), and more recently combined PVE and HVE. Surgical procedures include associated liver partition and portal vein ligation for staged hepatectomy, and more recently the combined portal embolization and arterial ligation procedure. This review aimed to clarify the pathophysiology of liver regeneration; it also describes radiological or surgical procedures employed to improve liver regeneration in terms of volumetric changes, the feasibility of the second step and the benefits and drawbacks of each procedure.
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Affiliation(s)
- B Le Roy
- Department of Digestive and Hepatobiliary Surgery, Hôpital Estaing, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France; UMR Auvergne UMR 6602 UCA/CNRS/SIGMA, Clermont-Ferrand Faculty of Medicine, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France.
| | - A Dupré
- Inserm, LabTAU UMR1032, Centre Léon-Bérard, Université Claude-Bernard Lyon 1, 69003 Lyon, France
| | - A Gallon
- Department of Vascular Radiology, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, place Henri-Dunant, 63000 Clermont-Ferrand, France; UMR Auvergne UMR 6602 UCA/CNRS/SIGMA, Clermont-Ferrand Faculty of Medicine, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - P Chabrot
- Department of Vascular Radiology, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, place Henri-Dunant, 63000 Clermont-Ferrand, France; UMR Auvergne UMR 6602 UCA/CNRS/SIGMA, Clermont-Ferrand Faculty of Medicine, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - J Gagnière
- Department of Digestive and Hepatobiliary Surgery, Hôpital Estaing, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - E Buc
- Department of Digestive and Hepatobiliary Surgery, Hôpital Estaing, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France; UMR Auvergne UMR 6602 UCA/CNRS/SIGMA, Clermont-Ferrand Faculty of Medicine, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France
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Özgür E, Koo B, Le Roy B, Buc E, Bartoli A. Preoperative liver registration for augmented monocular laparoscopy using backward–forward biomechanical simulation. Int J Comput Assist Radiol Surg 2018; 13:1629-1640. [DOI: 10.1007/s11548-018-1842-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/31/2018] [Indexed: 12/01/2022]
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18
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Phutane P, Buc E, Poirot K, Ozgur E, Pezet D, Bartoli A, Le Roy B. Preliminary trial of augmented reality performed on a laparoscopic left hepatectomy. Surg Endosc 2017; 32:514-515. [PMID: 28791423 DOI: 10.1007/s00464-017-5733-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 07/14/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Laparoscopic liver surgery is seldom performed, mainly because of the risk of hepatic vein bleeding or incomplete resection of the tumour. This risk may be reduced by means of an augmented reality guidance system (ARGS), which have the potential to aid one in finding the position of intrahepatic tumours and hepatic veins and thus in facilitating the oncological resection and in limiting the risk of operative bleeding. METHODS We report the case of an 81-year-old man who was diagnosed with a hepatocellular carcinoma after an intraabdominal bleeding. The preoperative CT scan did not show metastases. We describe our preferred approach for laparoscopic left hepatectomy with initial control of the left hepatic vein and preliminary results of our novel ARGS achieved postoperatively. In our ARGS, a 3D virtual anatomical model is created from the abdominal CT scan and manually registered to selected laparoscopic images. For this patient, the virtual model was composed of the segmented left liver, right liver, tumour and median hepatic vein. RESULTS The patient's operating time was summed up to 205 min where a blood loss of 300 cc was recorded. The postoperative course was simple. Histopathological analysis revealed the presence of a hepatocellular carcinoma with free margins. Our results of intrahepatic visualization suggest that ARGS can be beneficial in detecting the tumour, transection plane and medial hepatic vein prior to parenchymal transection, where it does not work due to the substantial changes to the liver's shape. CONCLUSIONS As of today, we have performed eight similar left hepatectomies, with good results. Our ARGS has shown promising results and should now be attempted intraoperatively.
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Affiliation(s)
- Priyanka Phutane
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Emmanuel Buc
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France. .,Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France. .,Department of HPB surgery, Clermont-Ferrand University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex, France.
| | - Karine Poirot
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France.,Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
| | - Erol Ozgur
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
| | - Adrien Bartoli
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Bertrand Le Roy
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France.,Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
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19
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Le Roy B, Dupré A, Gallon A, Buc E. Portal blood pressure and hypoxemia: The 2 main mechanisms of liver regeneration? Surgery 2017. [PMID: 28645633 DOI: 10.1016/j.surg.2017.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bertrand Le Roy
- Department of Digestive and Hepatobiliary Surgery, Estaing hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, Clermont-Ferrand, France.
| | - Aurélien Dupré
- Department of Surgical Oncology, Léon Bérard Cancer Centre, Lyon, France
| | - Arnaud Gallon
- Department of Vascular Radiology, Gabriel Montpied hospital, CHU Clermont-Ferrand, Place Henri Dunant, Clermont-Ferrand, France
| | - Emmanuel Buc
- Department of Digestive and Hepatobiliary Surgery, Estaing hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, Clermont-Ferrand, France
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20
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Aumont O, Dupré A, Abjean A, Pereira B, Veziant J, Le Roy B, Pezet D, Buc E, Gagnière J. Does intraoperative closed-suction drainage influence the rate of pancreatic fistula after pancreaticoduodenectomy? BMC Surg 2017; 17:58. [PMID: 28511699 PMCID: PMC5434540 DOI: 10.1186/s12893-017-0257-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 03/14/2017] [Accepted: 05/10/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although drainage of pancreatic anastomoses after pancreaticoduodenectomy (PD) is still debated, it remains recommended, especially in patients with a high risk of post-operative pancreatic fistula (POPF). Modalities of drainage of pancreatic anastomoses, especially the use of passive (PAD) or closed-suction (CSD) drains, and their impact on surgical outcomes, have been poorly studied. The aim was to compare CSD versus PAD on surgical outcomes after PD. METHODS Retrospective analysis of 197 consecutive patients who underwent a standardized PD at two tertiary centers between March 2012 and April 2015. Patients with PAD (n = 132) or CSD (n = 65) were compared. RESULTS There was no significant difference in terms of 30-day overall and severe post-operative morbidity, post-operative hemorrhage, post-operative intra-abdominal fluid collections, 90-day post-operative mortality and mean length of hospital stay. The rate of POPF was significantly increased in the CSD group (47.7% vs. 32.6%; p = 0.04). CSD was associated with an increase of grade A POPF (21.5% vs. 8.3%; p = 0.03), while clinically relevant POPF were not impacted. In patients with grade A POPF, the rate of undrained intra-abdominal fluid collections was increased in the PAD group (46.1% vs. 21.4%; p = 0.18). After multivariate analysis, CSD was an independent factor associated with an increased rate of POPF (OR = 2.43; p = 0.012). CONCLUSIONS There was no strongly relevant difference in terms of surgical outcomes between PAD or CSD of pancreatic anastomoses after PD, but CSD may help to decrease the rate of undrained post-operative intra-abdominal collections in some patients. Further randomized, multi-institutional studies are needed.
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Affiliation(s)
- Ophélie Aumont
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, 1, place Lucie et Raymond Aubrac, 63000, Clermont-Ferrand, France
| | - Aurélien Dupré
- Department of Surgical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Adeline Abjean
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, 1, place Lucie et Raymond Aubrac, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics, Délégation à la Recherche Clinique et à l'Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Julie Veziant
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, 1, place Lucie et Raymond Aubrac, 63000, Clermont-Ferrand, France
| | - Bertrand Le Roy
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, 1, place Lucie et Raymond Aubrac, 63000, Clermont-Ferrand, France
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, 1, place Lucie et Raymond Aubrac, 63000, Clermont-Ferrand, France.,UMR 1071 INSERM / Clermont Auvergne University, Clermont-Ferrand, France
| | - Emmanuel Buc
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, 1, place Lucie et Raymond Aubrac, 63000, Clermont-Ferrand, France.,UMR 1071 INSERM / Clermont Auvergne University, Clermont-Ferrand, France
| | - Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery, Estaing University Hospital, 1, place Lucie et Raymond Aubrac, 63000, Clermont-Ferrand, France. .,UMR 1071 INSERM / Clermont Auvergne University, Clermont-Ferrand, France.
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21
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Le Roy B, Buc E, Hordonneau C, Veziant J, Pezet D, Gagnière J. An original technique of venous autoplasty after duodenopancreatectomy for tumors involving the infrarenal inferior vena cava. J Surg Case Rep 2017; 2017:rjx011. [PMID: 28458822 PMCID: PMC5400417 DOI: 10.1093/jscr/rjx011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/13/2016] [Accepted: 01/24/2017] [Indexed: 11/19/2022] Open
Abstract
Tumor involvement of the inferior vena cava (IVC) by hepatobiliary, pancreatic or duodenal malignancies can compromise adequate resection. However, radical resection with negative histological margins remains the only chance of cure. Various techniques are used for venous reconstruction, using a prosthetic graft interposition in most of the cases. However, in case of associated digestive resections, such as pancreaticoduodenectomy, postoperative complications can be responsible for prosthesis infection and related vascular complications. In this setting, the use of biological material for venous reconstruction appears to be preferable. We present an original, easy and useful technique of a venous autoplasty after pancreaticoduodenectomy for tumors involving the anterior wall of the infrarenal IVC, using a patch from the posterior wall of the IVC.
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Affiliation(s)
- Bertrand Le Roy
- 1Department of Digestive and Hepatobiliary Surgery, Liver Transplantation, Estaing University Hospital, Clermont-Ferrand 63000, France
| | - Emmanuel Buc
- 1Department of Digestive and Hepatobiliary Surgery, Liver Transplantation, Estaing University Hospital, Clermont-Ferrand 63000, France.,UMR 1071 Inserm, University of Auvergne, Clermont-Ferrand 63000, France
| | - Constance Hordonneau
- Department of Radiology, Estaing University Hospital, Clermont-Ferrand 63000, France
| | - Julie Veziant
- 1Department of Digestive and Hepatobiliary Surgery, Liver Transplantation, Estaing University Hospital, Clermont-Ferrand 63000, France
| | - Denis Pezet
- 1Department of Digestive and Hepatobiliary Surgery, Liver Transplantation, Estaing University Hospital, Clermont-Ferrand 63000, France.,UMR 1071 Inserm, University of Auvergne, Clermont-Ferrand 63000, France
| | - Johan Gagnière
- 1Department of Digestive and Hepatobiliary Surgery, Liver Transplantation, Estaing University Hospital, Clermont-Ferrand 63000, France.,UMR 1071 Inserm, University of Auvergne, Clermont-Ferrand 63000, France
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22
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Le Roy B, Perrey A, Fontarensky M, Gagnière J, Abergel A, Pereira B, Lambert C, Boyer L, Pezet D, Chabrot P, Buc E. Combined Preoperative Portal and Hepatic Vein Embolization (Biembolization) to Improve Liver Regeneration Before Major Liver Resection: A Preliminary Report. World J Surg 2017; 41:1848-1856. [DOI: 10.1007/s00268-017-4016-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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23
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Le Roy B, Fetche N, Buc E, Pereira B, Genty F, Antomarchi O, Gagnière J, Pezet D, Slim K. Feasibility prospective study of laparoscopic cholecystectomy with suprapubic approach. J Visc Surg 2016; 153:327-331. [PMID: 27118171 DOI: 10.1016/j.jviscsurg.2016.03.005] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since the publication of laparoscopic cholecystectomy (LC) using three ports instead of four, no significant evolution has impacted on our clinical practice in order to improve length of stay, postoperative pain, time of recovery and cosmetic results. Recently, a renewed interest has been observed with the suprapubic approach, called occult scar laparoscopic cholecystectomy (OSLC). The aim of this prospective multicentric study was to evaluate the feasibility of OSLC in 2 French centers. METHODS From March to September 2014, 60 patients were prospectively included in this study. The operation incisions consisted of an umbilical incision for camera; an incision in the right groin for maneuvers of exposition and a suprapubic incision for instrumental dissection and clipping. Outcome was by operative time, operative complications, hospital length of stay, analgesia required after surgery, and cosmetic outcomes. The Patient Satisfaction Scale and Visual Analog Score (VAS) also were used to evaluate the level of cosmetic result and postoperative pain. RESULTS No laparoscopy was converted to an open procedure, the mean operative time was 53±20min. No patient had intraoperative bile duct injury or significant bleeding. The mean length of stay was 1.70±0.76 days. Two patients (3%) experienced postoperative complication (1 intra-abdominal abscess treated by antibiotics and 1 subcutaneous seroma of the 11-mm port wound treated successfully by needle aspiration). CONCLUSION The technique proved to be safe and feasible with no specific complication and without specific instrument. It offers satisfactory postoperative pain level and good cosmetic results.
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Affiliation(s)
- B Le Roy
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
| | - N Fetche
- Digestive Surgery Department, Jacques-Lacarin Hospital, 1, boulevard Deniere, 03200 Vichy, France
| | - E Buc
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - B Pereira
- Biostatistics Unit (DRCI), Clermont-Ferrand University Hospital, 63003 Clermont-Ferrand, France
| | - F Genty
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - O Antomarchi
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J Gagnière
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - D Pezet
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - K Slim
- Digestive Department, Estaing Hospital, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
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Le Roy B, Gagnière J, Chabrot P, Pezet D, Abergel A, Buc E. Non-lethal Right Liver Atrophy After TIPS Occlusion in A Cirrhotic Patient: Introducing The Hepatic Biembolization. J Gastrointest Surg 2016; 20:1671-2. [PMID: 27015903 DOI: 10.1007/s11605-016-3133-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is the standard procedure in the treatment of refractory ascites and variceal bleeding in the setting of portal hypertension. Secondary obstruction of the shunt is a classic but potentially lethal complication. METHODS We present here the case of a cirrhotic patient that underwent a TIPS for refractory ascites, with early complete thrombosis without lethal complication. RESULTS Obstruction of the TIPS led to thrombosis of both the right hepatic and the right portal veins with progressive total atrophy of the right liver and marked hypertrophy of the left liver. Despite initial poor liver function, biological hepatic markers improved slowly until complete recovery. CONCLUSION Hence, we suggest the concept of combined right portal and hepatic vein embolization as a new procedure to induce partial liver hypertrophy before major liver resection, even in cirrhotic patients.
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Affiliation(s)
- Bertrand Le Roy
- Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.
| | - Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
| | - Pascal Chabrot
- Department of Vascular Radiology, Gabriel Montpied Hospital, CHU Clermont-Ferrand, Place Henri Dunant, 63000, Clermont-Ferrand, France.,Faculty of Medicine from Clermont-Ferrand, UMR Auvergne CNRS 6284, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
| | - Armand Abergel
- Department of Hepatology, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.,Faculty of Medicine from Clermont-Ferrand, UMR Auvergne CNRS 6284, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Emmanuel Buc
- Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France.,Faculty of Medicine from Clermont-Ferrand, UMR Auvergne CNRS 6284, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
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Gagnière J, Selvy M, Fontarensky M, Garcier JM, Buc E, Le Roy B. Complete agenesis of the coeliac artery: the first documented case. ANZ J Surg 2016; 88:E627-E628. [PMID: 27080986 DOI: 10.1111/ans.13587] [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: 01/19/2016] [Revised: 02/13/2016] [Accepted: 02/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery, CHU Estaing, Clermont-Ferrand, France
| | - Marie Selvy
- Department of Digestive and Hepatobiliary Surgery, CHU Estaing, Clermont-Ferrand, France
| | | | | | - Emmanuel Buc
- Department of Digestive and Hepatobiliary Surgery, CHU Estaing, Clermont-Ferrand, France
| | - Bertrand Le Roy
- Department of Digestive and Hepatobiliary Surgery, CHU Estaing, Clermont-Ferrand, France
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Le Roy B, Tixier L, Pereira B, Sauvanet P, Buc E, Pétorin C, Déchelotte P, Pezet D, Balayssac D. Assessment of the Relation between the Expression of Oxaliplatin Transporters in Colorectal Cancer and Response to FOLFOX-4 Adjuvant Chemotherapy: A Case Control Study. PLoS One 2016; 11:e0148739. [PMID: 26859833 PMCID: PMC4747515 DOI: 10.1371/journal.pone.0148739] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/22/2016] [Indexed: 12/13/2022] Open
Abstract
Background Adjuvant chemotherapy for colorectal cancer is mainly based on the combination of 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX-4). The pharmacological target of oxaliplatin remains intracellular and therefore dependent on its entry into cells. The intracellular distribution of oxaliplatin is mediated by organic cation transporters 1, 2 and 3 (OCT1, 2 and 3), copper transporter 1 (CTR1) and ATPase Cu2+ transporting beta polypeptide (ATP7B) and may modulate the efficacy of oxaliplatin-based chemotherapy. The aim of this study was to perform a retrospective study to assess the relation between the expression of oxaliplatin transporters in colorectal cancer before chemotherapy and the response to FOLFOX-4 adjuvant chemotherapy in responder and non-responder patients. Methods This retrospective study was conducted at a single center (University Hospital of Clermont-Ferrand, France). The target population was patients with resectable colorectal cancer operated between 2006 and 2013. Inclusion criteria were defined for the responder patients as no cancer recurrence 3 years after the end of chemotherapy, and for the non-responder patients as cancer recurrence within 1 year. Other inclusion criteria were stages IIb–IV cancers, first-line adjuvant FOLFOX-4 chemotherapy, and the availability of resected primary tumor samples. Exclusion criteria were preoperative chemotherapy and/or radiotherapy, a targeted therapy, other anticancer drugs, cancer recurrence between the first and the third year after the end of chemotherapy and follow-up < 3 years. Immunostaining of oxaliplatin transporters (OCT1, 2, 3, CTR1 and ATP7B) and Ki-67 was assessed in tumor samples. Results Retrospectively, 31 patients have been selected according to inclusion and exclusion criteria (15 responders and 16 non-responders). Before FOLFOX-4 regimen, OCT3 expression was significantly lower in responder patients compared to non-responders (p<0.001). According to multivariate analysis, OCT3 remains an independent criterion for adjuvant FOLFOX chemotherapy response (p = 0.039). No significant relation is reported between chemotherapy response and the expression of OCT1 (p = 0.49), OCT2 (p = 0.09), CTR1 (p = 0.45), ATP7B (p = 0.94) and Ki-67 (p = 0.34) in tumors. Conclusions High expression of OCT3 could be an independent factor related to resistance to FOLFOX-4 chemotherapy.
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Affiliation(s)
- Bertrand Le Roy
- CHU Clermont-Ferrand, Service de chirurgie et oncologie digestive, F-63003, Clermont-Ferrand, France
| | - Lucie Tixier
- CHU Clermont-Ferrand, Service d’anatomopathologie, F-63003, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l’Innovation, F-63003, Clermont-Ferrand, France
| | - Pierre Sauvanet
- CHU Clermont-Ferrand, Service de chirurgie et oncologie digestive, F-63003, Clermont-Ferrand, France
- INSERM/UdA U1071, USC INRA 2018, M2iSH, F-63001, Clermont-Ferrand, France
| | - Emmanuel Buc
- CHU Clermont-Ferrand, Service de chirurgie et oncologie digestive, F-63003, Clermont-Ferrand, France
- INSERM/UdA U1071, USC INRA 2018, M2iSH, F-63001, Clermont-Ferrand, France
| | - Caroline Pétorin
- CHU Clermont-Ferrand, Service de chirurgie et oncologie digestive, F-63003, Clermont-Ferrand, France
| | - Pierre Déchelotte
- CHU Clermont-Ferrand, Service d’anatomopathologie, F-63003, Clermont-Ferrand, France
- Université d’Auvergne, R2D2 – EA 7281, F-63001, Clermont-Ferrand, France
| | - Denis Pezet
- CHU Clermont-Ferrand, Service de chirurgie et oncologie digestive, F-63003, Clermont-Ferrand, France
- INSERM/UdA U1071, USC INRA 2018, M2iSH, F-63001, Clermont-Ferrand, France
| | - David Balayssac
- CHU Clermont-Ferrand, Délégation à la Recherche Clinique et à l’Innovation, F-63003, Clermont-Ferrand, France
- INSERM U1107, Neuro-Dol, F-63001, Clermont-Ferrand, France
- * E-mail:
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Gagnière J, Raisch J, Veziant J, Barnich N, Bonnet R, Buc E, Bringer MA, Pezet D, Bonnet M. Gut microbiota imbalance and colorectal cancer. World J Gastroenterol 2016; 22:501-518. [PMID: 26811603 PMCID: PMC4716055 DOI: 10.3748/wjg.v22.i2.501] [Citation(s) in RCA: 475] [Impact Index Per Article: 59.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 09/06/2015] [Accepted: 10/20/2015] [Indexed: 02/06/2023] Open
Abstract
The gut microbiota acts as a real organ. The symbiotic interactions between resident micro-organisms and the digestive tract highly contribute to maintain the gut homeostasis. However, alterations to the microbiome caused by environmental changes (e.g., infection, diet and/or lifestyle) can disturb this symbiotic relationship and promote disease, such as inflammatory bowel diseases and cancer. Colorectal cancer is a complex association of tumoral cells, non-neoplastic cells and a large amount of micro-organisms, and the involvement of the microbiota in colorectal carcinogenesis is becoming increasingly clear. Indeed, many changes in the bacterial composition of the gut microbiota have been reported in colorectal cancer, suggesting a major role of dysbiosis in colorectal carcinogenesis. Some bacterial species have been identified and suspected to play a role in colorectal carcinogenesis, such as Streptococcus bovis, Helicobacter pylori, Bacteroides fragilis, Enterococcus faecalis, Clostridium septicum, Fusobacterium spp. and Escherichia coli. The potential pro-carcinogenic effects of these bacteria are now better understood. In this review, we discuss the possible links between the bacterial microbiota and colorectal carcinogenesis, focusing on dysbiosis and the potential pro-carcinogenic properties of bacteria, such as genotoxicity and other virulence factors, inflammation, host defenses modulation, bacterial-derived metabolism, oxidative stress and anti-oxidative defenses modulation. We lastly describe how bacterial microbiota modifications could represent novel prognosis markers and/or targets for innovative therapeutic strategies.
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Phelip JM, Mineur L, De la Fouchardière C, Chatelut E, Quesada JL, Roblin X, Pezet D, Mendoza C, Buc E, Rivoire M. High Resectability Rate of Initially Unresectable Colorectal Liver Metastases After UGT1A1-Adapted High-Dose Irinotecan Combined with LV5FU2 and Cetuximab: A Multicenter Phase II Study (ERBIFORT). Ann Surg Oncol 2016; 23:2161-6. [PMID: 26739304 DOI: 10.1245/s10434-015-5072-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND The purpose of this study was to assess the efficacy and tolerance of induction chemotherapy combining LV5FU2 with increased doses of irinotecan adapted to UGT1A1 genotyping and cetuximab in untreated potentially resectable liver metastases of colorectal cancer. METHODS Twenty-six patients, PS 0-1, with class II hepatic metastases received chemotherapy combining irinotecan 260 mg/m(2) on day 1 for UGT1A1 6/6 and 6/7 genotypes and 220 mg/m(2) for UGT1A1 7/7 genotypes, with leucovorin on day 1, 5FU 400 mg/m(2) bolus on day 1 and continuous 5FU infusion for 46 h, and cetuximab on day 1 (day 1 = day 14). Primary prevention with lenograstim (day 5-9) was given to UGT1A1 6/7 and 7/7 genotypes. The primary endpoint was the response rate (RECIST1.1), and the secondary endpoints were tolerance (NCI-CTC criteria) and R0 resection rate. RESULTS The average number of cycles per patient was 6 (±1.9). The UGT1A1 genotype was 6/6 in 34.6 %, 6/7 in 53.9 %, and 7/7 in 11.5 % of patients. At 6 cycles, 18 patients (69.2 %) presented a partial response, 5 patients (19.2 %) had stable disease, 2 patients (7.7 %) died independently of chemotherapy, and 1 patient (3.9 %) refused the treatment after 3 cycles. Four patients received 2 more cycles and the cumulative response rate at 8 cycles was 76.9 % (20/26). There was no progression. Among assessable patients (n = 23), the overall response rate was 82.6 % and 21 patients (80.7 %) had a metastasis resection. The most frequent grade 3-4 toxicities were neutropenia (31 %), diarrhea (20.8 %), and anorexia (16.4 %). There were no deaths due to toxicity. CONCLUSIONS High-dose FOLFIRI combined with cetuximab yielded high response rates and enabled complete resection of class II hepatic metastases in most patients. It seemed to be well-tolerated among healthy selected patients thanks to irinotecan dose adaptation according to UGT1A1 pharmacogenomics status. This intensified chemotherapy regimen needs to be confirmed in a randomized, phase III study.
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Affiliation(s)
- Jean Marc Phelip
- Department of Gastroenterology and Digestive Oncology, LINA EA4624 Jean Monet University, University Hospital of Saint Etienne, 42055, Saint Etienne Cedex 2, France.
| | | | | | | | | | - Xavier Roblin
- Department of Gastroenterology and Digestive Oncology, LINA EA4624 Jean Monet University, University Hospital of Saint Etienne, 42055, Saint Etienne Cedex 2, France
| | - Denis Pezet
- University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | | | - Emmanuel Buc
- University Hospital of Clermont Ferrand, Clermont Ferrand, France
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Guandalino M, Dupré A, François M, Leroy B, Antomarchi O, Buc E, Dubois A, Guy L, Pezet D, Gagnière J. Previous radiation for prostate neoplasm alters surgical and oncologic outcomes after rectal cancer surgery. J Surg Oncol 2015; 112:802-8. [DOI: 10.1002/jso.24075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 10/10/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Marlène Guandalino
- Department of Digestive Surgery; Estaing University Hospital; Clermont-Ferrand France
| | - Aurélien Dupré
- Department of Digestive Surgery; Estaing University Hospital; Clermont-Ferrand France
| | - Marie François
- Department of Digestive Surgery; Estaing University Hospital; Clermont-Ferrand France
| | - Bertrand Leroy
- Department of Digestive Surgery; Estaing University Hospital; Clermont-Ferrand France
| | - Olivier Antomarchi
- Department of Digestive Surgery; Estaing University Hospital; Clermont-Ferrand France
| | - Emmanuel Buc
- Department of Digestive Surgery; Estaing University Hospital; Clermont-Ferrand France
| | - Anne Dubois
- Department of Digestive Surgery; Estaing University Hospital; Clermont-Ferrand France
| | - Laurent Guy
- Department of Digestive Surgery; Estaing University Hospital; Clermont-Ferrand France
| | - Denis Pezet
- Department of Digestive Surgery; Estaing University Hospital; Clermont-Ferrand France
| | - Johan Gagnière
- Department of Digestive Surgery; Estaing University Hospital; Clermont-Ferrand France
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Poincloux L, Rouquette O, Buc E, Privat J, Pezet D, Dapoigny M, Bommelaer G, Abergel A. Endoscopic ultrasound-guided biliary drainage after failed ERCP: cumulative experience of 101 procedures at a single center. Endoscopy 2015; 47:794-801. [PMID: 25961443 DOI: 10.1055/s-0034-1391988] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIM Endoscopic ultrasound (EUS)-guided biliary access is an alternative to percutaneous access after failed endoscopic retrograde cholangiopancreatography (ERCP). This report presents 7 years' cumulative experience of EUS-guided biliary drainage for obstructive jaundice in patients with failed ERCP. PATIENTS AND METHODS Between February 2006 and February 2013, 101 patients (malignant = 98, benign = 3) with previous failed ERCP underwent an EUS intra- or extrahepatic approach with transluminal stenting or an EUS-guided rendezvous procedure with transpapillary stent placement. A single endoscopist performed all procedures. RESULTS A total of 71 patients underwent the intrahepatic approach (66 hepatogastrostomies and 5 EUS-guided rendezvous), and 30 underwent the extrahepatic approach (26 choledochoduodenostomies, 1 choledochojejunostomy, 1 choledochoantrostomy, and 2 EUS-guided cholangiographies). Technical and clinical success rates were 98.0 % and 92.1 %, respectively. There was no difference in efficacy between hepatogastrostomies and choledochoduodenostomies (94 % vs. 90 %; P = 0.69) or in major complications (10.6 % vs. 6.7 %; P = 1). Adverse events occurred in 12 patients (11.9 %): 10 in the hepatogastrostomy group (2 limited pneumoperitoneum, 1 hepatic hematoma, 5 bile leakage, 2 sepsis), and 2 in the choledochoduodenostomy group (1 arteriobiliary fistula and 1 sepsis). There were six procedure-related deaths, five among the first 50 patients and one among the last 51 patients. Hepatogastrostomy vs. choledochoduodenostomy, plastic vs. metal stenting, stent-in-stent vs. 1 stent, nasobiliary drain, or postoperative octreotide infusion were not prognostic of bile leakage. CONCLUSION EUS-guided biliary drainage is an efficient technique, but is associated with significant morbidity that seems to decrease with the learning curve. It should be performed in tertiary care centers in selected patients. Prospective randomized studies are needed to compare EUS-guided biliary drainage with percutaneous transhepatic cholangiography drainage.
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Affiliation(s)
- Laurent Poincloux
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Rouquette
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Buc
- Department of Digestive Surgery, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Jocelyn Privat
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Denis Pezet
- Department of Digestive Surgery, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Michel Dapoigny
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Gilles Bommelaer
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - Armando Abergel
- Department of Digestive and Hepatobiliary Diseases, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
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Cougnoux A, Dalmasso G, Martinez R, Buc E, Delmas J, Gibold L, Sauvanet P, Darcha C, Déchelotte P, Bonnet M, Pezet D, Wodrich H, Darfeuille-Michaud A, Bonnet R. Bacterial genotoxin colibactin promotes colon tumour growth by inducing a senescence-associated secretory phenotype. Gut 2014; 63:1932-42. [PMID: 24658599 DOI: 10.1136/gutjnl-2013-305257] [Citation(s) in RCA: 299] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Escherichia coli strains harbouring the pks island (pks+ E. coli) are often seen in human colorectal tumours and have a carcinogenic effect independent of inflammation in an AOM/IL-10(-/-) (azoxymethane/interleukin) mouse model. OBJECTIVE To investigate the mechanism sustaining pks+ E. coli-induced carcinogenesis. METHOD Underlying cell processes were investigated in vitro and in vivo (xenograft model) using intestinal epithelial cells infected by pks+ E. coli or by an isogenic mutant defective for pks (pks- E. coli). The results were supported by data obtained from an AOM/DSS (azoxymethane/dextran sodium sulphate) colon cancer mouse model and from human colon cancer biopsy specimens colonised by pks+ E. coli or pks- E. coli. RESULTS Colibactin-producing E. coli enhanced tumour growth in both xenograft and AOM/DSS models. Growth was sustained by cellular senescence (a direct consequence of small ubiquitin-like modifier (SUMO)-conjugated p53 accumulation), which was accompanied by the production of hepatocyte growth factor (HGF). The underlying mechanisms involve microRNA-20a-5p, which targets SENP1, a key protein regulating p53 deSUMOylation. These results are consistent with the expression of SENP1, microRNA-20a-5p, HGF and phosphorylation of HGF receptor found in human and mouse colon cancers colonised by pks+ E. coli. CONCLUSION These data reveal a new paradigm for carcinogenesis, in which colibactin-induced senescence has an important role.
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Affiliation(s)
- Antony Cougnoux
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, Clermont-Ferrand, France INRA, USC 2018, Clermont-Ferrand, France
| | - Guillaume Dalmasso
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, Clermont-Ferrand, France INRA, USC 2018, Clermont-Ferrand, France
| | - Ruben Martinez
- Microbiologie Fondamentale et Pathogénicité, CNRS UMR 5234, Université Bordeaux Segalen, Bordeaux, France
| | - Emmanuel Buc
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, Clermont-Ferrand, France INRA, USC 2018, Clermont-Ferrand, France Service de Chirurgie Digestive, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Julien Delmas
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, Clermont-Ferrand, France INRA, USC 2018, Clermont-Ferrand, France Service de Bactériologie, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Lucie Gibold
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, Clermont-Ferrand, France INRA, USC 2018, Clermont-Ferrand, France Service de Bactériologie, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Pierre Sauvanet
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, Clermont-Ferrand, France INRA, USC 2018, Clermont-Ferrand, France Service de Chirurgie Digestive, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Claude Darcha
- Servie d'anatomo-pathologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Déchelotte
- Servie d'anatomo-pathologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Mathilde Bonnet
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, Clermont-Ferrand, France INRA, USC 2018, Clermont-Ferrand, France
| | - Denis Pezet
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, Clermont-Ferrand, France INRA, USC 2018, Clermont-Ferrand, France Service de Chirurgie Digestive, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Harald Wodrich
- Microbiologie Fondamentale et Pathogénicité, CNRS UMR 5234, Université Bordeaux Segalen, Bordeaux, France
| | - Arlette Darfeuille-Michaud
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, Clermont-Ferrand, France INRA, USC 2018, Clermont-Ferrand, France
| | - Richard Bonnet
- Clermont Université, UMR 1071 Inserm/Université d'Auvergne, Clermont-Ferrand, France INRA, USC 2018, Clermont-Ferrand, France Service de Bactériologie, Centre Hospitalier Universitaire, Clermont-Ferrand, France
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Buc E, Orry D, Antomarchi O, Gagnière J, Da Ines D, Pezet D. Resection of pancreatic ductal adenocarcinoma with synchronous distant metastasis: is it worthwhile? World J Surg Oncol 2014; 12:347. [PMID: 25407113 PMCID: PMC4289271 DOI: 10.1186/1477-7819-12-347] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 02/23/2014] [Accepted: 07/04/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study is to report prolonged survival in patients with metastatic pancreatic ductal adenocarcinoma (PDAC) managed by chemotherapy and surgery. METHODS Between January 2009 and August 2013, 284 patients with metastatic PDAC were managed in our oncologic department. Among them, three (1%) with a single metastasis (liver in two cases and interaorticaval in one case) underwent one- or two-stage surgical resection of the metastasis and the main tumor. Perioperative data were recorded retrospectively, including disease-free and overall survival. RESULTS The three patients had chemotherapy (FOLFOX or FOLFIRINOX regimen) with objective response or stable disease prior to surgery. Median time between chemotherapy and surgery was 9 (8 to 15) months. Resection consisted in pancreaticoduodenectomy in the three cases. None of the patients had grade III/IV postoperative complications, and median hospital stay was 12 (12 to 22) days. All the patients had postoperative chemotherapy. Only one patient experienced recurrence 11 months after surgery and died after 32.5 months. The two other patients were alive with no recurrence 26.3 and 24.7 months after initial treatment. CONCLUSION Radical resection of PDAC with single distant metastases can offer prolonged survival with low morbidity after accurate selection by neoadjuvant chemotherapy.
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Affiliation(s)
- Emmanuel Buc
- />Department of Digestive and HPB Surgery, CHU Estaing - 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
| | - David Orry
- />Department of Oncologic Surgery, Centre Georges François Leclerc, Dijon, France
| | - Olivier Antomarchi
- />Department of Digestive and HPB Surgery, CHU Estaing - 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
| | - Johan Gagnière
- />Department of Digestive and HPB Surgery, CHU Estaing - 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
| | - David Da Ines
- />Department of Radiology, CHU Estaing, Clermont-Ferrand, France
| | - Denis Pezet
- />Department of Digestive and HPB Surgery, CHU Estaing - 1, Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
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Buc E, Couvelard A, Kwiatkowski F, Dokmak S, Ruszniewski P, Hammel P, Belghiti J, Sauvanet A. Adenocarcinoma of the pancreas: Does prognosis depend on mode of lymph node invasion? Eur J Surg Oncol 2014; 40:1578-85. [DOI: 10.1016/j.ejso.2014.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/08/2014] [Accepted: 04/27/2014] [Indexed: 12/13/2022] Open
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Raisch J, Buc E, Bonnet M, Sauvanet P, Vazeille E, de Vallée A, Déchelotte P, Darcha C, Pezet D, Bonnet R, Bringer MA, Darfeuille-Michaud A. Colon cancer-associated B2 Escherichia coli colonize gut mucosa and promote cell proliferation. World J Gastroenterol 2014; 20:6560-6572. [PMID: 24914378 PMCID: PMC4047342 DOI: 10.3748/wjg.v20.i21.6560] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/10/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To provide further insight into the characterization of mucosa-associated Escherichia coli (E. coli) isolated from the colonic mucosa of cancer patients.
METHODS: Phylogroups and the presence of cyclomodulin-encoding genes of mucosa-associated E. coli from colon cancer and diverticulosis specimens were determined by PCR. Adhesion and invasion experiments were performed with I-407 intestinal epithelial cells using gentamicin protection assay. Carcinoembryonic antigen-related cell adhesion molecule 6 (CEACAM6) expression in T84 intestinal epithelial cells was measured by enzyme-linked immunosorbent assay and by Western Blot. Gut colonization, inflammation and pro-carcinogenic potential were assessed in a chronic infection model using CEABAC10 transgenic mice. Cell proliferation was analyzed by real-time mRNA quantification of PCNA and immunohistochemistry staining of Ki67.
RESULTS: Analysis of mucosa-associated E. coli from colon cancer and diverticulosis specimens showed that whatever the origin of the E. coli strains, 86% of cyclomodulin-positive E. coli belonged to B2 phylogroup and most harbored polyketide synthase (pks) island, which encodes colibactin, and/or cytotoxic necrotizing factor (cnf) genes. In vitro assays using I-407 intestinal epithelial cells revealed that mucosa-associated B2 E. coli strains were poorly adherent and invasive. However, mucosa-associated B2 E. coli similarly to Crohn’s disease-associated E. coli are able to induce CEACAM6 expression in T84 intestinal epithelial cells. In addition, in vivo experiments using a chronic infection model of CEACAM6 expressing mice showed that B2 E. coli strain 11G5 isolated from colon cancer is able to highly persist in the gut, and to induce colon inflammation, epithelial damages and cell proliferation.
CONCLUSION: In conclusion, these data bring new insights into the ability of E. coli isolated from patients with colon cancer to establish persistent colonization, exacerbate inflammation and trigger carcinogenesis.
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Gagnière J, Dupré A, Ines DD, Tixier L, Pezet D, Buc E. Giant mucinous cystic adenoma with pancreatic atrophy mimicking dorsal agenesis of the pancreas. World J Gastrointest Surg 2014; 6:42-46. [PMID: 24672649 PMCID: PMC3964414 DOI: 10.4240/wjgs.v6.i3.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/15/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
Mucinous cystic adenoma (MCA) of the pancreas is a rare benign cystic tumor with ovarian-like stroma and lack of communication with the pancreatic ductal system. The ovarian tissue is incorporated from the left gonad within the dorsal pancreas during embryogenesis. Consequently, congenital dorsal agenesis of the pancreas (DAP) cannot be associated with MCA. We report the case of a giant MCA associated with atrophy of the dorsal pancreas mimicking complete DAP. Pancreato-magnetic resonance imaging failed to identify the dorsal pancreas but the absence of diabetes mellitus and compression of the splenic vein with major tributaries rectified the diagnosis of secondary atrophy of the distal pancreas. Unusual proximal location of the cyst in the pancreas may have induced chronic obstruction of both the dorsal pancreatic duct and the splenic vein, with secondary atrophy of the distal pancreas.
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Bonnet M, Buc E, Sauvanet P, Darcha C, Dubois D, Pereira B, Déchelotte P, Bonnet R, Pezet D, Darfeuille-Michaud A. Colonization of the Human Gut by E. coli and Colorectal Cancer Risk. Clin Cancer Res 2013; 20:859-67. [PMID: 24334760 DOI: 10.1158/1078-0432.ccr-13-1343] [Citation(s) in RCA: 280] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Dupré A, Gagnière J, Tixier L, Ines DD, Perbet S, Pezet D, Buc E. Massive hepatic necrosis with toxic liver syndrome following portal vein ligation. World J Gastroenterol 2013; 19:2826-2829. [PMID: 23687421 PMCID: PMC3653158 DOI: 10.3748/wjg.v19.i18.2826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 01/08/2013] [Accepted: 02/06/2013] [Indexed: 02/06/2023] Open
Abstract
Right portal vein ligation (PVL) is a safe and widespread procedure to induce controlateral liver hypertrophy for the treatment of bilobar colorectal liver metastases. We report a case of a 60-year-old man treated by both right PVL and ligation of the glissonian branches of segment 4 for colorectal liver metastases surrounding the right and median hepatic veins. After surgery, the patient developed massive hepatic necrosis with secondary pulmonary and renal insufficiency requiring transfer to the intensive care unit. This so-called toxic liver syndrome finally regressed after hemofiltration and positive oxygen therapy. Diagnosis of acute congestion of the ligated lobe was suspected. The mechanism suspected was an increase in arterial inflow secondary to portal vein ligation concomitant with a decrease in venous outflow due to liver metastases encircling the right and median hepatic vein. This is the first documented case of toxic liver syndrome in a non-cirrhotic patient with favorable issue, and a rare complication of PVL.
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Fontarensky M, Montoriol PF, Buc E, Poincloux L, Petitcolin V, Da Ines D. Advantages of gadobenate dimeglumine-enhanced MR cholangiography in the diagnosis of post-liver transplant bile leakage. Diagn Interv Imaging 2013; 94:443-52. [PMID: 23433543 DOI: 10.1016/j.diii.2013.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the value of magnetic resonance cholangiography with gadobenate dimeglumine (Gd-BOPTA) where there is a suspicion of bile leakage in the post-liver transplant patient. PATIENTS AND METHODS Eight patients who had undergone a liver transplant underwent 14 MR cholangiograms, five of whom presented bile leakage while the other three had no biliary system complications. The results were compared to conventional bile duct opacification (by endoscopy or t-tube cholangiogram). The analysis covered whether there was opacification of the common bile duct and intrahepatic bile ducts on T1-weighted sequences after an injection of Gd-BOPTA on delayed biliary excretion phase sequences that were carried out on average 74 min after the injection. Enhancing perihepatic collections were also taken into account. RESULTS Opacification of the bile ducts on delayed-phase MR cholangiogram sequences was always seen in the absence of bile leakage, and was never found when leakage was present. Enhancing perihepatic collections pointed to bile leakage every time. CONCLUSION Gd-BOPTA-enhanced MR cholangiography is a simple and non-invasive technique for detecting bile leakage in the post-liver transplant patient.
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Affiliation(s)
- M Fontarensky
- Clermont-Ferrand University Hospital, Estaing University Hospital, Radiology and Medical Imaging Department, 1 place Lucie-Aubrac, Clermont-Ferrand cedex 1, France
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Buc E, Dubois D, Sauvanet P, Raisch J, Delmas J, Darfeuille-Michaud A, Pezet D, Bonnet R. High prevalence of mucosa-associated E. coli producing cyclomodulin and genotoxin in colon cancer. PLoS One 2013; 8:e56964. [PMID: 23457644 PMCID: PMC3572998 DOI: 10.1371/journal.pone.0056964] [Citation(s) in RCA: 340] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 01/18/2013] [Indexed: 02/08/2023] Open
Abstract
Some Escherichia coli strains produce toxins designated cyclomodulins (CMs) which interfere with the eukaryotic cell cycle of host cells, suggesting a possible link between these bacteria and cancers. There are relatively few data available concerning the colonization of colon tumors by cyclomodulin- and genotoxic-producing E. coli. We did a qualitative and phylogenetic analysis of mucosa-associated E. coli harboring cyclomodulin-encoding genes from 38 patients with colorectal cancer (CRC) and 31 with diverticulosis. The functionality of these genes was investigated on cell cultures and the genotoxic activity of strains devoid of known CM-encoding gene was investigated. Results showed a higher prevalence of B2 phylogroup E. coli harboring the colibatin-producing genes in biopsies of patients with CRC (55.3%) than in those of patients with diverticulosis (19.3%), (p<0.01). Likewise, a higher prevalence of B2 E. coli harboring the CNF1-encoding genes in biopsies of patients with CRC (39.5%) than in those of patients with diverticulosis (12.9%), (p = 0.01). Functional analysis revealed that the majority of these genes were functional. Analysis of the ability of E. coli to adhere to intestinal epithelial cells Int-407 indicated that highly adherent E. coli strains mostly belonged to A and D phylogroups, whatever the origin of the strains (CRC or diverticulosis), and that most E. coli strains belonging to B2 phylogroup displayed very low levels of adhesion. In addition, 27.6% (n = 21/76) E. coli strains devoid of known cyclomodulin-encoding genes induced DNA damage in vitro, as assessed by the comet assay. In contrast to cyclomodulin-producing E. coli, these strains mainly belonged to A or D E. coli phylogroups, and exhibited a non significant difference in the distribution of CRC and diverticulosis specimens (22% versus 32.5%, p = 0.91). In conclusion, cyclomodulin-producing E. coli belonging mostly to B2 phylogroup colonize the colonic mucosa of patients with CRC.
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Affiliation(s)
- Emmanuel Buc
- UMR 1071 Inserm/Université d'Auvergne, Clermont Université, Clermont-Ferrand, France
- USC 2018, INRA, Clermont-Ferrand, France
- Service de Chirurgie digestive, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Damien Dubois
- UMR 1071 Inserm/Université d'Auvergne, Clermont Université, Clermont-Ferrand, France
- USC 2018, INRA, Clermont-Ferrand, France
- Service de Bactériologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pierre Sauvanet
- UMR 1071 Inserm/Université d'Auvergne, Clermont Université, Clermont-Ferrand, France
- USC 2018, INRA, Clermont-Ferrand, France
- Service de Chirurgie digestive, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jennifer Raisch
- UMR 1071 Inserm/Université d'Auvergne, Clermont Université, Clermont-Ferrand, France
- USC 2018, INRA, Clermont-Ferrand, France
| | - Julien Delmas
- UMR 1071 Inserm/Université d'Auvergne, Clermont Université, Clermont-Ferrand, France
- USC 2018, INRA, Clermont-Ferrand, France
- Service de Bactériologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Arlette Darfeuille-Michaud
- UMR 1071 Inserm/Université d'Auvergne, Clermont Université, Clermont-Ferrand, France
- USC 2018, INRA, Clermont-Ferrand, France
- Service de Bactériologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Denis Pezet
- UMR 1071 Inserm/Université d'Auvergne, Clermont Université, Clermont-Ferrand, France
- USC 2018, INRA, Clermont-Ferrand, France
- Service de Chirurgie digestive, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Richard Bonnet
- UMR 1071 Inserm/Université d'Auvergne, Clermont Université, Clermont-Ferrand, France
- USC 2018, INRA, Clermont-Ferrand, France
- Service de Bactériologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Bonnet M, Buc E, Sauvanet P, Darcha C, Pereira B, Pezet D, Darfeuille-Michaud A. 701 Escherichia Coli and Colorectal Carcinogenesis. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kalenderian AC, Chabrot P, Buc E, Cassagnes L, Ravel A, Pezet D, Boyer L. Embolisation portale préopératoire par Amplatzer® Vascular Plugs (AVP) : 17 patients. ACTA ACUST UNITED AC 2011; 92:899-908. [DOI: 10.1016/j.jradio.2011.06.001] [Citation(s) in RCA: 5] [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] [Received: 02/01/2011] [Revised: 06/16/2011] [Accepted: 06/23/2011] [Indexed: 12/12/2022]
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Buc E, Dokmak S, Zappa M, Denninger MH, Valla DC, Belghiti J, Farges O. Hepatic veins as a site of clot formation following liver resection. World J Gastroenterol 2011; 17:403-6. [PMID: 21253403 PMCID: PMC3022304 DOI: 10.3748/wjg.v17.i3.403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 09/06/2010] [Accepted: 09/13/2010] [Indexed: 02/06/2023] Open
Abstract
Pulmonary embolism occurs more frequently after hepatectomy than previously thought but is infrequently associated with peripheral deep vein thrombosis. In this paper, we report 2 cases of postoperative hepatic vein thrombosis after liver resection. Both patients had undergone major hepatectomy of a non-cirrhotic liver largely exposing the middle hepatic vein. Clots were incidentally found in the middle hepatic vein 4 and 17 d after surgery despite routine systemic thrombo-prophylaxis with low molecular weight heparin. Coagulation of the transition plan in a context of mutation of the prothrombin gene and inflammation induced biloma were the likely predisposing conditions. Clots disappeared following curative anticoagulation. We conclude that thrombosis of hepatic veins may occur after liver resection and is a potential source of pulmonary embolism.
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Da Ines D, Buc E, Petitcolin V, Flamein R, Lannareix V, Achim A, Garcier JM. Massive hepatic necrosis with gastric, splenic, and pancreatic infarctions after ethanol ablation for hepatocellular carcinoma. J Vasc Interv Radiol 2010; 21:1301-5. [PMID: 20598566 DOI: 10.1016/j.jvir.2010.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 03/18/2010] [Accepted: 04/05/2010] [Indexed: 01/11/2023] Open
Abstract
Hepatic necrosis after ethanol ablation for hepatocellular carcinoma (HCC), although rare, is well known and described, particularly in patients with chronic liver disease. The present report describes a rare case of massive hepatic necrosis with partial gastric, splenic, and pancreatic infarctions after local treatment of liver HCC with ethanol ablation and discusses the reasons for this complication. With the increasing use of percutaneous techniques to treat liver tumors, it is imperative for the interventional radiologist to be aware of the potential vascular complications of these techniques. An appreciation of vascular anatomy via multidetector computed tomography (CT) and/or magnetic resonance (MR) angiography is important when planning image-guided interventions.
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Affiliation(s)
- David Da Ines
- Department of Medical Imaging, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand F 63001, France.
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Durando X, Farges MC, Buc E, Abrial C, Petorin-Lesens C, Gillet B, Vasson MP, Pezet D, Chollet P, Thivat E. Dietary methionine restriction with FOLFOX regimen as first line therapy of metastatic colorectal cancer: a feasibility study. Oncology 2010; 78:205-9. [PMID: 20424491 DOI: 10.1159/000313700] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 12/24/2009] [Indexed: 11/19/2022]
Abstract
UNLABELLED The methionine (MET) dependency of tumor cells opens interesting perspectives for targeting tumor cells and potentiating chemotherapy treatment, like 5-fluorouracil (5-FU) and platinum compound. Since MET deprivation can individually potentiate the different chemotherapeutic agents used in the 48-hour combined regimen of 5-FU, leucovorin and oxaliplatin (FOLFOX) regimen, we initiated a feasibility study associating dietary MET restriction with the FOLFOX regimen in patients with metastatic colorectal cancer. OBJECTIVES (i) To evaluate the depletion in the plasma MET concentration, and (ii) to assess the feasibility of this combination. METHODS Eleven patients were enrolled in this study. They received a median number of 3 two-week cycles of a MET-free diet (3 consecutive days) and FOLFOX6 regimen. RESULTS The plasma MET concentration was reduced by dietary MET restriction, with a depletion of 58% on the 1st day of MET-free diet. Indeed, we demonstrated the feasibility and good tolerance (nutritional status and toxicity) of the association of a MET-free diet with the FOLFOX regimen. Despite good compliance to the diet, this study revealed the difficulty of administering this combination during further months. Among the 4 patients evaluable for response, 3 experienced a partial response and 1 patient a disease stabilization.
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Affiliation(s)
- Xavier Durando
- Centre Jean Perrin, Unité de Recherche Clinique, UMR 990, Université Clermont 1, UFR Médecine, CIC 501, Clermont-Ferrand, France
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Buc E, Flamein R, Golffier C, Dubois A, Nagarajan G, Futier E, Pezet D. Peng's binding pancreaticojejunostomy after pancreaticoduodenectomy: a French prospective study. J Gastrointest Surg 2010; 14:705-10. [PMID: 20054660 DOI: 10.1007/s11605-009-1125-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [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: 07/09/2009] [Accepted: 11/30/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pancreatic fistula (PF) is the single most important complication after pancreaticoduodenectomy. Recently, a 0% rate of PF was reported using a binding pancreaticojejunostomy with intussusception of the pancreatic stump. The aim of this study was to assess the safety of this new binding pancreaticojejunostomy in condition most susceptible to PF, i.e. soft pancreas and non-dilated main pancreatic duct. METHODS Forty-five consecutive patients with soft pancreas and non-dilated main pancreatic duct underwent a binding pancreaticojejunostomy. Post-operative PF was defined according to the International Study Group of Pancreatic Fistula. RESULTS Four patients (8.9%) developed a PF. In one case, PF developed on post-operative day 3 due to a technical deficiency. In the three other cases, pancreatic fistula developed after the tenth post-operative day; all the patients had local and/or general co-morbidities before PF occurrence. CONCLUSIONS Binding pancreaticojejunostomy according to Peng is a safe and secure technique that improves the rate of pancreatic fistula, especially in case of soft texture of the pancreas remnant. However, a 0% rate seems to be hard to achieve because other abdominal and general complications are frequent and can lead to secondary leakage of the pancreatic anastomosis.
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Affiliation(s)
- Emmanuel Buc
- Service de Chirurgie Digestive et Hépatobiliaire, CHU Clermont-Ferrand, Hôtel Dieu-Bd Léon Malfreyt, 63058 Clermont-Ferrand, France.
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Buc E, Dupre A, Golffier C, Chabrot P, Flamein R, Dubois A, Pezet D. Positive PET-CT scan in hepatocellular adenoma with concomitant benign liver tumors. ACTA ACUST UNITED AC 2010; 34:338-41. [PMID: 20227207 DOI: 10.1016/j.gcb.2010.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 01/20/2010] [Accepted: 01/26/2010] [Indexed: 12/29/2022]
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Laurent-Puig P, Cayre A, Manceau G, Buc E, Bachet JB, Lecomte T, Rougier P, Lievre A, Landi B, Boige V, Ducreux M, Ychou M, Bibeau F, Bouché O, Reid J, Stone S, Penault-Llorca F. Analysis of PTEN, BRAF, and EGFR status in determining benefit from cetuximab therapy in wild-type KRAS metastatic colon cancer. J Clin Oncol 2009; 27:5924-30. [PMID: 19884556 DOI: 10.1200/jco.2008.21.6796] [Citation(s) in RCA: 562] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The occurrence of KRAS mutation is predictive of nonresponse and shorter survival in patients treated by anti-epidermal growth factor receptor (anti-EGFR) antibody for metastatic colorectal cancer (mCRC), leading the European Medicine Agency to limit its use to patients with wild-type KRAS tumors. However, only half of these patients will benefit from treatment, suggesting the need to identify additional biomarkers for cetuximab-based treatment efficacy. PATIENTS AND METHODS We retrospectively collected tumors from 173 patients with mCRC. All but one patient received a cetuximab-based regimen as second-line or greater therapy. KRAS and BRAF status were assessed by allelic discrimination. EGFR amplification was assessed by chromogenic in situ hybridization and fluorescent in situ hybridization, and the expression of PTEN was assessed by immunochemistry. RESULTS In patients with KRAS wild-type tumors (n = 116), BRAF mutations (n = 5) were weakly associated with lack of response (P = .063) but were strongly associated with shorter progression-free survival (P < .001) and shorter overall survival (OS; P < .001). A high EGFR polysomy or an EGFR amplification was found in 17.7% of the patients and was associated with response (P = .015). PTEN null expression was found in 19.9% of the patients and was associated with shorter OS (P = .013). In multivariate analysis, BRAF mutation and PTEN expression status were associated with OS. CONCLUSION BRAF status, EGFR amplification, and cytoplasmic expression of PTEN were associated with outcome measures in KRAS wild-type patients treated with a cetuximab-based regimen. Subsequent studies in clinical trial cohorts will be required to confirm the clinical utility of these markers.
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Azuar AS, Bouillet-Dejou L, Jardon K, Lenglet Y, Canis M, Bolandard F, Storme B, Bonnin M, Pezet D, Buc E, Lemery D, Gallot D. [Laparoscopy during pregnancy: experience of the French university hospital of Clermont-Ferrand]. ACTA ACUST UNITED AC 2009; 37:598-603. [PMID: 19577945 DOI: 10.1016/j.gyobfe.2009.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe perioperative management and perinatal outcome for patients undergoing laparoscopy during pregnancy. PATIENTS AND METHODS We conducted a retrospective study of all cases of laparoscopy during pregnancy performed in our university hospital over a period of six years (from February 2000 to February 2006). RESULTS We observed 34 cases managed from five to 30 weeks of gestation (11 cases of adnexal torsion, ten adnexal masses, eight appendicitis, one cholecystitis, one sigmoid volvulus, one pelvic peritonitis, two heterotopic pregnancies). Open laparoscopy was used in 12 cases. Conversion was required in two cases mainly due to adherences (one borderline lesion at 16 weeks and one tubal cyst torsion at 24 weeks). No maternal complication was observed. One miscarriage occurred at Day 1 (peritonitis, five weeks of gestation) and one patient opted for abortion. No threatened preterm labour occurred after the perioperative course and no neonate required admission in neonatology unit. DISCUSSION AND CONCLUSION This study illustrates safety and efficacy of laparoscopy in management of surgical diseases in the gravid patient. Emergent indications are the most common, highlighting the need for all physicians to know specific recommendations related to laparoscopy during pregnancy.
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Affiliation(s)
- A-S Azuar
- Pôle gynéco-obstétrique-reproduction humaine, CHU Clermont-Ferrand, Hôtel-Dieu, boulevard Léon-Malfreyt, 63003 Clermont-Ferrand, France
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Abstract
The liver hanging manoeuvre (LHM) facilitates the anterior approach (AA), which is one of the most important innovations in the field of major hepatic resections. The AA confers some definite advantages over the classical approach, in that it provides for: less haemorrhage; less tumoral manipulation and rupture; better haemodynamic stability by avoiding any twisting of the inferior vena cava; reduced ischaemic damage of the liver remnant, and better survival for patients with hepatocellular carcinoma (HCC). The LHM makes the AA easier because it serves as a guide to the correct anatomical transection plane and elevates the deep parenchymal plane. The LHM is a safe technique, in which minor complications have been reported in < or = 7% of patients and >90% feasibility has been demonstrated in experienced centres. Over the years, different variants of the LHM have been developed to facilitate almost all anatomical liver resections. In view of its advantages, feasibility and safety, the LHM should be considered for most anatomical hepatectomies.
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Affiliation(s)
- Guido Liddo
- Department of Hepato-Pancreato-Biliary Surgery and Transplantation, Beaujon Hospital-University Denis Diderot Paris, Assistance Publique-Hôpitaux de Paris, Clichy, France
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Vacher A, Chabrot P, Cassagnes L, Lesens O, Buc E, Pezet D, Laurichesse H, Boyer L. [Role of endovascular treatment of symptomatic splanchnic artery stenoses in HIV patients: report of three cases]. ACTA ACUST UNITED AC 2009; 90:221-4. [PMID: 19308007 DOI: 10.1016/s0221-0363(09)72473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients with HIV or AIDS frequently present with GI symptoms, sometimes due to early and diffuse atherosclerosis. We report 3 cases of HIV patients with abdominal pain due to severe splanchnic arterial stenosis. Only one patient presented typical clinical findings of mesenteric ischemic. Endovascular treatment was performed in all three cases. Good clinical outcome was immediate in 2 cases. In the third case, subsequent bowel resection was required due to irreversible ischemic injury in spite of local thrombolysis and endovascular revascularization in a patient presenting with acute severe mesenteric ischemia. In all three cases, vascular patency was demonstrated at follow-up. Mesenteric ischemia is a severe complication requiring early diagnosis in HIV patients, especially those with vascular risk factors, especially since endovascular treatment is a valid therapeutic option.
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Affiliation(s)
- A Vacher
- Services de Radiologie B, Chirurgie Digestive, et Maladies infectieuses et Tropicales, CHU Clermont-Ferrand, 63003 Clermont-Ferrand
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