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Seitlinger J, Wollbrett C, Mazzella A, Schmid S, Guerrera F, Banga Nkomo D, Hassan M, Brindel A, Ruuth-Praz J, Schmitt P, Clément-Duchêne C, Douiri N, Reeb J, Prisciandaro E, Siat J, Spaggiari L, Ruffini E, Filosso P, Ferri L, Santelmo N, Spicer J, Renaud S. Safety and Feasibility of Thoracic Malignancy Surgery During the COVID-19 Pandemic. Ann Thorac Surg 2020; 112:1870-1876. [PMID: 33333085 PMCID: PMC7834157 DOI: 10.1016/j.athoracsur.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has decreased surgical activity, particularly in the field of oncology, because of the suspicion of a higher risk of COVID-19–related severe events. This study aimed to investigate the feasibility and safety of thoracic cancer surgery in the most severely affected European and Canadian regions during the COVID-19 pandemic. Methods The study investigators prospectively collected data on surgical procedures for malignant thoracic diseases from January 1 to April 30, 2020. The study included patients from 6 high-volume thoracic surgery departments: Nancy and Strasbourg (France), Freiburg (Germany), Milan and Turin (Italy), and Montreal (Canada). The centers involved in this research are all located in the most severely affected regions of those countries. An assessment of COVID-19–related symptoms, polymerase chain reaction (PCR)–confirmed COVID-19 infection, rates of hospital and intensive care unit admissions, and death was performed for each patient. Every deceased patient was tested for COVID-19 by PCR. Results In the study period, 731 patients who underwent 734 surgical procedures were included. In the whole cohort, 9 cases (1.2%) of COVID-19 were confirmed by PCR, including 5 in-hospital contaminants. Four patients (0.5%) needed readmission for oxygen requirements. In this subgroup, 2 patients (0.3%) needed intensive care unit and mechanical ventilatory support. The total number of deaths in the whole cohort was 22 (3%). A single death was related to COVID-19 (0.14%). Conclusions Maintaining surgical oncologic activity in the era of the COVID-19 pandemic seems safe and feasible, with very low postoperative morbidity or mortality. To continue to offer the best care to patients who do not have COVID-19, reports on other diseases are urgently needed.
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Affiliation(s)
- Joseph Seitlinger
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Christophe Wollbrett
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Antonio Mazzella
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Severin Schmid
- Department of Thoracic Surgery, University Hospital Freiburg, Freiburg, Germany; Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University, Montreal, Canada
| | | | - Douglas Banga Nkomo
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Mohamed Hassan
- Department of Thoracic Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Aurélien Brindel
- Chest Department, Nancy Regional University Hospital, Nancy, France
| | - Julia Ruuth-Praz
- Chest Department, Nancy Regional University Hospital, Nancy, France
| | - Pierre Schmitt
- Chest Department, Sarreguemines Private Hospital, Sarreguemines, France
| | | | - Nawal Douiri
- Department of Internal Medicine and Infectious Disease, Rhena Private Hospital, Strasbourg, France
| | - Jérémie Reeb
- Department of Thoracic Surgery, Rhena Private Hospital, Strasbourg, France
| | - Elena Prisciandaro
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Joelle Siat
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Enrico Ruffini
- Thoracic Surgery Unit, University of Turin, Turin, Italy
| | | | - Lorenzo Ferri
- Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University, Montreal, Canada
| | - Nicola Santelmo
- Department of Thoracic Surgery, Rhena Private Hospital, Strasbourg, France
| | - Jonathan Spicer
- Department of Thoracic Surgery and Upper Gastrointestinal Surgery, McGill University, Montreal, Canada
| | - Stéphane Renaud
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France.
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Kassegne L, Degot T, Morel O, Reeb J, Carmona A, Schuller A, Hirschi S, Porzio M, Martin G, Riou M, Kessler R, Renaud-Picard B. Acute Cardiac Failure Due to Takotsubo Cardiomyopathy Secondary to a Phone Call for Lung Transplantation: A Case Report. Transplant Proc 2019; 51:3167-3170. [PMID: 31619342 DOI: 10.1016/j.transproceed.2019.07.003] [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] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/09/2019] [Indexed: 11/19/2022]
Abstract
Lung transplantation is a therapeutic option for certain end-stage lung diseases. The phone call for lung transplantation is a major event in the life of these patients; as a result, it can generate significant stress. We herein present the case of a 58-year-old female patient with end-stage chronic obstructive pulmonary disease (COPD) who, while on the lung transplantation waiting list, received such a call. Complete transplant work-up, including cardiac tests undertaken shortly before, had revealed no contraindication to lung transplantation. She was admitted with severe acute respiratory failure, and her extensive work-up was compatible with pulmonary edema due to takotsubo cardiomyopathy. The lung transplantation was thus cancelled, owing to the patient's health condition and the poor quality of the graft as well. The patient stayed in the intensive care unit for several days, requiring noninvasive ventilation. The left ventricular function recovered completely within 10 days postdiagnosis, and the patient was discharged 13 days after her admission. The patient was transplanted 1 month thereafter, without any particular problems; she is currently, 8 months post-transplantation, in good condition. In the given case, the call for lung transplantation could have generated emotional stress severe enough to lead to takotsubo cardiomyopathy.
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Affiliation(s)
- L Kassegne
- Service de Pneumologie, Groupe de Transplantation Pulmonaire de Strasbourg, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - T Degot
- Service de Pneumologie, Groupe de Transplantation Pulmonaire de Strasbourg, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - O Morel
- Service de Cardiologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - J Reeb
- Service de Chirurgie Thoracique, Clinique Rhéna, Strasbourg, France
| | - A Carmona
- Service de Cardiologie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - A Schuller
- Service de Pneumologie, Groupe de Transplantation Pulmonaire de Strasbourg, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S Hirschi
- Service de Pneumologie, Groupe de Transplantation Pulmonaire de Strasbourg, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - M Porzio
- Service de Pneumologie, Groupe de Transplantation Pulmonaire de Strasbourg, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - G Martin
- Service de Pneumologie, Groupe de Transplantation Pulmonaire de Strasbourg, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - M Riou
- Service de Pneumologie, Groupe de Transplantation Pulmonaire de Strasbourg, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - R Kessler
- Service de Pneumologie, Groupe de Transplantation Pulmonaire de Strasbourg, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - B Renaud-Picard
- Service de Pneumologie, Groupe de Transplantation Pulmonaire de Strasbourg, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Renaud S, Guerrera F, Seitlinger J, Reeb J, Voegeli AC, Legrain M, Mennecier B, Santelmo N, Falcoz PE, Quoix E, Chenard MP, Weingertner N, Beau-Faller M, Massard G. KRAS-specific Amino Acid Substitutions are Associated With Different Responses to Chemotherapy in Advanced Non-small-cell Lung Cancer. Clin Lung Cancer 2018; 19:e919-e931. [PMID: 30217639 DOI: 10.1016/j.cllc.2018.08.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 07/10/2018] [Accepted: 08/11/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Emerging data highlight different clinical behaviors according to KRAS amino acid substitutions (AASs) in patients with non-small-cell lung cancer (NSCLC). We aimed to evaluate whether different KRAS AASs were associated with different responses to chemotherapy. PATIENTS AND METHODS We retrospectively reviewed data from 1190 patients with KRAS mutations who underwent first-line platinum-based chemotherapy for stage IV NSCLC. The response to different chemotherapy regimens was evaluated using the Response Evaluation Criteria In Solid Tumors criteria (v 1.1). Overall survival and time to progression (TTP) were secondary endpoints. RESULTS Taxane was associated with the best response in the entire cohort (odds ratio, 2.52; 95% confidence interval [CI], 1.82-3.48; P < .001), especially in G12V patients (odds ratio, 2.15; 95% CI, 1.05-4.41; P = .036). Taxane was associated with improved TTP in the entire cohort (hazard ratio [HR], 0.31; 95% CI, 0.26-0.38; P < .001), especially in G13D patients (HR, 0.47; 95% CI, 0.22-1.01; P = .054). Pemetrexed was associated with the worst TTP in the entire cohort, particularly in G12V patients, who had the worst response rates (HR, 0.55; 95% CI, 0.30-0.99; P = .049). No impact on overall survival was observed according to different chemotherapy regimens and AASs. CONCLUSION KRAS-specific AAS appears to induce different responses to chemotherapy regimens after first-line platinum-based chemotherapy in advanced NSCLC.
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Affiliation(s)
- Stéphane Renaud
- Department of Thoracic Surgery, Nancy Regional University Hospital, Nancy, France.
| | - Francesco Guerrera
- Department of Thoracic Surgery, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Joseph Seitlinger
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Jérémie Reeb
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Anne-Claire Voegeli
- Department of Biochemistry and Molecular Biology, Strasbourg University Hospital, Strasbourg, France
| | - Michèle Legrain
- Department of Biochemistry and Molecular Biology, Strasbourg University Hospital, Strasbourg, France
| | - Bertrand Mennecier
- Department of Pneumology, Strasbourg University Hospital, Strasbourg, France
| | - Nicola Santelmo
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Elisabeth Quoix
- Department of Pneumology, Strasbourg University Hospital, Strasbourg, France
| | | | - Noëlle Weingertner
- Department of Pathology, Strasbourg University Hospital, Strasbourg, France
| | - Michèle Beau-Faller
- Department of Biochemistry and Molecular Biology, Strasbourg University Hospital, Strasbourg, France
| | - Gilbert Massard
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
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Wagner C, Porzio M, Olland A, Reeb J, Greget M, Grenet D, Bouilloud F, Bonnette P, Berney T, Javelot Jacquelin C, Baltzinger P, Kessler R, Kessler L. WS19.6 Feasibility and efficacy of combined lung and pancreatic islet transplantation in Cystic Fibrosis-Related Diabetes: a pilot study. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30231-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Renaud S, Seitlinger J, Guerrera F, Reeb J, Beau-Faller M, Voegeli AC, Siat J, Clément-Duchêne C, Tiotiu A, Santelmo N, Costardi L, Ruffini E, Falcoz PE, Vignaud JM, Massard G. Prognostic Value of Exon 19 Versus 21 EGFR Mutations Varies According to Disease Stage in Surgically Resected Non-small Cell Lung Cancer Adenocarcinoma. Ann Surg Oncol 2018; 25:1069-1078. [DOI: 10.1245/s10434-018-6347-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Renaud-Picard B, Toussaint J, Leclercq A, Reeb J, Kessler L, Toti F, Kessler R. [Membranous microparticles and respiratory disease]. Rev Mal Respir 2017; 34:1058-1071. [PMID: 29132745 DOI: 10.1016/j.rmr.2017.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 05/05/2017] [Indexed: 01/30/2023]
Abstract
Microparticles (MP) are plasmic membrane fragments released from cells after physiological stimulation or stress conditions like inflammation or infection. Their production is correlated to the rate of cell apoptosis. All types of cells can produce MP but they are produced mainly by platelets, endothelial cells, and leukocytes. They carry many bio-active molecules on their surface, specific to the parental cell, giving them the ability to be biomarkers and bio-effectors. MP are present in circulating blood, tissues and many biological fluids. Circulating MP levels can change during the course of many diseases. They have been the subject of many studies in the fields of cardiovascular disease and oncology. In the lungs, they are present in circulating blood and in the airways. They seem to have a role in pulmonary homeostasis in physiological situations and also in the expression of several disease processes. In this review of the literature, we were interested in the quantitative and qualitative variations in MP and their impact in airway diseases like chronic obstructive pulmonary disease (COPD) and asthma, pulmonary fibrosis and pulmonary hypertension.
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Affiliation(s)
- B Renaud-Picard
- Service de pneumologie, nouvel hôpital Civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; EA 7293, fédération de médecine translationnelle, université de Strasbourg, 67000 Strasbourg, France.
| | - J Toussaint
- EA 7293, fédération de médecine translationnelle, université de Strasbourg, 67000 Strasbourg, France
| | - A Leclercq
- Service de pneumologie, nouvel hôpital Civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; EA 7293, fédération de médecine translationnelle, université de Strasbourg, 67000 Strasbourg, France
| | - J Reeb
- EA 7293, fédération de médecine translationnelle, université de Strasbourg, 67000 Strasbourg, France
| | - L Kessler
- EA 7293, fédération de médecine translationnelle, université de Strasbourg, 67000 Strasbourg, France
| | - F Toti
- EA 7293, fédération de médecine translationnelle, université de Strasbourg, 67000 Strasbourg, France
| | - R Kessler
- Service de pneumologie, nouvel hôpital Civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; EA 7293, fédération de médecine translationnelle, université de Strasbourg, 67000 Strasbourg, France
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Reeb J, Olland A, Renaud S, Kindo M, Santelmo N, Massard G, Falcoz PE. Principi e indicazioni dell’assistenza circolatoria e respiratoria extracorporea in chirurgia toracica. EMC - Tecniche Chirurgiche - Chirurgia Generale 2017. [PMCID: PMC7164803 DOI: 10.1016/s1636-5577(17)82113-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In origine, l’extracorporeal membrane oxygenation (ECMO) era una tecnica di assistenza respiratoria che utilizzava uno scambiatore gassoso a membrana. Per estensione, l’ECMO è diventata una tecnica respiratoria e cardiopolmonare utilizzata in caso di deficit respiratorio e/o cardiaco nell’attesa della restaurazione della funzione deficitaria o di un eventuale trapianto. Il supporto emodinamico può essere parziale o totale. Gli accessi vascolari possono essere periferici o centrali. Questo tipo di assistenza utilizza il concetto di circolazione extracorporea (CEC) sanguigna che in epoca moderna si è estesa con l’utilizzo di polmoni artificiali a membrana. Il circuito di base è semplice e comprende una pompa, un ossigenatore (che permette al sangue di caricarsi di O2 e di eliminare CO2) e delle vie d’accesso (una di drenaggio e una di reinfusione). La sua attuazione è facile, veloce e può essere avviata al letto del malato. Il miglioramento delle attrezzature, una migliore conoscenza delle tecniche e delle indicazioni, e le politiche di salute pubblica hanno reso popolare questa tecnica. Alcuni centri di chirurgia toracica la utilizzano di routine come assistenza alla realizzazione di un intervento terapeutico (soprattutto trapianto) assieme a team di rianimazione per il trattamento della sindrome da distress respiratorio acuto. Nel quadro della malattia polmonare dell’adulto, l’idea principale è quella di sviluppare il concetto di strategia minimalista con l’uso di una CEC adiuvante parziale – più che sostitutiva totale – che permetterebbe il recupero metabolico ad integrum del paziente. Nei prossimi anni, i progressi della tecnologia e dell’ingegneria così come le conoscenze approfondite permetteranno il miglioramento della prognosi dei pazienti colpiti da deficit respiratorio sotto assistenza meccanica.
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Affiliation(s)
- J. Reeb
- Service de chirurgie thoracique, Groupe de transplantation pulmonaire, Nouvel Hôpital civil, Hôpitaux universitaires de Strasbourg, 1, place de l’Hôpital, 67100 Strasbourg, France
- The Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, 200, Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - A. Olland
- Service de chirurgie thoracique, Groupe de transplantation pulmonaire, Nouvel Hôpital civil, Hôpitaux universitaires de Strasbourg, 1, place de l’Hôpital, 67100 Strasbourg, France
| | - S. Renaud
- Service de chirurgie thoracique, Groupe de transplantation pulmonaire, Nouvel Hôpital civil, Hôpitaux universitaires de Strasbourg, 1, place de l’Hôpital, 67100 Strasbourg, France
| | - M. Kindo
- Service de chirurgie cardiovasculaire, Nouvel Hôpital civil, Hôpitaux universitaires de Strasbourg, 1, place de l’Hôpital, 67100 Strasbourg, France
| | - N. Santelmo
- Service de chirurgie thoracique, Groupe de transplantation pulmonaire, Nouvel Hôpital civil, Hôpitaux universitaires de Strasbourg, 1, place de l’Hôpital, 67100 Strasbourg, France
| | - G. Massard
- Service de chirurgie thoracique, Groupe de transplantation pulmonaire, Nouvel Hôpital civil, Hôpitaux universitaires de Strasbourg, 1, place de l’Hôpital, 67100 Strasbourg, France
| | - P.-E. Falcoz
- Service de chirurgie thoracique, Groupe de transplantation pulmonaire, Nouvel Hôpital civil, Hôpitaux universitaires de Strasbourg, 1, place de l’Hôpital, 67100 Strasbourg, France
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Renaud S, Schaeffer M, Falcoz PE, Seitlinger J, Romain B, Voegeli AC, Legrain M, Reeb J, Santelmo N, Rohr S, Brigand C, Olland A, Guenot D, Massard G. Perioperative bevacizumab improves survival following lung metastasectomy for colorectal cancer in patients harbouring v-Ki-ras2 Kirsten rat sarcoma viral oncogene homologue exon 2 codon 12 mutations†. Eur J Cardiothorac Surg 2017; 51:255-262. [PMID: 28186237 DOI: 10.1093/ejcts/ezw304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/01/2016] [Revised: 07/14/2016] [Accepted: 07/25/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The role of perioperative chemotherapy (POC) and targeted therapies in lung metastasectomy for colorectal cancer (CRC) is still subject to debate. We aimed to evaluate whether POC and targeted therapies were associated with different outcomes according to the mutational status. METHODS We reviewed data from 223 patients who underwent pulmonary metastasectomy for CRC from 1998 to 2015 and for whom the V-Ki-ras2 Kirsten sarcoma viral oncogene homologue (KRAS) and V-raf Murine sarcoma viral oncogene homologue B1 (BRAF) mutational statuses were known. RESULTS A total of 167 patients (74%) underwent POC: 62 (37%) received neoadjuvant therapy, 59 (35%) were in the adjuvant setting and 46 (28%) were in both the neoadjuvant and adjuvant settings. POC did not significantly influence either the loco-regional recurrence free survival (LRRFS) (P = 0.21) or the overall survival (OS) (P = 0.29). Furthermore, in cases of adjuvant chemotherapy, outcomes were not significantly different in cases of neoadjuvant chemotherapy or both neoadjuvant and adjuvant treatment (P = 0.26 for OS, P = 0.14 for LRRFS). For patients with KRAS mutation, perioperative bevacizumab was associated with a significant improvement in both LRRFS [70 months (41.58–98.42) vs 24 months (1.15–46.86), P = 0.001] and OS [101 vs 55 months (49.77–60.23), P = 0.004]. However, this benefit was only significant in cases of KRAS exon 2 codon 12 mutations [median OS: 101 months (83.97–118.02) vs 60 months (53–66.99), P < 0.001; median LRRFS: 76 months (64.62–87.38) vs 44 months (35.27–52.73), P < 0.001]. CONCLUSION Perioperative bevacizumab appears to be beneficial in patients with exon 2 codon 12 KRAS mutations who have undergone lung metastasectomy for CRC.
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Affiliation(s)
- Stéphane Renaud
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.,Research Unit EA 3430: Tumoral Progression and Microenvironment, Translational and Epidemiological Approaches, Strasbourg University, Strasbourg, France
| | - Mickaël Schaeffer
- Biostatistics Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Joseph Seitlinger
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Benoit Romain
- Research Unit EA 3430: Tumoral Progression and Microenvironment, Translational and Epidemiological Approaches, Strasbourg University, Strasbourg, France.,Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Anne-Claire Voegeli
- Department of Molecular Biology, Strasbourg University Hospital, Strasbourg, France
| | - Michèle Legrain
- Department of Molecular Biology, Strasbourg University Hospital, Strasbourg, France
| | - Jérémie Reeb
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Nicola Santelmo
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Serge Rohr
- Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Cécile Brigand
- Department of General and Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Anne Olland
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Dominique Guenot
- Research Unit EA 3430: Tumoral Progression and Microenvironment, Translational and Epidemiological Approaches, Strasbourg University, Strasbourg, France
| | - Gilbert Massard
- Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France
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Olland A, Reeb J, Guinard S, Seitlinger J, Santelmo N, Kessler R, Falcoz PE, Massard G. Clamshell Closure With Absorbable Sternal Pins in Lung Transplant Recipients. Ann Thorac Surg 2017; 104:e207-e209. [DOI: 10.1016/j.athoracsur.2017.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/29/2017] [Accepted: 04/16/2017] [Indexed: 10/19/2022]
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10
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Seitlinger J, Renaud S, Falcoz PE, Schaeffer M, Olland A, Reeb J, Santelmo N, Legrain M, Voegeli AC, Weingertner N, Chenard MP, Beau-Faller M, Massard G. Epidermal growth factor receptor and v-Ki-ras2 Kirsten rat sarcoma viral oncogen homologue-specific amino acid substitutions are associated with different histopathological prognostic factors in resected non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2016; 23:902-907. [DOI: 10.1093/icvts/ivw250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Abstract
Management of stage IIIA-N2 non-small cell lung cancer is still matter of ongoing controversy. The debate is flawed by the heterogeneity of this group of patients, lack of strong evidence from controlled trials, diverging treatment strategies, and hesitating estimation of prognosis. Surgery is credited a survival advantage in a trimodality setting. For many teams, N2 is by principle managed with induction chemotherapy, followed by surgery if the patient is down-staged. However, surgery remains a suitable option even in case of persistent N2. On the other hand, outcomes are comparable, regardless whether chemotherapy has been given as induction or adjuvant treatment. Hence, upfront surgery without invasive staging, followed by adjuvant therapies, appears reasonable in resectable single station N2 disease, simplifying patient care and reducing cost. We expect that molecular biomarkers will improve estimation of prognosis and patient selection in the future.
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Affiliation(s)
- Gilbert Massard
- Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 7293 "Vascular and Tissular Stress in Transplantation", Translational Research Federation, Strasbourg University, Strasbourg, France
| | - Stéphane Renaud
- Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 3430 "Tumour progression and microenvironment", Translational Research Federation, Strasbourg University, Strasbourg, France
| | - Jérémie Reeb
- Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 7293 "Vascular and Tissular Stress in Transplantation", Translational Research Federation, Strasbourg University, Strasbourg, France
| | - Nicola Santelmo
- Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Olland
- Service de chirurgie thoracique, University Hospital of Strasbourg, Strasbourg, France;; Research unit EA 7293 "Vascular and Tissular Stress in Transplantation", Translational Research Federation, Strasbourg University, Strasbourg, France
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Renaud S, Falcoz P, Schaeffer M, Romain B, Olland A, Reeb J, Voegeli' A, Legrain M, Brigand C, Rohr S, Dominique G, Massard G. F-077PERIOPERATIVE BEVACIZUMAB IMPROVES SURVIVAL IN LUNG METASTASECTOMY OF COLORECTAL CANCER HARBORING KRAS EXON 2 CODON 12 MUTATIONS. Interact Cardiovasc Thorac Surg 2016. [DOI: 10.1093/icvts/ivw260.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Olland A, Reeb J, Puyraveau M, Hirschi S, Seitlinger J, Santelmo N, Collange O, Mertes PM, Kessler R, Falcoz PE, Massard G. Bronchial complications after lung transplantation are associated with primary lung graft dysfunction and surgical technique. J Heart Lung Transplant 2016; 36:157-165. [PMID: 27618455 DOI: 10.1016/j.healun.2016.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/03/2016] [Accepted: 08/10/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND After lung transplantation, bronchial complications are one of the major concerns for surgeons and physicians. In the era of evolving immunosuppressive regimens and surgical approaches, we have reassessed risk factors for bronchial complications after lung transplantation. METHODS We undertook a retrospective study of all consecutive lung transplantations performed at a single center from 2004 to 2014. We monitored the incidence of symptomatic bronchial complications. Demographic data of donors and recipients were also studied. Our objective was to evaluate the impact of 3 subsequent immunosuppressive regimens (including the use of induction therapy), and of a technical modification of bronchial anastomosis on the incidence of airway complications. RESULTS We performed 270 consecutive lung transplantations during the study period. On multivariate analysis, bronchial complications were not directly associated with the different immunosuppressive regimens. In subgroup analysis, when comparing different immunosuppressive regimens, primary graft dysfunction within 72 hours (odds ratio [OR] = 2.55; p = 0.08), lung infection within the first month (OR = 2.96; p = 0.039), diabetes before transplantation (OR = 2.66; p = 0.11) and chronic obstructive pulmonary disease (OR = 2.20; p = 0.04) appeared as major risk factors (c-index = 0.77 on multivariate analysis). The use of a modified bronchial suture technique was associated with fewer bronchial complications (OR = 0.47; p = 0.059) (c-index = 0.71 on multivariate analysis). CONCLUSIONS The mode of immunosuppression had no influence on airway complications. We were able to reproduce the beneficial effect of a modified suture technique.
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Affiliation(s)
- Anne Olland
- Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France; EA 7293 "Stress Vasculaire et Tissulaire en Transplantation," Translational Medecine Federation Strasbourg, University of Strasbourg, Strasbourg, France.
| | - Jérémie Reeb
- Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France; EA 7293 "Stress Vasculaire et Tissulaire en Transplantation," Translational Medecine Federation Strasbourg, University of Strasbourg, Strasbourg, France
| | - Marc Puyraveau
- Clinical Methodology Center, University Hospital Besançon, Besançon, France
| | - Sandrine Hirschi
- Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France
| | - Joseph Seitlinger
- Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France
| | - Nicola Santelmo
- Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France
| | - Olivier Collange
- Intensive Care and Anesthesiology Department, University Hospital Strasbourg, Strasbourg, France
| | - Paul-Michel Mertes
- Intensive Care and Anesthesiology Department, University Hospital Strasbourg, Strasbourg, France
| | - Romain Kessler
- Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France; EA 7293 "Stress Vasculaire et Tissulaire en Transplantation," Translational Medecine Federation Strasbourg, University of Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France
| | - Gilbert Massard
- Lung Transplantation Group, Thoracic Surgery Department, University Hospital Strasbourg, Strasbourg, France; EA 7293 "Stress Vasculaire et Tissulaire en Transplantation," Translational Medecine Federation Strasbourg, University of Strasbourg, Strasbourg, France
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Olland A, Reeb J, Leclerq A, Renaud-Picard B, Falcoz PE, Kessler R, Schini-Kerth V, Kessler L, Toti F, Massard G. Microparticles: A new insight into lung primary graft dysfunction? Hum Immunol 2016; 77:1101-1107. [PMID: 27381358 DOI: 10.1016/j.humimm.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 04/17/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
Abstract
Lung transplantation is the only life-saving treatment for end stage respiratory disease. The immediate outcome is still hampered by primary graft dysfunction. The latter is a form of acute lung injury occurring within the 30min following the unclamping of the pulmonary artery that prompts ischemia reperfusion injury. Severe forms may need prolonged mechanical ventilation and extra-corporeal membrane oxygenation. Overall, primary graft dysfunction accounts for at least one third of the deaths during the first post-operative month. Despite increasing experience and knowledge on the underlying cellular events, there is still a lack of an early marker of ischemia reperfusion graft injuries. Microparticles are plasma membrane vesicles that are released from damaged or stressed cells in biological fluids and remodeling tissues, among which the lung parenchyma during acute or chronic injury. We recently evidenced alveolar microparticles as surrogate markers of strong ischemia injury in ex-vivo reperfusion experimental models. We propose herein new insights on how microparticles may be helpful to evaluate the extent of lung ischemia reperfusion injuries and predict the occurrence of primary graft dysfunction.
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Affiliation(s)
- Anne Olland
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg France; EA 7293 SVTT 'Stress Vasculaire et Tissulaire en Transplantation', Translational Medecine Federation, University of Strasbourg, Strasbourg, France.
| | - Jérémie Reeb
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg France; EA 7293 SVTT 'Stress Vasculaire et Tissulaire en Transplantation', Translational Medecine Federation, University of Strasbourg, Strasbourg, France
| | - Alexandre Leclerq
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg France; EA 7293 SVTT 'Stress Vasculaire et Tissulaire en Transplantation', Translational Medecine Federation, University of Strasbourg, Strasbourg, France
| | - Benjamin Renaud-Picard
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg France; EA 7293 SVTT 'Stress Vasculaire et Tissulaire en Transplantation', Translational Medecine Federation, University of Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg France; EA 7293 SVTT 'Stress Vasculaire et Tissulaire en Transplantation', Translational Medecine Federation, University of Strasbourg, Strasbourg, France
| | - Romain Kessler
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg France; EA 7293 SVTT 'Stress Vasculaire et Tissulaire en Transplantation', Translational Medecine Federation, University of Strasbourg, Strasbourg, France
| | - Valérie Schini-Kerth
- UMR CNRS 7213, Biophotonique and Pharmacology Laboratory, Pharmacology School, University of Strasbourg, Strasbourg, France
| | - Laurence Kessler
- Lung Transplantation Group, University Hospital Strasbourg, Strasbourg France; EA 7293 SVTT 'Stress Vasculaire et Tissulaire en Transplantation', Translational Medecine Federation, University of Strasbourg, Strasbourg, France
| | - Florence Toti
- UMR CNRS 7213, Biophotonique and Pharmacology Laboratory, Pharmacology School, University of Strasbourg, Strasbourg, France
| | - Gilbert Massard
- Labex Transplantex, Translational Medecine Federation, University of Strasbourg, Strasbourg, France; Lung Transplantation Group, University Hospital Strasbourg, Strasbourg France; EA 7293 SVTT 'Stress Vasculaire et Tissulaire en Transplantation', Translational Medecine Federation, University of Strasbourg, Strasbourg, France
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Yeung J, dos Santos PR, Reeb J, Yasufuku K, de Perrot M, Pierre A, Waddell T, Singer L, Keshavjee S, Cypel M. Single Center Results with Normothermic Ex Vivo Lung Perfusion: A Propensity Matched Analysis. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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16
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Renaud S, Falcoz PE, Schaëffer M, Guenot D, Romain B, Olland A, Reeb J, Santelmo N, Chenard MP, Legrain M, Voegeli AC, Beau-Faller M, Massard G. Prognostic value of the KRAS G12V mutation in 841 surgically resected Caucasian lung adenocarcinoma cases. Br J Cancer 2015; 113:1206-15. [PMID: 26372703 PMCID: PMC4647870 DOI: 10.1038/bjc.2015.327] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 05/13/2015] [Revised: 07/23/2015] [Accepted: 08/14/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Identifying patients who will experience lung cancer recurrence after surgery remains a challenge. We aimed to evaluate whether mutant forms of epidermal growth factor receptor (EGFR) and Kirsten rat sarcoma viral oncogene homolog (KRAS) (mEGFR and mKRAS) are useful biomarkers in resected non-small cell lung cancer (NSCLC). METHODS We retrospectively reviewed data from 841 patients who underwent surgery and molecular testing for NSCLC between 2007 and 2012. RESULTS mEGFR was observed in 103 patients (12.2%), and mKRAS in 265 (31.5%). The median overall survival (OS) and time to recurrence (TTR) were significantly lower for mKRAS (OS: 43 months; TTR: 19 months) compared with mEGFR (OS: 67 months; TTR: 24 months) and wild-type patients (OS: 55 months; disease-free survival (DFS): 24 months). Patients with KRAS G12V exhibited worse OS and TTR compared with the entire cohort (OS: KRAS G12V: 26 months vs COHORT 60 months; DFS: KRAS G12V: 15 months vs COHORT 24 months). These results were confirmed using multivariate analyses (non-G12V status, hazard ratio (HR): 0.43 (confidence interval: 0.28-0.65), P<0.0001 for OS; HR: 0.67 (0.48-0.92), P=0.01 for TTR). Risk of recurrence was significantly lower for non-KRAS G12V (HR: 0.01, (0.001-0.08), P<0.0001). CONCLUSIONS mKRAS and mEGFR may predict survival and recurrence in early stages of NSCLC. Patients with KRAS G12V exhibited worse OS and higher recurrence incidences.
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Affiliation(s)
- Stéphane Renaud
- Department of Thoracic Surgery, Strasbourg University Hospital, Nouvel Hôpital Civil, 67000 Strasbourg, France.,Reasearch Unit EA3430: Tumoral Progression and Micro-environment, Translational and Epidemiological Approaches, Translational Medicine Federation, Strasbourg University. 67000 Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Strasbourg University Hospital, Nouvel Hôpital Civil, 67000 Strasbourg, France
| | - Mickaël Schaëffer
- Department of Biostatistics, Strasbourg University Hospital. 67000 Strasbourg, France
| | - Dominique Guenot
- Reasearch Unit EA3430: Tumoral Progression and Micro-environment, Translational and Epidemiological Approaches, Translational Medicine Federation, Strasbourg University. 67000 Strasbourg, France
| | - Benoit Romain
- Reasearch Unit EA3430: Tumoral Progression and Micro-environment, Translational and Epidemiological Approaches, Translational Medicine Federation, Strasbourg University. 67000 Strasbourg, France.,Department of General and Digestive Surgery, Strasbourg University Hospital, Hôpital de Hautepierre, Strasbourg, France
| | - Anne Olland
- Department of Thoracic Surgery, Strasbourg University Hospital, Nouvel Hôpital Civil, 67000 Strasbourg, France
| | - Jérémie Reeb
- Department of Thoracic Surgery, Strasbourg University Hospital, Nouvel Hôpital Civil, 67000 Strasbourg, France
| | - Nicola Santelmo
- Department of Thoracic Surgery, Strasbourg University Hospital, Nouvel Hôpital Civil, 67000 Strasbourg, France
| | - Marie-Pierre Chenard
- Department of Pathology, Strasbourg University Hospital. 67000 Strasbourg, France
| | - Michèle Legrain
- Department of Molecular Biology, Oncobiology Laboratory, Regional Institute of Cancer Strasbourg University Hospital, Hôpital de Hautepierre, Strasbourg, France
| | - Anne-Claire Voegeli
- Department of Molecular Biology, Oncobiology Laboratory, Regional Institute of Cancer Strasbourg University Hospital, Hôpital de Hautepierre, Strasbourg, France
| | - Michèle Beau-Faller
- Reasearch Unit EA3430: Tumoral Progression and Micro-environment, Translational and Epidemiological Approaches, Translational Medicine Federation, Strasbourg University. 67000 Strasbourg, France.,Department of Molecular Biology, Oncobiology Laboratory, Regional Institute of Cancer Strasbourg University Hospital, Hôpital de Hautepierre, Strasbourg, France
| | - Gilbert Massard
- Department of Thoracic Surgery, Strasbourg University Hospital, Nouvel Hôpital Civil, 67000 Strasbourg, France
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Olland A, Reeb J, Falcoz PE, Garnon J, Germain P, Santelmo N, Kessler R, Massard G. Anomalous Pulmonary Venous Return of the Left Upper Lobe in a Donor Lung. Ann Thorac Surg 2015; 99:2199-202. [PMID: 26046876 DOI: 10.1016/j.athoracsur.2014.07.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/23/2014] [Accepted: 07/30/2014] [Indexed: 11/28/2022]
Abstract
We report a case of partial anomalous pulmonary venous return from the left upper lobe in a donor lung discovered during lung transplantation. The upper lobe vein could be implanted successfully into the donor atrial cuff to restore physiologic venous drainage. The abnormality was retrospectively identified on the donor's chest computed tomographic scan. Cardiac magnetic resonance imaging performed in the recipient 6 months after transplantation demonstrated patent left pulmonary venous drainage. This is the third reported case of partial anomalous pulmonary venous return in a donor lung, but the first description of direct ex vivo suture into the donor cuff.
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Affiliation(s)
- Anne Olland
- Groupe de Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; EA 7293 Stress Vasculaire et Tissulaire en Transplantation, Fédération de Médecine Translationnelle de Strasbourg, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | - Jérémie Reeb
- Groupe de Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; EA 7293 Stress Vasculaire et Tissulaire en Transplantation, Fédération de Médecine Translationnelle de Strasbourg, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Groupe de Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Pôle de Radiologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Germain
- Pôle de Radiologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nicola Santelmo
- Groupe de Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Romain Kessler
- Groupe de Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; EA 7293 Stress Vasculaire et Tissulaire en Transplantation, Fédération de Médecine Translationnelle de Strasbourg, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Gilbert Massard
- Groupe de Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; EA 7293 Stress Vasculaire et Tissulaire en Transplantation, Fédération de Médecine Translationnelle de Strasbourg, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg, France
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Renaud S, Falcoz PE, Schaeffer M, Beau-Faller M, Romain B, Olland A, Reeb J, Santelmo N, Massard G, Voegeli AC. Prognostic Influence of Mutational Status in Resected Non-Small Cell Lung Cancer: the KRAS G12V Worse Value. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv048.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Renaud-Picard B, Dégot T, Biondini D, Weingertner N, Reeb J, Chenard M, Kessler R. Successful Lung Retransplantation in a Patient With Acute Fibrinous and Organizing Pneumonia: A Case Report. Transplant Proc 2015; 47:182-5. [DOI: 10.1016/j.transproceed.2014.08.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 08/19/2014] [Indexed: 11/16/2022]
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Renaud S, Falcoz PE, Olland A, Reeb J, Santelmo N, Massard G. Mediastinal downstaging after induction treatment is not a significant prognostic factor to select patients who would benefit from surgery: the clinical value of the lymph node ratio. Interact Cardiovasc Thorac Surg 2014; 20:222-7. [PMID: 25413781 DOI: 10.1093/icvts/ivu378] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Multimodal management of N2 non-small-cell lung cancer is still a matter of debate. In particular, the place of surgery for persistent N2 after induction treatment is controversial and surgery is usually reserved for patients experiencing a mediastinal downstaging (pN1 and pN0). We aimed to evaluate whether there might exist subgroups of pN2 according to the lymph node ratio (LNR). METHODS Between 1996 and 2012, we retrospectively reviewed the data from 152 potentially resectable cN2 patients who underwent an induction treatment before surgery. RESULTS The median follow-up time was 32 months (2-112). The average age at the time of diagnosis was 58.52 ± 10.47 years. In univariate analysis, overall survival (OS) was significantly influenced by extracapsular spread (32 ± 5.33 vs 24 ± 12.73 months, P = 0.01), pN after surgery (65 ± 2.45 months for pN0, 44 ± 2.14 months for pN1 and 19 ± 1.72 months for pN2, P <0.0001) and LNR ≥ 1/3 (30 ± 3.77 months vs 16 ± 1.39 months, P <0.0001). When pN0 and pN1 patients were staged according to the LNR, the OS was divided by two for pN1 patients with an LNR ≥ 1/3 (48 ± 2.64 months vs 26 ± 5.65 months, P <0.001), whereas it decreased from 26 ± 0.87 to 15 ± 1.85 months (P <0.0001) for pN2 patients. OS was significantly better with adjuvant radio-chemotherapy than with chemotherapy or radiation therapy alone (P <0.0001). In multivariate analysis, mediastinal downstaging {Hazard Ratio (HR): 0.184 (95% confidence interval (CI): 0.084-0.403), P <0.0001} and LNR [HR: 0.359 (95% CI: 0.194-0.665], P = 0.001) remained significantly independent prognostic factors. CONCLUSIONS The LNR may potentially identify subgroups of pN+ patients and allow enhancement of adjuvant treatments. Because pN2 with a low LNR had an equivalent survival to pN1 with a high LNR, mediastinal downstaging does not seem to be a sufficient prognostic factor to exclude patients after induction treatment from surgery.
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Affiliation(s)
- Stéphane Renaud
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France EA3430: Federation of Translational Medicine, University of Strasbourg, Strasbourg, France
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Anne Olland
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Jérémie Reeb
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Nicola Santelmo
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
| | - Gilbert Massard
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Strasbourg University Hospital, Strasbourg, France
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Renaud S, Falcoz PE, Olland A, Schaeffer M, Reeb J, Santelmo N, Massard G. The intrathoracic lymph node ratio seems to be a better prognostic factor than the level of lymph node involvement in lung metastasectomy of colorectal carcinoma. Interact Cardiovasc Thorac Surg 2014; 20:215-21. [DOI: 10.1093/icvts/ivu364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Falcoz PE, Vitale L, Renaud S, Reeb J, Olland A, Santelmo N, Massard G. F-043VIDEO-THORACOSCOPIC LOBECTOMIES IN THE EPITHOR® DATABASE: EPIDEMIOLOGICAL ANALYSIS AND COMPARISON WITH THE OPEN TECHNIQUE OVER A 9-YEAR PERIOD. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reeb J, Falcoz P, Santelmo N, Mansour Z, Lejay A, Renaud S, Parissiadis A, Hanau D, Kessler R, Massard G. 529 Significance of Anti-HLA Immunization in Lung Transplantation. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Reeb J, Falcoz PE, Pottecher J, Delabranche X, Santelmo N, Steib A, Hasselmann M, Massard G. Two years' experience with bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation in adult refractory acute respiratory distress syndrome. Crit Care 2012. [PMCID: PMC3363517 DOI: 10.1186/cc10706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Reeb J, Falcoz PE, Santelmo N, Massard G. Double lumen bi-cava cannula for veno-venous extracorporeal membrane oxygenation as bridge to lung transplantation in non-intubated patient. Interact Cardiovasc Thorac Surg 2011; 14:125-7. [PMID: 22108944 DOI: 10.1093/icvts/ivr046] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is used for refractory respiratory failure. Normally, ECMO is implanted in intubated patients as a last resort. We report the case of a non-intubated patient who benefited from veno-venous (VV) ECMO. A 35-year old cystic fibrosis man presented a severe respiratory decompensation with refractory hypercapnia. We opted for an ECMO instead of mechanical ventilation (MV). We implanted a double lumen bi-cava cannula (DLC) (Avalon Elite(TM)) in the right jugular vein. Before ECMO implantation, the patient presented refractory respiratory failure (pH = 7.1, PaO(2) = 83 mmHg, PaCO(2 )= 103 mmHg). We proposed that the patient be placed on the high emergency lung transplantation waiting list after failure to wean him from ECMO. This registration was effective 10 days after ECMO implantation. The patient was grafted the next day. Under ECMO, mean PaO(2), PaCO(2) and TCA were 80.6 ± 14.2, 53.8 ± 6.4 mmHg and 56.2 ± 9.7 s, respectively. The patient could eat, drink, talk and practice chest physiotherapy. The evolution was uneventful under ECMO. Weaning from ECMO was done in the operating theatre after transplantation. VV ECMO with DLC is safe and feasible in non-intubated patients. It avoids potential complications of MV, and allows respiratory assistance as bridge to transplantation.
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Affiliation(s)
- Jérémie Reeb
- Department of Thoracic Surgery, Lung Transplantation Team, Nouvel Hôpital Civil, University Hospital, Strasbourg, France
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Small J, Colazo M, Ambrose D, Mapletoft R, Reeb J, Kastelic J. 183PREGNANCY RATE FOLLOWING TRANSFER OF IN VITRO- AND IN VIVO-PRODUCED
BOVINE EMBRYOS TO LH-TREATED RECIPIENTS. Reprod Fertil Dev 2004. [DOI: 10.1071/rdv16n1ab183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The objective was to evaluate the effect of pLH treatment on pregnancy rates in recipients receiving in vivo- or in vitro-produced bovine embryos. Heifers (n=37) and lactating (n=28) and non-lactating (n=150) beef cows were treated at random stages of the cycle with 100μg GnRH i.m. (Cystorelin, Merial Canada Inc., Victoriaville, Quebec, Canada) on Day −9, 500μg cloprostenol i.m. (PGF; Estrumate, Schering Plough Animal Health, Pointe-Claire, Quebec, Canada) on Day —2 and GnRH on Day 0 (66h post-PGF; without estrus detection). Cattle were placed at random, by class, into three groups: no further treatment (Control; n=71), or 12.5mg pLH (Lutropin-V, Bioniche Animal Health, Belleville, Ontario, Canada) on Day 5 (n=72) or on Day 7 (n=72) after the second GnRH. On Day 7, cattle with a CL >10mm in diameter (determined ultrasonically) received in vivo-produced, fresh (Simmental) or frozen (Holstein), or in vitro-produced frozen (Holstein) embryos (embryo type balanced among groups). Embryos were cryopreserved in 10% ethylene glycol; in vivo-produced frozen embryos were thawed 5 to 10s in air, 15s in a water-bath at 30°C and then “direct-transferred” nonsurgically. In vitro-produced frozen embryos (donated by IND Lifetech Inc., Delta, British Columbia, Canada) were thawed in a water-bath at 27°C for 10s and placed in ViGro Holding Plus medium (AB Technology, Pullman, WA, USA) at room temperature, evaluated and then transferred nonsurgically. Pregnancy was determined by ultrasonography on Day 35. Data were analyzed with CATMOD, chi-square and GLM procedures (SAS Institute, Cary, NC, USA.). Twenty cattle (9.3%) did not receive embryos; five heifers had cervical problems, and five heifers and 10 cows did not have a CL >10mm. Overall, 7.1% of the recipients had two CL on the day of embryo transfer. There was no effect (P>0.05) of treatment, embryo type (or interaction) or class of recipient on pregnancy rate (overall, 44.1%, 86/195; Table 1). Similarly, mean (±SD) CL diameter and luteal area did not differ (P>0.05) among groups or between pregnant and open recipients (overall, 22.0±3.4mm and 352.0±108.7mm, respectively). However, recipients with a CL diameter ≥18mm tended (P<0.1) to have a higher pregnancy rate (45.8 vs 25.0%). In a subset of 40 recipients examined ultrasonically on Day 12, 50% of those treated on Day 5 and 70% of those treated with pLH on Day 7 had two CL. In summary, overall pregnancy rate in GnRH-synchronized recipients receiving in vitro- or in vivo-produced embryos by nonsurgical transfer was 44.1%. Embryo survival to Day 35 was not affected by type of embryo or treatment with pLH 5 or 7 days after ovulation.
Table 1
Pregnancy rate in recipients on Day 35 based on pLH treatment and embryo-type
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Lubisch W, Behl B, Henn C, Hofmann HP, Reeb J, Regner F, Vierling M. Pyrrolylquinoxalinediones carrying a piperazine residue represent highly potent and selective ligands to the homomeric kainate receptor GluR5. Bioorg Med Chem Lett 2002; 12:2113-6. [PMID: 12127516 DOI: 10.1016/s0960-894x(02)00335-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pyrrolylquinoxalinediones carrying aminoalkyl residues were evaluated for affinity to the recombinant, homomeric kainate receptors GluR5, GluR6 and GluR7. Most derivatives preferred binding to GluR5. In particular, the piperazine 6e represents a highly potent and selective antagonist to GluR5.
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Affiliation(s)
- W Lubisch
- Department of CNS Discovery Research, Abbott GmbH & Co. KG, PO Box 210805, 67008, Ludwigshafen, Germany.
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Mailer CM, Mawas E, Parizot H, Reeb J. Spontaneous luxation of the eyeballs. Report of a patient with brachycephaly and anomalies of the extraocular muscles. Br J Ophthalmol 1969; 53:846-53. [PMID: 5386375 PMCID: PMC506770 DOI: 10.1136/bjo.53.12.846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Mawas E, Mailer M, Parizot H, Reeb J. [Recurrent spontaneous dislocations of the eyeballs in a brachycephalic]. Bull Soc Ophtalmol Fr 1969; 69:28-38. [PMID: 5405101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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