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Stosic K, Senar OA, Tarfouss J, Bouchart C, Navez J, Van Laethem JL, Arsenijevic T. A Comprehensive Review of the Potential Role of Liquid Biopsy as a Diagnostic, Prognostic, and Predictive Biomarker in Pancreatic Ductal Adenocarcinoma. Cells 2023; 13:3. [PMID: 38201207 PMCID: PMC10778087 DOI: 10.3390/cells13010003] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Pancreatic ductal adenocarcinoma is one of the most lethal malignant diseases, with a mortality rate being close to incidence. Due to its heterogeneity and plasticity, as well as the lack of distinct symptoms in the early phases, it is very often diagnosed at an advanced stage, resulting in poor prognosis. Traditional tissue biopsies remain the gold standard for making a diagnosis, but have an obvious disadvantage in their inapplicability for frequent sampling. Blood-based biopsies represent a non-invasive method which potentially offers easy and repeated sampling, leading to the early detection and real-time monitoring of the disease and hopefully an accurate prognosis. Given the urgent need for a reliable biomarker that can estimate a patient's condition and response to an assigned treatment, blood-based biopsies are emerging as a potential new tool for improving patients' survival and surveillance. In this article, we discuss the current advances and challenges in using liquid biopsies for pancreatic cancer, focusing on circulating tumour DNA (ctDNA), extracellular vesicles (EVs), and circulating tumour cells (CTCs), and compare the performance and reliability of different biomarkers and combinations of biomarkers.
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Affiliation(s)
- Kosta Stosic
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, 1070 Brussels, Belgium (O.A.S.); (C.B.)
| | - Oier Azurmendi Senar
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, 1070 Brussels, Belgium (O.A.S.); (C.B.)
| | - Jawad Tarfouss
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, 1070 Brussels, Belgium (O.A.S.); (C.B.)
| | - Christelle Bouchart
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, 1070 Brussels, Belgium (O.A.S.); (C.B.)
- Department of Radiation Oncology, Hopital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Julie Navez
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, 1070 Brussels, Belgium (O.A.S.); (C.B.)
- Department of Hepato-Biliary-Pancreatic Surgery, Hopital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Jean-Luc Van Laethem
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, 1070 Brussels, Belgium (O.A.S.); (C.B.)
- Department of Gastroenterology, Hepatology and Digestive Oncology, Hopital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
| | - Tatjana Arsenijevic
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, 1070 Brussels, Belgium (O.A.S.); (C.B.)
- Department of Gastroenterology, Hepatology and Digestive Oncology, Hopital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
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Bouchart C, Navez J, Borbath I, Geboes K, Vandamme T, Closset J, Moretti L, Demetter P, Paesmans M, Van Laethem JL. Preoperative treatment with mFOLFIRINOX or Gemcitabine/Nab-paclitaxel +/- isotoxic high-dose stereotactic body Radiation Therapy (iHD-SBRT) for borderline resectable pancreatic adenocarcinoma (the STEREOPAC trial): study protocol for a randomised comparative multicenter phase II trial. BMC Cancer 2023; 23:891. [PMID: 37735634 PMCID: PMC10512504 DOI: 10.1186/s12885-023-11327-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND For patients with pancreatic ductal adenocarcinoma (PDAC), surgical resection remains the only potentially curative treatment. Surgery is generally followed by postoperative chemotherapy associated with improved survival, yet neoadjuvant therapy is a rapidly emerging concept requiring to be explored and validated in terms of treatment options and oncological outcomes. In this context, stereotactic body radiation (SBRT) appears feasible and can be safely integrated into a neoadjuvant chemotherapy regimen of modified FOLFIRINOX (mFFX) with promising benefits in terms of R0 resection, local control and survival. However, the optimal therapeutic sequence is still not known, especially for borderline resectable PDAC, and the role of adding SBRT to chemotherapy in the neoadjuvant setting needs to be evaluated in randomised controlled trials. The aim of the STEREOPAC trial is to assess the impact and efficacy of adding isotoxic high-dose SBRT (iHD-SBRT) to neoadjuvant mFFX or Gemcitabine/Nab-Paclitaxel (Gem/Nab-P) in patients with borderline resectable PDAC. METHODS This is a randomised comparative multicentre phase II trial, planning to enrol patients (n = 256) diagnosed with a borderline resectable biopsy-confirmed PDAC. Patients will receive 4 cycles of mFFX (or 6 doses of Gem/Nab-P). After full disease restaging, non-progressive patients will be randomised for receiving either 4 additional mFFX cycles (or 6 doses of Gem/Nab-P) (Arm A), or 2 mFFX cycles (or 3 doses of Gem/Nab-P) + iHD-SBRT (35 to 55 Gy in 5 fractions) + 2 mFFX cycles (or 3 doses of Gem/Nab-P) (Arm B). Then curative surgery will be performed followed by adjuvant chemotherapy according to patient's condition. The co-primary endpoints are R0 resection and disease-free survival after the complete sequence strategy. The secondary endpoints include resection rate, overall survival, locoregional failure / distant metastasis free interval, pathologic complete response, toxicity, postoperative complications and quality of life assessment. DISCUSSION This trial will help define the best neoadjuvant treatment sequence for borderline resectable PDAC and aims to evaluate if a total neoadjuvant treatment integrating iHD-SBRT improves the patients' oncological outcomes. TRIAL REGISTRATION The study was registered at ClinicalTrails.gov (NCT05083247) on October 19th, 2021, and in the Clinical Trials Information System (CTIS) EU CT database (2022-501181-22-01) on July 2022.
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Affiliation(s)
- Christelle Bouchart
- Department of Radiation Oncology, Université Libre de Bruxelles (ULB), Hopital Universitaire de Bruxelles (H.U.B.), Institut Jules Bordet, Rue Meylenmeersch 90, 1070 Brussels, Belgium
| | - Julie Navez
- Department of Hepato-biliary-pancreatic surgery, Hopital Universitaire de Bruxelles H.U.B. - CUB Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ivan Borbath
- Department of Gastroenterology and Digestive Oncology, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Karen Geboes
- Department of Gastroenterology, Digestive Oncology, UZ Gent, Corneel Heymanslaan 10, 9000 Gent, Belgium
| | - Timon Vandamme
- Department of Oncology, UZ Antwerpen, Drie Eikenstraat 655, 2650 Antwerpen, Belgium
| | - Jean Closset
- Department of Hepato-biliary-pancreatic surgery, Hopital Universitaire de Bruxelles H.U.B. - CUB Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Luigi Moretti
- Department of Radiation Oncology, Université Libre de Bruxelles (ULB), Hopital Universitaire de Bruxelles (H.U.B.), Institut Jules Bordet, Rue Meylenmeersch 90, 1070 Brussels, Belgium
| | - Pieter Demetter
- Department of Pathology, Université Libre de Bruxelles (ULB), Hopital Universitaire de Bruxelles (H.U.B.), Institut Jules Bordet, Rue Meylenmeersch 90, 1070 Brussels, Belgium
| | - Marianne Paesmans
- Information Management Unit, Hopital Universitaire de Bruxelles (H.U.B.), Institut Jules Bordet, Rue Meylenmeersch 90, 1070 Brussels, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology, Hepatology and Digestive Oncology, Hopital Universitaire de Bruxelles H.U.B., Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
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Francisse S, Gkolfakis P, Viesca MFY, Mans L, Demols A, Pezzullo M, Loi P, Navez J, Closset J, Bali MA, Wettere MV, D’Haene N, Demetter P, Verset L, Bouchart C, Lemmers A, Deviere J, Delhaye M, Laethem JLV, Arvanitakis M. The impact of a multidisciplinary team approach on the management of focal pancreatic lesions: a single tertiary center experience. Ann Gastroenterol 2023; 36:580-587. [PMID: 37664233 PMCID: PMC10433261 DOI: 10.20524/aog.2023.0827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Multidisciplinary team (MDT) meetings aim to optimize patient management. We evaluated the impact of MDT discussions on the management and diagnosis of focal pancreatic lesions in a single tertiary center. Methods All patients with an initial diagnosis of solid or cystic pancreatic lesion discussed in our institution's MDT meeting on pancreatic diseases between January 1, 2020, and December 31, 2021, were included. The impact of MDT discussion on patient management, defined as a modification of the initially proposed therapeutic plan after MDT discussion, as well as the criteria leading to this modification, were the primary outcomes. Impact on diagnosis was the secondary outcome. Results A total of 522 patients were included. Of these, 185 (35.4%) and 337 (64.6%) had an initial diagnosis of cystic or solid lesion, respectively. The most common referral query was regarding the management plan (349/522; 66.9%). Endoscopy was the procedure most often proposed before MDT discussion (109/522; 20.9%). Overall, the MDT discussion led to modification of the management plan in 377/522 patients (72.2%), with a statistically significant difference between cystic and solid lesions (63.2% vs. 77.2%; P<0.001). Management modifications were mainly driven by revision of cross-sectional radiological images. MDT discussion led to modification of the diagnosis in 92/522 patients (17.6%), with a significant difference regarding cystic lesions (35.7% vs. 7.7%; P<0.001). Conclusion MDT discussion impacts the management of patients with cystic and solid pancreatic lesions, leading to a modification of the initially proposed management in two-thirds of them, mainly through revision of cross-sectional imaging.
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Affiliation(s)
- Sophie Francisse
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB (Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB (Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis)
| | - Michael Fernandez Y. Viesca
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB (Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis)
| | - Laura Mans
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB (Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis)
| | - Anne Demols
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB (Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis)
| | - Martina Pezzullo
- Department of Radiology, Erasme University Hospital, HUB (Martina Pezzullo, Morgane Van Wettere)
| | - Patricia Loi
- Department of Digestive Surgery, Surgical Oncology, Metabolic Surgery, Hepatopancreatology, Liver and Kidney Transplantations, Erasme University Hospital, HUB (Patricia Loi, Julie Navez, Jean Closset)
| | - Julie Navez
- Department of Digestive Surgery, Surgical Oncology, Metabolic Surgery, Hepatopancreatology, Liver and Kidney Transplantations, Erasme University Hospital, HUB (Patricia Loi, Julie Navez, Jean Closset)
| | - Jean Closset
- Department of Digestive Surgery, Surgical Oncology, Metabolic Surgery, Hepatopancreatology, Liver and Kidney Transplantations, Erasme University Hospital, HUB (Patricia Loi, Julie Navez, Jean Closset)
| | | | - Morgane Van Wettere
- Department of Radiology, Erasme University Hospital, HUB (Martina Pezzullo, Morgane Van Wettere)
| | - Nicki D’Haene
- Department of Pathology, Erasme University Hospital, HUB (Nicki D’Haene)
| | - Pieter Demetter
- Department of Pathology, Institute Jules Bordet, HUB (Pieter Demetter, Laurine Verset)
| | - Laurine Verset
- Department of Pathology, Institute Jules Bordet, HUB (Pieter Demetter, Laurine Verset)
| | - Christelle Bouchart
- Department of Radiation-Oncology, Institute Jules Bordet, HUB (Christelle Bouchart), Brussels, Belgium
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB (Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis)
| | - Jacques Deviere
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB (Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis)
| | - Myriam Delhaye
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB (Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis)
| | - Jean-Luc Van Laethem
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB (Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis)
| | - Marianna Arvanitakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme University Hospital, HUB (Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y Viesca, Laura Mans, Anne Demols, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis)
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Lete C, Brichard M, Rosa ML, Salavracos M, Hubert C, Navez B, Closset J, Pezzullo M, Navez J. Spleen-preserving pancreatectomy with removal of splenic vessels: impact on splenic parenchyma ? BMC Surg 2023; 23:245. [PMID: 37605170 PMCID: PMC10441733 DOI: 10.1186/s12893-023-02133-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND While outcomes after spleen-preserving distal pancreatectomy (SP-DP) have been widely reported, impacts on splenic parenchyma have not been well studied. This study aimed to compare postoperative outcomes, particularly spleen-related outcomes, by assessing splenic imaging after SP-DP with or without splenic vessels removal. METHODS Data for all patients who underwent SP-DP with splenic vessels removal (Warshaw technique, WDP) or preservation (Kimura technique, KDP) between 2010 and 2022 in two tertiary centres were retrospectively analysed. Splenic ischemia and volume at early/late imaging and postoperative outcomes were reviewed. RESULTS Eighty-seven patients were included, 51 in the WDP and 36 in the KDP groups. Median Charlson's Comorbidity Index was significantly higher in the WDP group compared with the KDP group. Postoperative morbidity was similar between groups. There was more splenic ischemia at early imaging in the WDP group compared to the KDP group (55% vs. 14%, p = 0.018), especially severe ischemia (23% vs. 0%). Partial splenic atrophy was observed in 29% and 0% in the WDP and KDP groups, respectively (p = 0.002); no complete splenic atrophy was observed. Platelet levels at POD 1, 2 and 6 were significantly higher in the WDP group compared to KDP group. At univariate analysis, age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction were prognostic factors for development of splenic atrophy. No episodes of overwhelming post-splenectomy infection or secondary splenectomy were recorded after a median follow-up of 9 and 11 months in the WDP and KDP groups, respectively. CONCLUSIONS Splenic ischemia appeared in one-half of patients undergoing SP-DP with splenic vessels removal at early imaging, and partial splenic atrophy in almost 30% at late imaging, without clinical impact or complete splenic atrophy. Age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction could help to predict the occurrence of splenic atrophy.
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Affiliation(s)
- Coralie Lete
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Route de Lennik 808, Brussels, 1070, Belgium
| | - Martin Brichard
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, Brussels, 1200, Belgium
| | - Maria Luisa Rosa
- Department of Radiology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, 1070, Belgium
| | - Mike Salavracos
- Department of Radiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, Brussels, 1200, Belgium
- Surgiprint 3D Intelligence, Louvain-La-Neuve, 1348, Belgium
| | - Catherine Hubert
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, Brussels, 1200, Belgium
| | - Benoit Navez
- Hepato-Biliary and Pancreatic Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Avenue Hippocrate 10, Brussels, 1200, Belgium
| | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Route de Lennik 808, Brussels, 1070, Belgium
| | - Martina Pezzullo
- Department of Radiology, Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Route de Lennik 808, Brussels, 1070, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology Hôpital Erasme, Hôpital Universitaire de Bruxelles (HUB), Route de Lennik 808, Brussels, 1070, Belgium.
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Vital R, Navez J, Gunes S, Tonneau C, Mehdi A, Moussaoui IE, Closset J. Long-Term Outcomes 10 Years after Laparoscopic Sleeve Gastrectomy: a Single Center Retrospective Analysis. Obes Surg 2023; 33:2356-2360. [PMID: 37382873 DOI: 10.1007/s11695-023-06709-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric procedure in the world. The aim of the study was to evaluate outcomes after 10 years. METHODS Patients who underwent LSG between 2005 and 2010 in a single center were retrospectively assessed, focusing mainly on the percentage of excess weight loss (%EWL) after 10 years. Inadequate weight loss was defined as a %EWL < 50% or the need to perform a revisional bariatric surgery. RESULTS Overall, 149 patients underwent LSG, with a median preoperative body mass index of 42.0 ± 6.5 kg/m2. Ten patients (6.7%) underwent previous bariatric procedure. Patients eating behavior was described as volume eaters in 73 (49%), sweet eaters in 11 (7.4%) and both volume and sweet eaters in 65 (43.6%). Six patients died during follow-up and 25 patients were lost to follow-up, leaving 118 (79%) patients who completed full follow-up. Thirty-five patients (23.5%) needed a revisional bariatric surgery. For the 83 remaining patients, the mean %EWL was 35.9% at 10 years, only 23 of 83 patients (27.7%) had a %EWL ≥ 50%. Thus 80.5% patients (95/118) experienced inadequate weight loss 10 years after LSG. A lower %EWL after 1 year was predictive for inadequate weight loss after 10 years. CONCLUSION Ten years after LSG, the rate of inadequate weight loss was high, reaching 80% of patients. Thirty percent of patients required a revisional bariatric procedure. New studies must try to identify patients who are good candidates for LSG and strategies to improve long-term outcomes.
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Affiliation(s)
- Roxane Vital
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Seda Gunes
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Camille Tonneau
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Abdelilah Mehdi
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Imad El Moussaoui
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium
| | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Erasmus Hospital, Route de Lennik 808, 1070, Brussels, Belgium.
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Racu ML, Bernardi D, Chaouche A, Zindy E, Navez J, Loi P, Maris C, Closset J, Van Laethem JL, Decaestecker C, Salmon I, D’Haene N. SMAD4 Positive Pancreatic Ductal Adenocarcinomas Are Associated with Better Outcomes in Patients Receiving FOLFIRINOX-Based Neoadjuvant Therapy. Cancers (Basel) 2023; 15:3765. [PMID: 37568581 PMCID: PMC10417261 DOI: 10.3390/cancers15153765] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND SMAD4 is inactivated in 50-55% of pancreatic ductal adenocarcinomas (PDACs). SMAD4 loss of expression has been described as a negative prognostic factor in PDAC associated with an increased rate of metastasis and resistance to therapy. However, the impact of SMAD4 inactivation in patients receiving neoadjuvant therapy (NAT) is not well characterized. The aim of our study was to investigate whether SMAD4 status is a prognostic and predictive factor in patients receiving NAT. METHODS We retrospectively analyzed 59 patients from a single center who underwent surgical resection for primary PDAC after NAT. SMAD4 nuclear expression was assessed by immunohistochemistry, and its relationship to clinicopathologic variables and survival parameters was evaluated. Interaction testing was performed between SMAD4 status and the type of NAT. RESULTS 49.15% of patients presented loss of SMAD4. SMAD4 loss was associated with a higher positive lymph node ratio (p = 0.03), shorter progression-free survival (PFS) (p = 0.02), and metastasis-free survival (MFS) (p = 0.02), but it was not an independent prognostic biomarker in multivariate analysis. Interaction tests demonstrated that patients with SMAD4-positive tumors receiving FOLFIRINOX-based NAT showed the best outcome. CONCLUSION This study highlights the potential prognostic and predictive role of SMAD4 status in PDAC patients receiving FOLFIRINOX-based NAT.
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Affiliation(s)
- Marie-Lucie Racu
- Departement of Pathology, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium; (D.B.); (A.C.); (C.M.); (I.S.); (N.D.)
| | - Dana Bernardi
- Departement of Pathology, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium; (D.B.); (A.C.); (C.M.); (I.S.); (N.D.)
| | - Aniss Chaouche
- Departement of Pathology, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium; (D.B.); (A.C.); (C.M.); (I.S.); (N.D.)
| | - Egor Zindy
- Digital Image Analysis in Pathology (DIAPath), Center for Microscopy and Molecular Imaging (CMMI), Université Libre de Bruxelles (ULB), 6041 Gosselies, Belgium; (E.Z.); (C.D.)
- Laboratory of Image Synthesis and Analysis (LISA), Brussels School of Engineering/École Polytechnique de Bruxelles, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Julie Navez
- Department of Hepato-Biliary-Pancreatic Surgery, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium; (J.N.); (P.L.); (J.C.); (J.-L.V.L.)
| | - Patrizia Loi
- Department of Hepato-Biliary-Pancreatic Surgery, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium; (J.N.); (P.L.); (J.C.); (J.-L.V.L.)
| | - Calliope Maris
- Departement of Pathology, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium; (D.B.); (A.C.); (C.M.); (I.S.); (N.D.)
| | - Jean Closset
- Department of Hepato-Biliary-Pancreatic Surgery, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium; (J.N.); (P.L.); (J.C.); (J.-L.V.L.)
| | - Jean-Luc Van Laethem
- Department of Hepato-Biliary-Pancreatic Surgery, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium; (J.N.); (P.L.); (J.C.); (J.-L.V.L.)
| | - Christine Decaestecker
- Digital Image Analysis in Pathology (DIAPath), Center for Microscopy and Molecular Imaging (CMMI), Université Libre de Bruxelles (ULB), 6041 Gosselies, Belgium; (E.Z.); (C.D.)
- Laboratory of Image Synthesis and Analysis (LISA), Brussels School of Engineering/École Polytechnique de Bruxelles, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Isabelle Salmon
- Departement of Pathology, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium; (D.B.); (A.C.); (C.M.); (I.S.); (N.D.)
- Digital Image Analysis in Pathology (DIAPath), Center for Microscopy and Molecular Imaging (CMMI), Université Libre de Bruxelles (ULB), 6041 Gosselies, Belgium; (E.Z.); (C.D.)
| | - Nicky D’Haene
- Departement of Pathology, CUB Hôpital Erasme, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium; (D.B.); (A.C.); (C.M.); (I.S.); (N.D.)
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De Pauw V, Pezzullo M, Bali MA, El Moussaoui I, Racu ML, D'haene N, Bouchart C, Closset J, Van Laethem JL, Navez J. Peritoneal patch in vascular reconstruction during pancreaticoduodenectomy for pancreatic cancer: a single Centre experience. Acta Chir Belg 2023; 123:257-265. [PMID: 34503397 DOI: 10.1080/00015458.2021.1979173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/16/2021] [Accepted: 09/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Concomitant venous resection during pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma with mesenterico-portal vein involvement is increasingly performed to achieve oncological resection. This study aims to report a single centre experience in peritoneal patch (PP) as autologous graft for vascular reconstruction (VR) during PD. METHODS A retrospective analysis of all patients who underwent PD + VR with PP between December 2019 and September 2020 was performed, using a prospective collected database. Postoperative outcome and pathological margins were evaluated. Venous patency was assessed by computed tomography at day 7 and week 12 post surgery. RESULTS Fifteen patients underwent PD + VR with PP reconstruction for pancreatic cancer, including one total pancreatectomy. VR consisted of lateral (n = 14) or tubular (n = 1) patch. The median PP length was 30 mm [26.3-33.8] and venous clamping time 30 min [27.5-39.0]. Computed tomography showed a patent VR in 93.3% and 53.3% after 7 days and 12 weeks, respectively; venous patency loss was always asymptomatic. The only postoperative VR-related complication was one mesenteric venous thrombosis. Five other patients experienced VR-unrelated complications: septic shock (n = 3), biliary fistula (n = 1) and post-traumatic subdural hematoma (n = 1). Mortality was nihil. At pathology, R0 resection (≥1 mm) was observed in 40.0% (6/15), venous margin was free in 46.7% (7/15), and venous wall was involved in 40.0% (6/15). CONCLUSIONS Use of PP as venous substitute during PD + VR is safe and feasible with an acceptable postoperative morbidity, and a decreased but asymptomatic venous patency after 12 weeks which should question the role of anticoagulation therapy.
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Affiliation(s)
- Vincent De Pauw
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martina Pezzullo
- Department of Radiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Antonietta Bali
- Department of Radiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiology, Institut Jules Bordet, Brussels, Belgium
| | - Imad El Moussaoui
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie-Lucie Racu
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicky D'haene
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Van Laethem
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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8
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Navez J, Bouchart C, Mans L, Devos S, Loi P, Closset J, Van Laethem JL. Neoadjuvant chemotherapy associated with isotoxic high-dose stereotactic body radiotherapy does not increase postoperative complications after pancreaticoduodenectomy for nonmetastatic pancreatic cancer. J Surg Oncol 2023. [PMID: 36999597 DOI: 10.1002/jso.27252] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/02/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND OBJECTIVES The role of radiotherapy in the therapeutic sequence of nonmetastatic pancreatic cancer (PC) is controversial, including isotoxic high-dose stereotactic body radiotherapy (iHD-SBRT). This study aimed to compare postoperative outcome of patients with nonmetastatic PC undergoing neoadjuvant treatment (NAT) including iHD-SBRT versus upfront pancreaticoduodenectomy (PD). METHODS All patients undergoing PD for PC from 2017 to 2021 were retrospectively analyzed, identifying patients receiving NAT with iHD-SBRT. Toxicity of treatments and postoperative outcome were assessed and analyzed in a propensity score-matched population. RESULTS Eighty-nine patients underwent upfront surgery (surgery group) and 22 after NAT and iHD-SBRT (SBRT group). No major side effects SBRT-related were identified preoperatively. Postoperative morbidity was similar between groups. There was no postoperative death in SBRT group, and six in surgery group (p = 0.597). No difference was observed in the rates of complications related to pancreatic surgery. The postoperative hospital stay was shorter in SBRT versus surgery groups (p = 0.016). After propensity score matching, no significant difference in the postoperative morbidity was observed between groups. CONCLUSIONS Incorporation of iHD-SBRT in the NAT sequence before PD for PC did not increase postoperative morbidity compared with upfront surgery. These results confirm the feasibility and safety of iHD-SBRT for the upcoming STEREOPAC trial.
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Affiliation(s)
- Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Laura Mans
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Soline Devos
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrizia Loi
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jean-Luc Van Laethem
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles (HUB) - Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Benkhaled S, Peters C, Jullian N, Arsenijevic T, Navez J, Van Gestel D, Moretti L, Van Laethem JL, Bouchart C. Combination, Modulation and Interplay of Modern Radiotherapy with the Tumor Microenvironment and Targeted Therapies in Pancreatic Cancer: Which Candidates to Boost Radiotherapy? Cancers (Basel) 2023; 15:cancers15030768. [PMID: 36765726 PMCID: PMC9913158 DOI: 10.3390/cancers15030768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
Pancreatic ductal adenocarcinoma cancer (PDAC) is a highly diverse disease with low tumor immunogenicity. PDAC is also one of the deadliest solid tumor and will remain a common cause of cancer death in the future. Treatment options are limited, and tumors frequently develop resistance to current treatment modalities. Since PDAC patients do not respond well to immune checkpoint inhibitors (ICIs), novel methods for overcoming resistance are being explored. Compared to other solid tumors, the PDAC's tumor microenvironment (TME) is unique and complex and prevents systemic agents from effectively penetrating and killing tumor cells. Radiotherapy (RT) has the potential to modulate the TME (e.g., by exposing tumor-specific antigens, recruiting, and infiltrating immune cells) and, therefore, enhance the effectiveness of targeted systemic therapies. Interestingly, combining ICI with RT and/or chemotherapy has yielded promising preclinical results which were not successful when translated into clinical trials. In this context, current standards of care need to be challenged and transformed with modern treatment techniques and novel therapeutic combinations. One way to reconcile these findings is to abandon the concept that the TME is a well-compartmented population with spatial, temporal, physical, and chemical elements acting independently. This review will focus on the most interesting advancements of RT and describe the main components of the TME and their known modulation after RT in PDAC. Furthermore, we will provide a summary of current clinical data for combinations of RT/targeted therapy (tRT) and give an overview of the most promising future directions.
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Affiliation(s)
- Sofian Benkhaled
- Department of Radiation Oncology, Hopital Universitaire de Bruxelles (H.U.B.), Institut Jules Bordet, Université Libre de Bruxelles (ULB), Rue Meylenmeersch 90, 1070 Brussels, Belgium
- Department of Radiation Oncology, UNIL-CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Cedric Peters
- Department of Radiation Oncology, AZ Turnhout, Rubensstraat 166, 2300 Turnhout, Belgium
| | - Nicolas Jullian
- Department of Radiation Oncology, Hopital Universitaire de Bruxelles (H.U.B.), Institut Jules Bordet, Université Libre de Bruxelles (ULB), Rue Meylenmeersch 90, 1070 Brussels, Belgium
| | - Tatjana Arsenijevic
- Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
- Department of Gastroenterology, Hepatology and Digestive Oncology, Hopital Universitaire de Bruxelles H.U.B. CUB Hopital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
| | - Julie Navez
- Department of Hepato-Biliary-Pancreatic Surgery, Hopital Universitaire de Bruxelles H.U.B. CUB Hopital Erasme, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, Hopital Universitaire de Bruxelles (H.U.B.), Institut Jules Bordet, Université Libre de Bruxelles (ULB), Rue Meylenmeersch 90, 1070 Brussels, Belgium
| | - Luigi Moretti
- Department of Radiation Oncology, Hopital Universitaire de Bruxelles (H.U.B.), Institut Jules Bordet, Université Libre de Bruxelles (ULB), Rue Meylenmeersch 90, 1070 Brussels, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology, Hepatology and Digestive Oncology, Hopital Universitaire de Bruxelles H.U.B. CUB Hopital Erasme, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070 Brussels, Belgium
| | - Christelle Bouchart
- Department of Radiation Oncology, Hopital Universitaire de Bruxelles (H.U.B.), Institut Jules Bordet, Université Libre de Bruxelles (ULB), Rue Meylenmeersch 90, 1070 Brussels, Belgium
- Correspondence: ; Tel.: +32-25-413-800
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Manderlier M, Navez J, Hein M, Engelholm JL, Closset J, Bali MA, Van Gestel D, Moretti L, Van Laethem JL, Bouchart C. Isotoxic High-Dose Stereotactic Body Radiotherapy (iHD-SBRT) Versus Conventional Chemoradiotherapy for Localized Pancreatic Cancer: A Single Cancer Center Evaluation. Cancers (Basel) 2022; 14:cancers14235730. [PMID: 36497212 PMCID: PMC9741086 DOI: 10.3390/cancers14235730] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Given the lack of direct comparative evidence, we aimed to compare the oncological outcomes of localized pancreatic ductal adenocarcinoma (PDAC) treated in the same tertiary cancer center with isotoxic high-dose stereotactic body radiotherapy (iHD-SBRT) or conventional chemoradiotherapy (CRT). Biopsy-proven borderline/locally advanced patients treated with iHD-SBRT (35 Gy in 5 fractions with a simultaneous integrated boost up to 53 Gy) or CRT (45−60 Gy in 25−30 fractions) were retrospectively included from January 2006 to January 2021. The median overall survival (mOS) was evaluated trough uni- and multivariate analyses. The progression free survival (PFS) and the 1-year local control (1-yLC) were also reported. Eighty-two patients were included. The median follow-up was 19.7 months. The mOS was in favour of the iHD-SBRT group (22.5 vs. 15.9 months, p < 0.001), including after multivariate analysis (HR 0.39 [CI95% 0.18−0.83], p = 0.014). The median PFS and the 1-yLC were also significantly better for iHD-SBRT (median PFS: 16.7 vs. 11.5 months, p = 0.011; 1-yLC: 75.8 vs. 39.3%, p = 0.004). In conclusion, iHD-SBRT is a promising RT option and may offer an improvement in OS in comparison to CRT for localized PDAC. Further validation is required to confirm the exact role of iHD-SBRT and the optimal therapeutic sequence for the treatment of localized PDAC.
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Affiliation(s)
- Martin Manderlier
- Department of Radiation Oncology, HUB Institut Jules Bordet, Université Libre de Bruxelles, Rue Meylenmeersch 90, 1070 Brussels, Belgium
- Department of Radiation Oncology, CHU de Charleroi, Boulevard Zoé Drion 1, 6000 Charleroi, Belgium
| | - Julie Navez
- Department of Hepato-Biliary-Pancreatic Surgery, Hôpital Universitaire Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Matthieu Hein
- Faculty of Medicine, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Jean-Luc Engelholm
- Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium
- Department of Radiology, Hopitaux Iris Sud, 1190 Brussels, Belgium
| | - Jean Closset
- Department of Hepato-Biliary-Pancreatic Surgery, Hôpital Universitaire Erasme, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology, HUB Institut Jules Bordet, Université Libre de Bruxelles, Rue Meylenmeersch 90, 1070 Brussels, Belgium
| | - Luigi Moretti
- Department of Radiation Oncology, HUB Institut Jules Bordet, Université Libre de Bruxelles, Rue Meylenmeersch 90, 1070 Brussels, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology, Hepatology and Digestive Oncology, HUB Bordet Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Christelle Bouchart
- Department of Radiation Oncology, HUB Institut Jules Bordet, Université Libre de Bruxelles, Rue Meylenmeersch 90, 1070 Brussels, Belgium
- Correspondence:
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11
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Racu ML, Bernardi D, Chaouche A, Zindy E, Navez J, Loi P, Maris C, Closset J, Van Laethem JL, Decaestecker C, Salmon I, D'Haene N. Abstract B043: Impact of SMAD4 loss in patients with pancreatic ductal adenocarcinoma receiving neoadjuvant therapy. Cancer Res 2022. [DOI: 10.1158/1538-7445.panca22-b043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Abstract
Introduction: SMAD4, the central mediator of the Transforming Growth-Beta (TGF-Beta) signaling pathway, is inactivated in 50-55% of pancreatic ductal adenocarcinomas (PDACs). SMAD4 loss of expression has been described as a negative prognostic factor in PDAC and associated with increased rate of metastasis and resistance to adjuvant therapy. However, the impact of SMAD4 inactivation in patients receiving neoadjuvant therapy (NAT) is not well characterized. The aim of our study is to investigate if SMAD4 loss is a prognostic factor in a cohort of patients who underwent surgery for PDAC and, more specifically, in patients receiving NAT. Material and methods: We analyzed a single center retrospective series of 204 patients who underwent surgical resection for PDAC between 2004-2021. SMAD4 nuclear expression was semi-quantitively assessed by immunohistochemistry (IHC) on tumor samples and related to clinical variables including overall survival (OS) and disease free survival (DFS). Results: Among the 204 patients, 64 (31,37%) received NAT and 140 (68,63%) did not. In the NAT cohort, 33 (51,47%) tumors were SMAD4-positive and 31 (48,43%) were SMAD4-negative and in the non-NAT group, 84 (60%) and 56 (40%) patients presented SMAD4-positive and -negative tumors, respectively (p=0.28). Both in the NAT and non-NAT cohort of patients, SMAD4 status was not associated with clinico-pathological variables and did not impact OS. However, regarding DFS, in patients without NAT, SMAD4 loss seems to be associated with shorter DFS (p=0.073). In a multivariate analysis including the significant clinico-pathological variables, SMAD4 status showed a tendency to remain an independent prognostic variable (p=0.052). Moreover, in patients that received NAT, univariate analysis indicated that SMAD4 loss was associated with worse DFS (p=0.018). However, in a multivariate analysis, only vascular invasion (p=0.02) and the subtype of administrated NAT (FOLFIRINOX or GEMCITABINE-based) (p=0.0004) were independent prognostic factors for DFS. We therefore evaluated the prognostic significance of SMAD4 loss in a homogenous group of patients receiving FOLFIRINOX-based therapy (n=45). Univariate and multivariate analysis indicated that in these patients, SMAD4 loss was an independent negative prognostic factor (p=0.009) as well as vascular invasion (p=0.003). Conclusion: This study highlights the potential prognostic role of SMAD4 loss in the DFS of PDAC patients, more specifically in patients receiving NAT.
Citation Format: Marie-Lucie Racu, Dana Bernardi, Aniss Chaouche, Egor Zindy, Julie Navez, Patrizia Loi, Calliope Maris, Jean Closset, Jean-Luc Van Laethem, Christine Decaestecker, Isabelle Salmon, Nicky D'Haene. Impact of SMAD4 loss in patients with pancreatic ductal adenocarcinoma receiving neoadjuvant therapy [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr B043.
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Affiliation(s)
| | | | | | - Egor Zindy
- 2Université Libre de Bruxelles, Brussels, Belgium
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Frezin J, Navez J, Johnson P, Bouchard P, Drolet S. Colorectal resection in end-stage renal disease (ESRD) patients: experience from a single tertiary center. Acta Chir Belg 2022; 122:92-98. [PMID: 33496207 DOI: 10.1080/00015458.2020.1871290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND End-stage renal disease (ESRD) and renal replacement therapy (RRT) are important risk factors for post-operative morbidity and mortality but remains poorly reported in colorectal surgery. This study aims to evaluate postoperative outcomes of ESRD patients under RRT undergoing colorectal resection. METHODS All ESRD patients under RRT who underwent colorectal resection between 2006 and 2019 were retrospectively reviewed. Perioperative outcomes were analysed, such as risk factors of postoperative complications. RESULTS Forty-two patients were analysed, including 27 emergency and 15 elective surgeries. The most frequent indication was acute colonic ischemia for emergency and malignancy for elective procedures. Laparoscopic approach was used in 12 patients (29%), without difference between elective and emergency groups. Postoperative severe complications rate (including deaths) was 50% (21/42), including 56% (15/27) and 40% (6/15) in emergency and elective groups, respectively (p = .334). Anastomotic leak was observed in 3 of the 23 patients (13%) undergoing digestive anastomosis, (1 in emergency and 2 in elective groups, p = .246). The postoperative mortality rate was 29%, not significantly different between groups. The median hospital stay was 14.5 days (8-42). At univariate analysis, history of cardiac event (p = .028) and open approach (p = .040) were associated with severe complications, and ASA score >3 (p = .043), history of cardiac event (p = .001) and diabetes (p = .030) associated with mortality. CONCLUSIONS Colorectal surgery in ESRD patient exposes to high risk of morbidity and mortality, even in the elective setting, especially in patients with comorbidities like cardiac event and diabetes. Careful patient selection and closed management is required in such fragile patients.
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Affiliation(s)
- Julie Frezin
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
- Department of General Surgery, Clinique Notre Dame de Grâce de Gosselies, Charleroi, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Paryse Johnson
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
| | - Philippe Bouchard
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, CHU de Québec, Université de Laval, Québec, QC, Canada
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Hublet S, Galland M, Navez J, Loi P, Closset J, Forget P, Lafère P. Correction to: Opioid-free versus opioid-based anesthesia in pancreatic surgery. BMC Anesthesiol 2022; 22:33. [PMID: 35065595 PMCID: PMC8783518 DOI: 10.1186/s12871-022-01572-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chinikar R, Patricio D, Gosse J, Ickx B, Delhaye M, Closset J, El Moussaoui I, Hites M, Navez J. Perioperative antimicrobial prophylaxis in patients undergoing pancreatoduodenectomy: retrospective analysis of bacteriological profile and susceptibility. Acta Chir Belg 2021:1-8. [PMID: 34779697 DOI: 10.1080/00015458.2021.2006887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pancreatic tumours are frequently associated with obstructive jaundice requiring preoperative biliary drainage (PBD) before pancreatoduodenectomy (PD), exposing patients to infectious complications. This study aims to compare postoperative complications after PD with or without PBD and to analyse bile bacteriology and antibiotic susceptibility. METHODS All patients undergoing PD between 2014 and 2019 were retrospectively evaluated, and postoperative outcomes were compared according to PBD use. Prophylactic narrow-spectrum antibiotic therapy was given for 24 h, then adapted according to bacteriologic profile. Intraoperative bile cultures and antibiograms were collected. RESULTS Among 164 patients with intraoperative bile culture during PD (75 PBD+, 89 PBD-), an infected bile was observed in 95% and 70% of PBD + and PBD- groups, respectively (p < 0.001). Postoperative mortality and severe morbidity including infectious complications were similar between groups (5% and 15%). The median duration of antibiotherapy was longer in PBD + compared to PBD- groups (9 vs. 2 days, p = 0.009). Malignant indication and PBD were associated with bile contamination using univariate analysis, and PBD was significantly relevant at multivariate analysis. Most common pathogens identified in bile cultures were Escherichia coli, Klebsiella spp. and Enterobacter spp. Overall antibiotic susceptibility to commonly used antibiotics was decreased, including those used in our local guidelines. CONCLUSIONS PBD exposes nearly 100% of patients undergoing PD to bile infection and an increased duration of postoperative antimicrobial therapy, without increasing infectious complications in this study. Adaptation of antimicrobial prophylaxis should be further evaluated according to performance of PBD and local epidemiology, in order to avoid overuse of antibiotics.
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Affiliation(s)
- Reza Chinikar
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles (CUB)-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Department of Surgery, CHU Tivoli, La Louvière, Belgium
| | - Daniel Patricio
- Department of Anesthesiology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Brigitte Ickx
- Department of Anesthesiology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Myriam Delhaye
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles (CUB)-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles (CUB)-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Imad El Moussaoui
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles (CUB)-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maya Hites
- Department of Infectious Diseases, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Cliniques Universitaires de Bruxelles (CUB)-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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15
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Verocq C, Racu ML, Bafort D, Butorano G, Perez-Casanova Garcia L, Navez J, Witterwulghe M, Sheahan K, Swan N, Closset J, Van Laethem JL, Maris C, D'Haene N. Pancreatic medullary carcinoma developed on a pancreatic intraductal papillary mucinous neoplasm with loss of MSH2 and MSH6 expression: a case report. Diagn Pathol 2021; 16:117. [PMID: 34895278 PMCID: PMC8667442 DOI: 10.1186/s13000-021-01178-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/02/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Pancreatic medullary carcinoma (PMC) is a rare pancreatic tumor, usually showing the presence of microsatellite instability, mostly MLH1 silencing, and a wild-type KRAS mutation status. We report here a PMC arising from a Pancreatic Intraductal Papillary Mucinous Neoplasm (IPMN), both having KRAS and TP53 mutations. CASE PRESENTATION We report the case of a 73-year-old woman presenting with right iliac fossa pain. MRI revealed a 16 mm diameter mass in the pancreas, leading to a pancreatic duct stricture and upstream a dilatation of the distal pancreatic duct of Wirsung. A fine needle aspiration was performed, and pathology analysis revealed malignant glandular cells. The patient underwent distal pancreatectomy. Gross examination revealed an12 mm indurated white lesion, adjacent to a cystic lesion extending into the rest of the pancreatic body. Microscopically, the cystic area represented a mixed (gastric-type and pancreatobiliary-type) IPMN, involving the main and secondary pancreatic ducts with low-grade and high-grade dysplasia. In the periphery of this IPMN, a 14mm associated invasive carcinoma was observed, characterized by focal gland formation and by poorly differentiated cells with a syncytial appearance, associated with a dense lymphoplasmocytic and neutrophilic infiltrate. Immunohistochemical analyses showed loss of MSH2 and MSH6 expression. Microsatellite instability was confirmed by molecular test. Molecular analysis was performed both on the invasive carcinoma and on the high-grade dysplasia IPMN, revealing the same mutation profile with KRAS and TP53 mutations. The proposed diagnosis was mixed IPMN with associated invasive medullary carcinoma that presented loss of MSH2 and MSH6 expression. CONCLUSIONS The present case reports for the first time, at the best of our knowledge, the coexistence of IPMN lesions and PMC, both having the same molecular alterations. It also describes the second case of PMC with microsatellite instability, MSH2 and MSH6 silenced.
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Affiliation(s)
- Camille Verocq
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
- Hôpital Erasme, Route de Lennik, 808 Laboratoire d'anatomopathologie, hôpital de jour, 2ième étage, 1070, Bruxelles, Belgium.
| | - Marie-Lucie Racu
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Dominique Bafort
- Centre Universitaire Inter Régional d'Expertise en Anatomie Pathologique Hospitalière (CurePath), 6040, Charleroi, Belgium
| | - Gloria Butorano
- Centre Universitaire Inter Régional d'Expertise en Anatomie Pathologique Hospitalière (CurePath), 6040, Charleroi, Belgium
| | | | - Julie Navez
- Department of Hepato-Biliary-Pancreatic Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Witterwulghe
- Department of Gastroenterology, CHIREC Hospitals, Delta, Brussels, Belgium
| | - Kieran Sheahan
- Department of Pathology, UCD School of Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Swan
- Department of Pathology, UCD School of Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Jean Closset
- Department of Hepato-Biliary-Pancreatic Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology and Digestive oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Calliope Maris
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Centre Universitaire Inter Régional d'Expertise en Anatomie Pathologique Hospitalière (CurePath), 6040, Charleroi, Belgium
| | - Nicky D'Haene
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Abstract
INTRODUCTION Prostatic cancer metastases (PCM) are usually systemic. Isolated PCM liver metastases (PCLM) are very rare. The treatment of PCM consists of hormono- and chemotherapy eventually combined with stereotactic radiation. PATIENT AND DISCUSSION A case of a 67-year old man presenting with a solitary, metachronous PCLM undergoing a left extended hepatectomy due to resistance to hormono- and chemotherapy is reported. He died of recurrent systemic disease 31 months later. CONCLUSIONS The very rare indication and possible role of liver resection in the treatment of PCLM is discussed.
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Affiliation(s)
- Gilles Tilmans
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Julie Navez
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mina Komuta
- Department of Pathology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Thibaud Saussez
- Department of Urology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jan Lerut
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- IREC - Centre for Experimental and Clincal Research, Université catholique Louvain, Brussels, Belgium
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17
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Bouchart C, Engelholm JL, Closset J, Navez J, Loi P, Gökburun Y, De Grez T, Mans L, Hendlisz A, Bali MA, Eisendrath P, Van Gestel D, Hein M, Moretti L, Van Laethem JL. Isotoxic high-dose stereotactic body radiotherapy integrated in a total multimodal neoadjuvant strategy for the treatment of localized pancreatic ductal adenocarcinoma. Ther Adv Med Oncol 2021; 13:17588359211045860. [PMID: 34691244 PMCID: PMC8529314 DOI: 10.1177/17588359211045860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/25/2021] [Indexed: 01/06/2023] Open
Abstract
Background Our aim was to evaluate the feasibility and safety of isotoxic high-dose (iHD) stereotactic body radiation therapy (SBRT) in a total neoadjuvant sequence for the treatment of localized pancreatic adenocarcinoma. Materials and methods Biopsy-proven borderline resectable/locally advanced pancreatic cancer (BR/LAPC) patients were included in this observational prospective analysis from August 2017 to April 2020 without excluding tumours showing a radiological direct gastrointestinal (GI) invasion. An induction chemotherapy by modified fluorouracil, irinotecan and oxaliplatin was performed for a median of six cycles. In case of non-progression, an isotoxic high-dose stereotactic body radiotherapy (iHD-SBRT) was delivered in 5 fractions followed by a surgical exploration. The primary endpoint was acute/late gastrointestinal grade ⩾3 toxicity. Secondary endpoints were overall survival (OS), progression-free survival (PFS) and local control (LC). Results A total of 39 consecutive patients (21 BR and 18 LAPC) were included: 34 patients (87.2%, 18 BR and 16 LAPC) completed the planned neoadjuvant sequence. After iHD-SBRT, 19 patients [55.9% overall, 13/18 BR (72.2%) and 6/16 LAPC (37.5%)] underwent an oncological resection among the 25 patients surgically explored (73.5%). The median follow up was 18.2 months. The rates of acute and late GI grade 3 toxicity were, respectively, 2.9% and 4.2%. The median OS and PFS from diagnosis were, respectively, 24.5 and 15.6 months. The resected patients had improved median OS and PFS in comparison with the non-resected patients (OS: 32.3 versus 18.2 months, p = 0.02; PFS: 24.1 versus 7.1 months, p < 0.001). There was no survival difference between the BR and LAPC patients. The 1-year LC from SBRT was 74.1% and the median locoregional PFS was not reached for both BR and LAPC patients. Conclusions iHD-SBRT displays an excellent toxicity profile, also for potentially high-risk patients with radiological direct GI invasion at diagnosis and can be easily integrated in a total neoadjuvant strategy. The oncological outcomes are promising and emphasise the need for further exploration of iHD-SBRT in phase II/III trials.
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Affiliation(s)
- Christelle Bouchart
- Department of Radiation-Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo, 121, Brussels 1000, Belgium
| | - Jean-Luc Engelholm
- Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Closset
- Department of Hepato-Biliary-Pancreatic Surgery, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Navez
- Department of Hepato-Biliary-Pancreatic Surgery, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrizia Loi
- Department of Hepato-Biliary-Pancreatic Surgery, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Yeter Gökburun
- Department of Gastroenterology, CHR Namur, Namur, Belgium
| | | | - Laura Mans
- Department of Gastroenterology, Hepatology and Digestive Oncology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Hendlisz
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Antonietta Bali
- Department of Radiology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Pierre Eisendrath
- Department of Gastroenterology, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation-Oncology, Institut Jules Bordet,Université Libre de Bruxelles, Brussels, Belgium
| | - Matthieu Hein
- Sleep Laboratory, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Luigi Moretti
- Department of Radiation-Oncology, Institut Jules Bordet,Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology, Hepatology and Digestive Oncology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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18
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El Moussaoui I, Navez J, El Moussaoui K, Barea-Fernandez M, Schaeken A, Closset J. Impact of COVID-19 Lockdown on Short-Term Results After Laparoscopic Sleeve Gastrectomy. Obes Surg 2021; 31:2614-2618. [PMID: 33608818 PMCID: PMC7894611 DOI: 10.1007/s11695-021-05283-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 01/21/2023]
Abstract
Background The recent COVID-19 pandemic has led several countries worldwide to confine the population. Consequently, people’s mobility and physical activity are limited in addition to a negative psychosocial effect. The aim of this study was to assess the impact of COVID-19 crisis on short-term weight loss and the remission of obesity-associated comorbidities in patients undergoing sleeve gastrectomy (SG). Methods A case-control study was conducted comparing percentage of total weight loss (%TWL), excess weight lost (%EWL), and the remission rate of obesity-related comorbidities at the first postoperative year between patients who underwent primary SG between June 2019 and October 2019 (1-year postoperative period affected by COVID-19 lockdown; COV-group), and a control group operated between June 2018 and October 2018 (1-year postoperative period not affected by COVID-19 lockdown; CONTROL-group). Results In total, 45 patients from COV-group were compared to 57 patients from CONTROL-group. Demographic data were similar between groups. The follow-up rate at 1 year was 100%. The mean %TWL and %EWL was lower at 28.2 ± 12.7% and 67.6 ± 23.5% in COV-group patients compared to 34.3 ± 14.1% and 78.3 ± 27.2% in CONTROL-group patients at 1 year from SG (p=0.025 and p=0.036, respectively). The remission rate of obesity-related comorbidities at 1 year from SG including type 2 diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea syndrome was 57.1%, 60.0%, 71.4%, and 41.7% in COV-group and 66.7%, 72.4%, 85.3%, and 52.9% in CONTROL-group, respectively, without any statistically significant difference between groups. Conclusions The COVID-19 lockdown had a negative effect on weight loss in the first year after SG. Larger studies are needed to confirm these results, and we are expecting for a longer follow-up to evaluate the long-term impact on weight loss and comorbidities.
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Affiliation(s)
- Imad El Moussaoui
- Department of Digestive Surgery, Surgical Oncology, Metabolic Surgery, Hepatopancreatology, Liver and Kidney Transplantations, Erasme Hospital, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Julie Navez
- Department of Digestive Surgery, Surgical Oncology, Metabolic Surgery, Hepatopancreatology, Liver and Kidney Transplantations, Erasme Hospital, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Kamal El Moussaoui
- Department of Digestive Surgery, Surgical Oncology, Metabolic Surgery, Hepatopancreatology, Liver and Kidney Transplantations, Erasme Hospital, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Marie Barea-Fernandez
- Department of Digestive Surgery, Surgical Oncology, Metabolic Surgery, Hepatopancreatology, Liver and Kidney Transplantations, Erasme Hospital, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Anne Schaeken
- Department of Digestive Surgery, Surgical Oncology, Metabolic Surgery, Hepatopancreatology, Liver and Kidney Transplantations, Erasme Hospital, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jean Closset
- Department of Digestive Surgery, Surgical Oncology, Metabolic Surgery, Hepatopancreatology, Liver and Kidney Transplantations, Erasme Hospital, Route de Lennik, 808, 1070 Brussels, Belgium
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19
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Navez J, Bouchart C, Lorenzo D, Bali MA, Closset J, van Laethem JL. What Should Guide the Performance of Venous Resection During Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma with Venous Contact? Ann Surg Oncol 2021; 28:6211-6222. [PMID: 33479866 PMCID: PMC8460578 DOI: 10.1245/s10434-020-09568-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 09/25/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022]
Abstract
Complete surgical resection, most often associated with perioperative chemotherapy, is the only way to offer a chance of cure for patients with pancreatic cancer. One of the most important factors in determining survival outcome that can be influenced by the surgeon is the R0 resection. However, the proximity of mesenteric vessels in cephalic pancreatic tumors, especially the mesenterico-portal venous axis, results in an increased risk of vein involvement and/or the presence of malignant cells in the venous bed margin. A concomitant venous resection can be performed to decrease the risk of a positive margin. Given the additional technical difficulty that this implies, many surgeons seek a path between the tumor and the vein, hoping for the absence of tumor infiltration into the perivascular tissue on pathologic analysis, particularly in cases with administration of neoadjuvant therapy. The definition of optimal surgical margin remains a subject of debate, but at least 1 mm is an independent predictor of survival after pancreatic cancer surgical resection. Although preoperative radiologic assessment is essential for accurate planning of a pancreatic resection, intraoperative decision-making with regard to resection of the mesenterico-portal vein in tumors with a venous contact remains unclear and variable. Although venous histologic involvement and perivascular infiltration are not accurately predictable preoperatively, clinicians must examine the existing criteria and normograms to guide their surgical management according to the integration of new imaging techniques, preoperative chemotherapy use, tumor biology and molecular histopathology, and surgical techniques.
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Affiliation(s)
- Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Diane Lorenzo
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jean Closset
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc van Laethem
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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20
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Pau L, Navez J, Cawich SO, Dapri G. Laparoscopic Management of Blunt and Penetrating Abdominal Trauma: A Single-Center Experience and Review of the Literature. J Laparoendosc Adv Surg Tech A 2021; 31:1262-1268. [PMID: 33428516 DOI: 10.1089/lap.2020.0552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Trauma is a leading cause of death in young patients. The prevalence of blunt and penetrating trauma varies widely across the globe. Similarly, the global experience with laparoscopy in trauma patients also varies. There is a growing body of evidence to suggest that laparoscopy is feasible in trauma patients. We sought to contribute to these data by reporting our experience with laparoscopic management of blunt and penetrating trauma in a Belgian center. Materials and Methods: We retrospectively collected data on all trauma patients admitted to the Saint-Pierre University Hospital in Brussels, Belgium, over the 4-year period from January 2014 to December 2017. Hospital records for patients subjected to exploratory laparoscopy were retrospectively reviewed, and a descriptive analysis was reported. Results: There were 26 patients at a mean age of 40 years treated with laparoscopic exploration for injuries from blunt trauma (7), stab wounds (14), and gunshot injuries (5). The median interval between the arrival at the emergency unit and diagnostic laparoscopy was 175 minutes (range: 27-1440), and the median duration of operation was 119 minutes (range: 8-300). In all patients who underwent laparoscopy for trauma, there were 27% overall morbidity, no mortality, 11% reoperation rate, 7.4% conversions, and 19% incidence of negative laparoscopy. The median intensive care unit stay was 3 days (range: 0-41), and median total hospital stay was 7 days (range: 2-78). Conclusions: Laparoscopy is a safe, feasible, and effective tool in the surgical armamentarium to treat hemodynamically stable patients with blunt and penetrating abdominal trauma. It allows complete and thorough evaluation of intra-abdominal viscera, reduces the incidence of nontherapeutic operations, and allows therapeutic intervention to repair a variety of injuries. However, it requires appropriate surgeon training and experience with advanced laparoscopic techniques to ensure good outcomes.
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Affiliation(s)
- Luca Pau
- Department of Gastrointestinal Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Navez
- Department of Surgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Shamir O Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Giovanni Dapri
- Department of Gastrointestinal Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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21
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De Pauw V, Navez J, Holbrechts S, Lemaitre J. Acute appendicitis as an unusual cause of invasive ductal breast carcinoma metastasis. J Surg Case Rep 2020; 2020:rjaa535. [PMID: 33391657 PMCID: PMC7769581 DOI: 10.1093/jscr/rjaa535] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/25/2020] [Indexed: 11/12/2022] Open
Abstract
Acute appendicitis is one of the most common causes of abdominal pain at the emergency room. In rare cases, it can be caused by malignancy, even metastatic lesions from extra-abdominal neoplasia. Herein, we report a case of a 64-year-old female with a history of invasive ductal carcinoma of the breast treated by chemotherapy, surgery, radiotherapy and hormonotherapy, relapsing several years later as a bone and a pleura metastasis successfully cured by locoregional therapy and hormonal treatment. She presented with acute abdominal pain without signs of peritonitis. Abdominal computed tomodensitometry showed sign of appendicitis. Therefore, laparoscopic exploration and appendicectomy was performed. During surgery, multiple peritoneal nodules were found and harvested. Pathology showed metastatic nodules of invasive ductal breast carcinoma, including in the appendicular wall, concluding to peritoneal carcinomatosis. The postoperative course was uneventful, but the patient died 1 year later after refusing anticancer treatment.
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Affiliation(s)
- Vincent De Pauw
- Department of Abdominal Surgery, CHU Ambroise-Paré, Mons, Belgium
| | - Julie Navez
- Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jean Lemaitre
- Department of Abdominal Surgery, CHU Ambroise-Paré, Mons, Belgium
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22
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Navez J, Iesari S, Kourta D, Baami-Mariza K, Nadiri M, Goffette P, Baldin P, Ackenine K, Bonaccorsi-Riani E, Ciccarelli O, Coubeau L, Moreels T, Lerut J. The real incidence of biliary tract complications after adult liver transplantation: the role of the prospective routine use of cholangiography during post-transplant follow-up. Transpl Int 2020; 34:245-258. [PMID: 33188645 DOI: 10.1111/tri.13786] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/13/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
Biliary tract complications (BTCs) still burden liver transplantation (LT). The wide reporting variability highlights the absence of systematic screening. From 2000 to 2009, simultaneous liver biopsy and direct biliary visualization were prospectively performed in 242 recipients at 3 and 6 months (n = 212, 87.6%) or earlier when indicated (n = 30, 12.4%). Median follow-up was 148 (107-182) months. Seven patients (2.9%) experienced postprocedural morbidity. BTCs were initially diagnosed in 76 (31.4%) patients; 32 (42.1%) had neither clinical nor biological abnormalities. Acute cellular rejection (ACR) was present in 27 (11.2%) patients and in 6 (22.2%) BTC patients. Nine (3.7%) patients with normal initial cholangiography developed BTCs after 60 (30-135) months post-LT. BTCs directly lead to 7 (2.9%) re-transplantations and 14 (5.8%) deaths resulting in 18 (7.4%) allograft losses. Bile duct proliferation at 12-month biopsy proved an independent risk factor for graft loss (P = 0.005). Systematic biliary tract and allograft evaluation allows the incidence and extent of biliary lesions to be documented more precisely and to avoid erroneous treatment of ACR. The combination 'abnormal biliary tract-canalicular proliferation' is an indicator of worse graft outcome. BTCs are responsible for important delayed allograft and patient losses. These results underline the importance of life-long follow-up and appropriate timing for re-transplantation.
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Affiliation(s)
- Julie Navez
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Medico-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Samuele Iesari
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Dhoha Kourta
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Kente Baami-Mariza
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Marwan Nadiri
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Pierre Goffette
- Interventional Radiology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Pamela Baldin
- Pathology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Kevin Ackenine
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Eliano Bonaccorsi-Riani
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.,Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Olga Ciccarelli
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Laurent Coubeau
- Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Tom Moreels
- Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Jan Lerut
- Pôle de Chirurgie Expérimentale et Transplantation, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
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23
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El Moussaoui I, De Pauw V, Navez J, Closset J. Roux-En-Y gastric bypass after lung transplantation: case report and literature review. Surg Obes Relat Dis 2020; 17:239-241. [PMID: 33199198 DOI: 10.1016/j.soard.2020.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Imad El Moussaoui
- Department of Bariatric Surgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Vincent De Pauw
- Department of Bariatric Surgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Julie Navez
- Department of Bariatric Surgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Closset
- Department of Bariatric Surgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Navez J, Marique L, Hubert C, Van Laethem JL, Komuta M, Maris C, D'Haene N, Navez B, Closset J. Distal pancreatectomy for pancreatic neoplasia: is splenectomy really necessary? A bicentric retrospective analysis of surgical specimens. HPB (Oxford) 2020; 22:1583-1589. [PMID: 32067888 DOI: 10.1016/j.hpb.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND While distal pancreatectomy with splenectomy (DPS) is the reference treatment for pancreatic body and tail neoplasia, oncological benefits of splenectomy have never been demonstrated. Involvement of spleen, splenic hilum and lymph nodes (LN) was therefore assessed on DPS specimens. METHODS All DPS pancreatic neoplasia specimens obtained in 2 Brussels University Hospitals over 15 years (2004-2018) were reviewed retrospectively, using both preoperative radiological imaging and postoperative pathological analyses of splenic parenchyma, hilar tissue and LN. RESULTS The total of 130 DPS specimens included 85 adenocarcinomas, 37 neuroendocrine neoplasms and 8 other carcinomas. Tumours involved the pancreatic body without tail invasion for 59 specimens (B, Body group), and the pancreatic tail with/without body for 71 (T, Tail group). At pathology, direct splenic and/or hilar involvement was observed in 13 T specimens (13/71, 18.3%), but in none belonging to the Body group. The observed numbers of splenic hilar LN (only reported in 49/130 patients) were low, only one T adenocarcinoma had positive splenic LN in addition to direct splenic involvement. CONCLUSION Splenectomy remains justified during pancreatectomy for neoplasia involving the pancreatic tail, but in case of pancreatic body tumours, its benefits should be questioned in the light of absent splenic LN/parenchymal involvement.
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Affiliation(s)
- Julie Navez
- Department of Abdominal Surgery and Transplantation, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Brussels, Belgium.
| | - Lancelot Marique
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Catherine Hubert
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Luc Van Laethem
- Department of Oncology, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mina Komuta
- Department of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Calliope Maris
- Department of Pathology, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicky D'Haene
- Department of Pathology, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Benoit Navez
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jean Closset
- Department of Abdominal Surgery and Transplantation, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Bouchart C, Navez J, Closset J, Hendlisz A, Van Gestel D, Moretti L, Van Laethem JL. Novel strategies using modern radiotherapy to improve pancreatic cancer outcomes: toward a new standard? Ther Adv Med Oncol 2020; 12:1758835920936093. [PMID: 32684987 PMCID: PMC7343368 DOI: 10.1177/1758835920936093] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive solid tumours with an estimated 5-year overall survival rate of 7% for all stages combined. In this highly resistant disease that is located in the vicinity of many radiosensitive organs, the role of radiotherapy (RT) and indications for its use in this setting have been debated for a long time and are still under investigation. Although a survival benefit has yet to be clearly demonstrated for RT, it is the only technique, other than surgery, that has been demonstrated to lead to local control improvement. The adjuvant approach is now strongly challenged by neoadjuvant treatments that could spare patients with rapidly progressive systemic disease from unnecessary surgery and may increase free margin (R0) resection rates for those eligible for surgery. Recently developed dose-escalated RT treatments, designed either to maintain full-dose chemotherapy or to deliver a high biologically effective dose, particularly to areas of contact between the tumour and blood vessels, such as hypofractionated ablative RT (HFA-RT) or stereotactic body RT (SBRT), are progressively changing the treatment landscape. These modern strategies are currently being tested in prospective clinical trials with encouraging preliminary results, paving the way for more effective treatment combinations using novel targeted therapies. This review summarizes the current literature regarding the use of RT for the treatment of primary PDAC, describes the limitations of conventional RT, and discusses the emerging role of dose-escalated RT and heavy-particle RT.
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Affiliation(s)
- Christelle Bouchart
- Department of Radiation-Oncology, Institut Jules Bordet, Boulevard de Waterloo, 121, Brussels, 1000, Belgium
| | - Julie Navez
- Department of Hepato-Biliary-Pancreatic Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Closset
- Department of Hepato-Biliary-Pancreatic Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Hendlisz
- Department of Gastroenterology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation-Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Luigi Moretti
- Department of Radiation-Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Van Laethem
- Department of Gastroenterology, Hepatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Navez J, Hubert C, Dokmak S, Frick De La Maza I, Tabchouri N, Benoit O, Hermand H, Zech F, Gigot JF, Sauvanet A. Early Versus Late Oral Refeeding After Pancreaticoduodenectomy for Malignancy: a Comparative Belgian-French Study in Two Tertiary Centers. J Gastrointest Surg 2020; 24:1597-1604. [PMID: 31325133 DOI: 10.1007/s11605-019-04316-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/19/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the era of fast-track surgery, because pancreaticoduodenectomy (PD) carries a significant morbidity, surgeons hesitate to begin early oral feeding and achieve early discharge. We compared the outcome of two different approaches to the postoperative management of PD in two tertiary centers. METHODS Of patients having undergone PD for malignancy from 2008 to 2017, 100 patients who received early postoperative oral feeding (group A) were compared to 100 patients from another center who received early enteral feeding and a delayed oral diet (group B). Surgical indication and approach and type of pancreatic anastomosis were similar between both groups. Postoperative outcomes were retrospectively reviewed. RESULTS Patient characteristics were similar between both groups, except significantly more neoadjuvant treatment in group A (A = 20% vs. B = 9%, p < 0.01). Mortality rates were 3% and 4% in groups A and B, respectively (p = 0.71). The rate of severe postoperative morbidity was significantly lower in group A (13% vs. 26%, p = 0.02), resulting in a lower reoperation rate (p < 0.01). Delayed gastric emptying and clinically relevant pancreatic fistula were similar between both groups but chyle leaks were more frequent in group A (10% vs. 3%, p = 0.04). The median hospital stay was shorter in group A (16 vs. 20 days, p < 0.01). CONCLUSION In the present study, early postoperative oral feeding after PD was associated with a shorter hospital stay and did not increase severe postoperative morbidity or the rate of pancreatic fistula. However, it resulted in more chyle leaks and did not prevent delayed gastric emptying.
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Affiliation(s)
- Julie Navez
- Hepato-Biliary and Pancreatic Surgery Division, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.,Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France
| | - Catherine Hubert
- Hepato-Biliary and Pancreatic Surgery Division, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Safi Dokmak
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France
| | - Isadora Frick De La Maza
- Hepato-Biliary and Pancreatic Surgery Division, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Nicolas Tabchouri
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France
| | - Olivier Benoit
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France
| | - Hélène Hermand
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France
| | - Francis Zech
- Institute of Experimental and Clinical Research, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Jean-François Gigot
- Hepato-Biliary and Pancreatic Surgery Division, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Alain Sauvanet
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Pôle des Maladies de l'Appareil Digestif, et Université Paris VII, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, Clichy, 92110, Paris, France.
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Navez J, Gigot JF, Deprez PH, Goffette P, Annet L, Zech F, Hubert C. Long-term results of secondary biliary repair for cholecystectomy-related bile duct injury: results of a tertiary referral center. Acta Chir Belg 2020; 120:92-101. [PMID: 30727824 DOI: 10.1080/00015458.2019.1570741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Management of bile duct injury (BDI) after cholecystectomy is challenging. The authors analyzed their center's 49-year experience.Methods: From 1968 to 2016, 120 consecutive patients were managed in a tertiary HBP center, 105 referred from other centers (Group A), 15 from our center (Group B). Surgical strategies and long-term outcomes were retrospectively reviewed.Results: Primary cholecystectomy approach was open in 35% and laparoscopic in 65%. In Group A, intraoperative BDI diagnosis was made in 25/105 patients, including 13 via intraoperative cholangiography (IOC) which was used in 21% of cases. Median time from BDI to referral was 148 days (range 0-10,758), and 3 patients had BDI-related secondary cirrhosis. Ninety-four patients underwent secondary surgical repair, mostly a complex biliary procedure (97%). Postoperative overall and severe morbidity rates were 26% and 6%, respectively. One patient with biliary cirrhosis at referral died postoperatively from hepatic failure. Nine patients (9.6%) developed a secondary biliary stricture after a median of 54 months from repair (6-228 months). In Group B, IOC was performed in 14/15 in whom BDI were intraoperatively detected and immediately repaired. There were 13 minor and 2 major BDIs, all repaired by uncomplex procedures with uneventful postoperative course. One patient had a secondary biliary stricture after 5 months, successfully treated by temporary endoprosthesis.Conclusion: Late follow-up after primary or secondary repair of BDI is recommended to detect recurrent biliary stricture. Bile duct injuries may occur in a tertiary center, but are intraoperatively detected with routine IOC and immediately repaired resulting in satisfactory outcome.
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Affiliation(s)
- Julie Navez
- Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Jean-François Gigot
- Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Pierre H. Deprez
- Department of Hepato-Gastro-Enterology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Pierre Goffette
- Department of Radiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Laurence Annet
- Department of Radiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Francis Zech
- Institute of Experimental and Clinical Research, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Catherine Hubert
- Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Brussels, Belgium
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Navez J, Cauchy F, Dokmak S, Goumard C, Faivre E, Weiss E, Paugam C, Scatton O, Soubrane O. Complex liver resection under hepatic vascular exclusion and hypothermic perfusion with versus without veno-venous bypass: a comparative study. HPB (Oxford) 2019; 21:1131-1138. [PMID: 30723061 DOI: 10.1016/j.hpb.2018.12.012] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/14/2018] [Accepted: 12/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND While hypothermic liver perfusion has been shown to improve parenchymal tolerance to complex resections in patients requiring prolonged hepatic vascular exclusion (HVE), the benefit of associated veno-venous bypass (VVB) in this setting remains poorly evaluated. METHODS All patients undergoing liver resection requiring HVE and hypothermic liver perfusion for at least 55 min between 2006 and 2017 were retrospectively reviewed. Perioperative outcomes were compared between patients with (VVB+) or without VVB (VVB-). RESULTS Twenty-seven patients were analyzed, including 13 VVB+ and 14 VVB-. Median HVE duration was similar in VVB+ and VVB- patients (96 vs. 75 min, respectively). VVB+patients had longer operative time (460 vs. 375 min, p = 0.023) but less blood loss (p = 0.010). Five (19%) patients died postoperatively from liver failure or sepsis, without difference between groups. Postoperative major morbidity rate was similar between VVB+ and VVB- patients (30% vs. 50%, respectively) such as rates of liver failure, haemorrhage, renal insufficiency and sepsis, but VVB- patients experienced more respiratory complications (64% vs. 15%, p = 0.012). CONCLUSION During liver resection under HVE and hypothermic liver perfusion, use of VVB allows for reducing blood loss and postoperative respiratory complications. VVB should be recommended in case of liver resection with prolonged HVE.
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Affiliation(s)
- Julie Navez
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplant, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - François Cauchy
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplant, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - Safi Dokmak
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplant, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - Claire Goumard
- Department of Hepatobiliary Surgery and Liver transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France(5)
| | - Evelyne Faivre
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - Catherine Paugam
- Department of Anesthesiology and Critical Care, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4)
| | - Olivier Scatton
- Department of Hepatobiliary Surgery and Liver transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France(5)
| | - Olivier Soubrane
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplant, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France(4).
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Hubert C, Lucidi V, Weerts J, Dili A, Demetter P, Massart B, Komuta M, Navez J, Reding R, Gigot JF, Sempoux C. Impact of biological agents on the prevalence of chemotherapy associated liver injury (CALI): Multicentric study of patients operated for colorectal liver metastases. Eur J Surg Oncol 2018; 44:1532-1538. [DOI: 10.1016/j.ejso.2018.07.050] [Citation(s) in RCA: 8] [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: 04/05/2018] [Revised: 06/27/2018] [Accepted: 07/18/2018] [Indexed: 01/10/2023] Open
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Navez J, Remue C, Leonard D, Bachmann R, Kartheuser A, Hubert C, Coubeau L, Komuta M, Van den Eynde M, Zech F, Jabbour N. Surgical Treatment of Colorectal Cancer with Peritoneal and Liver Metastases Using Combined Liver and Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Report from a Single-Centre Experience. Ann Surg Oncol 2016; 23:666-673. [PMID: 27646023 DOI: 10.1245/s10434-016-5543-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Chemotherapeutic advances have enabled successful cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) expansion in treating metastatic colorectal cancer. OBJECTIVES The aims of this study were to evaluate the safety of combining liver surgery (LS) with HIPEC and CRS (which remains controversial) and its impact on overall survival (OS) rates. METHODS From 2007 to 2015, a total of 77 patients underwent CRS/HIPEC for peritoneal carcinomatosis (PC) of colorectal cancer. Twenty-five of these patients underwent concomitant LS for suspicion of liver metastases (LM; group 2), and were compared with patients who underwent CRS/HIPEC only (group 1). Demographic and clinical data were reviewed retrospectively. RESULTS Among the group 2 patients, two underwent major hepatectomies, six underwent multiple wedge resections, 16 underwent single wedge resections (one with radiofrequency ablation), and one underwent radiofrequency ablation alone. For groups 1 and 2, median peritoneal cancer index was 6 and 10 (range 0-26; p = 0.08), complication rates were 15.4 and 32.0 % (Dindo-Clavien ≥3; p = 0.15), and median follow-up was 34.2 and 25.5 months (range 0-75 and 3-97), respectively. One group 2 patient died of septic shock after 66 days. Pathology confirmed LM in 21 patients in group 2 (four with benign hepatic lesions were excluded from long-term outcome analysis). Two-year OS rates were 89.5 and 70.2 % (p = 0.04), and 2-year recurrence-free survival rates were 38.3 and 13.4 % (p = 0.01) in groups 1 and 2, respectively. CONCLUSIONS Simultaneous surgery for colorectal LM and PC is both feasible and safe, with low postoperative morbidity. Further longer-term studies would help determine its impact on patient survival.
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Affiliation(s)
- Julie Navez
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.,Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Remue
- Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Daniel Leonard
- Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Radu Bachmann
- Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Alex Kartheuser
- Colorectal Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Catherine Hubert
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Laurent Coubeau
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mina Komuta
- Department of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Marc Van den Eynde
- Department of Medical Oncology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Francis Zech
- Department of Internal Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Nicolas Jabbour
- Hepatobiliary Surgery Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
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Navez J, Golse N, Bancel B, Rode A, Ducerf C, Mezoughi S, Mohkam K, Mabrut JY. Traumatic biliary neuroma after orthotopic liver transplantation: a possible cause of “unexplained” anastomotic biliary stricture. Clin Transplant 2016; 30:1366-1369. [DOI: 10.1111/ctr.12802] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Julie Navez
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Nicolas Golse
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Brigitte Bancel
- Department of Pathology; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Agnès Rode
- Department of Radiology; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Christian Ducerf
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Salim Mezoughi
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
| | - Kayvan Mohkam
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
- Université Claude Bernard Lyon 1; EMR 3738, EDISS 205 Lyon France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation; Hospices Civils de Lyon; Croix-Rousse University Hospital; Lyon France
- Université Claude Bernard Lyon 1; EMR 3738, EDISS 205 Lyon France
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Navez J, Dardamanis D, Thissen JP, Navez B. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: comparison of primary versus revisional bypass by using the BAROS score. Obes Surg 2015; 25:812-7. [PMID: 25366292 DOI: 10.1007/s11695-014-1473-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vertically banded gastroplasty or adjustable gastric banding often result in weight regain, complications, or side effects. Failed restrictive bariatric procedures can be converted in revisional laparoscopic Roux-en-Y gastric bypass (LRYGB). This study aimed to compare weight loss, evolution of comorbidities, and quality of life (QOL) between primary versus revisional LRYGB. METHODS Between 2004 and 2012, 374 patients underwent LRYGB as primary or revisional surgery performed by a single surgeon. Patient data were retrospectively reviewed; questionnaires of QOL were sent to all patients. Outcomes were evaluated according to Bariatric Analysis and Reporting Outcome System (BAROS) taking into account excess body mass index loss (EBMIL), correction of comorbidities, improvement in QOL, and complications. RESULTS Two hundred thirty-two patients (62%) responded to the questionnaire, 163 patients in the primary group and 69 in the revisional group. Median follow-up was 36 months (12-108). Median percentages of EBMIL were, respectively, 74% (26.8-126.8) and 50% (-31.6-124.2) in the primary and the revisional groups (p < 0.01). Median BAROS score reached 6.5 (-2-9) in the primary group, against 4.3 (-1.8-9) in the revisional group (p < 0.01). There were significantly less "fair" and more "excellent" scores in the primary group, considering initial BMI before gastroplasty. Arterial hypertension and sleep apnea syndrome resolved, respectively, in 51 and 56% in the primary group and only in 29 and 33% in the revisional group (p < 0.01). CONCLUSIONS According to BAROS score, revisional LRYGB for failed restrictive procedures provided poorer results than primary LRYGB in terms of weight loss, resolution of comorbidities and QOL.
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Affiliation(s)
- Julie Navez
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Brussels, Belgium,
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Navez J, Hubert C, Gigot JF, Borbath I, Annet L, Sempoux C, Lannoy V, Deprez P, Jabbour N. Impact of Intraoperative Pancreatoscopy with Intraductal Biopsies on Surgical Management of Intraductal Papillary Mucinous Neoplasm of the Pancreas. J Am Coll Surg 2015; 221:982-7. [PMID: 26304184 DOI: 10.1016/j.jamcollsurg.2015.07.451] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 07/19/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Because of its known malignant potential, precise histologic diagnosis of intraductal papillary mucinous neoplasm of the pancreas (IPMN) during intraoperative pancreatoscopy (IOP) is essential for complete surgical resection. The impact of IOP on perioperative IPMN patient management was reviewed over 20 years of practice at Cliniques universitaires Saint-Luc, Brussels, Belgium. STUDY DESIGN Among 86 IPMN patients treated by pancreatectomy between 1991 and 2013, 21 patients had a dilated main pancreatic duct enabling IOP and were retrospectively reviewed. The IOP was performed using an ultrathin flexible endoscope and biopsy forceps, and specimens of all suspicious lesions underwent frozen section examination. RESULTS Complete IOP with intraductal biopsies was easily and safely performed in 21 patients, revealing 8 occult IPMN lesions. In 5 cases (23.8%), initially planned surgical resection was modified secondary to IOP: 3 for carcinoma in situ and 2 for invasive carcinoma. The postoperative morbidity rate at 3 months was 25.0% (5 of 20); 1 patient died from septic shock postoperatively and was excluded. Median follow-up was 93 months (range 13 to 248 months). Nineteen of 21 patients were still alive and free of disease at last follow-up (90.5%); there was 1 patient with invasive carcinoma at initial pathology (pT3 N1) who died of pulmonary recurrence 21 months after surgery. CONCLUSIONS Intraoperative pancreatoscopy of the main pancreatic duct combined with intraductal biopsies plays a significant role in the surgical management of IPMN patients and should be used in all patients presenting a sufficiently dilated main pancreatic duct.
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Affiliation(s)
- Julie Navez
- Unit of Hepato-biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Catherine Hubert
- Unit of Hepato-biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Jean-François Gigot
- Unit of Hepato-biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Ivan Borbath
- Department of Hepato-Gastro-Enterology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Laurence Annet
- Department of Imaging study, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Christine Sempoux
- Department of Pathology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Valérie Lannoy
- Cancer Center Institute Roi Albert II, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Pierre Deprez
- Department of Hepato-Gastro-Enterology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium
| | - Nicolas Jabbour
- Unit of Hepato-biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
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Navez J, Hubert C, Gigot JF, Navez B, Lambert C, Jamar F, Danse E, Lannoy V, Jabbour N. Does the site of platelet sequestration predict the response to splenectomy in adult patients with immune thrombocytopenic purpura? Platelets 2014; 26:573-6. [PMID: 25275667 DOI: 10.3109/09537104.2014.959915] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Splenectomy is the only potentially curative treatment for chronic immune thrombocytopenic purpura (ITP) in adults. However, one-third of the patients relapse without predictive factors identified. We evaluate the predictive value of the site of platelet sequestration on the response to splenectomy in patients with ITP. Eighty-two consecutive patients with ITP treated by splenectomy between 1992 and 2013 were retrospectively reviewed. Platelet sequestration site was studied by (111)Indium-oxinate-labeled platelets in 93% of patients. Response to splenectomy was defined at last follow-up as: complete response (CR) for platelet count (PC) ≥100 × 10(9)/L, response (R) for PC≥30 × 10(9)/L and <100 × 10(9)/L with absence of bleeding, no response (NR) for PC<30 × 10(3)/L or significant bleeding. Laparoscopic splenectomy was performed in 81 patients (conversion rate of 16%), and open approach in one patient. Median follow-up was 57 months (range, 1-235). Platelet sequestration study was performed in 93% of patients: 50 patients (61%) exhibited splenic sequestration, 9 (11%) hepatic sequestration and 14 patients (17%) mixed sequestration. CR was obtained in 72% of patients, R in 25% and NR in 4% (two with splenic sequestration, one with hepatic sequestration). Preoperative PC, age at diagnosis, hepatic sequestration and male gender were significant for predicting CR in univariate analysis, but only age (HR = 1.025 by one-year increase, 95% CI [1.004-1.047], p = 0.020) and pre-operative PC (HR = 0.112 for > 100 versus <=100, 95% CI [0.025-0.493], p = 0.004) were significant predictors of recurrence-free survival in multivariate analysis. Response to splenectomy was independent of the site of platelet sequestration in patients with ITP. Pre-operative platelet sequestration study in these patients cannot be recommended.
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Affiliation(s)
- Julie Navez
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc (Université Catholique de Louvain) , Brussels , Belgium
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Abstract
Laparoscopy has become a routine procedure in the management of acute abdominal disease and can be considered both an excellent therapeutic and additional diagnostic tool in selected cases. However, a high level of expertise in laparoscopic and emergency surgery is required. Hemodynamic instability, huge abdominal distension, fecal peritonitis and perforated cancer are relative contraindications for the laparoscopic approach. In recent years, abdominal emergencies have increasingly been managed successfully by laparoscopy. In acute appendicitis, acute cholecystitis and perforated peptic ulcer, randomized controlled trials have proven that the laparoscopic approach is as safe and as effective as open surgery, with fewer complications and a quicker postoperative recovery. Other indications such as blunt and penetrating trauma to the abdomen, small bowel occlusion and perforated diverticular disease are under debate, indicating that more randomized controlled trials comparing laparoscopic and open surgery are still necessary.
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Affiliation(s)
- Benoit Navez
- Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium.
| | - Julie Navez
- Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium
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Navez B, Ungureanu F, Michiels M, Claeys D, Muysoms F, Hubert C, Vanderveken M, Detry O, Detroz B, Closset J, Devos B, Kint M, Navez J, Zech F, Gigot JF. Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium. Surg Endosc 2012; 26:2436-45. [PMID: 22407152 DOI: 10.1007/s00464-012-2206-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [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: 03/24/2011] [Accepted: 01/27/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy is considered nowadays as the standard management of acute cholecystitis (AC). However, results from multicentric studies in the general surgical community are still lacking. METHODS A prospective multicenter survey of surgical management of AC patients was conducted over a 2-year period in Belgium. Operative features and patients' clinical outcome were recorded. The impact of independent predictive factors on the choice of surgical approach, the risk of conversion, and the occurrence of postoperative complications was studied by multivariate logistic regression analysis. RESULTS Fifty-three surgeons consecutively and anonymously included 1,089 patients in this prospective study. A primary open approach was chosen in 74 patients (6.8%), whereas a laparoscopic approach was the first option in 1,015 patients (93.2%). Independent predictive factors for a primary open approach were previous history of upper abdominal surgery [odds ratio (OR) 4.13, p < 0.001], patient age greater than 70 years (OR 2.41, p < 0.05), surgeon with more than 10 years' experience (OR 2.08, p = 0.005), and gangrenous cholecystitis (OR 1.71, p < 0.05). In the laparoscopy group, 116 patients (11.4%) required conversion to laparotomy. Overall, 38 patients (3.5%) presented biliary complications and 49 had other local complications (4.5%). Incidence of bile duct injury was 1.2% in the whole series, 2.7% in the open group, and 1.1% in the laparoscopy group. Sixty patients had general complications (5.5%). The overall mortality rate was 0.8%. All patients who died were in poor general condition [American Society of Anesthesiologists (ASA) III or IV]. CONCLUSIONS Although laparoscopic cholecystectomy is currently considered as the standard treatment for acute cholecystitis, an open approach is still a valid option in more advanced disease. However, overall mortality and incidence of bile duct injury remain high.
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Affiliation(s)
- Benoit Navez
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium.
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Navez J, Yeung R, Remue C, Descamps C, Navez B, Gigot JF, Starkel P, Philippe M, Jouret-Mourin A, Van de Weerdt ML, Zech F, Gianello P, Deprez PH. Acute-phase response in pigs undergoing laparoscopic, transgastric or transcolonic notes peritoneoscopy with us or eus exploration. Acta Gastroenterol Belg 2012; 75:28-34. [PMID: 22567744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Laparoscopic surgery is associated with reduced surgical trauma, therefore with acute-phase response of lower magnitude as compared with open surgery. We hypothesized that NOTES might induce reduced immune response as compared with laparoscopy. OBJECTIVE To compare acute-phase reactants in a controlled trial of laparoscopic peritoneoscopy and ultrasonography versus transgastric or transcolonic NOTES peritoneoscopy and intraperitoneal endoscopic US. METHODS Eighteen pigs were divided in 3 groups: laparoscopy, transgastric and transcolonic NOTES. Serum levels of IL-6 and TNF-α were determined preoperatively and at day 2. Serum levels of haptoglobin and IL-6 mRNA levels from isolated white blood cells were measured by RT-PCR at days 0, 1, 2 and 7. Necropsy was performed at sacrifice, with peritoneal fluid microbiological analysis, macroscopic and microscopic examinations on gastrotomy/colotomy or abdominal wall closure sites, liver and parietal peritoneum biopsy sites and any area suggestive of infection. RESULTS The groups were similar with regards to peritoneoscopy completeness, ultrasonographic examination and biopsies. The duration of NOTES procedures was significantly longer than laparoscopic procedures. Minor complications were observed in most animals by macroscopic and microscopic examination, but NOTES procedures were associated with severe complications in 3 pigs (fistula, abscess, mortality). No significant differences in acute-phase reactants levels were found between groups. CONCLUSIONS No significant difference in the acute-phase reactants could be demonstrated between surgical and NOTES procedures. NOTES was however associated with more severe septic complications. Optimal closure remains a challenge and better devices are needed to avoid them.
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Affiliation(s)
- Julie Navez
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium.
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