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Ailhaud A, Girard E, Fournier J, Abba J, Devant E, Betry C, Risse O, Roth GS, d'Engremont C, Chirica M. Completion pancreatectomy during pancreatoduodenectomy: A lifesaving solution in high-risk patients. World J Surg 2024; 48:1123-1131. [PMID: 38553833 DOI: 10.1002/wjs.12159] [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: 12/17/2023] [Accepted: 03/05/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is responsible of most major complications and fatalities after PD. By avoiding POPF, TP may improve operative outcomes in high-risk patients. The aim was to compare total pancreatectomy (TP) and pancreatoduodenectomy (PD) in high-risk patients and evaluate results of implementing a risk-tailored strategy in clinical practice. METHODS Between 2014 and 2023, 139 patients (76 men, median age 67 years) underwent resection of disease located in the head of the pancreas. Starting January 1, 2022, we offered TP to patients at high POPF risks (fistula risk score (FRS) ≥7) and to patients with intermediate POPF risks (FRS: 3-6) and high risks of failure to rescue (age> 75 years, ASA score ≥3). We compared outcomes of TP and PD and evaluated the results of the new strategy implementation on operative outcomes. Propensity score-based analysis was performed to limit bias of between-group comparison. RESULTS Eventually, 26 (19%) patients underwent TP and 113 (81%) patients underwent PD. Severe complications occurred in 42 (30%) patients and 13 (9%) patients died. TP resulted in shorter lengths of hospital stay (median: 14 days [11; 18] vs. 17 days [13; 24], p = 0.016) and less risks of post-pancreatectomy hemorrhage (PPH) (0% vs. 20%, p < 0.001) compared to PD. Crude and propensity match analysis showed that the implementation of a risk-tailored strategy led to significant reduction of reoperation, POPF, PPH and mortality rates. CONCLUSION The use of TP as part of a risk-tailored strategy in high-risk patients can be lifesaving.
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Affiliation(s)
- Antoine Ailhaud
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC, Grenoble, France
- Department of Digestive Surgery, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Edouard Girard
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC, Grenoble, France
- Department of Digestive Surgery, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Joey Fournier
- Department of Public Health Centre, Hospitalier Grenoble Alpes, Grenoble, France
| | - Julio Abba
- Department of Digestive Surgery, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Emmanuel Devant
- Department of Digestive Surgery, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Cecile Betry
- Univ. Grenoble Alpes, LRB, INSERM, Endocrinology Department, CHU Grenoble Alpes, Grenoble, France
| | - Olivier Risse
- Department of Digestive Surgery, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Gaël S Roth
- Univ. Grenoble Alpes/Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes/Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, Grenoble, France
| | - Christelle d'Engremont
- Univ. Grenoble Alpes/Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes/Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, Grenoble, France
| | - Mircea Chirica
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC, Grenoble, France
- Department of Digestive Surgery, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
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Ezanno AC, Chkair S, Quesada JL, Abba J, Malgras B, Trilling B, Sage PY, Bouvet S, Foote A, Aime A, Glehen O, Pocard M, Arvieux C, Tidadini F. Oncological outcomes and hospitalization cost of hyperthermic intraperitoneal chemotherapy (HIPEC) open and closed abdomen techniques: Results from two French expert centers. Eur J Surg Oncol 2024; 50:107931. [PMID: 38181533 DOI: 10.1016/j.ejso.2023.107931] [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: 10/20/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) associated with CC0 excision is performed using either an open (OPEN_HIPEC) or closed abdominal technique (CLOSED_HIPEC). However, little data is available on the costs of this treatment, as there is no code for HIPEC in the French Classification of Medical Acts. Oncological outcomes and the mean cost of hospitalization were compared. METHODS Between 2017 and 2021, 144 patients with peritoneal carcinomatosis (all etiologies) were included (OPEN_HIPEC, n = 70; CLOSED_HIPEC, n = 74) in this retrospective two-center study. Morbi-mortality, overall survival (OS), recurrence-free-survival (RFS) and mean cost of hospitalization were compared. RESULTS The median OS and RFS were 71.3 months [63-71.5] and 26.8 months [20-35.3] respectively, and were similar for both techniques; and after stratification by histology. Multivariate analysis adjusted on PCI score of OS identified mitomycin as a protective factor (HR = 0.31 [0.10-0.90], p = 0.032) and ASA score>2 (HR = 2.32 [1.32- 4.06], p = 0.003) and number of resection (HR = 1.21 [1.06-1.39], p = 0.006) as a risk factors of RFS. Complication rates at day 30 were similar between OPEN and CLOSED_HIPEC, 31 (44.3 %) vs 42 (56.8 %); p = 0.135. OPEN_HIPEC had more severe complications (11 (35.5 %) vs 6 (14.3 %); p = 0.034). The mean cost of hospitalization was estimated as €15,627 for OPEN_HIPEC and €14,211 for CLOSED_HIPEC for a mean length-of-stay of 12.7 and 16.7 days respectively. The mean amount received by the hospital per hospitalization was estimated at €16,399 and €15,536 respectively. CONCLUSIONS OS and RFS were similar for open and closed HIPEC. Severe complications at day 30 were more frequent in OPEN_HIPEC group. The amount received by hospital for both HIPEC techniques is sufficient.
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Affiliation(s)
- Anne-Cécile Ezanno
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France.
| | - Sihame Chkair
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France; IDESP, UMR-INSERM, Montpellier, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Julio Abba
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Brice Malgras
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France; French Military Health Service Academy, Ecole du Val de Grâce, Paris, France
| | - Bertrand Trilling
- Univ. Grenoble Alpes, CNRS, CHU Grenoble Alpes, Department of digestive Surgery, Grenoble INP, TIMC, 38000, Grenoble, France
| | - Pierre-Yves Sage
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Sophie Bouvet
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Alison Foote
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Adeline Aime
- Department of Digestive Surgery, Begin Military Teaching Hospital, Saint Mandé, France
| | - Olivier Glehen
- Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Marc Pocard
- Department of Digestive Surgery, La Pitié Salpêtrière Hospital, Paris, France, INSERM, U965 CART Unit, Paris, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France; Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Fatah Tidadini
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France; Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France.
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Tidadini F, Abba J, Quesada JL, Trilling B, Bonne A, Foote A, Faucheron JL, Arvieux C. Oncological Outcomes After Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in the Treatment of Peritoneal Carcinomatosis. J Gastrointest Cancer 2023; 54:632-641. [PMID: 35778645 DOI: 10.1007/s12029-022-00843-x] [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] [Accepted: 06/11/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new surgical technique for the treatment of initially unresectable peritoneal carcinomatosis (PC). Our objective was to assess its oncological outcomes. METHODS Between July 2016 and September 2020, data from 100 PIPAC procedures with oxaliplatin or doxorubicin-cisplatin in 49 patients with PC (all etiologies) were analyzed. We studied the evolution of the peritoneal cancer index (PCI), the need for radical surgery (R0), and overall survival (OS). RESULTS The patients' median age was 65 (59; 71) years, and 55.1% were women. Median PIPAC procedures per patient were 2 (1-3), and 28 (57.1%) underwent more than one PIPAC procedure. Median PCI at the first PIPAC was 19 (15-22). PCI decreased for 37%, remained stable for 29.6%, and increased for 33.4% patients. Four (8.3%) underwent radical R0 surgery after PIPAC. After a median follow-up of 16.1 months (1.5-90.1), the median overall survival from PC diagnosis was 29.1 months (14.8-34.3), with a median gastric and colorectal PC survival of 11.3 (7.2-34.3) and 29.1 months (16.1-31) respectively. Overall survival after the first PIPAC session was 11.6 months (6-17.3), with median survival after gastric and colorectal PCs being 6 (2.9-15.5) and 13.3 months (5-17.6), respectively. Stratification of patients according to the number of lines of systemic chemotherapy, PIPAC procedures, and the chronology of PC onset did not result in a significant difference in survival. CONCLUSION The OS was in line with the literature. PIPAC could delay oncological progression and improve survival. These encouraging results justify the ongoing and future evaluations of PIPAC by prospective randomized trials.
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Affiliation(s)
- Fatah Tidadini
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10232, 38043, 38043, CEDEX 09, Grenoble, France
- Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Julio Abba
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10232, 38043, 38043, CEDEX 09, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10232, 38043, 38043, CEDEX 09, Grenoble, France
- UMR 5525, CNRS, TIMC-IMAG, University Grenoble Alps, Grenoble, France
| | - Aline Bonne
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10232, 38043, 38043, CEDEX 09, Grenoble, France
| | - Alison Foote
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10232, 38043, 38043, CEDEX 09, Grenoble, France
| | - Jean-Luc Faucheron
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10232, 38043, 38043, CEDEX 09, Grenoble, France
- UMR 5525, CNRS, TIMC-IMAG, University Grenoble Alps, Grenoble, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CS 10232, 38043, 38043, CEDEX 09, Grenoble, France.
- Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France.
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Tidadini F, Ezanno AC, Trilling B, Aime A, Abba J, Quesada JL, Foote A, Chevallier T, Glehen O, Faucheron JL, Chkair S, Arvieux C. Hospitalization cost of Pressurized Intraperitoneal Aerosol chemotherapy (PIPAC). Eur J Surg Oncol 2023; 49:165-172. [PMID: 36008216 DOI: 10.1016/j.ejso.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/21/2022] [Accepted: 07/31/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Pressurized Intraperitoneal Aerosol chemotherapy (PIPAC) is a new surgical technique for the treatment of unresectable peritoneal carcinomatosis. Very little data is available on the costs of this treatment in France as there is currently no code for PIPAC in the French Common Classification of Medical Acts (CCAM). Our objective was to estimate the mean cost of hospitalization for PIPAC in two French public teaching hospitals. METHODS The mean cost of hospitalization was estimated from the mean fixed-rate remuneration paid to the hospital and the mean additional costs of treatment paid by the hospital. At discharge a patient's hospitalization is classified into a diagnosis related group, which determines the fixed-rate remuneration paid to the hospital (obtained from the national hospitals database - PMSI). Costs of medical devices and drug treatments specific to PIPAC, not covered by the fixed-rate remuneration, were obtained from the hospital pharmacies. RESULTS Between July 2016 and November 2021, 205 PIPAC procedures were performed on 79 patients (mean procedures per patient = 2.6). Mean operating room occupancy was 165 min. The mean fixed-rate remuneration received by the hospitals per PIPAC hospitalization was €4031. The actual mean cost per hospitalization was €6562 for a mean length-of-stay of 3.3 days. Thus, each PIPAC hospitalization cost the hospital €2531 on average. CONCLUSION The current reimbursement of PIPAC treatment by the national health system is insufficient and represents only 61% of the real cost. The creation of a new fixed-rate remuneration for PIPAC taking into account this cost differential is necessary.
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Affiliation(s)
- Fatah Tidadini
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France; Lyon Center for Lnnovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Anne-Cecile Ezanno
- Department of Visceral and Endocrine Surgery, Bégin Army Teaching Hospital, Saint-Mande, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Adeline Aime
- Department of Visceral and Endocrine Surgery, Bégin Army Teaching Hospital, Saint-Mande, France
| | - Julio Abba
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Alison Foote
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Thierry Chevallier
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France; IDESP, UMR-INSERM, Montpellier, France
| | - Olivier Glehen
- Lyon Center for Lnnovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Jean-Luc Faucheron
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Sihame Chkair
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France; IDESP, UMR-INSERM, Montpellier, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France; Lyon Center for Lnnovation in Cancer, EA 3738, Lyon 1 University, Lyon, France; Department of Visceral and Endocrine Surgery, Bégin Army Teaching Hospital, Saint-Mande, France.
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Hübner M, Somashekhar SP, Teixeira Farinha H, Abba J, Rao RG, Alyami M, Willaert W. Treatment Response After Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for Peritoneal Metastases of Colorectal Originf. Ann Surg Open 2022; 3:e203. [PMID: 37600288 PMCID: PMC10406066 DOI: 10.1097/as9.0000000000000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 03/05/2023] Open
Abstract
The objective of this study is to analyze oncological outcomes of patients with peritoneal metastases (PM) of colorectal origin treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC). Background PIPAC has been demonstrated to be a feasible and safe novel treatment for patients with PM of various origins. Only small series reports on survival after PIPAC by disease entity. Methods International retrospective cohort study of consecutive patients with PM of colorectal origin. Outcome measures were overall survival (OS), radiological response according to Response Evaluation Criteria in Solid Tumors (RECIST), histological response (peritoneal regression grading score [PRGS]: complete response: 1-4: no response), change of peritoneal cancer index (PCI), and symptom control. Results Seventeen eligible centers compiled 256 non-selected patients (mean age 61 [50.6-69.2], 43% female) and 606 procedures. Sixty-three percent were treated after 2 lines of chemotherapy, median PCI at PIPAC1 was 18 (interquartile range [IQR] = 10-27). Median OS was 19.00 months (IQR = 12.9-29.8) from diagnosis and 9.4 months (IQR = 4.5-16.8) from PIPAC1. One hundred and four of 256 patients (40.6%) had ≥3 procedures (per protocol [pp]) with the following outcomes at PIPAC3: RECIST: 59.3% partial response/stable, 40.7% progression; mean PRGS: 2.1 ± 0.9. Median PCI was 21 (IQR = 15-29) at baseline and 20 (IQR = 12-27) at PIPAC3 (P = 0.02). Fifty-six (54%) and 48 (46%) patients were symptomatic at baseline and PIPAC3, respectively (P = 0.267). Median OS for the pp cohort was 11.9 months (IQR = 10.7-15.0) from PIPAC1. Independent predictors for survival were radiological response (HR = 3.0; 95% CI = 1.6-5.7) and no symptoms (HR = 4.5, 95% CI = 2.2-9.1) at PIPAC3. Conclusions Objective treatment response and encouraging survival were demonstrated after PIPAC for colorectal PM. Prospective registry data and comparative studies are now needed in to confirm these data.
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Affiliation(s)
- Martin Hübner
- From the Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland
| | - S. P. Somashekhar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bengaluru, India
| | - Hugo Teixeira Farinha
- From the Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland
| | | | - Ramya G. Rao
- Department of Surgical Oncology, Manipal Comprehensive Cancer Centre, Manipal Hospital, Bengaluru, India
| | - Mohammad Alyami
- Department of General Surgery and Surgical Oncology, Oncology Center, King Khalid Hospital, Najran, Saudi Arabia
| | - Wouter Willaert
- Department of human structure and repair, Ghent University, Ghent, Belgium
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Somashekhar SP, Abba J, Sgarbura O, Alyami M, Teixeira Farinha H, Rao RG, Willaert W, Hübner M. Assessment of Treatment Response after Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC) for Appendiceal Peritoneal Metastases. Cancers (Basel) 2022; 14:4998. [PMID: 36291781 PMCID: PMC9599491 DOI: 10.3390/cancers14204998] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 08/30/2023] Open
Abstract
Background The aim of this study was to analyse survival and surrogates for oncological response after PIPAC for appendiceal tumours. Methods This retrospective cohort study included consecutive patients with appendiceal peritoneal metastases (PM) treated in experienced PIPAC centers. Primary outcome measure was overall survival (OS) from the date of diagnosis of PM and from the start of PIPAC. Predefined secondary outcome included radiological response (RECIST criteria), repeat laparoscopy and peritoneal cancer index (PCI), histological response assessed by the Peritoneal regression grading system (PRGS) and clinical response. Results Final analysis included 77 consecutive patients (208 PIPAC procedures) from 15 centres. Median OS was 30 months (23.00-46.00) from time of diagnosis and 19 months (13.00-28.00) from start of PIPAC. 35/77 patients (45%) had ≥3 procedures (pp: per protocol). Objective response at PIPAC3 was as follows: RECIST: complete response 4 (11.4%), 11 (31.4%) partial/stable; mean PRGS at PIPAC3: 1.8 ± 0.9. Median PCI: 21 (IQR 18-27) vs. 22 (IQR 17-28) at baseline (p = 0.59); 21 (60%) and 18 (51%) patients were symptomatic at baseline and PIPAC3, respectively (p = 0.873). Median OS in the pp cohort was 22.00 months (19.00-NA) from 1st PIPAC. Conclusion Patients with PM of appendiceal origin had objective treatment response after PIPAC and encouraging survival curves call for further prospective evaluation.
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Affiliation(s)
- SP Somashekhar
- Manipal Comprehensive Cancer Center, Manipal Hospital, HAL Old Airport Rd, Kodihalli, Bengaluru 560017, India
| | - Julio Abba
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, CEDEX 09, F-38043 Grenoble, France
| | - Olivia Sgarbura
- Surgical Oncology Department, Montpellier Cancer Institute (ICM), University of Montpellier, F-34298 Montpellier, France
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Université de Montpellier, F-34298 Montpellier, France
| | - Mohammad Alyami
- Department of General Surgery and Surgical Oncology, Oncology Center, King Khalid Hospital, Najran 66262, Saudi Arabia
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Ramya G. Rao
- Manipal Comprehensive Cancer Center, Manipal Hospital, HAL Old Airport Rd, Kodihalli, Bengaluru 560017, India
| | - Wouter Willaert
- Department of GI Surgery, Ghent University Hospital, 9000 Ghent, Belgium
| | - Martin Hübner
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Tidadini F, Abba J, Quesada JL, Villeneuve L, Foote A, Baudrant M, Bonne A, Glehen O, Trilling B, Faucheron JL, Arvieux C. Assessment of postoperative pain after pressurized intraperitoneal aerosol chemotherapy (PIPAC) in the treatment of peritoneal metastasis. Int J Colorectal Dis 2022; 37:1709-1717. [PMID: 35639123 DOI: 10.1007/s00384-022-04182-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 05/07/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new surgical technique, for the treatment of initially unresectable peritoneal metastasis (PM). Our objective was to assess postoperative pain and morbidity. METHODS Between July 2016 and September 2020, data from 100 consecutive PIPAC procedures with oxaliplatin (PIPAC Ox) or doxorubicin-cisplatin (PIPAC C/D) in 49 patients with PM (all etiologies) were analyzed. Pain was self-assessed using a visual analog scale (VAS) of 0-10. RESULTS The median PIPAC procedures per patient were 2 [1-3]. Patients indicated greatest pain at 4 pm on the day of the procedure (D0) and on postoperative D1 at 8 am and 4 pm. Postprocedural moderate-to-severe pain (VAS 4-10) was more frequent with PIPAC Ox than with PIPAC C/D, respectively 14 (36.8%) vs 7 (13.5%); p = 0.010. Hospitalization was longer for patients with moderate-to-severe pain than for others (median 4 days [3-7] vs 3 days [2-4], p = 0.004). Multivariate analysis identified oxaliplatin as a factor associated with greater pain (OR [95% CI], 2.95 [1.10-7.89]. Opiate administration was similar after PIPAC Ox and PIPAC C/D procedures, p = 0.477. CONCLUSION PIPAC was well-tolerated, and pain was well-controlled in the majority of patients. Pain was greatest at 4 pm on D0 and 8 am and 4 pm on D1. PIPAC Ox is associated with greater pain than PIPAC C/D, independently of opiate treatment. Moderate-to-severe pain was associated with longer hospital stays.
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Affiliation(s)
- Fatah Tidadini
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Julio Abba
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Villeneuve
- Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Alison Foote
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Magalie Baudrant
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Aline Bonne
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Olivier Glehen
- Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,UMR 5525, CNRS, TIMC-IMAG, University Grenoble Alpes, 38000, Grenoble, France
| | - Jean-Luc Faucheron
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,UMR 5525, CNRS, TIMC-IMAG, University Grenoble Alpes, 38000, Grenoble, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France. .,Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France.
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Robella M, Hubner M, Sgarbura O, Reymond M, Khomiakov V, di Giorgio A, Bhatt A, Bakrin N, Willaert W, Alyami M, Teixeira H, Kaprin A, Ferracci F, De Meeus G, Berchialla P, Vaira M, Villeneuve L, Cortés-Guiral D, Nowacki M, So J, Abba J, Afifi A, Mortensen MB, Brandl A, Ceelen W, Coget J, Courvoiser T, de Hingh IH, Delhorme JB, Dumont F, Escayola C, Eveno C, Ezanno AC, Gagnière J, Galindo J, Glatz T, Glehen O, Jäger T, Kepenekian V, Kothonidis K, Lehmann K, Lynch C, Mehta S, Moldovan B, Nissan A, Orry D, Pérez GO, Paquette B, Paskonis M, Piso P, Pocard M, Rau B, Singh S, Somashekhar S, Soravia C, Taibi A, Torkington J, Vizzielli G. Feasibility and safety of PIPAC combined with additional surgical procedures: PLUS study. Eur J Surg Oncol 2022; 48:2212-2217. [DOI: 10.1016/j.ejso.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/04/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
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9
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Mercier F, Passot G, Bonnot PE, Cashin P, Ceelen W, Decullier E, Villeneuve L, Walter T, Levine EA, Glehen O, Baik SH, Baratti D, Bhatt A, De Hingh I, De Simone M, Dubé P, Edwards RP, Franko J, Gonzalez-Bayon L, Gushchin V, Holtzman MP, Hsieh MC, Kecmanovic D, Lee KW, Lehmann K, Liu Y, Mehta S, Morris DL, O’Dwyer S, Orsenigo E, Pande PK, Park EJ, Pingpank JF, Piso P, Rajan F, Rau B, Sardi A, Sideris L, Sommariva A, Spiliotis J, Tentes AAK, Teo M, Yarema R, Younan R, Zaveri SS, Zeh HJ, Abba J, Abboud K, Alyami M, Arvieux C, Bakrin N, Bereder JM, Bouzard D, Brigand C, Carrère S, Delroeux D, Dumont F, Eveno C, Facy O, Guyon F, Ferron G, Kianmanesh R, Dico RL, Lorimier G, Marchal F, Mariani P, Meeus P, Msika S, Ortega-Deballon P, Paquette B, Peyrat P, Pirro N, Pocard M, Porcheron J, Quenet F, Rat P, Sgarbura O, Thibaudeau E, Tuech JJ, Zinzindohoue F. An International Registry of Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. World J Surg 2022; 46:1336-1343. [PMID: 35286418 DOI: 10.1007/s00268-022-06498-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Peritoneal carcinomatosis from appendiceal goblet cell carcinoma (A-GCC) is a rare and aggressive form of appendiceal tumor. Cytoreductive surgery (CRS) and hyperthermic intra peritoneal chemotherapy (HIPEC) was reported as an interesting alternative regarding survival compared to surgery without HIPEC and/or systemic chemotherapy. Our aim was to evaluate the impact of CRS and HIPEC for patients presenting A-GCC through an international registry. METHODS A prospective multicenter international database was retrospectively searched to identify all patients with A-GCC tumor and peritoneal metastases who underwent CRS and HIPEC through the Peritoneal Surface Oncology Group International (PSOGI). The post-operative complications, long-term results, and principal prognostic factors were analyzed. RESULTS The analysis included 83 patients. After a median follow-up of 47 months, the median overall survival (OS) was 34.6 months. The 3- and 5-year OS was 48.5% and 35.7%, respectively. Patients who underwent complete macroscopic CRS had a significantly better survival than those treated with incomplete CRS. The 5-year OS was 44% and 0% for patients who underwent complete, and incomplete CRS, respectively (HR 9.65, p < 0.001). Lymph node involvement and preoperative chemotherapy were also predictive of a worse prognosis. There were 3 postoperative deaths, and 30% of the patients had major complications. CONCLUSION CRS and HIPEC may increase long-term survival in selected patients with peritoneal metastases of A-GCC origin, especially when complete CRS is achieved. Ideally, randomized control trials or more retrospective data are needed to confirm CRS and HIPEC as the gold standard in this pathology.
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Affiliation(s)
- Frederic Mercier
- Department of Surgical Oncology, CHU Montreal, University of Montreal, 1000 St-Denis, Montreal, QC, H2X 0C1, Canada. .,The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.
| | - Guillaume Passot
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | | | - Peter Cashin
- Department of Surgery, Akademiska Sjukhuset, Uppsala University Hospital, Uppasala, Sweden
| | - Wim Ceelen
- Department of Gastrointestinal Surgery, Gent University Hospital, Ghent, Belgium
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle Santé Publique, Unité de Recherche Clinique, Lyon, France
| | - Laurent Villeneuve
- EMR 37-38, Lyon 1 University, Lyon, France.,Hospices Civils de Lyon, Pôle Santé Publique, Unité de Recherche Clinique, Lyon, France
| | - Thomas Walter
- Department of Gastroenterology and Oncology, Hospices Civils de Lyon, Edouard Herriot Hospital University of Lyon, Lyon, France
| | - Edward A Levine
- Section of Surgical Oncology, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Olivier Glehen
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
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10
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Farinha HT, Hubner M, sp Somashekhar, Abba J, Rao RG, Willaert W. Treatment response after Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for peritoneal metastases of colorectal origin. European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2021.12.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Tidadini F, Abba J, Quesada JL, Baudrant M, Bonne A, Foote A, Faucheron JL, Glehen O, Villeneuve L, Arvieux C. Effect of Pressurized Intraperitoneal Aerosol Chemotherapy on the Survival Rate of Patients with Peritoneal Carcinomatosis of Gastric Origin. J Gastrointest Cancer 2021; 53:971-979. [PMID: 34677795 DOI: 10.1007/s12029-021-00698-8] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new surgical technique for the treatment of initially unresectable peritoneal carcinomatosis (PC). Our objective was to compare the results of PIPAC associated with systemic chemotherapy (PIPAC_CHEM) with those of systemic chemotherapy alone (ONLY_CHEM) in patients with gastric PC without metastasis other than peritoneal, and the WHO performance status < 3. METHODS This was a retrospective, single center, comparative non-randomized study. Seventeen PIPAC_CHEM patients were compared to 29 ONLY_CHEM patients. The primary endpoint was overall survival at 6 months from diagnosis of PC. RESULTS Ninety-eight patients were screened and 46 were included (PIPAC_CHEM, n = 17; ONLY_CHEM, n = 29). The PIPAC_ CHEM population was significantly younger (median 64 years [56; 68] vs 74 years [61; 79]; p = 0.0054). Median PIPAC session per patient is 2 [1-3]. Six-month survival was significantly higher in the PIPAC_CHEM group than in the ONLY_CHEM group 16/17 (94.1% [65-99.2]) vs 19/29 (65.5% [45.4-79.7]), respectively; p = 0.029. Over the entire follow-up, median survival [95% CI] was 12.8 months [7.2-34.3] with PIPAC vs 9.1 months [5.4-11.5] without, p = 0.056. At 6 months, median length of additional hospitalization was significantly less for PIPAC_CHEM (median 2 days [2-7]) than without PIPAC (median 11 days [3-21]) (p = 0.045). CONCLUSION The overall survival at 6 months after the diagnosis of carcinomatosis was significantly better for PIPAC_CHEM patients. This difference appears to continue until at least 18 months. At 6 months, days of additional hospitalization was significantly less in the PIPAC_CHEM group. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT 04,879,953.
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Affiliation(s)
- Fatah Tidadini
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,Lyon Center for lnnovation in Cancer- EA 3738, Lyon 1 University, Lyon, EA, France
| | - Julio Abba
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Magalie Baudrant
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Aline Bonne
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Alison Foote
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Luc Faucheron
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Olivier Glehen
- Lyon Center for lnnovation in Cancer- EA 3738, Lyon 1 University, Lyon, EA, France
| | - Laurent Villeneuve
- Lyon Center for lnnovation in Cancer- EA 3738, Lyon 1 University, Lyon, EA, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France. .,Lyon Center for lnnovation in Cancer- EA 3738, Lyon 1 University, Lyon, EA, France.
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12
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Devant E, Girard E, Abba J, Ghelfi J, Sage PY, Sengel C, Risse O, Bricault I, Trilling B, Chirica M. Delayed Postoperative Hemorrhage Complicating Major Supramesocolic Surgery Management and Outcomes. World J Surg 2021; 45:2432-2438. [PMID: 33866425 DOI: 10.1007/s00268-021-06116-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The place of surgery and interventional radiology in the management of delayed (> 24 h) hemorrhage (DHR) complicating supramesocolic surgery is still to define. The aim of the study was to evaluate outcomes of DHR using a combined multimodal strategy. METHODS Between 2005 and 2019, 57 patients (median age 64 years) experienced 86 DHR episodes after pancreatic resection (n = 26), liver transplantation (n = 24) and other (n = 7). Hemodynamically stable patients underwent computed tomography evaluation followed by interventional radiology (IR) treatment (stenting and/or embolization) or surveillance. Hemodynamically unstable patients were offered upfront surgery. Failure to identify the leak was managed by either prophylactic stenting/embolization of the most likely bleeding source or surveillance. RESULTS Mortality was 32% (n = 18). Bleeding recurrence occurred in 22 patients (39%) and was multiple in 7 (12%). Sentinel bleeding was recorded in 77 (81%) of episodes, and the bleeding source could not be identified in 26 (30%). Failure to control bleeding was recorded in 9 (28%) of 32 episodes managed by surgery and 4 (11%) of 41 episodes managed by IR (p = 0.14). Recurrence was similar after stenting and embolization (n = 4/18, 22% vs n = 8/26, 31%, p = 0.75) of the bleeding source. Recurrence was significantly lower after prophylactic IR management than surveillance of an unidentified bleeding source (n = 2/10, 20% vs. n = 11/16, 69%, p = 0.042). CONCLUSION IR management should be favored for the treatment of DHR in hemodynamically stable patients. Prophylactic IR management of an unidentified leak decreases recurrence risks.
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Affiliation(s)
- Emmanuel Devant
- Centre Hospitalier Universitaire Grenoble Alpes, Department of Digestive Surgery, Grenoble, France
| | - Edouard Girard
- Centre Hospitalier Universitaire Grenoble Alpes, Department of Digestive Surgery, Grenoble, France.,Université Grenoble Alpes, CNRS, Grenoble, France
| | - Julio Abba
- Centre Hospitalier Universitaire Grenoble Alpes, Department of Digestive Surgery, Grenoble, France
| | - Julien Ghelfi
- Centre Hospitalier Universitaire Grenoble Alpes, Department of Radiology, Grenoble, France
| | - Pierre-Yves Sage
- Centre Hospitalier Universitaire Grenoble Alpes, Department of Digestive Surgery, Grenoble, France
| | - Christian Sengel
- Centre Hospitalier Universitaire Grenoble Alpes, Department of Radiology, Grenoble, France
| | - Olivier Risse
- Centre Hospitalier Universitaire Grenoble Alpes, Department of Digestive Surgery, Grenoble, France
| | - Ivan Bricault
- Université Grenoble Alpes, CNRS, Grenoble, France.,Centre Hospitalier Universitaire Grenoble Alpes, Department of Radiology, Grenoble, France
| | - Bertrand Trilling
- Centre Hospitalier Universitaire Grenoble Alpes, Department of Digestive Surgery, Grenoble, France.,Université Grenoble Alpes, CNRS, Grenoble, France
| | - Mircea Chirica
- Centre Hospitalier Universitaire Grenoble Alpes, Department of Digestive Surgery, Grenoble, France.
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Abstract
Abdominal compartment syndrome (ACS), defined by the presence of increased intra-abdominal pressure>20mmHg in association with failure of at least one organ system, is a common and feared complication that may occur in the early phase of severe acute pancreatitis (AP). This complication can lead to patient death in the very short term. The goal of this review is to provide the surgeon and intensivist with objective information to help them in their decision-making. In the early phase of severe AP, it is essential to monitor intra-vesical pressure (iVP) to allow early diagnosis of intra-abdominal hypertension or ACS. The treatment of ACS is both medical and surgical requiring close collaboration between the surgical and resuscitation teams. Medical treatment includes vascular volume repletion, prokinetic agents, effective curarization and percutaneous drainage of large-volume ascites. If uncontrolled respiratory or cardiac failure develops or if maximum medical treatment fails, most teams favor performing an emergency xipho-pubic decompression laparotomy with laparostomy. This procedure follows the principles of abbreviated laparotomy as described for abdominal trauma.
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Affiliation(s)
- M Siebert
- Department of Surgery, GHI Le Raincy-Montfermeil, 93370 Montfermeil, France; Department of general surgery and emergency surgery, CHU de Grenoble, Grenoble, France.
| | - A Le Fouler
- Department of Surgery, GHI Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - N Sitbon
- Department of Surgery, GHI Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - J Cohen
- Multipurpose intensive care unit, GHI Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - J Abba
- Department of general surgery and emergency surgery, CHU de Grenoble, Grenoble, France
| | - E Poupardin
- Department of Surgery, GHI Le Raincy-Montfermeil, 93370 Montfermeil, France
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14
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Manceau G, Sabbagh C, Mege D, Lakkis Z, Bege T, Tuech JJ, Benoist S, Lefèvre JH, Karoui M, Bridoux V, Venara A, Beyer‐Berjot L, Codjia T, Dazza M, Gagnat G, Hamel S, Mallet L, Martre P, Philouze G, Roussel E, Tortajada P, Dumaine AS, Heyd B, Paquette B, Brunetti F, Esposito F, Lizzi V, Michot N, Denost Q, Rullier E, Tresallet C, Tetard O, Rivier P, Fayssal E, Collard M, Moszkowicz D, Lupinacci R, Peschaud F, Etienne JC, Loge L, Bege T, Corte H, D’Annunzio E, Humeau M, Issard J, Munoz N, Abba J, Jafar Y, Lacaze L, Sage PY, Susoko L, Trilling B, Arvieux C, Mauvais F, Ulloa‐Severino B, Pitel S, Vauchaussade de Chaumont A, Badic B, Blanc B, Bert M, Rat P, Ortega‐Deballon P, Chau A, Dejeante C, Piessen G, Grégoire E, Alfarai A, Cabau M, David A, Kadoche D, Dufour F, Goin G, Goudard Y, Pauleau G, Sockeel P, Villeon B, Pautrat K, Eveno C, Abdalla S, Couchard AC, Balbo G, Mabrut JY, Bellinger J, Bertrand M, Aumont A, Duchalais E, Messière AS, Tranchart A, Cazauran JB, Pichot‐Delahaye V, Dubuisson V, Maggiori L, Panis Y, Djawad‐Boumediene B, Fuks D, Kahn X, Huart E, Catheline JM, Lailler G, Baraket O, Baque P, Diaz de Cerio JM, Mariol P, Maes B, Fernoux P, Guillem P, Chatelain E, de Saint Roman C, Fixot K, Voron T, Parc Y. Colon sparing resection versus extended colectomy for left-sided obstructing colon cancer with caecal ischaemia or perforation: a nationwide study from the French Surgical Association. Colorectal Dis 2020; 22:1304-1313. [PMID: 32368856 DOI: 10.1111/codi.15111] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/02/2020] [Indexed: 02/08/2023]
Abstract
AIM It is not known whether patients with obstructive left colon cancer (OLCC) with caecal ischaemia or diastatic perforation (defined as a blowout of the caecal wall related to colonic overdistension) should undergo a (sub)total colectomy (STC) or an ileo-caecal resection with double-barrelled ileo-colostomy. We aimed to compare the results of these two strategies. METHOD From 2000 to 2015, 1220 patients with OLCC underwent surgery by clinicians who were members of the French Surgical Association. Of these cases, 201 (16%) were found to have caecal ischaemia or diastatic perforation intra-operatively: 174 patients (87%) underwent a STC (extended colectomy group) and 27 (13%) an ileo-caecal resection with double-end stoma (colon-sparing group). Outcomes were compared retrospectively. RESULTS In the extended colectomy group, 95 patients (55%) had primary anastomosis and 79 (45%) had a STC with an end ileostomy. In the colon-sparing group, 10 patients (37%) had simultaneous resection of their primary tumour with segmental colectomy and an anastomosis which was protected by a double-barrelled ileo-colostomy. The demographic data for the two groups were comparable. Median operative time was longer in the STC group (P = 0.0044). There was a decrease in postoperative mortality (7% vs 12%, P = 0.75) and overall morbidity (56% vs 67%, P = 0.37) including surgical (30% vs 40%, P = 0.29) and severe complications (17% vs 27%, P = 0.29) in the colon-sparing group, although these differences did not reach statistical significance. Cumulative morbidity included all surgical stages and the rate of permanent stoma was 66% and 37%, respectively, with no significant difference between the two groups. Overall survival and disease-free survival were similar between the two groups. CONCLUSION The colon-sparing strategy may represent a valid and safe alternative to STC in OLCC patients with caecal ischaemia or diastatic perforation.
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Affiliation(s)
- G Manceau
- Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - C Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - D Mege
- Department of Digestive Surgery, Assistance Publique-Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - Z Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - T Bege
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - J J Tuech
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - S Benoist
- Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - J H Lefèvre
- Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Sorbonne Université, Paris, France
| | - M Karoui
- Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Sorbonne Université, Paris, France
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15
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Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, Patrice D. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg 2020; 107:268-277. [PMID: 31916594 DOI: 10.1002/bjs.11406] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - F Cauchy
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - C Goumard
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - O Soubrane
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - E Salamé
- Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Tours University, Tours, France
| | - D Cherqui
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - E Vibert
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - O Scatton
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | | | - T Nomi
- Nara Medical University, Nara, Japan
| | - N Oudafal
- Institut Mutualiste Montsouris, Paris, France
| | - T Kawai
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Komatsu
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Okumura
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | | | - A Laurent
- Hôpital Henri Mondor, APHP, Creteil, France
| | - P Bucur
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - L Barbier
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - B Trechot
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - J Nunèz
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M Tedeschi
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M-A Allard
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - N Golse
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - O Ciacio
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - G Pittau
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - R Adam
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - C Laurent
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - L Chiche
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - P Leourier
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Rebibo
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - J-M Regimbeau
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Ferre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F R Souche
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J Chauvat
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J-M Fabre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F Jehaes
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Mohkam
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Lesurtel
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Ducerf
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-Y Mabrut
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - T Hor
- St Antoine Hospital, APHP, Paris, France
| | - F Paye
- St Antoine Hospital, APHP, Paris, France
| | - P Balladur
- St Antoine Hospital, APHP, Paris, France
| | - B Suc
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - F Muscari
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - G Millet
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - M El Amrani
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - C Ratajczak
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - K Lecolle
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - E Boleslawski
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - S Truant
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - F-R Pruvot
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - A-R Kianmanesh
- Robert Debré Hospital, Hospital University Centre of Reims, Reims, France
| | - T Codjia
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - L Schwarz
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - E Girard
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - J Abba
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - C Letoublon
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - M Chirica
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | | | | | - Z Cherkaoui
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - X Unterteiner
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - R Memeo
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - P Pessaux
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - E Buc
- Hospital University Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Lermite
- Hospital University Centre of Angers, Angers, France
| | - J Barbieux
- Hospital University Centre of Angers, Angers, France
| | - M Bougard
- Hospital University Centre of Angers, Angers, France
| | - U Marchese
- Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Institut Paoli-Calmettes, Marseille, France
| | - O Turini
- Institut Paoli-Calmettes, Marseille, France
| | - A Thobie
- Hospital University Centre of Caen Normandie, Caen, France
| | - B Menahem
- Hospital University Centre of Caen Normandie, Caen, France
| | - A Mulliri
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Lubrano
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Zemour
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - H Fagot
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - G Passot
- Hospital University Centre of Lyon Sud, Lyon, France
| | - E Gregoire
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - J Hardwigsen
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - Y-P le Treut
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - D Patrice
- Louis Pasteur Hospital, Colmar, France
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Mancini A, Mougin N, Venchiarutti V, Shen Z, Risse O, Abba J, Arvieux C. Goni Moreno progressive preoperative pneumoperitoneum for giant hernias: a monocentric retrospective study of 162 patients. Hernia 2020; 24:545-550. [DOI: 10.1007/s10029-019-02113-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/23/2019] [Indexed: 11/24/2022]
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17
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Manceau G, Mege D, Bridoux V, Lakkis Z, Venara A, Voron T, De Angelis N, Ouaissi M, Sielezneff I, Karoui M, Dazza M, Gagnat G, Hamel S, Mallet L, Martre P, Philouze G, Roussel E, Tortajada P, Dumaine AS, Heyd B, Paquette B, Brunetti F, Esposito F, Lizzi V, Michot N, Denost Q, Tresallet C, Tetard O, Regimbeau JM, Sabbagh C, Rivier P, Fayssal E, Collard M, Moszkowicz D, Peschaud F, Etienne JC, loge L, Beyer L, Bege T, Corte H, D'Annunzio E, Humeau M, Issard J, Munoz N, Abba J, Jafar Y, Lacaze L, Sage PY, Susoko L, Trilling B, Arvieux C, Mauvais F, Ulloa‐Severino B, Lefevre JH, Pitel S, Vauchaussade de Chaumont A, Badic B, Blanc B, Bert M, Rat P, Ortega‐Deballon P, Chau A, Dejeante C, Piessen G, Grégoire E, Alfarai A, Cabau M, David A, Kadoche D, Dufour F, Goin G, Goudard Y, Pauleau G, Sockeel P, De la Villeon B, Pautrat K, Eveno C, Brouquet A, Couchard AC, Balbo G, Mabrut JY, Bellinger J, Bertrand M, Aumont A, Duchalais E, Messière AS, Tranchart A, Cazauran JB, Pichot‐Delahaye V, Dubuisson V, Maggiori L, Djawad‐Boumediene B, Fuks D, Kahn X, Huart E, Catheline JM, Lailler G, Baraket O, Baque P, Diaz de Cerio JM, Mariol P, Maes B, Fernoux P, Guillem P, Chatelain E, de Saint Roman C, Fixot K. Thirty-day mortality after emergency surgery for obstructing colon cancer: survey and dedicated score from the French Surgical Association. Colorectal Dis 2019; 21:782-790. [PMID: 30884089 DOI: 10.1111/codi.14614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/09/2018] [Accepted: 02/27/2019] [Indexed: 02/08/2023]
Abstract
AIM The aim was to define risk factors for postoperative mortality in patients undergoing emergency surgery for obstructing colon cancer (OCC) and to propose a dedicated score. METHOD From 2000 to 2015, 2325 patients were treated for OCC in French surgical centres by members of the French National Surgical Association. A multivariate analysis was performed for variables with P value ≤ 0.20 in the univariate analysis for 30-day mortality. Predictive performance was assessed by the area under the receiver operating characteristic curve. RESULTS A total of 1983 patients were included. Thirty-day postoperative mortality was 7%. Multivariate analysis found five significant independent risk factors: age ≥ 75 (P = 0.013), American Society of Anesthesiologists (ASA) score ≥ III (P = 0.027), pulmonary comorbidity (P = 0.0002), right-sided cancer (P = 0.047) and haemodynamic failure (P < 0.0001). The odds ratio for risk of postoperative death was 3.42 with one factor, 5.80 with two factors, 15.73 with three factors, 29.23 with four factors and 77.25 with five factors. The discriminating capacity in predicting 30-day postoperative mortality was 0.80. CONCLUSION Thirty-day postoperative mortality after emergency surgery for OCC is correlated with age, ASA score, pulmonary comorbidity, site of tumour and haemodynamic failure, with a specific score ranging from 0 to 5.
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Affiliation(s)
- G Manceau
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - D Mege
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - V Bridoux
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Z Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - A Venara
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - T Voron
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Saint Antoine Hospital, Sorbonne Université, Paris, France
| | - N De Angelis
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Université Paris-Est (UEP), Créteil, France
| | - M Ouaissi
- Department of Digestive Surgery, Tours University Hospital, Tours, France
| | - I Sielezneff
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - M Karoui
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
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Mancini A, Duramé A, Barbois S, Abba J, Ageron FX, Arvieux C. Relevance of early CT scan diagnosis of blunt diaphragmatic injury: A retrospective analysis from the Northern French Alps Emergency Network. J Visc Surg 2018; 156:3-9. [PMID: 30472050 DOI: 10.1016/j.jviscsurg.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Diaphragmatic rupture following blunt trauma occurs rarely. Classically described after high-velocity accidents, ruptures are often associated with multiple organ injuries. The diagnosis is sometimes difficult. The goal of this study was to analyze and to discuss the modalities of early radiologic diagnosis and management of these injuries. PATIENTS AND METHODS This multicenter retrospective study included patients seen between 2009 and 2017 within the Northern Alpine Emergency Network [REseau Nord Alpin des Urgences (RENAU)]. Clinical, radiologic and surgical data from all patients sustaining blunt diaphragmatic rupture were studied. RESULTS Thirty-one patients (18 men and 13 women), median age 44, were included. The principle mechanism of injury was road or traffic accidents for 22 patients. Diaphragmatic rupture occurred on the left side in 23 patients. Diagnosis was delayed in two patients, at 11 days and three months after the initial accident. Chest X-rays were diagnostic in 18 of 29 patients. CT scan was the reference investigation since it was performed in all patients and confirmed the diagnosis in 26 instances. Repair was surgical via a midline laparotomy in 27 patients, via laparoscopy in three, and via thoracoscopy in one. Three patients died. CONCLUSION At urgent surgical exploration in the unstable blunt trauma patient, the surgeon should keep in mind the relatively poor diagnostic performance of chest X-rays. Accurate diagnosis relies on routine inspection of the diaphragmatic cupolas. In the stable trauma victim, contrast-enhanced abdomino-thoracic CT with reconstruction can lead to early diagnosis, which allows for repair under optimal conditions, whether by laparotomy, laparoscopy or thoracoscopy, according to local conditions and expertise.
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Affiliation(s)
- A Mancini
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - A Duramé
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - S Barbois
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - J Abba
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - F-X Ageron
- Urgences SAMU-SMUR, centre hospitalier Annecy-Genevois, 74370 Metz-Tessy, France
| | - C Arvieux
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France.
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Faucheron JL, Abba J, Trilling B. If you must operate on a patient presenting with purulent peritonitis secondary to sigmoid diverticular perforation…do not throw the baby out with the bathwater, not yet…. J Visc Surg 2018; 156:81-83. [PMID: 30241908 DOI: 10.1016/j.jviscsurg.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J-L Faucheron
- Department of Surgery, Colorectal Unit, Michallon University Hospital, 38000 Grenoble, France; University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000 Grenoble, France.
| | - J Abba
- Department of Surgery, Emergency Unit, Michallon University Hospital, 38000 Grenoble, France
| | - B Trilling
- Department of Surgery, Colorectal Unit, Michallon University Hospital, 38000 Grenoble, France; University Grenoble Alps, UMR 5525, CNRS, TIMC-IMAG, 38000 Grenoble, France
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20
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Amblard I, Mercier F, Bartlett D, Ahrendt S, Lee K, Zeh H, Levine E, Baratti D, Deraco M, Piso P, Morris D, Rau B, Tentes A, Tuech JJ, Quenet F, Akaishi E, Pocard M, Yonemura Y, Lorimier G, Delroeux D, Villeneuve L, Glehen O, Passot G, Abba J, Abboud K, Alyami M, Arvieux C, Bakrin N, Bereder JM, Bouzard D, Brigand C, Carrère S, Delroeux D, Dumont F, Eveno C, Facy O, Guyon F, Kianmanesh R, Lo Dico R, Lorimier G, Marchal F, Mariani P, Meeus P, Msika S, Ortega-Deballon P, Paquette B, Peyrat P, Pirro N, Pocard M, Porcheron J, Quenet F, Rat P, Sgarbura O, Thibaudeau E, Tuech JJ, Zinzindohoue F, Ahrendt S, Akaishi E, Baik S, Baratti D, Bhatt A, Cachin P, Ceelen W, De Hingh I, De Simone M, Dubé P, Edwards R, Franko J, Gonzalez-Bayon L, Gushchin V, Holtzman M, Hsieh MC, Kecmanovic D, Lee K, Lehmann K, Liu Y, Mehta S, Morris D, O'Dwyer S, Orsevigo E, Pande P, Park E, Pingpank J, Piso P, Rajan F, Rau B, Sardi A, Sideris L, Sommariva A, Spiliotis J, Sugarbaker P, Tentes A, Teo M, Yarema R, Younan R, Zaveri S, Zeh H. Cytoreductive surgery and HIPEC improve survival compared to palliative chemotherapy for biliary carcinoma with peritoneal metastasis: A multi-institutional cohort from PSOGI and BIG RENAPE groups. Eur J Surg Oncol 2018; 44:1378-1383. [PMID: 30131104 DOI: 10.1016/j.ejso.2018.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/12/2022] Open
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Girard E, Abba J, Boussat B, Trilling B, Mancini A, Bouzat P, Létoublon C, Chirica M, Arvieux C. Damage Control Surgery for Non-traumatic Abdominal Emergencies. World J Surg 2018; 42:965-973. [PMID: 28948335 DOI: 10.1007/s00268-017-4262-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Damage control surgery (DCS) was a major paradigm change in the management of critically ill trauma patients and has gradually expanded in the general surgery arena, but data in this setting are still scarce. The study aim was to evaluate outcomes of DCS in patients with general surgery emergencies. METHODS Between 2005 and 2015, 164 patients (104 men, age 66) underwent DCS for non-traumatic abdominal emergencies. The decision to perform DCS was triggered by the presence of at least one trauma DCS criterion: hypotension (<70 mmHg), hypothermia (<35 °C), acidosis (pH < 7.25), coagulopathy (INR ≥ 1.7) and massive (>5 RBC) transfusion. Statistical tests were performed to identify risk factors for operative mortality. Observed outcomes were compared to those predicted by commonly employed scores (APACHE II, POSSUM, P-POSSUM, SAPS II). RESULTS DCS was performed for acute mesenteric ischemia (n = 68), peritonitis (n = 44), pancreatitis (n = 28), bleeding (n = 14) and other (n = 10). Abdominal compartment syndrome was associated in 52 patients (32%). Seventy-four (45%) patients died and 150 patients (91%) experienced complications. On multivariate analysis, age (p = 0.018) and INR ≥ 1.7 (p = 0.001) were independent predictors of mortality. Mortality was 24% (13/55), 48% (22/46) and 62% (39/63) in patients with one, two and ≥3 DCS criteria, respectively. Comparison of observed and score-predicted mortality suggested DCS use resulted in significant survival benefit of the whole cohort and of patients with pancreatitis and postoperative peritonitis. CONCLUSIONS DCS can be lifesaving in critically ill patients with general surgery emergencies. Patients with peritonitis and acute pancreatitis are those who benefit most of the DCS approach.
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Affiliation(s)
- Edouard Girard
- Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France.
- TIMC Research Unit, CNRS, Grenoble-Alpes University, Grenoble, France.
- Service de Chirurgie Digestive et Générale, Hôpital Michallon, Centre Hospitalier Universitaire Grenoble-Alpes, Boulevard de la Chantourne, 38700, Grenoble, La Tronche, France.
| | - Julio Abba
- Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Bastien Boussat
- TIMC Research Unit, CNRS, Grenoble-Alpes University, Grenoble, France
- Quality of Care Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Bertrand Trilling
- Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France
- TIMC Research Unit, CNRS, Grenoble-Alpes University, Grenoble, France
| | - Adrian Mancini
- Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Pierre Bouzat
- Anesthesiology and Intensive Care Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - Christian Létoublon
- Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Mircea Chirica
- Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Catherine Arvieux
- Digestive and Emergency Surgery Department, Grenoble-Alpes University Hospital, Grenoble, France
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Gauss T, Balandraud P, Frandon J, Abba J, Ageron FX, Albaladejo P, Arvieux C, Barbois S, Bijok B, Bobbia X, Charbit J, Cook F, David JS, Maurice GDS, Duranteau J, Garrigue D, Gay E, Geeraerts T, Ghelfi J, Hamada S, Harrois A, Kobeiter H, Leone M, Levrat A, Mirek S, Nadji A, Paugam-Burtz C, Payen JF, Perbet S, Pirracchio R, Plenier I, Pottecher J, Rigal S, Riou B, Savary D, Secheresse T, Tazarourte K, Thony F, Tonetti J, Tresallet C, Wey PF, Picard J, Bouzat P. Strategic proposal for a national trauma system in France. Anaesth Crit Care Pain Med 2018; 38:121-130. [PMID: 29857186 DOI: 10.1016/j.accpm.2018.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 02/26/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 11/26/2022]
Abstract
In this road map for trauma in France, we focus on the main challenges for system implementation, surgical and radiology training and upon innovative training techniques. Regarding system organisation: procedures for triage, designation and certification of trauma centres are mandatory to implement trauma networks on a national scale. Data collection with registries must be created, with a core dataset defined and applied through all registries. Regarding surgical and radiology training, diagnostic-imaging processes should be standardised and the role of the interventional radiologist within the trauma team and the trauma network should be clearly defined. Education in surgery for trauma is crucial and recent changes in medical training in France will promote trauma surgery as a specific sub-specialty. Innovative training techniques should be implemented and be based on common objectives, scenarios and evaluation, so as to improve individual and team performances. The group formulated 14 proposals that should help to structure and improve major trauma management in France over the next 10 years.
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Affiliation(s)
- Tobias Gauss
- Department of anaesthesia and intensive care, Beaujon hospital, hôpitaux-Paris-Nord-Val-De-Seine, AP-HP, 92110 Clichy, France
| | - Paul Balandraud
- Department of Surgery, French Military Medical Academy, école du Val-de-Grâce, 75000 Paris, France
| | - Julien Frandon
- Department of radiology, Nîmes University Hospital, 30029 Nîmes, France
| | - Julio Abba
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Francois Xavier Ageron
- Northern French Alps Emergency Network (RENAU), Annecy Genevois hospital, 74374 Epagny-Annecy, France
| | - Pierre Albaladejo
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Catherine Arvieux
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Sandrine Barbois
- Northern French Alps Emergency Network (RENAU), Annecy Genevois hospital, 74374 Epagny-Annecy, France
| | - Benjamin Bijok
- Emergency department, Lille university hospital, 59000 Lille, France
| | - Xavier Bobbia
- Department of Anaesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr-Debré, 30029 Nîmes, France
| | - Jonathan Charbit
- Trauma Intensive and Critical Care Unit, Department of Anaesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, 75000 Montpellier, France
| | - Fabrice Cook
- Department of Anaesthesiology and Intensive Care, Henri Mondor Hospital and University Paris-Est, Assistance publique-Hôpitaux de Paris, 94010 Créteil, France
| | - Jean-Stephane David
- Department of anaesthesia and intensive care, Lyon Sud hospital, 69495 Pierre-Bénite cedex, France
| | - Guillaume De Saint Maurice
- Intensive care and Anaesthesiology department, Percy Military Teaching Hospital, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - Jacques Duranteau
- Department of Anaesthesiology and Critical Care, Paris Saclay university AP-HP, Bicêtre hôpitaux universitaires Paris-Sud, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Delphine Garrigue
- Emergency department, Lille university hospital, 59000 Lille, France
| | - Emmanuel Gay
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Thomas Geeraerts
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, University Toulouse 3, Paul Sabatier, UMR 1214, Inserm/UPS, ToNIC: Toulouse NeuroImaging Center, 75000 Toulouse, France
| | - Julien Ghelfi
- Emergency department, Lille university hospital, 59000 Lille, France
| | - Sophie Hamada
- Department of Anaesthesiology and Critical Care, Paris Saclay university AP-HP, Bicêtre hôpitaux universitaires Paris-Sud, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Anatole Harrois
- Department of Anaesthesiology and Critical Care, Paris Saclay university AP-HP, Bicêtre hôpitaux universitaires Paris-Sud, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Hicham Kobeiter
- Medical imaging, CHU Henri-Mondor, Assistance publique-Hôpitaux de Paris (AP-HP), 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - Marc Leone
- Department of anaesthesia and intensive care, Assistance publique-Hôpitaux de Marseille, hôpital Nord, 13000 Marseille, France
| | - Albrice Levrat
- Department of anaesthesia and intensive care, Annecy Genevois hospital, 74374 Epagny-Annecy, France
| | - Sebastien Mirek
- Department of anaesthesia and intensive care, Dijon university hospital, BP 77908, 21709 Dijon, France
| | - Abdel Nadji
- Department of anaesthesia and intensive care, Dijon university hospital, BP 77908, 21709 Dijon, France
| | - Catherine Paugam-Burtz
- Department of anaesthesia and intensive care, Beaujon hospital, Assistance publique-Hôpitaux de Paris, 92110 Clichy, France; Hôpitaux-Paris-Nord-Val-De-Seine, université Paris-Diderot, 75018 Paris, France
| | - Jean Francois Payen
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Sebastien Perbet
- Adult intensive care & continuing care unit, Perioperative medicine, Clermont-Ferrand university hospital, 75000 Clermont-Ferrand, France; Anaesthesiology and Intensive Care Department, European Hospital Georges-Pompidou, 75015 Paris, France
| | - Romain Pirracchio
- Paris Descartes University, Sorbonne Paris Cité, 75000 Paris, France
| | - Isabelle Plenier
- Department of Anaesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr-Debré, 30029 Nîmes, France
| | - Julien Pottecher
- Strasbourg university hospital, Hautepierre hospital, Department of anaesthesia and surgical intensive care-Strasbourg university, faculté de médecine, Fédération de médecine translationnelle de strasbourg (FMTS), Strasbourg, France
| | - Sylvain Rigal
- Department of Surgery, French Military Medical Academy, école du Val-de-Grâce, 75000 Paris, France
| | - Bruno Riou
- Sorbonne University, UMR Inserm 1166, IHU ICAN, Assistance publique-Hôpitaux de Paris, Emergency department, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Dominique Savary
- Northern French Alps Emergency Network (RENAU), Annecy Genevois hospital, 74374 Epagny-Annecy, France
| | - Thierry Secheresse
- CEnSIM, Centre d'enseignement par simulation, centre hospitalier Metropole Savoie, 73000 Chambéry, France; LaRAC-laboratoire de recherche sur les apprentissages en contexte, University Grenoble Alpes, 38000 Grenoble, France
| | - Karim Tazarourte
- Emergency medicine department, Hospices civils de Lyon, Lyon university, HESPER EA 7425, centre hospitalier Herriot, 69003 Lyon, France
| | - Frederic Thony
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Jerome Tonetti
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Christophe Tresallet
- Department of general, visceral and endocrinous surgery, hôpital de la Pitié-Salpêtrière, Sorbonne university, UMR CNRS-Inserm U678, Assistance publique des Hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - Pierre-Francois Wey
- Intensive Care & Anaesthesia Department-Desgenettes Teaching Military Hospital, 69003 Lyon, France
| | - Julien Picard
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France
| | - Pierre Bouzat
- Grenoble Alps Trauma centre, Grenoble University Hospital, Grenoble Alps University, 38000 Grenoble, France.
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Passot G, Dumont F, Goéré D, Arvieux C, Rousset P, Regimbeau JM, Elias D, Villeneuve L, Glehen O, Abba J, Abboud K, Carere S, Durand-Fontanier S, Eveno C, Facy O, Gelli M, Gilly FN, Karoui M, Lo Dico R, Ortega-Deballon P, Pocard M, Quenet F, Rat P, Sabbagh C, Sgarbura O, Thibaudeau E, Vaudoyer D, Wernert R. Multicentre study of laparoscopic or open assessment of the peritoneal cancer index (BIG-RENAPE). Br J Surg 2018; 105:663-667. [DOI: 10.1002/bjs.10723] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/01/2017] [Accepted: 09/06/2017] [Indexed: 02/04/2023]
Abstract
Abstract
Background
The peritoneal cancer index (PCI) is a comparative prognostic factor for colorectal peritoneal metastasis (CRPM). The ability of laparoscopy to determine the PCI in consideration of cytoreductive surgery remains undetermined, and this study was designed to compare it with laparotomy.
Methods
A prospective multicentre study was conducted for patients with no known CRPM, but at risk of peritoneal disease. Surgery began with laparoscopic exploration followed by open exploration to determine the PCI. Concordance between laparoscopic and open assessment was evaluated for the diagnosis of CRPM and for the PCI.
Results
Among 50 patients evaluated, CRPM recurrence was found in 29 (58 per cent) and 34 (68 per cent) at laparoscopic and open surgery respectively. Laparoscopy was feasible in 88 per cent (44 of 50) and deemed satisfactory by the surgeon in 52 per cent (26 of 50). Among the 25 evaluable patients with satisfactory laparoscopy, there was concordance of 96 per cent (24 of 25 patients) and 38 per cent (10 of 25) for laparoscopic and open assessment of CRPM and the PCI respectively. Where there were discrepancies, it was laparoscopy that underestimated the PCI.
Conclusion
Laparoscopy may underestimate the extent of CRPM.
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Affiliation(s)
- G Passot
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
| | - F Dumont
- Department of Surgery, Institut de Cancérologie de l'Ouest (René Gauducheau), Site Hospitalier Nord, Saint-Herblain, France
| | - D Goéré
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Villejuif, France
| | - C Arvieux
- Department of Visceral Surgery, Grenoble University Hospital, Hôpital Albert Michallon, Grenoble, France
| | - P Rousset
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
| | - J-M Regimbeau
- Department of Digestive Surgery, Amiens-Picardie University Medical Centre, Amiens, France
| | - D Elias
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Villejuif, France
| | - L Villeneuve
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
| | - O Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
| | - J Abba
- Department of Digestive Surgery, Grenoble University Hospital, Grenoble, France
| | - K Abboud
- Department of General Surgery, St Etienne University Hospital, St Etienne, France
| | - S Carere
- Department of Surgical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - S Durand-Fontanier
- Department of Visceral Surgery and Transplantation, Dupuytren University Hospital, Limoges, France
| | - C Eveno
- Surgical Oncological and Digestive Unit, Lariboisiere University Hospital, Paris, France
| | - O Facy
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - M Gelli
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - F-N Gilly
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France
| | - M Karoui
- Department of Digestive Surgery, La Pitié-Salpétriêre University Hospital, Paris, France
| | - R Lo Dico
- Surgical Oncological and Digestive Unit, Lariboisiere University Hospital, Paris, France
| | - P Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - M Pocard
- Surgical Oncological and Digestive Unit, Lariboisiere University Hospital, Paris, France
| | - F Quenet
- Department of Surgical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - P Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - C Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - O Sgarbura
- Department of Surgical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - E Thibaudeau
- Department of Surgery, lnstitut de Cancerologie de l'Ouest (Rene Gauducheau), Saint-Herblain, France
| | - D Vaudoyer
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France
| | - R Wernert
- Department of Surgical Oncology, Institut de Cancerologie de l'Ouest, Paul Papin Cancer Center, Angers, France
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Abstract
OBJECTIVE Resuscitative thoracotomy, a potentially life-saving procedure, is used exceptionally, and essentially for penetrating trauma. Most of the available literature is American while reports from Europe are sparse. We report our experience in a French level 1-trauma center. MATERIAL AND METHODS Patient records (patient age, gender, mechanism of injury, indication for emergency thoracotomy, anatomic injuries, interventions and survival) for all patients who underwent emergency thoracotomy between January 2005 and December 2015 were analyzed. RESULTS Twenty-two patients (19 males) underwent emergency thoracotomy. Median age was 27.5 (12-67) years. Twelve were performed for blunt trauma (55%) and 10 for penetrating injuries (45%). Thirteen patients presented with cardiac arrest, while nine had deep and refractory hypotension. Overall, survival was 32% (n=7). There were no survivors in the blunt trauma group while seven of ten with penetrating injuries survived. All patients presenting with cardiac arrest died. CONCLUSION The survival rate in this French retrospective study was in accordance with the literature.
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Affiliation(s)
- A Mancini
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - A Bonne
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - A Pirvu
- Service de chirurgie thoracique, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - P Porcu
- Service de chirurgie cardiaque, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - P Bouzat
- Service d'anesthésiologie et réanimation, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - J Abba
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France
| | - C Arvieux
- Service de chirurgie digestive et de l'urgence, CHU Grenoble-Alpes, CS 102017, 38043 Grenoble cedex, France.
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Barbois S, Mancini A, Abba J, Arvieux C. [Current management of penetrating abdominal trauma]. Rev Prat 2017; 67:e218-e220. [PMID: 30512683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Sandrine Barbois
- Clinique universitaire de chirurgie digestive et de l'urgence, hôpital Albert-Michalon, 38043 Grenoble Cedex 09, France
| | - Adrian Mancini
- Clinique universitaire de chirurgie digestive et de l'urgence, hôpital Albert-Michalon, 38043 Grenoble Cedex 09, France
| | - Julio Abba
- Clinique universitaire de chirurgie digestive et de l'urgence, hôpital Albert-Michalon, 38043 Grenoble Cedex 09, France
| | - Catherine Arvieux
- Clinique universitaire de chirurgie digestive et de l'urgence, hôpital Albert-Michalon, 38043 Grenoble Cedex 09, France
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Barbois S, Mancini A, Abba J, Arvieux C. [Acute peritonitis]. Rev Prat 2017; 67:e211-e217. [PMID: 30512682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Sandrine Barbois
- Clinique universitaire de chirurgie digestive et de l'urgence, hôpital Albert-Michalon, 38043 Grenoble Cedex 09, France
| | - Adrian Mancini
- Clinique universitaire de chirurgie digestive et de l'urgence, hôpital Albert-Michalon, 38043 Grenoble Cedex 09, France
| | - Julio Abba
- Clinique universitaire de chirurgie digestive et de l'urgence, hôpital Albert-Michalon, 38043 Grenoble Cedex 09, France
| | - Catherine Arvieux
- Clinique universitaire de chirurgie digestive et de l'urgence, hôpital Albert-Michalon, 38043 Grenoble Cedex 09, France
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Barbois S, Abba J, Guigard S, Quesada J, Pirvu A, Waroquet P, Reche F, Risse O, Bouzat P, Thony F, Arvieux C. Management of penetrating abdominal and thoraco-abdominal wounds: A retrospective study of 186 patients. J Visc Surg 2016; 153:69-78. [DOI: 10.1016/j.jviscsurg.2016.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Villeneuve L, Thivolet A, Bakrin N, Mohamed F, Isaac S, Valette PJ, Glehen O, Rousset P, Abba J, Abboud K, Arvieux C, Balagué G, Barrau V, Rejeb H, Bereder JM, Bibeau F, Bouzard D, Brigand C, Carrère S, Carretier M, de Chaisemartin C, Chassang M, Chevallier A, Courvoisier T, Dartigues P, Delroeux D, Desolneux G, Dohan A, Dromain C, Dumont F, Durand-Fontanier S, Elias D, Eveno C, Evrard S, Fay O, Ferron G, Geffroy D, Gilly FN, Fontaine J, Goasguen N, Ghouti L, Goéré D, Guilloit JM, Guyon F, Heyd B, Kaci R, Karoui M, Kianmanesh R, Labbé C, Lacroix J, Lang-Averous G, Laverriere MH, Lefevre J, Lelong B, Leroux A, Dico R, Loi V, Lorimier G, Marchal F, Mariani A, Mariani P, Mariette C, Meeus P, Mery E, Messager M, Msika S, Nadeau C, Ortega-Deballon P, Passot G, Petorin C, Peyrat P, Pezet D, Piessen G, Pirro N, Pocard M, Poizat F, Porcheron J, Pourcher G, Quenet F, Rat P, Regimbeau JM, Rousselot P, Sabbagh C, Svrcek M, Tetreau R, Thibaudeau E, Tuech JJ, Valmary-Degano S, Vaudoyer D, Velasco S, Verriele-Beurrier V, Wernert R, Zinzindohoue F. A new internet tool to report peritoneal malignancy extent. PeRitOneal MalIgnancy Stage Evaluation (PROMISE) application. Eur J Surg Oncol 2016; 42:877-82. [DOI: 10.1016/j.ejso.2016.03.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/12/2016] [Accepted: 03/16/2016] [Indexed: 11/17/2022] Open
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Letoublon C, Abba J, Broux C, Arvin-Berod A, Thony F, Chirica M, Blin D. Cardiopulmonary bypass in treatment of complete traumatic avulsion of hepatic inferior vena cava junction. J Visc Surg 2016; 153:233-6. [PMID: 27209080 DOI: 10.1016/j.jviscsurg.2016.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- C Letoublon
- Department of digestive and emergency surgery, Grenoble Alpes university, Grenoble university hospital, 38043 Grenoble, France.
| | - J Abba
- Department of digestive and emergency surgery, Grenoble Alpes university, Grenoble university hospital, 38043 Grenoble, France
| | - C Broux
- Department of anesthesiology and intensive care, Grenoble Alpes university, Grenoble university hospital, 38043 Grenoble, France
| | - A Arvin-Berod
- Department of digestive and emergency surgery, Grenoble Alpes university, Grenoble university hospital, 38043 Grenoble, France
| | - F Thony
- Department of radiology, Grenoble Alpes university, Grenoble university hospital, 38043 Grenoble, France
| | - M Chirica
- Department of digestive and emergency surgery, Grenoble Alpes university, Grenoble university hospital, 38043 Grenoble, France
| | - D Blin
- Department of anesthesiology and intensive care, Grenoble Alpes university, Grenoble university hospital, 38043 Grenoble, France
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Trilling B, Riboud R, Abba J, Girard E, Faucheron JL. Energy vessel sealing systems versus mechanical ligature of the inferior mesenteric artery in laparoscopic sigmoidectomy. Int J Colorectal Dis 2016; 31:903-8. [PMID: 26841803 DOI: 10.1007/s00384-016-2508-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE With the development of new devices, our ligation technique of the inferior mesenteric artery changed from mechanical ligature (ML) to energized vessel sealing systems (EVSS) ligature. The aim of this study was to determine if EVSS could be considered as safe and effective as the more convention ML of the inferior mesenteric vessels division during elective laparoscopic left colectomy. METHODS Between 2001 and 2014, 200 consecutive patients (111 males) of mean age 54.1 years were operated laparoscopically for a symptomatic sigmoid diverticulitis. Vascular interruptions were performed using mechanical ligatures including double clipping, staples or surgical thread (100 patients) or, starting from 2006, with EVSS thereafter (100 patients). Section of the inferior mesenteric artery is performed systematically at its origin in our institution for teaching purposes. Technical results were prospectively collected perioperatively and postoperatively. RESULTS There was no mortality. Mean operating time was 253.7 and 200.7 min in the ML and EVSS groups, respectively (p < 0.001). Mean hospital stay was 10.4 and 8.1 days (p < 0.001). Thirty-day complications occurred in 31 versus 25 % of patients (p = 0.26). Leakage with peritonitis occurred in 3 patients in the ML group. Hemorrhagic events occurred in both groups (2 in ML group versus 1 in EVSS group). Limitations of the study are its retrospective design and the bias due to the comparison of two historical cohorts. CONCLUSIONS EVSS for the inferior mesenteric artery are as safe and effective as ML in elective sigmoidectomy for diverticular disease with lower operative time and hospital stay.
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Affiliation(s)
- Bertrand Trilling
- Colorectal Unit, Department of Surgery, Michalon University Hospital, CS 10 217, 38 043, Grenoble cedex, France.,Grenoble Alpes University, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France
| | - Romain Riboud
- Colorectal Unit, Department of Surgery, Michalon University Hospital, CS 10 217, 38 043, Grenoble cedex, France.,Visceral Surgery Department, Voiron Regional Hospital, Voiron, France
| | - Julio Abba
- Colorectal Unit, Department of Surgery, Michalon University Hospital, CS 10 217, 38 043, Grenoble cedex, France
| | - Edouard Girard
- Colorectal Unit, Department of Surgery, Michalon University Hospital, CS 10 217, 38 043, Grenoble cedex, France.,Grenoble Alpes University, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France
| | - Jean-Luc Faucheron
- Colorectal Unit, Department of Surgery, Michalon University Hospital, CS 10 217, 38 043, Grenoble cedex, France. .,Grenoble Alpes University, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France.
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Abstract
INTRODUCTION Pancreatic trauma (PT) is associated with high morbidity and mortality; the therapeutic options remain debated. MATERIAL AND METHODS Retrospective study of PT treated in the University Hospital of Grenoble over a 22-year span. The decision for initial laparotomy depended on hemodynamic status as well as on associated lesions. Main pancreatic duct lesions were always searched for. PT lesions were graded according to the AAST classification. RESULTS Of a total of 46 PT, 34 were grades II or I. Hemodynamic instability led to immediate laparotomy in 18 patients, for whom treatment was always drainage of the pancreatic bed; morbidity was 30%. Eight patients had grade III injuries, six of whom underwent immediate operation: three underwent splenopancreatectomy without any major complications while the other three who had simple drainage required re-operation for peritonitis, with one death related to pancreatic complications. Four patients had grades IV or V PT: two pancreatoduodenectomies were performed, with no major complication, while one patient underwent duodenal reconstruction with pancreatic drainage, complicated by pancreatic and duodenal fistula requiring a hospital stay of two months. The post-trauma course was complicated for all patients with main pancreatic duct involvement. Our outcomes were similar to those found in the literature. CONCLUSION In patients with distal PT and main pancreatic duct involvement, simple drainage is associated with high morbidity and mortality. For proximal PT, the therapeutic options of drainage versus pancreatoduodenectomy must be weighed; pancreatoduodenectomy may be unavoidable when the duodenum is injured as well. Two-stage (resection first, reconstruction later) could be an effective alternative in the emergency setting when there are other associated traumatic lesions.
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Affiliation(s)
- E Girard
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - J Abba
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - C Arvieux
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - B Trilling
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - P Y Sage
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - N Mougin
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - S Perou
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - P Lavagne
- Réanimation post-chirurgicale, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France
| | - C Létoublon
- Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France.
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Guillaud A, Moszkowicz D, Nedelcu M, Caballero-Caballero A, Rebibo L, Reche F, Abba J, Arvieux C. Gastrobronchial Fistula: A Serious Complication of Sleeve Gastrectomy. Results of a French Multicentric Study. Obes Surg 2015; 25:2352-9. [DOI: 10.1007/s11695-015-1702-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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35
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Faucheron JL, Voirin D, Abba J. Rectal perforation with life-threatening peritonitis following stapled haemorrhoidopexy. Br J Surg 2012; 99:746-53. [PMID: 22418745 DOI: 10.1002/bjs.7833] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2011] [Indexed: 01/12/2023]
Abstract
BACKGROUND Stapled haemorrhoidopexy is a well recognized alternative to haemorrhoidectomy, and is associated with reduced pain and earlier return to normal activity. This paper reports all published cases of life-threatening sepsis following stapled haemorrhoidopexy, identifies causative factors and makes recommendations. METHODS A systematic review of the literature was performed by searching the major electronic databases. All relevant references were reviewed for possible inclusion. All references of the relevant articles were screened for any further articles that were not identified in the initial search. RESULTS From 2000 to the present, 29 articles reporting complications in 40 patients were identified. Thirty-five patients underwent laparotomy with faecal diversion and a further patient was treated by low anterior resection. A specific complication was rectal perforation with peritonitis. Factors that led to life-threatening sepsis were identified in 30 patients. Despite surgical treatment and resuscitation, there were four deaths. CONCLUSION Severe sepsis can complicate stapled haemorrhoidopexy. Rectal perforation and peritonitis are a particular risk of this technique and the associated mortality rate is high.
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Affiliation(s)
- J-L Faucheron
- Colorectal Unit, Department of Surgery, University Hospital, Grenoble, France.
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36
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Affiliation(s)
- C Letoublon
- Clinique chirurgicale de chirurgie digestive et de l'urgence, Trauma centre, université Joseph-Fourier-Grenoble-I, CHU de Grenoble, BP 217, 38043 Grenoble cedex, France.
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