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Le Roy C, Barbe R, Sun R, Burtin P, Gelli M, Deutsch E, Durand-Labrunie J. PO-1292 Stereotactic radiotherapy after chemotherapy in patients with locally advanced pancreatic cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gelli M, Sourrouille I, Smolenschi C, Combari P, Hollebecque A, Benhaim L, Peggy D, Faron M, Elias D, Goere D, Charles H, Boige V, Malka D, Ducreux M. 586P Bidirectional chemotherapy for initially unresectable malignant peritoneal mesothelioma: Proof of concept of a new conversion strategy? Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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3
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Kerbage F, Ducreux M, Eid R, Boige V, Malka D, Gelli M, Perret A, Smolenschi C, Prieux C, Verlingue L, Martin-Romano P, Massard C, Hollebecque A. 1563P Early clinical trials in patients with pancreatic cancer: Assessment of factors limiting eligibility and effectiveness. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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4
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Javed S, Benoist S, De Fouchardiere CL, Truant S, Sefrioui D, Galais M, Hautefeuille V, Artru P, Guimbaud R, Cohen R, Lievre A, Edeline J, Bachet JB, Gelli M, Herrero A, Marchese U, Amrani ME, Devos P, Turpin A, Ploquin A. BRAF-mutated colorectal metastases: What is the benefit of liver surgery? Results from a cohort of 91 patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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5
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Bachet JB, Moreno-Lopez N, Vigano L, Marchese U, Gelli M, Raoux L, Truant S, Laurent C, Herrero A, Le Roy B, Deguelte Lardiere S, Passot G, Hautefeuille V, De La Fouchardiere C, Artru P, Ameto T, Mabrut JY, Schwarz L, Rousseau B, Lepère C, Coriat R, Brouquet A, Sa Cunha A, Benoist S. BRAF mutation is not associated with an increased risk of recurrence in patients undergoing resection of colorectal liver metastases. Br J Surg 2019; 106:1237-1247. [PMID: 31183866 DOI: 10.1002/bjs.11180] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND BRAF mutation is associated with a poor prognosis in patients with metastatic colorectal cancer. For patients with resectable colorectal liver metastases (CRLMs), the prognostic impact of BRAF mutation is unknown and the benefit of surgery debated. This nationwide intergroup (ACHBT, FRENCH, AGEO) study aimed to evaluate the oncological outcome of patients undergoing liver resection for BRAF-mutated CRLMs. METHODS The study included patients who underwent resection for BRAF-mutated CRLMs in 24 centres between 2012 and 2016. A case-matched comparison was made with 183 patients who underwent resection of CRLMs with wild-type BRAF during the same interval. RESULTS Sixty-six patients who underwent resection for BRAF-mutated CRLMs in 24 centres were compared with 183 patients with wild-type BRAF. The 1- and 3-year disease-free survival (DFS) rates were 46 and 19 per cent for the BRAF-mutated group, and 55·4 and 27·8 per cent for the group with wild-type BRAF (P = 0·430). In multivariable analysis, BRAF mutation was not associated with worse DFS (hazard ratio 1·16, 95 per cent c.i. 0·72 to 1·85; P = 0·547). The 1- and 3-year overall survival rates after surgery were 94 and 54 per cent respectively among patients with BRAF mutation, and 95·8 and 82·9 per cent in those with wild-type BRAF (P = 0·004). Median survival after disease progression was 23·0 (95 per cent c.i. 11·0 to 35·0) months among patients with mutated BRAF and 44·3 (35·9 to 52·6) months in those with wild-type BRAF (P = 0·050). Multisite disease progression was more common in the BRAF-mutated group (48 versus 29·8 per cent; P = 0·034). CONCLUSION These results support surgical treatment for resectable BRAF-mutated CRLM, as BRAF mutation by itself does not increase the risk of relapse after resection. BRAF mutation is associated with worse survival in patients whose disease relapses after resection of CRLM, as for non-metastatic colorectal cancer.
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Affiliation(s)
- J-B Bachet
- Sorbonne Université, University Pierre and Marie Curie, Paris, France.,Department of Hepato-Gastroenterology, Hôpital Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - N Moreno-Lopez
- Department of Digestive Surgery, Dijon University Hospital, Dijon, France
| | - L Vigano
- Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - U Marchese
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - M Gelli
- Department of General Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - L Raoux
- Department of Digestive Surgery, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France
| | - S Truant
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - C Laurent
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Saint André Hospital, Bordeaux, France
| | - A Herrero
- Department of General Surgery, Division of Transplantation, University of Montpellier - College of Medicine, Saint Eloi Hospital, Montpellier, France
| | - B Le Roy
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - S Deguelte Lardiere
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France
| | - G Passot
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - V Hautefeuille
- Department of Gastroenterology, Amiens-Picardie University Hospital, Amiens, France
| | | | - P Artru
- Department of Oncology, Hôpital Privé Jean Mermoz, Lyon, France
| | - T Ameto
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - J Y Mabrut
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Croix Rousse, Lyon, France
| | - L Schwarz
- Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen, France
| | - B Rousseau
- Department of Oncology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - C Lepère
- Department of Gastroenterology and Digestive Oncology, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - R Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, AP-HP, Paris, France
| | - A Brouquet
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, AP-HP, Paris-Sud University, Le Kremlin Bicêtre, France.,Paris-Sud University, Le Kremlin Bicêtre, France
| | - A Sa Cunha
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France.,Paris-Sud University, Le Kremlin Bicêtre, France
| | - S Benoist
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, AP-HP, Paris-Sud University, Le Kremlin Bicêtre, France.,Paris-Sud University, Le Kremlin Bicêtre, France
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6
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Allard MA, Nishioka Y, Beghdadi N, Imai K, Gelli M, Yamashita S, Kitano Y, Kokudo T, Yamashita YI, Sa Cunha A, Vibert E, Elias D, Cherqui D, Goere D, Adam R, Baba H, Hasegawa K. Multicentre study of perioperative versus adjuvant chemotherapy for resectable colorectal liver metastases. BJS Open 2019; 3:678-686. [PMID: 31592094 PMCID: PMC6773651 DOI: 10.1002/bjs5.50174] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/20/2019] [Indexed: 01/17/2023] Open
Abstract
Background It is not known whether perioperative chemotherapy, compared with adjuvant chemotherapy alone, improves disease‐free survival (DFS) in patients with upfront resectable colorectal liver metastases (CLM). The aim of this study was to estimate the impact of neoadjuvant 5‐fluorouracil, leucovorin and oxaliplatin (FOLFOX) on DFS in patients with upfront resectable CLM. Methods Consecutive patients who presented with up to five resectable CLM at two Japanese and two French centres in 2008–2015 were included in the study. Both French institutions favoured perioperative FOLFOX, whereas the two Japanese groups systematically preferred upfront surgery plus adjuvant chemotherapy. Inverse probability of treatment weighting (IPTW) and Cox regression multivariable models were used to adjust for confounding. The primary outcome was DFS. Results Some 300 patients were included: 151 received perioperative chemotherapy and 149 had upfront surgery plus adjuvant chemotherapy. The weighted 3‐year DFS rate was 33·5 per cent after perioperative chemotherapy compared with 27·1 per cent after upfront surgery plus adjuvant chemotherapy (hazard ratio (HR) 0·85, 95 per cent c.i. 0·62 to 1·16; P = 0·318). For the subgroup of 165 patients who received adjuvant FOLFOX successfully (for at least 3 months), the adjusted effect of neoadjuvant chemotherapy was not significant (HR 1·19, 0·74 to 1·90; P = 0·476). No significant effect of neoadjuvant chemotherapy was observed in multivariable regression analysis. Conclusion Compared with adjuvant chemotherapy, perioperative FOLFOX does not improve DFS in patients with resectable CLM, provided adjuvant chemotherapy is given successfully.
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Affiliation(s)
- M-A Allard
- Centre Hépatobiliaire Paul Brousse Hospital, Université Paris Sud Villejuif France
| | - Y Nishioka
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine University of Tokyo Tokyo Japan
| | - N Beghdadi
- Centre Hépatobiliaire Paul Brousse Hospital, Université Paris Sud Villejuif France
| | - K Imai
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - M Gelli
- Department of Oncological Surgery Gustave Roussy Villejuif France
| | - S Yamashita
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine University of Tokyo Tokyo Japan
| | - Y Kitano
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - T Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine University of Tokyo Tokyo Japan
| | - Y-I Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - A Sa Cunha
- Centre Hépatobiliaire Paul Brousse Hospital, Université Paris Sud Villejuif France
| | - E Vibert
- Centre Hépatobiliaire Paul Brousse Hospital, Université Paris Sud Villejuif France
| | - D Elias
- Department of Oncological Surgery Gustave Roussy Villejuif France
| | - D Cherqui
- Centre Hépatobiliaire Paul Brousse Hospital, Université Paris Sud Villejuif France
| | - D Goere
- Department of Oncological Surgery Gustave Roussy Villejuif France
| | - R Adam
- Centre Hépatobiliaire Paul Brousse Hospital, Université Paris Sud Villejuif France
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - K Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine University of Tokyo Tokyo Japan
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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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8
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Le Roy B, Gelli M, Pittau G, Allard MA, Pereira B, Serji B, Vibert E, Castaing D, Adam R, Cherqui D, Sa Cunha A. Neoadjuvant chemotherapy for initially unresectable intrahepatic cholangiocarcinoma. Br J Surg 2017; 105:839-847. [PMID: 28858392 DOI: 10.1002/bjs.10641] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/05/2017] [Accepted: 06/10/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Locoregional extension of intrahepatic cholangiocarcinoma (ICC) at the time of diagnosis results in a low resectability rate and poor prognosis. The aim of this retrospective study was to assess the efficacy of neoadjuvant chemotherapy for locally advanced ICC. METHODS All consecutive patients with ICC between 2000 and 2013 were included prospectively in a single-centre database and analysed retrospectively. Patients with locally advanced ICC considered as initially unresectable received primary chemotherapy, followed by surgery in those with secondary resectability. Results of patients who underwent surgery for locally advanced ICC were compared with those of patients with initially resectable ICC treated by surgery alone. RESULTS A total of 186 patients were included in the study. Of 74 patients with locally advanced ICC, 39 (53 per cent) underwent secondary resection after a median of six chemotherapy cycles. Patients in this group were younger (P = 0·030) and had more advanced disease than those who had surgery alone, and presented more frequently with lymphadenopathy (P = 0·010) and vascular invasion (P = 0·010). Postoperative morbidity and mortality were no different between the groups. The median survival of patients who had surgery after chemotherapy was 24·1 months, and that of patients who had surgery alone was 25·7 months (P = 0·391). CONCLUSION Patients with locally advanced ICC treated by surgery following neoadjuvant chemotherapy had similar short- and long-term results to patients with initially resectable ICC who had surgery alone. Neoadjuvant chemotherapy as a first-line treatment for locally advanced ICC may be an effective downstaging option, facilitating secondary resectability in patients with initially unresectable disease.
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Affiliation(s)
- B Le Roy
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France.,Service de Chirurgie Digestive, Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - M Gelli
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - G Pittau
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - M-A Allard
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - B Pereira
- Biostatistics Unit (Direction de la Recherche Clinique et de l'Innovation), Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - B Serji
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - E Vibert
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - D Castaing
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - R Adam
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - D Cherqui
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
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9
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Fuks D, Nomi T, Ogiso S, Gelli M, Velayutham V, Conrad C, Louvet C, Gayet B. Laparoscopic two-stage hepatectomy for bilobar colorectal liver metastases. Br J Surg 2015; 102:1684-90. [DOI: 10.1002/bjs.9945] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/13/2015] [Accepted: 08/20/2015] [Indexed: 12/11/2022]
Abstract
Abstract
Background
Despite the gradual diffusion of laparoscopic liver resection, the feasibility and results of laparoscopic two-stage hepatectomy (TSH) for bilobar colorectal liver metastases (CRLM) have not been described frequently. This study aimed to evaluate the feasibility, safety and oncological outcomes of laparoscopic TSH for bilobar CRLM.
Methods
All patients eligible for laparoscopic TSH among those treated for bilobar CRLM from 2000 to 2013 were included. Demographics, tumour characteristics, surgical procedures, and short- and long-term outcomes were analysed.
Results
Laparoscopic TSH was planned in 34 patients with bilobar CRLM, representing 17·2 per cent of all 198 patients treated for bilobar CRLM. Thirty patients received preoperative chemotherapy, and 20 had portal vein occlusion to increase the volume of the remnant liver. Laparoscopic resection of the primary colorectal tumour was integrated within the first-stage hepatectomy in 11 patients. After a median interval of 3·1 months, 26 patients subsequently had a successful laparoscopic second-stage hepatectomy, including 18 laparoscopic right or extended right hepatectomies. The mortality rate for both stages was 3 per cent (1 of 34), and the overall morbidity rate for the first and second stages was 50 per cent (17 of 34) and 54 per cent (14 of 26) respectively. Mean length of hospital stay was 6·1 and 9·0 days respectively. With a median follow-up of 37·8 (range 6–129) months, 3- and 5-year overall survival rates in patients who completed TSH were 78 and 41 per cent respectively. The 3- and 5-year disease-free survival rates were 26 and 13 per cent respectively.
Conclusion
Laparoscopic TSH for bilobar CRLM is safe and does not jeopardize long-term outcomes in selected patients.
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Affiliation(s)
- D Fuks
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - T Nomi
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
- Department of Surgery, Nara Medical University, Nara, Japan
| | - S Ogiso
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - M Gelli
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - V Velayutham
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - C Conrad
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - C Louvet
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - B Gayet
- Department of Digestive Disease, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
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Abstract
Portal biliopathy (PB) refers to the biliary abnormalities of the biliary ducts observed in patients with extrahepatic portal hypertension. Although majority of patients are asymptomatic, approximately 20% of these patients present with biliary symptoms (pain, pruritus, jaundice, cholangitis). The pathogenesis of PB is uncertain but compression by dilated veins into or around common bile duct may play the main role. CT-scan, MR cholangiopancreatography with MR portography should be the initial investigations in the evaluation of PB. Treatment is limited to symptomatic cases and is dictated by clinical manifestations and complications of the disease. Treatment of PB could be done by endoscopy (sphincterotomy, stone extraction or biliary stenting of the common bile duct) or surgery (definitive decompression by porto-systemic shunt followed by bilioenteric anastomosis, if necessary). This review describes pathogenesis, clinical features, investigation and management of portal biliopathy.
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Affiliation(s)
- B Le Roy
- Service de chirurgie et oncologie digestive, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France; Service de chirurgie hépatobiliaire, centre hépato-bilaire Paul-Brousse, 94800 Villejuif, France
| | - M Gelli
- Service de chirurgie hépatobiliaire, centre hépato-bilaire Paul-Brousse, 94800 Villejuif, France
| | - B Serji
- Service de chirurgie hépatobiliaire, centre hépato-bilaire Paul-Brousse, 94800 Villejuif, France; Faculté de médecine, université Mohammed Premier Oujda, Morocco
| | - R Memeo
- Service de chirurgie hépatobiliaire, centre hépato-bilaire Paul-Brousse, 94800 Villejuif, France
| | - E Vibert
- Service de chirurgie hépatobiliaire, centre hépato-bilaire Paul-Brousse, 94800 Villejuif, France.
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11
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Piaggio F, Dodi F, Bottino G, Andorno E, Gentile R, Ferrari C, Barabino G, Giannone A, Immordino G, Miggino M, Magoni Rossi A, Moraglia E, Gasloli G, Gelli M, Ferrante R, Morelli N, Casaccia M, Valente U. Torque Teno Virus--cause of viral liver disease following liver transplantation: a case report. Transplant Proc 2014; 41:1378-9. [PMID: 19460564 DOI: 10.1016/j.transproceed.2009.03.047] [Citation(s) in RCA: 7] [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] [Indexed: 01/03/2023]
Abstract
Torque Teno Virus (TTV), a nonenveloped human virus of the Circoviridae family, is hepatotropic, causing liver damage, cirrhosis, and, rarely, fulminant hepatitis. It prevails in 10% to 75% of blood donors due to environmental differences, independent of chronic hepatitis B virus (HBV)/HCV hepatitis, cryptogenic cirrhosis, alcoholic cirrhosis, and in fulminant hepatitis non-A-G. Reports about the efficacy of clinical alpha interferon are rare. In July 2007, a 65-year-old man who was serologically negative for A-E viruses presented with acute liver failure due to a ruptured hepatic artery aneurysm and underwent orthotopic liver transplantation (OLT). Immunosuppression was based on cyclosporine and steroids. At postoperative day 20, there was persistent hypertransaminasemia with otherwise normal liver function. A percutaneous hepatic biopsy documented pattern suggestive of a viral etiology. Multiple tests for hepatotropic viruses in the donor and the recipient from the pre- and post-OLT periods remained negative. Only the TTV qualitative test, assessed by polymerase chain reaction (PCR) on patient sera, was positive. Immunosuppressive therapy was not changed; no antiviral therapy was undertaken. At 6 months posttransplantation, transaminase levels spontaneously normalized and the clinical situation was unchanged. No complications were observed; the patient is in good clinical condition. No graft rejection was observed. In histologically proven non-A-E viral hepatitis, it is important to consider TTV as an incidental pathogenic agent. It may be useful to extend virological tests to TTV among transplant recipients and donors and to gain further knowledge about this virus.
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Affiliation(s)
- F Piaggio
- Department of General Surgery, San Martino Hospital, University of Genoa, Genoa, Italy.
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Angelico M, Nardi A, Romagnoli R, Marianelli T, Corradini SG, Tandoi F, Gavrila C, Salizzoni M, Pinna AD, Cillo U, Gridelli B, De Carlis LG, Colledan M, Gerunda GE, Costa AN, Strazzabosco M, Cillo U, Fagiuoli S, Strazzabosco M, Caraceni P, Toniutto P, Nanni Costa A, Salizzoni TM, Romagnoli R, Bertolotti G, Patrono D, De Carlis L, Slim A, Mangoni J, Rossi G, Caccamo L, Antonelli B, Mazzaferro V, Regalia E, Sposito C, Colledan M, Corno V, Tagliabue F, Marin S, Cillo U, Vitale A, Gringeri E, Donataccio M, Donataccio D, Baccarani U, Lorenzin D, Bitetto D, Valente U, Gelli M, Cupo P, Gerunda G, Rompianesi G, Pinna A, Grazi G, Cucchetti A, Zanfi C, Risaliti A, Faraci M, Tisone G, Anselmo A, Lenci I, Sforza D, Agnes S, Di Mugno M, Avolio A, Ettorre G, Miglioresi L, Vennarecci G, Berloco P, Rossi M, Ginanni Corradini S, Molinaro A, Calise F, Scuderi V, Cuomo O, Migliaccio C, Lupo L, Notarnicola G, Gridelli B, Volpes R, Li Petri S, Zamboni F, Carbotta G, Dedola S, Nardi A, Marianelli T, Gavrila C, Ricci A, Vespasiano F. A Bayesian methodology to improve prediction of early graft loss after liver transplantation derived from the liver match study. Dig Liver Dis 2014; 46:340-7. [PMID: 24411484 DOI: 10.1016/j.dld.2013.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/07/2013] [Accepted: 11/10/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND To generate a robust predictive model of Early (3 months) Graft Loss after liver transplantation, we used a Bayesian approach to combine evidence from a prospective European cohort (Liver-Match) and the United Network for Organ Sharing registry. METHODS Liver-Match included 1480 consecutive primary liver transplants performed from 2007 to 2009 and the United Network for Organ Sharing a time-matched series of 9740 transplants. There were 173 and 706 Early Graft Loss, respectively. Multivariate analysis identified as significant predictors of Early Graft Loss: donor age, donation after cardiac death, cold ischaemia time, donor body mass index and height, recipient creatinine, bilirubin, disease aetiology, prior upper abdominal surgery and portal thrombosis. RESULTS A Bayesian Cox model was fitted to Liver-Match data using the United Network for Organ Sharing findings as prior information, allowing to generate an Early Graft Loss-Donor Risk Index and an Early Graft Loss-Recipient Risk Index. A Donor-Recipient Allocation Model, obtained by adding Early Graft Loss-Donor Risk Index to Early Graft Loss-Recipient Risk Index, was then validated in a distinct United Network for Organ Sharing (year 2010) cohort including 2964 transplants. Donor-Recipient Allocation Model updating using the independent Turin Transplant Centre dataset, allowed to predict Early Graft Loss with good accuracy (c-statistic: 0.76). CONCLUSION Donor-Recipient Allocation Model allows a reliable donor and recipient-based Early Graft Loss prediction. The Bayesian approach permits to adapt the original Donor-Recipient Allocation Model by incorporating evidence from other cohorts, resulting in significantly improved predictive capability.
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Affiliation(s)
- Mario Angelico
- Liver Unit, Tor Vergata University, Rome, Italy; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy
| | | | - Renato Romagnoli
- Liver Transplant Unit, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Italy; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy.
| | - Tania Marianelli
- Liver Unit, Tor Vergata University, Rome, Italy; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy
| | - Stefano Ginanni Corradini
- Gastroenterology Unit, La Sapienza University, Rome, Italy; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy
| | - Francesco Tandoi
- Liver Transplant Unit, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Italy
| | - Caius Gavrila
- Department of Mathematics, Tor Vergata University, Rome, Italy
| | - Mauro Salizzoni
- Liver Transplant Unit, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Italy
| | | | - Umberto Cillo
- Liver Transplant Unit, Università of Padua, Italy; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy
| | | | | | | | | | | | - Mario Strazzabosco
- Digestive Disease Section, University of Milan Bicocca, Milan, Italy; Yale University Liver Centre, New Haven, USA; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy
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Di Domenico S, Santori G, Balbis E, Traverso N, Gentile R, Bocca B, Gelli M, Andorno E, Cottalasso D, Valente U. Biochemical and morphologic effects after extended liver resection in rats: preliminary results. Transplant Proc 2010; 42:1061-5. [PMID: 20534224 DOI: 10.1016/j.transproceed.2010.03.116] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
After hepatic resection and transplantation with a partial graft, death and regeneration of the hepatocytes coexist in the liver. However, when the functional liver mass is inadequate to ensure a proper balance between regeneration vs functional and metabolic demands, small-for-size syndrome develops. We assessed the early effects of extended hepatic resection on liver function in a rat model. Six male Sprague-Dawley rats underwent 80% resection of the liver, and 6 rats served as a control group. At 6 hours after resection, blood samples were obtained from the hepatic vein for measurement of reduced glutathione (GSH), oxidized glutathione (GSSG), and hepatic venous oxygen saturation (Shvo(2)), and for standard liver function tests including determination of concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase, and total bilirubin. The remnant lobe was removed for GSH assay and histopathologic analysis. In the resection group, values were significantly higher for ALT (P = .002), AST (P = .002), and Shvo(2) (P = .01), whereas a significant decrease was observed for blood GSH (P = .009) but not liver GSH. Also in the resection group, we observed characteristic hepatocyte vacuolization with a gradient from periportal acinar zone 1 to the centrolobular area, the presence of hemorrhagic necrosis, and several leukocyte adhesions. The Shvo(2) and GSH data suggest early alteration of oxygen metabolism, as demonstrated by the reduction in oxygen uptake and decreased liver GSH secretion, with preservation of hepatic GSH. Mitochondrial dysfunction and oxidative injury seem to have a crucial role in early onset of liver damage.
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Affiliation(s)
- S Di Domenico
- Department of Transplantation, San Martino University Hospital, Genoa, Italy.
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Andorno E, Bottino G, Morelli N, Casaccia M, Gelli M, Piredda D, Immordino G, Ferrante R, Nardi I, Troilo BM, Di Domenico S, Ravazzoni F, Valente U. Preliminary results of liver transplantation for hepatocellular carcinoma among allocation organ policy strategies, neoadjuvant treatments, and intention-to-treat analysis. Transplant Proc 2008; 40:1972-3. [PMID: 18675103 DOI: 10.1016/j.transproceed.2008.05.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We retrospectively evaluated the impact of our strategy for patients with hepatocellular carcinoma (HCC) according to an intention-to-treat analysis and drop-out probability. We evaluated only patients within the Milan criteria. We analyzed the outcomes of neoadjuvant strategies for HCC, organ allocation policy, and systematic application of strategies to increase the deceased donor pool as the current tendency to expand transplantability criteria for those patients. Kaplan-Meier survival probability rates at 1, 3, and 5 years according to an intention-to-treat analysis were 87.02%, 74.53%, and 65.93% for transplanted patients (n=108), and 50%, 14.29%, and 14.29% for the excluded or waiting list group (n=13), respectively (P< .0001). Drop-out risk at 3, 6, and 12 months was 2.40%, 8.59%, and 16.54%, respectively. During the same period, the mortality probability rates at 3, 6, and 12 months among patients without HCC awaiting orthotopic liver transplantation (OLT) were 3.60%, 9.50%, and 18.34%, respectively. Drop-out rate was lower among patients treated before OLT (P< .0001). On the basis of the neoadjuvant treatment results to reduce drop-out risk, we suggest avoiding the high priority for the HCC cohort, particularly within the first 6 months from entrance on the waiting list, because this approach can reduce the chances of patients with end-stage liver disease (ESLD) alone.
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Affiliation(s)
- E Andorno
- Department of General Surgery and Organ Transplantation, S. Martino Hospital, Genoa, Italy
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Gelli M, Ferraretti G, Cadossi R. Use of low frequency pulsing electromagnetic fields (P.M.F.) in dentistry to promote bone growth. ACTA ACUST UNITED AC 1985. [DOI: 10.1016/0302-4598(85)85032-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gelli M, Rubboli G, Bonfatti M. [Personal experience of general anesthesia in odontostomatology]. Riv Ital Stomatol 1977; 46:31-5. [PMID: 278124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Gelli M, Rubboli G. [Composition of dentin during development]. Riv Ital Stomatol 1977; 46:36-8. [PMID: 278126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Gelli M, Zaniboni G, Cuppini A. [Qualitative and quantitative evaluation of the lipid component in the large salivary glands of adult cattle]. Mondo Odontostomatol 1968; 10:700-2. [PMID: 5253337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Martani F, Cuppini A, Gelli M. [Effects of synthetic corticosteroids on the level of the temporomandibular joint. (Clinical contribution--distant controls)]. Mondo Odontostomatol 1968; 10:574-82. [PMID: 5247338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Gelli M, Kovacs V, Zaniboni G. [Histochemical and biochemical characteristics of chronic granulomatous apical periodontitis. II. Considerations on the nature of the soluble proteins examined by means of cellulose acetate electrophoresis]. Mondo Odontostomatol 1968; 10:459-62. [PMID: 4176656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Gelli M, Kovacs V. [Qualitative and quantitative determination of the lipid content in human dentin by thin layer chromatography]. Riv Ital Stomatol 1967; 22:1546-53. [PMID: 4872268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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