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Alamer LA, Almukhadhib OY, Al Zahrani KA, Adham M, AlMousa RA. Ovarian Brenner Tumor: A Report of Two Cases and Literature Review. Cureus 2023; 15:e46613. [PMID: 37937033 PMCID: PMC10626313 DOI: 10.7759/cureus.46613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
Brenner tumors are relatively uncommon surface epithelial tumors of the ovary, accounting for less than 2% of all ovarian tumors. They may be of benign, borderline, or malignant nature as classified by the World Health Organization. Definitive diagnosis is made by histopathological examination after surgical excision, as it does not have pathognomonic imaging features. Due to the rarity of these tumors, reporting these cases may be beneficial to develop diagnostic and treatment criteria. We herein report two cases of Brenner tumor and discuss the available literature. Two cases of Brenner tumor were reported in addition to the literature review. Electronic search in different databases was used, accessing published full free-text articles in the English language, between January 2010 and December 2017, with the following MeSH terms: ovarian Brenner, Brenner, and ovary Brenner. Nineteen articles were located, of which seven articles were selected because they were consistent with the aims of the review. Twelve articles were excluded as they did not meet the aim of the review. Data from the reviewed articles were used to finalize the conclusive recommendations. Brenner tumors are rare ovarian tumors that are diagnosed by histopathological examination. Radiological investigation has a negligible role in the diagnosis, as Brenner tumors exhibit nonspecific features in imaging studies. To date, surgical excision remains the primary modality in diagnosing and treating Brenner tumors. The clinical characteristics of Brenner tumors require more research to be fully understood.
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Affiliation(s)
- Latifah A Alamer
- Obstetrics and Gynecology, King Fahd Hospital of the University, Khobar, SAU
- Obstetrics and Gynecology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Omar Y Almukhadhib
- Obstetrics and Gynecology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Khalid A Al Zahrani
- Obstetrics and Gynecology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Maysoon Adham
- Obstetrics and Gynecology, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Rahaf A AlMousa
- Obstetrics and Gynecology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Adham M, Anam K, Reksodiputro L. Treatment prioritization and risk stratification of head and neck cancer during COVID-19 pandemic: A systematic review. Med J Malaysia 2022; 77:53-59. [PMID: 35086995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Treatment of head and neck cancer patients amidst the COVID-19 pandemic is challenging, whereas prolonged treatment initiation in head and neck squamous cell carcinoma may increase mortality and likelihood of recurrence. Special attention is needed to ensure safe and appropriate care of these patients. This article aims to review and discuss existing research on treatment prioritization and risk stratification of head and neck cancer patients during the pandemic. MATERIALS AND METHODS The authors conducted literature search in three databases (PubMed, Cochrane, and Clinical Key) on July 15th, 2020. The keywords were ("Head and Neck Mucosal Malignancy" OR "Head and Neck Cancer") AND ("Management" OR "Head and Neck Surgery") AND ("COVID-19" OR "Pandemic"). The inclusion criteria were cancer in adult patients, published from 2020 in English, and with available access to full text. The exclusion criteria were comments, letters, and case reports. The articles were critically appraised using the Centre of Evidence-based Medicine (CEBM), University of Oxford and Duke University. The literature search strategy is illustrated using Preferred Reporting Items for Systematic review and meta-analysis (PRISMA) flow diagram. RESULTS A total of 150 articles were identified; 21 articles were gathered from Clinical Key, 33 from Cochrane, and 96 from Pubmed. After screening abstracts and reviewing the full text, the authors determined five articles met the inclusion criteria. There are several key points of head and neck cancer management in the COVID-19 pandemic. Head and neck cancer management is considered a high-risk procedure; the clinician should use proper personal protective equipment. Before operative treatment, all patients should undergo a PCR test 14 days before surgery. In diagnosing head and neck cancer, laryngoscopy should be considered carefully; and cytology should be preferred instead. Medically Necessary, Time-sensitive (MeNTS) score is recommended for risk stratification and surgery prioritization; it has three domains: procedure, disease, and patient. However, it is not specified to head and neck cancer; therefore, it should be combined with other references. Stanford University Head and Neck Surgery Division Department of Otolaryngology made surgery prioritization into three groups, urgent (should be operated immediately), can be postponed for 30 days, and can be postponed for 30- 90 days. Some urgent cases and should be operated on immediately include cancers involving the airways, decreased renal function, and metastases. For chemoradiation decision to delay or continue should refer to the goal of treatment, current oncologic status, and tolerance to radiation. In terms of patient's follow up, telephone consultation should be maximized. CONCLUSION MeNTS scoring combined with Guideline from Department of Otolaryngology at Stanford University prioritizing criteria can be helpful in decision making of stratifying Risk and prioritizing surgery in head and neck cancer management.
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Affiliation(s)
- M Adham
- Universitas Indonesia, Faculty of Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Indonesia.
| | - K Anam
- Universitas Indonesia, Faculty of Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Indonesia
| | - L Reksodiputro
- Universitas Indonesia, Faculty of Medicine, Department of Otorhinolaryngology Head and Neck Surgery, Indonesia
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Schneider M, Labgaa I, Vrochides D, Zerbi A, Nappo G, Perinel J, Adham M, van Roessel S, Besselink M, Mieog JSD, Groen JV, Demartines N, Schäfer M, Joliat GR. External validation of three nomograms predicting survival using an international cohort of patients with resected pancreatic head ductal adenocarcinoma. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Lymph node ratio (LNR, positive lymph nodes/collected lymph nodes during surgery) was identified as an important prognostic factor of survival in resected pancreatic cancer. Several nomograms based on LNR were recently proposed to predict survival after pancreatoduodenectomy (PD). The present study aimed to externally validate 3 published nomograms using an international cohort.
Methods
Consecutive patients with ductal adenocarcinoma of the pancreatic head who underwent PD without neoadjuvant treatment from 6 tertiary centers in Europe and the USA were retrospectively collected from 2000 to 2017. Patients with metastases at diagnosis, R2 resection, missing data regarding LNR, and who died within 90 postoperative days were excluded. The 3 selected nomograms were the updated Amsterdam nomogram (including LNR, adjuvant therapy, margin status, and tumor grade), the nomogram by Pu et al. (including LNR, age, tumor grade, and T stage) and the nomogram by Li et al. (including LNR, age, tumor location, grade, size, and TNM stage). Overall survivals (OS) were calculated using Kaplan-Meier method. For the validation, calibration (Hosmer-Lemeshow test), discrimination capacity (ROC curves for 3-year OS), and clinical utility (sensitivity and specificity at the value of Youden index) were assessed.
Results
After exclusion of 95 patients with metastases, R2 resection, and who died within 90 postoperative days, 1167 patients were included. Median OS of the entire cohort was 23 months (95% confidence interval: 21-24).
For the 3 nomograms, Kaplan-Meier curves showed significant diminution of OS with increasing scores (p < 0.01 for the 3 nomograms). All nomograms showed good calibration (non significant Hosmer-Lemeshow goodness-of-fit tests). For the updated Amsterdam nomogram, the area under the ROC curve (AUROC) for 3-year OS was 0.66. Sensitivity and specificity were 73% and 50%. Regarding the nomogram by Pu et al., the AUROC was 0.67. Sensitivity and specificity were 65% and 60%. For the nomogram by Li et al., the AUROC was 0.67, while sensitivity and specificity were 56% and 71%.
Conclusion
The 3 selected nomograms were validated using an external international cohort and displayed interesting and comparable predictive values. Those nomograms may be used in clinical practice to estimate survival after PD for ductal adenocarcinoma.
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Affiliation(s)
- M Schneider
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - I Labgaa
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - D Vrochides
- Division of Hepatobiliary and Pancreatic Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - A Zerbi
- Humanitas Clinical and Research Center, Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - G Nappo
- Humanitas Clinical and Research Center, Humanitas Research Hospital, Milan, Italy
| | - J Perinel
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Department of Digestive Surgery, Edouard Herriot Hospital, Lyon, France
| | - M Adham
- Department of Digestive Surgery, Edouard Herriot Hospital, Lyon, France
| | - S van Roessel
- Department of Surgery, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - M Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - J S D Mieog
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - J V Groen
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - G -R Joliat
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
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Regenet N, Sauvanet A, Muscari F, Meunier B, Mariette C, Adham M, Moutardier V, Delpero JR, Regimbeau JM, Pessaux P, Paye F, Sa Cunha A, Ansquer C. The value of 18F-FDG positron emission tomography to differentiate benign from malignant intraductal papillary mucinous neoplasms: A prospective multicenter study. J Visc Surg 2020; 157:387-394. [DOI: 10.1016/j.jviscsurg.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Vriz O, Al Humeid M, Adham M, Al Amro B, Galzerano D, Al Admawi M, Al Sergiani H, Al Hussein M, Al Buraiki J. P1686 Inverted biventricular takotsubo syndrome: early onset in heart transplanted patient. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1049] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Takostubo syndrome (TTS) is supposed to be a disturbances of myocardial microcirculation and increased catecholamine concentration (ie, epinephrine, norepinephrine, and dopamine), could be responsible of microvascular spasms or myocyte involvement. Catecholamine increased is related to sympathetic overactivity caused by stress but also as inotropic drugs.
A 39-year-old women underwent heart transplant due to rheumatic heart disease, status post mitral valve repair, in New York Heart Association Class IV heart failure despite optimal therapy. The donor was a 36-year-old young women without significant past medical history. The echocardiogram before explantation was normal and palpation of the epicardial coronary arteries did not reveal any gross pathology, areas of atheromatous disease, or calcium.
An orthotopic heart transplantation was carried out using the bicaval technique without any complication. The postoperative course was in post-surgery intensive care unite with the patient on mechanical ventilation and inotropic support. Within the first 24-hours, changes in T wave were observed and the echocardiography revealed normal left ventricle (LV) size, LV systolic function was mildly reduced (Ejection Fraction 45- 50%), presence of wall motion abnormalities characterized by akinesia of the basal septum, dyskinesia of the basal segment of the lateral wall and hypokinesia of the basal segments of the other walls and akinesia of the basal segments of the right ventricle (RV) suggesting TTS. Because of the donor’s age and risk profile, epicardial coronary artery disease was not considered to be the causing factor of the wall motion abnormality, coronary catheterization plus biopsy was done 7 days later with no evidence of coronary obstruction and biopsy result showed 1R rejection. The echocardiogram performed in the same day showed complete recovery of the wall motion abnormalities while the global strain was still low for the basal segments either for LV or RV.
The rest of the hospitalization was uneventful and she was discharged after 10 days from heart transplant and the echocardiographyic study showed an additional improvement of the global strain for both ventricle but not complete recovery.
Conclusion
This is a rare case of TC that happened the first day after heart transplant, when the heart is denervated. We hypothesized that the present case of TTS was more related to the drug inotropic support and by epinephrine released by suprarenal medulla rather than endogenous catecholamines released locally by the systemic nervous.
Figure 1.
First echocardiographic exam during the acute phase of TTS, LV GLS was – 6.5% and RV free wall GLS -4%. After 7 days the LV GLS was -9.1% and RV free wall was -7.6%. After 3 weeks the LV GLS was – 10.5% and the RV free wall was – 11%.
Abstract P1686 Figure.
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Affiliation(s)
- O Vriz
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - M Al Humeid
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - M Adham
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - B Al Amro
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - D Galzerano
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - M Al Admawi
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - H Al Sergiani
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - M Al Hussein
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - J Al Buraiki
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Handoko H, Gondhowiardjo S, Adham M, Lisnawati L, Tobing D, Kodrat H, Haryoga I, Dwiyono A, Kristian Y, Mayang Permata T. PD-L1 profile of nasopharyngeal cancer patients in Indonesia. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz438.017] [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: 11/12/2022] Open
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Kepenekian V, Muller A, Valette PJ, Rousset P, Chauvenet M, Phelip G, Walter T, Adham M, Glehen O, Passot G. Evaluation of a strategy using pretherapeutic fiducial marker placement to avoid missing liver metastases. BJS Open 2019; 3:344-353. [PMID: 31183451 PMCID: PMC6551408 DOI: 10.1002/bjs5.50140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/23/2018] [Accepted: 12/06/2018] [Indexed: 12/19/2022] Open
Abstract
Background Hepatic surgery is appropriate for selected patients with colorectal liver metastases (CRLM). Advances in chemotherapy have led to modification of management, particularly when metastases disappear. Treatment should address all initial CRLM sites based on pretherapeutic cross-sectional imaging. This study aimed to evaluate pretherapeutic fiducial marker placement to optimize CRLM treatment. Methods This pilot investigation included patients with CRLM who were considered for potentially curative treatment between 2009 and 2016. According to a multidisciplinary team decision, lesions smaller than 25 mm in diameter that were more than 10 mm deep in the hepatic parenchyma and located outside the field of a planned resection were marked. Complication rates and clinicopathological data were analysed. Results Some 76 metastases were marked in 43 patients among 217 patients with CRLM treated with curative intent. Of these, 23 marked CRLM (30 per cent), with a mean(s.d.) size of 11·0(3·4) mm, disappeared with preoperative chemotherapy. There were four complications associated with marking: two intrahepatic haematomas, one fiducial migration and one misplacement. After a median follow-up of 47·7 (range 18·1-144·9) months, no needle-track seeding was noted. Of four disappearing CRLM that were marked and resected, two presented with persistent active disease. Other missing lesions were treated with thermoablation. Conclusion Pretherapeutic fiducial marker placement appears useful for the curative management of CRLM.
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Affiliation(s)
- V Kepenekian
- Department of Digestive Surgery Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - A Muller
- Department of Radiology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - P J Valette
- Department of Radiology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - P Rousset
- Department of Radiology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - M Chauvenet
- Department of Digestive Oncology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - G Phelip
- Department of Digestive Oncology Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - T Walter
- Department of Medical Oncology Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon 1 University Lyon France
| | - M Adham
- Department of Digestive Surgery Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon 1 University Lyon France
| | - O Glehen
- Department of Digestive Surgery Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
| | - G Passot
- Department of Digestive Surgery Hospices Civils de Lyon, Centre Hospitalier Lyon Sud Lyon France
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Uzunoglu FG, Welte MN, Gavazzi F, Maggino L, Perinel J, Salvia R, Janot M, Reeh M, Perez D, Montorsi M, Zerbi A, Adham M, Uhl W, Bassi C, Izbicki JR, Malleo G, Bockhorn M. Evaluation of the MDACC clinical classification system for pancreatic cancer patients in an European multicenter cohort. Eur J Surg Oncol 2018; 45:793-799. [PMID: 30585172 DOI: 10.1016/j.ejso.2018.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/06/2018] [Accepted: 12/18/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The MDACC group recommends to extend the current borderline classification for pancreatic cancer into three groups: type A patients with resectable/borderline tumor anatomy, type B with resectable/borderline resectable tumor anatomy and clinical findings suspicious for extrapancreatic disease and type C with borderline resectable and marginal performance status/severe pre-existing comorbidity profile or age>80. This study intents to evaluate the proposed borderline classification system in a multicenter patient cohort without neoadjuvant treatment. METHODS Evaluation was based on a multicenter database of pancreatic cancer patients undergoing surgery from 2005 to 2016 (n = 1020). Complications were classified based on the Clavien-Dindo classification. χ2-test, Kaplan-Meier estimator and Cox regression hazard model were used for statistical analysis. RESULTS Most patients (55.1%) were assigned as type A patients, followed by type C (35.8%) and type B patients (9.1%). Neither the complication rate, nor the mortality rate revealed a correlation to any subgroup. Type B patients had a significant worse progression free (p < 0.001) and overall survival (p = 0.005). Type B classification was identified as an independent prognostic marker for progression free survival (p = 0.005, HR 1.47). CONCLUSION The evaluation of the proposed classification in a cohort without neoadjuvant treatment did not justify an additional medical borderline subgroup. A new subgroup based on prognostic borderline patients might be the main target group for neoadjuvant protocols in future.
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Affiliation(s)
- F G Uzunoglu
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M-N Welte
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - F Gavazzi
- Department of General Surgery, Humanitas Research Hosptital and University, Istituto Clinico Humanitas IRCCS, Milan, Italy
| | - L Maggino
- Department of Surgery and Oncology, Unit of General and Pancreatic Surgery, The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - J Perinel
- Hospices Civils de Lyon & Lyon Sud Faculty of Medicine, UCBL1, E. Herriot Hospital, Department of Digestive Surgery, Lyon, France
| | - R Salvia
- Department of Surgery and Oncology, Unit of General and Pancreatic Surgery, The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - M Janot
- Department of Surgery, St. Josef-Hospital Bochum, Hospital of the Ruhr- University, Bochum, Germany
| | - M Reeh
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - D Perez
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Montorsi
- Department of General Surgery, Humanitas Research Hosptital and University, Istituto Clinico Humanitas IRCCS, Milan, Italy
| | - A Zerbi
- Department of General Surgery, Humanitas Research Hosptital and University, Istituto Clinico Humanitas IRCCS, Milan, Italy
| | - M Adham
- Hospices Civils de Lyon & Lyon Sud Faculty of Medicine, UCBL1, E. Herriot Hospital, Department of Digestive Surgery, Lyon, France
| | - W Uhl
- Department of Surgery, St. Josef-Hospital Bochum, Hospital of the Ruhr- University, Bochum, Germany
| | - C Bassi
- Department of Surgery and Oncology, Unit of General and Pancreatic Surgery, The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - J R Izbicki
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - G Malleo
- Department of Surgery and Oncology, Unit of General and Pancreatic Surgery, The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - M Bockhorn
- Department of General, Visceral and Thoracic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
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Mohkam K, Farges O, Vibert E, Soubrane O, Adam R, Pruvot FR, Regimbeau JM, Adham M, Boleslawski E, Mabrut JY, Ducerf C, Pradat P, Darnis B, Cazauran JB, Lesurtel M, Dokmak S, Aussilhou B, Dondero F, Allard MA, Ciacio O, Pittau G, Cherqui D, Castaing D, Sa Cunha A, Truant S, Hardwigsen J, Le Treut YP, Grégoire E, Scatton O, Brustia R, Sepulveda A, Cosse C, Laurent C, Adam JP, El Bechwaty M, Perinel J. Risk score to predict biliary leakage after elective liver resection. Br J Surg 2017; 105:128-139. [DOI: 10.1002/bjs.10647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 05/29/2017] [Accepted: 06/11/2017] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Biliary leakage remains a major cause of morbidity after liver resection. Previous prognostic studies of posthepatectomy biliary leakage (PHBL) lacked power, population homogeneity, and model validation. The present study aimed to develop a risk score for predicting severe PHBL.
Methods
In this multicentre observational study, patients who underwent liver resection without hepaticojejunostomy in one of nine tertiary centres between 2012 and 2015 were randomly assigned to a development or validation cohort in a 2 : 1 ratio. A model predicting severe PHBL (International Study Group of Liver Surgery grade B/C) was developed and further validated.
Results
A total of 2218 procedures were included. PHBL of any severity and severe PHBL occurred in 141 (6·4 per cent) and 92 (4·1 per cent) patients respectively. In the development cohort (1475 patients), multivariable analysis identified blood loss of at least 500 ml, liver remnant ischaemia time 45 min or more, anatomical resection including segment VIII, transection along the right aspect of the left intersectional plane, and associating liver partition and portal vein ligation for staged hepatectomy as predictors of severe PHBL. A risk score (ranging from 0 to 5) was built using the development cohort (area under the receiver operating characteristic curve (AUROC) 0·79, 95 per cent c.i. 0·74 to 0·85) and tested successfully in the validation cohort (AUROC 0·70, 0·60 to 0·80). A score of at least 3 predicted an increase in severe PHBL (19·4 versus 2·6 per cent in the development cohort, P < 0·001; 15 versus 3·1 per cent in the validation cohort, P < 0·001).
Conclusion
The present risk score reliably predicts severe PHBL. It represents a multi-institutionally validated prognostic tool that can be used to identify a subset of patients at high risk of severe PHBL after elective hepatectomy.
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Affiliation(s)
- K Mohkam
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Ecole Doctorale Interdisciplinaire Sciences Santé 205 – Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon, France
| | - O Farges
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - E Vibert
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France
| | - O Soubrane
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - R Adam
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France
| | - F-R Pruvot
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France
| | - J-M Regimbeau
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - M Adham
- Department of Hepatopancreatobiliary Surgery, Hôpital Edouard Herriot, Lyon, France
| | - E Boleslawski
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France
| | - J-Y Mabrut
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Ecole Doctorale Interdisciplinaire Sciences Santé 205 – Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon, France
| | - C Ducerf
- Hôpital de la Croix-Rousse, Lyon, France
| | - P Pradat
- Hôpital de la Croix-Rousse, Lyon, France
| | - B Darnis
- Hôpital de la Croix-Rousse, Lyon, France
| | | | - M Lesurtel
- Hôpital de la Croix-Rousse, Lyon, France
| | | | | | | | | | - O Ciacio
- Hôpital Paul Brousse, Villejuif, France
| | - G Pittau
- Hôpital Paul Brousse, Villejuif, France
| | - D Cherqui
- Hôpital Paul Brousse, Villejuif, France
| | | | | | - S Truant
- Hôpital Claude Huriez, Lille, France
| | | | | | | | - O Scatton
- Hôpital de la Pitié-Salpétrière, Paris, France
| | - R Brustia
- Hôpital de la Pitié-Salpétrière, Paris, France
| | - A Sepulveda
- Hôpital de la Pitié-Salpétrière, Paris, France
| | - C Cosse
- Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - C Laurent
- Hôpital Haut-Lévêque, Bordeaux, France
| | - J-P Adam
- Hôpital Haut-Lévêque, Bordeaux, France
| | | | - J Perinel
- Hôpital Edouard Herriot, Lyon, France
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11
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Adham M, Musa Z, Lisnawati, Suryati I. Sensitivity and specificity of narrow-band imaging nasoendoscopy compared to histopathology results in patients with suspected nasopharyngeal carcinoma. ACTA ACUST UNITED AC 2017. [DOI: 10.1088/1742-6596/884/1/012114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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12
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Duconseil P, Périnel J, Autret A, Adham M, Sauvanet A, Chiche L, Mabrut JY, Tuech JJ, Mariette C, Régenet N, Fabre JM, Bachellier P, Delpéro JR, Paye F, Turrini O. Resectable invasive IPMN versus sporadic pancreatic adenocarcinoma of the head of the pancreas: Should these two different diseases receive the same treatment? A matched comparison study of the French Surgical Association (AFC). Eur J Surg Oncol 2017; 43:1704-1710. [PMID: 28687431 DOI: 10.1016/j.ejso.2017.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/25/2017] [Accepted: 06/08/2017] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare survival and impact of adjuvant chemotherapy in patients who underwent pancreaticoduodenectomy (PD) for invasive intraductal papillary mucinous neoplasm (IIPMN) and sporadic pancreatic ductal adenocarcinoma (PDAC). METHODS From 2005 to 2012, 240 patients underwent pancreatectomy for IIPMN and 1327 for PDAC. Exclusion criteria included neoadjuvant treatment, pancreatic resection other than PD, vascular resection, carcinoma in situ, or <11 examined lymph nodes. Thus, 82 IIPMN and 506 PDAC were eligible for the present study. Finally, The IIPMN group was matched 1:2 to compose the PDAC group according to TNM disease stage, perineural invasion, lymph node ratio, and margin status. RESULTS There was no difference in patient's characteristics, intraoperative parameters, postoperative outcomes, and histologic parameters. Overall survival and disease-free survival times were comparable between the 2 groups. In each group, overall survival time was significantly poorer in patients who did not achieve adjuvant chemotherapy (p = 0.03 for the IIPMN group; p = 0.03 for the PDAC group). In lymph-node negative patients of the IIPMN group, adjuvant chemotherapy did not have any significant impact on overall survival time (OR = 0.57; 95% CI [0.24-1.33]). Considering the whole population (i.e. patients with IIPMN and PDAC; n = 246), patients who did not achieve adjuvant chemotherapy had poorer survival (p < 0.01). CONCLUSIONS The courses of IIPMN and PDAC were similar after an optimized stage-to-stage comparison. Adjuvant chemotherapy was efficient in both groups. However, in lymph node negative patients, adjuvant chemotherapy seemed not to have a significant impact.
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Affiliation(s)
- P Duconseil
- Department of Surgery, Hôpital Nord, Marseille, France.
| | - J Périnel
- Department of Surgery, Hôpital Edouard-Herriot, HCL, UCBL1, Lyon, France
| | - A Autret
- Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France
| | - M Adham
- Department of Surgery, Hôpital Edouard-Herriot, HCL, UCBL1, Lyon, France
| | - A Sauvanet
- Department of Surgery, Hôpital Beaujon, Paris, France
| | - L Chiche
- Department of Surgery, Maison du Haut-Lévêque, Bordeaux, France
| | - J-Y Mabrut
- Department of Surgery, Hôpital de la Croix Rousse, Lyon, France
| | - J-J Tuech
- Department of Surgery, Hôpital Charles Nicolle, Rouen, France
| | - C Mariette
- Department of Surgery, Hôpital Claude-Huriez, Lille, France
| | - N Régenet
- Department of Surgery, Hôpital Hôtel Dieu, Nantes, France
| | - J-M Fabre
- Department of Surgery, Hôpital Saint Eloi, Montpellier, France
| | - P Bachellier
- Department of Surgery, Hôpital de Hautepierre, Strasbourg, France
| | - J-R Delpéro
- Department of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - F Paye
- Department of Surgery, Hôpital Saint Antoine, Paris, France
| | - O Turrini
- Department of Surgery, Institut Paoli-Calmettes, Marseille, France
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13
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Abstract
Pancreatic surgery is still considered as a high-risk abdominal surgery. While the mortality rate is low, the morbidity remains high ranging from 30 to 60%. In 2012, the ERAS study group published the official recommendations to implement the enhanced recovery after surgery (ERAS) program in patients undergoing PD. Non-randomized studies have shown that ERAS was safe and feasible. They reported a significantly shortened LOS with lower morbidity in ERAS group. However, the level of evidence remains low due to absence of randomized study and because of a substantial heterogeneity in the content of ERAS protocols. Future studies should be prospective, multicentric and designed with a structured implementation of standardized ERAS pathway.
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Affiliation(s)
- J Perinel
- Hospices Civils de Lyon & Lyon Sud Faculty of Medicine, UCBL1, E Herriot Hospital, Department of Digestive Surgery, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France
| | - M Adham
- Hospices Civils de Lyon & Lyon Sud Faculty of Medicine, UCBL1, E Herriot Hospital, Department of Digestive Surgery, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France.
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14
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Abstract
The introduction and widespread application of minimally invasive surgery has been one of the most important innovations that radically changed the practice of surgery during the last few decades. The application to pancreatic surgery of minimally invasive approach has only recently emerged: both laparoscopic distal pancreatectomy (LDP) and laparoscopic pancreaticoduodenectomy (LPD) can be competently performed. LDP and LPD are advocated to improved perioperative outcomes, including decreased blood loss, shorter length of stay, reduced postoperative pain and expedited time to functional recovery. However, the indication to minimally invasive approach for pancreatic surgery is often benign or low-grade malignant pathologies. In this review, we summarize the current data on minimally invasive pancreatic surgery, focusing on indication, perioperative and oncological outcomes.
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Affiliation(s)
- G Nappo
- Department of HBP Surgery, Edouard Herriot Hopsital, HCL and Lyon Faculty of Medicine, Lyon, France
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15
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Boschetti G, Walter T, Benet T, Chopin-Laly X, Adham M, Comte B, Vanhems P, Lombard-Bohas C, Castel-Kremer E. Pancreatic adenocarcinoma in elderly patients: Benefits on oncogeriatric approach and oncological care. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.103] [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: 10/24/2022]
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16
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Adham M, Bredt LC, Robert M, Perinel J, Lombard-Bohas C, Ponchon T, Valette PJ. Pancreatic resection in elderly patients: should it be denied? Langenbecks Arch Surg 2014. [DOI: https:/doi.org/10.1007/s00423-014-1183-9] [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: 01/24/2023]
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17
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Mariette C, Wind P, Micelli Lupinacci R, Tresallet C, Adham M, Arvieux C, Benoist S, Berdah S, Berger A, Briez N, Brigand C, Caiazzo R, Carrere N, Casa C, Collet D, Deguelte S, Dousset B, Dubuisson V, Glehen O, Gineste JC, Hamy A, Lacaine F, Laurent C, Lehur PA, Mabrut JY, Mathieu P, Mathonnet M, Meunier B, Michot F, Ouaissi M, Palot JP, Parc Y, Pattou F, Paye F, Pezet D, Piessen G, Pocard M, Regenet N, Regimbeau JM, Sabbagh C, Zerbib P, Toussaint JM. Practice patterns in complex ventral hernia repair and place of biological grafts: A national survey among French digestive academic surgeons. J Visc Surg 2014; 151:9-16. [DOI: 10.1016/j.jviscsurg.2013.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Abstract
Objective and Background: Polycystic ovary syndrome (PCOS) is a complex condition and has been described in women who have polycystic ovaries as the underlying cause of hirsutism and chronic anovulation. Studies on PCOS in the Saudi population are very few. The aim of this study was to investigate the reproductive hormones levels in patients with PCOS. Effect of age and body mass index (BMI) on the hormonal findings was eliminated through a multivariate analysis. Materials and Methods: A comparative study was conducted on Saudi subjects attending the outpatient clinic of National Guard Hospital in Riyadh. A total of 62 cases with PCOS and 40 healthy Saudi women were included in this study. Physical evaluation and laboratory investigations were carried out. Blood luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2), dehydroepiandrosterone sulfate (DHEA-SO4), sex hormone-binding globulin (SHBG), total testosterone, prolactin, and progesterone were determined. To adjust for the potentially confounding effect of age and BMI, we carried out multivariate linear regression analyses for the association between each of the reproductive hormones and PCOS. Results: Serum levels of FSH, SHBG, and progesterone were significantly lower in PCOS compared to controls (respective P values 0.001, 0.001, and 0.002), while LH/FSH and testosterone levels were higher in PCOS cases than in controls (P = 0.008 and 0.003, respectively). When multivariate linear regression analyses were carried out, LH/FSH and total testosterone were positively correlated with the disease [95% confidence interval (CI) = 0.02–0.35 and 0.02–0.17, respectively], whereas FSH, SHBG, and progesterone were negatively correlated with the disease (95% CI = –0.06 to 0.001, –0.01 to 0.001, and –0.17 to –0.03, respectively), independent of age and BMI. Conclusion: Our study suggests that regardless of the age and weight factors, Saudi patients with PCOS have higher levels of LH/FSH and total testosterone; but have lower levels of FSH, SHBG, and progesterone compared to controls.
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Affiliation(s)
- Hana Fakhoury
- Department of Basic Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hani Tamim
- Department of Basic Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mazen Ferwana
- Department of Basic Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Imran A Siddiqui
- Department of Basic Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Maysoon Adham
- Department of Obstetrics and Gynecology, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Waleed Tamimi
- Department of Basic Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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19
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Del Chiaro M, Verbeke C, Salvia R, Klöppel G, Werner J, McKay C, Friess H, Manfredi R, Van Cutsem E, Löhr M, Segersvärd R, Adham M, Albin N, Andren-Sandberg Å, Arnelo U, Bruno M, Cahen D, Cappelli C, Costamagna G, Del Chiaro M, Delle Fave G, Esposito I, Falconi M, Friess H, Ghaneh P, Gladhaug IP, Haas S, Hauge T, Izbicki JR, Klöppel G, Lerch M, Lundell L, Lüttges J, Löhr M, Manfredi R, Mayerle J, McKay C, Oppong K, Pukitis A, Rangelova E, Rosch T, Salvia R, Schulick R, Segersvärd R, Sufferlein T, Van Cutsem E, Van der Merwe SW, Verbeke C, Werner J, Zamboni G. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013; 45:703-11. [PMID: 23415799 DOI: 10.1016/j.dld.2013.01.010] [Citation(s) in RCA: 301] [Impact Index Per Article: 27.4] [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: 11/06/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 12/11/2022]
Abstract
Cystic lesions of the pancreas are increasingly recognized. While some lesions show benign behaviour (serous cystic neoplasm), others have an unequivocal malignant potential (mucinous cystic neoplasm, branch- and main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm). European expert pancreatologists provide updated recommendations: diagnostic computerized tomography and/or magnetic resonance imaging are indicated in all patients with cystic lesion of the pancreas. Endoscopic ultrasound with cyst fluid analysis may be used but there is no evidence to suggest this as a routine diagnostic method. The role of pancreatoscopy remains to be established. Resection should be considered in all symptomatic lesions, in mucinous cystic neoplasm, main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm as well as in branch duct intraductal papillary mucinous neoplasm with mural nodules, dilated main pancreatic duct >6mm and possibly if rapidly increasing in size. An oncological partial resection should be performed in main duct intraductal papillary mucinous neoplasm and in lesions with a suspicion of malignancy, otherwise organ preserving procedures may be considered. Frozen section of the transection margin in intraductal papillary mucinous neoplasm is suggested. Follow up after resection is recommended for intraductal papillary mucinous neoplasm, solid pseudo-papillary neoplasm and invasive cancer.
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Affiliation(s)
- Marco Del Chiaro
- Division of Surgery, CLINTEC, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden.
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20
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Fuks D, Regimbeau JM, Pessaux P, Bachellier P, Raventos A, Mantion G, Gigot JF, Chiche L, Pascal G, Azoulay D, Laurent A, Letoublon C, Boleslawski E, Rivoire M, Mabrut JY, Adham M, Le Treut YP, Delpero JR, Navarro F, Ayav A, Boudjema K, Nuzzo G, Scotte M, Farges O. Is port-site resection necessary in the surgical management of gallbladder cancer? J Visc Surg 2013; 150:277-84. [PMID: 23665059 DOI: 10.1016/j.jviscsurg.2013.03.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Gallbladder carcinoma is frequently discovered incidentally on pathologic examination of the specimen after laparoscopic cholecystectomy (LC) performed for presumed "benign" disease. The objective of the present study was to assess the role of excision of port-sites from the initial LC for patients with incidental gallbladder carcinoma (IGBC) in a French registry. METHODS Data on patients with IGBC identified after LC between 1998 and 2008 were retrospectively collated in a French multicenter database. Among those patients undergoing re-operation with curative intent, patients with port-site excision (PSE) were compared with patients without PSE and analyzed for differences in recurrence patterns and survival. RESULTS Among 218 patients with IGBC after LC (68 men, 150 women, median age 64 years), 148 underwent re-resection with curative intent; 54 patients had PSE and 94 did not. Both groups were comparable with regard to demographic data (gender, age > 70, co-morbidities), surgical procedures (major resection, lymphadenectomy, main bile duct resection) and postoperative morbidity. In the PSE group, depth of tumor invasion was T1b in six, T2 in 24, T3 in 22, and T4 in two; this was not significantly different from patients without PSE (P = 0.69). Port-site metastasis was observed in only one (2%) patient with a T3 tumor who died with peritoneal metastases 15 months after resection. PSE did not improve the overall survival (77%, 58%, 21% at 1, 3, 5 years, respectively) compared to patients with no PSE (78%, 55%, 33% at 1, 3, 5 years, respectively, P = 0.37). Eight percent of patients developed incisional hernia at the port-site after excision. CONCLUSION In patients with IGBC, PSE was not associated with improved survival and should not be considered mandatory during definitive surgical treatment.
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Affiliation(s)
- D Fuks
- Département de chirurgie digestive et métabolique, université de Picardie, hôpital Nord-Amiens, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 01, France
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21
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Darnis B, Lebeau R, Chopin-Laly X, Adham M. Postpancreatectomy hemorrhage (PPH): predictors and management from a prospective database. Langenbecks Arch Surg 2013; 398:441-8. [PMID: 23435636 DOI: 10.1007/s00423-013-1047-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 01/07/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postpancreatectomy hemorrhage (PPH) is a dreaded complication in pancreatic surgery. Today, there is a definition and grading of PPH without therapeutic consensus. We reviewed our prospective database to identify predictors and assess therapeutic strategy. METHOD We included all patients who underwent pancreatectomy between 2005 and 2010. Data were collected prospectively. We used the International Study Group Of Pancreatic Surgery (ISGPS) definition for PPH to include patients in the PPH group. RESULTS Forty-six of 285 patients showed a PPH (16.1 %). The ISGPS classification was graded A = 3, B = 26, and C = 17. The average time to the onset of PPH was 7 days. CT-scan identified the origin of PPH in 43.5 % of the cases. PPH was responsible for a longer duration of hospital stay (p = 0.004), a higher hospital mortality (21.7 vs 2.5 %, p < 0.0001) and a lower survival (40 vs 70 % (p = 0.05) at 36 months). The first-intention treatment of PPH was conservative in 32 % and interventional in 68 %: endoscopy (6.4 %), transcatheter arterial embolization (TAE, 30.4 %), and surgical (30.4 %). In multivariate analysis, predictors of PPH were: pancreatic fistula (24 vs 8 % p = 0.028), pancreatoduodenectomy (70 vs 43 % p = 0.029), age (61.6 vs 58.8 %, p = 0.03), and nutritional risk index (NRI) (p = 0.048). CONCLUSION In our series, risk factors for PPH were age, pancreatic fistula, pancreatoduodenectomy, and NRI. Its occurrence is associated with significantly higher hospital mortality and a lower survival rate. Our first-line treatment was radiological TAE. Surgical treatment is offered in case of failure of interventional radiology or in case of uncontrolled hemodynamic.
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Affiliation(s)
- B Darnis
- Department of HBP Surgery, Edouard Herriot hospital, HCL, Lyon Faculty of Medicine, UCBL1, 5 Place d'Arsonval, 69437 Lyon, Cedex 03, France
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Farges O, Regimbeau JM, Fuks D, Le Treut YP, Cherqui D, Bachellier P, Mabrut JY, Adham M, Pruvot FR, Gigot JF. Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma. Br J Surg 2012; 100:274-83. [PMID: 23124720 DOI: 10.1002/bjs.8950] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Indications for preoperative biliary drainage (PBD) in the context of hepatectomy for hilar malignancies are still debated. The aim of this study was to investigate current European practice regarding biliary drainage before hepatectomy for Klatskin tumours. METHODS This was a retrospective analysis of all patients who underwent formal or extended right or left hepatectomy for hilar cholangiocarcinoma between 1997 and 2008 at 11 European teaching hospitals, and for whom details of serum bilirubin levels at admission and at the time of surgery were available. PBD was performed at the physicians' discretion. The primary outcome was 90-day mortality. Secondary outcomes were morbidity and cause of death. The association of PBD and of preoperative serum bilirubin levels with postoperative mortality was assessed by logistic regression, in the entire population as well as separately in the right- and left-sided hepatectomy groups, and was adjusted for confounding factors. RESULTS A total of 366 patients were enrolled; PBD was performed in 180 patients. The overall mortality rate was 10·7 per cent and was higher after right- than left-sided hepatectomy (14·7 versus 6·6 per cent; adjusted odds ratio (OR) 3·16, 95 per cent confidence interval 1·50 to 6·65; P = 0·001). PBD did not affect overall postoperative mortality, but was associated with a decreased mortality rate after right hepatectomy (adjusted OR 0·29, 0·11 to 0·77; P = 0·013) and an increased mortality rate after left hepatectomy (adjusted OR 4·06, 1·01 to 16·30; P = 0·035). A preoperative serum bilirubin level greater than 50 µmol/l was also associated with increased mortality, but only after right hepatectomy (adjusted OR 7·02, 1·73 to 28·52; P = 0·002). CONCLUSION PBD does not affect overall mortality in jaundiced patients with hilar cholangiocarcinoma, but there may be a difference between patients undergoing right-sided versus left-sided hepatectomy.
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Affiliation(s)
- O Farges
- Department of Hepatobiliary Surgery, Hôpital Beaujon, Assistance-Publique Hôpitaux de Paris, Université Paris 7, Clichy, France.
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23
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Adham M. Reply to Peparini. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.07.010] [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: 10/28/2022] Open
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24
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Nyst H, Wildeman M, Indrasari S, Karakullukcu B, van Veen R, Adham M, Stewart F, Levendag P, Sterenborg H, Tan I. Temoporfin mediated photodynamic therapy in patients with local persistent and recurrent nasopharyngeal carcinoma after curative radiotherapy: A feasibility study. Photodiagnosis Photodyn Ther 2012; 9:274-81. [DOI: 10.1016/j.pdpdt.2012.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 07/18/2012] [Accepted: 07/22/2012] [Indexed: 10/28/2022]
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25
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Adham M, Singhirunnusorn J. Surgical technique and results of total mesopancreas excision (TMpE) in pancreatic tumors. Eur J Surg Oncol 2012; 38:340-5. [PMID: 22264964 DOI: 10.1016/j.ejso.2011.12.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 12/11/2011] [Accepted: 12/19/2011] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Retro pancreatic invasion is a major concern in pancreatic head carcinoma. Posterior clearance has been recognized as an independent risk factor for disease recurrence and hence patient survival. The aim of this study was to report a standardized method that ensures posterior clearance with Total Mesopancreas Excision (TMpE). METHODS Our procedure consisted in a posterior approach with cranio-caudal dissection at the origin of the superior mesenteric artery and the celiac trunk all along their right semi-circumference. This allowed a complete clearance of retro pancreatic tissues with safe control of pancreaticoduodenal arteries at their origin. RESULTS Fifty-two consecutive pancreatic resections with TMpE were performed. Sixteen cases were associated to vascular resection. Pathology revealed an adenocarcinoma of the pancreatic duct, distal bile duct, periampullary and neuroendocrine carcinoma. Mesopancreas was invaded by cancer in 12 cases, of these, 3 had invaded margins and 7 had a margin less than 1 mm. Mesopancreas was the only site of tumour infiltration. Applying the International Union Against Cancer criteria, an R0 resection was thus achieved in 42 patients. CONCLUSION Our procedure is feasible and safe in experienced hand. It is a description of a standardized method for TMpE that clearly shows an advantage in improving posterior clearance and R0 resection.
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Affiliation(s)
- M Adham
- Department of Hepato-biliary and Pancreatic Surgery, Edouard Herriot Hospital, HCL, Lyon, France.
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26
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Adham M, Froelicher ES, Batieha A, Ajlouni K. Glycaemic control and its associated factors in type 2 diabetic patients in Amman, Jordan. East Mediterr Health J 2010. [DOI: 10.26719/2010.16.7.732] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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27
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Adham M, Froelicher ES, Batieha A, Ajlouni K. Glycaemic control and its associated factors in type 2 diabetic patients in Amman, Jordan. East Mediterr Health J 2010; 16:732-739. [PMID: 20799529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A study of 1000 patients attending a diabetes referral centre in Amman, Jordan, identified factors associated with good glycaemic control, as measured by glycosylated haemoglobin (HbA1c) levels. Glycaemic control improved significantly between the first clinic visit and at 12-months follow-up. The proportion of patients with extreme HbA1c (> or = 10%) decreased from 15.3% to 6.0% after 12 months. The percentage of patients with optimal control (HbA1c < 7%) increased from 25.4% at the first visit to 27.5% at 12-month follow-up. Multivariate regression showed that low body mass index, shorter duration of diabetes and higher baseline HbA1c were related to reductions in HbA1c between the first and 12-month visits.
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Affiliation(s)
- M Adham
- National Centre for Diabetes, Endocrinology and Genetics, University of Jordan, Amman, Jordon
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28
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Golse N, Spina A, Abdelaal A, Mennesson N, Feugier P, Dumortier J, Boillot O, Adham M. Extra-anatomical hepatic artery reconstruction following post-embolization iatrogenic dissection and arterial anastomotic rupture in two liver transplant recipients. ACTA ACUST UNITED AC 2010; 34:111-4. [PMID: 20071115 DOI: 10.1016/j.gcb.2009.11.003] [Citation(s) in RCA: 4] [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] [Received: 08/17/2009] [Revised: 09/07/2009] [Accepted: 11/12/2009] [Indexed: 12/13/2022]
Abstract
When hepatic artery reconstruction is required during hepatic transplantation, this is generally performed with donor vessels. We describe two cases requiring a prosthesis. The first case was a 58-year-old man transplanted for cirrhosis complicated by hepatocellular carcinoma. During transplantation, dissection of the celiac trunk occurred due to arterial embolization and the use of the patient's vessels was impossible. An extra-anatomical bypass between the infra-renal aorta and the donor hepatic artery was performed via the interposition of a graft tube. The second case was a 52-year-old man transplanted for cirrhosis complicated by hepatocellular carcinoma. On day 16, a ruptured anastomosis was suspected and the patient underwent emergency revision laparotomy. Arterial revascularisation was performed with an aortohepatic bypass using a synthetic GoreTex((R)) graft. Patient follow-up was uneventful.
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Affiliation(s)
- N Golse
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Edouard Herriot Hospital, HCL, UFR Grange Blanche-UCBL1, Pavillon D 5, Place d'Arsonval, 69437 Lyon cedex, France
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29
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Naseef O, Adham M, Hervieu V, Le Borgne J, Partensky C. Long-term survival (superior to 20 years) after pancreaticoduodenectomy for pancreatic duct adenocarcinoma: report of two cases. Hepatogastroenterology 2008; 55:1110-1111. [PMID: 18705340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pancreatic duct adenocarcinoma (PDA) is associated with dismal survival. This study reports two cases of very long survival after pancreatectomy for PDA. These were two male patients with pT30M0 and pT2N0M0 tumour. Both received adjuvant treatment and are currently alive after 21y 6 months and 22 y 2 months respectively. Very long term survival for PDA can be achieved for some patients who benefit from R0 resection.
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Affiliation(s)
- O Naseef
- Department of Digestive Surgery and Liver Transplantation, Edouard Herriot Hospital, Lyon, France
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30
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Mwaura B, Mahendran B, Hynes N, Defreitas D, Avalos G, Adegbola T, Adham M, Connolly CE, Sultan S. The Impact of Differential Expression of Extracellular Matrix Metalloproteinase Inducer, Matrix Metalloproteinase-2, Tissue Inhibitor of Matrix Metalloproteinase-2 and PDGF-AA on the Chronicity of Venous Leg Ulcers. Eur J Vasc Endovasc Surg 2006; 31:306-10. [PMID: 16169261 DOI: 10.1016/j.ejvs.2005.08.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2004] [Accepted: 08/14/2005] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Alteration in the expression of extracellular matrix metalloproteinase inducer (EMMPRIN), matrix metalloproteinase-2 (MMP-2), tissue inhibitors of matrix metalloproteinases (TIMP-2) and platelet derived growth factor (PDGF-AA) may contribute to poor healing in venous leg ulcers. AIM The aim of this study is to determine the expression of EMMPRIN, MMP-2, TIMP-2 and PDGF-AA in the ulcer exudates and perivascular tissue of healing and non-healing chronic venous ulcers. PATIENTS, MATERIALS AND METHODS Forty patients with chronic venous ulcers were included in this study, with a mean age of 60 years. Eleven patients were males and 29 were females. All patients had normal ankle brachial index and a venous ulcer of at least 8 weeks duration. Immuno-histochemistry using monoclonal antibodies to PDGF-AA, MMP-2, TIMP-2 and EMMPRIN was carried out on paraffin embedded punch biopsy skin specimens from the ulcer edge. Enzyme linked immunosorbent assay for PDGF, MMP-2 and TIMP-2 were carried out on wound fluids collected from patients. The ulcer size and character at the initial assessment and after 8 weeks were assessed to determine the status of ulcer healing. RESULTS No significant difference was seen in the expression of TIMP-2, MMP-2 and EMMPRIN between the two groups. However, in the non-healing group high levels of MMP-2 and low levels of TIMP-2 in the wound fluid suggest a strong correlation of these two markers in the state of healing. Analysis of wound fluid by ELISA demonstrated high PDGF-AA in the healing group (p = 0.021). Significantly increased levels of PDGF-AA (p<0001) was noted in the perivascular area on immuno-histochemistry of healing ulcers. These data suggest that PDGF-AA plays an important role in healing of venous ulcers. CONCLUSION Non-healing venous ulcers are associated with greater activity MMP-2 activity. The ratio of MMPs to their inhibitors TIMPs, dictate the rate of healing of the ulcers. PDGF-AA activity is associated with ulcer healing, though the mechanism is unclear. EMMPRIN expression in chronic venous ulcers probably parallels the chronicity of the condition rather than propagate it. However, further studies with larger samples are needed.
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Affiliation(s)
- B Mwaura
- Department of Vascular and Endovascular Surgery, and Western Vascular Institute, University College Hospital, Galway, Ireland
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31
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Adham M, Valette PJ, Partensky C. Pancreaticobiliary maljunction without choledochal dilatation associated with gallbladder cancer: report of 2 European cases. Surgery 2006; 138:961. [PMID: 16291403 DOI: 10.1016/j.surg.2005.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Accepted: 07/07/2005] [Indexed: 10/25/2022]
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32
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Adham M, Mirza DF, Chapuis F, Mayer AD, Bramhall SR, Coldham C, Baulieux J, Buckels J. Results of vascular resections during pancreatectomy from two European centres: an analysis of survival and disease-free survival explicative factors. HPB (Oxford) 2006; 8:465-73. [PMID: 18333103 PMCID: PMC2020757 DOI: 10.1080/13651820600839944] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The object of our study was to report on the experience with vascular resections at pancreatectomy in two European specialist hepatopancreatobiliary centres and evaluate outcome and prognostic factors. PATIENTS AND METHODS From 1989 to 2002, 45 patients (21 men, 24 women) underwent pancreatectomy for a pancreatic mass: Whipple's procedure (n=33), total pancreatectomy (n=10) or left splenopancreatectomy (n=2), along with a vascular resection, i.e. venous (n=39), arterial (n=1) or venous + arterial (n=5). RESULTS Operative mortality was nil, postoperative mortality was 2.2% (n=1); 34 patients had an uneventful postoperative course. Reoperations were performed for portal vein thrombosis (n=1), pancreatic leak (n=1), gastric outlet syndrome (n=1) and gastrointestinal bleeding (n=1). In all, 43 patients had cancer on pathology examination, with retropancreatic invasion in 72% and lymph node extension in 62.8%. Resection was R0 in 21 cases. Vessel wall invasion was present in 13 cases and 19 had perivascular invasion. Disease-free survival (DFS) at 1, 2 and 3 years was 36.0%, 15.0% and 12.0%, respectively. Median DFS length was 8.7 months (95% CI: 7.2; 10.2). Overall survival rates were 56.6%, 28.9% and 19.2%, respectively. Median survival length was 14.2 months (95% CI: 9.8; 18.6). A multivariate analysis of prognostic variables identified tumour location (other than head of pancreas), neoadjuvant chemotherapy and advanced disease stage as adverse factors for DFS. CONCLUSION Survival and DFS rates of these patients are comparable to those without vascular resection. Tumour localization, tumour stage, neoadjuvant treatment and tumour recurrence are explanatory variables of survival. Tumour localization, tumour stage and neoadjuvant treatment were explanatory variables for DFS. However, the type and extent of vascular resections as well as vessel wall invasion does not affect survival and DFS.
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Affiliation(s)
- M. Adham
- Service de Chirurgie Digestive et de la Transplantation, Hôpital de la Croix RousseLyonFrance
| | - D. F. Mirza
- The Liver Unit, Queen Elisabeth HospitalBirminghamUK
| | - F. Chapuis
- Département d'Information Médicale, Hospices Civils de LyonLyonFrance
| | - A. D. Mayer
- The Liver Unit, Queen Elisabeth HospitalBirminghamUK
| | | | - C. Coldham
- The Liver Unit, Queen Elisabeth HospitalBirminghamUK
| | - J. Baulieux
- Service de Chirurgie Digestive et de la Transplantation, Hôpital de la Croix RousseLyonFrance
| | - J. Buckels
- The Liver Unit, Queen Elisabeth HospitalBirminghamUK
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Terryn F, Mabrut JY, Olagne E, Gignoux B, Garbit V, de La Roche E, Adham M, Gerard M, Souquet JC, Ducerf C, Baulieux J. [Gastrojejunocolic fistula, report of two recent cases with original management]. ACTA ACUST UNITED AC 2005; 130:491-4. [PMID: 16084484 DOI: 10.1016/j.anchir.2005.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Accepted: 04/27/2005] [Indexed: 11/26/2022]
Abstract
Gastrojejunocolic fistulae, ultimate complication of anastomotic peptic ulceration, are presently uncommon. We report two recent cases of postoperative gastrojejunocolic fistulas (after duodenal ulcer surgery and total duodenopancreatectomy), which were complicated at time of diagnosis (acute peritonitis and liver cirrhosis) and required a two-stage treatment.
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Affiliation(s)
- F Terryn
- Service de chirurgie générale digestive et de la transplantation hépatique, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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Cherki S, Mabrut JY, Adham M, De La Roche E, Ducerf C, Gouillat C, Berard P, Baulieux J. [Reinterventions for complication and defect of coloesophagoplasty]. Ann Chir 2005; 130:242-8. [PMID: 15847859 DOI: 10.1016/j.anchir.2005.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Accepted: 02/04/2005] [Indexed: 11/21/2022]
Abstract
AIM OF THE STUDY To report a series of 17 patients operated for a complication oesophagocoloplasty, with evaluation of therapeutic modalities, and both early and distant results. MATERIALS AND METHOD From 1985 to 2003, 17 patients with a mean age of 50 years (range: 23-76) were reoperated after coloplasty pediculated on left superior colic vessels. Initial diseases were caustic ingestion (N=7), cancer (N=6), oesophageal perforation (N=2), gastric lymphoma (N=1) and oesotracheal fistula (N=1). Coloplasty has been performed as a first-intent procedure in 13 cases and as a second-intent procedure after failure of a previous operation in 4 cases. Nine patients were initially operated in another center and were subsequently referred in our unit. Complications needing reoperation were graft necrosis in 8 cases (47%) and stricture in 9 cases (53%). All patients with necrosis were reoperated within the 10 first postoperative days. RESULTS Necroses were treated by complete (N=5) or partial (N=3) resection of the coloplasty. Strictures were treated by resection-reanastomosis (N=3), right ileocoloplasty (N=2), colic stricturoplasty (N=2), a free antebrachial flap (N=1) and a tubulized latissimus dorsi myocutaneous pedicled flap (N=1). The 30-day mortality rate was 12% (N=2) and the overall morbidity rate was 66%. All deaths occurred after reoperation for necrosis. Eleven patients (65%) kept or recovered digestive continuity (including the 9 with stenosis) and 8 (73%) eat normally. Four patients with transplant necrosis died before reestablishment. Four patients operated for necrosis died before restoration of digestive continuity and 2 patients are still awaiting restoration. CONCLUSION Use of colon as an oesophageal substitute is risky. Reoperations for stenosis allows satisfactory oral feeding, while reoperation for necrosis is associated with both high early mortality and a low rate of restoration or digestive continuity. This later requires a range of complex surgical procedures.
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Affiliation(s)
- S Cherki
- Service de chirurgie générale et digestive et de la transplantation hépatique, hôpital de la Croix-Rousse, 103, rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
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El-Meteini M, Fayez A, Fathy M, Abdalaal A, Safaan H, Mostafa I, Abdalaal M, Syam M, Refay R, Abou-Alfetouh F, Khedr H, El-Halafawy Y, Taher Y, Hamed H, Badawy S, Ryad A, Awad H, Abdallah A, Ghafar TA, El-Monayeri M, Hoballah A, El-Dorry A, Adham M, Boillot O. Living related liver transplantation in Egypt: an emerging program. Transplant Proc 2004; 35:2783-6. [PMID: 14612119 DOI: 10.1016/j.transproceed.2003.09.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- M El-Meteini
- Department of Surgery, Ain-Shams University, Cairo, Egypt.
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Abstract
The feasibility of laparoscopic pancreatic resection has been demonstrated. However, the real clinical benefit for the patients remains questioned. The best indication for a laparoscopic approach appears to be the resection of benign or neuro-endocrine tumors without a need for pancreato-enteric reconstruction (i.e enucleation or distal pancreatectomy). The use of the laparoscopic approach for malignant tumors still remains controversial. The benefits of minimally invasive surgery are clearly correlated with the successful management of the pancreatic stump. Pancreatic related complication rate (fistula and collection) is 15% when using pancreatic transection with a laparoscopic endostappler.
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Affiliation(s)
- J-Y Mabrut
- Service de chirurgie générale, digestive et de la transplantation hépatique, hôpital de la Croix-Rousse, 103, Grande rue de la Croix-Rousse, 69317 Lyon 04, France.
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Bobin JY, Al-Lawati T, Granero LE, Adham M, Romestaing P, Chapet O, Issac S, Gerard JP. Surgical management of retroperitoneal sarcomas associated with external and intraoperative electron beam radiotherapy. Eur J Surg Oncol 2003; 29:676-81. [PMID: 14511617 DOI: 10.1016/s0748-7983(03)00139-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
AIMS To report outcomes of adults with retroperitoneal sarcoma (RS) treated by surgery, external beam radiotherapy (EBRT) and intraoperative electron beam radiotherapy (IORT). METHODS From July 1988 to February 2001; 24 patients with primary and recurrent RS were diagnosed and treated. The median dose and energy of IORT delivered was 15 Gy/9meV. EBRT dose varies between 45-50 Gy. RESULTS There were five primary and 19 recurrent tumours. One primary and five recurrent tumours underwent R0 resection. There were 12 liposarcomas and 19 grade I tumours; 13 patients developed local recurrence and three developed distant metastases.Twenty-two patients received IORT associated with EBRT: 11 developed recurrences. Six patients developed Neurotoxicity (4 grade II and 2 grade III). Disease free survival and overall survival at 5 years was 28 and 56% respectively. CONCLUSIONS EBRT with IORT treatment is a promising technique for local control. Lower recurrence rates are associated with radical (R0) surgical procedures.
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Affiliation(s)
- J Y Bobin
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 69495 Pierre Benite Cedex, France.
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Glehen O, Chapet O, Adham M, Nemoz JC, Gerard JP. Long-term results of the Lyons R90-01 randomized trial of preoperative radiotherapy with delayed surgery and its effect on sphincter-saving surgery in rectal cancer. Br J Surg 2003; 90:996-8. [PMID: 12905554 DOI: 10.1002/bjs.4162] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [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: 12/23/2022]
Abstract
Delayed surgery does not reduce local recurrance or improve survival
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Affiliation(s)
- O Glehen
- Department of Surgery, Centre Hospitalier Lyon-Sud, Lyons, France.
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39
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Cherki S, Adham M, Bizollon T, Gaudin JL, Baulieux J. [Intussusception of the small intestine due to Peutz-Jeghers syndrome: a case report and review of the literature]. Ann Chir 2002; 127:714-7. [PMID: 12658833 DOI: 10.1016/s0003-3944(02)00867-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
One case of small bowel's intussuception has been found in one patient with abdominal pains. Since 13 years this patient has a Peutz-Jeghers syndrome. A resection of the small bowel has been performed followed by total intraoperative enteroscopy. Besides small bowel, Peutz-Jeghers syndrome can affect many organs with an increased risk for cancer for patients affected by this genetic disease.
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Affiliation(s)
- S Cherki
- Service de chirurgie générale et digestive et de la transplantation hépatique, hôpital de la Croix-Rousse, 103, rue de la Croix-Rousse, 69317 Lyon, France.
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Costa AM, Tuchweber B, Rubbia-Brandt L, Peyrol S, Chevallie M, Adham M, Gabbiani G, Rosenbaum J, Desmoulière A. Early activation of hepatic stellate cells and perisinusoidal extracellular matrix changes during ex vivo pig liver perfusion. J Submicrosc Cytol Pathol 2001; 33:231-40. [PMID: 11846091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
In previous works, we observed during liver transplantation procedure, the early activation of hepatic stellate cells (HSC) which acquire alpha-smooth muscle (SM) actin expression. In this study, we evaluated changes in HSC and in perisinusoidal extracellular matrix during ex vivo pig liver perfusion. Under general anesthesia, pig livers were flushed and removed, and then perfused ex vivo for 6 h with homologous blood. Liver biopsies were taken before and after washout, at 5 min perfusion, and then hourly. Tissues were processed for immunohistochemistry, immunofluorescence, confocal microscopy, in situ hybridization and electron microscopy. Before and after liver washout, alpha-SM actin was present in vessel walls but in very few lobular HSC. After 1 h perfusion, a strong reactivity for alpha-SM actin was present in HSC, particularly along dilated sinusoids. At the ultrastructural level, numerous microfilament bundles appeared in HSC cytoplasmic processes. During perfusion, type I and type IV collagens, type III procollagen, and fibronectin acquired a looser organisation in relation with the enlargement of perisinusoidal spaces; laminin appeared in perisinusoidal spaces around portal areas and fibrillin deposits increased. In situ hybridization studies showed an increase of the type I procollagen mRNA expression mainly in portal tracts and septa. Ex vivo liver perfusion induces: 1) an early activation of HSC which acquire the expression of alpha-SM actin, and 2) significant changes in the perisinusoidal extracellular matrix. These results are compatible with the view that HSC function as liver specific pericytes participating in the regulation of sinusoidal blood pressure.
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Affiliation(s)
- A M Costa
- Research Group for Liver Study, INSERM E99 17, Victor Segalen University, Bordeaux, France
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41
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Affiliation(s)
- M Adham
- Department of General, Digestive Surgery and Liver Transplantation. Croix Rousse Hospital, Lyon, France.
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42
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Mabrut JY, Adham M, Bourgeot JP, Eljaafari A, DelaRoche E, Ducerf C, Baulieux J, Rigal D. Mechanical and histological characteristics of human trachea before and after cryopreservation: an opportunity for tracheal tissue banking. Transplant Proc 2001; 33:609-11. [PMID: 11266982 DOI: 10.1016/s0041-1345(00)02166-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- J Y Mabrut
- Department of Surgery and Transplantation, Croix-Rousse Hospital, Lyon, France
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43
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Olagne E, Baulieux J, de la Roche E, Adham M, Berthoux N, Bourdeix O, Gerard JP, Ducerf C. Functional results of delayed coloanal anastomosis after preoperative radiotherapy for lower third rectal cancer. J Am Coll Surg 2000; 191:643-9. [PMID: 11129813 DOI: 10.1016/s1072-7515(00)00756-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to assess functional outcomes of patients who had a delayed coloanal anastomosis for a lower third rectal cancer after preoperative radiotherapy. STUDY DESIGN From January 1988 to December 1997, 35 patients with an adenocarcinoma of the lower third of the rectum received preoperative radiotherapy (45Gy) followed by a rectal resection, combining an abdominal and transanal approach. Colorectal resection was performed about 32 days after the end of the radiotherapy. The distal colon stump was pulled through the anal canal. On postoperative day 5 the colonic stump was resected and a direct coloanal anastomosis performed without colostomia diversion. RESULTS There was no mortality. There was no leakage. One patient had a pelvic abscess. One patient had a necrosis of the left colon requiring reoperation. Another delayed coloanal anastomosis could be performed. Median followup was 43 months (range 6 to 113 months). Functional results were evaluated with a new scoring system including 13 items. Function was considered good in 59% and 70% at 1 and 2 years, respectively. CONCLUSIONS This new procedure is a safe and effective sphincter-preserving operation that avoids a diverting stoma for patients with rectal cancer of the lower third of the rectum. This technique is well adapted for patients receiving preoperative radiotherapy, with low local morbidity and good functional results. Further adaptation could be imagined for a coelioscopic approach.
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Affiliation(s)
- E Olagne
- Department of General and Digestive Surgery, Croix Rousse Hospital, Lyon, France
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Bizollon T, Ahmed SN, Guichard S, Chevallier P, Adham M, Ducerf C, Baulieux J, Trepo C. Anti-hepatitis C virus core IgM antibodies correlate with hepatitis C recurrence and its severity in liver transplant patients. Gut 2000; 47:698-702. [PMID: 11034588 PMCID: PMC1728104 DOI: 10.1136/gut.47.5.698] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND The significance of immunoglobulin (Ig) M antibody to hepatitis C virus (HCV) core antigen was studied in 60 patients with HCV infection after orthotopic liver transplantation (OLT) diagnosed by polymerase chain reaction. METHODS Patients were followed up for a mean of 28 months after transplantation. Sera collected three months before transplantation, and one and 12 months after transplantation were analysed for anti-HCV core IgM (HCV-IgM EIA 2.0 assay). After OLT protocol biopsies, procedures were performed routinely every six months. Semiquantitative histopathological assessment of allograft hepatitis was performed using Knodell's score. The results were correlated with clinical features, liver histology findings, and virological features, such as genotype and viraemic levels assessed by a branched DNA assay. RESULTS One year after liver transplantation, 29/60 (48%) patients had chronic hepatitis on graft biopsy. The presence of anti-HCV core IgM one month (p=0.004) and 12 months (p=0.003) after OLT was positively correlated with recurrence of chronic hepatitis. The positive predictive value of anti-HCV core IgM detected one month after transplantation was 0.88. A significant relationship was observed between severity of graft disease and presence of anti-HCV core IgM 12 months after transplantation. The mean Knodell score was 8.9 in anti-HCV core IgM positive patients compared with 3.6 in those who were anti-HCV core IgM negative (p=0.001). The presence of IgM anti-HCV did not correlate with serum HCV RNA level or HCV genotype. CONCLUSION We confirm that the presence of anti-HCV core IgM after OLT is a marker of HCV induced graft damage. The recurrence and severity of HCV hepatitis in patients undergoing OLT for HCV cirrhosis is related to the presence of anti-HCV core IgM after liver transplantation. These findings have diagnostic relevance and confirm that measurement of IgM anti-HCV core may help to better monitor the treatment of HCV recurrence after transplantation.
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Affiliation(s)
- T Bizollon
- Hepatology Unit, Hôtel-Dieu, Lyon 69288, France.
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45
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Adham M, Baulieux J, Mornex F, de La Roche de Bransat E, Ducerf C, Souquet JC, Gerard JP. Combined chemotherapy and radiotherapy followed by surgery in the treatment of patients with squamous cell carcinoma of the esophagus. Cancer 2000; 89:946-54. [PMID: 10964323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Surgery remains the treatment of choice for patients with esophageal squamous cell carcinoma (SCC), but survival rates have not improved over the past decades. The objective of this study was to evaluate the effect of multimodal therapy on resectability, on the overall and on disease free survival (DFS) rates, and on the laryngeal resection rate. METHODS Fifty-five patients (49 men and 6 women) with a mean age of 58 +/- 8 years underwent combined modality treatment for esophageal SCC. The tumor location was in the upper one-third of the esophagus in 19 patients, the middle one-third in 22 patients, the lower one-third in 9 patients, and the upper and lower one-thirds in 5 patients. The intent of combined therapy was curative in 87.3% of patients and palliative in 12.7% of patients. Neoadjuvant treatment consisted of two courses of 5-fluorouracil and cisplatin on Days 1-5 and Days 21-25. Radiotherapy was commenced on Day 21 and consisted of 36 grays delivered in 12 fractions over 17 days. Surgery was performed on Day 60. RESULTS Full neoadjuvant treatment was possible in 67.3% of patients and was uneventful in 56. 4% of patients. The resection rate was 96.4% (complete macroscopic resection with histologic clear margins [R0], 83.6%; complete macroscopic resection with microscopic disease at the resection margin [R1], 1.8%; and macroscopic residual disease [R2], 10.9%). The operative mortality rate was 0%, whereas the hospital mortality was 7.3%. Twenty-three patients had a complete macroscopic response, 12 of whom (21.8%) had a complete histopathologic response. The tumor stages according to the American Joint Committee on Cancer staging system were pT0N0 in 12 patients, Stage 0 in 8 patients, Stage IIa in 6 patients, Stage IIb in 6 patients, Stage III in 8 patients, and Stage IV in 13 patients. Laryngeal preservation was achieved in 8 of 12 patients in whom total pharyngolaryngoesophagectomy initially was indicated because of tumor response and an R0 resection. The overall survival rates at 1 year, 3 years, and 5 years were 61%, 39%, and 33%, respectively, and the DFS rates were 49%, 32%, and 29%, respectively. The respective survival rates for responders were 82%, 58%, and 53%, and the DFS rates were 68%, 54%, and 48%. CONCLUSIONS Neoadjuvant treatment is tolerated well by most patients. Combination therapy increases the resectability rate and facilitates laryngeal preservation. Significant improvements in the actuarial survival rate and the DFS rate were observed in the group of patients who achieved partial and complete responses.
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Affiliation(s)
- M Adham
- Department of General, Digestive Surgery and Liver Transplantation, Croix Rousse Hospital, Lyon, France. [corrected]
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Abstract
Although percutaneous endoscopic gastrostomy (PEG) has become a common technique for the placement of gastrostomy tubes, gastrostomy can be performed via the laparoscopic approach with minimal trauma or by using a percutaneous gastrostomy kit. In this report, we describe two procedures for laparoscopic gastrostomy using standard instruments. Standard laparoscopic techniques are used to create a pneumoperitoneum. In the first method, three transparieto-transgastric U stitches are placed to surround the site selected for the gastrostomy. A Foley catheter is inserted through the abdominal and gastric opening, then tied to the stomach with a pursestring suture. Traction on the balloon catheter brings the stomach to the anterior abdominal wall, where the three U stitches can be tied. In the second method, a 9-cm vascularized isoperistaltic gastric tube is made on the greater curvature using an endoscopic linear cutter and preserving the gastro-omental vessels. This gastric tube is then brought out through the anterior abdominal wall via a trocar orifice, opened, and fixed to the skin as for standard ostomy. Laparoscopic gastrostomy is a straightforward procedure that reduces postoperative pain and ileus. It obviates the need for a laparotomy while creating an adequate gastrostomy. Postoperative recovery is prompt, with rapid return of intestinal function and early discharge from the hospital. It not only represents an alternative to PEG when this route is not suitable or after failure of the procedure, but can also be widely used for patients as a first choice.
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Affiliation(s)
- M Adham
- Department of General and Digestive Surgery and Liver Transplantation, Croix-Rousse Hospital, 93, Gde rue de la Croix Rousse, 69317 Lyon cedex, France.
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Adham M, Blanc P, Douek P, Henri L, Ducerf C, Baulieux J. Laparoscopic resection of a proximal splenic artery aneurysm. Surg Endosc 2000; 14:372. [PMID: 10854524 DOI: 10.1007/s004640010051] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/1999] [Accepted: 09/15/1999] [Indexed: 10/25/2022]
Abstract
The usual treatment for splenic artery aneurysm is resection under laparotomy. In recent years, the laparoscopic approach has consisted of ligation without resection. More recently,laparoscopic resection was reported by the Cleveland Clinic. In this paper, we describe the technique used in the laparoscopic resection of our first case of laparoscopic resection of splenic artery aneurysm (SAA). The patient was a young woman with a 12-mm SAA discovered on systematic abdominal ultrasound. The laparoscopic procedure was done successfully, and the aneurysm was resected using an ultrasonic dissector. The postoperative course was uneventful, and the patient was discharged on the 3rd postoperative day. Pathological examination revealed the atherosclerotic origin of the aneurysm. The patient is doing well 12 months after surgery, with normal splanchnic Doppler ultrasound. This procedure offers a one-step definitive cure via a minimally invasive surgical procedure.
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Affiliation(s)
- M Adham
- Department of General and Gastrointestinal Surgery and Liver Transplantation, Croix Rousse Hospital, 103, Gde rue de la Croix Rousse, 69317 Lyon, France.
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Blanc P, Adham M, Berthoux N, Baulieux J. [Extended venous ischemia of the small intestine caused by portal thrombosis. Value of diagnostic celioscopy and intestinal bi-exclusion (Thiry-Vella technique)]. Ann Chir 2000; 53:920-4. [PMID: 10633945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Mesenteric venous thrombosis is a rare disease with no specific signs. It's major risk is intestinal ischaemia and necrosis. We report the case of a young women who presented with unexplained abdominal pain and subnormal abdominal ultrasound. The diagnosis was made on laparoscopic exploration which allowed anticoagulant therapy followed by proximal and distal divertingostomies of the ischemic bowel. Small bowel continuity was re-established after 3 month of total parenteral nutrition. The patients is doing well 1 year after surgery. She is still under anticoagulant therapy. The etiology found was a hypermegacaryocytosis as seen in myeloproliferative disease.
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Affiliation(s)
- P Blanc
- Service de Chirurgie Générale Digestive et Transplantation Hépatique, Hôpital de la Croix-Rousse, Lyon
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Ducerf C, Mechet I, Landry JL, DeLaRoche E, Berthoux N, Bourdeix O, Adham M, Bizollon T, Baulieux J. Hemodynamic profiles during piggyback liver grafts using arterial or portal revascularization. J Am Coll Surg 2000; 190:89-93. [PMID: 10625238 DOI: 10.1016/s1072-7515(99)00227-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The order of revascularization in human liver grafts is still discussed. This study tries to answer this question in terms of hemodynamic data. STUDY DESIGN Fifty-nine patients were randomized in this study to compare hemodynamic data just before and 15 minutes after revascularization of liver grafts in relation to first hepatic artery (n = 29) or first portal vein (n = 30) revascularization procedure. RESULTS Hemodynamic variations were significantly greater in the portal vein group than in the hepatic artery group in terms of mean arterial pressure, cardiac index, central venous pressure, pulmonary capillary pressure, and systemic vascular resistance. The latter decreased from 741.8 +/- 390.3 to 659.9 +/- 411.1 dynes/ cm5 (NS) in the hepatic artery group versus 807.7 +/-336.7 to 439.7 +/- 215 dynes/cm5 (p < 0.05) in the portal vein group. Clinical results and postoperative complications, graft characteristics, patient survival, and graft survival were not significantly different between the groups. CONCLUSIONS Initial arterial revascularization of the liver graft leads to a more stable hemodynamic profile during revascularization of the liver graft after vascular unclamping. This technique is always feasible and has become our reference procedure.
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Affiliation(s)
- C Ducerf
- Department of Digestive Surgery and Transplantation, Croix-Rousse Hospital, Lyon, France
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Baulieux J, Mabrut JY, Ducerf C, Adham M, de la Roche E, Berthoux N, Bourdeix O, Gaudin JL, Souquet JC. [Barrett's esophagus and antireflux surgery: a study of a series of 26 patients]. Chirurgie 1999; 124:398-405. [PMID: 10546393 DOI: 10.1016/s0001-4001(00)80012-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY AIM The aim of this study was to report the results of a retrospective series of 26 patients with Barrett's esophagus treated by antireflux surgery. PATIENTS AND METHODS From 1979 to 1998, 21 men and five women (mean age: 53 years) with histologically proven Barrett's esophagus underwent an antireflux procedure. The mean length of Barrett's epithelium was 5.9 cm for 19 patients (73.1%). Six patients (23.1%) had tongue lesions of Barrett's epithelium, and one (3.8%) had ectopic gastric mucosa. None of the patients had a preoperative esophageal biopsy that revealed high-grade dysplasia or carcinoma. Laparotomy was performed in 17 cases and laparoscopy in nine cases. Preoperative endoscopic local treatment with argon coagulation was performed in one patient. RESULTS Clinical mean follow-up was 78 months and endoscopic mean follow-up was 59.3 months. No increase in the length of the Barrett's epithelium was observed. Seven patients (27%) had complete or partial regression (among them three patients with tongue lesions and one patient preoperatively treated by argon). No patients developed high-grade dysplasia or carcinoma. CONCLUSION Regression of Barrett's esophagus is possible but not frequent and unpredictable after antireflux procedure. However, endoscopic and histological surveillance should be continued postoperatively.
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Affiliation(s)
- J Baulieux
- Service de chirurgie et de la transplantation hépatique, hôpital de la Croix-Rousse, Lyon, France
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