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Diciolla A, Gianoni M, Fleury M, Szturz P, Demartines N, Peters S, Duran R, Desseauve D, Panchaud MA, Fasquelle F, Digklia A. Gallbladder cancer during pregnancy treated with surgery and adjuvant gemcitabine: A case report and review of the literature. Front Oncol 2022; 12:1006387. [PMID: 36353558 PMCID: PMC9638103 DOI: 10.3389/fonc.2022.1006387] [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] [Received: 08/03/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundGallbladder cancer (GBC) represents the most common biliary tract cancer. Prognosis remains poor with 5-year overall survival rates less than 5% in advanced stages. GBCs are diagnosed more frequently in women, supposedly due to endocrine factors.CaseA 35-year-old woman, diagnosed with a non-metastatic GBC in the 22nd week of gestation, underwent a complete surgical resection 5 weeks later. Adjuvant gemcitabine was administered without complications, temporarily discontinued in the 32nd week to allow childbirth. The patient was disease-free for more than 3 years with ongoing remission at the last visit in July 2022. During the follow-up period, the child had no developmental, cognitive, or other health issues.ConclusionMalignant tumors occur in about 0.1% of pregnant women, many are treated with chemotherapy. In oncology, the need to deliver optimal treatment in these patients represents a major concern. Both surgery and adjuvant chemotherapy of locally advanced GBC can be performed safely, with certain considerations, in the second trimester of pregnancy.
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Affiliation(s)
- A. Diciolla
- Département d’Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - M. Gianoni
- University of Lausanne (UNIL) et Service de Gynécologie, CHUV, Lausanne, Switzerland
| | - M. Fleury
- Département d’Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - P. Szturz
- Département d’Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - N. Demartines
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - S. Peters
- Département d’Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - R. Duran
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - D. Desseauve
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Monnat A. Panchaud
- Service of Pharmacy Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - F. Fasquelle
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Institut Universitaire de Pathologie, Pathologie Clinique, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - A. Digklia
- Département d’Oncologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- *Correspondence: A. Digklia,
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2
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Delabays C, Demartines N, Melloul E, Joliat G. Enhanced Recovery After Surgery (ERAS) after liver surgery in cirrhotic patients: A systematic review and meta-analysis. Clin Nutr ESPEN 2022. [DOI: 10.1016/j.clnesp.2022.06.023] [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: 11/27/2022]
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3
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Matter M, Mateev E, Sykiotis G, Demartines N. Hypocortisolemia following unilateral adrenalectomy. Br J Surg 2022. [DOI: 10.1093/bjs/znac177.001] [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
Unilateral adrenalectomy (UA) is the best option for unilateral functioning and non-functioning adrenal adenomas, localized primary or metastatic carcinomas. Post-operative hypocortisolemia (HC) in Cushing Syndrome is well known, but several studies reported HC after UA for other indications. A systematic full endocrine investigation for all adrenal mass is not systematic and dexamethasone suppression test (DST) is not recommended in non-Cushing functioning tumours. Double secretion (autonomous cortisol co-secretion) is a rare phenomenon. The purpose of the study was to review incidence of postoperative HC in a tertiary centre.
Methods
Retrospective study (2012–2020) looking for hypocortisolemia after UA in patients operated for Cushing Syndrome and other endocrine tumours. Pre- and postoperative laboratory findings were reviewed in a total of 115 patients with UA. Patients receiving perioperative dexamethasone (DEX) for nausea and vomiting prophylaxis were included as well.
Results
UA (51 right and 64 left) were performed in 47 women and 68 men (mean age 53.5 y.), laparoscopically in 97 (84.3%, 3 converted). UA indications included: Cushing (8), autonomous cortisol secretion (10, in 2 with combined Conn), Conn syndrome (37), pheochromocytoma (24), non-functioning adenoma (10, adrenal carcinoma (3), adrenal metastasis (19) and other diagnosis (4). 18 patients had a preoperative DST (15.7%). Anaesthesia reports revealed that 53/115 patients received DEX. 51/115 patients had a control of postoperative cortisol level. Hypocortisolemia was observed overall in 28/51 patients, by excluding Cushing patients in 24/45, in 19/53 patients who received DEX and in 7/48 in those without DEX. Confusion comes when patients receiving DEX had normal postoperative cortisolemia.
Conclusion
The fact that some patients received DEX (ERAS pathway), complicated the interpretation of cortisol levels at postoperative day one (D1). DEX is known to supress the hypothalamic-pituitary-adrenal axis (HPA axis) at D1. Thus, claiming that hypocortisolemia is the result of cortisol co-secretion (adenoma with double secretion), also able to supress the HPA axis, is not possible in patients who received DEX. These results suggests 1) to fully investigate all hormone functions in case of adrenal mass and 2) not administrating DEX in patients undergoing UA, for adequately assessing the HPA axis function postoperatively.
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Affiliation(s)
- M Matter
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - E Mateev
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - G Sykiotis
- Department of Endocrinology, Lausanne University Hospital , Lausanne, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
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4
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Gaspar-Figueiredo S, Joliat GR, Borgstein ABJ, Van Berge Henegouwen MI, Brunel C, Demartines N, Allemann P, Schäfer M. Impact of positive resection margins (R1) on long-term survival of patients with advanced diffuse type gastric cancer. Br J Surg 2022. [DOI: 10.1093/bjs/znac188.002] [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: 11/13/2022]
Abstract
Abstract
Objective
Gastric cancer (GC) is a leading cause of cancer-related mortality worldwide. Diffuse type GC have a much worse prognosis compared to intestinal type GC. There is an ongoing debate whether microscopic involvement of the proximal margin (R1 resection) influences overall survival (OS) in advanced gastric cancer.
The aim of this study was to assess OS in patients with diffuse gastric cancers and positive lymph node involvement who underwent oncological gastrectomy with R0 and R1 resections.
Methods
All consecutive patients from two tertiary centers operated with curative intent for diffuse gastric cancer between January 2005 and December 2018 were analyzed. Patients with R2 resections or missing data were excluded. Extracted data included demographics, major comorbidities, ASA score, neo-adjuvant treatment, pre- and postoperative staging (TNM 8th edition), postoperative complication with grading according to Clavien classification, survival data and pattern of recurrence. Lymph node involvement was based on pathology.
Kaplan-Meier curves with log-rank test for comparison were used to evaluate survival between groups.
Results
A total of 94 patients with diffuse gastric cancer were included. Two patients were excluded because of R2 resection and missing data regarding pathology, leaving a cohort of 92 patients (48 male, 44 female, median age 62 years). Sixty-four patients were lymph node positive (pN+); 48 patients (75%) with R0 resection and 16 patients (25%) with R1 resection. No difference in terms of preoperative data and intraoperative characteristics was found between R0 and R1 groups. Median OS was better in the R0 group (27 months, 95% CI 17–37) compared to R1 group (7 months, 95% CI 3–11, p<0.001). Similar results were found with disease-free survival (DSF) (25 vs. 6 months, p=0.002).
On multivariable analysis, T stage and resection margin (R status) were independent factors predicting OS (T stage: HR 4.5, p<0.001, R status: HR 4.2, p<0.001) and DFS (T stage: HR 2.9, p=0.004, R status: HR 3.5, p=0.001) in the cohort of patients with lymph node involvement.
Conclusion
The present series confirmed that patients with negative surgical margins have better OS compared to patients with positive margins in case of locally advanced diffuse GC. Therefore, R0 resections should be the goal of oncological gastrectomies.
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Affiliation(s)
- S Gaspar-Figueiredo
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - G-R Joliat
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - A B J Borgstein
- Department of Surgery, Amsterdam University Medical Center , Amsterdam, The Netherlands
| | | | - C Brunel
- Institute of Pathology, Lausanne University Hospital , Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - P Allemann
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
- Department of Surgery , Clinique de la Source, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
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5
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Deslarzes P, Jurt J, Hübner M, Demartines N, Grass F. Compliance to infection-preventing measures in colorectal surgery – a word of caution. Br J Surg 2022. [DOI: 10.1093/bjs/znac181.004] [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: 11/12/2022]
Abstract
Abstract
Objective
The success of a colorectal surgical site infection (SSI) preventing bundle is dependent on compliance to individual infection-preventing measures. The present study aimed to assess whether challenging circumstances may affect bundle compliance.
Methods
Retrospective analysis including consecutive patients undergoing colorectal surgery and appendectomy between November 2018 and October 2020, after implementation of an evidence-based SSI-preventing care bundle. Bundle items were antibiotic administration, disinfection, core temperature control, glove change, intra-abdominal lavage and drain placement according to pre-defined standards. Compliance to each item was assessed according to surgical duration, patient age and time of surgery.
Results
Over the study period, 463 patients underwent appendectomy, 458 patients colonic surgery and 98 patients rectal resections. Compliance to intraabdominal lavage standards decreased significantly with surgical duration of colonic resections (88% for surgeries lasting <90 minutes vs. 56% for surgeries lasting > 180 minutes), while similar decreasing compliance patterns were observed regarding intraabdominal drain placement (86% vs. 68%) and core temperature control (64% vs. 57%, all p>0.05) with long lasting procedures. Compliance to antibiotic timing and glove change recommendations was higher in patients undergoing day-time colectomies (08 h and 16 h) compared to patients operated on during night shifts (0h-08 h, 93% vs. 69% and 87% vs. 58%, respectively, both p<0.05). Specific compliance patterns were not observed in patients undergoing appendectomy or rectal surgery. Furthermore, patient age had no impact on bundle compliance.
Conclusion
The present study revealed decreasing compliance to several infection-preventing bundle items with increasing surgical duration and during night shifts. This may contribute to worse outcomes in these challenging settings but may be a point of attention that can be corrected.
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Affiliation(s)
- P Deslarzes
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - J Jurt
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - F Grass
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
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6
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Joliat GR, de Man R, Rijckborst V, Cimino M, Torzilli G, Choi GH, Lee HS, Goh B, Kokudo T, Shirata C, Hasegawa K, Nishioka Y, Vauthey JN, Baimas-George M, Vrochides D, Demartines N, Halkic N, Labgaa I. Long-term outcomes of ruptured hepatocellular carcinoma: An international multicentric propensity score-matched study. Br J Surg 2022. [DOI: 10.1093/bjs/znac178.002] [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
Long-term outcomes of patients with ruptured hepatocellular carcinoma (rHCC) remain scant. This study aimed to assess disease-free survival (DFS) and overall survival (OS) after surgical resection of rHCC compared to non-ruptured HCC (nrHCC).
Methods
Patients with rHCC and nrHCC were collected from 8 centers in Europe, Asia, and North America. Resected rHCC patients were matched 1:1 to patients undergoing surgery for nrHCC using propensity score and nearest-neighbor method (matching criteria: age, tumor size, cirrhosis, Child-Pugh score, Barcelona Clinic Liver Cancer stage, resection status, grade, and microvascular invasion). Survival rates were calculated using Kaplan-Meier method.
Results
A total of 2033 patients were included: 226 rHCC patients (172 operated: 68 with upfront surgery and 104 after embolization) and 1807 nrHCC patients. Median DFS and OS of rHCC patients (all treatments confounded) were 10 months (95% CI 7–13) and 22 months (95% CI 13–31). Prognostic factors for worse OS among rHCC patients were absence of preoperative arterial embolization (HR 2.3, 95% CI 1.2–4.6, p=0.016), cirrhosis Child B/C (HR 2.4, 95% CI 1.1–5.4, p=0.040), and R1/R2 margins (HR 2, 95% CI 1–5, p=0.049). Survivals were similar between Western and Eastern rHCC patients.
After propensity score matching, 106 rHCC patients and 106 nrHCC patients displayed similar characteristics. Patients with rHCC had shorter median DFS (12 months, 95% CI 7–17 vs. 22 months, 95% CI 12–32, p=0.011), but similar median OS compared to nrHCC patients (43 months, 95% CI 21–65 vs. 63 months, 95% CI 21–105, p=0.060).
Conclusion
In this large dataset including Eastern and Western patients, rHCC was associated with shorter DFS compared to nrHCC, while OS was similar.
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Affiliation(s)
- G-R Joliat
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - R de Man
- Department of Gastroenterology and Hepatology, Erasmus Medical Center , Rotterdam, The Netherlands
| | - V Rijckborst
- Department of Gastroenterology and Hepatology, Erasmus Medical Center , Rotterdam, The Netherlands
| | - M Cimino
- Department of General and Minimally Invasive Surgery, Humanitas Clinical and Research Hospital , Milan, Italy
| | - G Torzilli
- Department of General and Minimally Invasive Surgery, Humanitas Clinical and Research Hospital , Milan, Italy
| | - G H Choi
- Department of Surgery, Yonsei University College of Medicine , Seoul, South Korea
| | - H S Lee
- Department of Surgery, Yonsei University College of Medicine , Seoul, South Korea
| | - B Goh
- Department of Surgery, Singapore General Hospital , Singapore, Singapore
| | - T Kokudo
- Department of Surgery, The University of Tokyo Hospital , Tokyo, Japan
| | - C Shirata
- Department of Surgery, The University of Tokyo Hospital , Tokyo, Japan
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - K Hasegawa
- Department of Surgery, The University of Tokyo Hospital , Tokyo, Japan
| | - Y Nishioka
- Department of Surgical Oncology, MD Anderson Cancer Center , Houston, USA
| | - J-N Vauthey
- Department of Surgical Oncology, MD Anderson Cancer Center , Houston, USA
| | - M Baimas-George
- Department of Surgery, Atrium Health, Carolinas Medical Center , Charlotte, USA
| | - D Vrochides
- Department of Surgery, Atrium Health, Carolinas Medical Center , Charlotte, USA
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - N Halkic
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - I Labgaa
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
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7
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Zwicky SN, Gloor S, Tschan F, Candinas D, Demartines N, Weber M, Beldi G. Impact of gender on surgical site infections in abdominal surgery: A multi-center study. Br J Surg 2022. [DOI: 10.1093/bjs/znac181.002] [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: 11/13/2022]
Abstract
Abstract
Objective
Male sex is controversially discussed as a risk factor for surgical site infections (SSI). The aim of the present study was to evaluate the impact of gender on SSI in abdominal surgery under elimination of relevant confounders.
Methods
Clinicopathological data of 6603 patients undergoing abdominal surgery from a multi-center prospective database of four Swiss hospitals including patients between 2015 and 2018 were assessed. Patients were stratified according to postoperative SSI and risk factors for SSI were assessed using univariate and multivariate analysis.
Results
In 649 of 6603 patients SSI was reported (9.8%). SSI was significantly associated with increased risk of reoperation (22.7% vs. 3.4%, p <0.001), higher mortality rate (4.6% vs. 0.9%, p <0.001) and higher rate of length of hospital stay > 75th percentile (57.0% vs. 17.9%, p <0.001). In univariate analysis male sex was a significant risk factor for SSI (p = 0.01). In multivariate analysis including multiple confounders’ such as comorbidities and perioperative factors there was no association between male sex and risk of SSI (OR 1.1 [CI 0.8–1.4]). BMI >= 30 kg/m2 (OR 1.8 [CI 1.3–2.3]), duration of surgery > 75th percentile (OR 2.3 [1.8–2.9]), high contamination level (OR 1.3 [1.0–1.6]), laparotomy (OR 1.3 [1.0–1.7]), previous laparotomy (OR 1.4 [1.1–1.7]), blood transfusion (OR 1.7 [1.2–2.4]), cancer (OR 1.3 [1.0–1.8]), malnutrition (OR 2.5 [1.8–3.4]) were independent risk factors for SSI in multivariate analysis.
Conclusion
Under elimination of relevant confounders there is no significant correlation between gender and risk of SSI after abdominal surgery. Independent risk factors for SSI as BMI >= 30 kg/m2, duration of surgery > 75th percentile, high contamination level, surgical approach or malnutrition should be considered during treatment.
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Affiliation(s)
- S N Zwicky
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital , Bern, Switzerland
| | - S Gloor
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital , Bern, Switzerland
| | - F Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel , Neuchâtel, Switzerland
| | - D Candinas
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital , Bern, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital , Lausanne, Switzerland
| | - M Weber
- Department of Surgery, Triemli Hospital Zurich , Zurich, Switzerland
| | - G Beldi
- Department for Visceral Surgery and Medicine, Inselspital, Bern University Hospital , Bern, Switzerland
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8
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Hanzalova I, Schäfer M, Demartines N, Clerc D. Spigelian hernia: current approaches to surgical treatment-a review. Hernia 2021; 26:1427-1433. [PMID: 34665343 DOI: 10.1007/s10029-021-02511-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/05/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Spigelian hernias (SpH) belong to the group of eponymous abdominal wall hernias. Major reasons for diagnostic difficulties are its low incidence reaching maximum 2% of abdominal wall hernias, a specific anatomical localization with intact external oblique aponeurosis covering the hernia sac and non-constant clinical presentation. METHODS A literature review was completed to summarize current knowledge on surgical treatment options and results. RESULTS SpH presents a high incarceration risk and therefore should be operated upon even if the patient is asymptomatic. Both laparoscopic and open repair approaches are validated by current guidelines with lesser postoperative complications and shorter hospital stay in favour of minimally invasive surgery, regardless of the technique used. Overall recurrence rate is very low. CONCLUSION All diagnosed SpH should be planned for elective operation to prevent strangulated hernia and, therefore emergency surgery. Both open and laparoscopic SpH treatment can be safely performed, depending on surgeon's experience. In most cases, a mesh repair is generally advised.
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Affiliation(s)
- I Hanzalova
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
| | - D Clerc
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland
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9
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Bordry N, Germann M, Foukas PG, Sempoux C, Yan P, Dormond O, Speiser DE, Demartines N, Sauvain MO. Immune cell infiltration in colonic cancer: correlation between biopsy and surgical specimens. Br J Surg 2021; 108:346-350. [PMID: 33792645 DOI: 10.1093/bjs/znaa142] [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] [Received: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 11/14/2022]
Abstract
Infiltration of CD3+ and CD8+ T cells in tumour biopsies of patients with colonic cancer correlated positively with CD3+ and CD8+ T cell infiltration in matched tumour surgical specimens. This opens new perspectives in the potential of tumour biopsies for prognosis and treatment decisions.
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Affiliation(s)
- N Bordry
- Department of Oncology, University Hospital of Geneva, Geneva, Switzerland
| | - M Germann
- Ecole Polytechnique Fédérale de Lausanne, School of Life Sciences, Swiss Institute for Experimental Cancer Research, Lausanne, Switzerland
| | - P G Foukas
- Second Department of Pathology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - C Sempoux
- Institute of Pathology, Lausanne University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - P Yan
- Institute of Pathology, Lausanne University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - O Dormond
- Department of Visceral Surgery, Lausanne University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - D E Speiser
- Department of Oncology, University of Lausanne, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - M-O Sauvain
- Department of Visceral Surgery, Lausanne University Hospital Centre and University of Lausanne, Lausanne, Switzerland.,Service de Chirurgie, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
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10
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Zandirad E, Teixeira-Farinha H, Demartines N, Schäfer M, Mantziari S. Multimodal management of gastroesophageal junction adenocarcinoma: Which type of neoadjuvant treatment? Br J Surg 2021. [DOI: 10.1093/bjs/znab202.002] [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: 11/13/2022]
Abstract
Abstract
Objective
The current treatment for locally advanced gastroesophageal junction (GEJ) adenocarcinoma consists of neoadjuvant treatment (NAT) followed by surgery. Preoperative chemotherapy (CT) and radio-chemotherapy (RCT) are both valid options, but comparative data for their efficacy remain scarce. This study aimed to assess the efficacy of RCT and CT to achieve a complete pathologic response (CPR) for locally advanced GEJ adenocarcinoma. Secondary endpoints were R0 resection rates, postoperative complications, long-term survival and recurrence.
Methods
All consecutive patients with locally advanced GEJ adenocarcinoma treated with CT or RCT and oncologic resection from 2009 to 2018 were included. A CPR was defined with the Mandard tumor regression score. Standard statistical tests were used as appropriate. Overall and disease-free survival were compared with the Kaplan Meier method and log-rank test. Multivariate analysis was performed to define independent predictors of CPR, and long-term survival.
Results
Among the 94 patients (84%male, median age 62 years [IQR 9.7]), 67 (71.3%) received preoperative RCT and 27 (28.7%) CT. Patient’s characteristics and pretreatment tumor stages were comparable. Surgical approach was thoracoabdominal Lewis resection in 95.5% RCT and 81.5% CT patients (P = 0.085). CPR was more frequent in the RCT than the CT group (13.4% vs 7.4%, P = 0.009), but R0 resection rates were similar (72.1% vs 66.7%, P = 0.628). There was a trend to higher ypN0 stage in the RCT group (55.2% vs 33.3%; P = 0.057). Postoperatively, RCT patients presented more cardiovascular complications (35.8% vs 11.1%; P = 0.017), although overall morbidity was similar (68.6% vs 62.9%, P = 0.988). 5-year overall survival was comparable (61.1% RCT vs 75.7% CT, P = 0.259), as was 5-year disease-free survival (33.5% RCT vs 22.8% CT, P = 0.763). Isolated loco-regional recurrence occurred in 2.9% RCT vs 3.7% CT patients (P = 0.976). NAT type was not an independent predictor for complete pathologic response nor long-term survival in the multivariate analysis. Median follow-up was 30 months [95%CI 21.3-38.8] for all patients.
Conclusion
Patients with locally advanced GEJ adenocarcinoma demonstrated higher rates of CPR after RCT than CT, and a trend to a better lymph node sterilization, although this did not translate in a significant survival benefit or decreased recurrence rate.
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Affiliation(s)
- E Zandirad
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - H Teixeira-Farinha
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
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11
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Jurt J, Clerc D, Curchod P, Hübner M, Hahnloser D, Senn L, Demartines N, Grass F. Prospective surveillance after implementation of a colorectal surgical site infection prevention bundle. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.018] [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: 11/12/2022]
Abstract
Abstract
Objective
Surgical site infections (SSI) are the most frequent complications after colorectal surgery. The aim of the present study was to evaluate the impact of a standardized SSI prevention bundle.
Methods
The multimodal, evidence-based care bundle included 9 intraoperative items (antibiotic type, timing and re-dosing, desinfection, induction temperature control >36.5°, glove change, intracavity lavage, wound protection and closure strategy). The bundle was implemented in November 2018 and applied to all consecutive patients undergoing colonic resections. Demographics, surgical specifics and overall compliance to the care bundle were prospectively assessed until October 2020. The primary outcome SSI was defined according to the definition of the Center for Disease Control (CDC) and independently assessed by the National Infection Surveillance Committee (Swissnoso) up to 30 postoperative days. A historical, institutional pre-implementation control group (2012-2017, DOI: 10.1016/j.jhin.2018.09.011) with identical methodology was used for comparison.
Results
In total, 243 patients were included. The control group included 1’263 patients. Both groups were comparable regarding main demographics (age, sex, body mass index, American Society of Anaesthesiologists class) and surgical characteristics (type and duration of surgery). Overall compliance to the care bundle was 77% (IQR 77-88). Lowest compliance was observed for temperature control (48%), intracavity lavage (59%) and predefined wound closure strategy (74%). Surgical site infections were reported in 54 patients (22.2%) vs. 21.4% in the control group, p = 0.79. Infection rates were comparable throughout the CDC categories: superficial: 11 patients (4.5%) vs. 4.2%, p = 0.82, deep incisional: 9 patients (3.7%) vs. 5.1%, p = 0.34, organ space: 34 (14%) vs. 12.4%, p = 0.48.
Conclusion
Implementation of a standardized surgical care bundle had no impact on SSI rates according to these preliminary results. Improved compliance to individual measures may help to achieve a clinical benefit.
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Affiliation(s)
- J Jurt
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - D Clerc
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - P Curchod
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - D Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - L Senn
- Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Grass
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
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12
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Schneider M, Hübner M, Becce F, Koerfer J, Collinot JA, Demartines N, Hahnloser D, Grass F, Martin D. Sarcopenia and surgical outcomes in patients undergoing oncologic colonic surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.012] [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: 11/13/2022]
Abstract
Abstract
Objective
Sarcopenia is a marker for malnutrition and frailty which could lead to higher complication rate and prolonged length of stay (LOS) after surgery. The study aim was to assess the correlation between sarcopenia and clinical outcomes in oncologic colonic surgery.
Methods
This retrospective study included consecutive patients operated between 2014 and 2019. Three radiological indices of sarcopenia were measured at the level of the third lumbar vertebra on preoperative CT scans: Skeletal Muscle Area (SMA), Skeletal Muscle Radiation Attenuation (SMRA), and Skeletal Muscle Index (SMI). Patients with major complications (> grade 3a) according to Clavien classification were compared to those without. Statistical correlation between sarcopenia indices, LOS and Comprehensive Complication Index (CCI) was tested by use of the Pearson correlation.
Results
A total of 325 patients were included, 50 (15.4%) with and 275 (84.6%) without major complications. SMA and SMI were comparable between both groups (respectively 126.0 vs 125.2 cm2, p = 0.974, and 43.4 vs 44.3 cm2/m2, p = 0.636), while SMRA was significantly lower in patients with major complications (33.6 vs 37.3 HU, p = 0.018). A lower SMRA was correlated with prolonged LOS (r=-0.207, p < 0.01) and higher CCI (r=-0.144, p < 0.01), while the other sarcopenia indices had no influence on surgical outcomes.
Conclusion
Preoperative SMRA or muscle quality appears to be a weak predictor for adverse outcomes after oncologic colectomy.
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Affiliation(s)
- M Schneider
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Becce
- Department of Radiology, Lausanne University Hospital, Lausanne, Lausanne
| | - J Koerfer
- Department of Radiology, Lausanne University Hospital, Lausanne, Lausanne
| | - J -A Collinot
- Department of Radiology, Lausanne University Hospital, Lausanne, Lausanne
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - D Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Grass
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - D Martin
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
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13
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Martin D, Besson C, Pache B, Michel A, Geinoz S, Gremeaux-Bader V, Larcinese A, Benaim C, Kayser B, Demartines N, Hübner M. Feasibility of a prehabilitation program before major abdominal surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.095] [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
Prehabilitation programs claim to improve exercise capacity and postoperative outcomes. The study aim was to assess the feasibility of a prehabilitation program and its effects on fitness and clinical outcomes after major abdominal surgery.
Methods
In this prospective pilot study, patients were assigned to high-intensity physical exercise training with 3 training sessions per week for 3 weeks preoperatively. Feasibility of this intervention was assessed based on recruitment and adherence to the training program. Impact on fitness (VO2 AT) was evaluated and correlated with complications and length of stay (LOS).
Results
Of 980 eligible patients, 87 patients (8.9%) were approached for inclusion. Main obstacles to not approach patients were insufficient time (< 3 weeks) prior to scheduled surgery (n = 276, 28.2%) or screening failure (n = 312, 31.8%). Out of these 87 patients, 24 (28%) declined to participate, 43 (49%) met exclusion criteria and 20 (23%) were included. Six patients (30%) could not complete the prehabilitation program due to contra-indication for exercise training evidenced during the test (n = 3), lack of motivation (n = 2) and modification of the planned operating date (n = 1). VO2 AT increased from 9.8 to 11.5 ml/min/kg (p = 0.050). There were no correlations between the change in VO2 AT and postoperative complications (r = -0.133, p = 0.649) and LOS (r = -0.94, p = 0.750).
Conclusion
Prehabilitation programs are difficult to implement and many patients are either not eligible or not motivated. Future efforts should concentrate on those patients who are most likely to benefit from these time- and cost-intensive interventions.
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Affiliation(s)
- D Martin
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - C Besson
- Sports Medicine Center, Physical Medicine and Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - B Pache
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - A Michel
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - S Geinoz
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - V Gremeaux-Bader
- Sports Medicine Center, Physical Medicine and Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - A Larcinese
- Physiotherapy, Lausanne University Hospital, Lausanne, Switzerland
| | - C Benaim
- Department of Rheumatology, Physical Medicine and Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - B Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
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14
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St-Amour P, Mantziari S, Dromain C, Winiker M, Godat S, Schöpfer A, Demartines N, Schäfer M. Preoperative hiatal hernia in oesophageal adenocarcinoma: An impact on patient outcomes? Br J Surg 2021. [DOI: 10.1093/bjs/znab202.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Uncontrolled gastroesophageal reflux and the often-associated hiatal hernia (HH) are frequently encountered in oesophageal adenocarcinoma patients. Previous data suggest unfavourable long-term oncologic outcomes in the presence of a HH, but the evidence remains scarce. The aim of this study was to assess the potential impact of preoperative HH on histologic response after neoadjuvant treatment (NAT), as well as on overall and disease-free survival.
Methods
All patients operated for an adenocarcinoma of the oesophagus or gastro-oesophageal junction (GOJ) between 2012-2018 were assessed. Baseline endoscopy and CT-scan images were retrospectively reviewed to identify the presence of a clinically significant HH (≥3cm). Response to neoadjuvant treatment (Mandard TRG grade), postoperative outcomes and survival were compared between HH and non-HH patients. Categorical variables were compared with the x2 or Fisher’s test, whereas continuous ones with the Mann-Whitney-U test. Survival analyses were performed with the Kaplan-Meier method and log-rank test.
Results
Overall, 101 patients were included (84.1% male, median age 63 years); among them, 33 (32.7%) had a HH ≥ 3cm at diagnosis of oesophageal cancer. There were no significant baseline differences in demographics and tumour stages between the two groups. NAT was used in 80.9% of non-HH versus 81.8% HH patients (P = 0.910), most often chemoradiation (57.3% in non-HH versus 63.6% in HH patients, P = 0.423). Surgical approach and postoperative complication rates were similar in all patients. Good response to NAT (TRG 1-2) was observed in 32.3% of non-HH, versus 33.3% of HH patients (P = 0.297), whereas R0 resection was achieved in 94.1% vs 90.9% of patients respectively (P = 0.551). Overall survival was comparable between HH (median 28 mo, 95%CI 22-NA) and non-HH patients (median 41mo, 95% CI 29-NA) (P = 0.605). Disease-free survival was also similar (median 18 mo, 95%CI 12-NA for HH, vs 34mo, 95%CI 14-NA for non-HH patients, P = 0.283), although HH patients experienced higher rates of distant (51.6% vs 29.2% for non-HH, P = 0.033), but not locoregional recurrence.
Conclusion
A clinically significant HH is encountered in almost a third of patients with oesophageal adenocarcinoma. However, in our study, it was not associated with a worse response to NAT, nor did it lead to a worse overall and disease-free survival.
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Affiliation(s)
- P St-Amour
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - C Dromain
- Institute of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - M Winiker
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Godat
- Institute of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - A Schöpfer
- Institute of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
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15
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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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16
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Schneider M, Kobayashi K, Uldry E, Demartines N, Golshayan D, Halkic N. Rhizomucor hepatosplenic abscesses in a patient with renal and pancreatic transplantation. Ann R Coll Surg Engl 2021; 103:e131-e135. [PMID: 33682478 DOI: 10.1308/rcsann.2020.7125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Fungal infections are generally observed in immunosuppressed patients only, with a diagnostic challenge due to non-specific symptoms. For this reason, appropriate management may be delayed. This case report concerns a 36-year-old man with history of pancreas and kidney transplantation. He had chemotherapy for post-transplant B-cell lymphoma and presented with left upper abdominal pain and fever. Multiple investigations led to a final diagnosis of disseminated abdominal mucormycosis with multiple Rhizomucor abscesses in the liver, spleen and kidney transplant. Treatment was antifungal therapy and laparotomy with splenectomy, wedge resection of two fungal abscesses in segments II and IVb, and segmental left colic resection.
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Affiliation(s)
- M Schneider
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - K Kobayashi
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - E Uldry
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - N Demartines
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - D Golshayan
- Lausanne University Hospital and University of Lausanne, Switzerland
| | - N Halkic
- Lausanne University Hospital and University of Lausanne, Switzerland
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17
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Gonvers S, Jurt J, Joliat GR, Halkic N, Melloul E, Hübner M, Demartines N, Labgaa I. Biological impact of an enhanced recovery after surgery programme in liver surgery. BJS Open 2020; 5:6043605. [PMID: 33688943 PMCID: PMC7944514 DOI: 10.1093/bjsopen/zraa015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/27/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The clinical and economic impacts of enhanced recovery after surgery (ERAS) programmes have been demonstrated extensively. Whether ERAS protocols also have a biological effect remains unclear. This study aimed to investigate the biological impact of an ERAS programme in patients undergoing liver surgery. METHODS A retrospective analysis of patients undergoing liver surgery (2010-2018) was undertaken. Patients operated before and after ERAS implementation in 2013 were compared. Surrogate markers of surgical stress were monitored: white blood cell count (WBC), C-reactive protein (CRP) level, albumin concentration, and haematocrit. Their perioperative fluctuations were defined as Δvalues, calculated on postoperative day (POD) 0 for Δalbumin and Δhaematocrit and POD 2 for ΔWBC and ΔCRP. RESULTS A total of 541 patients were included, with 223 and 318 patients in non-ERAS and ERAS groups respectively. Groups were comparable, except for higher rates of laparoscopy (24.8 versus 11.2 per cent; P < 0.001) and major resection (47.5 versus 38.1 per cent; P = 0.035) in the ERAS group. Patients in the ERAS group showed attenuated ΔWBC (2.00 versus 2.75 g/l; P = 0.013), ΔCRP (60 versus 101 mg/l; P <0.001) and Δalbumin (12 versus 16 g/l; P < 0.001) compared with those in the no-ERAS group. Subgroup analysis of open resection showed similar results. Multivariable analysis identified ERAS as the only independent factor associated with high ΔWBC (odds ratio (OR) 0.65, 95 per cent c.i. 0.43 to 0.98; P = 0.038), ΔCRP (OR 0.41, 0.23 to 0.73; P = 0.003) and Δalbumin (OR 0.40, 95 per cent c.i. 0.22 to 0.72; P = 0.002). CONCLUSION Compared with conventional management, implementation of ERAS was associated with an attenuated stress response in patients undergoing liver surgery.
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Affiliation(s)
- S Gonvers
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - J Jurt
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - G-R Joliat
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - N Halkic
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - E Melloul
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - I Labgaa
- Department of Visceral Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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18
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St-Amour P, Djafarrian R, Zingg T, La Rosa S, Demartines N, Matter M. Laparoscopic resection of an adrenal oncocytic neoplasm: Report of a case and review of the literature. Int J Surg Case Rep 2020; 76:305-309. [PMID: 33068855 PMCID: PMC7567174 DOI: 10.1016/j.ijscr.2020.09.185] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/10/2022] Open
Abstract
Oncocytic adrenal neoplasms are rare and mostly benign lesions. Preoperative determination of malignancy remains difficult. Surgical excision planification is based on preoperative investigations.
Introduction Oncocytic adrenal neoplasms are rare and mostly benign lesions. Available literature supports indication for a surgical resection, but criteria to predict aggressive behavior are unreliable, thus making decision of surgical approach (laparotomy versus laparoscopy), and extent of resection, difficult to define. Presentation of case This is the case of a 46-year-old male, with an incidental finding of a 10 cm asymptomatic tumor in the left adrenal gland identified by MRI, performed in the setting of the initial assessment of liver steatosis. Adrenal hormone levels were in the normal range, thus, a CT-guided needle biopsy was performed and showed an adrenocortical oncocytic neoplasm. A laparoscopic left adrenalectomy was performed sparing the adjacent left kidney. Histological examination of the resected tumor showed a 10 cm oncocytic adrenocortical neoplasm of uncertain malignant potential with negative resection margins. A follow-up MRI was scheduled at six months after surgery, and no recurrence was found. Conclusions Although rare, oncocytic neoplasms should be included in the differential diagnosis of adrenal “incidentalomas”. Determination of their malignant potential is difficult in the preoperatory setting. Final diagnosis is based on histological analysis of the whole surgical specimen. Laparoscopic complete excision with negative resection margins is feasible and safe.
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Affiliation(s)
- P St-Amour
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - R Djafarrian
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - T Zingg
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - S La Rosa
- Institute of Pathology, University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - M Matter
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
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19
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Agri F, Hahnloser D, Demartines N, Hübner M. Gains and limitations of a connected tracking solution in the perioperative follow-up of colorectal surgery patients. Colorectal Dis 2020; 22:959-966. [PMID: 32012423 DOI: 10.1111/codi.14998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 01/25/2020] [Indexed: 01/31/2023]
Abstract
AIM The means to target shorter hospital stay include information technology strategies to improve communication between caregivers and patients in order to limit potentially avoidable readmissions. The aim of the present study was to analyse the benefits and limitations of a smartphone-based connected tracking solution in the perioperative follow-up of colorectal surgery patients. METHOD This was a retrospective monocentric cohort study of consecutive patients after colorectal surgery between February and December 2018. The mobile health application included information delivery and daily structured questionnaires on a personalized patient electronic profile, before the hospital stay and for 7 days post-discharge. The medical team answered automatic alerts in real time. RESULTS A total of 93 eligible patients were approached and 36 had to be excluded (26 no smartphone, five no email, five not French speaking). Among the potential users, 50 (88%) engaged in an mHealth app and seven refused. Of these 50 patients, seven dropped out. Of the remaining 43 patients, the app detected 12 adverse events, and 10 (83%) were handled through the app. Healthcare providers responded to patient-generated alerts after a median time of 90 min (range 9-448 min). Patients' mean satisfaction level was 4 ± 0.97 out of 5. CONCLUSION In total, 88% of smartphone-equipped patients showed a willingness to engage in mHealth. Reasons for exclusion were the absence of connection tools and a language barrier. Patients who responded to the survey were satisfied with the solution and 83% of post-discharge adverse events were solved through the app, avoiding emergency consultations.
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Affiliation(s)
- F Agri
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - D Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
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20
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Mehrabi A, Kulu Y, Sabagh M, Khajeh E, Mohammadi S, Ghamarnejad O, Golriz M, Morath C, Bechstein WO, Berlakovich GA, Demartines N, Duran M, Fischer L, Gürke L, Klempnauer J, Königsrainer A, Lang H, Neumann UP, Pascher A, Paul A, Pisarski P, Pratschke J, Schneeberger S, Settmacher U, Viebahn R, Wirth M, Wullich B, Zeier M, Büchler MW. Consensus on definition and severity grading of lymphatic complications after kidney transplantation. Br J Surg 2020; 107:801-811. [PMID: 32227483 DOI: 10.1002/bjs.11587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. METHODS Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. RESULTS Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. CONCLUSION A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Y Kulu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Sabagh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - E Khajeh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - S Mohammadi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - O Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Golriz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - C Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - G A Berlakovich
- Division of Transplantation, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - N Demartines
- Department of Visceral Surgery, CHUV University Hospital, Lausanne, Switzerland
| | - M Duran
- Department of Vascular and Endovascular Surgery, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - L Fischer
- Department of Visceral and Transplantation Surgery, Hamburg-Eppendorf University Hospital, Hamburg, Germany
| | - L Gürke
- Department of Vascular and Transplantation Surgery, Basel University Hospital, Basel, Switzerland
| | - J Klempnauer
- Department of General, Visceral, and Transplantation Surgery, Hannover Medical University, Hannover, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplantation Surgery, Eberhard-Karls-University Hospital, Tübingen, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg Medical University, Mainz, Germany
| | - U P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Germany
| | - A Pascher
- Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Münster, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany
| | - P Pisarski
- Department of General, Visceral and Surgery, Freiburg University Hospital, Freiburg, Germany
| | - J Pratschke
- Department of Surgery, Charité University Hospital, Berlin, Germany
| | - S Schneeberger
- Department of Visceral, Transplantation and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - R Viebahn
- Department of Surgery, Knappschaftskrankenhaus University Hospital of Bochum, Ruhr University of Bochum, Bochum, Germany
| | - M Wirth
- Department of Urology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - M Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
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21
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Grass F, Hübner M, Mathis KL, Hahnloser D, Dozois EJ, Kelley SR, Demartines N, Larson DW. Identification of patients eligible for discharge within 48 h of colorectal resection. Br J Surg 2020; 107:546-551. [PMID: 31912500 DOI: 10.1002/bjs.11399] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/06/2019] [Accepted: 09/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study aimed to identify patients eligible for a 48-h stay after colorectal resection, to provide guidance for early discharge planning. METHODS A bi-institutional retrospective cohort study was undertaken of consecutive patients undergoing major elective colorectal resection for benign or malignant pathology within a comprehensive enhanced recovery pathway between 2011 and 2017. Overall and severe (Clavien-Dindo grade IIIb or above) postoperative complication and readmission rates were compared between patients who were discharged within 48 h and those who had hospital stay of 48 h or more. Multinominal logistic regression analysis was performed to ascertain significant factors associated with a short hospital stay (less than 48 h). RESULTS In total, 686 of 5122 patients (13·4 per cent) were discharged within 48 h. Independent factors favouring a short hospital stay were age below 60 years (odds ratio (OR) 1·34; P = 0·002), ASA grade less than III (OR 1·42; P = 0·003), restrictive fluid management (less than 3000 ml on day of surgery: OR 1·46; P < 0·001), duration of surgery less than 180 min (OR 1·89; P < 0·001), minimally invasive approach (OR 1·92; P < 0·001) and wound contamination grade below III (OR 4·50; P < 0·001), whereas cancer diagnosis (OR 0·55; P < 0·001) and malnutrition (BMI below 18 kg/m2 : OR 0·42; P = 0·008) decreased the likelihood of early discharge. Patients with a 48-h stay had fewer overall (10·8 per cent versus 30·6 per cent in those with a longer stay; P < 0·001) and fewer severe (2·6 versus 10·2 per cent respectively; P < 0·001) complications, and a lower readmission rate (9·0 versus 11·8 per cent; P = 0·035). CONCLUSION Early discharge of selected patients is safe and does not increase postoperative morbidity or readmission rates. In these patients, outpatient colorectal surgery should be feasible on a large scale with logistical optimization.
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Affiliation(s)
- F Grass
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - K L Mathis
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - D Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - E J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - S R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - D W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
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22
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Joliat GR, Demartines N, Uldry E. Author response: Defensive medicine and second victims in surgery. Br J Surg 2019; 107:152-153. [PMID: 31869456 DOI: 10.1002/bjs.11431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 11/08/2022]
Affiliation(s)
- G-R Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - E Uldry
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
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23
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Martin D, Teixeira Farinha H, Dattner N, Rotman S, Demartines N, Sauvain MO. Spontaneous non-traumatic splenic artery aneurysm rupture: a case report and review of the literature. Eur Rev Med Pharmacol Sci 2019; 22:3147-3150. [PMID: 29863260 DOI: 10.26355/eurrev_201805_15074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The current case report is about spontaneous non-traumatic rupture of a splenic artery aneurysm (SAA) in a 53-year-old woman with no particular medical history. An emergent laparotomy with splenectomy was required, unfortunately without success as the patient died. SAA is the most common visceral artery aneurysm. Most of SAA remain asymptomatic and are discovered incidentally on imaging. The overall risk of rupture increases with the size of SAA, especially when above 2 cm. Initial presentation of SAA has been associated with acute rupture and hemodynamic instability leading to substantial perioperative morbidity and mortality.
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Affiliation(s)
- D Martin
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
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24
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Joliat GR, Demartines N, Uldry E. Systematic review of the impact of patient death on surgeons. Br J Surg 2019; 106:1429-1432. [PMID: 31373690 DOI: 10.1002/bjs.11264] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND The death of a patient is experienced at some time by most surgeons. The aim of this review was to use existing literature to establish how surgeons have dealt with the death of patients. METHODS A systematic review of the medical literature was performed. MEDLINE/PubMed, Ovid, Web of Science, Embase, and Google Scholar were searched for qualitative and quantitative studies on surgeon reactions when facing death or a dying patient. This systematic review was performed following the recommendations of the Cochrane collaboration and reported following the PRISMA guidelines. Individual and interview-based opinions were summarized and synthesized. RESULTS An initial search found 652 articles. After exclusion of articles that did not satisfy the inclusion criteria, 20 articles remained and seven were included. Two of these articles were personal opinion of the author and five were interviews or surveys. The main findings were that facing death routinely induces a strong psychological burden and that surgeons are more at risk than the general population to develop psychological morbidity. CONCLUSION Although it is a frequent and emotional subject in the surgical world, the impact of patient death on surgeons is not abundantly studied in the literature. Dealing with patient death or taking care of a dying patient might have long-lasting psychological impact on surgeons.
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Affiliation(s)
- G-R Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - E Uldry
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
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25
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Hübner M, Pache B, Solà J, Blanc C, Hahnloser D, Demartines N, Grass F. Thresholds for optimal fluid administration and weight gain after laparoscopic colorectal surgery. BJS Open 2019; 3:532-538. [PMID: 31388646 PMCID: PMC6677103 DOI: 10.1002/bjs5.50166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/26/2019] [Indexed: 12/20/2022] Open
Abstract
Background Perioperative fluid overload is an important modifiable risk factor for adverse outcomes after colorectal surgery. This study aimed to define critical thresholds for perioperative fluid management and postoperative weight gain for patients undergoing elective laparoscopic colorectal surgery. Methods This was an analysis of consecutive elective laparoscopic colorectal resections at Lausanne University Hospital from May 2011 to May 2017. Main outcomes were overall, major (Clavien–Dindo grade IIIb or above) and respiratory complications, and postoperative ileus. Thresholds regarding perioperative fluid management and postoperative weight gain were identified through receiver operating characteristic (ROC) analysis and clinical judgement. Independent risk factors for all four outcomes were assessed by multinominal logistic regression. Results Overall and major complications occurred in 210 (36·2 per cent) and 46 (7·9 per cent) of 580 patients respectively. Twenty‐three patients (4·0 per cent) had respiratory complications and 98 (16·9 per cent) had postoperative ileus. Median length of hospital stay was 5 (i.q.r. 3–9) days. Based on respiratory complications, thresholds for perioperative intravenous fluid administration (postoperative day (POD) 0) were set pragmatically at 3000 ml for colonic (calculated threshold 3120 ml (area under ROC curve (AUROC) 0·63)) and 4000 ml for rectal (AUROC 0·79) procedures. Postoperative weight gain of 2·5 kg at POD 2 was predictive of respiratory complications. Multivariable analysis retained perioperative intravenous fluid administration over the above thresholds as an independent risk factor for overall (odds ratio (OR) 2·25, 95 per cent c.i. 1·23 to 4·11), major (OR 2·49, 1·17 to 5·31) and respiratory (OR 4·71, 1·42 to 15·58) complications. Weight gain above 2·5 kg at POD 2 was identified as a risk factor for respiratory complications (OR 3·58, 1·10 to 11·70) and ileus (OR 1·82, 1·02 to 3·52). Conclusion Perioperative intravenous fluid and weight thresholds were associated with postoperative adverse outcomes. These thresholds need independent validation.
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Affiliation(s)
- M Hübner
- Department of Visceral Surgery Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - B Pache
- Department of Visceral Surgery Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - J Solà
- Centre Suisse d'Electronique et de Microtechnique Neuchâtel Switzerland
| | - C Blanc
- Department of Anaesthesiology Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - D Hahnloser
- Department of Visceral Surgery Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - N Demartines
- Department of Visceral Surgery Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
| | - F Grass
- Department of Visceral Surgery Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland
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26
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Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS ®) Society Recommendations: 2018. World J Surg 2019; 43:659-695. [PMID: 30426190 DOI: 10.1007/s00268-018-4844-y] [Citation(s) in RCA: 936] [Impact Index Per Article: 187.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This is the fourth updated Enhanced Recovery After Surgery (ERAS®) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. METHODS A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS® protocol items are based on best available evidence; good-quality trials; meta-analyses of good-quality trials; or large cohort studies. The level of evidence for the use of each item is presented accordingly. CONCLUSIONS The evidence base and recommendation for items within the multimodal perioperative care pathway are presented by the ERAS® Society in this comprehensive consensus review.
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Affiliation(s)
- U O Gustafsson
- Department of Surgery, Danderyd Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - M J Scott
- Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, VA, USA
- Department of Anesthesiology, University of Pennsylvania, Philadelphia, USA
| | - M Hubner
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - J Nygren
- Department of Surgery, Ersta Hospital and Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - N Demartines
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - N Francis
- Colorectal Unit, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK
- University of Bath, Wessex House Bath, BA2 7JU, UK
| | - T A Rockall
- Department of Surgery, Royal Surrey County Hospital NHS Trust, and Minimal Access Therapy Training Unit (MATTU), Guildford, UK
| | - T M Young-Fadok
- Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - A G Hill
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland Middlemore Hospital, Auckland, New Zealand
| | - M Soop
- Irving National Intestinal Failure Unit, The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - H D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital, Groningen, The Netherlands
| | - R D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - G J Chang
- Department of Surgical Oncology and Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Fichera
- Division of Gastrointestinal Surgery, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H Kessler
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio, USA
| | - F Grass
- Department of Visceral Surgery, CHUV, Lausanne, Switzerland
| | - E E Whang
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - W J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital NHS Foundation Trust and University of Surrey, Guildford, UK
| | - F Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - D N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - K E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - A Balfour
- Department of Colorectal Surgery, Surgical Services, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - G Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - B Riedel
- Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - O Ljungqvist
- Department of Surgery, Örebro University and University Hospital, Örebro & Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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27
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Pache B, Hübner M, Solà J, Hahnloser D, Demartines N, Grass F. Receiver operating characteristic analysis to determine optimal fluid management during open colorectal surgery. Colorectal Dis 2019; 21:234-240. [PMID: 30407708 DOI: 10.1111/codi.14465] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/07/2018] [Accepted: 10/03/2018] [Indexed: 12/12/2022]
Abstract
AIM The present study aimed to analyse fluid management and to define optimal fluid-related thresholds for elective open colorectal surgery. METHOD A retrospective analysis was made of all consecutive elective open colorectal resections performed in our tertiary centre between May 2011 and May 2017. The main outcomes were postoperative complications [overall (I-V) and severe (IIIB-V) according to the Clavien classification], respiratory complications and postoperative ileus (POI). Critical thresholds regarding perioperative fluid management and postoperative weight gain were identified by using receiver operator characteristic (ROC) analysis. Independent risk factors for overall complications were identified by multivariable logistic regression analysis. RESULTS Of 121 patients who had open operations, 84 (69%) had some complication and 26 (21%) had severe complications. Respiratory complications and POI occurred in 15 (12%) and 46 patients (38%), respectively. The thresholds for intravenous fluids were 3.5 l at postoperative day (POD) 0 [area under ROC curve (AUROC) 0.7 for any 0.69 for respiratory complications] and 3.5 kg weight gain at POD 2 (AUROC 0.82 for respiratory complications). Multivariable analysis revealed weight gain of > 3.5 kg at POD 2 (OR 5.9; 95% CI 1.3-16.6) as a significant risk factor for overall complications. Acute kidney injury was observed in five patients (4%), three (5%) in the group with > 3.5 l at POD 0 and two (3%) in the group with < 3.5 l at POD 0 (P = 0.64). Creatinine increase was transitory and all patients regained baseline levels before discharge. CONCLUSION A weight gain of > 3.5 kg at POD 2 has been identified as the critical threshold for overall and respiratory complications and prolonged length of stay after open elective colorectal surgery.
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Affiliation(s)
- B Pache
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - J Solà
- Centre Suisse d'Electronique et de Microtechnique (CSEM), Neuchâtel, Switzerland
| | - D Hahnloser
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - F Grass
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
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28
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Martin D, Roulin D, Grass F, Addor V, Ljungqvist O, Demartines N, Hübner M. A multicentre qualitative study assessing implementation of an Enhanced Recovery After Surgery program. Clin Nutr 2018; 37:2172-2177. [DOI: 10.1016/j.clnu.2017.10.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/03/2017] [Accepted: 10/25/2017] [Indexed: 12/18/2022]
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29
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Allemann P, Mantziari S, Winiker M, Wagner A, Digklia A, van Berge Henegouwen M, Gisbertz S, Slaman A, van Hillegersberg R, Ruurda J, Brenkman H, Nilsson M, Satoshi K, Piessen G, Collet D, Gronnier C, Carrere N, Marinho A, Demartines N, Schafer M. Neoadjuvant radio-chemotherapy for esophageal cancer: A multicenter European study comparing paclitaxel/carboplatin, 5FU/cisplatin and FOLFOX. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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30
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Slieker J, Hübner M, Addor V, Duvoisin C, Demartines N, Hahnloser D. Application of an enhanced recovery pathway for ileostomy closure: a case–control trial with surprising results. Tech Coloproctol 2018; 22:295-300. [DOI: 10.1007/s10151-018-1778-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/05/2018] [Indexed: 12/18/2022]
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Abstract
This study assessed the accuracy of preoperative staging in patients undergoing oncological esophagectomy for adenocarcinoma and squamous cell carcinoma. All patients undergoing surgery for resectable esophageal cancer in a university hospital from 2005 to 2016 were identified from our institutional database. Patients with neoadjuvant treatment were excluded to avoid bias from down-staging effects. Routinely, all patients had an upper endoscopy with biopsy, a thoracoabdominal CT scan, an 18-FEG PET-CT, and endoscopic ultrasound. Preoperative staging was compared to histopathological staging of surgical specimen that was considered as gold standard. There were 51 patients with a median age of 65 years (IQR: 59.3-73 years) having 21 squamous cell carcinoma and 30 adenocarcinoma, respectively. T- and N-stages were correctly predicted in 26 (51%) and 37 patients (72%), respectively. Overall, 18 patients (35%) were preoperatively diagnosed with a correct T- and N-stage. There was no difference between adenocarcinoma and squamous cell carcinoma. Accuracy of the T-stage was not influenced by the smoking status. The N-stage was not correct in 7/22 smoking patients (32%) and 6/29 nonsmoking patients (21%).The N-stage was underestimated in smoking patients as 6/22 patients (27%) had a histologically confirmed N+ who were preoperatively classified as N0. In conclusion, only 35% of patients had a correct assessment. Separate T- and N-stage prediction was improved with 51% and 72%, respectively. Major efforts are needed for improvement.
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Affiliation(s)
- M Winiker
- Centre Hospitalier Universitaire Vaudois, Surgery, Lausanne, Switzerland
| | - S Mantziari
- Centre Hospitalier Universitaire Vaudois, Surgery, Lausanne, Switzerland
| | - S G Figueiredo
- Centre Hospitalier Universitaire Vaudois, Surgery, Lausanne, Switzerland
| | - N Demartines
- Centre Hospitalier Universitaire Vaudois, Surgery, Lausanne, Switzerland
| | - P Allemann
- Centre Hospitalier Universitaire Vaudois, Surgery, Lausanne, Switzerland
| | - M Schäfer
- Centre Hospitalier Universitaire Vaudois, Surgery, Lausanne, Switzerland
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32
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Thorell A, MacCormick AD, Awad S, Reynolds N, Roulin D, Demartines N, Vignaud M, Alvarez A, Singh PM, Lobo DN. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg 2017; 40:2065-83. [PMID: 26943657 DOI: 10.1007/s00268-016-3492-3] [Citation(s) in RCA: 327] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based "enhanced" perioperative protocol. METHODS The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. RESULTS Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials. CONCLUSIONS A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.
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Affiliation(s)
- A Thorell
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital & Department of Surgery, Ersta Hospital, 116 91, Stockholm, Sweden.
| | - A D MacCormick
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau Health, Auckland, New Zealand
| | - S Awad
- The East-Midlands Bariatric & Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK.,School of Clinical Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - N Reynolds
- The East-Midlands Bariatric & Metabolic Institute, Derby Teaching Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, DE22 3NE, UK
| | - D Roulin
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - M Vignaud
- Département d'anesthésie reanimation Service de chirurgie digestive, CHU estaing 1, place Lucie et Raymond Aubrac, Clermont Ferrand, France
| | - A Alvarez
- Department of Anesthesia, Hospital Italiano de Buenos Aires, Buenos Aires University, 1179, Buenos Aires, Argentina
| | - P M Singh
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - D N Lobo
- Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Navarro Rodrigo B, Bobisse S, Viganò S, Baumgartner P, Nguyen-Ngoc T, Gannon P, Genolet R, Stevenson B, Sempoux C, Sauvain MO, Hubner M, Hahnloser D, Demartines N, Montemurro M, Kandalaft L, Rusakiewicz S, Harari A, Coukos G. Exploring personalized immunotherapy opportunities in colorectal cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx376.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Grass F, Vuagniaux A, Teixeira-Farinha H, Lehmann K, Demartines N, Hübner M. Systematic review of pressurized intraperitoneal aerosol chemotherapy for the treatment of advanced peritoneal carcinomatosis. Br J Surg 2017; 104:669-678. [PMID: 28407227 DOI: 10.1002/bjs.10521] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/15/2016] [Accepted: 02/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a minimally invasive approach under investigation as a novel treatment for patients with peritoneal carcinomatosis of various origins. The aim was to review the available evidence on mechanisms, clinical effects and risks. METHODS This was a systematic review of the literature on pressurized intraperitoneal chemotherapy published between January 2000 and October 2016. All types of scientific report were included. RESULTS Twenty-nine relevant papers were identified; 16 were preclinical studies and 13 were clinical reports. The overall quality of the clinical studies was modest; five studies were prospective and there was no randomized trial. Preclinical data suggested better distribution and higher tissue concentrations of chemotherapy agents in PIPAC compared with conventional intraperitoneal chemotherapy by lavage. Regarding technical feasibility, laparoscopic access and repeatability rates were 83-100 and 38-82 per cent. Surgery-related complications occurred in up to 12 per cent. Postoperative morbidity was low (Common Terminology Criteria for Adverse Events grade 3-5 events reported in 0-37 per cent), and hospital stay was about 3 days. No negative impact on quality of life was reported. Histological response rates for therapy-resistant carcinomatosis of ovarian, colorectal and gastric origin were 62-88, 71-86 and 70-100 per cent respectively. CONCLUSION PIPAC is feasible, safe and well tolerated. Preliminary good response rates call for prospective analysis of oncological efficacy.
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Affiliation(s)
- F Grass
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - A Vuagniaux
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - H Teixeira-Farinha
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - K Lehmann
- Department of Visceral Surgery, University Hospital Zurich, Zurich, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Hübner M, Grass F, Teixeira-Farinha H, Pache B, Mathevet P, Demartines N. Pressurized IntraPeritoneal Aerosol Chemotherapy - Practical aspects. Eur J Surg Oncol 2017; 43:1102-1109. [PMID: 28431896 DOI: 10.1016/j.ejso.2017.03.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 01/11/2017] [Revised: 03/03/2017] [Accepted: 03/29/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) has been introduced as novel treatment for peritoneal carcinomatosis. Only proper patient selection, stringent safety protocol and careful surgery allow for a secure procedure. We hereby report the essentials for safe implementation. METHODS All consecutive procedures within 20 months after PIPAC implementation were analyzed with regards to practical and surgical aspects. Special emphasis was laid on modifications of technique and safety measures during the implementation process with systematic use of a dedicated checklist. Further, surgical difficulty was documented by use of a visual analogue scale (VAS). RESULTS 127 PIPAC procedures were performed in 58 patients from January 2015 until October 2016. 81% of patients had at least one previous laparotomy. Median operation time was 91 min (87-103) for the first 20 cases, 93 min (IQR 88-107) for PIPAC21-50, and 103 min (IQR 91-121) for the following 77 procedures. Primary and secondary non-access occurred in 3 patients (2%), all of them having prior hyperthermic intraperitoneal chemotherapy (HIPEC). Using open Hasson technique, one single bowel lesion occurred, which was the only intraoperative complication. One 5 mm and another 10/12 mm trocar were used in 88% of procedures while additional trocars were needed in 12%. No leak of cytostatics was observed and no procedure needed to be stopped. VAS for overall difficulty of the procedure was 3 ± 2.4, and 3 ± 2.9 and 3 ± 2.5, respectively, for abdominal access and intraoperative staging. CONCLUSIONS With standardized surgical approach and dedicated safety checklist, PIPAC can be safely introduced in clinical routine with minimal learning curve.
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Affiliation(s)
- M Hübner
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
| | - F Grass
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
| | - H Teixeira-Farinha
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
| | - B Pache
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
| | - P Mathevet
- Department of Gynecology, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
| | - N Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland.
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Zingg T, Teixeira Farinha H, Demartines N, Pascual M, Matter M. A Renal Paratransplant Hernia Causing Complete Small Bowel Obstruction: A Case Report and Review of the Literature. Transplant Proc 2017; 49:210-212. [PMID: 28104139 DOI: 10.1016/j.transproceed.2016.11.032] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/22/2016] [Indexed: 11/16/2022]
Abstract
A rare type of acquired internal hernia, the renal paratransplant hernia (RPTH), of which only 11 cases have been reported in the literature so far, can follow renal transplantation. We report a patient who presented with acute abdominal pain and vomiting 6 weeks after renal transplantation in the right iliac fossa. A noncontrast abdominal computed tomography scan showed signs of small bowel obstruction. The patient was taken to the operating room for a midline laparotomy, and RPTH with incarcerated small bowel was diagnosed. The bowel loop was released and found to be viable. The postoperative course was unremarkable. It is unclear whether perioperative peritoneal defects or spontaneous ruptures of lymphoceles into the peritoneal cavity form the basis of this rare type of internal hernia. Surgeons should be aware of this entity and avoid both peritoneal defects and postoperative lymphoceles by paying careful attention to meticulous surgical technique.
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Affiliation(s)
- T Zingg
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
| | - H Teixeira Farinha
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - N Demartines
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - M Pascual
- Centre de Transplantation d'Organes, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - M Matter
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Rodrigo BN, Viganò S, Gannon P, Baumgartner P, Maisonneuve C, Sempoux C, Sauvain MO, Hahnloser D, Hubner M, Demartines N, Kandalaft L, Montemurro M, Harari A, Coukos G. Comprehensive assessment of the feasibility of adoptive cell therapy in colorectal carcinoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw378.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- A Kummer
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - D Hahnloser
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
| | - M Hübner
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Bekkar S, Gronnier C, Renaud F, Duhamel A, Pasquer A, Théreaux J, Gagnière J, Meunier B, Collet D, Mariette C, Dhahri A, Lignier D, Cossé C, Regimbeau JM, Luc G, Cabau M, Jougon J, Badic B, Lozach P, Bail JP, Cappeliez S, El Nakadi I, Lebreton G, Alves A, Flamein R, Pezet D, Pipitone F, Stan-Iuga B, Contival N, Pappalardo E, Coueffe X, Msika S, Mantziari S, Demartines N, Hec F, Vanderbeken M, Tessier W, Briez N, Fredon F, Gainant A, Mathonnet M, Bigourdan JM, Mezoughi S, Ducerf C, Baulieux J, Mabrut JY, Bigourdan JM, Baraket O, Poncet G, Adam M, Vaudoyer D, Jourdan Enfer P, Villeneuve L, Glehen O, Coste T, Fabre JM, Marchal F, Frisoni R, Ayav A, Brunaud L, Bresler L, Cohen C, Aze O, Venissac N, Pop D, Mouroux J, Donici I, Prudhomme M, Felli E, Lisunfui S, Seman M, Godiris Petit G, Karoui M, Tresallet C, Ménégaux F, Vaillant JC, Hannoun L, Malgras B, Lantuas D, Pautrat K, Pocard M, Valleur P, Lefevre JH, Chafai N, Balladur P, Lefrançois M, Parc Y, Paye F, Tiret E, Nedelcu M, Laface L, Perniceni T, Gayet B, Turner K, Filipello A, Porcheron J, Tiffet O, Kamlet N, Chemaly R, Klipfel A, Pessaux P, Brigand C, Rohr S, Carrère N, Da Re C, Dumont F, Goéré D, Elias D, Bertrand C. Multicentre study of neoadjuvant chemotherapy for stage I and II oesophageal cancer. Br J Surg 2016; 103:855-62. [DOI: 10.1002/bjs.10121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/11/2015] [Accepted: 01/05/2016] [Indexed: 12/28/2022]
Abstract
Abstract
Background
The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease.
Methods
Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics.
Results
Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017).
Conclusion
NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.
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Affiliation(s)
- S Bekkar
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - C Gronnier
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- North of France University, Lille, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1172, Team 5 ‘Mucins, epithelial differentiation and carcinogenesis’, Jean-Pierre Aubert Research Centre, Lille, France
| | - F Renaud
- Department of Pathology, Lille University Hospital, Lille, France
| | - A Duhamel
- Department of Biostatistics, Lille University Hospital, Lille, France
- Site de Recherche Intégré en Cancérologie OncoLille, Lille, France
| | - A Pasquer
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - J Théreaux
- Cavale Blanche University Hospital, Brest, France
| | - J Gagnière
- Estaing University Hospital, Clermont-Ferrand, France
| | - B Meunier
- Pontchaillou University Hospital, Rennes, France
| | - D Collet
- Haut-Levêque University Hospital, Bordeaux, France
| | - C Mariette
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- North of France University, Lille, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1172, Team 5 ‘Mucins, epithelial differentiation and carcinogenesis’, Jean-Pierre Aubert Research Centre, Lille, France
- Site de Recherche Intégré en Cancérologie OncoLille, Lille, France
| | - A Dhahri
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - D Lignier
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - C Cossé
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - J-M Regimbeau
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - G Luc
- Department of Digestive Surgery, Pessac University Hospital, Bordeaux, France
| | - M Cabau
- Department of Thoracic Surgery, Pessac University Hospital, Bordeaux, France
| | - J Jougon
- Department of Thoracic Surgery, Pessac University Hospital, Bordeaux, France
| | - B Badic
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - P Lozach
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - J P Bail
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - S Cappeliez
- Department of Digestive Surgery, Brussel ULB Erasme Bordet University, Brussels, Belgium
| | - I El Nakadi
- Department of Digestive Surgery, Brussel ULB Erasme Bordet University, Brussels, Belgium
| | - G Lebreton
- Department of Digestive Surgery, Caen University Hospital, Caen, France
| | - A Alves
- Department of Digestive Surgery, Caen University Hospital, Caen, France
| | - R Flamein
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - D Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - F Pipitone
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - B Stan-Iuga
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - N Contival
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - E Pappalardo
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - X Coueffe
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - S Msika
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - S Mantziari
- Department of Digestive Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - N Demartines
- Department of Digestive Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Hec
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - M Vanderbeken
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - W Tessier
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - N Briez
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - F Fredon
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - A Gainant
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - M Mathonnet
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - J M Bigourdan
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - S Mezoughi
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - C Ducerf
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J Baulieux
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J-Y Mabrut
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J M Bigourdan
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - O Baraket
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - G Poncet
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - M Adam
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - D Vaudoyer
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - P Jourdan Enfer
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - L Villeneuve
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - O Glehen
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - T Coste
- Department of Digestive Surgery, Montpellier, France
| | - J-M Fabre
- Department of Digestive Surgery, Montpellier, France
| | - F Marchal
- Department of Digestive Surgery, Institut de Cancérologie de Lorraine, Nancy, France
| | - R Frisoni
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - A Ayav
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - L Brunaud
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - L Bresler
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - C Cohen
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - O Aze
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - N Venissac
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - D Pop
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - J Mouroux
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - I Donici
- Department of Digestive Surgery, Nîmes University Hospital, Nîmes, France
| | - M Prudhomme
- Department of Digestive Surgery, Nîmes University Hospital, Nîmes, France
| | - E Felli
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - S Lisunfui
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - M Seman
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - G Godiris Petit
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - M Karoui
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - C Tresallet
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - F Ménégaux
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - J-C Vaillant
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - L Hannoun
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - B Malgras
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - D Lantuas
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - K Pautrat
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - M Pocard
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - P Valleur
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - J H Lefevre
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - N Chafai
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - P Balladur
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - M Lefrançois
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - Y Parc
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - F Paye
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - E Tiret
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - M Nedelcu
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - L Laface
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - T Perniceni
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - B Gayet
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - K Turner
- Department of Digestive Surgery, Rennes, France
| | - A Filipello
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - J Porcheron
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - O Tiffet
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - N Kamlet
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - R Chemaly
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - A Klipfel
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - P Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - C Brigand
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - S Rohr
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - N Carrère
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - C Da Re
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - F Dumont
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - D Goéré
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - D Elias
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - C Bertrand
- Mont-Godinne University Hospital, Yvoir, Belgium
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Guarnero V, Hoffmann H, Hetzer F, Oertli D, Turina M, Zingg U, Demartines N, Ris F, Hahnloser D. A new stomaplasty ring (Koring™) to prevent parastomal hernia: an observational multicenter Swiss study. Tech Coloproctol 2016; 20:293-297. [DOI: 10.1007/s10151-016-1452-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/16/2016] [Indexed: 11/28/2022]
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Pittet O, Nocito A, Balke H, Duvoisin C, Clavien PA, Demartines N, Hahnloser D. Rectal enema is an alternative to full mechanical bowel preparation for primary rectal cancer surgery. Colorectal Dis 2015; 17:1007-10. [PMID: 25880356 DOI: 10.1111/codi.12974] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 08/11/2014] [Accepted: 03/14/2015] [Indexed: 02/08/2023]
Abstract
AIM According to the French GRECCAR III randomized trial, full mechanical bowel preparation (MBP) for rectal surgery decreases the rate of postoperative morbidity, in particular postoperative infectious complications, but MBP is not well tolerated by the patient. The aim of the present study was to determine whether a preoperative rectal enema (RE) might be an alternative to MBP. METHODS An analysis was performed of 96 matched cohort patients undergoing rectal resection with primary anastomosis and protective ileostomy at two different university teaching hospitals, whose rectal cancer management was comparable except for the choice of preoperative bowel preparation (MBP or RE). Prospective databases were retrospectively analysed. RESULTS Patients were well matched for age, gender, body mass index and Charlson index. The surgical approach and cancer characteristics (level above anal verge, stage and use of neoadjuvant therapy) were comparable between the two groups. Anastomotic leakage occurred in 10% of patients having MBP and in 8% having RE (P = 1.00). Pelvic abscess formation (6% vs 2%, P = 0.63) and wound infection (8% vs 15%, P = 0.55) were also comparable. Extra-abdominal infection (13% vs 13%, P = 1.00) and non-infectious abdominal complications such as ileus and bleeding (27% and 31%, P = 0.83) were not significantly different. Overall morbidity was comparable in the two groups (50% vs 54%, P = 0.83). CONCLUSION A simple RE before rectal surgery seems not to be associated with more postoperative infectious complications nor a higher overall morbidity than MBP.
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Affiliation(s)
- O Pittet
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - A Nocito
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - H Balke
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - C Duvoisin
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - P A Clavien
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - D Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland.,Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
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42
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Joliat GR, Labgaa I, Petermann D, Hübner M, Griesser AC, Demartines N, Schäfer M. Cost-benefit analysis of an enhanced recovery protocol for pancreaticoduodenectomy. Br J Surg 2015; 102:1676-83. [PMID: 26492489 DOI: 10.1002/bjs.9957] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/04/2015] [Accepted: 08/28/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) programmes have been shown to decrease complications and hospital stay. The cost-effectiveness of such programmes has been demonstrated for colorectal surgery. This study aimed to assess the economic outcomes of a standard ERAS programme for pancreaticoduodenectomy. METHODS ERAS for pancreaticoduodenectomy was implemented in October 2012. All consecutive patients who underwent pancreaticoduodenectomy until October 2014 were recorded. This group was compared in terms of costs with a cohort of consecutive patients who underwent pancreaticoduodenectomy between January 2010 and October 2012, before ERAS implementation. Preoperative, intraoperative and postoperative real costs were collected for each patient via the hospital administration. A bootstrap independent t test was used for comparison. ERAS-specific costs were integrated into the model. RESULTS The groups were well matched in terms of demographic and surgical details. The overall complication rate was 68 per cent (50 of 74 patients) and 82 per cent (71 of 87 patients) in the ERAS and pre-ERAS groups respectively (P = 0·046). Median hospital stay was lower in the ERAS group (15 versus 19 days; P = 0·029). ERAS-specific costs were €922 per patient. Mean total costs were €56 083 per patient in the ERAS group and €63 821 per patient in the pre-ERAS group (P = 0·273). The mean intensive care unit (ICU) and intermediate care costs were €9139 and €13 793 per patient for the ERAS and pre-ERAS groups respectively (P = 0·151). CONCLUSION ERAS implementation for pancreaticoduodenectomy did not increase the costs in this cohort. Savings were noted in anaesthesia/operating room, medication and laboratory costs. Fewer patients in the ERAS group required an ICU stay.
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Affiliation(s)
- G-R Joliat
- Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - I Labgaa
- Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - D Petermann
- Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - M Hübner
- Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - A-C Griesser
- Medical Directorate, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
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43
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Joliat GR, Pittet O, Demartines N, Hahnloser D. [Acute sigmoid diverticulitis: toward a more and more conservative treatment]. Rev Med Suisse 2015; 11:1717-1720. [PMID: 26591083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Acute diverticulitis of the colon is a frequent pathology especially among elderly people and people of Caucasian origin. The prevalence is higher among sedentary people and in people with low-fiber diet. Its diagnosis is mainly based on computed tomography (CT) that allows guiding the therapeutic management. Over the last few years the treatment of acute diverticulitis has passably changed with in particular an evolution toward a restriction of the elective and emergency surgery indications and a reduction of the antiobiotherapy and hospitalization number. This article reviews the epidemiology, the diagnostic tools, and the management of this frequent digestive pathology.
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Du Pasquier C, Uldry E, Halkic N, Demartines N, Schäfer M. 372. Reverse treatment for patients with colorectal cancer and synchronous liver metastasis. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.362] [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] Open
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45
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Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M, Carli F, Demartines N, Griffin SM, Lassen K, Fearon KCF, Ljungqvist O, Lobo DN, Revhaug A. Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Br J Surg 2014; 101:1209-29. [PMID: 25047143 DOI: 10.1002/bjs.9582] [Citation(s) in RCA: 434] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/20/2014] [Accepted: 05/08/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Application of evidence-based perioperative care protocols reduces complication rates, accelerates recovery and shortens hospital stay. Presently, there are no comprehensive guidelines for perioperative care for gastrectomy. METHODS An international working group within the Enhanced Recovery After Surgery (ERAS®) Society assembled an evidence-based comprehensive framework for optimal perioperative care for patients undergoing gastrectomy. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and were discussed until consensus was reached within the group. The quality of evidence was rated 'high', 'moderate', 'low' or 'very low'. Recommendations were graded as 'strong' or 'weak'. RESULTS The available evidence has been summarized and recommendations are given for 25 items, eight of which contain procedure-specific evidence. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. CONCLUSION The present evidence-based framework provides comprehensive advice on optimal perioperative care for the patient undergoing gastrectomy and facilitates multi-institutional prospective cohort registries and adequately powered randomized trials for further research.
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Affiliation(s)
- K Mortensen
- Department of Gastrointestinal and Hepatobiliary Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | | | | | | | | | | | | | | | | | | | | | - K C F Fearon
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, UK
| | - O Ljungqvist
- Department of Surgery, Örebro University Hospital, Örebro and Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - D N Lobo
- Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre National Institute for Health Research, Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - A Revhaug
- Department of Gastrointestinal and Hepatopancreaticobiliary Surgery, University Hospital of Northern Norway, Tromsø, Norway
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Mantziari S, Allemann P, Dayer A, Demartines N, Schäfer M. [Gastroesophageal cancer: an update on diagnosis and treatment]. Rev Med Suisse 2014; 10:1331-1336. [PMID: 25051595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Esophago-gastric cancer remains a relatively rare pathology with, however, an ascending tendency in the recent years due to a variety of predisposing factors. An extensive preoperative workup and a thorough multidisciplinary discussion are the key elements to define treatment strategy. Surgery is the cornerstone of treatment for resectable tumors, even if it is associated with morbidity rates of 40-60% in medium and high-volume centers. Long-term consequences (e.g. malnutrition and late anastomotic stenosis) are present in a high proportion of patients and they raise the need for a close follow-up with the collaboration of the general practitioner, surgeon and oncologist. This multidisciplinary treatment and aftercare has the best chance to offer to the patient not only a longer overall survival, but a better quality of life as well.
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Demartines N, Morel P. [Tribute to Professor Gilles Mentha]. Rev Med Suisse 2014; 10:1323. [PMID: 25051593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Roulin D, Blanc C, Demartines N, Hübner M. [Enhanced Recovery After Surgery--optimal management of the surgical patient]. Rev Med Suisse 2014; 10:1343-1347. [PMID: 25051597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Enhanced Recovery After Surgery (ERAS) is a multimodal, standardized and evidence-based perioperative care pathway. With ERAS, postoperative complications are significantly lowered, and, as a secondary effect, length of hospital stay and health cost are reduced. The patient recovers better and faster allowing to reduce in addition the workload of healthcare providers. Despite the hospital discharge occurs sooner, there is no increased charge of the outpatient care. ERAS can be safely applied to any patient by a tailored approach. The general practitioner plays an essential role in ERAS by assuring the continuity of the information and the follow-up of the patient.
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Venara A, Hubner M, Le Naoures P, Hamel JF, Hamy A, Demartines N. Surgery for incarcerated hernia: short-term outcome with or without mesh. Langenbecks Arch Surg 2014; 399:571-7. [PMID: 24789811 DOI: 10.1007/s00423-014-1202-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 04/21/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Incarcerated hernias represent about 5-15 % of all operated hernias. Tension-free mesh is the preferred technique for elective surgery due to low recurrence rates. There is however currently no consensus on the use of mesh for the treatment of incarcerated hernias, especially in case of bowel resection. AIM The aims of this study were (i) to report our current practice for the treatment of incarcerated hernias, (ii) to identify risk factors for postoperative complications, and (iii) to assess the safety of mesh placement in potentially infected surgical fields. METHODS This retrospective study included 166 consecutive patients who underwent emergency surgery for incarcerated hernia between January 2007 and January 2012 in two university hospitals. Demographics, surgical details, and short-term outcome were collected. Univariate analysis was employed to identify risk factors for overall, infectious, and major complications. RESULTS Eighty-four patients (50.6 %) presented inguinal hernias, 43 femoral (25.9 %), 37 umbilical hernias (22.3 %), and 2 mixed hernias (1.2 %), respectively. Mesh was placed in 64 patients (38.5 %), including 5 patients with concomitant bowel resection. Overall morbidity occurred in 56 patients (32.7 %), and 8 patients (4.8 %) developed surgical site infections (SSI). Univariate risk factors for overall complications were ASA grade 3/4 (P = 0.03), diabetes (P = 0.05), cardiopathy (P = 0.001), aspirin use (P = 0.023), and bowel resection (P = 0.001) which was also the only identified risk factor for SSI (P = 0.03). In multivariate analysis, only bowel incarceration was associated with a higher rate of major morbidity (OR = 14.04; P = 0.01). CONCLUSION Morbidity after surgery for incarcerated hernia remains high and depends on comorbidities and surgical presentation. The use of mesh could become current practice even in case of bowel resection.
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Affiliation(s)
- A Venara
- Visceral and Endocrine Surgery Department, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France,
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50
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Pittet O, Demartines N, Hahnloser D. [Acute anal pain]. Rev Med Suisse 2014; 10:555-560. [PMID: 24701675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Anal pain is a common reason for consultation, whose etiology is varied and should not be limited to the hemorrhoidal disease. The purpose of this article is to conduct a review of the literature on anorectal pathologies most frequently encountered and make recommendations regarding their management.
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