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Potolicchio A, Jehaes C, Merlot B, Assenat V, Dennis T, Roman H, Francois MO, Denost Q. Treatment techniques for rectovaginal fistulas after low rectal resection for deep endometriosis. Tech Coloproctol 2024; 28:51. [PMID: 38684547 DOI: 10.1007/s10151-024-02923-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/16/2024] [Indexed: 05/02/2024]
Abstract
Endometriosis is a benign gynecologic affection that may lead to major surgeries, such as colorectal resections. Rectovaginal fistulas (RVF) are among the possible complications. When they occur, it is necessary to adapt the repair surgery as best as possible to limit their functional consequences. This video shows three different techniques for correcting RVF after rectal resection for endometriosis, with a combination of perineal surgery and laparoscopy: a mucosal flap, a transanal transection and single stapled anastomosis (TTSS) and a pull through. Supplementary file1 (MP4 469658 KB).
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Affiliation(s)
- A Potolicchio
- Clinique Tivoli-Ducos, Bordeaux Colorectal Institute, Bordeaux, France
| | - C Jehaes
- Clinique Tivoli-Ducos, Bordeaux Colorectal Institute, Bordeaux, France.
| | - B Merlot
- Clinique Tivoli-Ducos, Franco-European Multidisciplinary Endometriosis Institute, Bordeaux, France
| | - V Assenat
- Clinique Tivoli-Ducos, Bordeaux Colorectal Institute, Bordeaux, France
| | - T Dennis
- Clinique Tivoli-Ducos, Franco-European Multidisciplinary Endometriosis Institute, Bordeaux, France
| | - H Roman
- Clinique Tivoli-Ducos, Franco-European Multidisciplinary Endometriosis Institute, Bordeaux, France
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - M-O Francois
- Clinique Tivoli-Ducos, Bordeaux Colorectal Institute, Bordeaux, France
| | - Q Denost
- Clinique Tivoli-Ducos, Bordeaux Colorectal Institute, Bordeaux, France
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Arquillière J, Dubois A, Rullier E, Rouanet P, Denost Q, Celerier B, Pezet D, Passot G, Aboukassem A, Colombo PE, Mourregot A, Carrere S, Vaudoyer D, Gourgou S, Gauthier L, Cotte E. Learning curve for robotic-assisted total mesorectal excision: a multicentre, prospective study. Colorectal Dis 2023; 25:1863-1877. [PMID: 37525421 DOI: 10.1111/codi.16695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/19/2023] [Accepted: 06/26/2023] [Indexed: 08/02/2023]
Abstract
AIM Robotic-assisted surgery (RAS) is becoming increasingly important in colorectal surgery. Recognition of the short, safe learning curve (LC) could potentially improve implementation. We evaluated the extent and safety of the LC in robotic resection for rectal cancer. METHOD Consecutive rectal cancer resections (January 2018 to February 2021) were prospectively included from three French centres, involving nine surgeons. LC analyses only included surgeons who had performed more than 25 robotic rectal cancer surgeries. The primary endpoint was operating time LC and the secondary endpoint conversion rate LC. Interphase comparisons included demographic and intraoperative data, operating time, conversion rate, pathological specimen features and postoperative morbidity. RESULTS In 174 patients (69% men; mean age 62.6 years) the mean operating time was 334.5 ± 92.1 min. Operative procedures included low anterior resection (n = 143) and intersphincteric resection (n = 31). For operating time, there were two or three (centre-dependent) LC phases. After 12-21 cases (learning phase), there was a significant decrease in total operating time (all centres) and an increase in the number of harvested lymph nodes (two centres). For conversion rate, there were two or four LC phases. After 9-14 cases (learning phase), the conversion rate decreased significantly in two centres; in one centre, there was a nonsignificant decrease despite the treatment of significantly more obese patients and patients with previous abdominal surgery. There were no significant differences in interphase comparisons. CONCLUSION The LC for RAS in rectal cancer was achieved after 12-21 cases for the operating time and 9-14 cases for the conversion rate. RAS for rectal cancer was safe during this time, with no interphase differences in postoperative complications and circumferential resection margin.
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Affiliation(s)
- J Arquillière
- Department of Digestive and Oncological Surgery, Lyon University Hospital, Lyon-Sud Hospital, Pierre-Bénite, France
| | - A Dubois
- Department of Colorectal Surgery, CHU Estaing, Clermont-Ferrand, France
| | - E Rullier
- Department of Digestive Surgery, Colorectal Unit, Bordeaux University Hospital, Haut-Lévèque Hospital, Pessac, France
| | - P Rouanet
- Department of Colorectal Surgery, Institut Du Cancer De Montpellier, Montpellier, France
| | - Q Denost
- Bordeaux Colorectal Institute, Clinique Tivoli, Bordeaux, France
| | - B Celerier
- Department of Digestive Surgery, Colorectal Unit, Bordeaux University Hospital, Haut-Lévèque Hospital, Pessac, France
| | - D Pezet
- Department of Colorectal Surgery, CHU Estaing, Clermont-Ferrand, France
| | - G Passot
- Department of Digestive and Oncological Surgery, Lyon University Hospital, Lyon-Sud Hospital, Pierre-Bénite, France
- Lyon Center for Innovation in Cancer, CICLY EA 3738, Lyon 1 University, Lyon, France
| | - A Aboukassem
- Department of Colorectal Surgery, CHU Estaing, Clermont-Ferrand, France
| | - P E Colombo
- Department of Colorectal Surgery, Institut Du Cancer De Montpellier, Montpellier, France
| | - A Mourregot
- Department of Colorectal Surgery, Institut Du Cancer De Montpellier, Montpellier, France
| | - S Carrere
- Department of Colorectal Surgery, Institut Du Cancer De Montpellier, Montpellier, France
| | - D Vaudoyer
- Department of Digestive and Oncological Surgery, Lyon University Hospital, Lyon-Sud Hospital, Pierre-Bénite, France
- Lyon Center for Innovation in Cancer, CICLY EA 3738, Lyon 1 University, Lyon, France
| | - S Gourgou
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - L Gauthier
- Biometrics Unit, Montpellier Cancer Institute (ICM), University of Montpellier, Montpellier, France
| | - E Cotte
- Department of Digestive and Oncological Surgery, Lyon University Hospital, Lyon-Sud Hospital, Pierre-Bénite, France
- Lyon Center for Innovation in Cancer, CICLY EA 3738, Lyon 1 University, Lyon, France
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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de’Angelis N, Micelli Lupinacci R, Abdalla S, Genova P, Beliard A, Cotte E, Denost Q, Goasguen N, Lakkis Z, Lelong B, Manceau G, Meurette G, Perrenot C, Pezet D, Rouanet P, Valverde A, Pessaux P, Azagra S, Mege D, Di Saverio S, de Chaisemartin C, Espin-Basany E, Gaujoux S, Gómez-Ruiz M, Gronnier C, Karoui M, Spinoglio G. Robotic-assisted right colectomy. Official expert recommendations delivered under the aegis of the French Association of Surgery (AFC). J Visc Surg 2022; 159:212-221. [DOI: 10.1016/j.jviscsurg.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Martin M, Giraud N, Capdepont M, Sarrade C, Viaouet A, Smith D, Terrebonne E, Frulio N, Rullier A, Denost Q, Rullier E, Vendrely V. Morbidité chirurgicale sévère après une chimioradiothérapie néoadjuvante en technique conformationnelle tridimensionnelle comparée à la modulation d’intensité pour l’adénocarcinome rectal localement évolué. Cancer Radiother 2021. [DOI: 10.1016/j.canrad.2021.07.016] [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: 10/20/2022]
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Martin M, Giraud N, Capdepont M, Sarrade C, Viaouet A, Smith D, Terrebonne E, Frulio N, Rullier A, Denost Q, Rullier E, Vendrely V. PO-1244 Severe surgical morbidity after chemoradiotherapy conformational-3D versus IMRT for rectal cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07695-7] [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: 10/20/2022]
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Teste B, Rouanet P, Tuech JJ, Valverde A, Lelong B, Rivoire M, Faucheron JL, Jafari M, Portier G, Meunier B, Sielezneff I, Prudhomme M, Marchal F, Dubois A, Capdepont M, Denost Q, Rullier E. Early and late morbidity of local excision after chemoradiotherapy for rectal cancer. BJS Open 2021; 5:6294246. [PMID: 34097005 PMCID: PMC8183183 DOI: 10.1093/bjsopen/zrab043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022] Open
Abstract
Background Local excision (LE) after chemoradiotherapy is a new option in low rectal cancer, but morbidity has never been compared prospectively with total mesorectal excision (TME). Early and late morbidity were compared in patients treated either by LE or TME after neoadjuvant chemoradiotherapy for rectal cancer. Method This was a post-hoc analysis from a randomized trial. Patients with clinical T2/T3 low rectal cancer with good response to the chemoradiotherapy and having either LE, LE with eventual completion TME, or TME were considered. Early (1 month) and late (2 years) morbidities were compared between the three groups. Results There were no deaths following surgery in any of the three groups. Early surgical morbidity (20 per cent LE versus 36 per cent TME versus 43 per cent completion TME, P = 0.025) and late surgical morbidity (4 per cent versus 33 per cent versus 57 per cent, P < 0.001) were significantly lower in the LE group than in the TME or the completion TME group. of LE, was associated with the lowest rate of early (10 versus 18 versus 21 per cent, P = 0.217) and late medical morbidities (0 versus 7 versus 7 per cent, P = 0.154), although this did not represent a significant difference between the groups. The severity of overall morbidity was significantly lower at 2 years after LE compared with TME or completion TME (4 versus 28 versus 43 per cent grade 3–5, P < 0.001). Conclusion The rate of surgical complications after neoadjuvant chemoradiotherapy in the LE group was half that of TME group at 1 month and 10 times lower at 2 years. LE is a safe approach for organ preservation and should be considered as an alternative to watch-and-wait in complete clinical responders and to TME in subcomplete responders.
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Affiliation(s)
- B Teste
- Department of Colorectal Surgery, Magellan Centre, Haut-Leveque Hospital, University of Bordeaux, 33604 Pessac, France
| | - P Rouanet
- Département de Chirurgie Oncologique, ICM Val d'Aurelle, Montpellier, France
| | - J-J Tuech
- Service de Chirurgie Digestive, CHU Charles Nicolle, Rouen, France
| | - A Valverde
- Service de Chirurgie Digestive, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - B Lelong
- Département de Chirurgie Oncologique, Institut Paoli Calmette, Marseille, France
| | - M Rivoire
- Département de Chirurgie Oncologique, Centre Léon Bérard, Lyon, France
| | - J-L Faucheron
- Service de Chirurgie Digestive, Hôpital A. Michallon, La Tronche, France
| | - M Jafari
- Département de Chirurgie Oncologique, Centre Oscar Lambret, Lille, France
| | - G Portier
- Service de Chirurgie Digestive, Hôpital Purpan, Toulouse, France
| | - B Meunier
- Service de Chirurgie Viscérale, CHU Pontchaillou, Rennes, France
| | - I Sielezneff
- Service de Chirurgie Digestive, CHU Timone, Marseille, France
| | - M Prudhomme
- Département de Chirurgie Digestive et de Cancérologie Digestive, Hôpital Universitaire Carémeau, Nimes, France
| | - F Marchal
- Département de Chirurgie Oncologique, Institut de Cancérologie de Lorraine, Vandoeuvre les Nancy, France
| | - A Dubois
- Service de Chirurgie Générale et Digestive, Hôtel Dieu, Clermont-Ferrand, France
| | - M Capdepont
- Department of Colorectal Surgery, Magellan Centre, Haut-Leveque Hospital, University of Bordeaux, 33604 Pessac, France
| | - Q Denost
- Department of Colorectal Surgery, Magellan Centre, Haut-Leveque Hospital, University of Bordeaux, 33604 Pessac, France
| | - E Rullier
- Department of Colorectal Surgery, Magellan Centre, Haut-Leveque Hospital, University of Bordeaux, 33604 Pessac, France
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Celarier S, Monziols S, Célérier B, Assenat V, Carles P, Napolitano G, Laclau-Lacrouts M, Rullier E, Ouattara A, Denost Q. Low-pressure versus standard pressure laparoscopic colorectal surgery (PAROS trial): a phase III randomized controlled trial. Br J Surg 2021; 108:998-1005. [PMID: 33755088 DOI: 10.1093/bjs/znab069] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/19/2022]
Abstract
TRIAL DESIGN This is a phase III, double-blind, randomized, controlled trial. METHODS In this trial, patients with laparoscopic colectomy were assigned to either low pressure (LP: 7 mmHg) or standard pressure (SP: 12 mmHg) at a ratio of 1 : 1. The aim of this trial was to assess the impact of low-pressure pneumoperitoneum during laparoscopic colectomy on postoperative recovery. The primary endpoint was the duration of hospital stay. The main secondary endpoints were postoperative pain, consumption of analgesics and postoperative morbidity. RESULTS Some 138 patients were enrolled, of whom 11 were excluded and 127 were analysed: 62 with LP and 65 with SP. Duration of hospital stay (3 versus 4 days; P = 0.010), visual analog scale (0.5 versus 2.0; P = 0.008) and analgesic consumption (level II: 73 versus 88 per cent; P = 0.032; level III: 10 versus 23 per cent; P = 0.042) were lower with LP. Morbidity was not significantly different between the two groups (10 versus 17 per cent; P = 0.231). CONCLUSION Using low-pressure pneumoperitoneum in laparoscopic colonic resection improves postoperative recovery, shortening the duration of hospitalization and decreasing postoperative pain and analgesic consumption. This suggests that low pressure should become the standard of care for laparoscopic colectomy. TRIAL REGISTRATION NCT03813797.
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Affiliation(s)
- S Celarier
- CHU Bordeaux, Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Pessac, France
| | - S Monziols
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France
| | - B Célérier
- CHU Bordeaux, Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Pessac, France
| | - V Assenat
- CHU Bordeaux, Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Pessac, France
| | - P Carles
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France
| | - G Napolitano
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France
| | - M Laclau-Lacrouts
- CHU Bordeaux, Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Pessac, France
| | - E Rullier
- CHU Bordeaux, Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Pessac, France
| | - A Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France.,Université de Bordeaux, INSERM, U 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Q Denost
- CHU Bordeaux, Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Pessac, France
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Collard MK, Benoist S, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Corté H, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Souche R, Vicaut E, Panis Y, Brouquet A. A Reappraisal of Outcome of Elective Surgery After Successful Non-Operative Management of an Intra-Abdominal Abscess Complicating Ileocolonic Crohn's Disease: A Subgroup Analysis of a Nationwide Prospective Cohort. J Crohns Colitis 2021; 15:409-418. [PMID: 33090205 DOI: 10.1093/ecco-jcc/jjaa217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Few prospective data exist on outcomes of surgery in Crohn's disease [CD] complicated by an intra-abdominal abscess after resolution of this abscess by antibiotics optionally combined with drainage. METHODS From 2013 to 2015, all patients undergoing elective surgery for CD after successful non-operative management of an intra-abdominal abscess [Abscess-CD group] were selected from a nationwide multicentre prospective cohort. Resolution of the abscess had to be computed tomography/magnetic resonance-proven prior to surgery. Abscess-CD group patients were 1:1 matched to uncomplicated CD [Non-Penetrating-CD group] using a propensity score. Postoperative results and long-term outcomes were compared between the two groups. RESULTS Among 592 patients included in the registry, 63 [11%] fulfilled the inclusion criteria. The abscess measured 37 ± 20 mm and was primarily managed with antibiotics combined with drainage in 14 patients and nutritional support in 45 patients. At surgery, a residual fluid collection was found in 16 patients [25%]. Systemic steroids within 3 months before surgery [p = 0.013] and the absence of preoperative enteral support [p = 0.001] were identified as the two significant risk factors for the persistence of a fluid collection. After propensity score matching, there was no significant difference between the Abscess-CD and Non-Penetrating-CD groups in the rates of primary anastomosis [84% vs 90% respectively, p = 0.283], overall [28% vs 15% respectively, p = 0.077] and severe postoperative morbidity [7% vs 7% respectively, p = 1.000]. One-year recurrence rates for endoscopic recurrence were 41% in the Abscess-CD and 51% in the Non-Penetrating-CD group [p = 0.159]. CONCLUSIONS Surgery after successful non-operative management of intra-abdominal abscess complicating CD provides good early and long-term outcomes.
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Affiliation(s)
- M K Collard
- Digestive Surgery Department, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicetre, France
| | - S Benoist
- Digestive Surgery Department, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicetre, France
| | - L Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, APHP, Paris VII University, Clichy, France
| | - P Zerbib
- Digestive Surgery Department, University Hospital of Lille, Lille, France
| | - J H Lefevre
- Digestive Surgery Department, Saint-Antoine Hospital Saint-Antoine, APHP, Paris VI University, Paris, France
| | - Q Denost
- Digestive Surgery Department, Saint-Andre University Hospital, Bordeaux, France
| | - A Germain
- Digestive Surgery Department, University Hospital of Nancy, Nancy, France
| | - E Cotte
- Digestive Surgery Department, Lyon-Sud University Hospital, Pierre-Benite, France
| | - L Beyer-Berjot
- Digestive Surgery Department, Marseille-Nord University Hospital, Marseille, France
| | - H Corté
- Digestive Surgery Department, Saint-Louis Hospital, Paris VII University, Paris, France
| | - V Desfourneaux
- Digestive Surgery Department, University Hospital of Rennes, Rennes, France
| | - A Rahili
- Digestive Surgery Department, University Hospital of Nice, Nice, France
| | - J P Duffas
- Digestive Surgery Department, Rangueil University Hospital, Toulouse, France
| | - K Pautrat
- Digestive Surgery Department, Lariboisiere Hospital, Paris VII University, Paris, France
| | - C Denet
- Digestive Surgery Department, Montsouris Institute, Paris, France
| | - V Bridoux
- Digestive Surgery Department, University Hospital of Rouen, Rouen, France
| | - G Meurette
- Digestive Surgery Department, University Hospital of Nantes, Nantes, France
| | - J L Faucheron
- Digestive Surgery Department, Digestive Surgery Department, University Hospital of Grenoble, La Tronche, France
| | - J Loriau
- Digestive Surgery Department, Saint-Joseph Hospital, Paris, France
| | - R Souche
- Digestive Surgery Department, University Hospital of Montpellier, Montpellier, France
| | - E Vicaut
- Department of Clinical Research, Fernand Widal Hospital, APHP, Paris VII, Paris, France
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, APHP, Paris VII University, Clichy, France
| | - A Brouquet
- Digestive Surgery Department, Bicêtre Hospital, APHP, Paris-Sud University, Le Kremlin-Bicetre, France
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Denost Q, Rouanet P, Faucheron JL, Panis Y, Meunier B, Cotte E, Meurette G, Portier G, Sabbagh C, Loriau J, Benoist S, Piessen G, Sielezneff I, Lelong B, Mauvais F, Romain B, Barussaud ML, Capdepont M, Laurent C, Rullier E. Impact of early biochemical diagnosis of anastomotic leakage after rectal cancer surgery: long-term results from GRECCAR 5 trial. Br J Surg 2021; 108:605-608. [PMID: 33793764 DOI: 10.1093/bjs/znab003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 12/12/2022]
Abstract
Elevated C-reactive protein, should be used to prompt early detection of AL prior to the development of clinical symptoms. Early biochemical diagnosis and intervention of AL mitigates the negative impact of AL on oncological outcomes in patients with rectal cancer.
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Affiliation(s)
- Q Denost
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU Bordeaux, Pessac, France
| | - P Rouanet
- Département de Chirurgie Oncologique, ICM Val d'Aurelle, Montpellier, France
| | - J-L Faucheron
- Service de Chirurgie Digestive, Hôpital A. Michallon, La Tronche, France
| | - Y Panis
- Service de Chirurgie Digestive, Hôpital Beaujon, AP-HP, Clichy, France
| | - B Meunier
- Service de Chirurgie Viscérale, CHU Pontchaillou, Rennes, France
| | - E Cotte
- Service de Chirurgie Digestive, Hôpital Lyon Sud, CHU Lyon, Pierre-Bénite, France
| | - G Meurette
- Service de Chirurgie Digestive, Site Hôtel Dieu, Nantes, France
| | - G Portier
- Service de Chirurgie Digestive, Hôpital Purpan, Toulouse, France
| | - C Sabbagh
- Service de Chirurgie Digestive et Métabolique, CHU d'Amiens, Amiens, France
| | - J Loriau
- Service de Chirurgie Digestive et Obésité, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - S Benoist
- Service de Chirurgie Générale et Digestive, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - G Piessen
- Service de Chirurgie Digestive, Hôpital Claude Huriez, CHU Lille, Lille, France
| | - I Sielezneff
- Service de Chirurgie Digestive et Viscérale, CHU Timone, Marseille, France
| | - B Lelong
- Service de Chirurgie Digestive, Institut Paoli Calmette Institut Paoli Calmette, Marseille, France
| | - F Mauvais
- Service de Chirurgie Viscérale, CH de Beauvais, Beauvais, France
| | - B Romain
- Service de Chirurgie Générale et Digestive, Hôpital Universitaire de Hautepierre, Strasbourg, France
| | - M-L Barussaud
- Service de Chirurgie Digestive, CHU de Poitiers, Poitiers, France
| | - M Capdepont
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU Bordeaux, Pessac, France
| | - C Laurent
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU Bordeaux, Pessac, France
| | - E Rullier
- Département de Chirurgie Colorectal, Hôpital Haut-Lévèque, CHU Bordeaux, Pessac, France
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11
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Frontali A, Cohen L, Bridoux V, Myrelid P, Sica G, Poggioli G, Espin E, Beyer-Berjot L, Laharie D, Spinelli A, Zerbib P, Sampietro G, Frasson M, Louis E, Danese S, Fumery M, Denost Q, Altwegg R, Nancey S, Michelassi F, Treton X, Panis Y. Segmental Colectomy for Ulcerative Colitis: Is There a Place in Selected Patients Without Active Colitis? An International Multicentric Retrospective Study in 72 Patients. J Crohns Colitis 2020; 14:1687-1692. [PMID: 32498084 DOI: 10.1093/ecco-jcc/jjaa107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to report a multicentric experience of segmental colectomy [SC] in ulcerative colitis [UC] patients without active colitis, in order to assess if SC can or cannot represent an alternative to ileal pouch-anal anastomosis [IPAA]. METHODS All UC patients undergoing SC were included. Postoperative complications according to ClavienDindo's classification, long term results, and risk factors for postoperative colitis and reoperation for colitis on the remnant colon, were assessed. RESULTS: A TOTAL OF 72 UC patients underwent: sigmoidectomy [n = 28], right colectomy [n = 24], proctectomy [n = 11], or left colectomy [n = 9] for colonic cancer [n = 27], 'diverticulitis' [n = 17], colonic stenosis [n = 5], dysplasia or polyps [n = 8], and miscellaneous [n = 15]. Three patients died postoperatively and 5/69 patients [7%] developed early flare of UC within 3 months after SC. After a median followup of 40 months, 24/69 patients [35%] were reoperated after a median delay after SC of 19 months [range, 2-158 months]: 22/24 [92%] underwent total colectomy and ileorectal anastomosis [n = 9] or total coloproctectomy [TCP] [n = 13] and 2/24 [8%] an additional SC. Reasons for reoperation were: colitis [n = 14; 20%], cancer [n = 3] or dysplasia [n = 3], colonic stenosis [n = 1], and unknown reasons [n = 3]. Endoscopic score of colitis before SC was Mayo 23 in 5/5 [100%] patients with early flare vs 15/42 without early flare [36%; p = 0.0101] and in 9/12 [75%] patients with reoperation for colitis vs 11/35 without reoperation [31%; p = 0.016]. CONCLUSIONS After segmental colectomy in UC patients, postoperative early colitis is rare [7%]. Segmental colectomy could possibly represent an alternative to IPAA in selected UC patients without active colitis.
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Affiliation(s)
- A Frontali
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université de Paris, France
| | - L Cohen
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - V Bridoux
- CHU Rouen, Digestive Surgery, Rouen, France
| | - P Myrelid
- Department of Biomedical and Clinical Sciences, Linköping University and Department of Surgery, Linköping University Hospital, Linköping Sweden
| | - G Sica
- Policlinico Tor Vergata, Digestive Surgery, Roma, Italy
| | | | - E Espin
- Hospital Universitari Val d'Hebron, Digestive Surgery, Barcelona, Spain
| | | | - D Laharie
- Department of Gastroenterology, CHU Bordeaux, Bordeaux, France
| | - A Spinelli
- Department of Colorectal Surgery, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - P Zerbib
- CHU Lille, Digestive Surgery, Lille, France
| | - G Sampietro
- Department of Surgery, IBD Unit, Luigi Sacco University Hospital, Milano, Italy
| | - M Frasson
- University Hospital La Fe, Digestive Surgery, Valencia, Spain
| | - E Louis
- CHU Liege, Gastroenterology, Liege, France
| | - S Danese
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,IBD center, Department of Gastroenterology, Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - M Fumery
- Department of Gastroenterology, CHU Amiens Picardie, Amiens, France
| | - Q Denost
- Department of Colorectal Surgery, CHU Bordeaux, Bordeaux, France
| | - R Altwegg
- Department of Gastroenterology, CHU Montpellier, Montpellier, France
| | - S Nancey
- Department of Gastroenterology, CHU Lyon, Lyon, France
| | - F Michelassi
- Department of Surgery, New York Presbyterian Hospital Weill Cornell Medical Centre, New York, NY, USA
| | - X Treton
- Department of Gastroenterology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy and Université de Paris, France
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12
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Denost Q, Moreau JB, Vendrely V, Celerier B, Rullier A, Assenat V, Rullier E. Intersphincteric resection for low rectal cancer: the risk is functional rather than oncological. A 25-year experience from Bordeaux. Colorectal Dis 2020; 22:1603-1613. [PMID: 32649005 DOI: 10.1111/codi.15258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
AIM There are few data evaluating the long-term outcomes of intersphincteric resection (ISR), especially the impact of inclusion of more juxtapositioned and intra-anal tumours on oncological and functional outcomes. We compared the oncological and functional results of patients treated by total mesorectal excision and ISR for low rectal cancer over a 25-year period. METHOD This is a retrospective study from a single institution evaluating results of ISR over three periods: 1990-1998, 1999-2006 and 2007-2014. Patients treated by partial or total ISR, with or without neoadjuvant chemoradiotherapy, for low rectal cancer (≤ 6 cm from the anal verge) were included. We compared postoperative morbidity, quality of surgery and oncological and functional outcomes in the time periods studied. RESULTS Of 813 patients operated on for low rectal cancer, 303 had ISR. Tumour stage did not differ; however, the distance of the tumour from the anorectal junction decreased from 1 to 0 cm (P < 0.001) and the distal resection margin shortened from 25 to 10 mm (P < 0.001) from 1990 to 2014. The postoperative morbidity and quality of surgery did not change significantly over time. The 5-year local recurrence (4.3% vs 5.9% vs 3.5%; P = 0.741) and disease-free survival (72% vs 71% vs 75%; P = 0.918) did not differ between the three time periods. Functional results improved during the last period; however, overall 42% of patients experienced major bowel dysfunction. CONCLUSION Pushing the envelope of sphincter-saving resection in ultra-low rectal cancer reaching or invading the anal sphincter did not compromise oncological and functional outcomes. The main limitation of the ISR procedure appears to be functional rather than oncological, suggesting that bowel rehabilitation programmes should be developed.
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Affiliation(s)
- Q Denost
- Department of Colorectal Surgery, CHU Bordeaux, Haut-Leveque Hospital, University of Bordeaux, Pessac, France
| | - J-B Moreau
- Department of Colorectal Surgery, CHU Bordeaux, Haut-Leveque Hospital, University of Bordeaux, Pessac, France
| | - V Vendrely
- Department of Radiotherapy, CHU Bordeaux, Haut-Leveque Hospital, University of Bordeaux, Pessac, France
| | - B Celerier
- Department of Colorectal Surgery, CHU Bordeaux, Haut-Leveque Hospital, University of Bordeaux, Pessac, France
| | - A Rullier
- Department of Pathology, CHU Bordeaux, Pellegrin Hospital, University of Bordeaux, Bordeaux, France
| | - V Assenat
- Department of Colorectal Surgery, CHU Bordeaux, Haut-Leveque Hospital, University of Bordeaux, Pessac, France
| | - E Rullier
- Department of Colorectal Surgery, CHU Bordeaux, Haut-Leveque Hospital, University of Bordeaux, Pessac, France
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13
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François MO, Buscail E, Vendrely V, Célérier B, Assénat V, Moreau JB, Rullier E, Denost Q. Delayed coloanal anastomosis: an alternative option for restorative rectal cancer surgery after high-dose pelvic radiotherapy for prostate cancer. Colorectal Dis 2020; 22:1545-1552. [PMID: 32463973 DOI: 10.1111/codi.15144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/27/2020] [Indexed: 02/08/2023]
Abstract
AIM Restorative total mesorectal excision (TME) for rectal cancer after high-dose pelvic radiotherapy for prostate cancer has been reported to provide an unacceptable rate of pelvic sepsis. In a previous publication we proposed that delayed coloanal anastomosis (DCAA) should be performed in this situation. The present study aimed to assess the feasibility and outcomes of this strategy. METHOD Between 2000 and 2018, 1094 men were operated on for rectal cancer in our institution. All men with T2/T3 mid and low rectal cancer with preoperative radiotherapy and restorative TME were considered for this study (n = 416). Patients with external-beam high-dose radiotherapy (EBHRT) for prostate cancer (70-78 Gy) were identified and compared with patients with conventional long-course chemoradiotherapy (CRT) followed by TME. We compared our already published historical cohort (2000-2012), including arm A (CRT + TME; n = 236) and arm B (EBHRT + TME; n = 12), with our early cohort (2013-2018), including arm C (CRT + TME; n = 158) and arm D (EBHRT + TME-DCAA; n = 10). The end-points were morbidity, pelvic sepsis, reoperation rate and quality of the specimen. RESULTS Overall morbidity was not significantly different between groups. Pelvic sepsis decreased from 50% (arm B) to 10% (arm D) with the use of DCAA (P = 0.074), and was similar between arms A, C and D. Quality of the specimen was not significantly different between the four groups. CONCLUSION Our results suggest that TME with DCAA in patients with previous EBHRT is feasible, with the same postoperative pelvic sepsis rate as conventional CRT.
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Affiliation(s)
- M-O François
- Department of Digestive Surgery, CHU de Bordeaux, Haut-Lévêque Hospital, Pessac, France
| | - E Buscail
- Department of Digestive Surgery, CHU de Bordeaux, Haut-Lévêque Hospital, Pessac, France
| | - V Vendrely
- Department of Radiotherapy, CHU de Bordeaux, Haut-Lévêque Hospital, Pessac, France
| | - B Célérier
- Department of Digestive Surgery, CHU de Bordeaux, Haut-Lévêque Hospital, Pessac, France
| | - V Assénat
- Department of Digestive Surgery, CHU de Bordeaux, Haut-Lévêque Hospital, Pessac, France
| | - J-B Moreau
- Department of Digestive Surgery, CHU de Bordeaux, Haut-Lévêque Hospital, Pessac, France
| | - E Rullier
- Department of Digestive Surgery, CHU de Bordeaux, Haut-Lévêque Hospital, Pessac, France
| | - Q Denost
- Department of Digestive Surgery, CHU de Bordeaux, Haut-Lévêque Hospital, Pessac, France
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14
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Manceau G, Sabbagh C, Mege D, Lakkis Z, Bege T, Tuech JJ, Benoist S, Lefèvre JH, Karoui M, Bridoux V, Venara A, Beyer‐Berjot L, Codjia T, Dazza M, Gagnat G, Hamel S, Mallet L, Martre P, Philouze G, Roussel E, Tortajada P, Dumaine AS, Heyd B, Paquette B, Brunetti F, Esposito F, Lizzi V, Michot N, Denost Q, Rullier E, Tresallet C, Tetard O, Rivier P, Fayssal E, Collard M, Moszkowicz D, Lupinacci R, Peschaud F, Etienne JC, Loge L, Bege T, Corte H, D’Annunzio E, Humeau M, Issard J, Munoz N, Abba J, Jafar Y, Lacaze L, Sage PY, Susoko L, Trilling B, Arvieux C, Mauvais F, Ulloa‐Severino B, Pitel S, Vauchaussade de Chaumont A, Badic B, Blanc B, Bert M, Rat P, Ortega‐Deballon P, Chau A, Dejeante C, Piessen G, Grégoire E, Alfarai A, Cabau M, David A, Kadoche D, Dufour F, Goin G, Goudard Y, Pauleau G, Sockeel P, Villeon B, Pautrat K, Eveno C, Abdalla S, Couchard AC, Balbo G, Mabrut JY, Bellinger J, Bertrand M, Aumont A, Duchalais E, Messière AS, Tranchart A, Cazauran JB, Pichot‐Delahaye V, Dubuisson V, Maggiori L, Panis Y, Djawad‐Boumediene B, Fuks D, Kahn X, Huart E, Catheline JM, Lailler G, Baraket O, Baque P, Diaz de Cerio JM, Mariol P, Maes B, Fernoux P, Guillem P, Chatelain E, de Saint Roman C, Fixot K, Voron T, Parc Y. Colon sparing resection versus extended colectomy for left-sided obstructing colon cancer with caecal ischaemia or perforation: a nationwide study from the French Surgical Association. Colorectal Dis 2020; 22:1304-1313. [PMID: 32368856 DOI: 10.1111/codi.15111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/02/2020] [Indexed: 02/08/2023]
Abstract
AIM It is not known whether patients with obstructive left colon cancer (OLCC) with caecal ischaemia or diastatic perforation (defined as a blowout of the caecal wall related to colonic overdistension) should undergo a (sub)total colectomy (STC) or an ileo-caecal resection with double-barrelled ileo-colostomy. We aimed to compare the results of these two strategies. METHOD From 2000 to 2015, 1220 patients with OLCC underwent surgery by clinicians who were members of the French Surgical Association. Of these cases, 201 (16%) were found to have caecal ischaemia or diastatic perforation intra-operatively: 174 patients (87%) underwent a STC (extended colectomy group) and 27 (13%) an ileo-caecal resection with double-end stoma (colon-sparing group). Outcomes were compared retrospectively. RESULTS In the extended colectomy group, 95 patients (55%) had primary anastomosis and 79 (45%) had a STC with an end ileostomy. In the colon-sparing group, 10 patients (37%) had simultaneous resection of their primary tumour with segmental colectomy and an anastomosis which was protected by a double-barrelled ileo-colostomy. The demographic data for the two groups were comparable. Median operative time was longer in the STC group (P = 0.0044). There was a decrease in postoperative mortality (7% vs 12%, P = 0.75) and overall morbidity (56% vs 67%, P = 0.37) including surgical (30% vs 40%, P = 0.29) and severe complications (17% vs 27%, P = 0.29) in the colon-sparing group, although these differences did not reach statistical significance. Cumulative morbidity included all surgical stages and the rate of permanent stoma was 66% and 37%, respectively, with no significant difference between the two groups. Overall survival and disease-free survival were similar between the two groups. CONCLUSION The colon-sparing strategy may represent a valid and safe alternative to STC in OLCC patients with caecal ischaemia or diastatic perforation.
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Affiliation(s)
- G Manceau
- Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - C Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - D Mege
- Department of Digestive Surgery, Assistance Publique-Hôpitaux de Marseille, Timone University Hospital, Marseille, France
| | - Z Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - T Bege
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - J J Tuech
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - S Benoist
- Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, Bicêtre University Hospital, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - J H Lefèvre
- Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Sorbonne Université, Paris, France
| | - M Karoui
- Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, Pitié Salpêtrière University Hospital, Sorbonne Université, Paris, France
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15
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Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham‐Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angenete E, Antoniou A, Auer R, Austin KK, Aziz O, Baker RP, Bali M, Baseckas G, Bebington B, Bednarski BK, Beets GL, Berg PL, Beynon J, Biondo S, Boyle K, Bordeianou L, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo‐Marulanda A, Chan KKL, Chang GJ, Chew MH, Chong PC, Christensen HK, Clouston H, Codd M, Collins D, Colquhoun A, Corr A, Coscia M, Coyne PE, Creavin B, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Eglinton T, Enrique‐Navascues JM, Espin‐Basany E, Evans MD, Fearnhead NS, Flatmark K, Fleming F, Frizelle FA, Gallego MA, Garcia‐Granero E, Garcia‐Sabrido JL, Gentilini L, George ML, Ghouti L, Giner F, Ginther N, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Jenkins JT, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kelley SR, Keller DS, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kristensen HØ, Kroon HM, Kusters M, Lago V, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Lydrup ML, Lyons A, Lynch AC, Mantyh C, Mathis KL, Margues CFS, Martling A, Meijerink WJHJ, Merkel S, Mehta AM, McArthur DR, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Morton JR, Mullaney TG, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, O’Connell PR, O’Dwyer ST, Palmer G, Pappou E, Park J, Patsouras D, Pellino G, Peterson AC, Poggioli G, Proud D, Quinn M, Quyn A, Radwan RW, van Ramshorst GH, Rasheed S, Rasmussen PC, Regenbogen SE, Renehan A, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Ryan ÉJ, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu V, Selvasekar C, Shaikh I, Hellawell G, Shida D, Simpson A, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Sumrien H, Sutton PA, Swartking T, Taylor C, Tekkis PP, Teras J, Thurairaja R, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Vasquez‐Jimenez W, Verhoef C, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Wheeler JMD, Wild J, Wilson M, de Wilt JHW, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, van Zoggel D, Winter DC. Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative. Colorectal Dis 2020; 22:1258-1262. [PMID: 32294308 DOI: 10.1111/codi.15064] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/24/2020] [Indexed: 02/08/2023]
Abstract
AIM At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection. METHOD Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival. RESULTS Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006). CONCLUSION Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.
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16
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van Oostendorp SE, Smits LJH, Vroom Y, Detering R, Heymans MW, Moons LMG, Tanis PJ, de Graaf EJR, Cunningham C, Denost Q, Kusters M, Tuynman JB. Local recurrence after local excision of early rectal cancer: a meta-analysis of completion TME, adjuvant (chemo)radiation, or no additional treatment. Br J Surg 2020; 107:1719-1730. [PMID: 32936943 PMCID: PMC7692925 DOI: 10.1002/bjs.12040] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [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: 06/19/2020] [Revised: 07/13/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The risks of local recurrence and treatment-related morbidity need to be balanced after local excision of early rectal cancer. The aim of this meta-analysis was to determine oncological outcomes after local excision of pT1-2 rectal cancer followed by no additional treatment (NAT), completion total mesorectal excision (cTME) or adjuvant (chemo)radiotherapy (aCRT). METHODS A systematic search was conducted in PubMed, Embase and the Cochrane Library. The primary outcome was local recurrence. Statistical analysis included calculation of the weighted average of proportions. RESULTS Some 73 studies comprising 4674 patients were included in the analysis. Sixty-two evaluated NAT, 13 cTME and 28 aCRT. The local recurrence rate for NAT among low-risk pT1 tumours was 6·7 (95 per cent c.i. 4·8 to 9·3) per cent. There were no local recurrences of low-risk pT1 tumours after cTME or aCRT. The local recurrence rate for high-risk pT1 tumours was 13·6 (8·0 to 22·0) per cent for local excision only, 4·1 (1·7 to 9·4) per cent for cTME and 3·9 (2·0 to 7·5) per cent for aCRT. Local recurrence rates for pT2 tumours were 28·9 (22·3 to 36·4) per cent with NAT, 4 (1 to 13) per cent after cTME and 14·7 (11·2 to 19·0) per cent after aCRT. CONCLUSION There is a substantial risk of local recurrence in patients who receive no additional treatment after local excision, especially those with high-risk pT1 and pT2 rectal cancer. The lowest recurrence risk is provided by cTME; aCRT has outcomes comparable to those of cTME for high-risk pT1 tumours, but shows a higher risk for pT2 tumours.
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Affiliation(s)
- S E van Oostendorp
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - L J H Smits
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - Y Vroom
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - R Detering
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - M W Heymans
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - L M G Moons
- Department of Gastroenterology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - E J R de Graaf
- Department of Surgery, IJsselland Ziekenhuis, Capelle aan den Ijssel, the Netherlands
| | - C Cunningham
- Department of Surgery, Oxford University Hospitals, Oxford, UK
| | - Q Denost
- Department of Surgery, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - M Kusters
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - J B Tuynman
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands
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17
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Denost Q, Solomon M, Tuech JJ, Ghouti L, Cotte E, Panis Y, Lelong B, Rouanet P, Faucheron JL, Jafari M, Lefevre JH, Rullier E, Heriot A, Austin K, Lee P, Brown W, Maillou-Martinaud H, Savel H, Quintard B, Broc G, Saillour-Glénisson F. International variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis. Br J Surg 2020; 107:1846-1854. [PMID: 32786027 DOI: 10.1002/bjs.11854] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Tumour extension beyond the mesorectal plane (ymrT4) occurs in 5-10 per cent of patients with rectal cancer and 10 per cent of patients develop locally recurrent rectal cancer (LRRC) after primary surgery. There is global variation in healthcare delivery for these conditions. METHODS An international benchmark trial of the management of ymrT4 tumours and LRRC was undertaken in France and Australia between 2015 and 2017. Heterogeneity in management and operative decision-making were analysed by comparison of surgical resection rates, blinded intercountry reading of pelvic MRI, quality-of-life assessment and qualitative evaluations. RESULTS Among 154 patients (97 in France and 57 in Australia), 31·8 per cent had ymrT4 disease and 68·2 per cent LRRC. The surgical resection rates were 88 and 79 per cent in France and Australia respectively (P = 0·112). The concordance in operative planning was low (κ = 0·314); the rate of pelvic exenteration was lower in France than Australia both in clinical practice (36 of 78 versus 34 of 40; P < 0·001) and in theoretical conditions (10 of 25 versus 50 of 57; P = 0·002). The R0 resection rate was lower in France than Australia for LRRC (25 of 49 versus 18 of 21; P = 0·007) but not for ymrT4 tumours (21 of 26 versus 15 of 15; P = 0·139). Morbidity rates were similar. Patients who underwent non-exenterative procedures had higher scores on the mental functioning subscale at 12 months (P = 0·047), and a lower level of distress at 6 months (P = 0·049). Qualitative analysis highlighted five categories of psychosocial factors influencing treatment decisions: patient, strategy, specialist, organization and culture. CONCLUSION This international benchmark trial has highlighted the differences in worldwide treatment of locally advanced and LRRC. Standardized care should improve outcomes for these patients.
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Affiliation(s)
- Q Denost
- Department of Digestive Surgery, Colorectal Unit, Haut-leveque Hospital, Bordeaux University Hospital, Pessac, France
| | - M Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South, Wales
| | - J-J Tuech
- Department of Digestive Surgery, Charles Nicolle Hospital, Rouen University Hospital, Rouen, France
| | - L Ghouti
- Department of General and Digestive Surgery, Purpan Hospital, Toulouse University Hospital, Toulouse, France
| | - E Cotte
- Department of Digestive Surgery, Pierre-Bénite Hospital, Lyon University Hospital, Lyon, France
| | - Y Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, University Denis Diderot (Paris VII), Clichy, France
| | - B Lelong
- Department of Oncological Surgery, Paoli-Calmettes Institute, Marseille, France
| | - P Rouanet
- Department of Surgery, Montpellier Cancer Institute, University of Montpellier, Montpellier, France
| | - J-L Faucheron
- Colorectal Unit, Department of Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - M Jafari
- Department of Oncological Surgery, Oscar Lambret Centre, Lille, France
| | - J H Lefevre
- Department of General and Digestive Surgery, Saint-Antoine Hospital, Sorbonne Université, Paris, France
| | - E Rullier
- Department of Digestive Surgery, Colorectal Unit, Haut-leveque Hospital, Bordeaux University Hospital, Pessac, France
| | - A Heriot
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - K Austin
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South, Wales
| | - P Lee
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South, Wales
| | - W Brown
- Surgical Outcome Research Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South, Wales
| | - H Maillou-Martinaud
- Department of Digestive Surgery, Colorectal Unit, Haut-leveque Hospital, Bordeaux University Hospital, Pessac, France
| | - H Savel
- Methodological Support Unit for Clinical and Epidemiological, Bordeaux, France
| | - B Quintard
- Bordeaux University Laboratoire de Psychologie EA 4136 'Handicap, Activité, Cognition, Santé', Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (U)1219 - Bordeaux Population Health.,INSERM, Bordeaux School of Public Health (INSPED), Centre INSERM U1219 - Bordeaux Population Health, Team EMOS, Bordeaux, France
| | - G Broc
- University Paul Valéry Montpellier 3, University of Montpellier, Epsylon EA 4556, Montpellier, France
| | - F Saillour-Glénisson
- Service d'Information Médicale, Public Health Centre, Centre Hospitalier Universitaire, Bordeaux, France.,University of Bordeaux, ISPED, Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France
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18
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Affiliation(s)
- Q Denost
- Department of Colorectal Surgery, Centre medico-chirurgical Magellan, Centre Hospitalo-universitaire (CHU) de Bordeaux, Ave de Magellan, 33604 Pessac, France
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Celarier S, Monziols S, Francois MO, Assenat V, Carles P, Capdepont M, Fleming C, Rullier E, Napolitano G, Denost Q. Randomized trial comparing low-pressure versus standard-pressure pneumoperitoneum in laparoscopic colectomy: PAROS trial. Trials 2020; 21:216. [PMID: 32087762 PMCID: PMC7036186 DOI: 10.1186/s13063-020-4140-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 02/04/2020] [Indexed: 01/07/2023] Open
Abstract
Background Laparoscopy, by its minimally invasive nature, has revolutionized digestive and particularly colorectal surgery by decreasing post-operative pain, morbidity, and length of hospital stay. In this trial, we aim to assess whether low pressure in laparoscopic colonic surgery (7 mm Hg instead of 12 mm Hg) could further reduce pain, analgesic consumption, and morbidity, resulting in a shorter hospital stay. Methods and analysis The PAROS trial is a phase III, double-blind, randomized controlled trial. We aim to recruit 138 patients undergoing laparoscopic colectomy. Participants will be randomly assigned to either a low-pressure group (7 mm Hg) or a standard-pressure group (12 mm Hg). The primary outcome will be a comparison of length of hospital stay between the two groups. Secondary outcomes will compare post-operative pain, consumption of analgesics, morbidity within 30 days, technical and oncological quality of the surgical procedure, time to passage of flatus and stool, and ambulation. All adverse events will be recorded. Analysis will be performed on an intention-to-treat basis. Trial registration This research received the approval from the Committee for the Protection of Persons and was the subject of information to the ANSM. This search is saved in the ID-RCB database under registration number 2018-A03028–47. This research is retrospectively registered January 23, 2019, at http://clinicaltrials.gov/ed under the name “LaPAroscopic Low pRessure cOlorectal Surgery (PAROS)”. This trial is ongoing.
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Affiliation(s)
- S Celarier
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - S Monziols
- Department of Anesthesia ans Critical Care, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - M O Francois
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - V Assenat
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - P Carles
- Department of Anesthesia ans Critical Care, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - M Capdepont
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - C Fleming
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - E Rullier
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - G Napolitano
- Department of Anesthesia ans Critical Care, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France
| | - Q Denost
- Department of digestive Surgery, Colorectal Unit, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France. .,Department of digestive Surgery, Bordeaux University Hospital, 1 Avenue de Magellan, Pessac, 33600, France.
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20
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Kroon HM, Dudi-Venkata N, Bedrikovetski S, Thomas M, Kelly M, Aalbers A, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alberda W, Andric M, Antoniou A, Austin K, Baker R, Bali M, Baseckas G, Bednarski B, Beets G, Berg P, Beynon J, Biondo S, Bordeianou L, Brunner M, Buchwald P, Burger J, Burling D, Campain N, Chan K, Chang G, Chew M, C Chong P, Christensen H, Codd M, Colquhoun A, Corr A, Coscia M, Coyne P, Creavin B, Damjanovic L, Daniels I, Davies M, Davies R, de Wilt J, Denost Q, Dietz D, Dozois E, Duff M, Eglinton T, Enriquez-Navascues J, Evans M, Fearnhead N, Frizelle F, Garcia-Granero E, Garcia-Sabrido J, Gentilini L, George M, Glynn R, Golda T, Griffiths B, Harris D, Evans M, Hagemans J, Harji D, Heriot A, Hohenberger W, Holm T, Jenkins J, Kapur S, Kanemitsu Y, Kelley S, Keller D, Kim H, Koh C, Kok N, Kokelaar R, Kontovounisios C, Kusters M, Larson D, Law W, Laurberg S, Lee P, Lydrup M, Lynch A, Mantyh C, Mathis K, Martling A, Meijerink W, Merkel S, Mehta A, McDermott F, McGrath J, Mirnezami A, Morton J, Mullaney T, Mesquita-Neto J, Nielsen M, Nieuwenhuijzen G, Nilsson P, O'Connell P, Palmer G, Patsouras D, Pellino G, Poggioli G, Quinn M, Quyn A, Radwan R, Rasheed S, Rasmussen P, Regenbogen S, Rocha R, Rothbarth J, Roxburgh C, Rutten H, Ryan É, Sagar P, Saklani A, Schizas A, Schwarzkopf E, Scripcariu V, Shaikh I, Shida D, Simpson A, Smart N, Smith J, Solomon M, Sørensen M, Steele S, Steffens D, Stocchi L, Stylianides N, Tekkis P, Taylor C, Tsarkov P, Tsukamoto S, Turner W, Tuynman J, van Ramshorst G, van Zoggel D, Vasquez-Jimenez W, Verhoef C, Verstegen M, Wakeman C, Warrier S, Wasmuth H, Weiser M, Wheeler J, Wild J, Yip J, Winter D, Sammour T. Palliative pelvic exenteration: A systematic review of patient-centered outcomes. Eur J Surg Oncol 2019; 45:1787-1795. [DOI: 10.1016/j.ejso.2019.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/02/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
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21
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Manceau G, Mege D, Bridoux V, Lakkis Z, Venara A, Voron T, De Angelis N, Ouaissi M, Sielezneff I, Karoui M, Dazza M, Gagnat G, Hamel S, Mallet L, Martre P, Philouze G, Roussel E, Tortajada P, Dumaine AS, Heyd B, Paquette B, Brunetti F, Esposito F, Lizzi V, Michot N, Denost Q, Tresallet C, Tetard O, Regimbeau JM, Sabbagh C, Rivier P, Fayssal E, Collard M, Moszkowicz D, Peschaud F, Etienne JC, loge L, Beyer L, Bege T, Corte H, D'Annunzio E, Humeau M, Issard J, Munoz N, Abba J, Jafar Y, Lacaze L, Sage PY, Susoko L, Trilling B, Arvieux C, Mauvais F, Ulloa‐Severino B, Lefevre JH, Pitel S, Vauchaussade de Chaumont A, Badic B, Blanc B, Bert M, Rat P, Ortega‐Deballon P, Chau A, Dejeante C, Piessen G, Grégoire E, Alfarai A, Cabau M, David A, Kadoche D, Dufour F, Goin G, Goudard Y, Pauleau G, Sockeel P, De la Villeon B, Pautrat K, Eveno C, Brouquet A, Couchard AC, Balbo G, Mabrut JY, Bellinger J, Bertrand M, Aumont A, Duchalais E, Messière AS, Tranchart A, Cazauran JB, Pichot‐Delahaye V, Dubuisson V, Maggiori L, Djawad‐Boumediene B, Fuks D, Kahn X, Huart E, Catheline JM, Lailler G, Baraket O, Baque P, Diaz de Cerio JM, Mariol P, Maes B, Fernoux P, Guillem P, Chatelain E, de Saint Roman C, Fixot K. Thirty-day mortality after emergency surgery for obstructing colon cancer: survey and dedicated score from the French Surgical Association. Colorectal Dis 2019; 21:782-790. [PMID: 30884089 DOI: 10.1111/codi.14614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/27/2019] [Indexed: 02/08/2023]
Abstract
AIM The aim was to define risk factors for postoperative mortality in patients undergoing emergency surgery for obstructing colon cancer (OCC) and to propose a dedicated score. METHOD From 2000 to 2015, 2325 patients were treated for OCC in French surgical centres by members of the French National Surgical Association. A multivariate analysis was performed for variables with P value ≤ 0.20 in the univariate analysis for 30-day mortality. Predictive performance was assessed by the area under the receiver operating characteristic curve. RESULTS A total of 1983 patients were included. Thirty-day postoperative mortality was 7%. Multivariate analysis found five significant independent risk factors: age ≥ 75 (P = 0.013), American Society of Anesthesiologists (ASA) score ≥ III (P = 0.027), pulmonary comorbidity (P = 0.0002), right-sided cancer (P = 0.047) and haemodynamic failure (P < 0.0001). The odds ratio for risk of postoperative death was 3.42 with one factor, 5.80 with two factors, 15.73 with three factors, 29.23 with four factors and 77.25 with five factors. The discriminating capacity in predicting 30-day postoperative mortality was 0.80. CONCLUSION Thirty-day postoperative mortality after emergency surgery for OCC is correlated with age, ASA score, pulmonary comorbidity, site of tumour and haemodynamic failure, with a specific score ranging from 0 to 5.
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Affiliation(s)
- G Manceau
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - D Mege
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - V Bridoux
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - Z Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - A Venara
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - T Voron
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Saint Antoine Hospital, Sorbonne Université, Paris, France
| | - N De Angelis
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Université Paris-Est (UEP), Créteil, France
| | - M Ouaissi
- Department of Digestive Surgery, Tours University Hospital, Tours, France
| | - I Sielezneff
- Department of Digestive Surgery, Timone University Hospital, Marseille, France
| | - M Karoui
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
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Mege D, Manceau G, Bridoux V, Voron T, Sabbagh C, Lakkis Z, Venara A, Ouaissi M, Denost Q, Kepenekian V, Sielezneff I, Karoui M. Surgical management of obstructive left colon cancer at a national level: Results of a multicentre study of the French Surgical Association in 1500 patients. J Visc Surg 2019; 156:197-208. [DOI: 10.1016/j.jviscsurg.2018.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Saillour-Glénisson F, Kret M, Savel H, Denost Q, Quintard B, Salmi L. Enjeux méthodologiques et apports des analyses combinées de données qualitatives et quantitatives dans des études utilisant des méthodes mixtes. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.109] [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: 10/27/2022] Open
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Oliveira PN, Montembault A, Sudre G, Alcouffe P, Marcon L, Gehan H, Lux F, Albespy K, Centis V, Campos D, Roques S, Meulle M, Renard M, Durand M, Denost Q, Bordenave L, Vandamme M, Chereul E, Vandesteene M, Boucard N, David L. Self-crosslinked fibrous collagen/chitosan blends: Processing, properties evaluation and monitoring of degradation by bi-fluorescence imaging. Int J Biol Macromol 2019; 131:353-367. [PMID: 30817967 DOI: 10.1016/j.ijbiomac.2019.02.134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 12/22/2022]
Abstract
Porous collagen/chitosan scaffolds with different Collagen:Chitosan (Coll:Ch) ratios were prepared by freeze-drying followed by self-crosslinking via dehydrothermal treatment (DHT) and characterized as biomaterials for tissue engineering. Cy7 and Cy5.5 fluorochromes were covalently grafted to collagen and chitosan, respectively. Thus, it was possible, using optical fluorescence imaging of the two fluorochromes, to simultaneously track their in vivo biodegradation, in a blend scaffold form. The fluorescence signal evolution, due to the bioresorption, corroborated with histological analysis. In vitro cytocompatibility of Coll:Ch blend scaffolds were evaluated with standardized tests. In addition, the scaffolds showed a highly interconnected porous structure. Extent of crosslinking was analyzed by convergent analysis using thermogravimetry, Fourier Transform Infrared Spectroscopy and PBS uptake. The variations observed with these techniques indicate strong interactions between collagen and chitosan (covalent and hydrogen bonds) promoted by the DHT. The mechanical properties were characterized to elucidate the impact of the different processing steps in the sample preparation (DHT, neutralization and sterilization by β-irradiation) and showed a robust processing scheme with low impact of Coll:Ch composition ratio.
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Affiliation(s)
- P N Oliveira
- IMP, CNRS UMR 5223, Univ Claude Bernard Lyon 1, Univ Lyon, 15 bd Latarjet, 69622 Villeurbanne, France.
| | - A Montembault
- IMP, CNRS UMR 5223, Univ Claude Bernard Lyon 1, Univ Lyon, 15 bd Latarjet, 69622 Villeurbanne, France
| | - G Sudre
- IMP, CNRS UMR 5223, Univ Claude Bernard Lyon 1, Univ Lyon, 15 bd Latarjet, 69622 Villeurbanne, France
| | - P Alcouffe
- IMP, CNRS UMR 5223, Univ Claude Bernard Lyon 1, Univ Lyon, 15 bd Latarjet, 69622 Villeurbanne, France
| | - L Marcon
- ILM, CNRS UMR 5306, Univ Claude Bernard Lyon 1, Univ Lyon, 43 bd du 11 Nov 1918, 69622 Villeurbanne, France
| | - H Gehan
- ILM, CNRS UMR 5306, Univ Claude Bernard Lyon 1, Univ Lyon, 43 bd du 11 Nov 1918, 69622 Villeurbanne, France
| | - F Lux
- ILM, CNRS UMR 5306, Univ Claude Bernard Lyon 1, Univ Lyon, 43 bd du 11 Nov 1918, 69622 Villeurbanne, France
| | - K Albespy
- Biom'up, 8, allée Irène Joliot Curie, 69800 Saint Priest, France
| | - V Centis
- Biom'up, 8, allée Irène Joliot Curie, 69800 Saint Priest, France
| | - D Campos
- Biom'up, 8, allée Irène Joliot Curie, 69800 Saint Priest, France
| | - S Roques
- CIC1401, CHU Bordeaux, Inserm, Univ Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux, France
| | - M Meulle
- CIC1401, CHU Bordeaux, Inserm, Univ Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux, France
| | - M Renard
- CIC1401, CHU Bordeaux, Inserm, Univ Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux, France
| | - M Durand
- CIC1401, CHU Bordeaux, Inserm, Univ Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux, France; BIOTIS Inserm U1026, Univ Bordeaux, Bioingénierie tissulaire, 146 rue Léo Saignat, Bordeaux 33000, France
| | - Q Denost
- CIC1401, CHU Bordeaux, Inserm, Univ Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux, France; BIOTIS Inserm U1026, Univ Bordeaux, Bioingénierie tissulaire, 146 rue Léo Saignat, Bordeaux 33000, France
| | - L Bordenave
- CIC1401, CHU Bordeaux, Inserm, Univ Bordeaux, 146 rue Léo Saignat, 33000 Bordeaux, France; BIOTIS Inserm U1026, Univ Bordeaux, Bioingénierie tissulaire, 146 rue Léo Saignat, Bordeaux 33000, France
| | | | - E Chereul
- Voxcan, Marcy l'Etoile 69280, France
| | | | - N Boucard
- MDB Texinov, Saint-Didier-de-la Tour 38110, France
| | - L David
- IMP, CNRS UMR 5223, Univ Claude Bernard Lyon 1, Univ Lyon, 15 bd Latarjet, 69622 Villeurbanne, France
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Baird DLH, Denost Q, Simillis C, Pellino G, Rasheed S, Kontovounisios C, Tekkis PP, Rullier E. The effect of adjuvant chemotherapy on survival and recurrence after curative rectal cancer surgery in patients who are histologically node negative after neoadjuvant chemoradiotherapy. Colorectal Dis 2017; 19:980-986. [PMID: 28493401 DOI: 10.1111/codi.13714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/20/2017] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to evaluate whether adjuvant chemotherapy will affect recurrence rate or disease-free and overall survival in patients with rectal adenocarcinoma who were staged with MRI node-positive disease (mrN+) preoperatively. These patients underwent neoadjuvant chemoradiotherapy with curative rectal cancer surgery and their pathological staging was negative for nodal disease (ypN0). There is no consensus on the role of adjuvant chemotherapy in such patients. METHOD Patients who received neoadjuvant chemoradiotherapy and underwent curative rectal cancer surgery for rectal adenocarcinoma staged as [mrTxN+M0] on MRI staging and who on pathological staging were found to be [ypTxN0M0] were retrospectively identified from January 2008 December 2012 from two tertiary referral centres (Royal Marsden Hospital, London and Saint-Andre Hospital, Bordeaux). RESULTS One hundred and sixty-three patients were recruited and, after propensity matching at a ratio of 2:1, n = 80 patients were divided to receive adjuvant (n = 28) or no adjuvant treatment (n = 52). A comparison of adjuvant chemotherapy vs no adjuvant therapy showed that the mean overall survival was 2.67 vs 3.60 years (P = 0.42) and disease-free survival was 2.27 vs 3.32 years (P = 0.14). CONCLUSION This study found no significant difference in survival or disease recurrence between patients who received adjuvant chemotherapy and patients who did not. There is no clear evidence to support or dismiss the use of adjuvant chemotherapy for patients who were node positive on preoperative MRI and node negative on histopathological staging. Further multicentre prospective randomized trials are needed to identify the appropriate treatment regime for this group of patients.
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Affiliation(s)
- D L H Baird
- The Royal Marsden Hospital, London, UK.,Imperial College, London, UK
| | - Q Denost
- Saint-Andre Hospital, University of Bordeaux, Bordeaux, France
| | | | - G Pellino
- The Royal Marsden Hospital, London, UK
| | - S Rasheed
- The Royal Marsden Hospital, London, UK.,Imperial College, London, UK.,Chelsea and Westminster Hospital, London, UK
| | - C Kontovounisios
- The Royal Marsden Hospital, London, UK.,Imperial College, London, UK.,Chelsea and Westminster Hospital, London, UK
| | - P P Tekkis
- The Royal Marsden Hospital, London, UK.,Imperial College, London, UK.,Chelsea and Westminster Hospital, London, UK
| | - E Rullier
- Saint-Andre Hospital, University of Bordeaux, Bordeaux, France
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Vendrely V, Terlizzi M, Huguet F, Denost Q, Chiche L, Smith D, Bachet JB. [How to manage a rectal cancer with synchronous liver metastases? A question of strategy]. Cancer Radiother 2017; 21:539-543. [PMID: 28869194 DOI: 10.1016/j.canrad.2017.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 07/05/2017] [Indexed: 11/18/2022]
Abstract
The prognosis of patients with rectal cancer and synchronous liver metastasis has improved thanks to chemotherapy and rectal and liver surgery progresses. However, there is no consensus about optimal management and practices remain heterogeneous. A curative treatment may be considered for 20 to 30% of patients with complete resection of metastasis and primary tumor after induction chemotherapy. To this end, a primary optimal evaluation by a multidisciplinary board including hepatic and colorectal surgeons is crucial. The therapeutic strategy associates chemotherapy, radiotherapy, hepatic and rectal surgery. The most threatening site guides the sequence of treatments. If hepatic resectability is uncertain, a "liver first" strategy associating induction chemotherapy and hepatic surgery is preferred. In non-resectable metastatic cases, chemotherapies with targeted therapies might lead to secondary resection for 30% of patients (conversion). This has changed our practice and triggers reconsidering resectability after chemotherapy. When metastases remain non-resectable, additional treatment focusing on primary tumor should control pelvic symptoms otherwise hardly impacting quality of life. Rectal surgery, short-course radiotherapy (5×5Gy), conformational long-course chemoradiotherapy or intensity-modulated radiation therapy with dose escalation are options discussed in this review.
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Affiliation(s)
- V Vendrely
- Service de radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France; Inserm U1035, biothérapies des maladies génétiques, inflammatoires et du cancer (BMGIC), université de Bordeaux, bâtiment TP 4(e) étage, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
| | - M Terlizzi
- Service de radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
| | - Q Denost
- Service de chirurgie viscérale, centre Magellan, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - L Chiche
- Service de chirurgie viscérale, centre Magellan, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - D Smith
- Service d'oncologie digestive, centre Magellan, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - J-B Bachet
- Service d'hépato-gastroentérologie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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Zerbib F, Siproudhis L, Lehur PA, Germain C, Mion F, Leroi AM, Coffin B, Le Sidaner A, Vitton V, Bouyssou-Cellier C, Chene G, Zerbib F, Simon M, Denost Q, Lepicard P, Lehur PA, Meurette G, Wyart V, Kubis C, Mion F, Roman S, Damon H, Barth X, Leroi AM, Bridoux V, Gourcerol G, Coffin B, Castel B, Gorbatchef C, Le Sidaner A, Mathonnet M, Vitton V, Lesavre N, Orsoni P, Siproudhis L, Brochard C, Desfourneaux V. Randomized clinical trial of sacral nerve stimulation for refractory constipation. Br J Surg 2016; 104:205-213. [DOI: 10.1002/bjs.10326] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/03/2016] [Accepted: 08/23/2016] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Open studies have reported favourable results for sacral nerve stimulation in the treatment of refractory constipation. Here, its efficacy was assessed in a double-blind crossover RCT.
Methods
Patients with at least two of the following criteria were included: fewer than three bowel movements per week; straining to evacuate on more than 25 per cent of attempts; or sensation of incomplete evacuation on more than 25 per cent of occasions. Response to therapy was defined as at least three bowel movements per week and/or more than 50 per cent improvement in symptoms. Responders to an initial 3-week peripheral nerve evaluation were offered permanent implantation of a pulse generator and were assigned randomly in a crossover design to two 8-week intervals of active or sham stimulation. At the end of the two trial periods, the patients received active stimulation until the final evaluation at 1 year.
Results
Thirty-six patients (34 women; mean(s.d.) age 45(14) years) underwent peripheral nerve evaluation. Twenty responded and received a permanent stimulator. A positive response was observed in 12 of 20 and 11 of 20 patients after active and sham stimulation periods respectively (P = 0·746). Pain related to the device occurred in five patients and wound infection or haematoma in three, leading to definitive removal of the pulse generator in two patients. At 1 year, 11 of the 20 patients with an implanted device continued to respond. Stimulation had no significant effect on colonic transit time.
Conclusion
These results do not support the recommendation of permanent implantation of a pulse generator in patients with refractory constipation who initially responded to temporary nerve stimulation. Registration number: NCT01629303 (http://www.clinicaltrials.gov).
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Affiliation(s)
- F Zerbib
- Department of Gastroenterology, Bordeaux University Hospital, and Université de Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM) CIC 1401, Bordeaux, France
| | - L Siproudhis
- Department of Gastroenterology, Rennes University Hospital, and Université de Rennes, Rennes, France
| | - P-A Lehur
- Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - C Germain
- Clinical Epidemiology Unit, and Bordeaux University Hospital and INSERM CIC 1401-EC, Bordeaux, France
| | - F Mion
- Department of Digestive Physiology, Lyon University Hospital, and Université Claude Bernard, Lyon, France
| | - A-M Leroi
- Department of Digestive and Urinary Physiology, Rouen University Hospital, and Université de Rouen, Rouen, France
| | - B Coffin
- Department of Gastroenterology, Louis Mourier University Hospital, Assistance Publique – Hôpitaux de Paris, Colombes, and Université Denis Diderot Paris 7, Paris, France
| | - A Le Sidaner
- Department of Gastroenterology, Limoges University Hospital, Limoges, France
| | - V Vitton
- Department of Gastroenterology, Hôpital Nord, Assistance Publique – Hôpitaux de Marseille, and Plateforme d'Interface Clinique, CRN2M, Unité Mixte de Recherche 7286, and Aix Marseille Université, Marseille, France
| | - C Bouyssou-Cellier
- Department of Gastroenterology, Bordeaux University Hospital, and Université de Bordeaux and Institut National de la Santé et de la Recherche Médicale (INSERM) CIC 1401, Bordeaux, France
| | - G Chene
- Clinical Epidemiology Unit, and Bordeaux University Hospital and INSERM CIC 1401-EC, Bordeaux, France
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Celerier B, Denost Q, Van Geluwe B, Pontallier A, Rullier E. The risk of definitive stoma formation at 10 years after low and ultralow anterior resection for rectal cancer. Colorectal Dis 2016; 18:59-66. [PMID: 26391723 DOI: 10.1111/codi.13124] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 05/15/2015] [Indexed: 12/11/2022]
Abstract
AIM The long-term risk of definitive stoma after sphincter-saving resection (SSR) for rectal cancer is underestimated and has never been reported for ultralow conservative surgery. We report the 10-year risk of definitive stoma after SSR for low rectal cancer. METHOD From 1994 to 2008, patients with low rectal cancer who were suitable for SSR were analysed retrospectively. Patients were divided into the following four groups: low colorectal anastomosis (LCRA); coloanal anastomosis (CAA); partial intersphincteric resection (pISR); and total intersphincteric resection (tISR). The end-point was the risk of a definitive stoma according to the type of anastomosis. RESULTS During the study period, 297 patients had SSR for low rectal cancer. The incidence of definitive stoma increased from 11% at 1 year to 22% at 10 years. The reasons were no closure of the loop ileostomy (4.7%), anastomotic morbidity (6.5%), anal incontinence (8%) and local recurrence (5.2%). The risk of definitive stoma was not influenced by type of surgery: 26% vs 18% vs 18% vs 19% (P = 0.578) for LCRA, CAA, pISR and tISR, respectively. Independent risk factors for definitive stoma were age > 65 years and surgical morbidity. CONCLUSION The risk of a definitive stoma after SSR increased two-fold between 1 and 10 years after surgery, from 11% to 22%. Ultralow conservative surgery (pISR and tISR) did not increase the risk of definitive stoma compared with conventional CAA or LCRA.
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Affiliation(s)
- B Celerier
- Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Bordeaux, France.,Université Bordeaux Segalen, Bordeaux, France
| | - Q Denost
- Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Bordeaux, France.,Université Bordeaux Segalen, Bordeaux, France
| | - B Van Geluwe
- Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Bordeaux, France.,Université Bordeaux Segalen, Bordeaux, France
| | - A Pontallier
- Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Bordeaux, France.,Université Bordeaux Segalen, Bordeaux, France
| | - E Rullier
- Department of Digestive Surgery, CHU Bordeaux, Saint André Hospital, Bordeaux, France.,Université Bordeaux Segalen, Bordeaux, France
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Denost Q, Faucheron J, Lefevre J, Panis Y, Cotte E, Rouanet P, Jafari M, Capdepont M, Rullier E, Pezet, Tuech, Benchimol, Massard, Prudhomme, Gainant, Regimbeau, Chenet, Pautrat, Paineau, Peluchon, Elias, Dumont, Evrard, Beaulieu, Mabrut, Vaudois, Rio, Gouthi, Mauvais, Bresler, Boissel, Tiret, Parc, Glehen, Rohr, Sastre, Paineau, Chenet, Fancois, Singier, Voirin, Risse, Quenet, Joyeux, Saint-Aubert, Khalil. French current management and oncological results of locally recurrent rectal cancer. Eur J Surg Oncol 2015; 41:1645-52. [DOI: 10.1016/j.ejso.2015.09.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/26/2015] [Accepted: 09/22/2015] [Indexed: 12/18/2022] Open
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Buscail E, Blondeau V, Adam JP, Pontallier A, Laurent C, Rullier E, Denost Q. Surgery for rectal cancer after high-dose radiotherapy for prostate cancer: is sphincter preservation relevant? Colorectal Dis 2015; 17:973-9. [PMID: 25824545 DOI: 10.1111/codi.12962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/23/2015] [Indexed: 12/14/2022]
Abstract
AIM The feasibility and outcome of sphincter-saving resection for rectal cancer were assessed in patients previously treated by high-dose radiotherapy for prostate cancer. METHOD Between 2000 and 2012, 1066 patients underwent rectal excision for rectal cancer. Of these, 236 were treated by conventional radiotherapy (45 Gy) and sphincter-saving resection (Group A) and 12 were treated by external-beam radiotherapy (EBRT) for prostate cancer (70 Gy) and sphincter-saving resection (Group B) of whom five had a metachronous and seven a synchronous cancer. The end-points were surgical morbidity, pelvic sepsis, reoperation and definitive stoma. RESULTS Tumour characteristics were similar in both groups. Surgical morbidity (67% vs 25%, P = 0.004), anastomotic leakage (50% vs 10%, P = 0.001, and reoperation (50% vs 17%, P = 0.011) were significantly higher in Group B. Multivariate analyses showed that EBRT for prostate cancer was the only independent factor for anastomotic leakage (OR = 5.12; 95% CI 1.45-18.08; P = 0.011) and definitive stoma (OR = 10.56; 95% CI 3.02-39.92; P < 0.001). CONCLUSION High-dose radiotherapy for prostate cancer increases morbidity from rectal surgery and the risk of a permanent stoma. This suggests that a delayed coloanal anastomosis or a Hartmann procedure should be proposed as an alternative to low anterior resection in this population.
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Affiliation(s)
- E Buscail
- Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France
| | - V Blondeau
- Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France
| | - J-P Adam
- Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France
| | - A Pontallier
- Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France
| | - C Laurent
- Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France
| | - E Rullier
- Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France
| | - Q Denost
- Department of Digestive Surgery and Université Bordeaux Segalen, CHU Bordeaux, Saint André Hospital, Bordeaux, France
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Messager M, Sabbagh C, Denost Q, Regimbeau JM, Laurent C, Rullier E, Sa Cunha A, Mariette C. Is there still a need for prophylactic intra-abdominal drainage in elective major gastro-intestinal surgery? J Visc Surg 2015; 152:305-13. [PMID: 26481067 DOI: 10.1016/j.jviscsurg.2015.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 12/16/2022]
Abstract
Prophylactic drainage of the abdominal cavity after gastro-intestinal surgery is widely used. The rationale is that intra-abdominal drainage enhances early detection of complications (gastro-intestinal leakage, hemorrhage, bile leak), prevents collection of fluid or pus, reduces morbidity and mortality, and decreases the duration of hospital stay. However, dogmatic attitudes favoring systematic drain placement should be questioned. The aim of this review was to evaluate the evidence supporting systematic use of prophylactic abdominal drainage following gastrectomy, pancreatectomy, liver resection, and rectal resection. Based on this review of the literature: (i) there was no evidence in favor of intra-peritoneal drainage following total or sub-total gastrectomy with respect to morbidity-mortality, nor was it helpful in the diagnosis or management of leakage, however the level of evidence is low, (ii) following pancreatic resection, data are conflicting but, overall, suggest that the absence of drainage is prejudicial, and support the notion that short-term drainage is better than long-term drainage, (iii) after liver resection without hepatico-intestinal anastomosis, high level evidence supports that there is no need for abdominal drainage, and (iv) following rectal resection, data are insufficient to establish recommendations. However, results from the French multicenter randomized controlled trial GRECCAR5 (NCT01269567) should provide new evidence this coming year. Accumulating data support that systematic drainage of the abdominal cavity in digestive surgery is a non-beneficial and obsolete practice, except following pancreatectomy where the consensus appears to indicate the usefulness of short-term drainage. While the level of evidence is high for liver resections, new randomized controlled trials are awaited regarding gastric, pancreatic and rectal surgery.
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Affiliation(s)
- M Messager
- Service de Chirurgie Digestive et Générale, Centre Hospitalier Régional Universitaire de Lille, Hôpital Claude-Huriez, Place de Verdun, 59037 Lille cedex, France
| | - C Sabbagh
- Service de Chirurgie Digestive et Oncologique, CHU d'Amiens, Amiens, France
| | - Q Denost
- Service de Chirurgie Colorectale, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - J M Regimbeau
- Service de Chirurgie Digestive et Oncologique, CHU d'Amiens, Amiens, France
| | - C Laurent
- Service de Chirurgie Colorectale, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - E Rullier
- Service de Chirurgie Colorectale, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - A Sa Cunha
- Service de Chirurgie Digestive, Hôpital Paul-Brousse, Villejuif, France
| | - C Mariette
- Service de Chirurgie Digestive et Générale, Centre Hospitalier Régional Universitaire de Lille, Hôpital Claude-Huriez, Place de Verdun, 59037 Lille cedex, France.
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Denost Q, Quintane L, Buscail E, Martenot M, Laurent C, Rullier E. Short- and long-term impact of body mass index on laparoscopic rectal cancer surgery. Colorectal Dis 2013; 15:463-9. [PMID: 23534683 DOI: 10.1111/codi.12026] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Obesity is associated with increased technical difficulty in laparoscopic surgery. However, its impact has been measured mainly for colectomy but not specifically for rectal excision. The aim of the study was to assess the impact of body mass index (BMI) on technical feasibility and oncological outcome of laparoscopic rectal excision for cancer. METHOD A total of 490 patients treated by laparoscopic rectal excision for rectal cancer from January 1999 to June 2010 were included. Seventy per cent had had preoperative radiochemotherapy. Patients were separated into four groups according to BMI (kg/m(2) ): < 20, 20-25, 25-30 and ≥ 30. The impact of BMI on conversion, surgical morbidity, quality of excision (Quirke mesorectal grade and circumferential resection margin) and long-term oncological outcome was determined. RESULTS Among the 490 patients BMI was < 20 in 43, 20-25 in 223, 25-30 in 177 and ≥ 30 in 47. Mortality (overall 1%) and morbidity (overall 19%) were similar between the groups. Conversion in the four groups was 5%, 14%, 23% and 32% (P = 0.001). The quality of mesorectal excision and circumferential margins did not differ between the groups. The 5-year local recurrence rates (0%, 4.6%, 5.3% and 5.9% respectively; P = 0.823) and the overall and disease-free survival were not significantly influenced by BMI. CONCLUSION In laparoscopic surgery for rectal cancer, BMI influenced the risk of conversion but not surgical morbidity, quality of surgery and survival. This suggests that all patients, including obese patients, are suitable for laparoscopic surgery.
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Affiliation(s)
- Q Denost
- CHU Bordeaux, Saint-Andre Hospital, Digestive Surgery, Bordeaux, F-33075, France
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Denost Q, Chafai N, Arrive L, Mourra N, Paye F. Hereditary intraductal papillary mucinous neoplasm of the pancreas. Clin Res Hepatol Gastroenterol 2012; 36:e23-5. [PMID: 22225963 DOI: 10.1016/j.clinre.2011.11.013] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 11/04/2011] [Indexed: 02/04/2023]
Abstract
Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic tumor defined as intraductal mucin-producting neoplasm with tall, columnar, mucin-containing epithelium. IPMN have already been described in association with inherited genetic disorder including familial adenomatous polyposis and Peutz-Jeghers syndrome. However, there is no reported description of familial history of IPMN. We reported in this case-report IPMN in the first-degree relatives without familial history of colorectal polyposis or previous extra-pancreatic cancer. The rarety of IPMN suggests that the coexistence of this tumor in two first-degree relatives is probably due to a genetic inherited factor that remains to be elucidated.
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Affiliation(s)
- Q Denost
- Department of Digestive Surgery, Hôpital Saint-Antoine, 184, rue du faubourg Saint-Antoine, 75012 Paris, France.
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Abstract
AIM Laparoscopic sphincter-saving surgery has been investigated for rectal cancer but not for tumours of the lower third. We evaluated the feasibility and efficacy of laparoscopic intersphincteric resection for low rectal cancer. METHOD From 1990 to 2007, patients with rectal tumour below 6 cm from the anal verge and treated by open or laparoscopic curative intersphincteric resection were included in a retrospective comparative study. Surgery included total mesorectal excision with internal sphincter excision and protected low coloanal anastomosis. Neoadjuvant treatment was given to patients with T3 or N+ tumours. Recurrence and survival were evaluated by the Kaplan-Meier method and compared using the Logrank test. Function was assessed using the Wexner continence score. RESULTS Intersphincteric resection was performed in 175 patients with low rectal cancer: 110 had laparoscopy and 65 had open surgery. The two groups were similar according to age, sex, body mass index, ASA score, tumour stage and preoperative radiotherapy. Postoperative mortality (zero) and morbidity (23%vs 28%; P = 0.410) were similar in both groups. There was no difference in 5-year local recurrence (5%vs 2%; P = 0.349) and 5-year disease-free survival (70%vs 71%; P = 0.862). Function and continence scores (11 vs 12; P = 0.675) were similar in both groups. CONCLUSION Intersphincteric resection did not alter long-term tumour control of low rectal cancer. The safety and efficacy of the laparoscopic approach for intersphincteric resection are suggested by a similar short- and long-term outcome as obtained by open surgery.
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Affiliation(s)
- C Laurent
- CHU Bordeaux, Saint André Hospital, Department of Digestive Surgery, Bordeaux, France Université Victor Segalen Bordeaux 2, Bordeaux, France.
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