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Gero D, Vannijvel M, Okkema S, Deleus E, Lloyd A, Lo Menzo E, Tadros G, Raguz I, San Martin A, Kraljević M, Mantziari S, Frey S, Gensthaler L, Sammalkorpi H, Garcia-Galocha JL, Zapata A, Tatarian T, Wiggins T, Bardisi E, Goreux JP, Vonlanthen R, Widmer J, Thalheimer A, Himpens J, Hollymann M, Welbourn R, Aggarwal R, Beekley A, Sepulveda M, Torres A, Juuti A, Salminen P, Prager G, Iannelli A, Suter M, Peterli R, Boza C, Rosenthal R, Higa K, Lannoo M, Hazebroek EJ, Dillemans B, Clavien PA, Puhan M, Raptis DA, Bueter M. Defining global benchmarks in elective secondary bariatric surgery comprising conversional, revisional and reversal procedures. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Management of poor response and of long-term complications after bariatric surgery (BS) is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. Benchmarking uses best performance in a given field as reference point for improvement. Our aim was to define ‘‘best possible’’ outcomes for elective secondary BS.
Methods
The establishment of benchmarks in secondary BS followed a standardized methodology, based on recommendations of a Delphi consensus panel of experts. This multicenter study analyzed patients undergoing elective secondary BS in 18 high-volume centers on 4 continents from 06/2013 to 05/2019. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers. Benchmark cases had no: previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI>50kg/m2 or age>65 years. Descriptive statistics, multivariate logistic regression and data visualization were performed using the R software.
Results
Out of 44’884 elective bariatric procedures performed in the participating centers, 5’328 secondary BS cases were identified. The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8±10 years, 8.4±5.3 years after primary BS, with a body mass index 35.2±7kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.57% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.36) and after conversional or revisional procedures with gastrointestinal suture/stapling (OR 1.7). Benchmark cutoffs at 90-days postoperatively were ≤5.8% re-intervention and ≤8.8% re-operation rate. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation.
Conclusion
Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
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Affiliation(s)
- D Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Vannijvel
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - S Okkema
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - E Deleus
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Lloyd
- Department of Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, USA
| | - E Lo Menzo
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - G Tadros
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - I Raguz
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A San Martin
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - L Gensthaler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - H Sammalkorpi
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - J L Garcia-Galocha
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Zapata
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - T Tatarian
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - T Wiggins
- Bariatric and Metabolic Surgery Center, Musgrove Park Hospital, Taunton, United Kingdom
| | - E Bardisi
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - J -P Goreux
- Department of Surgery, Delta CHIREC Hospital, Brussels, Belgium
| | - R Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Himpens
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - M Hollymann
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Aggarwal
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - A Beekley
- Bariatric and Metabolic Surgery Center, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - M Sepulveda
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - A Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Juuti
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - P Salminen
- Department of Surgery, University of Turku, Turku, Finland
| | - G Prager
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - A Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - M Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - C Boza
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - R Rosenthal
- Bariatric and Metabolic Surgery Department, Cleveland Clinic Florida, Weston, USA
| | - K Higa
- Bariatric and Metabolic Surgery Center, Fresno Heart and Surgical Hospital, Fresno, USA
| | - M Lannoo
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - E J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - B Dillemans
- Department of Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - P -A Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - D A Raptis
- Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, United Kingkom
| | - M Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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3
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St-Amour P, Mantziari S, Dromain C, Winiker M, Godat S, Schöpfer A, Demartines N, Schäfer M. Preoperative hiatal hernia in oesophageal adenocarcinoma: An impact on patient outcomes? Br J Surg 2021. [DOI: 10.1093/bjs/znab202.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Uncontrolled gastroesophageal reflux and the often-associated hiatal hernia (HH) are frequently encountered in oesophageal adenocarcinoma patients. Previous data suggest unfavourable long-term oncologic outcomes in the presence of a HH, but the evidence remains scarce. The aim of this study was to assess the potential impact of preoperative HH on histologic response after neoadjuvant treatment (NAT), as well as on overall and disease-free survival.
Methods
All patients operated for an adenocarcinoma of the oesophagus or gastro-oesophageal junction (GOJ) between 2012-2018 were assessed. Baseline endoscopy and CT-scan images were retrospectively reviewed to identify the presence of a clinically significant HH (≥3cm). Response to neoadjuvant treatment (Mandard TRG grade), postoperative outcomes and survival were compared between HH and non-HH patients. Categorical variables were compared with the x2 or Fisher’s test, whereas continuous ones with the Mann-Whitney-U test. Survival analyses were performed with the Kaplan-Meier method and log-rank test.
Results
Overall, 101 patients were included (84.1% male, median age 63 years); among them, 33 (32.7%) had a HH ≥ 3cm at diagnosis of oesophageal cancer. There were no significant baseline differences in demographics and tumour stages between the two groups. NAT was used in 80.9% of non-HH versus 81.8% HH patients (P = 0.910), most often chemoradiation (57.3% in non-HH versus 63.6% in HH patients, P = 0.423). Surgical approach and postoperative complication rates were similar in all patients. Good response to NAT (TRG 1-2) was observed in 32.3% of non-HH, versus 33.3% of HH patients (P = 0.297), whereas R0 resection was achieved in 94.1% vs 90.9% of patients respectively (P = 0.551). Overall survival was comparable between HH (median 28 mo, 95%CI 22-NA) and non-HH patients (median 41mo, 95% CI 29-NA) (P = 0.605). Disease-free survival was also similar (median 18 mo, 95%CI 12-NA for HH, vs 34mo, 95%CI 14-NA for non-HH patients, P = 0.283), although HH patients experienced higher rates of distant (51.6% vs 29.2% for non-HH, P = 0.033), but not locoregional recurrence.
Conclusion
A clinically significant HH is encountered in almost a third of patients with oesophageal adenocarcinoma. However, in our study, it was not associated with a worse response to NAT, nor did it lead to a worse overall and disease-free survival.
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Affiliation(s)
- P St-Amour
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - C Dromain
- Institute of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - M Winiker
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Godat
- Institute of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - A Schöpfer
- Institute of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
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6
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Bekkar S, Gronnier C, Renaud F, Duhamel A, Pasquer A, Théreaux J, Gagnière J, Meunier B, Collet D, Mariette C, Dhahri A, Lignier D, Cossé C, Regimbeau JM, Luc G, Cabau M, Jougon J, Badic B, Lozach P, Bail JP, Cappeliez S, El Nakadi I, Lebreton G, Alves A, Flamein R, Pezet D, Pipitone F, Stan-Iuga B, Contival N, Pappalardo E, Coueffe X, Msika S, Mantziari S, Demartines N, Hec F, Vanderbeken M, Tessier W, Briez N, Fredon F, Gainant A, Mathonnet M, Bigourdan JM, Mezoughi S, Ducerf C, Baulieux J, Mabrut JY, Bigourdan JM, Baraket O, Poncet G, Adam M, Vaudoyer D, Jourdan Enfer P, Villeneuve L, Glehen O, Coste T, Fabre JM, Marchal F, Frisoni R, Ayav A, Brunaud L, Bresler L, Cohen C, Aze O, Venissac N, Pop D, Mouroux J, Donici I, Prudhomme M, Felli E, Lisunfui S, Seman M, Godiris Petit G, Karoui M, Tresallet C, Ménégaux F, Vaillant JC, Hannoun L, Malgras B, Lantuas D, Pautrat K, Pocard M, Valleur P, Lefevre JH, Chafai N, Balladur P, Lefrançois M, Parc Y, Paye F, Tiret E, Nedelcu M, Laface L, Perniceni T, Gayet B, Turner K, Filipello A, Porcheron J, Tiffet O, Kamlet N, Chemaly R, Klipfel A, Pessaux P, Brigand C, Rohr S, Carrère N, Da Re C, Dumont F, Goéré D, Elias D, Bertrand C. Multicentre study of neoadjuvant chemotherapy for stage I and II oesophageal cancer. Br J Surg 2016; 103:855-62. [DOI: 10.1002/bjs.10121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/11/2015] [Accepted: 01/05/2016] [Indexed: 12/28/2022]
Abstract
Abstract
Background
The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease.
Methods
Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics.
Results
Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017).
Conclusion
NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.
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Affiliation(s)
- S Bekkar
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - C Gronnier
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- North of France University, Lille, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1172, Team 5 ‘Mucins, epithelial differentiation and carcinogenesis’, Jean-Pierre Aubert Research Centre, Lille, France
| | - F Renaud
- Department of Pathology, Lille University Hospital, Lille, France
| | - A Duhamel
- Department of Biostatistics, Lille University Hospital, Lille, France
- Site de Recherche Intégré en Cancérologie OncoLille, Lille, France
| | - A Pasquer
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - J Théreaux
- Cavale Blanche University Hospital, Brest, France
| | - J Gagnière
- Estaing University Hospital, Clermont-Ferrand, France
| | - B Meunier
- Pontchaillou University Hospital, Rennes, France
| | - D Collet
- Haut-Levêque University Hospital, Bordeaux, France
| | - C Mariette
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- North of France University, Lille, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1172, Team 5 ‘Mucins, epithelial differentiation and carcinogenesis’, Jean-Pierre Aubert Research Centre, Lille, France
- Site de Recherche Intégré en Cancérologie OncoLille, Lille, France
| | - A Dhahri
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - D Lignier
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - C Cossé
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - J-M Regimbeau
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - G Luc
- Department of Digestive Surgery, Pessac University Hospital, Bordeaux, France
| | - M Cabau
- Department of Thoracic Surgery, Pessac University Hospital, Bordeaux, France
| | - J Jougon
- Department of Thoracic Surgery, Pessac University Hospital, Bordeaux, France
| | - B Badic
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - P Lozach
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - J P Bail
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - S Cappeliez
- Department of Digestive Surgery, Brussel ULB Erasme Bordet University, Brussels, Belgium
| | - I El Nakadi
- Department of Digestive Surgery, Brussel ULB Erasme Bordet University, Brussels, Belgium
| | - G Lebreton
- Department of Digestive Surgery, Caen University Hospital, Caen, France
| | - A Alves
- Department of Digestive Surgery, Caen University Hospital, Caen, France
| | - R Flamein
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - D Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - F Pipitone
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - B Stan-Iuga
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - N Contival
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - E Pappalardo
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - X Coueffe
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - S Msika
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - S Mantziari
- Department of Digestive Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - N Demartines
- Department of Digestive Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Hec
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - M Vanderbeken
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - W Tessier
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - N Briez
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - F Fredon
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - A Gainant
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - M Mathonnet
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - J M Bigourdan
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - S Mezoughi
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - C Ducerf
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J Baulieux
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J-Y Mabrut
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J M Bigourdan
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - O Baraket
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - G Poncet
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - M Adam
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - D Vaudoyer
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - P Jourdan Enfer
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - L Villeneuve
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - O Glehen
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - T Coste
- Department of Digestive Surgery, Montpellier, France
| | - J-M Fabre
- Department of Digestive Surgery, Montpellier, France
| | - F Marchal
- Department of Digestive Surgery, Institut de Cancérologie de Lorraine, Nancy, France
| | - R Frisoni
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - A Ayav
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - L Brunaud
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - L Bresler
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - C Cohen
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - O Aze
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - N Venissac
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - D Pop
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - J Mouroux
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - I Donici
- Department of Digestive Surgery, Nîmes University Hospital, Nîmes, France
| | - M Prudhomme
- Department of Digestive Surgery, Nîmes University Hospital, Nîmes, France
| | - E Felli
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - S Lisunfui
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - M Seman
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - G Godiris Petit
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - M Karoui
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - C Tresallet
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - F Ménégaux
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - J-C Vaillant
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - L Hannoun
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - B Malgras
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - D Lantuas
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - K Pautrat
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - M Pocard
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - P Valleur
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - J H Lefevre
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - N Chafai
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - P Balladur
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - M Lefrançois
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - Y Parc
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - F Paye
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - E Tiret
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - M Nedelcu
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - L Laface
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - T Perniceni
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - B Gayet
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - K Turner
- Department of Digestive Surgery, Rennes, France
| | - A Filipello
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - J Porcheron
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - O Tiffet
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - N Kamlet
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - R Chemaly
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - A Klipfel
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - P Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - C Brigand
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - S Rohr
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - N Carrère
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - C Da Re
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - F Dumont
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - D Goéré
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - D Elias
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - C Bertrand
- Mont-Godinne University Hospital, Yvoir, Belgium
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