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Avanzini S, Dall'Igna P, Bjornland K, Braungart S, Cross K, Flores P, Gabra HOS, Gomez-Chacon J, Irtan S, Lobos P, Loh A, Matthyssens LE, Metzelder M, Parodi S, Pio L, Van de Ven CP, Fuchs J, Losty PD, Sarnacki S. Beyond image defined risk factors (IDRFs): a delphi survey highlighting definition of the surgical complexity index (SCI) in neuroblastoma. Pediatr Surg Int 2023; 39:191. [PMID: 37140693 DOI: 10.1007/s00383-023-05477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Preoperative evaluation of Image Defined Risk Factors (IDRFs) in neuroblastoma (NB) is crucial for determining suitability for upfront resection or tumor biopsy. IDRFs do not all carry the same weighting in predicting tumor complexity and surgical risk. In this study we aimed to assess and categorize a surgical complexity (Surgical Complexity Index, SCI) in NB resection. METHODS A panel of 15 surgeons was involved in an electronic Delphi consensus survey to identify and score a set of shared items predictive and/or indicative of surgical complexity, including the number of preoperative IDRFs. A shared agreement included the achievement of at least 75% consensus focused on a single or two close risk categories. RESULTS After 3 Delphi rounds, agreement was established on 25/27 items (92.6%). A severity score was established for each item ranging from 0 to 3 with an overall SCI range varying from a minimum score of zero to a maximum score of 29 points for any given patient. CONCLUSIONS A consensus on a SCI to stratify the risks related to neuroblastoma tumor resection was established by the panel experts. This index will now be deployed to critically assign a better severity score to IDRFs involved in NB surgery.
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Affiliation(s)
- S Avanzini
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Largo G, Gaslini 5, 16147, Genoa, Italy.
| | - P Dall'Igna
- Pediatric Surgery, Dipartimento di Medicina di Precisione e Rigenerativa a Area Jonica, Azienda Ospedaliera-Universitaria Consorziale Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - K Bjornland
- Department of Pediatric Surgery, Oslo University Hospital/University of Oslo, Oslo, Norway
| | - S Braungart
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Cross
- Great Ormond Street Hospital for Children, Specialist Neonatal and Pediatric Surgery, NHS Foundation Trust, London, UK
| | - P Flores
- Pediatric Surgery Department Garrahan Hospital, Buenos Aires, Argentina
| | - H O S Gabra
- Department of Paediatric Surgery, The Great North Children Hospital, Newcastle University Hospitals Foundation Trust, Newcastle Upon Tyne, UK
| | - J Gomez-Chacon
- Department of Pediatric Surgery, Surgical Oncology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Irtan
- Department of Visceral Pediatric and Neonatal Surgery, Sorbonne Université, Armand Trousseau Hospital, AP-HP, Paris, France
| | - P Lobos
- Department of Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - L E Matthyssens
- Department of Gastrointestinal and Pediatric Surgery, Princess Elisabeth Children's Hospital, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - M Metzelder
- Department of Pediatric and Adolescent Surgery, Medical University of Vienna, Vienna, Austria
| | - S Parodi
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - L Pio
- Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Largo G, Gaslini 5, 16147, Genoa, Italy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - C P Van de Ven
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - J Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University of Tuebingen, Tübingen, Germany
| | - P D Losty
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - S Sarnacki
- Department of Pediatric Surgery, APHP Centre, University Hospital Necker Enfants Malades, University Paris Cité, Paris, France
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2
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Valent A, Delorme L, Roland E, Lambe C, Sarnacki S, Cattan P, Plaud B. Peri-operative management of an adult with POLG-related mitochondrial disease. Anaesth Rep 2022; 10:e12159. [PMID: 35309182 PMCID: PMC8918921 DOI: 10.1002/anr3.12159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
POLG-related mitochondrial disease is a rare mitochondrial disorder that is potentially associated with anaesthetic complications such as propofol-related infusion syndrome. A 19-year-old man with mitochondrial DNA deletions and POLG-related disorders presented for an elective robotic Heller-Dor myotomy for the treatment of oesophageal pseudo-achalasia associated with severe gastro-oesophageal reflux. The fasting period was minimised to reduce the risk of metabolic stress. The anaesthetic technique included a rapid sequence induction with propofol and rocuronium, a remifentanil and sevoflurane-based general anaesthesia with multimodal monitoring and peri-operative lactate-free intravenous fluids with added dextrose. The patient did not experience propofol-related infusion syndrome but did have delayed tracheal extubation due to residual neuromuscular blockade requiring a second dose of sugammadex. This report demonstrates the safety of single-use, low-dose propofol in this patient group. Patients with POLG-related mitochondrial disease may be at risk of prolonged neuromuscular blockade, and appropriate dosing of neuromuscular blocking agents with monitoring of neuromuscular blockade is strongly encouraged.
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Affiliation(s)
- A Valent
- Department of Anaesthesiology Saint-Louis Hospital Paris France
| | - L Delorme
- Department of Anaesthesiology Saint-Louis Hospital Paris France
| | - E Roland
- Department of Anaesthesiology Saint-Louis Hospital Paris France
| | - C Lambe
- Paediatric Gastroenterology, Hepatology and Nutrition Necker Enfants-Malades Hospital Paris France
| | - S Sarnacki
- Department of Paediatric Surgery Necker Enfants-Malades Hospital Paris France
| | - P Cattan
- Department of Surgery Saint-Louis Hospital Paris France
| | - B Plaud
- Department of Anaesthesiology Saint-Louis Hospital Paris France
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3
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Vinit N, Grevent D, Millischer-Bellaiche AE, Pandya VM, Sonigo P, Delmonte A, Sarnacki S, Aigrain Y, Boddaert N, Bessières B, Benchimol G, Salomon LJ, Stirnemann JJ, Blanc T, Ville Y. Biometric and morphological features on magnetic resonance imaging of fetal bladder in lower urinary tract obstruction: new perspectives for fetal cystoscopy. Ultrasound Obstet Gynecol 2020; 56:86-95. [PMID: 31006924 DOI: 10.1002/uog.20297] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/03/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Incompatibility between currently available fetoscopes and the anatomical constraints of the distended fetal bladder, with the resulting curvature around the bladder neck, account for most technical difficulties during fetal cystoscopy in lower urinary tract obstruction (LUTO). The aim of this anatomical study was to assess by magnetic resonance imaging (MRI) the variation in three bladder angles (bladder-neck angle (BNA), vesicourethral angle (VUA) and angle between bladder dome and posterior urethra (DUA)), according to gestational age (GA), bladder volume and the presence of LUTO. METHODS From our fetal medicine database, we retrieved for review 46 MRI examinations of male fetuses between 2015 and 2019, including 17 with LUTO, examined at a mean GA of 28.1 (range, 17.3-35.0) weeks and 29 age-matched controls, examined at 29.9 (range, 21.9-35.0) weeks. We measured bladder volume, bladder-wall thickness and the three bladder angles, and used the Mann-Whitney U-test to compare values between groups. Variations according to GA and bladder volume were determined using analysis of variance (ANOVA). A reliability study was performed using the Bland-Altman method and Lin's correlation coefficient was calculated. RESULTS Both bladder volume and bladder-wall thickness were significantly greater in the LUTO group (P < 0.01). BNA was significantly larger in LUTO compared with control fetuses: the mean (range) was 127.1° (101.6-161.6°) vs 111.2° (88.5-157.3°) (P < 0.01). DUA averaged 117° and showed no difference between the groups (P = 0.92). No statistical comparison was performed on VUA since this was not measurable in most control fetuses. ANOVA showed no variation of any angle with bladder volume in both LUTO fetuses and control fetuses. BNA in LUTO fetuses was the only angle to vary with GA, being larger after, compared with at or before, 25 weeks (P = 0.04). The reliability study showed an acceptable bias for both intra- and interobserver reproducibility for all three angles. CONCLUSION The findings that BNA is increased by approximately 15° in fetuses with LUTO and DUA averages 117° could aid in development of a customized fetal cystoscope and help to overcome the current technical challenges of fetal cystoscopy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- N Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
| | - D Grevent
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
- INSERM U1000 and UMR1163, Imagine Institute, Paris, France
| | - A-E Millischer-Bellaiche
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - V M Pandya
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - P Sonigo
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - A Delmonte
- IMAG2 Laboratory, Imagine Institute, Paris, France
| | - S Sarnacki
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- IMAG2 Laboratory, Imagine Institute, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Y Aigrain
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - N Boddaert
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
- INSERM U1000 and UMR1163, Imagine Institute, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - B Bessières
- Department of Histology, Embryology and Cytogenetics, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - G Benchimol
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - L J Salomon
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - J J Stirnemann
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Y Ville
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
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4
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Collignon C, Carton M, Brisse HJ, Pannier S, Gauthier A, Sarnacki S, Tiléa B, Savignoni A, Helfre S, Philippe-Chomette P, Cardoen L, Boccara O, Pierron G, Orbach D. Soft tissue sarcoma in children, adolescents and young adults: Outcomes according to compliance with international initial care guidelines. Eur J Surg Oncol 2019; 46:1277-1286. [PMID: 31839437 DOI: 10.1016/j.ejso.2019.11.518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/14/2019] [Accepted: 11/29/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Outcomes for adults with soft tissue sarcoma are better when managed at referral centers. Care guidelines advise for 5 main criteria: 1-Imaging before biopsy; 2-Tumor biopsy before surgery; 3-Multidiscipinary team discussion (MTD) before biopsy; 4-Biopsy in "expert centers"; 5-Somatic molecular biology feasible. The aim is to describe and assess the prognostic impact of initial management of STS according to the type of referring centers and the number of optimal criteria. METHODS Monocentric retrospective analysis of the management of 127 youths (0-25 years) with localized STS treated from 2006 to 2015. RESULTS Median age at diagnosis was 9.6 years (range: 025). Overall, only 41% patients had 5/5, 28% 3-4, 31% ≤2. No adequate imaging was performed before surgery/biopsy for 18% patients, no biopsy before treatment for 29%. Patients referred by "expert centers" had higher compliance to guidelines (P = 0.025). Upfront surgery was performed in 59/127 patients. Immediate re-operation was inversely related to the number of criteria (0% when 5 criteria vs. 14% for 3-4, 46% if ≤ 2; P < 0.001). For malignant tumors, outcome was better when 5 criteria were reached: 5 year EFS 90.8% (81.4-100.0%) vs. 71.6 for (60.4-84.9%; ≤4 criteria; p = 0.033), OS 93.6% (85.5-100%) vs. 79.5% (68.9-91.8%; p = 0.11), and LRFFS 90.6% (81.0-100.0) vs. 73.1% (62.0-86.3%; p = 0.047). CONCLUSION Less than half of the youths with STS are initially managed according to international guidelines, highlighting the need for better information about optimal management. These results plead for immediate management in reference centers to reduce initial burden of therapy.
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Affiliation(s)
- C Collignon
- SIREDO Oncology Center Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer Institut Curie, PSL University, Paris, France.
| | - M Carton
- Department of Biostatistics, Institut Curie, PSL University, Paris, France
| | - H J Brisse
- Imaging Department, Institut Curie, Paris, France
| | - S Pannier
- Department of Orthopedic Pediatric Surgery, Necker Enfants Malades Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - A Gauthier
- Department of Pathology, Institut Curie, Paris, France
| | - S Sarnacki
- Department of Pediatric Surgery and Urology, Necker Enfants Malades Hospital, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - B Tiléa
- Department of Radiology, Robert Debré́ Hospital, Paris, France
| | - A Savignoni
- Department of Biostatistics, Institut Curie, PSL University, Paris, France
| | - S Helfre
- Department of Radiotherapy, Institut Curie, Paris, France
| | | | - L Cardoen
- Imaging Department, Institut Curie, Paris, France
| | - O Boccara
- Department of Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université Paris Descartes, Sorbonne Paris Cité, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, France
| | - G Pierron
- Department of Somatic Genetics, Institut Curie, Paris, France
| | - D Orbach
- SIREDO Oncology Center Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer Institut Curie, PSL University, Paris, France
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5
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de la Monneraye Y, Michon J, Pacquement H, Aerts I, Orbach D, Doz F, Bourdeaut F, Sarnacki S, Philippe-Chomette P, Audry G, Coulomb A, Fréneaux P, Klijanienko J, Berrebi D, Zucker JM, Schleiermacher G, Brisse HJ. Indications and results of diagnostic biopsy in pediatric renal tumors: A retrospective analysis of 317 patients with critical review of SIOP guidelines. Pediatr Blood Cancer 2019; 66:e27641. [PMID: 30746839 DOI: 10.1002/pbc.27641] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/09/2019] [Accepted: 01/15/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES According to the Renal Tumor Study Group (RTSG) of the International Society of Paediatric Oncology (SIOP), diagnostic biopsy of renal tumors prior to neoadjuvant chemotherapy is not mandatory unless the presentation is atypical for a Wilms tumor (WT). This study addresses the relevance of this strategy as well as the accuracy and safety of image-guided needle biopsy. METHODS Clinical, radiological, and pathological data from 317 children (141 males/176 females, mean age: 4 years, range, 0-17.6) consecutively treated in one SIOP-affiliated institution were retrospectively analyzed. RESULTS Presumptive chemotherapy for WT was decided for 182 patients (57% of the cohort), 24 (8%) were operated upfront, and 111 (35%) were biopsied at diagnosis. A non-WT was confirmed after surgery in 5/182 (3%), 11/24 (46%), and 28/111 (25%), respectively. Age at diagnosis was the most commonly (46%) used criterion to go for biopsy but a nine-year threshold should be retrospectively considered more relevant. Tumor volumes of clear cell sarcoma of the kidney and WT were significantly higher than those of other tumors (P = 0.002). The agreement between core-needle biopsy (CNB) and final histology was 99%. No significant morbidity was associated with CNB. CONCLUSION The use of SIOP criteria to identify patients eligible for presumptive WT neoadjuvant chemotherapy or upfront surgery avoided biopsy in 65% of children and led to a 97% rate of appropriate preoperative chemotherapy. Image-guided CNB is a safe and accurate diagnostic procedure. The relevance of SIOP biopsy criteria might be improved by using an older age threshold (9 years instead of 6 years) and by adding initial tumor volume.
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Affiliation(s)
- Yvan de la Monneraye
- Department of Pediatrics, APHP, University Hospital Ambroise Paré, Boulogne-Billancourt, Paris, France.,Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - J Michon
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - H Pacquement
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - I Aerts
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - Daniel Orbach
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - F Doz
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France.,University Paris Descartes, Paris, France
| | - F Bourdeaut
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - S Sarnacki
- Department of Surgery, APHP, University Hospital Necker-Enfants-Malades, Paris, France
| | - P Philippe-Chomette
- Department of Surgery, APHP, University Hospital Robert Debré, Paris, France
| | - G Audry
- Department of Surgery, APHP, University Hospital Armand-Trousseau, Paris, France
| | - A Coulomb
- Department of Pathology, APHP, University Hospital Armand-Trousseau, Paris, France
| | - P Fréneaux
- Department of Biopathology, Institut Curie, Paris, France
| | - J Klijanienko
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - D Berrebi
- Department of Pathology, APHP, University Hospital Robert Debré, Paris, France.,University Paris Diderot, Paris, France
| | - J-M Zucker
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France
| | - G Schleiermacher
- Oncology Center SIREDO (Care, Innovation, Research for Cancer in Children, Adolescents and Young Adults), Institut Curie, Paris, France.,INSERM U830 Transfer Department, RTOP (Translational Research in Pediatric Oncology), Institut Curie, Paris, France
| | - H J Brisse
- Imaging Department, Institut Curie, Paris, France.,Paris Sciences et Lettres Research University, Paris, France
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6
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Honoré C, Atallah V, Mir O, Orbach D, Ferron G, LePéchoux C, Delhorme JB, Philippe-Chomette P, Sarnacki S, Msika S, Terrier P, Glehen O, Martelli H, Minard-Colin V, Bertucci F, Blay JY, Bonvalot S, Elias D, LeCesne A, Sargos P. Abdominal desmoplastic small round cell tumor without extraperitoneal metastases: Is there a benefit for HIPEC after macroscopically complete cytoreductive surgery? PLoS One 2017; 12:e0171639. [PMID: 28234908 PMCID: PMC5325210 DOI: 10.1371/journal.pone.0171639] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/23/2017] [Indexed: 11/19/2022] Open
Abstract
Background Desmoplastic Small Round Cell Tumor (DSRCT) is a rare disease affecting predominantly children and young adults and for which the benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) after complete cytoreductive surgery (CCRS) remains unknown. Methods To identify patients with DSRCT without extraperitoneal metastases (EPM) who underwent CCRS between 1991 and 2015, a retrospective nation-wide survey was conducted by crossing the prospective and retrospective databases of the French Network for Rare Peritoneal Malignancies, French Reference Network in Sarcoma Pathology, French Sarcoma Clinical Network and French Pediatric Cancer Society. Results Among the 107 patients with DSRCT, 48 had no EPM and underwent CCRS. The median peritoneal cancer index (PCI) was 9 (range: 2–27). Among these 48 patients, 38 (79%) had pre- and/or postoperative chemotherapy and 23 (48%) postoperative whole abdominopelvic radiotherapy (WAP-RT). Intraperitoneal chemotherapy was administered to 11 patients (23%): two received early postoperative intraperitoneal chemotherapy (EPIC) and nine HIPEC. After a median follow-up of 30 months, the median overall survival (OS) of the entire cohort was 42 months. The 2-y and 5-y OS were 72% and 19%. The 2-y and 5-y disease-free survival (DFS) were 30% and 12%. WAP-RT was the only variable associated with longer peritoneal recurrence-free survival and DFS after CCRS. The influence of HIPEC/EPIC on OS and DFS was not statistically conclusive. Conclusion The benefit of HIPEC is still unknown and should be evaluated in a prospective trial. The value of postoperative WAP-RT seems to be confirmed.
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Affiliation(s)
- C. Honoré
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
- * E-mail:
| | - V. Atallah
- Department of Radiotherapy, Bergonié Institute, Bordeaux, France
| | - O. Mir
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - D. Orbach
- Department of Pediatric, Adolescent and Young Adult Oncology, Curie Institute, Paris, France
| | - G. Ferron
- Department of Surgical Oncology, Claudius Régaud Institute, Toulouse, France
| | - C. LePéchoux
- Department of Radiotherapy, Gustave Roussy Cancer Campus, Villejuif, France
| | - J. B. Delhorme
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University, Strasbourg, France
| | | | - S. Sarnacki
- Department of Pediatric Surgery, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France
| | - S. Msika
- of Digestive Surgery, Louis Mourier Hospital, Paris Diderot University, Colombes, France
| | - P. Terrier
- Department of Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - O. Glehen
- Department of Surgical Oncology, Lyon Civil Hospices, South Lyon University Hospital Center, Lyon, France
| | - H. Martelli
- Department of Pediatric Surgery, Kremlin-Bicêtre Hospital, Paris 11 University, Kremlin-Bicêtre, France
| | - V. Minard-Colin
- Department of Pediatric Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - F. Bertucci
- Department of Medical Oncology, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - J. Y. Blay
- Department of Medical Oncology, Leon Bérard Center, Lyon, France
| | - S. Bonvalot
- Department of Surgery, Curie Institute, Paris, France
| | - D. Elias
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - A. LeCesne
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - P. Sargos
- Department of Radiotherapy, Bergonié Institute, Bordeaux, France
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7
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Mathieu S, Eveno C, Fourcade L, Faure Conter C, Sudour H, Rubie H, Habonimana E, Grapin C, Mansuy L, Sarnacki S, Orbach D, Gorde Grosjean S, Lopez Perrin K, Kalfa N, Plantaz D, Casagranda L, Lacour B, Berger C, Varlet F, Patural H, Stephan J. CO-45 – Tumeurs intra thoraciques du nouveau-né: une étude de 20 observations. Arch Pediatr 2015. [DOI: 10.1016/s0929-693x(15)30146-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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8
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Rod J, Orbach D, Verité C, Coze C, Stephan JL, Varlet F, Thomas-de-Montpreville V, Reguerre Y, Besse B, Sarnacki S. Surgical management of thymic epithelial tumors in children: lessons from the French Society of Pediatric Oncology and review of the literature. Pediatr Blood Cancer 2014; 61:1910-5. [PMID: 25130986 DOI: 10.1002/pbc.25159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 05/28/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE We report the results of a French multicenter retrospective study based on a period of more than 30 years and a review of the literature in order to more clearly define the surgical approach and specific pediatric risk factors. METHODS Clinical data of children comprising all histologic subtypes of thymic epithelial tumors (TET) treated between 1979 and 2009 in French pediatric oncology centers were retrospectively analyzed and discussed in the light of a review of all pediatric cases reported in the literature. RESULTS Nine cases were identified, corresponding to five females and four males with a median age of 13 years (range: 7.5-17). Histologic subtypes were type AB (n = 1), type B (n = 5) and type C (n = 3). Treatment consisted of tumor resection (4 R0, 4 R1, 1 R2) via right anterior thoracotomy, posterolateral thoracotomy, left thoracoscopy, sternotomy and cervicosternotomy, and/or chemotherapy, mainly cyclophosphamide-doxorubicin-cisplatin (CAP; n = 5), and/or radiotherapy (n = 4). Two patients with TET type C died. All other patients are alive with a median follow-up of 4 years (range: 1.5-20). Review of a total of 93 pediatric cases reported in the literature showed statistically significant associations between less favorable histologic subtypes and male gender (P = 0.012), advanced Masaoka stage (P < 0.001) and quality of resection (P < 0.001) respectively. CONCLUSIONS A review of the literature and our series identified several risk factors to take into account in the therapeutically decision. Complete resection through a sternotomy is highly recommended.
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Affiliation(s)
- J Rod
- Department of Pediatric Surgery, University of Caen Hospital, France
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9
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Dumoucel S, Gauthier-Villars M, Stoppa-Lyonnet D, Parisot P, Brisse H, Philippe-Chomette P, Sarnacki S, Boccon-Gibod L, Rossignol S, Baumann C, Aerts I, Bourdeaut F, Doz F, Orbach D, Pacquement H, Michon J, Schleiermacher G. Malformations, genetic abnormalities, and Wilms tumor. Pediatr Blood Cancer 2014; 61:140-4. [PMID: 23970395 DOI: 10.1002/pbc.24709] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 04/23/2013] [Accepted: 07/05/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Wilms Tumor (WT) can occur in association with tumor predisposition syndromes and/or with clinical malformations. These associations have not been fully characterized at a clinical and molecular genetic level. This study aims to describe clinical malformations, genetic abnormalities, and tumor predisposition syndromes in patients with WT and to propose guidelines regarding indications for clinical and molecular genetic explorations. PROCEDURE This retrospective study analyzed clinical abnormalities and predisposition syndromes among 295 patients treated for WT between 1986 and 2009 in a single pediatric oncological center. RESULTS Clinically identified malformations and predisposition syndromes were observed in 52/295 patients (17.6%). Genetically proven tumor predisposition syndromes (n = 14) frequently observed were syndromes associated with alterations of the chromosome WT1 region such as WAGR (n = 6) and Denys-Drash syndromes (n = 3), syndromes associated with alterations of the WT2 region (Beckwith-Wiedeman syndrome, n = 3), and Fanconi anemia (n = 2). Hemihypertrophy and genito-urinary malformations (n = 12 and n = 16, respectively) were the most frequently identified malformations. Other different syndromes or malformations (n = 10) were less frequent. Median age of WT diagnosis was significantly earlier for children with malformations than those without (27 months vs. 37 months, P = 0.0009). There was no significant difference in terms of 5-year EFS and OS between WT patients without or with malformations. CONCLUSIONS The frequency of malformations observed in patients with WT underline the need of genetic counseling and molecular genetic explorations for a better follow-up of these patients, with a frequently good outcome. A decisional tree, based on clinical observations of patients with WT, is proposed to guide clinicians for further molecular genetic explorations.
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Affiliation(s)
- S Dumoucel
- Department of Pediatric Oncology, Institut Curie, Paris, France
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10
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Cretolle C, Rousseau V, Lottmann H, Irtan S, Lortat-Jacob S, Alova I, Michel JL, Aigrain Y, Podevin G, Lehur PA, Sarnacki S. [Anorectal malformations]. Arch Pediatr 2013; 20 Suppl 1:S19-27. [PMID: 23992833 DOI: 10.1016/s0929-693x(13)71405-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Anorectal malformations (ARM) are the result of an abnormal development of the terminal part of the digestive tract interesting anus and/or rectum that occur early between the sixth and tenth week of embryonic development. They carry a malformation spectrum of severity depending on the level of disruption of the anorectal canal and of the associated caudal malformations (sacrum and spine). ARM are associated in over half the cases with other malformations that can be integrated in some cases in known syndromes. If surgical treatment to restore anatomy as normal as possible is indispensable, post-operative care is essential for these patients whose defecation mechanisms are altered, to reach if not continence, at least a socially acceptable cleanliness.
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Affiliation(s)
- C Cretolle
- Service de Chirurgie pédiatrique, CRMR Malformations ano-rectales et pelviennes rares (MAREP), Hôpital Necker Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
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11
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Mantoo S, Meurette G, Wyart V, Hardouin J, Cretolle C, Capito C, Sarnacki S, Podevin G, Lehur PA. The impact of anorectal malformations on anorectal function and social integration in adulthood: report from a national database. Colorectal Dis 2013; 15:e330-5. [PMID: 23464709 DOI: 10.1111/codi.12186] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 08/28/2012] [Accepted: 12/15/2012] [Indexed: 12/21/2022]
Abstract
AIM The impact of anorectal malformation (ARM) on bowel function and social, educational and occupational end-points was investigated in adult patients entered on a national database. METHOD Data from a national database of adult patients operated on between 1962 and 1999 for ARM were analysed. The database Malformations Ano-rectales et Pelviennes rares (MAREP) was part of a common information system, CEMARA, on rare congenital disorders. A self-administered questionnaire regarding bowel function, academic qualifications, employment and family status was mailed to patients. The type of ARM, subsequent follow-up and management including surgical interventions were retrospectively retrieved from medical records. RESULTS Of 210 adult patients on the registry since 2008, 68 were included in this study. Only three (8.5%) had had regular follow-up. All reported some disturbance in bowel function. The fertility rate of 1.5 children per woman did not differ from the general population. CONCLUSION Anorectal malformation ARM often leads to suboptimal bowel function in adulthood. This has an impact on social integration.
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Affiliation(s)
- S Mantoo
- Department of Surgery, Khoo Teck Puat Hospital, Singapore City, Singapore
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12
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Cretolle C, Lehur PA, Sarnacki S. Malformations ano-rectales : prise en charge et devenir à long terme. Arch Pediatr 2013. [DOI: 10.1016/s0929-693x(13)71339-3] [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: 10/26/2022]
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13
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You S, Zuber J, Kuhn C, Baas M, Valette F, Sauvaget V, Sarnacki S, Sawitzki B, Bach JF, Volk HD, Chatenoud L. Induction of allograft tolerance by monoclonal CD3 antibodies: a matter of timing. Am J Transplant 2012; 12:2909-19. [PMID: 22882762 DOI: 10.1111/j.1600-6143.2012.04213.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Despite remarkable progress in organ transplantation through the development of a wealth of immunosuppressive drugs highly effective at controlling acute rejection, two major problems still remain, the loss of transplants due to chronic rejection and the growing number of sensitized recipients due to previous transplants, transfusions or pregnancies. Induction of immune tolerance appears to be the only way to curb this complex situation. Here we describe that a therapy, already successfully used to restore immune tolerance to self-antigens in overt autoimmunity, is effective at promoting transplant tolerance. We demonstrate that a short low-dose course with CD3 antibodies started after transplantation, at the time of effector T cell priming to alloantigens, induces permanent acceptance of fully mismatched islet allografts. Mechanistic studies revealed that antigen-specific regulatory and effector T cells are differentially affected by the treatment. CD3 antibody treatment preferentially induces apoptosis of activated alloreactive T cells which is mandatory for tolerance induction. In contrast, regulatory T cells are relatively spared from CD3 antibody-induced depletion and can transfer antigen-specific tolerance thus arguing for their prominent role in sustaining long-term graft survival.
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Affiliation(s)
- S You
- Institut National de la Santé et de la Recherche Médicale, Unité U1013, Paris, France
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14
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Abstract
Both technical and anatomical features and the need for a long follow-up, usually over several years, explain the specificity of lung surgery in children. Apart from the oncological resections, the main indications for this surgery are congenital lung anomalies (cystic adenomatoid malformation, bronchopulmonary sequestration, lobar emphysema), symptomatic postinfectious lesions (bronchiectasis, atelectasis, abscess) and pneumothorax. Advances in miniaturization of the surgical equipment are used to carry the majority of these interventions by thoracoscopy, except when performed at the neonatal period. In the newborn, for which the indications for lung surgical resections are exceptional, ventilatory conditions and the tightness of the chest lead to still prefer open surgery. Pulmonary malformations can also be managed prenatally when they affect lung development or cause heart failure because of compressive complications. These interventions, performed after the 30th week of gestation, are not intended to remove the lesions, but to release the compression. But these procedures are still under evaluation and, in light of possible fetal and maternal complications, they should only be performed in tertiary centers and in the context of specific protocols.
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Affiliation(s)
- N Khen-Dunlop
- Service de chirurgie pédiatrique viscérale, hôpital Necker-Enfants malades, 149 rue de Sèvres, Paris, France.
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15
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Galmiche L, Jaubert F, Sauvat F, Sarnacki S, Goulet O, Assouline Z, Vedrenne V, Lebre AS, Boddaert N, Brousse N, Chrétien D, Munnich A, Rötig A. Normal oxidative phosphorylation in intestinal smooth muscle of childhood chronic intestinal pseudo-obstruction. Neurogastroenterol Motil 2011; 23:24-9, e1. [PMID: 20879992 DOI: 10.1111/j.1365-2982.2010.01595.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic intestinal pseudo-obstruction (CIPO) is a severe disease of the digestive tract motility. In pediatric population, CIPO remains of unknown origin for most patients. Chronic intestinal pseudo-obstruction is also a common feature in the course of mitochondrial oxidative phosphorylation disorders related for some patients to mutations in TYMP, POLG1, mtDNA tRNA(leu(UUR)) or tRNA(lys) genes. We hypothesized that CIPOs could be the presenting symptom of respiratory chain enzyme deficiency and thus we investigated oxidative phosphorylation in small bowel and/or colon smooth muscle of primary CIPO children. METHODS We studied eight children with CIPO and 12 pediatric controls. We collected clinical, radiological and pathological data and measured respiratory chain enzymatic activity in isolated smooth muscle of the small bowel and/or the colon. We also sequenced TYMP, POLG, mtDNA tRNA(leu(UUR)) and tRNA(lys) genes. KEY RESULTS Neither pathological nor radiological data were in favor of a mitochondrial dysfunction. No respiratory chain enzyme deficiency was detected in CIPO children. In myogenic CIPO, respiratory enzymes and citrate synthase activities were increased in small bowel and/or colon whereas no abnormality was noted in neurogenic and unclassified CIPO. Levels of enzyme activities were higher in control small bowel than in control colon muscle. Sequencing of TYMP, POLG, mtDNA tRNA(leu(UUR)) and tRNA(lys) genes and POLG gene did not reveal mutation for any of the patients. CONCLUSIONS & INFERENCES The normal enzymatic activities as the lack of radiological and genetic abnormalities indicate that, at variance with adult patients, oxidative phosphorylation deficiency is not a common cause of childhood CIPO.
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Affiliation(s)
- L Galmiche
- Department of Pathology and Tumorothèque, Faculty of Medicine, Hôpital Necker Enfants-Malades and Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
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16
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17
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Sauvat F, Capito C, Sarnacki S, Borenstein N, Lefevre A, Poirot C, Binart N. CL067 - Restauration des fonctions ovariennes après greffe d’ovaire immature chez la brebis. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Khen-Dunlop N, Victor A, Grosos C, Soret R, Ménard S, Cerf-Bensussan N, Neunlist M, Sarnacki S. P266 - Plasiticité du plexus nerveux myentérique dans les atrésies du grêle. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70664-3] [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: 10/19/2022]
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19
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Dariel A, Khen-Dunlop N, Rousseau V, Nihoul-Fékété C, Révillon Y, Sarnacki S. CL042 - Anastomose œsophagienne versus œsophagoplastie dans l’atrésie de l’œsophage type 1. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70258-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Arnaud A, Crétolle C, Babarit C, Galmiche L, Munnich A, Lyonnet S, Vekemans M, Etchevers H, Sarnacki S. CL004 - Expression de marqueurs de pluripotence dans des cellules de tératome sacro-coccygien. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70220-7] [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: 10/19/2022]
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21
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Grosos C, Khen-Dunlop N, Victor A, Rousseau V, Sauvat F, Aigrain Y, Révillon Y, Cerf-Bensussan N, Neunlist M, Sarnacki S. P252 - Étude du phénotype neuro-glial dans les atrésies du grêle. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70650-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Bourdeaut F, Crétolle C, Landais P, Janoueix I, Schleiermacher G, Lyonnet S, Stoppa-Lyonnet D, Delattre O, Sarnacki S. P265 - Cancers pédiatriques et anomalies du développement : de nouveaux syndromes à caractériser. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70663-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Sauvat F, Sarnacki S, Binart N. [Fertility preservation before puberty: from mice to men]. Ann Endocrinol (Paris) 2010; 71:231-6. [PMID: 20362960 DOI: 10.1016/j.ando.2010.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 02/06/2010] [Accepted: 02/08/2010] [Indexed: 11/30/2022]
Abstract
Malignant tumors account for 1% of childhood cancers. The incidence is to the order of 122 cases per million children. The five-year survival after cancer before the age of 16years has improved from 50 to 80% in 40years. Assessment of potential for preservation of fertility should thus be a systematic element of care for children treated for a malignant tumor (high-dose chemotherapy with alkylizing agents, radiation therapy including the gonads) or those receiving hematopoietic stem cell grafts for malignant or benign disease (sickle-cell anemia, immune deficit). Among the techniques proposed, cryopreservation of ovarian tissue appears to be the most promising, or perhaps the only one available before puberty with encouraging result. Nevertheless the uncertainties, or even risks, related to these treatments, should not be neglected.
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Affiliation(s)
- F Sauvat
- Inserm, U845, 156, rue de Vaugirard, 75015 Paris, France; Faculté de médecine, université Paris Descartes, 75015 Paris, France
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24
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Fais PO, Carricaburu E, Sarnacki S, Berrebi D, Orbach D, Baudoin V, de Lagausie P. Is laparoscopic management suitable for solid pseudo-papillary tumors of the pancreas? Pediatr Surg Int 2009; 25:617-21. [PMID: 19479267 DOI: 10.1007/s00383-009-2388-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [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] [Accepted: 05/15/2009] [Indexed: 01/27/2023]
Abstract
PURPOSE Solid pseudo-papillary tumors (SPT) are rare pancreatic neoplasms of low-malignant potential occurring mainly in young women. The purpose of this report is to describe our experience with laparoscopic management of these tumors with 4-year follow-up. METHODS Three children with SPT were admitted to two hospitals in Paris, France, between February 2000 and December 2006. Diagnosis or treatment was carried out using laparoscopic techniques (biopsy and resection in one case and biopsy only in two). Long-term follow-up data were collected. RESULTS All three patients presented recurrences within 3 years after resection, i.e., disseminated peritoneal recurrence in two patients and local recurrence in one. The two patients with peritoneal recurrences were treated by surgical resection and chemotherapy. The patient with local recurrence could not be treated due to contraindicating local factors. All three patients were alive at the time of this writing. CONCLUSION This is the first report describing long-term follow-up after laparoscopic management of SPT. All three patients developed recurrences. These poor results contrast sharply with the low risk of local or disseminated recurrence after open laparotomy without chemotherapy that has been considered as the treatment of choice up to now. Recurrences after laparoscopic management may have been due to diffusion of tumor cells caused by gas insufflation especially during biopsy. Laparoscopic biopsy should not be performed in patients presenting SPT.
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Affiliation(s)
- P O Fais
- Department of Pediatric Surgery, Timone Enfants Hospital, 264 Bld Saint Pierre, 13385 Marseille Cedex 05, France
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Abstract
BACKGROUND As a result of advances in treatment, almost 80% of children and adolescents who currently receive a diagnosis of cancer become long-term survivors. Potential adverse consequences of treatment include impaired puberty and fertility due to gonadal removal, genital tract injury or damage to germ cells from adjuvant therapy. In recent years, treatment of solid tumors and hematological malignancies has been modified in an attempt to minimize damage to the reproductive system. Simultaneously, advances in assisted reproductive technologies have led to new possibilities for the prevention and treatment of infertility. We review experimental data in animal models and clinical experience in adults and discuss strategies to preserve fertility in prepubertal children. CONCLUSIONS Fertility preservation should now be considered in children facing cancer treatment that has a high risk of gonadal toxicity including high-dose chemotherapy and bilateral irradiation of the gonads at toxic doses.
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Affiliation(s)
- F Sauvat
- Department of Pediatric Surgery, Hospital Necker Enfants-Malades, Paris, France
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26
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Auber F, Jeanpierre C, Denamur E, Jaubert F, Schleiermacher G, Patte C, Cabrol S, Leverger G, Nihoul-Fékété C, Sarnacki S. Management of Wilms tumors in Drash and Frasier syndromes. Pediatr Blood Cancer 2009; 52:55-9. [PMID: 18816692 DOI: 10.1002/pbc.21759] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children with WT1 gene-related disorders such as Denys-Drash syndrome (DDS) and Frasier syndrome (FS) are at increased risk of Wilms tumor and end-stage renal disease. We investigated whether Wilms tumors in these patients displayed a specific phenotype or behavior and whether nephron-sparing surgery was beneficial. PROCEDURE We retrospectively studied all patients with DDS, FS, or other WT1 mutations treated at our institutions between 1980 and 2007. RESULTS We identified 20 patients, of whom 18 had benign or malignant tumors. Wilms tumors occurred in 15 patients, being unilateral in 10 and bilateral in 5 (20 tumors). Median age at Wilms tumor diagnosis was 9 months. No patients had metastases. According to the International Society of Pediatric Oncology Working Classification, there were 19 intermediate-risk tumors and one high-risk tumor; no tumor was anaplastic. In patients with nephropathy who underwent unilateral nephrectomy for Wilms tumor or nephron-sparing surgery for bilateral Wilms tumor, mean time to dialysis was 11 or 9 months, respectively. Other tumors included three gonadoblastomas (in two patients), one retroperitoneal soft-tissue tumor, and one transitional cell papilloma of the bladder. Two patients, both with stage I Wilms tumor, died from end-stage renal disease-related complications. The median follow-up time for the 18 survivors was 136 months (range, 17-224 months). CONCLUSION Most Wilms tumors in children with WT1-related disorders were early-stage and intermediate-risk tumors, with a young age at diagnosis. In patients without end-stage renal disease, nephron-sparing surgery should be considered for delaying the onset of renal failure.
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Affiliation(s)
- F Auber
- Department of Pediatric Surgery, AP-HP, Hôpital Armand Trousseau, Paris, France.
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27
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Galmiche L, Sarnacki S, Verkarre V, Boizet B, Duvillie B, Fabre M, Jaubert F. Transcription factors involved in pancreas development are expressed in paediatric solid pseudopapillary tumours. Histopathology 2008; 53:318-24. [DOI: 10.1111/j.1365-2559.2008.03108.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Marion B, Khen Dunlop N, Noche M, Fusaro F, Rousseau V, Revillon Y, Sarnacki S. SFCP-030 – Chirurgie viscérale – Volvulus du grêle de diagnostic périnatal : deux entités, deux pronostics. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)71982-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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29
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Auber F, Audry G, Jeanpierre C, Denamur E, Jaubert F, Schleiermacher G, Patte C, Leverger G, Salomon R, Ulinski T, Boccon-Gibod L, Cabrol S, Nihoul-Fékété C, Sarnacki S. SFCP-P01 – Chirurgie viscérale – Les tumeurs dans les syndromes de Drash et Frasier. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)72005-0] [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: 10/21/2022]
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30
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Jasienski S, Rousseau V, Puget S, Hamel-Teillac D, Emond S, Jaubert F, Revillon Y, Sarnacki S. SFCP-P22 – Chirurgie viscérale – Présentation inhabituelle de deux cas de tératome sacro coccygien. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)72026-8] [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: 10/21/2022]
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31
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Krug P, Schleiermacher G, Michon J, Valteau-Couanet D, Brisse H, Peuchmaur M, Sarnacki S, Martelli H, Desguerre I, Tardieu M. SFP-12 – Neurologie – Evolution neurologique des enfants atteints de syndrome opso-myoclonique associé ou non à un neuroblastome. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)72080-3] [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: 10/21/2022]
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Verkarre V, Galmiche-Rolland L, Sarnacki S, Jaubert F. Rhabdomyosarcoma an ubiquitous pediatric tumour. Arkh Patol 2008; 70:50-53. [PMID: 18727437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Rhabdomyosarcoma is the most common soft tissue tumor in children. It occurs everywhere and its prognosis depends on the location and its histological type--embryonic or alveolar. The new immunohistochemical markers desmin and myogenin in combination with molecular biological detection of specific translocations in alveolar rhabdomyosarcoma improved diagnostic capacities. Less aggressive treatment in curable cases reduces the undesirable outcomes of therapy.
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Affiliation(s)
- V Verkarre
- Anatomical Pathology Department, Surgical Department, Hopital Necker Enfants-Malades 149 rue de sevres 7501 Paris, France
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Delahaye S, Doz F, Sonigo P, Saada J, Mitanchez D, Sarnacki S, Benachi A. Prenatal diagnosis of dumbbell neuroblastoma. Ultrasound Obstet Gynecol 2008; 31:92-95. [PMID: 18058843 DOI: 10.1002/uog.5148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A neuroblastoma that develops in the sympathetic nodes can infiltrate the intervertebral foramina and invade the spinal canal, leading to spinal cord and nerve root compression and neurological impairment. Dumbbell neuroblastomas are now considered to be unresectable tumors and preoperative chemotherapy is recommended. We report the prenatal diagnosis of a dumbbell neuroblastoma successfully managed through premature delivery followed by immediate chemotherapy. We suggest that delivering prematurely in such cases is only of benefit if chemotherapy can be administered under favorable conditions. Chemotherapy should proceed immediately after delivery in order to reduce the size of the tumoral mass and its effects on the spine.
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Affiliation(s)
- S Delahaye
- Université Paris-Descartes, Faculté de Médecine, AP-HP, Maternité, Hôpital Necker-Enfants Malades, Paris, France.
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Abstract
Oesophageal atresia (OA) and/or tracheo-oesophageal fistula (TOF) are frequent malformations observed in approximately one in 3500 births. OA/TOF can be divided clinically into isolated OA (IOA) and syndromic OA (SOA) when associated with other features, the most frequent being cardiac, limb and vertebral malformations or anal atresia. SOA is observed in 50% of patients and can be subdivided into several causative groups comprising environmental agents, chromosomal disorders, malformative associations (CHARGE syndrome and VATER/VACTERL association), and other multiple congenital anomaly disorders. The observation of chromosomal disorders with SOA, as well as mouse models of OA provide support for the involvement of genetic factors in OA. Yet, epidemiological data (twin and family studies) do not support the major role of genetic factors in the majority of cases of IOA but rather a multifactorial model. However, several genes involved in SOA have been recently identified, namely N-MYC, SOX2, and CHD7 involved in Feingold (MIM 164280), anophthalmia-oesophageal-genital (MIM 600992) and CHARGE syndromes respectively (MIM 214800), suggesting that OA/TOF, at least in their syndromic forms, may be a highly genetically heterogeneous group.
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Affiliation(s)
- D Geneviève
- Département de Génétique et unité INSERM U-781, Paris, France.
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Crétolle C, Sarnacki S, Amiel J, Geneviève D, Encha-Razavi F, Zrelli S, Zérah M, Nihoul Fékété C, Lyonnet S. Currarino syndrome shown by prenatal onset ventriculomegaly and spinal dysraphism. Am J Med Genet A 2007; 143A:871-4. [PMID: 17352395 DOI: 10.1002/ajmg.a.31655] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The most frequent cause of ventriculomegaly is spina bifida when associated with Arnold-Chiari type II malformation. We report on a prenatal diagnosis of severe ventriculomegaly in association with spinal dysraphism that was indicative of a Currarino syndrome (CS) due to a c.584delA, p.H195fsX28 truncated mutation within the HLXB9 gene. Physiopathology of the ventriculomegaly is discussed in reference to the fetopathological examination and CS embryopathology. In the present case, prognosis was poor and pregnancy termination was authorized. However, such a decision may be controversial in fetuses with less severe malformations on sonographic examination, since mutations in the HLXB9 gene can predict neither the severity nor the long-term prognosis of the disease. Due to a lack of genotype-phenotype correlation and the broad variability of phenotype in heterozygotes, clinical and genetic investigations among relatives are mandatory in all HLXB9 gene mutation cases, to detect asymptomatic CS cases and to prevent the occurrence of severe complications.
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Affiliation(s)
- C Crétolle
- Département de Génétique, Hôpital Necker-Enfants Malades and INSERM U781, Paris, France
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36
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Mbarek B, Chajon E, Siala W, Martelli H, Sarnacki S, Dumas I, Albano M, Oberlin O, Haie-Meder C. Résultats fonctionnels de la chirurgie conservatrice et de la curiethérapie comme traitement conservateur des rhabdomyosarcomes vésicoprostatiques. Cancer Radiother 2006. [DOI: 10.1016/j.canrad.2006.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ruemmele FM, Sauvat F, Colomb V, Jugie M, Jan D, Canioni D, Damotte D, Sarnacki S, Brousse N, Revillon Y, Goulet O. Seventeen years after successful small bowel transplantation: long term graft acceptance without immune tolerance. Gut 2006; 55:903-4. [PMID: 16698765 PMCID: PMC1856207 DOI: 10.1136/gut.2006.093989] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Affiliation(s)
- O Goulet
- Integrated Program of Intestinal Failure, Home Parenteral Nutrition and Intestinal Transplantation, Hôpital Necker-Enfants Malades and Faculté de Médecine René Descartes, Paris, France.
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39
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Yagel S, Sonigo P, Rousseau V, Sarnacki S, Cohen S, Benachi A. Esophageal atresia diagnosed with three-dimensional ultrasonography. Ultrasound Obstet Gynecol 2005; 26:307-8. [PMID: 16116568 DOI: 10.1002/uog.1982] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- S Yagel
- Department of Obstetrics and Gynecology, Hadassah University Hospital--Mt Scopus, Jerusalem, Israel.
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40
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Goulet O, Sauvat F, Ruemmele F, Caldari D, Damotte D, Cezard JP, Lacaille F, Canioni D, Hugot JP, Berebi D, Sarnacki S, Colomb V, Jan D, Aigrain Y, Revillon Y. Results of the Paris Program: Ten Years of Pediatric Intestinal Transplantation. Transplant Proc 2005; 37:1667-70. [PMID: 15919425 DOI: 10.1016/j.transproceed.2005.03.153] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- O Goulet
- Combined Program of Intestinal Failure. Home Parenteral Nutrition, UFR Necker-Enfants Malades, National Reference Centre for Rare Digestive Diseases, FAMA de Transplantation Intestinale, AP-HP, Paris, France.
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41
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Mergan F, Jaubert F, Hartman O, Jan D, Lortat-Jacob S, Révillon Y, Fékété C, Sarnacki S. CO33 SFRP Expression en ALK, EBV et HHV-8 de 15 tumeurs myofibroblastiques inflammatoires chez l'enfant. Arch Pediatr 2003. [DOI: 10.1016/s0929-693x(03)90499-4] [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: 10/26/2022]
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42
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Auber F, Lortat-Jacob S, Sarnacki S, Jaubert F, Salomon R, Thibaud E, Jeanpierre C, Nihoul-Fékété C. Surgical management and genotype/phenotype correlations in WT1 gene-related diseases (Drash, Frasier syndromes). J Pediatr Surg 2003; 38:124-9; discussion 124-9. [PMID: 12592634 DOI: 10.1053/jpsu.2003.50025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE The WT1 gene plays a role in urogenital and gonadal development. Germline mutations of this gene have been observed in patients with Drash or Frasier syndrome (Sd). The purpose of this report is to compare phenotype and genotype of these patients. METHODS Retrospective study of 12 patients treated since 1980 for WT1 gene-related disorders was conducted. RESULTS End-stage renal disease (ESRD) occurred in 9 patients, mostly because of diffuse mesangial sclerosis (DMS) or focal and segmental glomerular sclerosis (FSGS). Seven patients underwent kidney transplantation, and 2 died. Eleven tumors occurred: 8 Wilms' tumors, one soft tissue tumor, one bladder papilloma, and one gonadoblastoma. Wilms' tumors occurred at a younger age than expected. Eight patients had a 46,XY karyotype. One of these XY patients had female phenotype (Frasier syndrome); she was raised as a girl with bilateral gonadectomy. Seven XY patients had ambiguous phenotype; 4 have been raised as boys and 3 as girls. Four patients had a 46,XX karyotype; they had female genitalia and were raised as girls. WT1 gene analysis was performed in 10 patients and showed heterozygous germline mutations in exon 9 (n = 6), intron 9 (n = 1), exon 3 (n = 1), exon 4 (n = 1), or exon 7 (n = 1). CONCLUSIONS ESRD was secondary to DMS when exon 9 was mutated, and secondary to FSGS when intron 9 was mutated. When exon 3, 4, and 7 were mutated, no nephropathy has been observed. Wilms' tumors occurred with any kind of WT1 mutation except intron 9. Abnormal sexual differentiation has been observed in all XY patients with WT1 mutation, and the most profound inversion of phenotype was observed with mutation in intron 9. Correlation between phenotype and genotype provides better understanding of the role of WT1, and can help the surgeon in the management of these patients.
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Affiliation(s)
- F Auber
- Hôspitale des Malades, Paris, France
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43
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Goulet O, Auber F, Fourcade L, Sarnacki S, Jan D, Colomb V, Cézard JP, Aigrain Y, Ricour C, Révillon Y. Intestinal transplantation including the colon in children. Transplant Proc 2002; 34:1885-6. [PMID: 12176614 DOI: 10.1016/s0041-1345(02)03109-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Olivier Goulet
- Combined Program of Liver and Intestinal Transplantation, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France.
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44
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Dokucu AI, Sarnacki S, Michel JL, Jan D, Goulet O, Ricour C, Nihoul-Fekété C. Indications and results of surgery in patients with Crohn's disease with onset under 10 years of age: a series of 18 patients. Eur J Pediatr Surg 2002; 12:180-5. [PMID: 12101500 DOI: 10.1055/s-2002-32725] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In order to examine the presentation and course of Crohn's disease (CD) with an onset of CD before the age of 10 and to assess indications and effects of surgery, a retrospective study was performed in 18 children. One hundred and twenty-two children with CD have been followed over the last 22 years in our institution. Thirty of them had the first onset of disease before 10 years of age. Eighteen out of these 30 underwent intestinal resection (IR). The mean age at the onset of CD was 6.4 years and the average duration of follow-up was 11.1 years. Most common symptoms were abdominal pain (72 %), diarrhoea (72 %), and growth retardation (50 %). Colon and ileum were the most frequently involved areas. Most of the children (94.5 %) received extensive medical and or nutritional treatment before surgery. We performed 26 IRs and 14 other operations in 18 patients. Indications for IR were chronic intestinal obstruction (13 cases) and chronic intestinal disability (13 cases). Improvements in the general clinical state were obtained in 17 cases out of 18. IR is beneficial for chronically ill children with ineffective medical therapy. A disease-free interval after surgery may provide an important time for improved growth and pubertal development and a return to nearly normal life for a long time.
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Affiliation(s)
- A I Dokucu
- Paediatric Surgery Department, Hôpital des Enfants Malades, Paris, France
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Abstract
BACKGROUND The functional integrity of transplanted fetal intestine was proven in rodents. The authors examined the morphology and development of intraperitoneally transplanted fetal intestine under cyclosporin A (CsA) monotherapy in a large mammal. METHODS Allogeneic fetal intestinal grafts were transplanted intraperitoneally in pigs. The graft was wrapped in omentum. Thirteen recipients received grafts harvested at 60 days of gestation and 5 at 105 days of gestation. All recipients received 25 mg/kg/d CsA. CsA blood levels were measured at the end of the study. The development of the grafts was assessed by inspection and histology studying revascularization, maturation, and immune rejection. RESULTS All grafts developed neovascularization. The intestinal wall in the 105-day-old group was thick enough to lead to complete mucosal destruction, whereas the 60-day-old group showed viable mucosa. All grafts induced an immune rejection. This immune response was correlated with the CsA blood level. The graft was destroyed within 15 days when CsA trough level was below 70 ng/mL, had a subacute rejection with villi atrophy when CsA trough level ranged from 70 to 150 ng/mL, and had a good appearance in spite of mild blunting of villi when CsA trough level was over 150 ng/mL. CONCLUSION Allogeneic fetal intestinal transplantation from 60-day-old embryos in pig achieved successful graft.
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Affiliation(s)
- F Zinzindohoué
- Hôpital Laennec and Hôpital Necker-Enfants Malades, Paris, France
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46
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Baudry D, Hamelin M, Cabanis MO, Fournet JC, Tournade MF, Sarnacki S, Junien C, Jeanpierre C. WT1 splicing alterations in Wilms' tumors. Clin Cancer Res 2000; 6:3957-65. [PMID: 11051244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Hereditary and sporadic forms of tumors are generally related to germ-line and somatic mutations of the same tumor suppressor gene. Unexpectedly, in Wilms' tumor, somatic mutations of the WT1 gene were found only occasionally in sporadic cases, although constitutional mutations of this gene are clearly associated with predisposition. It has been suggested that abnormal splicing may be another mode of somatic WT1 alteration. However, this idea was based on the analysis of a small series of tumors, precluding accurate evaluation of the frequency of such changes. To investigate WT1 changes at the somatic level in more detail, we analyzed the levels of the four isoform transcripts produced by alternative splicing events in a large series of 50 tumors, normal mature kidneys, and fetal kidneys. We characterized splicing alterations in 63% of sporadic Wilms' tumors. Moreover, taking into account the decreased and increased overall levels of WT1 mRNA, the percentage of sporadic tumors with changes in WT1 expression reached 90%. Whether and how these alterations of expression play a role in the tumorigenic process remain to be evaluated.
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Affiliation(s)
- D Baudry
- INSERM U383, Hôpital Necker-Enfants Malades, Université René Descartes, Paris France
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47
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Benyoussef K, Hamel-Teillac D, Sarnacki S, Jaubert F, De Prost Y. [An umbilical lesion. Isolated umbilical polyp]. Ann Dermatol Venereol 2000; 127:847-8. [PMID: 11060394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- K Benyoussef
- Service de Dermatologie, Groupe Hospitalier Necker-Enfants Malades, Paris
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48
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Sarnacki S, Auber F, Crétolle C, Camby C, Cavazzana-Calvo M, Müller W, Wagner N, Brousse N, Révillon Y, Fischer A, Cerf-Bensussan N. Blockade of the integrin alphaLbeta2 but not of integrins alpha4 and/or beta7 significantly prolongs intestinal allograft survival in mice. Gut 2000; 47:97-104. [PMID: 10861270 PMCID: PMC1727965 DOI: 10.1136/gut.47.1.97] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Small bowel transplantation remains a difficult therapeutic option endangered by a high rate of rejection and infectious complications. To improve these clinical results, it is mandatory to set up animal models to test alternative immunosuppressive regimens which may lead to immunotolerance. AIMS To determine the value of blockade of alphaLbeta2 (LFA-1) and alpha4 and beta7 integrins (alpha4beta1, alpha4beta7, and alphaEbeta7) in the prevention of rejection of fetal small bowel grafts in mice and the effect of the association of calcineurin dependent drugs in anti-LFA-1 treated mice. METHODS Adult recipient mice engrafted with allogeneic fetal small bowel received a short course of anti-alpha4 and/or anti-LFA-1 monoclonal antibodies (mAb) with or without FK506 or cyclosporin A. In addition, in a set of experiment, beta7-/- mice were used as recipients. Graft biopsies were performed and processed for standard histology. RESULTS Blockade of the pathways of the integrins alpha4 and beta7 had a modest or no effect on intestinal graft survival. In contrast, transitory, short administration of anti-LFA-1 monoclonal antibody alone, when started before engraftment (day -1), allowed long term survival of intestinal grafts, even when associated with calcineurin dependent drugs. However, early withdrawal of FK506 reversed the immunosuppressive effect of anti-LFA-1 treatment. CONCLUSION These results suggest that firstly, anti-LFA-1, but not anti-alpha4 mAb treatment, may be useful in improving the results of intestinal transplantation, and secondly, that this treatment is not incompatible with long term administration of tacrolimus currently used in the prevention of small bowel graft rejection in humans.
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Affiliation(s)
- S Sarnacki
- Service de Chirurgie Pédiatrique, Hôpital Necker Enfants-Malades, 149 rue de Sèvres, 75743 Paris Cedex 15, France
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49
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Crétolle-Vastel C, Camby C, Cerf-Bensussan N, Cavazzana-Calvo M, Fischer A, Révillon Y, Sarnacki S. [Role of calcineurin-dependent drugs on the immunosuppressive effect induced by the anti-LFA-1 antibody in a fetal intestinal transplantation model in mice]. Chirurgie 1999; 124:503-10. [PMID: 10615777 DOI: 10.1016/s0001-4001(00)88272-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY AIM We have previously demonstrated that anti-LFA-1 monoclonal antibody (mAb) can efficiently protect against rejection of small bowel allograft in a mouse model. The aim of the present work was to determine, in the same model, the optimum conditions for utilisation of anti-LFA-1 mAb and the effects of calcineurin-dependent drugs on the immunosuppression induced by anti-LFA-1 mAb treatment. MATERIALS AND METHODS Foetal small intestines of C57Bl/6 (H-2b) mice were transplanted into adult C3H/He (H-2k) mice. Recipients were treated with anti-LFA-1 mAb alone (with or without day-1 injection), or combined to cyclosporin (20 mg.kg-1.j-1 for 14 days), or to tacrolimus (1 mg.kg-1.j-1 from day 0 to day 7). Biopsies were performed after engraftment from day 5 to day 30. RESULTS Administration of anti-LFA-1 mAb alone is sufficient to induce significant prolongation of intestinal allograft survival, provided that the treatment starts one day before engraftment. This tolerogenic effect is reversed by the transitory administration of tacrolimus (p = 0.008). CONCLUSION Treatment with anti-LFA-1 mAb has to be started before the allogeneic response has begun. Calcineurin-dependent drugs can modulate the tolerogenic effect induced by anti-LFA-1. A transgenic mice model should give precise details about underlying mechanisms of these interactions, before a possible utilisation of anti-LFA-1 mAb in intestinal transplantation in humans.
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Affiliation(s)
- C Crétolle-Vastel
- Service de chirurgie pédiatrique, hôpital Necker-Enfants-Malades, Paris, France
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50
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Goulet O, Jan D, Lacaille F, Colomb V, Michel JL, Damotte D, Jouvet P, Brousse N, Faure C, Cézard JP, Sarnacki S, Peuchmaur M, Hubert P, Ricour C, Révillon Y. Intestinal transplantation in children: preliminary experience in Paris. JPEN J Parenter Enteral Nutr 1999; 23:S121-5. [PMID: 10483912 DOI: 10.1177/014860719902300530] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
From November 1994 to November 1998, 20 children (2.5 to 14 years) received a jejunoileal graft alone (SBTx; n = 10) or in combination with the liver (SBLTx; n = 10 and/or the right colon (5 SBTx). Indications were intractable diarrhea of infancy (n = 8), short bowel syndrome (n = 6), extensive Hirschsprung disease (n = 4), and chronic intestinal pseudoobstruction (n = 2). Immunosuppression included tacrolimus, methylprednisolone, and azathioprine. Current follow-up ranges from 6 to 54 months. Five patients died (3 SBTx) within the first 2 months. Acute liver rejection occurred in 5 patients during the first 2 months. Sixteen episodes of intestinal rejection during the first 3 months in 11 patients (8 in 4 SBTx) were successfully treated in all but 3 by increasing tacrolimus dose and/or a 3-day methyprednisolone bolus or required antilymphoglobulins in 3 cases. Surgical complications occurred 8 times after SBLTx and 3 after SBTx. Infectious complications were more frequent in SBLTx recipients. Reversible Epstein-Barr virus-related posttransplant lymphoproliferative disease occurred in 3 recipients. Five presented cytomegalovirus infection. The SB graft was removed in 5 recipients (3 chronic rejection). All patients were started with oral and/or enteral feeding from the 7th postoperative day by using either normal food or protein hydrolysate diet. Currently, 10 of 11 children (8 SBLTx) achieved digestive autonomy after 5 to 30 weeks. All recipients gained weight; however, growth velocity remained reduced during the first 6 months because of the steroid therapy. Overall graft and patient survival is higher after SBLTx. Intestinal transplantation is indicated for patients with permanent intestinal failure. However, because parenteral nutrition is generally well tolerated, even for long periods, each indication for transplantation must be weighed carefully in terms of risk and quality of life.
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Affiliation(s)
- O Goulet
- Combined Program of Liver and Intestinal Transplantation, Hôpital Necker-Enfants Malades, Paris, France
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