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Brugel M, Letrillart L, Evrard C, Thierry A, Tougeron D, El Amrani M, Piessen G, Truant S, Turpin A, d'Engremont C, Roth G, Hautefeuille V, Regimbeau JM, Williet N, Schwarz L, Di Fiore F, Borg C, Doussot A, Lambert A, Moulin V, Trelohan H, Bolliet M, Topolscki A, Ayav A, Lopez A, Botsen D, Piardi T, Carlier C, Bouché O. Impact of the COVID-19 pandemic on disease stage and treatment for patients with pancreatic adenocarcinoma: A French comprehensive multicentre ambispective observational cohort study (CAPANCOVID). Eur J Cancer 2022; 166:8-20. [PMID: 35259629 PMCID: PMC8828421 DOI: 10.1016/j.ejca.2022.01.040] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic caused major oncology care pathway disruption. The CAPANCOVID study aimed to evaluate the impact on pancreatic adenocarcinoma (PA) - from diagnosis to treatment - of the reorganisation of the health care system during the first lockdown. METHODS This multicentre ambispective observational study included 833 patients diagnosed with PA between September 1, 2019 and October 31, 2020 from 13 French centres. Data were compared over three periods defined as before the outbreak of COVID-19, during the first lockdown (March 1 to May 11, 2020) and after lockdown. RESULTS During the lockdown, mean weekly number of new cases decreased compared with that of pre-pandemic levels (13.2 vs. 10.8, -18.2%; p = 0.63) without rebound in the post-lockdown period (13.2 vs. 12.9, -1.7%; p = 0.97). The number of borderline tumours increased (13.6%-21.7%), whereas the rate of metastatic diseases rate dropped (47.1%-40.3%) (p = 0.046). Time-to-diagnosis and -treatment were not different over periods. Waiting neoadjuvant chemotherapy in resectable tumours was significantly favoured (24.7%-32.6%) compared with upfront surgery (13%-7.8%) (p = 0.013). The use of mFOLFIRINOX preoperative chemotherapy regimen decreased (84.9%-69%; p = 0.044). After lockdown, the number of borderline tumours decreased (21.7%-9.6%) and advanced diseases increased (59.7%-69.8%) (p = 0.046). SARS-CoV-2 infected 39 patients (4.7%) causing 5 deaths (12.8%). CONCLUSION This cohort study suggests the existence of missing diagnoses and of a shift in disease stage at diagnosis from resectable to advanced diseases with related therapeutic modifications whose prognostic consequences will be known after the planned follow-up. TRIAL REGISTRATION Clinicaltrials.gov NCT04406571.
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Affiliation(s)
- Mathias Brugel
- University of Reims Champagne-Ardenne (URCA), Digestive Oncology and Hepatogastroenterology Department, CHU Reims, Reims, France.
| | - Léa Letrillart
- University of Reims Champagne-Ardenne (URCA), Digestive Oncology and Hepatogastroenterology Department, CHU Reims, Reims, France
| | - Camille Evrard
- Medical Oncology Department, CHU Poitiers, Poitiers, France
| | - Aurore Thierry
- Department of Research and Public Health, CHU Reims, Reims, France
| | - David Tougeron
- University of Poitiers, Hepatogastroenterology Department, CHU Poitiers, Poitiers, France
| | - Mehdi El Amrani
- Digestive Surgery and Liver Transplantation Department, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France
| | - Guillaume Piessen
- Digestive and Oncological Surgery Department, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France
| | - Stéphanie Truant
- Digestive Surgery and Liver Transplantation Department, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France
| | - Anthony Turpin
- Medical Oncology Department, CHRU Lille, CANTHER Laboratory Inserm UMR-S1277, University of Lille, Lille, France
| | - Christelle d'Engremont
- Digestive Oncology and Hepatogastroenterology Department, CHU Grenoble-Alpes, Grenoble-Alpes University, Grenoble, France
| | - Gaël Roth
- Digestive Oncology and Hepatogastroenterology Department, CHU Grenoble-Alpes, Grenoble-Alpes University, Grenoble, France
| | - Vincent Hautefeuille
- Digestive Oncology and Gastroenterology Department, CHU Amiens-Picardie, Amiens, France
| | - Jean M Regimbeau
- Digestive Surgery Department, CHU Amiens-Picardie, SSPC (Simplification of Complex Patient Care) UR UPJV 7518, University of Picardie-Jules Verne, Amiens, France
| | - Nicolas Williet
- Hepatogastroenterology Department, CHU Saint Etienne, Saint-Priest-en-Jarez, France
| | - Lilian Schwarz
- Digestive Surgery Department, CHU Rouen, UNIROUEN, Inserm 1245, IRON Group, Normandie University, Rouen, France
| | - Frédéric Di Fiore
- Hepatogastroenterology Department, CHU Rouen, UNIROUEN, Inserm 1245, IRON Group, Normandie University, Rouen, France
| | - Christophe Borg
- Medical Oncology Department, CHU Besançon, INSERM, EFS BFC, UMR1098, RIGHT, University Bourgogne Franche-Comté, Besançon, France
| | - Alexandre Doussot
- Digestive Surgical Oncology and Liver Transplantation Department, CHU Besançon, Besançon, France
| | - Aurélien Lambert
- Medical Oncology Department, Lorraine Cancer Institute, Vandoeuvre-lès-Nancy, France
| | - Valérie Moulin
- Oncology Department, GH La Rochelle, La Rochelle, France
| | | | - Marion Bolliet
- Hepatogastroenterology Department, CH Colmar, Colmar, France
| | | | - Ahmet Ayav
- Hepatobiliary and Pancreatic Surgery Departement, CHRU Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Anthony Lopez
- Gastroenterology and Digestive Oncology, CHRU Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Damien Botsen
- University of Reims Champagne-Ardenne (URCA), Digestive Oncology and Hepatogastroenterology Department, CHU Reims, Reims, France; Department of Medical Oncology, Godinot Cancer Institute, Reims, France
| | - Tulio Piardi
- General, Digestive and Endocrine Surgery Department, CHU Reims, Research Unit EA 3797 (VieFra) University of Reims Champagne-Ardenne (URCA), Reims, France
| | - Claire Carlier
- University of Reims Champagne-Ardenne (URCA), Digestive Oncology and Hepatogastroenterology Department, CHU Reims, Reims, France; Department of Medical Oncology, Godinot Cancer Institute, Reims, France
| | - Olivier Bouché
- University of Reims Champagne-Ardenne (URCA), Digestive Oncology and Hepatogastroenterology Department, CHU Reims, Reims, France
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Brugel M, Bouché O, Kianmanesh R, Teuma L, Tashkandi A, Regimbeau JM, Pessaux P, Royer B, Rhaiem R, Perrenot C, Neuzillet C, Piardi T, Deguelte S. Time from first seen in specialist care to surgery does not influence survival outcome in patients with upfront resected pancreatic adenocarcinoma. BMC Surg 2021; 21:413. [PMID: 34876080 PMCID: PMC8649990 DOI: 10.1186/s12893-021-01409-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study evaluated the impact of time to surgery (TTS) on overall survival (OS), disease free survival (DFS) and postoperative complication rate in patients with upfront resected pancreatic adenocarcinoma (PA). METHODS We retrospectively included patients who underwent upfront surgery for PA between January 1, 2004 and December 31, 2014 from four French centers. TTS was defined as the number of days between the date of the first consultation in specialist care and the date of surgery. DFS for a 14-day TTS was the primary endpoint. We also analyzed survival depending on different delay cut-offs (7, 14, 28, 60 and 75 days). RESULTS A total of 168 patients were included. 59 patients (35%) underwent an upfront surgery within 14 days. Patients in the higher delay group (> 14 days) had significantly more vein resections and endoscopic biliary drainage. Adjusted OS (p = 0.44), DFS (p = 0.99), fistulas (p = 0.41), hemorrhage (p = 0.59) and severe post-operative complications (p = 0.82) were not different according to TTS (> 14 days). Other delay cut-offs had no impact on OS or DFS. DISCUSSION TTS seems to have no impact on OS, DFS and 90-day postoperative morbidity.
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Affiliation(s)
- M. Brugel
- Department of Ambulatory Oncology Care Unit, Centre Hospitalier Universitaire de Reims, Rue du general Koenig, Reims, France
| | - O. Bouché
- Department of Ambulatory Oncology Care Unit, Centre Hospitalier Universitaire de Reims, Rue du general Koenig, Reims, France
- University Reims Champagne-Ardenne (URCA), Reims, France
| | - R. Kianmanesh
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - L. Teuma
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - A. Tashkandi
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - J. M. Regimbeau
- Digestive Surgery Department, CHU Amiens Picardie, 1 rond-point du Professeur Christian Cabrol, Amiens, France
- University of Picardie Jules-Vernes, 51 boulevard de Chateaudun, Amiens, France
| | - P. Pessaux
- General, Digestive, and Endocrine Surgery, Nouvel Hôpital Civil, 1 quai Louis Pasteur, Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - B. Royer
- General Surgeon, Clinique de Courlancy, 38bis rue de Courlancy, Bezannes, France
| | - R. Rhaiem
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - C. Perrenot
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - C. Neuzillet
- Medical Oncology Department, Institut Curie, 35 rue Dailly, Saint-Cloud, France
- Versailles Saint-Quentin University, Paris Saclay University, Saint-Cloud, France
| | - T. Piardi
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
| | - S. Deguelte
- University Reims Champagne-Ardenne (URCA), Reims, France
- Digestive and Endocrine Surgery Department, Centre Hospitalier Universitaire de Reims, Rue du général Koenig, Reims, France
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Rhaiem R, Piardi T, Renard Y, Deguelte S, Kianmanesh R. Laparoscopic thermal ablation of liver tumours. J Visc Surg 2021; 158:173-179. [PMID: 33483291 DOI: 10.1016/j.jviscsurg.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Rhaiem
- Department of general, digestive and endocrine surgery, Robert-Debré Hospital, University Centre Hospital of Reims, Reims, France; University of Champagne-Ardenne, Reims, France; Anatomy Laboratory of the Reims-Champagne-Ardenne, Faculty of Medicine, Reims, France.
| | - T Piardi
- Department of general, digestive and endocrine surgery, Robert-Debré Hospital, University Centre Hospital of Reims, Reims, France; University of Champagne-Ardenne, Reims, France
| | - Y Renard
- Department of general, digestive and endocrine surgery, Robert-Debré Hospital, University Centre Hospital of Reims, Reims, France; University of Champagne-Ardenne, Reims, France; Anatomy Laboratory of the Reims-Champagne-Ardenne, Faculty of Medicine, Reims, France
| | - S Deguelte
- Department of general, digestive and endocrine surgery, Robert-Debré Hospital, University Centre Hospital of Reims, Reims, France; University of Champagne-Ardenne, Reims, France
| | - R Kianmanesh
- Department of general, digestive and endocrine surgery, Robert-Debré Hospital, University Centre Hospital of Reims, Reims, France; University of Champagne-Ardenne, Reims, France
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Affiliation(s)
- R Rhaiem
- Department of hepatobiliary, digestive and endocrine surgery, Robert-Debré hospital, university hospital of Reims, Reims, France; University of Champagne Ardenne, Reims faculty of medicine, Reims, France.
| | - T Piardi
- Department of hepatobiliary, digestive and endocrine surgery, Robert-Debré hospital, university hospital of Reims, Reims, France; University of Champagne Ardenne, Reims faculty of medicine, Reims, France
| | - R Kianmanesh
- Department of hepatobiliary, digestive and endocrine surgery, Robert-Debré hospital, university hospital of Reims, Reims, France; University of Champagne Ardenne, Reims faculty of medicine, Reims, France
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Brustia R, Fleres F, Tamby E, Rhaiem R, Piardi T, Kianmanesh R, Sommacale D. Postoperative collections after liver surgery: Risk factors and impact on long-term outcomes. J Visc Surg 2019; 157:199-209. [PMID: 31575482 DOI: 10.1016/j.jviscsurg.2019.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Postoperative collection (PC) can occur after liver surgery, but little is known on their impact on short and long-term outcomes. The aim of this study was to analyse factors predicting the occurrence of PC, the need of drainage and their impact on oncologic outcomes. METHODS This single-center, cohort-study included adult patients undergoing liver surgery between 2008 and 2017. The primary objective was to determine variables associated with PC occurrence defined by fluid collection on postoperative day-7 CT scan. Secondary objectives were factors predicting drainage requirement, and predictors of overall survival. RESULTS During the study period 395 patients were included: 53.6% of them (n=210) developed a PC with 12% (n=49) requiring drainage. Variables associated to the occurrence of PC were body mass index>35kg/m2 (OR 8.09, 95%CI (1.50,43.60) P=0.015) and extension of liver surgery (major vs. minor, OR 1.96, 95% CI (1.05,3.64) P<0.034) while laparoscopic approach was associated to a protective role (OR 0.35, 95%CI (0.18,0.67) P=0.001) in the multivariate analysis. The presence of a PC requiring treatment was associated to long-term mortality (OR:1.85, 95% CI (1.15, 2.97) P<0.01) in patients with malignant disease. CONCLUSIONS Patients undergoing to major open liver surgery with BMI>35kg/m2 have an increased risk to develop a PC: this target population need a systematic imaging in the postoperative period, even if the indication for drainage should be guided by clinical symptoms. Last, the presence of PC requiring treatment has a negative impact on overall survival among patients treated for malignant disease.
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Affiliation(s)
- R Brustia
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, Henri-Mondor University Hospital, AP-HP, Université Paris Est, 51 avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Research Unit BQR SSPC, Université de Picardie Jules-Verne, 32 rue des Minimes 80000 ,Amiens, France
| | - F Fleres
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - E Tamby
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - R Rhaiem
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - T Piardi
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - R Kianmanesh
- Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, University of Champagne-Ardennes, rue du Général Koenig 51100 Reims, France
| | - D Sommacale
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, Henri-Mondor University Hospital, AP-HP, Université Paris Est, 51 avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Amaro P, Duminil L, Bonneau S, Piardi T, Cousson J, Gabriel R, Graesslin O, Raimond E. Hemorrhagic pancreatic cyst during third trimester of pregnancy: A case-report. Eur J Obstet Gynecol Reprod Biol 2019; 237:137-138. [PMID: 31039487 DOI: 10.1016/j.ejogrb.2019.04.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 11/18/2022]
Affiliation(s)
- P Amaro
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - L Duminil
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - S Bonneau
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - T Piardi
- Department of General Surgery, Robert Debré Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - J Cousson
- Department of Reanimation, Robert Debre Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - R Gabriel
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - O Graesslin
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - E Raimond
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France.
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Tashkandi A, Rhaiem R, Adlani I, Fossaert V, Sommacale D, Kianmanesh R, Piardi T. Sequential treatment of rupture of pseudoaneurysm of hepatic artery with peritoneal patch and radiological embolization. J Surg Case Rep 2019; 2019:rjz103. [PMID: 30967936 PMCID: PMC6451181 DOI: 10.1093/jscr/rjz103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/19/2019] [Indexed: 01/23/2023] Open
Abstract
Bleeding after pancreatico-duodenectomy (PD) is a serious complication with high rates of morbidity and mortality. Interventional radiology techniques’ using embolization and/or stenting is the optimal management. In case of hemodynamic instability, surgical treatment is mandatory, but its mortality rate is considerable. Herein, we report the management of massive bleeding in a 52-year-old-male patient, 3 weeks after PD. The patient suffered severe hemorrhage with two cardiac arrests and surgical treatment was performed immediately after resuscitation. A defect in the distal part of the hepatic artery was repaired using a peritoneal patch. A postoperative CT scan confirmed bleeding control and the presence of a pseudoaneurysm within the patch area. The second step of the treatment was to perform selective embolization. The course was uneventful, and the patient was discharged 6 weeks later.
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Affiliation(s)
- A Tashkandi
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France.,Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - R Rhaiem
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - I Adlani
- Department of Radiology, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - V Fossaert
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - D Sommacale
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - R Kianmanesh
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
| | - T Piardi
- Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France
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Piardi T, Chetboun M, Sommacale D, Kianmanesh R. Microwave Thermosphere™ ablation in the multimodal management of colorectal cancer liver metastasis. Eur J Surg Oncol 2017; 43:1977-1978. [PMID: 28377076 DOI: 10.1016/j.ejso.2017.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- T Piardi
- University Hospital of Reims, General and Endocrine Surgery, France.
| | - M Chetboun
- University Hospital of Reims, General and Endocrine Surgery, France
| | - D Sommacale
- University Hospital of Reims, General and Endocrine Surgery, France
| | - R Kianmanesh
- University Hospital of Reims, General and Endocrine Surgery, France
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Piardi T, Amroun K, Msika S, Djerada Z, Diebold M, Bouché O, Sommacale D, Kianmanesch R. Radical surgery in the management of initially unresectable liver metastases from colorectal cancer in the era of bio-chemotherapy. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2014.10.031] [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] Open
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Seeliger B, Piardi T, Marzano E, Mutter D, Marescaux J, Pessaux P. Duodenal duplication cyst: a potentially malignant disease. Ann Surg Oncol 2012; 19:3753-4. [PMID: 22832999 DOI: 10.1245/s10434-012-2502-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Duodenal duplication cysts constitute a rare congenital anomaly of the gastrointestinal tract. A recent meta-analysis of the literature between 1999 and 2009 reported a total of 47 cases of duodenal duplication cysts.1 These abnormalities are mostly diagnosed in infancy and childhood. In rare cases, they can remain asymptomatic until adulthood, and 38 % of patients are diagnosed after age 20 years.1 (,) 2 Duodenal duplication cysts are generally benign lesions; nevertheless, three cases of malignant tumours arising inside have been reported.3 (-) 5 METHODS In this multimedia article, we illustrated the case of an 18 year-old female patient presenting with recurrent episodes of mild pancreatitis. MRI revealed a cystic structure measuring 2.5 cm in diameter located in the duodenal wall next to the papilla of Vater. Endoscopic ultrasound showed a cystic lesion cephalad to the papilla, protruding into the duodenal lumen. Endoscopic retrograde cholangiopancreatography was not feasible due to the dislocation of the papilla, whose macroscopic aspect was normal. To further elucidate the anatomical relations, 3D reconstruction of the MRI images was performed. There was neither dilatation of the biliary tract nor a visible communication between the common bile duct and the cystic structure. The pancreatic duct also was at distance. Those findings were suggestive of a duodenal duplication. Nevertheless, the differential diagnosis6 of a choledochocele (Todani III) could not be formally excluded. Indication for surgical resection was symptomatic disease in a context of potential malignancy. RESULTS By right subcostal incision (video), surgical exploration revealed a soft tissue mass palpable at the second portion of the duodenum. Following duodenotomy, the mucosa was incised cephalad to the papilla of Vater, which could previously be localized by methylene blue injection by a catheter inserted into the cystic duct. The cystic structure was dissected and no communication between the cyst and the biliary tract was individualized. The final diagnosis was made by histological examination showing duodenal duplication. There was neither heterotopic gastric mucosa nor excreto-biliary epithelial layer. There were no signs of malignancy. The postoperative course was marked by hematemesis externalised by the nasogastric tube. We reintervened at postoperative day 2 to ensure hemostasis. A clot was removed from the area of duodenal mucosa without any visible active bleeding. Further recovery was uneventful; the patient was discharged at postoperative day 10 and is actually asymptomatic. DISCUSSION The ideal treatment of duodenal duplication cysts is complete surgical resection.7 Due to proximity to the bilio-pancreatic duct, total resection sometimes requires pancreaticoduodenectomy. This major surgical procedure entails the disadvantages of high morbidity and mortality with poor quality of life. In our opinion, this procedure should remain an ultimate option. Less invasive approaches have been proposed, including partial resection or internal derivation.7 Marsupialization is a surgical approach that has been accomplished even endoscopically.1 Nevertheless, these techniques do not provide total resection and leave the risk of degenerescence. As cases of malignancy are reported, we decided to realize a complete surgical excision of the lesion. Three-dimensional reconstruction of the biliary anatomy is an innovative procedure, which allowed us to show the absence of any communication between the cyst and either the common bile duct or the pancreatic duct.8 So, the surgical approach could be specified preoperatively ensuring the integrity of the common bile duct. Duplication cysts could be connected to the pancreaticobiliary ducts in about 29 %.1 Subsequent realization of a total surgical excision combined the advantages of complete resection with minimal invasiveness. CONCLUSIONS For relieving symptoms and preventing further complications, such as pancreatitis or malignant transformation, surgical resection of duodenal duplication cysts is indicated. In cases of difficulties to individualize the neighboring anatomical structures preoperatively, 3D reconstruction is a helpful approach to determine the surgical strategy. Enucleation allows a total excision while minimizing the adverse effects and therefore it is our treatment of choice for duodenal duplication cysts without communication.
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Affiliation(s)
- B Seeliger
- Pôle d'hépato-digestive, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Faculté de Médecine, IRCAD/EITS, Institut Hospitalo-Universitaire (IHU) Mix Surg, Strasbourg, France
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Piardi T, Gheza F, Ellero B, Woehl-Jaegle ML, Ntourakis D, Cantu M, Marzano E, Audet M, Wolf P, Pessaux P. Number and tumor size are not sufficient criteria to select patients for liver transplantation for hepatocellular carcinoma. Ann Surg Oncol 2011; 19:2020-6. [PMID: 22179632 DOI: 10.1245/s10434-011-2170-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is an indication for liver resection or transplantation (LT). In most centers, patients whose HCC meets the Milan criteria are considered for LT. The first objective of this study was to analyze whether there is a correlation between the pathologic characteristics of the tumor, survival and recurrence rate. Second, we focused our attention on vascular invasion (VI). METHODS From January 1997 to December 2007, a total of 196 patients who had a preoperative diagnosis of HCC were included. The selection criteria for LT satisfied both the Milan and the San Francisco criteria (UCSF). Demographic, clinical, and pathologic information were recorded. RESULTS HCC was confirmed in 168 patients (85.7%). The median follow-up was 74 months. The pathologic findings showed that 106 patients (54.1%) satisfied the Milan criteria, 134 (68.4%) the UCSF criteria of whom 28 (14.3%) were beyond the Milan criteria but within the UCSF criteria, and 34 (17.3%) beyond the UCSF criteria. VI was detected in 41 patients (24%). The 1-, 3-, and 5-year overall survival rates were 90%, 85%, and 77%, respectively, according to the Milan criteria and 90%, 83%, and 76%, respectively, according to the UCSF criteria (P = NS). In univariate and multivariate analyses, tumor size and VI were significant prognostic factors affecting survival (P < 0.001). Two factors were significantly associated with VI: alfa-fetoprotein level of >400 ng/ml and tumor grade G3. CONCLUSIONS Tumor size and VI were the only significant prognostic factors affecting survival of HCC patients. Primary liver resection could be a potential selection treatment before LT.
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Affiliation(s)
- T Piardi
- Pôle de Pathologie Digestive, Hépatique et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
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12
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Panaro F, Gheza F, Piardi T, Woehl Jaegle M, Audet M, Cantù M, Cinqualbre J, Wolf P. Continuous Infusion of Local Anesthesia After Living Donor Nephrectomy: A Comparative Analysis. Transplant Proc 2011; 43:985-7. [DOI: 10.1016/j.transproceed.2011.01.144] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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13
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Cag M, Audet M, Saouli AC, Panaro F, Piardi T, Cinqualbre J, Wolf P. Does arterialisation time influence biliary tract complications after orthotopic liver transplantation? Transplant Proc 2011; 42:3630-3. [PMID: 21094829 DOI: 10.1016/j.transproceed.2010.08.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 07/28/2010] [Accepted: 08/19/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND In the cardiac death donor era, many reports deal with biliary tract complications and concerns about ischemic reperfusion injury owing to the exclusive arterial vascularization of the biliary tree, the warm ischemia time has been implicated as responsible for biliary lesions during organ procurement. We defined the arterialization time as the second warm ischemia time. Our purpose was to study the correlation between the arterialization time during liver implantation and the appearance of biliary lesions. METHODS We retrospectively collected data from the last 5-years of orthotopic liver transplantation: namely, indications, cold perfusion fluid, cold ischemia time, operative procedure times, and acute rejection events. We excluded split-liver transplantations, retransplantations, pediatric patients, transplantations for cholestatic disease, cases where hepatic artery thrombosis happened before biliary complications, or patients with posttransplant cytomegalovirus infection. We defined 2 groups: A) without biliary complications; and B) with biliary complications. We compared the mean arterialization time using Student t test to define whether the warm ischemic time during implantation was responsible for biliary tract complications. A P value of <.05 was considered to be significant. RESULTS Between 2004 and the end of 2008, we grafted 402 patients among whom 243 met the inclusion criteria: 198 in group A and 45 in group B. Only the cold ischemia time was significantly different between the 2 groups (P = .039). CONCLUSION After the anhepatic time, the surgeon may take time for the arterial anastomosis without fearing increased biliary damage.
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Affiliation(s)
- M Cag
- Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, 1 avenue Molière, 67098 Strasbourg Cedex, France.
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Audet M, Piardi T, Panaro F, Ghislotti E, Gheza F, Cag M, Jarzembowski T, Flicoteaux H, Wolf P, Cinqualbre J. Incidence and clinical significance of bacterial and fungal contamination of the preservation solution in liver transplantation. Transpl Infect Dis 2011; 13:84-8. [DOI: 10.1111/j.1399-3062.2010.00529.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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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15
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Panaro F, Piardi T, Audet M, Gheza F, Woehl-Jaegle ML, Portolani N, Cinqualbre J, Wolf P. Laparoscopic ultrasound-guided radiofrequency ablation as a bridge to liver transplantation for hepatocellular carcinoma: preliminary results. Transplant Proc 2010; 42:1179-81. [PMID: 20534255 DOI: 10.1016/j.transproceed.2010.03.091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of this study was to assess the impact of laparoscopic thermoablation (LTA) as a neoadjuvant therapy prior to orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). METHODS Between January 2008 and January 2009, 12 consecutive patients, including 10 males and 2 females with unresectable HCC within liver cirrhosis, were treated with LTA under ultrasound (US) guidance. Most patients were in Child-Pugh class B (54.1%) with a mean age of 60.7 +/- 7.74 years (range, 45-69; median, 60). RESULTS The LTA procedure was completed in all patients with thermoablation of 23 HCC nodules. LTA identified 4 new malignant lesions (20%) undetected by preoperative imaging (<0.5 cm). The mean length of surgery was 96 minutes (range, 45-118). Six procedures were performed in 4 patients. No postoperative hepatic insufficiency was reported. The mean hospital stay was 4.5 days; no postoperative morbidity was reported. Complete tumor necrosis was achieved in 19/23 thermoablated nodules (82.6%) as evidenced computed tomography (CT) scan by at 3 weeks after the treatment. All patients underwent OLT without complications. The histology of the native liver showed complete necrosis in 17/23 (74%) treated nodules. DISCUSSION There is currently no convincing evidence that LTA allows one to expand the current selection criteria for OLT, nor that LTA decreases dropout rates on the waiting list. However, LTA does not increase the risk of postoperative complications. There is insufficient evidence that LTA offers any benefit when used prior to OLT either for early or for advanced HCC.
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Affiliation(s)
- F Panaro
- Multi-organ Transplant Centre, University Louis Pasteur of Strasbourg, Strasbourg, France
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16
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Piardi T, Audet M, Panaro F, Gheza F, Cag M, Portolani N, Cinqualbre J, Wolf P. Incisional hernia repair after liver transplantation: role of the mesh. Transplant Proc 2010; 42:1244-7. [PMID: 20534272 DOI: 10.1016/j.transproceed.2010.03.085] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients undergoing orthotopic liver transplantation (OLT) show a high risk of developing an incisional hernia. The aim of this retrospective study was to establish the incidence and the factors influencing the outcomes of this complication. METHODS We reviewed 450 consecutive OLT performed in 422 adult recipient between January 2000 and December 2005. Herniae were analysed with aspect to localization, classification, repair technique, and recurrence. All treated herniae were followed for a median of 50.5 months. RESULTS Incisional herniae occurred in 36 patients (8.5%, Group 1). Their mean age OLT was 51.4 years with 94.4% male subjects. No significant difference was observed between affects and unaffected individuals for age, OLT indication, Child-Pugh score, albumin, comorbidities, operative time, transfusions, immunosuppressant regimen, and graft rejection episodes as well as for the incisional approach and hospital stay. Gender, body mass index (BMI), preoperative ascites, and pulmonary complications after OLT were significantly different (P < .01). Herniae were small (<5 cm; n = 12), medium (5-10 cm; n = 28), or large (> 10 cm; n = 2). Herniorrhaphy techniques included primary suture repair in 5 (13.9%) and mesh repair in 31 (86.1%) cases. In 3 patients with a primary repair and 1 patient with a mesh repair there were recurrences. CONCLUSIONS Preoperative ascites, gender, BMI, and pulmonary complications after OLT seemed to have significant influences on the formation of incisional herniae. Polypropylene mesh may be a first choice for the surgical treatment of there transplant recipients.
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Affiliation(s)
- T Piardi
- Multi-organ Transplant Centre of University Louis Pasteur of Strasbourg, Strasbourg, France.
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17
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Audet M, Piardi T, Panaro F, Cag M, Ghislotti E, Habibeh H, Giulini S, Jaeck D, Wolf P. Liver transplantation in recipients over 65 yr old: a single center experience. Clin Transplant 2010; 24:84-90. [DOI: 10.1111/j.1399-0012.2009.00972.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Piardi T, Audet M, Odeh M, Panaro F, Cag M, El-ahmar J, Baiocchi GL, Schneider A, Wolf P. Liver transplantation exceeding UCSF criteria: case report of a late recurrence treated by surgery and review of the literature. ACTA ACUST UNITED AC 2009; 44:52-5. [PMID: 19996598 DOI: 10.1159/000264635] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 07/20/2009] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Treatment of a recurrence of hepatocellular carcinoma (HCC) after liver transplantation. Surgery has seldom been considered in such a situation because HCC recurrences are generally considered as a systemic disease. PATIENT AND METHODS We describe a 47-year-old male patient who underwent liver transplantation in October 1999 for HCC exceeding the Milan and University of California, San Francisco (UCSF), criteria. RESULTS In 2007 (8 years after liver transplantation), the patient developed a cervical bone metastasis treated by surgery. In April 2008, HCC had disseminated to hepatic pedicle lymph nodes. An extended hepatic pedicle lymphadenectomy was then performed. Today, our patient is doing well, without signs of recurrence. DISCUSSION The risk of developing a tumor recurrence is the main argument against expanding the UCSF criteria. In case of an HCC recurrence, various treatments ranging from a change in the immunosuppression regimen to chemotherapy have been proposed. Surgical treatment has rarely been envisaged in the treatment of HCC recurrences because of the technical difficulties and the frequent dissemination of cancer.
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Affiliation(s)
- T Piardi
- Department of Surgery, Multivisceral Transplant Center, Hôpital Hautepierre, Louis Pasteur University of Strasbourg, FR-67000 Strasbourg, France.
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Ghedi M, Piardi T, Battaglia G, Giampaoli F, Faini GP, Pouché A. [Lipohyperplasia of the ileocecal valve: unusual cause of severe digestive surgery]. G Chir 2002; 23:22-5. [PMID: 12043465] [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: 02/25/2023]
Abstract
The lipohyperplasia of the ileocaecal valve is a condition of rare clinical observation mainly characterized by an abnormal accumulation of adipose tissue along the submucosal layer of the ileocaecal valve. This pathology presents an unspecific symptomatology that can make difficult the differential diagnosis with a local neoplastic process. Sometimes this pathology can be the cause of gastrointestinal bleeding of unknown origin. The Authors report a case of their observation that requested an emergency surgical operation for the massive digestive haemorrage at presentation. The definitive diagnosis could have been precised only after histological exam.
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Affiliation(s)
- M Ghedi
- Cattedra di Semeiotica Chirurgica, Università degli Studi di Brescia, Ospedali Civili di Brescia
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20
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Lancini GP, Lanzi S, Piardi T, Pulcini G, Galvani G, Vettoretto N, Grazioli L, Mahamat AA, Banchini E, Giulini SM, Pouché A. [Acute pancreatitis: resultos of a diagnostic-therapeutic protocol in 80 consecutive cases]. Chir Ital 2001; 53:505-14. [PMID: 11586569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The treatment of acute pancreatitis cannot be standardized in the absence of a prompt diagnosis and of an accurate severity and prognostic score. This study, based on 80 consecutively observed patients, compared the aetiological, clinical, diagnostic (laboratory and imaging) and prognostic data used to select the most appropriate therapy for each patient. The results confirm that the Ranson score shows a satisfactory prognostic relationship between the number of positive parameters and the severity of the disease. Ultrasound, which is useful for defining the aetiologic factors and in the follow-up of peripancreatic effusions, has proved to be limited as a means of imaging abnormalities of the pancreatic parenchyma. CT scans are confirmed as being the only method of accurately demonstrating the presence of necrosis and of evaluating its effective extent. ERCP was performed as soon as possible in the presence of biliary stasis or of suspect ultrasonographic signs. Surgical treatment proved necessary only in 7.5% of cases, on each occasion to drain infected necrotic foci. Promptness of the surgical indication plays an important role in the outcome of necrosectomy and drainage performed with the closed technique. Mortality was limited to 1.25% in our series. A correct diagnostic approach together with prompt treatment can reduce the mortality rate of this disease to a minimum.
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Affiliation(s)
- G P Lancini
- Semeiotica e Metodologia Chirurgica, Università degli Studi di Brescia
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21
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Piardi T, Biasca F, Giampaoli F, Ghedi M, Faini G, Pouchè A. [Necrotizing soft tissue infections as the only clinical manifestation of retroperitoneal colonic perforation]. Ann Ital Chir 2001; 72:227-31. [PMID: 11552479] [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: 02/21/2023]
Abstract
Necrotizing infections are rapidly progressive potentially lethal bacterial diseases of the soft tissues. In based on the widely varying levels of soft tissues affected and the variety of the microflora, two types of necrotizing soft tissue infections need to be delineated: pure Chlostridial myonecrosis and other necrotizing soft tissue infections (NSTI). From an etiopathogenetic point of view NSTI can be secondary to perianal or urogenital abscesses, traumatic lesions, wound infections, trophic or decubitus ulcers, oral cavity abscesses; only in a limited number of cases their origin can be idiopathic. Exceptionally it can happen that a NSTI could represent the only clinical manifestation of a retroperitoneal colic perforation. The Authors report their experience regarding two clinical cases recently observed. The first patient, who previously underwent colic resection for sigmoid carcinoma and adjuvant chemotherapy, had developed as only clinical manifestation of retroperitoneal anastomotic fistula a necrotizing infection at the root of the hip, extended along the whole leg. The second patient, with diverticular perforated disease, had developed rhe necrotizing infection in the lumbar region and in the perirenal tissues. Here will be discussed the sensitivity of the possible diagnostic investigative techniques and the therapeutical strategies that brought both the patients to a complete recovery.
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Affiliation(s)
- T Piardi
- Dipartimento di Scienze Mediche e Chirurgiche, Cattedra di Semeiotica Chirurgica, Università degli Studi di Brescja
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22
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Palmieri F, Pulcini G, Piardi T, Ottaviani GM, Longobardi U, Pouchè A. [Vascular trauma of the lower limbs]. MINERVA CHIR 2000; 55:841-6. [PMID: 11310182] [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: 02/19/2023]
Abstract
BACKGROUND This study was conducted to evaluate the results of treatment of vascular trauma of the lower extremities and those factors associated with limb loss. DESIGN a retrospective evaluation of a series with lower extremities vascular trauma. SETTING University Hospital. METHODS Thirty-one patients accounting for 45 vascular lesions of the lower extremities (27 arterial and 18 venous injuries), over a 15 years period ending December 1998. Age, sex, modality of the trauma, site of the lesion and associated skeletal injuries, diagnostic procedures, ischemic time, arterial and venous repair performed were analyzed. RESULTS Perioperative mortality was 7.4%. For arterial injuries, limb salvage was obtained in 22 patients (81.5%). Five amputations (18.5%), 1 primary and 4 secondary have been performed. Amputation rate was 26.7% for popliteal lesions versus 8.3% for other locations, 40% when a skeletal lesion was associated versus 5.9% for those without such injuries, 37.5% for reverse saphenous vein interpositions versus 5.6% for arterial repair without interposition. CONCLUSIONS In this study, the factors influencing limb loss in vascular trauma of the lower extremities are popliteal location, the association with skeletal injuries, the need of saphenous vein interposition for arterial repair.
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Affiliation(s)
- F Palmieri
- Cattedra di Semeiotica Chirurgica Spedali Civili di Brescia, III Divisione di Chirurgia Generale UDA, Università degli Studi, Brescia
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Piardi T, D'Adda F, Palmieri F, Vettoretto N, Lanzi S, Pouchè A. Shock and dyspnea after cardiopulmonary resuscitation: a case of iatrogenic gastric rupture. Chir Ital 2000; 52:593-6. [PMID: 11190556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Rupture of the stomach is a rarely reported complication of cardiopulmonary resuscitation. The number of cases reported in the literature since 1970 does not exceed 30. We present a recent case of a young woman submitted to cardiopulmonary resuscitation in whom a gastric rupture gave rise to massive pneumoperitoneum with haemodynamic shock and respiratory failure. Major distension of the abdomen and an extensive subcutaneous emphysema were present. After re-establishing the haemodynamic conditions and a diagnostic spiral thoracic-abdomen CT scan, an emergency laparoptomy was performed. We found two linear defects of the lesser curvature of the stomach, which were treated by closure with a primary interrupted two-layer suture. The postoperative recovery was uneventful. Iatrogenic gastric rupture carries a high risk of mortality. A prompt diagnosis and emergency surgical repair are essential for patient survival.
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Affiliation(s)
- T Piardi
- Department of Medical and Surgical Sciences, University of Brescia, Spedali Civili di Brescia
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Piardi T, D'Adda F, Giampaoli F, Pulcini G, Lancini GP, Pouché A. Solitary metachronous splenic metastases: an evaluation of surgical treatment. J Exp Clin Cancer Res 1999; 18:575-8. [PMID: 10746989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Splenic metastases occurring after primary tumor removal and apparently solitary have been documented only recently in Literature. They are, most of the times, clinically asymptomatic and their presence is casually determined by ultrasonographic follow-up in subjects otherwise in good conditions. The belief that splenic metastases occur only in disseminated cancer is today no longer accepted. Some Authors consider solitary splenic metachronous metastases eligible for surgical treatment as well as pulmonary or hepatic metastases. In the case presented, surgery was required due to abscess formation of a splenic metastasis, which was not responding to chemotherapy. Our experience, like others reported in Literature, verified a long-term post-operative survival in spite of limited disease-free time. Surgical treatment by splenectomy can be indicated in selected patients, considering that chemotherapy has been proved to be ineffective in the treatment of splenic metastases.
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Affiliation(s)
- T Piardi
- Cattedra di Semeiotica Chirurgica Università degli Studi di Brescia, Italy
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Lanzi S, Lancini GP, Piardi T, Biasca F, Ottaviani GM, Rossi G, Pizzoccaro C, Pouchè A. [Splenectomy in immune thrombocytopenia and other hematological diseases]. G Chir 1999; 20:479-86. [PMID: 10645065] [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: 02/15/2023]
Abstract
The Authors report a retrospective study of 74 splenectomies performed for hematologic diseases. The role of splenectomy has changed over recent years with increased indications for immune thrombocytopenic purpura (ITP). The aim of this study was to assess indications to surgery in relation to clinical presentation with typical hemorrhagic features or severe thrombocytopenia only; interval between onset of symptoms and splenectomy; failure of medical management and complications from steroid administration; scintigraphic studies predictive of response to splenectomy and preoperative treatment in patients with severe thrombocytopenia were also studied. The Authors reported response rates to splenectomy of 84% without mortality and only 11% of postoperative complications. These results encouraged to surgery for treatment of those patients with severe thrombocytopenia, who fail to obtain remission or develop serious complications after medical therapy. The splenectomy cured severe thrombocytopenia also in some patients with acquired immunodeficiency (HIV+). Moreover the Authors discuss the indications in patients with chronic lymphatic leukaemia and lymphoma diseases. In selected patients the splenectomy has the potential to relieve symptoms due to splenomegaly, correct cytopenias, specify hystological diagnosis and modify the disease course of malignant lymphomas. In fact splenomegaly sometimes complicated the course of malignant lymphomas because of hematologic abnormalities that are inconsistent with active chemotherapy.
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Affiliation(s)
- S Lanzi
- Cattedra di Semeiotica Chirurgica, Università degli Studi di Brescia
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Pulcini G, Biasca F, Lanzi S, Piardi T, Pouché A. [Primary malignant tumor of the 4th duodenal segment at the angle of Treitz. Report of a case]. Ann Ital Chir 1999; 70:105-10. [PMID: 10367515] [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: 02/12/2023]
Abstract
A case of 34-years old woman with adenocarcinoma of the IVth duodenal segment extended to the angle of Treitz, treated with duodenojejunal segmentary resection, is described. Clinical features and diagnostic strategies are reported. Personal observation compared with Literature confirms the difficulty of an early diagnosis. The most appropriate surgical techniques for the treatment of these particularly and uncommon neoplasms often discovered in advanced stage are discussed. The better prognosis of these adenocarcinomas compared with those of the proximal duodenum (Ist and IInd segments) can be supported by embryological differences currently to be investigated.
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Affiliation(s)
- G Pulcini
- Cattedra di Semeiotica e Metodologia Chirurgica, Università degli Studi di Brescia
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Pouchè A, Piardi T, Zorat S, Codignola C, Tiberio GA, Giovanetti M, Giulini SM. [Hepatic injuries: diagnostic and therapeutic features]. G Chir 1995; 16:169-75. [PMID: 7669497] [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: 01/26/2023]
Abstract
Sixty-four consecutive patients with hepatic trauma were examined. Five (7.8%) patients were managed nonoperatively and 59 (92.2%) underwent immediate laparotomy. Nonoperative management is appropriate in hemodinamically stable patients. It requires increasing use of computed tomography instead of peritoneal lavage to evaluate stable patients with blunt abdominal trauma. Patients with complicated associated injuries must be excluded. Analysis of patients who underwent immediate abdominal exploration showed that grade I through grade III injuries of AAST classification are the most common in blunt hepatic trauma (84.75%). Associated intra-abdominal injuries requiring operation for ongoing hemorrhage were observed in 50% of these patients. In the management of grade I through grade III hepatic injuries a simple suture was a safe and highly effective treatment. More complex injuries actively bleeding were controlled by finger fracture technique to achieve intrahepatic hemostasis with selective vascular ligation. Hepatic resection was exceptionally required (2%). On the contrary, resection was required in grade IV injuries with extensive parenchymal destruction and in grade V lesions for a better vascular control of the ruptured suprahepatic veins.
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Affiliation(s)
- A Pouchè
- Chirurgia Generale I, Università degli Studi di Brescia
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