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Ambille Dit Haure M, Aubry G, Delangle R, Belghiti J, Nikpayam M, Uzan C, Canlorbe G. [How I do… An inguinofemoral lymphadenectomy in vulvar cancer]. Gynecol Obstet Fertil Senol 2022; 50:494-496. [PMID: 35189394 DOI: 10.1016/j.gofs.2022.02.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Affiliation(s)
- M Ambille Dit Haure
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - G Aubry
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Delangle
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Belghiti
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Nikpayam
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Uzan
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Canlorbe
- Service de chirurgie gynécologique du Pr C. Uzan, hôpital de la Pitié-Salpêtrière, bâtiment Layani, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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2
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Benoit L, Delangle R, Van NT, Villefranque V, Koskas M, Belghiti J, Uzan C, Canlorbe G. [Feasibility and security of laparoscopic (± robotic) total hysterectomy in outpatient surgery: A French multicenter retrospective study]. Gynecol Obstet Fertil Senol 2022; 50:374-381. [PMID: 34979303 DOI: 10.1016/j.gofs.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the feasibility and safety of total hysterectomy by laparoscopic approach (± robot assisted) in ambulatory. MATERIALS AND METHODS French three-center retrospective study including 165 patients who had laparoscopic (± robot assisted) total hysterectomy scheduled as outpatients from January 2016 to December 2020. Clinical and perioperative data were collected. Factors associated with outpatient failure and rehospitalization were evaluated. RESULTS The outpatient success rate was 92.7%. Factors associated with outpatient failure were incision time>13:00, large volume of blood loss, intraoperative complications with Oslo score≥2, uterine weight≥250g, indication for benign pathology, and robot-assisted approach. Among patients managed as outpatients, 7.2% were rehospitalized at a mean of 10 days from surgery. The factors associated with rehospitalization were the use of an effective antiaggregant or anticoagulant treatment and the use of intraoperative adhesiolysis. Four patients (2.6%) underwent revision surgery. CONCLUSION Minimally invasive hysterectomy can be performed as an outpatient procedure even in cases of malignant pathology. Age and body mass index are not associated with an increased risk of failure or re-hospitalization within one month.
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Affiliation(s)
- L Benoit
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - R Delangle
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - N T Van
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - V Villefranque
- Service de gynécologie obstétrique, Hôpital Simone-Veil, 95600 Eaubonne, France
| | - M Koskas
- Service de gynécologie obstétrique, Bichat, université de Paris, AP-HP, 75018 Paris, France
| | - J Belghiti
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Inserm UMR_S_938, Cancer Biology and Therapeutics, centre de recherche Saint-Antoine (CRSA), Sorbonne Université, 75012 Paris, France
| | - G Canlorbe
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Inserm UMR_S_938, Cancer Biology and Therapeutics, centre de recherche Saint-Antoine (CRSA), Sorbonne Université, 75012 Paris, France.
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3
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Botter C, Favier A, Aubry G, Canlorbe G, Méningaud JP, Belghiti J, Hersant B. [How I do…to repair posterior perineal tissue loss with a posterior vaginal mucosa flap after vulvectomy]. Gynecol Obstet Fertil Senol 2022; 50:333-337. [PMID: 34871787 DOI: 10.1016/j.gofs.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 06/13/2023]
Affiliation(s)
- C Botter
- Department of maxillofacial and plastic, reconstructive, and aesthetic surgery, Henri-Mondor hospital, Créteil, France
| | - A Favier
- Department of gynecological and breast surgery and oncology, Pitié-Salpêtrière university hospital, Paris, France.
| | - G Aubry
- Department of gynecological and breast surgery and oncology, Pitié-Salpêtrière university hospital, Paris, France
| | - G Canlorbe
- Department of gynecological and breast surgery and oncology, Pitié-Salpêtrière university hospital, Paris, France
| | - J-P Méningaud
- Department of maxillofacial and plastic, reconstructive, and aesthetic surgery, Henri-Mondor hospital, Créteil, France
| | - J Belghiti
- Department of gynecological and breast surgery and oncology, Pitié-Salpêtrière university hospital, Paris, France
| | - B Hersant
- Department of maxillofacial and plastic, reconstructive, and aesthetic surgery, Henri-Mondor hospital, Créteil, France
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Sallée C, Margueritte F, Gouy S, Tardieu A, Belghiti J, Lambaudie E, Collinet P, Guyon F, Legros M, Monteil J, Gauthier T. 262 FDG-PET/CT and para-aortic staging in endometrial cancer. a french multicentric study. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.149] [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: 11/04/2022]
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5
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Haimeur Y, Canlorbe G, Gonthier C, Belghiti J, Uzan C, Azaïs H. [How I do… a laparoscopic lateral ovarian transposition with uterine fixation before pelvic radiation therapy]. Gynecol Obstet Fertil Senol 2021; 49:204-207. [PMID: 32919089 DOI: 10.1016/j.gofs.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Y Haimeur
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France; Sorbonne Université, Paris, France
| | - C Gonthier
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France
| | - J Belghiti
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France; Sorbonne Université, Paris, France
| | - H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, Paris, France.
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Boyer de Latour A, Popescu N, Uzan C, Gonthier C, Belghiti J, Canlorbe G, Azaïs H. [How I do… a perineal VAC therapy for the treatment of a disunion after vulvar surgery]. ACTA ACUST UNITED AC 2020; 49:553-556. [PMID: 33130257 DOI: 10.1016/j.gofs.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)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Indexed: 11/17/2022]
Affiliation(s)
- A Boyer de Latour
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - N Popescu
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - C Gonthier
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - J Belghiti
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France
| | - H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, Pitié-Salpêtrière, médecine Sorbonne université, AP-HP, Paris, France.
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Tabourin T, Sarfati J, Pinar U, Beaud N, Parra J, Vaessen C, Gomez F, Benamran D, Canlorbe G, Belghiti J, Chartier-Kastler E, Cussenot O, Seisen T, Roupret M. Évaluation du risque de contamination par le coronavirus après chirurgie robotique durant la pandémie COVID-19. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.011] [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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Maulat C, Regimbeau JM, Buc E, Boleslawski E, Belghiti J, Hardwigsen J, Vibert E, Delpero JR, Tournay E, Arnaud C, Suc B, Pessaux P, Muscari F. Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial. Br J Surg 2020; 107:824-831. [DOI: 10.1002/bjs.11405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/22/2019] [Accepted: 09/27/2019] [Indexed: 01/15/2023]
Abstract
Abstract
Background
Biliary fistula is one of the most common complications after hepatectomy. This study evaluated the effect of transcystic biliary drainage during hepatectomy on the occurrence of postoperative biliary fistula.
Methods
This multicentre RCT was carried out from 2009 to 2016 in nine centres. Patients were randomized to transcystic biliary drainage or no transcystic drainage (control). Patients underwent hepatectomy (more than 2 segments) of non-cirrhotic livers. The primary endpoint was the occurrence of biliary fistula after surgery. Secondary endpoints were morbidity, postoperative mortality, duration of hospital stay, reoperation, readmission to hospital, and complications caused by catheters. Intention-to-treat and per-protocol analyses were performed.
Results
A total of 310 patients were randomized. In intention-to-treat analysis, there were 158 patients in the transcystic group and 149 in the control group. Seven patients were removed from the per-protocol analysis owing to protocol deviations. The biliary fistula rate was 5·9 per cent in intention-to-treat and 6·0 per cent in per-protocol analyses. The rate was similar in the transcystic and control groups (5·7 versus 6·0 per cent; P = 1·000). There were no differences in terms of morbidity (49·4 versus 46·3 per cent; P = 0·731), mortality (2·5 versus 4·7 per cent; P = 0·367) and reoperations (4·4 versus 10·1 per cent; P = 1·000). Median duration of hospital stay was longer in the transcystic group (11 versus 10 days; P = 0·042). The biliary fistula risk was associated with the width and length of the hepatic cut surface.
Conclusion
This randomized trial did not demonstrate superiority of transcystic drainage during hepatectomy in preventing biliary fistula. The use of transcystic drainage during hepatectomy to prevent postoperative biliary fistula is not recommended. Registration number: NCT01469442 ( http://www.clinicaltrials.gov).
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Affiliation(s)
- C Maulat
- Department of Digestive Surgery and Liver Transplantation, Toulouse University Hospital, Toulouse, France
| | - J-M Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
- Simplifications des Soins Patients Chirurgicaux Complexes (SSPC), Unit of Clinical Research, University of Picardie Jules Verne, Amiens, France
| | - E Buc
- Department of Digestive Surgery and Liver Transplantation, Hôtel Dieu, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - E Boleslawski
- Department of Digestive Surgery and Liver Transplantation, Claude Huriez Hospital, Lille, France
| | - J Belghiti
- Department of Digestive Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
| | - J Hardwigsen
- Department of Digestive Surgery, La Conception University Hospital, Marseille, France
| | - E Vibert
- Department of Digestive Surgery and Liver Transplantation, Centre Hépato-Biliaire, Paul Brousse Hospital, Villejuif, France
| | - J-R Delpero
- Department of Digestive Surgery, Paoli Calmettes Institute, Marseille, France
| | - E Tournay
- Department of Epidemiology and Clinical Research, Toulouse University Hospital, Toulouse, France
| | - C Arnaud
- Department of Epidemiology and Clinical Research, Toulouse University Hospital, Toulouse, France
| | - B Suc
- Department of Digestive Surgery and Liver Transplantation, Toulouse University Hospital, Toulouse, France
| | - P Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France
| | - F Muscari
- Department of Digestive Surgery and Liver Transplantation, Toulouse University Hospital, Toulouse, France
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9
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Azaïs H, Belghiti J, Nikpayam M, Gonthier C, Canlorbe G, Uzan C. [Can robotic surgery help reduce medical discrimination for obese patients?]. ACTA ACUST UNITED AC 2019; 48:475-476. [PMID: 31870836 DOI: 10.1016/j.gofs.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 11/30/2022]
Affiliation(s)
- H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - J Belghiti
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Nikpayam
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Gonthier
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMR S 938 « Biologie et Thérapeutiques du Cancer », Hôpital Saint-Antoine, Paris, France; Institut universitaire de cancérologie, Sorbonne Université, Paris, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMR S 938 « Biologie et Thérapeutiques du Cancer », Hôpital Saint-Antoine, Paris, France; Institut universitaire de cancérologie, Sorbonne Université, Paris, France
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10
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Azaïs H, Maingon P, Da Maïa E, Nikpayam M, Gonthier C, Belghiti J, Canlorbe G, Uzan C. [For which patients could we consider de-escalation in the management of ductal carcinomas in situ?]. ACTA ACUST UNITED AC 2019; 47:872-879. [PMID: 31562924 DOI: 10.1016/j.gofs.2019.09.010] [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] [Received: 06/18/2019] [Indexed: 11/27/2022]
Abstract
Ductal carcinomas in situ (DCIS) of the breast account for 85% to 90% of breast cancer in situ. Current recommendations for the management of DCIS in France are based on surgical excision of the lesions, lumpectomy in healthy margins (margins of excision≥2mm) or mastectomy in case of extensive lesions. Radiation therapy is recommended after conservative surgical treatment. However, it seems relevant for some patients to discuss the benefit of a therapeutic de-escalation. Indeed, it has been reported that radiotherapy has no major impact on overall survival and that its interest could be discussed in the low-risk situations of invasive recurrence for which surgery alone could be sufficient, subject to sufficient margins. These questions call for the precise definition of low risk populations and to clarify the importance of taking into account decision support tools and new molecular markers. The place of scores like that of the University of Southern California - Van Nuys, and that of genomic tests such as the Oncotype test© DX DCIS (DCIS score) need to be specified. The expected results of several prospective studies could go in the direction of a significant therapeutic de-escalation for the management of DCIS in the years to come. In the meantime, however, it is advisable to remain cautious and the inclusion of patients in clinical trials should be favored.
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Affiliation(s)
- H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Maingon
- Service de radiothérapie, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Da Maïa
- Service d'anatomo-pathologie, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Nikpayam
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Gonthier
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Belghiti
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMR S 938 « biologie et thérapeutiques du cancer », hôpital universitaire Pitié-Salpêtrière, 45-83, boulevard de l'Hôpital, 75013 Paris, France; Institut universitaire de cancérologie, Sorbonne Université, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMR S 938 « biologie et thérapeutiques du cancer », hôpital universitaire Pitié-Salpêtrière, 45-83, boulevard de l'Hôpital, 75013 Paris, France; Institut universitaire de cancérologie, Sorbonne Université, 75013 Paris, France.
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Maria S, Hersant B, Belghiti J, Azaïs H, Gonthier C, Nikpayam M, Etienne M, Bézu C, Uzan C, Canlorbe G. [How I do…a V-Y flap for vulvar reconstruction]. ACTA ACUST UNITED AC 2019; 47:757-760. [PMID: 31421284 DOI: 10.1016/j.gofs.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Indexed: 11/25/2022]
Affiliation(s)
- S Maria
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, hôpitaux universitaires Pitié Salpêtrière-Charles-Foix, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - B Hersant
- Service de chirurgie maxillo-faciale et de chirurgie plastique, réparatrice et esthétique, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - J Belghiti
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, hôpitaux universitaires Pitié Salpêtrière-Charles-Foix, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - H Azaïs
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, hôpitaux universitaires Pitié Salpêtrière-Charles-Foix, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France; Sorbonne université,15-21, rue de l'École de médecine, 75006 Paris, France.
| | - C Gonthier
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, hôpitaux universitaires Pitié Salpêtrière-Charles-Foix, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - M Nikpayam
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, hôpitaux universitaires Pitié Salpêtrière-Charles-Foix, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - M Etienne
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, hôpitaux universitaires Pitié Salpêtrière-Charles-Foix, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - C Bézu
- Service de gynécologie obstétrique, hôpitaux universitaires Pitié Salpêtrière, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, hôpitaux universitaires Pitié Salpêtrière-Charles-Foix, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France; Sorbonne université,15-21, rue de l'École de médecine, 75006 Paris, France
| | - G Canlorbe
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, hôpitaux universitaires Pitié Salpêtrière-Charles-Foix, AP-HP, 47-83, boulevard de l'hôpital, 75013 Paris, France; Sorbonne université,15-21, rue de l'École de médecine, 75006 Paris, France.
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Trésallet C, Cardin JL, Belghiti J, Cortes A, Martinod E. Medical expert witness testimony in France and in Europe. J Visc Surg 2019; 156 Suppl 1:S3-S6. [PMID: 31104900 DOI: 10.1016/j.jviscsurg.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Health care professionals are usually at a loss when it comes to medical "complaints", essentially because they lack knowledge with regard to existing litigation procedures. After a short reminder of the different rights of appeal in France, we describe how medical appeals function in other European countries. Next, we give the details of how the evaluation of claims of bodily damage works, a process in which every physician may be called upon to participate several times in a career, either as the defendant, or as a medical counselor, or as an expert. The goal of this update is to understand the different compensation appeal circuits available to patients and help the surgeon demystify and dedramatize the situation while preparing for the medical expert witness testimony. All such testimony reports, via whatever appeal circuit, follow a similar procedure, even if they are not exactly identical.
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Affiliation(s)
- C Trésallet
- Service de chirurgie générale viscérale et endocrinienne, hôpital de la Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie (Paris 6), Sorbonne universités, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France; Direction des affaires juridiques (DAJ), département de la médiation, de la responsabilité hospitalière et du contentieux des séjours, Assistance Publique-Hôpitaux de Paris (AP-HP), 75004 Paris, France.
| | - J L Cardin
- Polyclinique du Maine, BP 1027, 53010 Laval cedex, France
| | - J Belghiti
- Direction des affaires juridiques (DAJ), département de la médiation, de la responsabilité hospitalière et du contentieux des séjours, Assistance Publique-Hôpitaux de Paris (AP-HP), 75004 Paris, France
| | - A Cortes
- Service de chirurgie viscérale et digestive, centre hospitalier de Marne-La-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France
| | - E Martinod
- Direction des affaires juridiques (DAJ), département de la médiation, de la responsabilité hospitalière et du contentieux des séjours, Assistance Publique-Hôpitaux de Paris (AP-HP), 75004 Paris, France; Chirurgie thoracique et vasculaire, hôpital Avicenne, hôpitaux universitaires Paris Seine-Saint-Denis, faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Assistance publique-Hôpitaux de Paris (AP-HP), 93000 Bobigny, France
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Trésallet C, Cardin JL, Belghiti J, Cortes A, Martinod E. Expert witness testimony step by step and how to prepare it. J Visc Surg 2019; 156 Suppl 1:S7-S14. [PMID: 31053418 DOI: 10.1016/j.jviscsurg.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The medical expert witness testimony is a key moment in the pathway of patient complaints as well as in the line of defense of the defendant-physician. For the defendant, it is a difficult time, often experienced as humiliating, because his or her competences are questioned, appraised and discussed in public. However, the defendant must perceive and use this encounter as an opportunity to express his/her viewpoint on the medical accident. This article provides the principal juridical rules that govern the medical expert witness testimony that must be known, as well as some practical advice on how the medical expert witness testimony evolves and how to protect oneself from the complaints, In order to enable the defendant to best prepare for this confrontation between the involved parties.
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Affiliation(s)
- C Trésallet
- Service de chirurgie générale viscérale et endocrinienne, hôpital de la Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie (Paris 6), Assistance publique-Hôpitaux de Paris (AP-HP), Sorbonne universités, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Département de la Médiation, de la Responsabilité Hospitalière et du contentieux des séjours, Direction des Affaires juridiques (DAJ), Assistance publique-Hôpitaux de Paris (AP-HP), 75004 Paris, France.
| | - J L Cardin
- Expert près la Cour d'Appel d'Angers et auprès de la Cour Administrative d'Appel de Nantes, Expert agréé par la Commission Nationale des accidents médicaux; Polyclinique du Maine, BP 1027, 53010 Laval cedex, France
| | - J Belghiti
- Département de la Médiation, de la Responsabilité Hospitalière et du contentieux des séjours, Direction des Affaires juridiques (DAJ), Assistance publique-Hôpitaux de Paris (AP-HP), 75004 Paris, France
| | - A Cortes
- Service de chirurgie viscérale et digestive, centre hospitalier de Marne La Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France
| | - E Martinod
- Département de la Médiation, de la Responsabilité Hospitalière et du contentieux des séjours, Direction des Affaires juridiques (DAJ), Assistance publique-Hôpitaux de Paris (AP-HP), 75004 Paris, France; Chirurgie thoracique et vasculaire, faculté de médecine SMBH, hôpital Avicenne, hôpitaux universitaires Paris Seine-Saint-Denis, université Paris 13, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, 93000 Bobigny, France
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Gloaguen S, Belghiti J, Azaïs H, Gonthier C, Nikpayam M, Uzan C, Canlorbe G. [How I do... a minimally invasive laparoscopic total hysterectomy, with extracorporeal manual tissue extraction in 10 steps (with video)]. ACTA ACUST UNITED AC 2019; 47:540-544. [PMID: 31009799 DOI: 10.1016/j.gofs.2019.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Indexed: 10/27/2022]
Affiliation(s)
- S Gloaguen
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, 75013 Paris, France
| | - J Belghiti
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, 75013 Paris, France
| | - H Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, 75013 Paris, France
| | - C Gonthier
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, 75013 Paris, France
| | - M Nikpayam
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, 75013 Paris, France
| | - C Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, 75013 Paris, France; Sorbonne université, biologie et thérapeutique du cancer, centre de recherche Saint-Antoine (CRSA), Paris, France
| | - G Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, service de chirurgie et oncologie gynécologique et mammaire, 75013 Paris, France; Sorbonne université, biologie et thérapeutique du cancer, centre de recherche Saint-Antoine (CRSA), Paris, France.
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Beffara F, Belghiti J, Uzan C, Prier P, Canlorbe G, Azaïs H. [How I do… an adnexectomy for a large ovarian mass with suspicion of borderline ovarian tumor by laparoscopy]. ACTA ACUST UNITED AC 2019; 47:606-609. [PMID: 30876828 DOI: 10.1016/j.gofs.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- F Beffara
- Service de chirurgie et cancérologie gynécologique et mammaire, Pitié-Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France
| | - J Belghiti
- Service de chirurgie et cancérologie gynécologique et mammaire, Pitié-Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, Pitié-Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France
| | - P Prier
- Service de chirurgie et cancérologie gynécologique et mammaire, Pitié-Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France
| | - G Canlorbe
- Service de chirurgie et cancérologie gynécologique et mammaire, Pitié-Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France
| | - H Azaïs
- Service de chirurgie et cancérologie gynécologique et mammaire, Pitié-Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France.
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Mahmood A, Belghiti J, Azaïs H, Uzan C, Canlorbe G. [Robotic assisted laparoscopic myomectomy of large uterine myoma with video]. ACTA ACUST UNITED AC 2018; 47:88-89. [PMID: 30573427 DOI: 10.1016/j.gofs.2018.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A Mahmood
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié Salpêtrière - Charles Foix, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Belghiti
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié Salpêtrière - Charles Foix, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié Salpêtrière - Charles Foix, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié Salpêtrière - Charles Foix, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié Salpêtrière - Charles Foix, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France.
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Aussilhou B, Dokmak S, Dondero F, Joly D, Durand F, Soubrane O, Belghiti J. Treatment of polycystic liver disease. Update on the management. J Visc Surg 2018; 155:471-481. [DOI: 10.1016/j.jviscsurg.2018.07.004] [Citation(s) in RCA: 9] [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: 12/26/2022]
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Vésale E, Azaïs H, Belghiti J, Nikpayam M, Uzan C, Canlorbe G. [How I do… a colpocleisis with hysterectomy for vaginal prolapse (Pitié-Salpêtrière Hospital, Paris, France)]. ACTA ACUST UNITED AC 2018; 46:440-443. [PMID: 29490891 DOI: 10.1016/j.gofs.2018.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 10/17/2022]
Affiliation(s)
- E Vésale
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière, Charles-Foix, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - H Azaïs
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière, Charles-Foix, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Belghiti
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière, Charles-Foix, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Nikpayam
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière, Charles-Foix, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière, Charles-Foix, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Canlorbe
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière, Charles-Foix, 47/83, boulevard de l'Hôpital, 75013 Paris, France.
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Azaïs H, Canlorbe G, Belghiti J, Nikpayam M, Mergui JL, Uzan C. [How I do… a cylindrical excision for in situ adenocarcinoma of the cervix]. ACTA ACUST UNITED AC 2017; 45:439-440. [PMID: 28711365 DOI: 10.1016/j.gofs.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- H Azaïs
- Service de chirurgie et cancérologie gynécologique et mammaire, Charles-Foix, hôpitaux universitaires Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France.
| | - G Canlorbe
- Service de chirurgie et cancérologie gynécologique et mammaire, Charles-Foix, hôpitaux universitaires Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Belghiti
- Service de chirurgie et cancérologie gynécologique et mammaire, Charles-Foix, hôpitaux universitaires Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Nikpayam
- Service de chirurgie et cancérologie gynécologique et mammaire, Charles-Foix, hôpitaux universitaires Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-L Mergui
- Service de chirurgie et cancérologie gynécologique et mammaire, Charles-Foix, hôpitaux universitaires Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, Charles-Foix, hôpitaux universitaires Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
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Kanté F, Belghiti J, Roseau G, Thomassin-Naggara I, Bazot M, Daraï E, Ballester M. [Comparison of the accuracy of rectal endoscopic sonography and magnetic resonance imaging in the diagnosis of colorectal endometriosis]. ACTA ACUST UNITED AC 2017; 45:131-136. [PMID: 28256410 DOI: 10.1016/j.gofs.2017.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 01/18/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To compare the accuracy of magnetic resonance imaging (MRI) and rectal endoscopic sonography (RES) for the diagnosis of colorectal endometriosis. METHODS In retrospective study, 407 patients operated on service of gynecology of Tenon hospital for deep endometriosis with suspected colorectal involvement. All patients underwent MRI and then RES. RESULTS In the study, 239 patients (59%) had colorectal endometriosis which were diagnosed with the histology. The sensitivity, specificity, positive and negative predictive value (PPV and NPV) of RES and MRI for the diagnosis of colorectal endometriosis were respectively 92%, 87%, 91%, 88% and 85%, 88%, 91%, 80%. The accuracy of RES was not significantly different than MRI (90% versus 86%, P=0.09). CONCLUSION RES is a good exam to diagnose colorectal endometriosis. It is able to improve diagnosis performances.
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Affiliation(s)
- F Kanté
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Service de radiologie, hôpital Tenon, AP-HP, Paris, France.
| | - J Belghiti
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - G Roseau
- Centre chirurgical Trocadéro, département d'endoscopie digestive, Paris, France.
| | - I Thomassin-Naggara
- Service de radiologie, hôpital Tenon, AP-HP, Paris, France; GRC6-UPMC, centre expert en endométriose (C3E), Paris, France; UMR_S938, université Pierre-et-Marie-Curie Paris 6, 75012 Paris, France.
| | - M Bazot
- Service de radiologie, hôpital Tenon, AP-HP, Paris, France; GRC6-UPMC, centre expert en endométriose (C3E), Paris, France; UMR_S938, université Pierre-et-Marie-Curie Paris 6, 75012 Paris, France.
| | - E Daraï
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC6-UPMC, centre expert en endométriose (C3E), Paris, France; UMR_S938, université Pierre-et-Marie-Curie Paris 6, 75012 Paris, France.
| | - M Ballester
- Service de gynécologie-obstétrique, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; GRC6-UPMC, centre expert en endométriose (C3E), Paris, France; UMR_S938, université Pierre-et-Marie-Curie Paris 6, 75012 Paris, France.
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Doussot A, Lim C, Gómez-Gavara C, Fuks D, Farges O, Regimbeau JM, Azoulay D, Pascal G, Castaing D, Cherqui D, Baulieux J, Mabrut JY, Ducerf C, Belghiti J, Nuzzo G, Giuliante F, Le Treut YP, Hardwigsen J, Pessaux P, Bachellier P, Pruvot FR, Boleslawski E, Rivoire M, Chiche L. Multicentre study of the impact of morbidity on long-term survival following hepatectomy for intrahepatic cholangiocarcinoma. Br J Surg 2016; 103:1887-1894. [PMID: 27629502 DOI: 10.1002/bjs.10296] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 06/26/2016] [Accepted: 07/13/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The impact of morbidity on long-term outcomes following liver resection for intrahepatic cholangiocarcinoma is currently unclear. METHODS This was a retrospective analysis of all consecutive patients who underwent liver resection for intrahepatic cholangiocarcinoma with curative intent in 24 university hospitals between 1989 and 2009. Severe morbidity was defined as any complication of Dindo-Clavien grade III or IV. Patients with severe morbidity were compared with those without in terms of demographics, pathology, management, morbidity, overall survival, disease-free survival and time to recurrence. Independent predictors of severe morbidity were identified by multivariable analysis. RESULTS A total of 522 patients were enrolled. Severe morbidity occurred in 113 patients (21·6 per cent) and was an independent predictor of overall survival (hazard ratio 1·64, 95 per cent c.i. 1·21 to 2·23), as were age at resection, multifocal disease, positive lymph node status and R0 resection margin. Severe morbidity did not emerge as an independent predictor of disease-free survival. Independent predictors of time to recurrence included severe morbidity, tumour size, multifocal disease, vascular invasion and R0 resection margin. Major hepatectomy and intraoperative transfusion were independent predictors of severe morbidity. CONCLUSION Severe morbidity adversely affects overall survival following liver resection for intrahepatic cholangiocarcinoma.
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Affiliation(s)
- A Doussot
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - C Lim
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - C Gómez-Gavara
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - D Fuks
- Department of Digestive Diseases, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - O Farges
- Department of Hepatobiliary Surgery, Hôpital Beaujon, AP-HP, Université Paris 7, Clichy, France
| | - J M Regimbeau
- Department of Surgery, Centre Hospitalier Universitaire Amiens, Amiens, France
| | - D Azoulay
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | | | - G Pascal
- Hôpital Paul Brousse, Villejuif, France
| | | | - D Cherqui
- Hôpital Paul Brousse, Villejuif, France
| | - J Baulieux
- Hopital de la Croix Rousse, Lyon, France
| | - J Y Mabrut
- Hopital de la Croix Rousse, Lyon, France
| | - C Ducerf
- Hopital de la Croix Rousse, Lyon, France
| | | | - G Nuzzo
- University Catholic di Roma, Roma, Italy
| | | | | | | | - P Pessaux
- Hopital Hautepierre, Strasbourg, France
| | | | | | | | | | - L Chiche
- Centre Hospitalier Universitaire Bordeaux, France
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Thomin A, Belghiti J, David C, Marty O, Bornes M, Ballester M, Roman H, Daraï E. Maternal and neonatal outcomes in women with colorectal endometriosis. BJOG 2016; 125:711-718. [DOI: 10.1111/1471-0528.14221] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A Thomin
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - J Belghiti
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - C David
- Department of Gynaecology and Obstetrics; Rouen University Hospital; Hospital-Charles Nicolle; Rouen France
| | - O Marty
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - M Bornes
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
| | - M Ballester
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
- UMRS938; Université Pierre et Marie Curie; Paris France
| | - H Roman
- Department of Gynaecology and Obstetrics; Rouen University Hospital; Rouen France
- Research Group 4308, Spermatogenesis and Gamete Quality; IHU Rouen Normandy; IFRMP23; Reproductive Biology Laboratory; Rouen University Hospital; Rouen France
| | - E Daraï
- Department of Gynaecology and Obstetrics; Hôpital Tenon; Assistance Publique des Hôpitaux de Paris; Université Pierre et Marie Curie; Paris France
- GRC 6 UPMC (C3E) Centre Expert en Endométriose; Paris France
- UMRS938; Université Pierre et Marie Curie; Paris France
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Kolanska K, Cohen J, Zanini-Grandon AS, Belghiti J, Bornes M, Daraï E. [How I do… in situ methotrexate injection in the treatment of intramyometrial pregnancy]. Gynecol Obstet Fertil 2016; 44:435-436. [PMID: 27426691 DOI: 10.1016/j.gyobfe.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/09/2016] [Indexed: 06/06/2023]
Affiliation(s)
- K Kolanska
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - J Cohen
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France.
| | - A S Zanini-Grandon
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - J Belghiti
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - M Bornes
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
| | - E Daraï
- Service de gynécologie-obstétrique, hôpital Tenon, Assistance publique des Hôpitaux de Paris, GRC 6-UPMC centre expert en endométriose (C3E), UMRS 938, université Pierre-et-Marie-Curie-Paris-6, 75020 Paris, France
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Dokmak S, Aussilhou B, Ftériche FS, de Chaumont A, Malgras B, Belghiti J, Sauvanet A. Laparoscopic pancreaticoduodenectomy: How I do it? (with video). J Visc Surg 2015; 152:393-4. [PMID: 26476676 DOI: 10.1016/j.jviscsurg.2015.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Dokmak
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
| | - B Aussilhou
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - F S Ftériche
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - A de Chaumont
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - B Malgras
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - J Belghiti
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - A Sauvanet
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Cauchy F, Fuks D, Nomi T, Schwarz L, Barbier L, Dokmak S, Scatton O, Belghiti J, Soubrane O, Gayet B. Risk factors and consequences of conversion in laparoscopic major liver resection. Br J Surg 2015; 102:785-95. [PMID: 25846843 DOI: 10.1002/bjs.9806] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/01/2015] [Accepted: 02/12/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although recent reports have suggested potential benefits of the laparoscopic approach in patients requiring major hepatectomy, it remains unclear whether conversion to open surgery could offset these advantages. This study aimed to determine the risk factors for and postoperative consequences of conversion in patients undergoing laparoscopic major hepatectomy (LMH). METHODS Data for all patients undergoing LMH between 2000 and 2013 at two tertiary referral centres were reviewed retrospectively. Risk factors for conversion were determined using multivariable analysis. After propensity score matching, the outcomes of patients who underwent conversion were compared with those of matched patients undergoing laparoscopic hepatectomy who did not have conversion, operated on at the same centres, and also with matched patients operated on at another tertiary centre during the same period by an open laparotomy approach. RESULTS Conversion was needed in 30 (13·5 per cent) of the 223 patients undergoing LMH. The most frequent reasons for conversion were bleeding and failure to progress, in 14 (47 per cent) and nine (30 per cent) patients respectively. On multivariable analysis, risk factors for conversion were patient age above 75 years (hazard ratio (HR) 7·72, 95 per cent c.i. 1·67 to 35·70; P = 0·009), diabetes (HR 4·51, 1·16 to 17·57; P = 0·030), body mass index (BMI) above 28 kg/m(2) (HR 6·41, 1·56 to 26·37; P = 0·010), tumour diameter greater than 10 cm (HR 8·91, 1·57 to 50·79; P = 0·014) and biliary reconstruction (HR 13·99, 1·82 to 238·13; P = 0·048). After propensity score matching, the complication rate in patients who had conversion was higher than in patients who did not (75 versus 47·3 per cent respectively; P = 0·038), but was not significantly different from the rate in patients treated by planned laparotomy (79 versus 67·9 per cent respectively; P = 0·438). CONCLUSION Conversion during LMH should be anticipated in patients with raised BMI, large lesions and biliary reconstruction. Conversion does not lead to increased morbidity compared with planned laparotomy.
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Affiliation(s)
- F Cauchy
- Department of Hepatobiliary and Liver Transplantation, Hôpital Saint Antoine, Paris, France; Department of Hepatobiliary and Liver Transplantation, Hôpital Beaujon, Clichy, France
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26
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Adam R, Delvart V, Karam V, Ducerf C, Navarro F, Letoublon C, Belghiti J, Pezet D, Castaing D, Le Treut YP, Gugenheim J, Bachellier P, Pirenne J, Muiesan P. Compared efficacy of preservation solutions in liver transplantation: a long-term graft outcome study from the European Liver Transplant Registry. Am J Transplant 2015; 15:395-406. [PMID: 25612492 DOI: 10.1111/ajt.13060] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 08/08/2014] [Accepted: 08/09/2014] [Indexed: 01/25/2023]
Abstract
Between 2003 and 2012, 42 869 first liver transplantations performed in Europe with the use of either University of Wisconsin solution (UW; N = 24 562), histidine-tryptophan-ketoglutarate(HTK; N = 8696), Celsior solution (CE; N = 7756) or Institute Georges Lopez preservation solution (IGL-1; N = 1855) preserved grafts. Alternative solutions to the UW were increasingly used during the last decade. Overall, 3-year graft survival was higher with UW, IGL-1 and CE (75%, 75% and 73%, respectively), compared to the HTK (69%) (p < 0.0001). The same trend was observed with a total ischemia time (TIT) >12 h or grafts used for patients with cancer (p < 0.0001). For partial grafts, 3-year graft survival was 89% for IGL-1, 67% for UW, 68% for CE and 64% for HTK (p = 0.009). Multivariate analysis identified HTK as an independent factor of graft loss, with recipient HIV (+), donor age ≥65 years, recipient HCV (+), main disease acute hepatic failure, use of a partial liver graft, recipient age ≥60 years, no identical ABO compatibility, recipient hepatitis B surface antigen (-), TIT ≥ 12 h, male recipient and main disease other than cirrhosis. HTK appears to be an independent risk factor of graft loss. Both UW and IGL-1, and CE to a lesser extent, provides similar results for full size grafts. For partial deceased donor liver grafts, IGL-1 tends to offer the best graft outcome.
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Affiliation(s)
- R Adam
- Centre Hépatobiliaire, AP-HP Hôpital Paul Brousse, Inserm U 776, Univ Paris Sud, Villejuif, France
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27
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Affiliation(s)
- J Figueras
- Department of Surgery, Dr Josep Trueta Hospital, Girona, Spain,
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28
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Cohen J, Thomin A, Mathieu D'Argent E, Laas E, Canlorbe G, Zilberman S, Belghiti J, Thomassin-Naggara I, Bazot M, Ballester M, Daraï E. Fertility before and after surgery for deep infiltrating endometriosis with and without bowel involvement: a literature review. Minerva Ginecol 2014; 66:575-587. [PMID: 25373015] [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: 06/04/2023]
Abstract
AIM Endometriosis affects from 10% to 15% of women of childbearing age and 20% of these women have deep infiltrating endometriosis (DIE). The goal of this review was to assess the impact of various locations of DIE on spontaneous fertility and the benefit of surgery and Medically Assisted Reproduction (MAR) (in vitro fertilization and intrauterine insemination) on fertility outcomes. METHODS MEDLINE search for articles on fertility in women with DIE published between 1990 and April 2013 using the following terms: "deep infiltrative endometriosis", "colorectal", "bowel", "rectovaginal", "uterosacral", "vaginal", "bladder" and "fertility" or "infertility". Twenty-nine articles reporting fertility outcomes in 2730 women with DIE were analysed. RESULTS Among the women with DIE and no bowel involvement (N.=1295), no preoperative data on spontaneous pregnancy rate (PR) were available. The postoperative spontaneous PR rate in these women was 50.5% (95% Confidence Interval [CI] =46.8-54.1) and overall PR (spontaneous pregnancies and after MAR) was 68.3% (95% CI=64.9-71.7). No evaluation of fertility outcome according to locations of DIE was feasible. For women with DIE with bowel involvement without surgical management (N.=115), PR after MAR was 29%; 95% CI=20.7-37.4). For those with bowel involvement who were surgically managed (N.=1320), postoperative spontaneous PR was 28.6% (95% CI=25-32.3) and overall postoperative PR was 46.9% (95% CI=42.9-50.9). CONCLUSION For women with DIE without bowel involvement, surgery alone offers a high spontaneous PR. For those with bowel involvement, the low spontaneous and relatively high overall PR suggests the potential benefit of combining surgery and MAR.
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Affiliation(s)
- J Cohen
- Department of Gynecology and Obstetrics Hôpital Tenon, Assistance Publique des Hôpitaux de Paris Université Pierre et Marie Curie Paris 6 GRC 6-UPMC Centre Expert en Endométriose (C3E), Paris, France -
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29
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Buc E, Couvelard A, Kwiatkowski F, Dokmak S, Ruszniewski P, Hammel P, Belghiti J, Sauvanet A. Adenocarcinoma of the pancreas: Does prognosis depend on mode of lymph node invasion? Eur J Surg Oncol 2014; 40:1578-85. [DOI: 10.1016/j.ejso.2014.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 04/08/2014] [Accepted: 04/27/2014] [Indexed: 12/13/2022] Open
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30
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Sommacale D, Dondero F, Sauvanet A, Francoz C, Durand F, Farges O, Kianmanesh R, Belghiti J. Liver resection in transplanted patients: a single-center Western experience. Transplant Proc 2014; 45:2726-8. [PMID: 24034033 DOI: 10.1016/j.transproceed.2013.07.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 02/07/2023]
Abstract
BACKGROUND Liver resection (LR) in liver transplant (OLT) recipients, an extremely rare situation, who performed on 8 recipients. METHODS This retrospective analysis of prospectively collected data concerned 8 (0.66%) 1198 LR cases among OLT performed from 1997 to 2011. We analyzed demographic data, surgical indications, and postoperative courses. RESULTS The indications were resectable recurrent hepatocellular carcinomas (HCC, n = 3), persistent fistula from a posterior sectorial duct (n = 1), recurrent cholangitis due to anastomotic stricture on the posterior sectorial duct (n = l), hydatid cyst (n = l), left arterial hepatic thrombosis with secondary ischemic cholangitis (n = 1), and a large symptomatic biliary cyst (n = 1). The mean interval time to liver resection was 23.7 months (range, 5-47). LR included right hepatectomy (n = 1), right posterior hepatectomy (n = 1), left lobectomy (n = 4), pericystectomy (n = 1), or biliary fenestration (n = 1). Which there was no postoperative mortality, the global morbidity rate was 62% (5/8). The mean follow-up after LR was 92 months (range, 11-156). No patients required retransplantation. None of the 3 patients who underwent LR for HCC showed a recurrence. CONCLUSIONS LR in OLT recipients is safe, but associated with a high morbidity rate. This procedure can avoid retransplantation in highly selected patients, presenting a possible option particularly for transplanted patients with a resectable, recurrent HCC.
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Affiliation(s)
- D Sommacale
- Department of Hepatopancreatobiliary and Liver Transplantation, Beaujon University-Hospital, APHP, Paris Diderot University (Paris 7), France.
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Abstract
Liver resection is the most available, efficient treatment for patients with hepatocellular carcinoma. Better liver function assessment, increased understanding of segmental liver anatomy using more accurate imaging studies, and surgical technical progress are the most important factors that have led to reduced mortality, with an expected 5 year survival of 70%. Impairment of liver function and the risk of tumor recurrence lead to consideration of liver transplantation (LT) as the ideal treatment for removal of the existing tumor and the preneoplastic underlying liver tissue. However, LT, which is not available in many countries, is restricted to patients with minimum risk of tumor recurrence under immunosuppression. Limited availability of grafts as well as the risk and the cost of the LT procedure has led to considerable interest in combined treatment involving resection and LT. An increasing amount of evidence has shown that initial liver resection in transplantable patients with a single limited tumor and good liver function is a valid indication. Histological analysis of specimens allows identification of the subgroup of patients who could benefit from follow-up with LT in case of recurrence.
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Affiliation(s)
- J Belghiti
- Department of HPB Surgery and Transplantation, Beaujon Hospital (Assistance Publique Hôpitaux de Paris), University Paris 7 Denis Diderot, Clichy, France
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Fuks D, Voitot H, Paradis V, Belghiti J, Vilgrain V, Farges O. Intracystic concentrations of tumour markers for the diagnosis of cystic liver lesions. Br J Surg 2014; 101:408-16. [PMID: 24477793 DOI: 10.1002/bjs.9414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Imaging occasionally fails to differentiate hepatic simple cysts from malignant or premalignant mucinous cystic lesions such as biliary cystadenomas. Hepatic simple cysts can be treated conservatively, whereas malignant or premalignant cysts require complete resection. This study assessed the ability of intracystic tumour marker concentrations to differentiate these disease entities. METHODS Intracystic fluid was sampled in patients undergoing partial or complete resection of a cystic lesion of the liver. The indication for surgery in hepatic simple cysts was symptoms or suspicion of a biliary cystadenoma. Intracystic concentrations of carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9 and tumour-associated glycoprotein (TAG) 72 were measured to assess the diagnostic accuracy of these tumour markers. Cut-off values were defined by receiver operating characteristic (ROC) curves. RESULTS The study population comprised 118 patients (94 women) with a median age of 59 years. There were 75 patients with hepatic simple cysts, 27 with mucinous cysts (19 biliary cystadenomas, 4 biliary cystadenocarcinomas, 4 intraductal papillary mucinous neoplasms of the bile duct) and 16 with miscellaneous cysts. Unlike CEA and CA19-9, a TAG-72 concentration of more than 25 units/ml differentiated hepatic simple cysts from mucinous cysts with a sensitivity and a specificity of 0·79 and 0·97 respectively. The area under the ROC curve was 0·98 for mucinous versus hepatic simple cysts. CONCLUSION The concentration of TAG-72 in cyst fluid accurately identified hepatic cysts that required complete resection.
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Affiliation(s)
- D Fuks
- Departments of Hepatobiliary Surgery, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, Pôle des Maladies de l'Appareil Digestif, Université Paris 7, Clichy, France
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Bert F, Larroque B, Dondero F, Durand F, Paugam-Burtz C, Belghiti J, Moreau R, Nicolas-Chanoine MH. Risk factors associated with preoperative fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae in liver transplant recipients. Transpl Infect Dis 2013; 16:84-9. [DOI: 10.1111/tid.12169] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 05/06/2013] [Accepted: 05/27/2013] [Indexed: 12/13/2022]
Affiliation(s)
- F. Bert
- Service de Microbiologie; Hôpital Beaujon; AP-HP; Clichy France
| | - B. Larroque
- Unité d'Epidémiologie et Recherche clinique; Hôpital Beaujon; AP-HP; Clichy France
| | - F. Dondero
- Service de Chirurgie digestive; Hôpital Beaujon; AP-HP; Clichy France
| | - F. Durand
- Service d'Hépatologie; Hôpital Beaujon; AP-HP; Clichy France
- Centre de Recherche Biomédicale Bichat-Beaujon (CRB3); INSERM U773; Paris France
- Faculté de Médecine D. Diderot; Université Paris VII; Paris France
| | - C. Paugam-Burtz
- Faculté de Médecine D. Diderot; Université Paris VII; Paris France
- Département d'Anesthésie-Réanimation; Hôpital Beaujon; AP-HP; Clichy France
| | - J. Belghiti
- Service de Chirurgie digestive; Hôpital Beaujon; AP-HP; Clichy France
- Faculté de Médecine D. Diderot; Université Paris VII; Paris France
| | - R. Moreau
- Service d'Hépatologie; Hôpital Beaujon; AP-HP; Clichy France
- Centre de Recherche Biomédicale Bichat-Beaujon (CRB3); INSERM U773; Paris France
| | - M.-H. Nicolas-Chanoine
- Service de Microbiologie; Hôpital Beaujon; AP-HP; Clichy France
- Centre de Recherche Biomédicale Bichat-Beaujon (CRB3); INSERM U773; Paris France
- Faculté de Médecine D. Diderot; Université Paris VII; Paris France
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Belghiti J, Coulm B, Kayem G, Blondel B, Deneux-Tharaux C. Administration d’ocytocine au cours du travail en France. Résultats de l’enquête nationale périnatale 2010. ACTA ACUST UNITED AC 2013; 42:662-70. [DOI: 10.1016/j.jgyn.2013.02.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/11/2013] [Accepted: 02/28/2013] [Indexed: 11/25/2022]
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Uzan C, Nikpayam M, Merlot B, Gouy S, Belghiti J, Haie-Meder C, Nickers P, Narducci F, Morice P, Leblanc E. Colpohystérectomie élargie par laparoscopie après curiethérapie préopératoire pour cancer du col utérin (stade 1B1) : faisabilité et résultats. ACTA ACUST UNITED AC 2013; 41:571-7. [DOI: 10.1016/j.gyobfe.2013.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Indexed: 11/16/2022]
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Belghiti J. Fatty liver disease as a predictor of local recurrence following resection of colorectal liver metastases (Br J Surg 2013: 100 : 820–826). Br J Surg 2013; 100:827. [DOI: 10.1002/bjs.9092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- J Belghiti
- Service de Chirurgie Digestive, Hôpital Beaujon, 100 Boulevard du Général Leclerc, Clichy 92118, France
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37
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Belghiti J. Que reste-t-il du traitement chirurgical ? Med Sci (Paris) 2013. [DOI: 10.4267/10608/3354] [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] Open
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38
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Hatwell C, Bretagnol F, Farges O, Belghiti J, Panis Y. Laparoscopic resection of colorectal cancer facilitates simultaneous surgery of synchronous liver metastases. Colorectal Dis 2013; 15:e21-8. [PMID: 23088162 DOI: 10.1111/codi.12068] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [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: 01/26/2012] [Accepted: 06/22/2012] [Indexed: 02/06/2023]
Abstract
AIM Combined resection of colorectal cancer with surgery for synchronous liver metastases (LM) still remains controversial because of the possible higher morbidity rate, the necessity of an adequate abdominal approach for both resections and the impact on oncological results. However, laparoscopy may be beneficial in terms of operative results and could facilitate this combined procedure. The aim was to assess the benefit of the laparoscopic approach for colorectal cancer resection in patients undergoing simultaneous liver resection for synchronous LM. METHOD From 2006 to 2011, all patients with colorectal cancer and resectable synchronous LM, for which the total length of the procedure was suspected to be less than 8 h, underwent colorectal laparoscopic resection combined with open and/or laparoscopic liver surgery. In order to identify selection criteria, a comparative analysis was performed between patients with and without major postoperative morbidity. RESULTS Fifty-one patients underwent combined surgery with laparoscopic colectomy (n = 31) and proctectomy (n = 20). The conversion rate was 8%. Liver resections included major surgery (n = 10) and minor surgery (n = 41). Extraction of the colorectal specimen was performed through an incision used for open liver resection, except in seven patients who underwent a total laparoscopic procedure. Overall and major morbidity rates were 55% and 25%, respectively. Median (range) hospital stay was 16 (6-40) days. Regarding patient and tumour characteristics, no independent criteria of major morbidity risk were identified. CONCLUSION This study showed that laparoscopic colorectal resection combined with liver resection for synchronous LM was feasible and safe. Moreover, laparoscopy facilitates the surgical abdominal approach for combined colorectal and liver resection.
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Affiliation(s)
- C Hatwell
- Department of Colorectal Surgery, Beaujon Hospital (APHP), Clichy, France
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39
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Janny S, Bert F, Dondero F, Chanoine MHN, Belghiti J, Mantz J, Paugam-Burtz C. Fatal Escherichia coli skin and soft tissue infections in liver transplant recipients: report of three cases. Transpl Infect Dis 2012; 15:E49-53. [PMID: 23278949 DOI: 10.1111/tid.12046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 09/26/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
Gram-negative bacilli are unusual agents of skin and soft tissue infections. Most previous cases have been reported in cirrhotic or immunocompromised patients, including a single case in a liver transplant recipient. The present report describes 3 cases of fatal skin or soft tissue infections caused by Escherichia coli that occurred in the postoperative course of liver transplantation. The 3 patients were profoundly immunosuppressed as a result of pre-transplant cirrhosis and the postoperative administration of a potent immunosuppressive therapy. Skin and soft tissue infections developed within the first week after liver transplantation, while graft liver function was satisfactory. The 3 patients presented with fever and skin lesions with or without bullae. Despite prompt appropriate antibiotic therapy and surgical debridement, the outcome was rapidly fatal (24 h on average). E. coli was isolated from subcutaneous tissues in 2 cases and from several blood cultures in the third one. The 3 isolates belonged to distinct phylogenetic groups, and did not harbor most of the virulence factors usually reported in extraintestinal pathogenic E. coli isolates. Our report suggests that E. coli can cause severe skin or soft tissue infection in the postoperative course of liver transplantation. The onset of infection is very early and the outcome is extremely poor, despite prompt adapted medical and surgical treatment. Host factors, rather than E. coli bacterial virulence potential, appear to be the major determinants of severity in these patients.
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Affiliation(s)
- S Janny
- Department of Anaesthesiology and Intensive Care, AP-HP Hôpital Beaujon, Clichy, France.
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Abstract
Surgery remains the best curative treatment for resectable patients with colorectal liver metastases. In patients initially considered unresectable, both refinements in surgical technique using portal vein occlusion or two-step resections and increased efficiency of chemotherapy regimen with the adjunction of antiangiogenics now allow secondary resection. Recent evidence suggests almost identical long-term survival in case of secondary downstaged lesions advocating an aggressive approach. However, these data lie on disparate and nonconsensual criteria for unresectability, which often do not gather technical and oncologic components together. Furthermore, both impaired general status and damaged underlying parenchyma as a consequence of prolonged chemotherapy to achieve resectability as well as the technical challenge required to perform adequate carcinologic resection could increase the operative risk in such patients. In our experience, a subgroup of slow chemo-responding initially unresectable patients who required preoperative liver volume modulation after ≥ 12 cycles of chemotherapy to achieve sufficient response experienced dramatically high operative risk which jeopardized postoperative chemotherapy and subsequently put these patients at increased risk of recurrence. Whether all patients preoperatively amenable to surgery using intensive chemotherapy and complex surgical strategy actually benefit from such an aggressive approach is a matter of ongoing debate, which needs a reappraisal.
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Affiliation(s)
- F Cauchy
- Department of Hepatobiliopancreatic Surgery, AP-HP, Beaujon Hospital and University Paris 7 Denis Diderot, Clichy, France
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41
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Gauss T, Merckx P, Brasher C, Kavafyan J, Le Bihan E, Aussilhou B, Belghiti J, Mantz J. Deviation from a preoperative surgical and anaesthetic care plan is associated with increased risk of adverse intraoperative events in major abdominal surgery. Langenbecks Arch Surg 2012; 398:277-85. [PMID: 23149461 DOI: 10.1007/s00423-012-1028-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 10/29/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perioperative coordination facilitates team communication and planning. The aim of this study was to determine how often deviation from predicted surgical conditions and a pre-established anaesthetic care plan in major abdominal surgery occurred, and whether this was associated with an increase in adverse clinical events. METHODS In this prospective observational study, weekly preoperative interdisciplinary team meetings were conducted according to a joint care plan checklist in a tertiary care centre in France. Any discordance with preoperative predictions and deviation from the care plan were noted. A link to the incidence of predetermined adverse intraoperative events was investigated. RESULTS Intraoperative adverse clinical events (ACEs) occurred in 15 % of all cases and were associated with postoperative complications [relative risk (RR) = 1.5; 95 % confidence interval (1.1; 2.2)]. Quality of prediction of surgical procedural items was modest, with one in five to six items not correctly predicted. Discordant surgical prediction was associated with an increased incidence of ACE. Deviation from the anaesthetic care plan occurred in around 13 %, which was more frequent when surgical prediction was inaccurate (RR > 3) and independently associated with ACE (odds ratio 6). CONCLUSION Surgery was more difficult than expected in up to one out of five cases. In a similar proportion, disagreement between preoperative care plans and observed clinical management was independently associated with an increased risk of adverse clinical events.
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Affiliation(s)
- T Gauss
- Department of Anaesthesiology and Critical Care, Hôpital Beaujon, 100 Bld Général Leclerc, Clichy, Paris, France.
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42
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Cauchy F, Zalinski S, Dokmak S, Fuks D, Farges O, Castera L, Paradis V, Belghiti J. Surgical treatment of hepatocellular carcinoma associated with the metabolic syndrome. Br J Surg 2012; 100:113-21. [PMID: 23147992 DOI: 10.1002/bjs.8963] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND The incidence of metabolic syndrome-associated hepatocellular carcinoma (MS-HCC) is increasing. However, the results following liver resection in this context have not been described in detail. METHODS Data for all patients with metabolic syndrome as a unique risk factor for HCC who underwent liver resection between 2000 and 2011 were retrieved retrospectively from an institutional database. Pathological analysis of the underlying parenchyma included fibrosis and non-alcoholic fatty liver disease activity score. Patients were classified as having normal or abnormal underlying parenchyma. Their characteristics and outcomes were compared. RESULTS A total of 560 resections for HCC were performed in the study interval. Sixty-two patients with metabolic syndrome, of median age 70 (range 50-84) years, underwent curative hepatectomy for HCC, including 32 major resections (52 per cent). Normal underlying parenchyma was present in 24 patients (39 per cent). The proportion of resected HCCs labelled as MS-HCC accounted for more than 15 per cent of the entire HCC population in more recent years. Mortality and major morbidity rates were 11 and 58 per cent respectively. Compared with patients with normal underlying liver, patients with abnormal liver had increased rates of mortality (0 versus 18 per cent; P = 0·026) and major complications (13 versus 42 per cent; P = 0·010). In multivariable analysis, a non-severely fibrotic yet abnormal underlying parenchyma was a risk factor for major complications (hazard ratio 5·66, 95 per cent confidence interval 1·21 to 26·52; P = 0·028). The 3-year overall and disease-free survival rates were 75 and 70 per cent respectively, and were not influenced by the underlying parenchyma. CONCLUSION HCC in patients with metabolic syndrome is becoming more common. Liver resection is appropriate but carries a high risk, even in the absence of severe fibrosis. Favourable long-term outcomes justify refinements in the perioperative management of these patients.
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Affiliation(s)
- F Cauchy
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France
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43
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Abstract
Liver resection is the most available, efficient treatment for patients with hepatocellular carcinoma. Better liver function assessment, increased understanding of segmental liver anatomy using more accurate imaging studies, and surgical technical progress are the most important factors that have led to reduced mortality, with an expected 5 year survival of 70%. Impairment of liver function and the risk of tumor recurrence lead to consideration of liver transplantation (LT) as the ideal treatment for removal of the existing tumor and the preneoplastic underlying liver tissue. However, LT, which is not available in many countries, is restricted to patients with minimum risk of tumor recurrence under immunosuppression. Limited availability of grafts as well as the risk and the cost of the LT procedure has led to considerable interest in combined treatment involving resection and LT. An increasing amount of evidence has shown that initial liver resection in transplantable patients with a single limited tumor and good liver function is a valid indication. Histological analysis of specimens allows identification of the subgroup of patients who could benefit from follow-up with LT in case of recurrence.
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Affiliation(s)
- J. Belghiti
- *Jacques Belghiti, MD, Department of HPB Surgery and Transplantation, Beaujon Hospital, 100 Boulevard du Général Leclerc, 92118 Clichy Cedex (France), Tel. +33 1 40 87 58 95, E-Mail
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44
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Belghiti J, Tassin M, Raiffort C, Zappa M, Poujade O, Bout H, Mandelbrot L. [Uterine necrosis after arterial embolization for postpartum hemorrhage]. ACTA ACUST UNITED AC 2012; 42:126-128. [PMID: 22342505 DOI: 10.1016/j.gyobfe.2011.07.045] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 05/31/2011] [Indexed: 11/15/2022]
Abstract
Radiologic embolization of the uterine arteries is increasingly used to treat severe postpartum hemorrhage, as an alternative to surgical procedures. Guidelines have been published in order to standardize the indications as well as the technique. An important objective was to limit severe complications such as uterine necrosis. We report a case of a uterine necrosis after arterial embolization for severe postpartum hemorrhage due to uterine atony on a uterus with fibroids. This complication occurred despite the use of the recommended technique.
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Affiliation(s)
- J Belghiti
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France
| | - M Tassin
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France
| | - C Raiffort
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France
| | - M Zappa
- Hôpital Beaujon, AP-HP, hôpitaux universitaires Paris Nord Val de Seine, université Paris-Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - O Poujade
- Hôpital Beaujon, AP-HP, hôpitaux universitaires Paris Nord Val de Seine, université Paris-Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - H Bout
- Hôpital Beaujon, AP-HP, hôpitaux universitaires Paris Nord Val de Seine, université Paris-Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - L Mandelbrot
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France.
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45
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Cauchy F, Fuks D, Belghiti J. HCC: current surgical treatment concepts. Langenbecks Arch Surg 2012; 397:681-95. [DOI: 10.1007/s00423-012-0911-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/17/2012] [Indexed: 12/28/2022]
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46
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Sommacale D, Rochas Dos Santos V, Dondero F, Francoz C, Durand F, Sibert A, Paugam-Burtz C, Sauvanet A, Belghiti J. Simultaneous surgical repair for combined biliary and arterial stenoses after liver transplantation. Transplant Proc 2011; 43:1765-9. [PMID: 21693275 DOI: 10.1016/j.transproceed.2011.01.171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 01/11/2011] [Indexed: 01/13/2023]
Abstract
After orthotopic liver transplantation (OLT), hepatic artery stenoses (HAS) and biliary strictures (BS) are frequent. These complications remain a significant cause of graft loss and patient death. The present study reported a group of 7 patients in whom both HAS and BS were identified and treated surgically in the same surgical session. The median times to diagnosis were 42 (range, 5-120) and 84 (range, 15-280) days after OLT for biliary and arterial stenosis, respectively. The mortality was nil. Two patients (28%) developed postoperative complications. The median hospital stay was 16 days (range, 10-42). All patients are alive; there was no graft loss. With a median of 76 months' follow-up (range, 38-132), only 1 patient (14%) developed recurrence of both BS and HAS. In patients with coincident biliary and artery stenosis, concomitant surgical repair is feasible, offering good long-term results.
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Affiliation(s)
- D Sommacale
- Department of Digestive Surgery, Hôpital Beaujon, University of Paris VII, Paris, France
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47
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Scatton O, Zalinski S, Jegou D, Compagnon P, Lesurtel M, Belghiti J, Boudjema K, Lentschener C, Soubrane O. Randomized clinical trial of ischaemic preconditioning in major liver resection with intermittent Pringle manoeuvre. Br J Surg 2011; 98:1236-43. [PMID: 21809337 DOI: 10.1002/bjs.7626] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vascular inflow occlusion is effective in avoiding excessive blood loss during hepatic parenchymal transection but may cause ischaemic damage to the remnant liver. Intermittent portal triad clamping (IPTC) is superior to continuous hepatic pedicle clamping as it avoids severe ischaemia-reperfusion (IR) injury in the liver remnant. Ischaemic preconditioning (IPC) before continuous Pringle manoeuvre may protect against IR during major liver resection. METHODS This RCT assessed the impact of IPC in major liver resection with intermittent vascular inflow occlusion. Patients undergoing major liver resection with intermittent vascular inflow occlusion were randomized, during surgery, to receive IPC (10 min inflow occlusion followed by 10 min reperfusion) or no IPC (control group). Data analysis was on an intention-to-treat basis. The primary endpoint was serum alanine aminotransferase (ALT) level on the day after surgery. RESULTS Eighty four patients were enrolled and randomized to IPC (n = 41) and no IPC (n = 43). The groups were comparable in terms of demographic data, preoperative American Society of Anesthesiologists grade and extent of liver resection. Intraoperative morbidity and postoperative outcomes were also similar. ALT levels on the day after operation were not decreased by IPC (mean(s.d.) 537·6(358·5) versus 525·0(400·6) units/ml in IPC and control group respectively; P = 0·881). Liver biochemistry tests in the week after operation showed the same pattern in both groups. CONCLUSION IPC did not reduce liver damage in patients undergoing major liver resection with IPTC. REGISTRATION NUMBER NCT00908245 (http://www.clinicaltrials.gov).
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Affiliation(s)
- O Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, France
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Bert F, Huynh B, Dondero F, Johnson JR, Paugam-Burtz C, Durand F, Belghiti J, Valla D, Moreau R, Nicolas-Chanoine MH. Molecular epidemiology of Escherichia coli bacteremia in liver transplant recipients. Transpl Infect Dis 2011; 13:359-65. [PMID: 21355970 DOI: 10.1111/j.1399-3062.2011.00618.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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
The characteristics of Escherichia coli strains causing bacteremia in profoundly immunosuppressed patients such as transplant recipients are undefined. The phylogenetic group and the virulence genotype of 57 distinct E. coli strains that caused bacteremia in 53 liver transplant recipients were investigated, and the association of these characteristics with host factors and in-hospital mortality was examined. Phylogenetic groups A, B1, B2, and D accounted for 39%, 10%, 25%, and 26% of the isolates, respectively. The most prevalent virulence genes were fyuA (yersiniabactin system: 70%) and iutA (aerobactin system: 63%), whereas hlyA (alpha-hemolysin) and cnf1 (cytotoxic necrotizing factor 1) occurred in only 14% and 12% of isolates, respectively. Most virulence genes were significantly more prevalent among group B2 and D isolates, vs. group A and B1 isolates. The overall rate of in-hospital mortality after E. coli bacteremia was 20%. Predictors of mortality included onset of bacteremia within 30 days of transplantation or during the intensive care unit stay, and non-urinary source and cutaneous source, but not E. coli phylogenetic group or virulence profile. Compared with historical E. coli bloodstream isolates from non-transplant patients, those from liver transplant recipients are characterized by a higher prevalence of groups A and B1 isolates and reduced virulence gene content. This finding can be explained by the severely immunocompromised status of the patients and the predominance of abdominal-source bacteremic episodes. Time of onset and source of bacteremia, not bacterial characteristics, predict mortality.
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Affiliation(s)
- F Bert
- Department of Microbiology, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, AP-HP, Clichy, France.
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Belghiti J, Saget A, Fuks D, Dokmak S, Faivre SJ, Ronot M, Paradis V. Safety of liver resection for HCC in patients previously treated with sorafenib. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
345 Background: The efficiency of sorafenib in HCC has led to its utilization in the neo-adjuvant setting in selected cases. We assessed the safety of liver surgery in patients previously treated with sorafenib. Methods: From January 2009 to April 2010, 8 patients were resected following treatment with sorafenib. The median length of treatment was 1.5 months (range: 0.23-15). Mean size of tumors was 6.4cm (2-10). Alphafoetoprotein (AFP) was elevated in 5 patients, ranging from 45 to 100,000. Six patients had chronic liver disease. The cohort of 8 patients was cross-matched with 17 comparable patients who underwent primary resection without sorafenib during the same period. Results: After sorafenib therapy there was a decrease of HCC size (n=4, median size decrease of 55%) and AFP level (n=4). AFP returned to normal in 3 patients. Peri-operative data showed that previous treatment with sorafenib was not associated with increased length of surgical procedure (265 vs. 293 min), blood loss (400 vs. 530cc) or blood transfusion (0 vs. 5 Units). No mortality was reported, while overall morbidity (50 vs. 61%), length of stay (10 vs. 12 days) and intensive care requirement (43 vs. 44%) were similar in both groups. Recovery of postoperative liver biochemical tests did not show significant differences between the groups. Specimen analysis showed a higher rate of tumor necrosis in the sorafenib group (100% vs 46%) while no hepatotoxicity induced by chemotherapy was found. Conclusions: The administration of preoperative sorafenib therapy, which can improve disease control of HCC, does not increase operative risk. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - D. Fuks
- Hôpital Beaujon, Clichy, France
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50
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Belghiti J, Rau C, Blanc B, Ronot M, Dokmak S, Fuks D, Paradis V, Vilgrain V, Faivre SJ. Analysis of preoperative CT and peroperative evaluation as predictors of involvement of hepatic pedicle LN in patients operated for CRLM. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
375 Background: Approximately 20% of patients who undergo resection for colorectal liver metastases (CLM) have additional metastases present in hepatic pedicle lymph nodes (HPLN). Although LN status is a major prognostic factor, routine LN dissection is controversial. We evaluated the accuracy of preoperative CT scans and peroperative surgical assessment to determine if these methods could help determining which patients are at high risk for nodal metastases and should undergo lymphadenectomy. Methods: Between 01-2008 and 06-2010, 76 consecutive patients who underwent liver resection and lymphadenectomy for CLM after neoadjuvant chemotherapy were enrolled in a prospective study. All patients had recent (<1 month) preoperative CT to evaluate their liver metastases and the presence, location, size and radiologic characteristics of LN were assessed. Peroperatively, the size and consistency of LN were evaluated by the surgeon. Surgeons and radiologists independently assessed LN involvement. Results were compared to the definitive pathologic examination. Results: Among the 76 patients, 241 nodes were analyzed with a mean number of 3 (± 2) nodes removed per patient. Lymphadenectomy increased the surgical procedure by 20 minutes (12-25 min) and there was no specific morbidity or mortality related to LN clearance. Pathologic HPLN involvement was observed in 15 (20%) patients with a median number of 2 (1-6) metastatic nodes per patient. Peroperative assessment had a high negative predictive value (NPV) = 91% with a low positive predictive value (PPV) = 43%. CT scan assessment had also a NPV and PPV of 85% and 56%, respectively. When considering both peroperative and radiologic data, 27% of patients with pathologic LN involvement were not anticipated and 25% of patients who were node negative on pathologic examination had suspected LN involvement. Conclusions: A selective strategy limiting HPLN clearance to high risk patients relies on information from preoperative CT scans and eroperative surgical assessment. Given that both modalities cannot accurately predict nodal pathologic status, routine HPLN dissection should be performed in patients who undergo resection of CRLM. No significant financial relationships to disclose.
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Affiliation(s)
- J. Belghiti
- Hôpital Beaujon, Clichy, France; Centre Hospitalier Universitaire de Beaujon, Clichy, France
| | - C. Rau
- Hôpital Beaujon, Clichy, France; Centre Hospitalier Universitaire de Beaujon, Clichy, France
| | - B. Blanc
- Hôpital Beaujon, Clichy, France; Centre Hospitalier Universitaire de Beaujon, Clichy, France
| | - M. Ronot
- Hôpital Beaujon, Clichy, France; Centre Hospitalier Universitaire de Beaujon, Clichy, France
| | - S. Dokmak
- Hôpital Beaujon, Clichy, France; Centre Hospitalier Universitaire de Beaujon, Clichy, France
| | - D. Fuks
- Hôpital Beaujon, Clichy, France; Centre Hospitalier Universitaire de Beaujon, Clichy, France
| | - V. Paradis
- Hôpital Beaujon, Clichy, France; Centre Hospitalier Universitaire de Beaujon, Clichy, France
| | - V. Vilgrain
- Hôpital Beaujon, Clichy, France; Centre Hospitalier Universitaire de Beaujon, Clichy, France
| | - S. J. Faivre
- Hôpital Beaujon, Clichy, France; Centre Hospitalier Universitaire de Beaujon, Clichy, France
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