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Martre P, Chati R, Schwarz L, Wood G, Logeay M, Grognu A, Tuech JJ, Huet E. Minimally invasive laparo-thoracoscopic Ivor-Lewis esophagectomy with semi-mechanical triangular anastomosis: Short-term outcomes of 114 consecutive patients. J Visc Surg 2023; 160:196-202. [PMID: 36333184 DOI: 10.1016/j.jviscsurg.2022.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/13/2023]
Abstract
INTRODUCTION Several surgical teams have developed so-called minimally invasive esophagectomy techniques with the intention of decreasing post-operative complications. The goal of this report is to determine the feasibility, reproducibility, morbidity and mortality of esophagectomy and intrathoracic anastomosis via thoracoscopy. METHODS This retrospective series included 114 consecutive non-selected patients who underwent Lewis Santy type esophagectomy between 2016 and 2020. The procedure was performed via abdominal laparoscopy, thoracoscopy with the patient in a supine position, without selective intubation, with intra-thoracic semi-mechanical triangular esophagogastric anastomosis. RESULTS Mean patient age was 62.8years. Conversion from laparoscopy to laparotomy was required in three patients (2.6%); no patient required conversion from thoracoscopy to thoracotomy. A semi-mechanical triangular esophagogastric anastomosis was successfully performed in all patients. Median duration of hospital stay was 16 (8-116) days. Mortality was 2.6%; 34 patients (29.8%) had major complications, 55 (48%) had a respiratory complication. The leakage rate was 12.3%; most were type I. Only 5.2% required an additional procedure. There was no mortality. CONCLUSION The analysis of this consecutive series found that this operative technique was reproducible and reliable. These results need to be confirmed by other studies. Pulmonary morbidity was high and remains the main challenge in this type of surgery.
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Affiliation(s)
- P Martre
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - R Chati
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - L Schwarz
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - G Wood
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - M Logeay
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - A Grognu
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
| | - J-J Tuech
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France.
| | - E Huet
- Digestive Surgery Department, CHU Rouen, 76031 Rouen cedex, France
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Ministrini S, Liberale L, Beer G, Puspitasari YM, Schwarz L, Niederberger R, Katan Kahles M, Bacigaluppi M, Akhmedov A, Montecucco F, Luescher TF, Camici GG. Endothelial expression of JCAD worsens outcome after acute ischemic stroke: a translational study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1993] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Despite the increasing availability of early reperfusion, acute ischemic stroke (AIS) is still burdened by high mortality and long-time disability. Junctional protein associated with Coronary Artery Disease (JCAD) was associated to multiple cardiovascular disorders, but its role in AIS has not been investigated so far.
Purpose
To investigate the role of endothelial JCAD in the pathogenesis of AIS and its potential as a therapeutic target.
Methods
Cerebral ischemia was induced by transient Middle Cerebral Artery Occlusion (tMCAO) in mice with either global or endothelial-specific JCAD genetic deletion, and littermate controls. Stroke size was assessed ex-vivo by tetrazolium chloride staining 48 hours after reperfusion. For neurological assessment, RotaRod Test and Bederson score were recorded 24 and 48 hours after reperfusion. In vivo silencing of JCAD was achieved by intravenous injection of a JCAD small interfering RNA (siRNA) after tMCAO.
In parallel, JCAD silencing was performed in vitro in human brain microvascular endothelial cells (HBMVECs) using siRNA transfection, followed by hypoxia/reoxygenation (H/R) injury. Cell death and trans-endothelial electrical resistance (TEER) were measured by LDH assay and electrical cell-substrate impedance sensing, respectively. Molecular mechanisms were investigated in vivo by immunohistochemistry and in vitro by Western blot, respectively.
Lastly, JCAD plasma levels were measured by ELISA in two independent cohorts of patients with AIS.
Results
The expression of JCAD was up-regulated in the ipsilateral hemisphere of stroke in wild-type mice. Both global and endothelial-specific JCAD knockout mice displayed reduced stroke size after tMCAO and a significantly improved Bederson score. Similarly, mice with post-ischemic JCAD silencing had a reduced stroke size and a better motor performance at the RotaRod test (Figure 1).
In vitro, JCAD-silenced HBMVECs showed a reduced cell death rate and a higher TEER after H/R injury, compared to controls. JCAD-silenced HBMVECs also had an increased phosphorylation of Akt. After treatment with the Akt/PI3K inhibitor Wortmannin, JCAD-silenced HBMVECs showed similar TEER and cell death rates to non-silenced cells, following H/R (Figure 2).
Lastly, an increase of circulating levels of JCAD was observed in patients with AIS within 24 hours from symptoms onset. Furthermore, higher levels of JCAD at the time of hospitalization were associated with a higher risk of death within 90 days after the event.
Conclusions
JCAD expression is associated with a larger brain damage in mice in vivo and with a higher mortality in patients. In vitro results suggest that JCAD plays a pivotal role in regulating the integrity of endothelium after a H/R injury, inducing cellular death through the inhibition of the Akt/PI3K pathway. Thus, post-ischemic silencing of JCAD may represent a therapeutic strategy to improve the prognosis of patients with acute ischemic stroke.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation
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Affiliation(s)
- S Ministrini
- University of Zurich, Center for Molecular Cardiology , Zurich , Switzerland
| | - L Liberale
- University of Genoa, Department of Internal Medicine and Medical Specialities , Genova , Italy
| | - G Beer
- University of Zurich, Center for Molecular Cardiology , Zurich , Switzerland
| | - Y M Puspitasari
- University of Zurich, Center for Molecular Cardiology , Zurich , Switzerland
| | - L Schwarz
- University of Zurich, Center for Molecular Cardiology , Zurich , Switzerland
| | - R Niederberger
- University of Zurich, Center for Molecular Cardiology , Zurich , Switzerland
| | | | | | - A Akhmedov
- University of Zurich, Center for Molecular Cardiology , Zurich , Switzerland
| | - F Montecucco
- University of Genoa, Department of Internal Medicine and Medical Specialities , Genova , Italy
| | - T F Luescher
- University of Zurich, Center for Molecular Cardiology , Zurich , Switzerland
| | - G G Camici
- University of Zurich, Center for Molecular Cardiology , Zurich , Switzerland
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Monge M, Chiavelli H, Pinson J, Papet E, Schwarz L, Tuech JJ. Successful outcome following resection of metachronous pancreatic metastasis from a rhabdomyosarcoma. Acta Chir Belg 2021; 121:354-356. [PMID: 31994975 DOI: 10.1080/00015458.2020.1722927] [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: 10/25/2022]
Abstract
BACKGROUND Pancreatic metastases (PM) are rare, comprising 3% of pancreatic tumours removed in sizable series of operations. This report presents the first case of metachronous pancreatic metastases from rhabdomyosarcoma successfully treated by pancreaticoduodenectomy. CASE REPORT A 19-year old man was admitted with a tumor in the head of the pancreas, 1 year after undergoing removal of an alveolar RMS from the right hand. . Computed tomography (CT) scan demonstrates a solitary hypodence tumour of the pancreas. The patient underwent a pancreaticoduodenectomy and the postoperative course was uneventful. Pathologic examination confirmed the metastatic alveolar RMS without lymph node involvement. At most recent follow-up, 36 months after pancreaticoduodenectomy, the patient has no evidence of disease. CONCLUSION Although rare, rhabdomyosarcoma can metastasize to the pancreas. The surgeons must be aware of this complication, and that such pancreatic metastases are potentially resectable with a good long term outcome.
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Affiliation(s)
- M. Monge
- Department of Digestive Surgery, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - H. Chiavelli
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - J. Pinson
- Department of Digestive Surgery, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - E. Papet
- Department of Digestive Surgery, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - L. Schwarz
- Department of Digestive Surgery, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - J. J. Tuech
- Department of Digestive Surgery, Rouen University Hospital-Charles Nicolle, Rouen, France
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Noren SR, Schwarz L, Robeck TR. Topographic Variations in Mobilization of Blubber in Relation to Changes in Body Mass in Short-Finned Pilot Whales ( Globicephala macrorhynchus). Physiol Biochem Zool 2021; 94:228-240. [PMID: 34010119 DOI: 10.1086/714637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractFat-level measurements used to indicate individual body condition and fitness are useful only when taken at a region along the body where fat responds to variations in caloric intake. Investigations to identify appropriate species-specific regions are limited, especially for cetaceans that have a specialized fat (blubber) that serves as an energy reserve and provides insulation. Over 18 mo, body mass of six pilot whales varied (range: 50-172 kg), and although caloric intake increased when water temperatures were lower, generally the best-fitting state-space model for length-adjusted mass was based on a single factor, caloric intake. After correcting for body length (range: 330-447 cm), the slope for blubber thickness and "blubber ring" thickness (average blubber thickness along a girth) in relation to body mass was positive and had a P value of <0.10 at six of 16 blubber measurement sites and one of five girth measurement sites, respectively. The slope for body girth (a reflection of changes in underlying blubber thickness) in relation to body mass was positive and had a lower P value ([Formula: see text]) at three of five girth measurement sites. Results indicate that blubber from the anterior insertion of the pectoral fins to the posterior insertion of the dorsal fin is the most metabolically active region. This region includes the midflank site, a location where blubber thickness measurements have historically been taken to monitor cetacean body condition. Conversely, blubber in the peduncle region was comparatively inert. These findings must be considered when measuring blubber thickness and body width (i.e., photogrammetry) to monitor the condition of free-ranging cetaceans.
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Floc'h M, Monge M, Schwarz L. A technical tip for enterotomy-drainage by balloon trocar of the small intestine. J Visc Surg 2021; 158:450-451. [PMID: 33863676 DOI: 10.1016/j.jviscsurg.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Floc'h
- Rouen University Hospital, Department of Digestive Surgery, 76000 Rouen, France
| | - M Monge
- Rouen University Hospital, Department of Digestive Surgery, 76000 Rouen, France
| | - L Schwarz
- Rouen University Hospital, Department of Digestive Surgery, 76000 Rouen, France; Normandie Univ, UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France.
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Graage R, Beck S, Koch M, Dolezal M, Schwarz L, Hennig-Pauka I. [Comparison between oral fluid samples and pooled serum samples for the detection of antibodies against Porcine Reproductive and Respiratory Syndrome Virus in weaning pig herds]. SCHWEIZ ARCH TIERH 2021; 162:531-538. [PMID: 32855120 DOI: 10.17236/sat00270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Monitoring of Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) in pig farms is performed usually by testing for antibodies against PRRSV in serum samples. A new method is the detection of PRRSV antibodies in porcine saliva. In this study serum samples and saliva were collected in nine farms suspicious for PRRSV and tested for the presence of PRRSV antibodies. In total 220 serum and 41 saliva samples were taken from pigs at the age of 8 weeks (± 1 week). One saliva and one pooled serum sample (1:5) were tested from each pen. In total 11 (Cut-off 0.4/0.3) or 14 (Cut-off 0.2) serum samples and 23 saliva out of 41 pens were positive for PRRSV antibodies. Cohen`s Kappa testing showed a moderate agreement (κ = 0.446). Saliva samples compared to pooled serum samples were very sensitive, the specificity was 60 and 67, respectively.
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Affiliation(s)
- R Graage
- Departement für Nutztiere, Abteilung Schweinemedizin, Vetsuisse-Fakultät, Universität Zürich
| | - S Beck
- Universitätsklinik für Schweine, Department für Nutztiere und öffentliches Veterinärwesen in der Veterinärmedizin, Veterinärmedizinische Universität Wien
| | - M Koch
- Universitätsklinik für Schweine, Department für Nutztiere und öffentliches Veterinärwesen in der Veterinärmedizin, Veterinärmedizinische Universität Wien
| | - M Dolezal
- Plattform Bioinformatik und Biostatistik, Veterinärmedizinische Universität Wien
| | - L Schwarz
- Universitätsklinik für Schweine, Department für Nutztiere und öffentliches Veterinärwesen in der Veterinärmedizin, Veterinärmedizinische Universität Wien
| | - I Hennig-Pauka
- Universitätsklinik für Schweine, Department für Nutztiere und öffentliches Veterinärwesen in der Veterinärmedizin, Veterinärmedizinische Universität Wien
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Tuech JJ, Schwarz L, Pocard M. [RE: Strategy for the practice of digestive and oncologic surgery in COVID-19 epidemic situation]. ACTA ACUST UNITED AC 2020; 158:101-102. [PMID: 33250944 PMCID: PMC7678451 DOI: 10.1016/j.jchirv.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- J-J Tuech
- Rouen university hospital, department of digestive surgery, 1, rue de Germont, 76031 Rouen cedex, France.,Normandie university, UNIROUEN, UMR 1245 Inserm, Rouen university Hospital, Department of genomic and personalized medicine in cancer and neurological Disorders, 76000 Rouen, France.,Université de Paris, UMR 1275 CAP Paris-Tech, 75010 Paris, France
| | - L Schwarz
- Rouen university hospital, department of digestive surgery, 1, rue de Germont, 76031 Rouen cedex, France.,Normandie university, UNIROUEN, UMR 1245 Inserm, Rouen university Hospital, Department of genomic and personalized medicine in cancer and neurological Disorders, 76000 Rouen, France.,Université de Paris, UMR 1275 CAP Paris-Tech, 75010 Paris, France
| | - M Pocard
- Service de chirurgie digestive et cancérologique Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France
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Morante Z, Ruiz R, Araujo JM, Pinto JA, Cruz-Ku GDL, Urrunaga-Pastor D, Namuche F, Flores C, Mantilla R, Luján MG, Fuentes H, Schwarz L, Aguilar A, Neciosup S, Gómez HL. Impact of the Delayed Initiation of Adjuvant Chemotherapy in the Outcome of Triple Negative Breast Cancer. Clin Breast Cancer 2020; 21:239-246.e4. [PMID: 33221201 DOI: 10.1016/j.clbc.2020.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adjuvant chemotherapy decreases the recurrence risk and improves survival rates; however, it is unclear whether a delayed initiation is associated with adverse outcomes, especially in triple negative breast cancer (TNBC). In this study, we evaluated the influence of the time to start adjuvant chemotherapy (TTC) in the outcomes of TNBC. PATIENTS AND METHODS We retrospectively analyzed 15 years of data from patients with TNBC who received adjuvant chemotherapy at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru). TTC was categorized into 4 groups: ≤ 30, 31 to 60, 61 to 90, and ≥ 91 days. We evaluated overall survival (OS) and distant recurrence-free survival (DRFS). Cox proportional hazard models were used to identify prognostic factors. RESULTS In total, 687 patients were included. The mean age at diagnosis was 49.1 years (SD, 11.8 years), and most (62.6%) patients had pathologic stage T2. The median TTC was 48.1 days (SD, 27.4 days); 189 (27.5%) received chemotherapy ≤ 30 days; 329 (47.9%), between 31 and 60 days; 115 (16.7%), between 61 and 90 days; and 54 (7.9%) in ≥ 90 days. In the multivariate analysis, a TTC between 31 and 60 days (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.17-2.72), 61 and 90 days (HR, 2.38; 95%CI, 1.43-3.97), and ≥ 91 days (HR, 2.45; 95% CI, 1.32-4.55) was associated with an increased mortality in contrast with a TTC < 30 days. Although a TTC between 31 and 60 days, 61 and 90 days, and ≥ 91 days was associated with an increased risk of DRFS (HR, 1.86; 95% CI, 1.24-2.79; HR, 2.34, 95% CI, 1.42-3.867; and HR, 3.16; 95% CI, 1.78-5.61, respectively). CONCLUSION A delaying in TTC ≥ 30 days was associated with poorer outcomes. Our data suggest that several efforts should be conducted to avoid a delayed TTC in patients with TNBC.
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Affiliation(s)
- Zaida Morante
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru; Grupo de Estudios Clínico Oncológicos Peruano (GECOPERU), Lima, Peru
| | - Rossana Ruiz
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Jhajaira M Araujo
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | | | - Diego Urrunaga-Pastor
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru; Universidad Científica del Sur, Lima, Peru
| | - Fernando Namuche
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Claudio Flores
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Raúl Mantilla
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - María G Luján
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Hugo Fuentes
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Luis Schwarz
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Alfredo Aguilar
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
| | - Silvia Neciosup
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Henry L Gómez
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Grupo de Estudios Clínico Oncológicos Peruano (GECOPERU), Lima, Peru.
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Sefrioui D, Verdier V, Savoye-Collet C, Beaussire L, Ghomadi S, Gangloff A, Goria O, Riachi G, Montialoux H, Schwarz L, Tuech JJ, Frebourg T, Michel P, Vasseur NS, Di Fiore F. 1007P cfDNA and ctDNA variations are predictive of disease progression to conventional transarterial chemoembolization (cTACE) in patients with hepatocellular carcinoma (HCC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1123] [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: 11/27/2022] Open
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Affiliation(s)
- P Tortajada
- Rouen university hospital, department of digestive surgery, 76000 Rouen, France
| | - J-J Tuech
- Rouen university hospital, department of digestive surgery, 76000 Rouen, France; Normandie Univ, UNIROUEN, UMR 1245 INSERM, Rouen university hospital, department of genomic and personalized medicine in cancer and neurological disorders, 76000 Rouen, France
| | - L Schwarz
- Rouen university hospital, department of digestive surgery, 76000 Rouen, France; Normandie Univ, UNIROUEN, UMR 1245 INSERM, Rouen university hospital, department of genomic and personalized medicine in cancer and neurological disorders, 76000 Rouen, France.
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Tuech JJ, Gangloff A, Di Fiore F, Michel P, Brigand C, Slim K, Pocard M, Schwarz L. Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic. J Visc Surg 2020; 157:S7-S12. [PMID: 32249098 PMCID: PMC7269902 DOI: 10.1016/j.jviscsurg.2020.03.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Covid-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery. Healthcare priorities and circuits are being modified. Emergency surgery is still a priority. Functional surgery is to be deferred. Laparoscopic surgery must follow strict rules so as not to expose healthcare professionals (HCPs) to added risk. The question looms large in cancer surgery-go ahead or defer? There is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery. For each type of cancer-colon, pancreas, oesogastric, hepatocellular carcinoma-morbidity and mortality rates are stated and compared with the oncological risk incurred by deferring surgery and/or the tumour doubling time. Strategies can be proposed based on this comparison. For colonic cancers T1-2, N0, it is advisable to defer surgery. For advanced colonic lesions, it seems judicious to undertake neoadjuvant chemotherapy and then wait. For rectal cancers T3-4 and/or N+, chemoradiotherapy is indicated, short radiotherapy must be discussed (followed by a waiting period) to reduce time of exposure in the hospital and to prevent infections. Most complex surgery with high morbidity and mortality-oesogastric, hepatic or pancreatic-is most often best deferred.
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Affiliation(s)
- J-J Tuech
- Rouen University Hospital, Department of Digestive Surgery, 1, rue de Germont, 76031 Rouen cedex, France; Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France.
| | - A Gangloff
- Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - F Di Fiore
- Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France; Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - P Michel
- Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France; Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - K Slim
- Department of digestive surgery, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - M Pocard
- Université de Paris, UMR 1275 CAP Paris-Tech, 75010 Paris, France; Service de chirurgie digestive et cancérologique Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France
| | - L Schwarz
- Rouen University Hospital, Department of Digestive Surgery, 1, rue de Germont, 76031 Rouen cedex, France; Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France
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Aguilar A, Mariñas M, Bravo L, Zavaleta J, Pinto J, Ruiz R, Schwarz L. Safety of immunotherapy in Peruvian patients with diverse type of malignancies: Experience at a private center. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19258] [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
e19258 Background: Immunotherapy has changed the landscape of cancer treatment. The aim of this work was to describe the adverse events related to immunotherapy treatment in diverse type of malignant tumors using real-world data. Methods: This is a retrospective review of patients with diverse type of advanced malignancies treated with immunotherapy at Oncosalud-AUNA (Lima-Peru) during the period 2016-2018. We present a descriptive analysis of the clinicopathological and treatment features of the patients, as well as data of safety of immunotherapeutic agents. Results: In total, 37 patients were included in the study. The median age was 67 years (38 to 84 years); 64.9% of patients were male; 54.1% were smoker/former smoker and 45.9% non-smokers. Regarding to the primary tumor, 75.7% were lung cancers (82.1%, adenocarcinomas and 17.9%, squamous cell carcinomas), 16.2% were melanomas, 5.4, head and neck cancers and 2.7%, were bladder cancers. Central nervous system metastases were present in 29.7% of patients. Immunotherapy was given after a first line in 43.2% of cases, 40.5% after the second line and 16.2%, after the third line of treatment. The types of immunotherapy were prembrolizumab in 54.1%, nivolumab in 40.5%, atezolizumab in 2.7% and avelumab in 2.7%. 27% of cases had combination of immuno with chemotherapy. Finally, regarding to adverse events, 94.6% had any adverse event; 48.6% fatigue and asthenia; 35.1%, nausea; 32.4, pruritus/rash; 27.7%, decreased appetite; 18.9%, hypo/hyperthyroidism; 13.5%, diarrhea/colitis; 10.8%, pneumonitis and 5.4%, infusion-related reactions. Conclusions: During the study period we had a slightly higher incidence of adverse events than reported by other works. It could be probably due to the age of patients and several prior lines of treatment.
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Affiliation(s)
| | | | - Leny Bravo
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - Jenny Zavaleta
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | | | - Rossana Ruiz
- Scientific & Academic Direction, Oncosalud-AUNA, Lima, Peru
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Tuech JJ, Gangloff A, Schwarz L. Our challenge is to adapt the organization of our system to the six stages of the epidemic to go beyond the COVID-19 crisis. Br J Surg 2020; 107:e189. [PMID: 32352560 PMCID: PMC7267433 DOI: 10.1002/bjs.11639] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023]
Affiliation(s)
- J J Tuech
- Department of Digestive Surgery, Rouen, France.,UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie Univ, Rouen, France
| | - A Gangloff
- Department of Digestive Oncology, Rouen University Hospital, Rouen, France
| | - L Schwarz
- Department of Digestive Surgery, Rouen, France.,UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie Univ, Rouen, France
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14
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Affiliation(s)
- L Schwarz
- Department of Digestive Surgery Rouen University Hospital, Rouen, France.,UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, Rouen, France
| | - J J Tuech
- Department of Digestive Surgery Rouen University Hospital, Rouen, France.,UNIROUEN, UMR 1245 INSERM, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Normandie University, Rouen, France
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Tuech JJ, Gangloff A, Di Fiore F, Michel P, Brigand C, Slim K, Pocard M, Schwarz L. [Strategy for the practice of digestive and oncologic surgery in COVID-19 epidemic situation]. ACTA ACUST UNITED AC 2020; 157:S6-S12. [PMID: 32834885 PMCID: PMC7271206 DOI: 10.1016/j.jchirv.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
La pandémie due au COVID-19 modifie l’organisation des soins et change la réalisation de la chirurgie digestive. Les priorités sanitaires et les circuits de soins sont modifiés. La chirurgie d’urgence reste prioritaire. Les interventions pour chirurgie fonctionnelles sont à reporter. La chirurgie par laparoscopie doit suivre des règles strictes pour ne pas exposer les professionnels à un surrisque. Le questionnement principal concerne la chirurgie oncologique, opérer ou reporter ? Il existe probablement un sur risque opératoire induit par la pandémie qui doit être mis en balance avec le retard de prise en charge chirurgical. Pour chaque type de cancer, colon, pancréas, œsogastrique, hépatocarcinome, la morbi-mortalité est rappelée et mise en parallèle avec le risque oncologique lié au retard à la chirurgie et/ou au temps de doublement de la tumeur. Cette comparaison permet de proposer des stratégies, ainsi pour les cancers coliques (T1-2, N0), il est souhaitable de retarder la chirurgie. Pour les lésions coliques avancées, il semble prudent de recommander une chimiothérapie néo adjuvante et d’attendre. Pour les cancers du rectum T3-4 et/ou N+, une radio-chimiothérapie est indiquée, une radiothérapie courte devra être discutée (suivie d’une période d’attente) afin de réduire le temps d’exposition à l’hôpital et d’éviter les infections. La majorité des chirurgies complexes à forte morbi-mortalité, œsogastrique, hépatique ou pancréatique doivent sans doute le plus souvent être reportée.
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Affiliation(s)
- J.-J. Tuech
- Department of Digestive Surgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Auteur correspondant.
| | - A. Gangloff
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - F. Di Fiore
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - P. Michel
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - C. Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - K. Slim
- Department of digestive surgery, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - M. Pocard
- UMR 1275 CAP Paris-Tech, université de Paris, 75010 Paris, France
- Service de chirurgie digestive et cancérologique, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - L. Schwarz
- Department of Digestive Surgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
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16
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Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, Patrice D. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg 2020; 107:268-277. [PMID: 31916594 DOI: 10.1002/bjs.11406] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - F Cauchy
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - C Goumard
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - O Soubrane
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - E Salamé
- Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Tours University, Tours, France
| | - D Cherqui
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - E Vibert
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - O Scatton
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | | | - T Nomi
- Nara Medical University, Nara, Japan
| | - N Oudafal
- Institut Mutualiste Montsouris, Paris, France
| | - T Kawai
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Komatsu
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Okumura
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | | | - A Laurent
- Hôpital Henri Mondor, APHP, Creteil, France
| | - P Bucur
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - L Barbier
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - B Trechot
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - J Nunèz
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M Tedeschi
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M-A Allard
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - N Golse
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - O Ciacio
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - G Pittau
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - R Adam
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - C Laurent
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - L Chiche
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - P Leourier
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Rebibo
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - J-M Regimbeau
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Ferre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F R Souche
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J Chauvat
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J-M Fabre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F Jehaes
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Mohkam
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Lesurtel
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Ducerf
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-Y Mabrut
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - T Hor
- St Antoine Hospital, APHP, Paris, France
| | - F Paye
- St Antoine Hospital, APHP, Paris, France
| | - P Balladur
- St Antoine Hospital, APHP, Paris, France
| | - B Suc
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - F Muscari
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - G Millet
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - M El Amrani
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - C Ratajczak
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - K Lecolle
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - E Boleslawski
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - S Truant
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - F-R Pruvot
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - A-R Kianmanesh
- Robert Debré Hospital, Hospital University Centre of Reims, Reims, France
| | - T Codjia
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - L Schwarz
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - E Girard
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - J Abba
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - C Letoublon
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - M Chirica
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | | | | | - Z Cherkaoui
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - X Unterteiner
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - R Memeo
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - P Pessaux
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - E Buc
- Hospital University Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Lermite
- Hospital University Centre of Angers, Angers, France
| | - J Barbieux
- Hospital University Centre of Angers, Angers, France
| | - M Bougard
- Hospital University Centre of Angers, Angers, France
| | - U Marchese
- Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Institut Paoli-Calmettes, Marseille, France
| | - O Turini
- Institut Paoli-Calmettes, Marseille, France
| | - A Thobie
- Hospital University Centre of Caen Normandie, Caen, France
| | - B Menahem
- Hospital University Centre of Caen Normandie, Caen, France
| | - A Mulliri
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Lubrano
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Zemour
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - H Fagot
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - G Passot
- Hospital University Centre of Lyon Sud, Lyon, France
| | - E Gregoire
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - J Hardwigsen
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - Y-P le Treut
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - D Patrice
- Louis Pasteur Hospital, Colmar, France
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Bachet JB, Moreno-Lopez N, Vigano L, Marchese U, Gelli M, Raoux L, Truant S, Laurent C, Herrero A, Le Roy B, Deguelte Lardiere S, Passot G, Hautefeuille V, De La Fouchardiere C, Artru P, Ameto T, Mabrut JY, Schwarz L, Rousseau B, Lepère C, Coriat R, Brouquet A, Sa Cunha A, Benoist S. BRAF mutation is not associated with an increased risk of recurrence in patients undergoing resection of colorectal liver metastases. Br J Surg 2019; 106:1237-1247. [PMID: 31183866 DOI: 10.1002/bjs.11180] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND BRAF mutation is associated with a poor prognosis in patients with metastatic colorectal cancer. For patients with resectable colorectal liver metastases (CRLMs), the prognostic impact of BRAF mutation is unknown and the benefit of surgery debated. This nationwide intergroup (ACHBT, FRENCH, AGEO) study aimed to evaluate the oncological outcome of patients undergoing liver resection for BRAF-mutated CRLMs. METHODS The study included patients who underwent resection for BRAF-mutated CRLMs in 24 centres between 2012 and 2016. A case-matched comparison was made with 183 patients who underwent resection of CRLMs with wild-type BRAF during the same interval. RESULTS Sixty-six patients who underwent resection for BRAF-mutated CRLMs in 24 centres were compared with 183 patients with wild-type BRAF. The 1- and 3-year disease-free survival (DFS) rates were 46 and 19 per cent for the BRAF-mutated group, and 55·4 and 27·8 per cent for the group with wild-type BRAF (P = 0·430). In multivariable analysis, BRAF mutation was not associated with worse DFS (hazard ratio 1·16, 95 per cent c.i. 0·72 to 1·85; P = 0·547). The 1- and 3-year overall survival rates after surgery were 94 and 54 per cent respectively among patients with BRAF mutation, and 95·8 and 82·9 per cent in those with wild-type BRAF (P = 0·004). Median survival after disease progression was 23·0 (95 per cent c.i. 11·0 to 35·0) months among patients with mutated BRAF and 44·3 (35·9 to 52·6) months in those with wild-type BRAF (P = 0·050). Multisite disease progression was more common in the BRAF-mutated group (48 versus 29·8 per cent; P = 0·034). CONCLUSION These results support surgical treatment for resectable BRAF-mutated CRLM, as BRAF mutation by itself does not increase the risk of relapse after resection. BRAF mutation is associated with worse survival in patients whose disease relapses after resection of CRLM, as for non-metastatic colorectal cancer.
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Affiliation(s)
- J-B Bachet
- Sorbonne Université, University Pierre and Marie Curie, Paris, France.,Department of Hepato-Gastroenterology, Hôpital Pitié Salpêtrière, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - N Moreno-Lopez
- Department of Digestive Surgery, Dijon University Hospital, Dijon, France
| | - L Vigano
- Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - U Marchese
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - M Gelli
- Department of General Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - L Raoux
- Department of Digestive Surgery, University Hospital of Toulouse, University Paul Sabatier, Toulouse, France
| | - S Truant
- Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France
| | - C Laurent
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Saint André Hospital, Bordeaux, France
| | - A Herrero
- Department of General Surgery, Division of Transplantation, University of Montpellier - College of Medicine, Saint Eloi Hospital, Montpellier, France
| | - B Le Roy
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - S Deguelte Lardiere
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré University Hospital, Reims, France
| | - G Passot
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - V Hautefeuille
- Department of Gastroenterology, Amiens-Picardie University Hospital, Amiens, France
| | | | - P Artru
- Department of Oncology, Hôpital Privé Jean Mermoz, Lyon, France
| | - T Ameto
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - J Y Mabrut
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Croix Rousse, Lyon, France
| | - L Schwarz
- Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen, France
| | - B Rousseau
- Department of Oncology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - C Lepère
- Department of Gastroenterology and Digestive Oncology, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - R Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, AP-HP, Paris, France
| | - A Brouquet
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, AP-HP, Paris-Sud University, Le Kremlin Bicêtre, France.,Paris-Sud University, Le Kremlin Bicêtre, France
| | - A Sa Cunha
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Paul Brousse Hospital, Villejuif, France.,Paris-Sud University, Le Kremlin Bicêtre, France
| | - S Benoist
- Department of Digestive Surgery and Surgical Oncology, Bicêtre Hospital, AP-HP, Paris-Sud University, Le Kremlin Bicêtre, France.,Paris-Sud University, Le Kremlin Bicêtre, France
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18
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Dembinski J, Mariette C, Tuech J, Mauvais F, Piessen G, Fuks D, Schwarz L, Truant S, Cosse C, Pruvot F, Regimbeau J. Early removal of intraperitoneal drainage after pancreatoduodenectomy in patients without postoperative fistula at POD3: Results of a randomized clinical trial. J Visc Surg 2019; 156:103-112. [DOI: 10.1016/j.jviscsurg.2018.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Araujo J, Flores C, Schwarz L, Doimi F, Dyer R, Gomez H, Pinto J. Prognostic capability of a TNBC 3-genes score among triplenegative breast cancer subtypes. Breast 2019. [DOI: 10.1016/s0960-9776(19)30141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Joseph JD, Darimont B, Zhou W, Arrazate A, Young A, Ingalla E, Walter K, Blake RA, Nonomiya J, Guan Z, Kategaya L, Govek SP, Lai AG, Kahraman M, Brigham D, Sensintaffar J, Lu N, Shao G, Qian J, Grillot K, Moon M, Prudente R, Bischoff E, Lee KJ, Bonnefous C, Douglas KL, Julien JD, Nagasawa JY, Aparicio A, Kaufman J, Haley B, Giltnane JM, Wertz IE, Lackner MR, Nannini MA, Sampath D, Schwarz L, Manning HC, Tantawy MN, Arteaga CL, Heyman RA, Rix PJ, Friedman L, Smith ND, Metcalfe C, Hager JH. Correction: The selective estrogen receptor downregulator GDC-0810 is efficacious in diverse models of ER+ breast cancer. eLife 2019; 8:44851. [PMID: 30614786 PMCID: PMC6322858 DOI: 10.7554/elife.44851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Broadnax D, Dozier M, Schwarz L, Ayers C. SUBJECTIVE HELPFULNESS OF COGNITIVE-REMEDIATION TREATMENT COMPONENTS FOR GERIATRIC HOARDING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - M Dozier
- San Diego State University/University of California at San Diego Joint Doctoral Program in Clinical Psychology
| | | | - C Ayers
- VA San Diego Healthcare System/University of California San Diego, Department of Psychiatry
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22
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Flores C, Aguilar A, Enriquez D, Mas L, Schwarz L, Vallejos C. P38 Incidence and Survival of Lung Cancer at Oncosalud - AUNA: A Dynamic Cohort Study. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.07.077] [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: 12/01/2022]
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Schwarz L, Gomez HL, Montenegro PC, Flores CJ, Requena M, Araujo JM, Tirado-Hurtado I, Raymond VM, Aguilar A, Vallejos Sologuren C. Impact of liquid-biopsy in the therapeutic decision making process in a Peruvian institution. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - María Requena
- Unidad de Investigación Clínica, Oncosalud-AUNA, Lima, Peru
| | | | - I. Tirado-Hurtado
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima, Peru
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Martre P, Codjia T, Tuech JJ, Schwarz L. Pelvic tumor fed by the superior mesenteric artery. What is your diagnosis? GIST complicating Meckel's diverticulum. J Visc Surg 2018; 155:83-85. [PMID: 29396111 DOI: 10.1016/j.jviscsurg.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/18/2022]
Affiliation(s)
- P Martre
- Service de chirurgie digestive, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - T Codjia
- Service de chirurgie digestive, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France
| | - J-J Tuech
- Service de chirurgie digestive, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Centre Normand de medicine génomique et de medicine personalisée, Inserm U1245, Groupe IRON, université de Rouen, CHU de Rouen, 76000 Rouen, France
| | - L Schwarz
- Service de chirurgie digestive, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Centre Normand de medicine génomique et de medicine personalisée, Inserm U1245, Groupe IRON, université de Rouen, CHU de Rouen, 76000 Rouen, France.
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Lee KM, Giltnane J, Balko J, Schwarz L, Guerrero A, Hutchinson K, Hicks M, Sanchez V, Sanders M, Lee T, Olejniczak E, Fesik S, Arteaga C. Abstract 3890: Mitochondrial MCL1 maintains triple negative breast cancer stem cells and contributes to chemotherapy resistance. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3890] [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: 11/16/2022]
Abstract
Abstract
Cytotoxic chemotherapy is the standard of care for patients with triple negative breast cancer (TNBC). Most patients with advanced TNBC progress after chemotherapy and die from metastatic disease. MCL1 is an anti-apoptotic Bcl-2 family member known to sequester and inactivate pro-apoptotic Bcl-2 family proteins and, thus, contribute to chemotherapy resistance. We previously reported that ~45% of residual TNBCs that remain in the breast after neoadjuvant chemotherapy harbor MCL1 amplification, suggesting a causal role for MCL1 in drug resistance. A recent report (Goodwin et al. 2015) suggested that siRNA-mediated ablation of MCL1 does not induce apoptosis in claudin-low TNBC cells with a cancer stem cell (CSC) gene expression signature. CSCs comprise a rare population of cells with tumor-initiating properties and refractoriness to chemotherapy. In this study, we showed that MCL1 expression is elevated in claudin-low TNBC SUM159PT and MDA436 CSCs as measured by ALDH+ by flow cytometry and ability to form mammospheres. RNA interference of MCL1 in SUM159PT cells reduced CSCs and attenuated tumor formation in vivo. Mitochondrial oxidative phosphorylation (mtOXPHOS) plays a crucial role in maintenance of CSCs. MCL1 has been shown to localize in the mitochondrial matrix and contribute to mitochondrial respiration. Thus, we hypothesized that MCL1 contributes to enrichment of TNBC CSCs and chemotherapy resistance via mitochondrial regulation. Stable transfection and overexpression of MCL1 in MDA468 cells increased oxygen consumption ratio, mitochondrial membrane potential, and production of reactive oxygen species (ROS), all features of activated mtOXPHOS. Conversely, RNAi-mediated ablation of MCL1 in SUM159PT and MDA436 cells repressed these markers of activated mtOXPHOS. A mutant of MCL1 lacking its mitochondrial target sequences (MTS) was unable to localize in mitochondria and, when transfected into MDA468 cells, reduced the CD44high/CD24low fraction and mammosphere formation. We next tested VU0659158, a BH3 mimetic in development at Vanderbilt that disrupts MCL1 interactions with BH3 domain-containing proteins, such as BID, BIM, NOXA and PUMA. Treatment of SUM159PT cells with VU0659158 increased caspase activity but did not attenuate mammosphere formation. Analysis of mRNA expression in TCGA revealed that genes induced by mtOXPHOS involved in the hypoxia pathway are significantly up-regulated in MCL1 amplified breast cancers. Finally, pharmacological inhibition of HIF-1α, a key regulator of hypoxia, with digoxin decreased CSCs and attenuated tumor formation in vivo. These data suggest that 1) MCL1 confers resistance to chemotherapy by expanding CSCs via mtOXPHOS independent of its BH3 domain-mediated, anti-apoptotic function, and 2) targeting mitochondrial respiration and the hypoxia pathway may delay or reverse chemotherapy resistance in MCL1 amplified TNBC.
Citation Format: Kyung-min Lee, Jennifer Giltnane, Justin Balko, Luis Schwarz, Angel Guerrero, Katie Hutchinson, Mellissa Hicks, Violeta Sanchez, Melinda Sanders, Taekyu Lee, Edward Olejniczak, Stephen Fesik, Carlos Arteaga. Mitochondrial MCL1 maintains triple negative breast cancer stem cells and contributes to chemotherapy resistance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3890. doi:10.1158/1538-7445.AM2017-3890
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Högler S, Lamp B, Schwarz L, Riedel C, Sinn L, Ladinig A, Rümenapf T, Weissenböck H. A Pestivirus Divergent from APPV Associated with Myoclonia Congenita in Piglets. J Comp Pathol 2017. [DOI: 10.1016/j.jcpa.2016.11.010] [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: 11/24/2022]
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Sefrioui D, Blanchard F, Basile P, Toure E, Dolfus C, Beaussire L, Vasseur N, Perdrix A, Gangloff A, Schwarz L, Clatot F, Tuech JJ, Sabourin JC, Frebourg T, Michel P, Di Fiore F. Diagnostic performance of liquid biopsy for pancreatic solid lesion as alternative to endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.18] [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: 11/13/2022] Open
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Joseph JD, Darimont B, Zhou W, Arrazate A, Young A, Ingalla E, Walter K, Blake RA, Nonomiya J, Guan Z, Kategaya L, Govek SP, Lai AG, Kahraman M, Brigham D, Sensintaffar J, Lu N, Shao G, Qian J, Grillot K, Moon M, Prudente R, Bischoff E, Lee KJ, Bonnefous C, Douglas KL, Julien JD, Nagasawa JY, Aparicio A, Kaufman J, Haley B, Giltnane JM, Wertz IE, Lackner MR, Nannini MA, Sampath D, Schwarz L, Manning HC, Tantawy MN, Arteaga CL, Heyman RA, Rix PJ, Friedman L, Smith ND, Metcalfe C, Hager JH. The selective estrogen receptor downregulator GDC-0810 is efficacious in diverse models of ER+ breast cancer. eLife 2016; 5:15828. [PMID: 27410477 PMCID: PMC4961458 DOI: 10.7554/elife.15828] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 07/09/2016] [Indexed: 12/14/2022] Open
Abstract
ER-targeted therapeutics provide valuable treatment options for patients with ER+ breast cancer, however, current relapse and mortality rates emphasize the need for improved therapeutic strategies. The recent discovery of prevalent ESR1 mutations in relapsed tumors underscores a sustained reliance of advanced tumors on ERα signaling, and provides a strong rationale for continued targeting of ERα. Here we describe GDC-0810, a novel, non-steroidal, orally bioavailable selective ER downregulator (SERD), which was identified by prospectively optimizing ERα degradation, antagonism and pharmacokinetic properties. GDC-0810 induces a distinct ERα conformation, relative to that induced by currently approved therapeutics, suggesting a unique mechanism of action. GDC-0810 has robust in vitro and in vivo activity against a variety of human breast cancer cell lines and patient derived xenografts, including a tamoxifen-resistant model and those that harbor ERα mutations. GDC-0810 is currently being evaluated in Phase II clinical studies in women with ER+ breast cancer.
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Affiliation(s)
- James D Joseph
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Beatrice Darimont
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Wei Zhou
- Department of Translational Oncology, Genentech, South San Francisco, United States
| | - Alfonso Arrazate
- Department of Translational Oncology, Genentech, South San Francisco, United States
| | - Amy Young
- Department of Translational Oncology, Genentech, South San Francisco, United States
| | - Ellen Ingalla
- Department of Translational Oncology, Genentech, South San Francisco, United States
| | - Kimberly Walter
- Department of Oncology Biomarker Development, Genentech, South San Francisco, United States
| | - Robert A Blake
- Department of Biochemical and Cellular Pharmacology, Genentech, South San Francisco, United States
| | - Jim Nonomiya
- Department of Biochemical and Cellular Pharmacology, Genentech, South San Francisco, United States
| | - Zhengyu Guan
- Department of Translational Oncology, Genentech, South San Francisco, United States
| | - Lorna Kategaya
- Departments of Discovery Oncology and Early Discovery Biochemistry, Genentech, South San Francisco, United States
| | - Steven P Govek
- Department of Chemistry, Seragon Pharmaceuticals, San Diego, United States
| | - Andiliy G Lai
- Department of Chemistry, Seragon Pharmaceuticals, San Diego, United States
| | - Mehmet Kahraman
- Department of Chemistry, Seragon Pharmaceuticals, San Diego, United States
| | - Dan Brigham
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - John Sensintaffar
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Nhin Lu
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Gang Shao
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Jing Qian
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Kate Grillot
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Michael Moon
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Rene Prudente
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Eric Bischoff
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Kyoung-Jin Lee
- Department of Drug Safety and Disposition, Seragon Pharmaceuticals, San Diego, United States
| | - Celine Bonnefous
- Department of Chemistry, Seragon Pharmaceuticals, San Diego, United States
| | - Karensa L Douglas
- Department of Chemistry, Seragon Pharmaceuticals, San Diego, United States
| | - Jackaline D Julien
- Department of Chemistry, Seragon Pharmaceuticals, San Diego, United States
| | - Johnny Y Nagasawa
- Department of Chemistry, Seragon Pharmaceuticals, San Diego, United States
| | - Anna Aparicio
- Department of Drug Safety and Disposition, Seragon Pharmaceuticals, San Diego, United States
| | - Josh Kaufman
- Department of Drug Safety and Disposition, Seragon Pharmaceuticals, San Diego, United States
| | - Benjamin Haley
- Department of Molecular Biology, Genentech, South San Francisco, United States
| | | | - Ingrid E Wertz
- Departments of Discovery Oncology and Early Discovery Biochemistry, Genentech, South San Francisco, United States
| | - Mark R Lackner
- Department of Oncology Biomarker Development, Genentech, South San Francisco, United States
| | - Michelle A Nannini
- Department of Translational Oncology, Genentech, South San Francisco, United States
| | - Deepak Sampath
- Department of Translational Oncology, Genentech, South San Francisco, United States
| | - Luis Schwarz
- Department of Medicine and Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, United States
| | - Henry Charles Manning
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, United States
| | - Mohammed Noor Tantawy
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, United States
| | - Carlos L Arteaga
- Department of Medicine and Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Nashville, United States
| | - Richard A Heyman
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
| | - Peter J Rix
- Department of Drug Safety and Disposition, Seragon Pharmaceuticals, San Diego, United States
| | - Lori Friedman
- Department of Translational Oncology, Genentech, South San Francisco, United States
| | - Nicholas D Smith
- Department of Chemistry, Seragon Pharmaceuticals, San Diego, United States
| | - Ciara Metcalfe
- Department of Translational Oncology, Genentech, South San Francisco, United States
| | - Jeffrey H Hager
- Department of Biology, Seragon Pharmaceuticals, San Diego, United States
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Abstract
AIM OF THE STUDY During minimally invasive abdominal surgery, a laparoscope is used to film the procedure, which is transmitted to a flat screen monitor. The horizontality of the image depends on the orientation in space and the visual comfort of the surgeon. Observing the screen via a lateral angle of incidence frequently results in the camera assistant making errors in determining the horizontality of the image. Thus, what is "right" for the camera assistant is not necessarily 'right' for the surgeon. We aimed to explain the impact of these errors in laparoscope manipulation, by the description of the parallax effect. PATIENTS AND METHODS To describe this phenomenon of perceptions changing depending on the angle of view, from the basis of the parallax effect, we observed the change of position and for two observers, (the surgeon and the camera assistant) seated at two different locations, using an experimental set up (i.e., photography equipment, a screen and a pelvitrainer). RESULTS The position of the camera assistant positioned at an angle of incidence of 45° from the surgeon, the observation of the screen with a lateral incidence changes the perception of the image viewed on the screen. For correcting the conflict between the subjective visual perception of the camera assistant and the actual image horizon, the camera assistant instinctively rotates the image, which can lead to an "incorrect" image, deleterious for the surgeon. CONCLUSIONS This article introduces a previously unexplained concept in medical literature, called the parallax effect. The parallax effect results in the camera assistant making systematic errors in determining image horizontality on the screen.
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Affiliation(s)
- J Cahais
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - L Schwarz
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - V Bridoux
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - E Huet
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France
| | - J-J Tuech
- Department of Digestive Surgery, Rouen University Hospital, 1, rue Germont, 76031 Rouen cedex, France.
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Schwarz L, Aloia TA, Eng C, Chang GJ, Vauthey JN, Conrad C. Transthoracic Port Placement Increases Safety of Total Laparoscopic Posterior Sectionectomy. Ann Surg Oncol 2016; 23:2167. [PMID: 26903047 DOI: 10.1245/s10434-016-5126-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anatomic posterior sectionectomy is performed infrequently due to the challenges of controlling the right posterior portal pedicle (RPPP) while preserving the anterior pedicle (RAPP), difficulty of visualizing the drainage of the right hepatic vein into the IVC, and the potential for significant blood loss during the caval and hepatovenous dissection. PATIENT A 62-year-old woman with three liver metastases to SVI and SVII from sigmoid colon cancer underwent five cycles of neoadjuvant chemotherapy with FOLFOX and bevacizumab with good response. She underwent a "Primary First" robotic low anterior rectosigmoid resection followed by a laparoscopic posterior sectionectomy. TECHNIQUE The patient was placed in a Modified French Position. As previously described, a transthoracic trocar was placed for optimal laparoscopic visualization and access of the superior retrohepatic IVC and drainage of the right hepatic vein into IVC. Intraoperative ultrasound was crucial to assess tumor location, define transection plane, and preserve flow to RAPP before division of RPPP. The parenchymal transection follows an oblique angle and exposes the right hepatic vein. CONCLUSIONS Transthoracic port placement augments the safety of the dissection along the IVC inferiorly and the right hepatic vein superiorly due to direct visualization. Also, it provides a direct instrument-to-target axis without the typical fulcrum of dissecting the postero/superior liver. Laparoscopic ultrasound is critical to confirm preserved flow to the RPPP and guide the parenchymal transection. Liver volumetry should be obtained before surgery to determine adequate future liver remnant if conversion to a right lobectomy becomes necessary.
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Affiliation(s)
- L Schwarz
- Division of Surgery, Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - T A Aloia
- Division of Surgery, Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Eng
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G J Chang
- Division of Surgery, Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J N Vauthey
- Division of Surgery, Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudius Conrad
- Division of Surgery, Department of Surgical Oncology, Hepato-Pancreato-Biliary Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Schwarz L, Fleming J, Katz M, Lee J, Aloia T, Vauthey N, Conrad C. Total Laparoscopic Central Pancreatectomy with Pancreaticogastrostomy for High-Risk Cystic Neoplasm. Ann Surg Oncol 2015; 23:1035. [PMID: 26542586 DOI: 10.1245/s10434-015-4957-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Organ-sparing pancreatic resection is important in prophylactic surgery for cystic neoplasms. There is controversy regarding the optimal surgical approach for pancreatic lesions in the neck or proximal body of the pancreas. Central compared with distal pancreatectomy is technically more challenging, but preserves more functional pancreatic tissue. Because of the prophylactic nature of the surgery and long survival of patients with benign and borderline malignant lesions, surgeons need to stratify greater importance to surgical morbidity and sparing pancreatic parenchyma. PATIENT The patient is a 59-year-old active woman with a symptomatic cystic neoplasm of the pancreas exhibiting high-risk imaging features. The cyst of 2.2 × 1.8 cm in the body of the pancreas was impinging on the portal venous confluence. TECHNIQUE The patient was positioned in the French Position, the lesser sac was opened, and the pancreatic body exposed. A retropancreatic tunnel was created with staple division of the neck. The body was mobilized off the portal vein and splenic vessels transected. A retrogastric pancreaticogastrostomy was sewn through an anterior gastrotomy. The stent was delivered past the pylorus to decrease pancreatic enzymatic activation. Pathology demonstrated a mixed predominantly branch duct IPMN with multifocal high grade dysplasia and PanIN3. CONCLUSIONS Laparoscopic ultrasound helps in defining cyst borders, and minimal blood loss optimizes visualization during the dissection. A minimally invasive pancreaticogastrostomy created through an anterior gastrotomy is technically feasible and safe. This approach can minimize the morbidity of prophylactic pancreatic surgery for patients with cystic neoplasms. Nevertheless, it should not compromise safety, oncologic completeness, or an organ-sparing approach.
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Affiliation(s)
- L Schwarz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Fleming
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - T Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - N Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Affiliation(s)
- L Schwarz
- Service de chirurgie hépatobiliaire et transplantation hépatique, centre hépatobiliaire, hôpital Paul-Brousse, 12-14, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - E Vibert
- Service de chirurgie hépatobiliaire et transplantation hépatique, centre hépatobiliaire, hôpital Paul-Brousse, 12-14, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - A Sa Cunha
- Service de chirurgie hépatobiliaire et transplantation hépatique, centre hépatobiliaire, hôpital Paul-Brousse, 12-14, avenue Paul-Vaillant-Couturier, 94800 Villejuif, 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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Tuech JJ, Schwarz L, Chati R, Bridoux V. Difficult hemostasis during rectal resection. J Visc Surg 2015; 152:57-60. [PMID: 25677208 DOI: 10.1016/j.jviscsurg.2015.01.005] [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] [Indexed: 10/24/2022]
Affiliation(s)
- J-J Tuech
- Département de Chirurgie Digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France.
| | - L Schwarz
- Département de Chirurgie Digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France
| | - R Chati
- Département de Chirurgie Digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France
| | - V Bridoux
- Département de Chirurgie Digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France
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Affiliation(s)
- J J Tuech
- Département de chirurgie digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France.
| | - L Schwarz
- Département de chirurgie digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France
| | - J Coget
- Département de chirurgie digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France
| | - V Bridoux
- Département de chirurgie digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France
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Schwarz L, Glos M, Pilz C, Blau A, Garcia C, Platzeck M, Fietze I, Penzel T. Evaluierung des Pharynxquerschnitts in der Diagnostik der obstruktiven Schlafapnoe bei Männern mit Normalgewicht und Präadipositas. Somnologie 2014. [DOI: 10.1007/s11818-014-0689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schwarz L, Faitot F, Soubrane O, Scatton O. Splenic artery ligation for severe oxaliplatin induced portal hypertension: A way to improve postoperative course and allow adjuvant chemotherapy for colorectal liver metastases. Eur J Surg Oncol 2014; 40:787-8. [DOI: 10.1016/j.ejso.2014.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 01/07/2014] [Indexed: 01/20/2023] Open
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Schwarz L, Sauvanet A, Regenet N, Mabrut JY, Gigot JF, Housseau E, Millat B, Ouaissi M, Gayet B, Fuks D, Tuech JJ. Long-term survival after pancreatic resection for renal cell carcinoma metastasis. Ann Surg Oncol 2014; 21:4007-13. [PMID: 24879589 DOI: 10.1245/s10434-014-3821-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgical resection of pancreatic metastasis (PM) is the only reported curative treatment for renal cell carcinoma. However, there is currently little information regarding very long-term survival. The primary objective of this study was to determine the 10-year survival of this condition using the largest surgical series reported to date. METHODS Between May 1987 and June 2003, we conducted a retrospective study of 62 patients surgically treated for PM from renal cell carcinoma at 12 Franco-Belgian surgical centers. Follow-up ended on May 31, 2012. RESULTS There were 27 male (44 %) and 35 female (56 %) patients with a median age of 54 years [31-75]. Mean disease-free interval from resection of primary tumor to reoperation for pancreatic recurrence was 9.8 years (median 10 years [0-25]). During a median follow-up of 91 months [12-250], 37 recurrences (60 %) were observed. After surgical resection of repeated recurrences, overall median survival time was 52.6 months versus 11.2 months after nonoperative management (p = 0.019). Cumulative 3-, 5-, and 10-year overall survival (OS) rates were 72, 63, and 32 %, respectively. The corresponding disease-free survival rates were 54, 35, and 27 %, respectively. Lymph node involvement and existence of extrapancreatic metastases before PM were associated with poor overall survival. CONCLUSIONS Aggressive surgical management of single or multiple PM, even in cases of extrapancreatic disease, should be considered in selected patients to allow a chance of long-term survival.
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Affiliation(s)
- L Schwarz
- Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen, France
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Maiwald B, Voigt P, Schwarz L, Schön J, Näther P, Wildberger G, Kahn T, Stumpp P. Evaluation der manuellen und automatischen Lebervolumetrie – wie verlässlich ist die radiologische Messung? ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373562] [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: 10/25/2022]
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Schwarz L, Lupinacci RM, Svrcek M, Lesurtel M, Bubenheim M, Vuarnesson H, Balladur P, Paye F. Para-aortic lymph node sampling in pancreatic head adenocarcinoma. Br J Surg 2014; 101:530-8. [PMID: 24633831 DOI: 10.1002/bjs.9444] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The significance of positive para-aortic nodes in patients with resectable pancreatic carcinoma is unclear. This study sought to evaluate the accuracy of intraoperative detection and prognostic significance of these lymph nodes in patients with resected adenocarcinoma of the pancreatic head. METHODS From 2000 to 2010, para-aortic node sampling was performed prospectively in all patients before pancreatoduodenectomy. Frozen sections were created and nodes categorized as positive or negative for metastases. Surgeons were blinded to the frozen-section results. This was followed by standard histopathological assessment of corresponding paraffin-embedded, haematoxylin and eosin-stained material. Nodes considered uninvolved by this analysis were examined immunohistochemically for micrometastases. RESULTS A total of 111 consecutive patients were included, with a median follow-up of 20·8 (range 1·5-126) months. The 1-, 2- and 5-year overall survival (OS) and disease-free survival (DFS) rates were 73·6, 54·0 and 24·7 per cent, and 51·8, 28·1 and 18·8 per cent respectively. Para-aortic node involvement was always associated with peripancreatic lymph node metastasis, and was detected by frozen-section analysis in 12 patients and by haematoxylin and eosin staining in 17. Sensitivity and specificity of frozen-section examination for detecting para-aortic lymph node metastases were 71 and 100 per cent respectively. Median OS for patients with and without para-aortic node involvement on frozen-section analysis was 9·7 versus 28·5 months respectively (P = 0·012), and 15·7 versus 27·2 months (P = 0·050) when assessed by haematoxylin and eosin staining. Median DFS for patients with and without para-aortic node involvement on frozen-section examination was 5·6 versus 12·9 months respectively (P = 0·041), and 8·4 versus 12·9 months (P = 0·038) for haematoxylin and eosin analysis. The presence of micrometastases in para-aortic nodes was not significantly associated with altered OS or DFS. CONCLUSION Para-aortic node sampling with frozen-section examination detects distant lymphatic involvement reliably. It should be performed systematically. When metastases are found, they should be considered a contraindication to pancreatic resection.
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Affiliation(s)
- L Schwarz
- Departments of Digestive Surgery and Marie Curie University, Paris
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Schwarz L, Huet E, Yzet T, Fuks D, Regimbeau JM, Scotte M. An extremely uncommon variant of left hepatic artery arising from the superior mesenteric artery. Surg Radiol Anat 2013; 36:91-4. [PMID: 23652481 DOI: 10.1007/s00276-013-1131-3] [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: 01/29/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
Abstract
We report a new variation of the left hepatic artery arising from the superior mesenteric artery. The variant was discovered during radiological examinations in a patient presenting with ruptured hepatocellular carcinoma of the left liver lobe. Anatomical description was based on CT-scan and angiographic analysis. When present the left hepatic artery originates from the left gastric artery, with an incidence of 12-34 %. Knowledge of left hepatic artery anatomy is mandatory to optimize surgical and radiological management in complex clinical situations.
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Affiliation(s)
- L Schwarz
- Department of Digestive Surgery, Rouen University Hospital-Hôpital Charles Nicolle, 76031, Rouen Cedex, France
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Bridoux V, Schwarz L, Kianifard B, Moutel G, Herve C, Tuech JJ. Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction (Br J Surg 2012; 99: 469–476). Br J Surg 2012; 99:1464; author reply 1464-5. [DOI: 10.1002/bjs.8929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- V Bridoux
- Department of Digestive Surgery, Rouen University Hospital, Rouen Cedex 76031, France
- Laboratoire d'Ethique Médicale et de Médecine Légale, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - L Schwarz
- Department of Digestive Surgery, Rouen University Hospital, Rouen Cedex 76031, France
| | - B Kianifard
- Department of Digestive Surgery, Centre Hospitalier du Mans, 72000 Le Mans, France
| | - G Moutel
- Laboratoire d'Ethique Médicale et de Médecine Légale, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - C Herve
- Laboratoire d'Ethique Médicale et de Médecine Légale, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - J-J Tuech
- Department of Digestive Surgery, Rouen University Hospital, Rouen Cedex 76031, France
- Laboratoire d'Ethique Médicale et de Médecine Légale, Faculté de Médecine, Université Paris Descartes, Paris, France
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Abstract
The palliative approach offers significant and practical care throughout the treatment of the dialysis patient until death. Varied aspects of quality of life for patients can be improved. It is possible to relieve symptoms such as sleep disorders, pain, constipation and pruritus, which, according to the present survey, are common symptoms. The treatment of dying dialysis patients or the possibility and legitimization of discontinuing treatment are complex, controversial issues with ethical and legal implications. But these issues have not yet been adequately dealt with by the nephrological community. The nurses who encounter patients daily, who constantly deal with great suffering and who lack tools to help, can lead the practice in this field within the framework of inter-disciplinary team work. In light of the obvious need for progress in this area, appropriate training courses should be considered. The implementation of the palliative approach in dialysis units could be a challenge for all of us in the coming years.
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Affiliation(s)
- H Madar
- PD unit, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel.
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Schwarz L, Moszkowicz D, Peschaud F, Keilani K, Michot F, Scotté M. Internal supravesical hernia: an unusual cause of small bowel obstruction. Clin Anat 2011; 25:663-7. [PMID: 21976395 DOI: 10.1002/ca.21284] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 08/01/2011] [Accepted: 09/02/2011] [Indexed: 11/11/2022]
Abstract
Internal hernia of the supravesical fossa is an unusual cause of small bowel obstruction. We report the case of a patient without previous abdominal surgery with an acute abdominal obstruction in which laparoscopic exploration revealed a strangulated internal supravesical hernia. To help clinicians with their pre-operative diagnosis and to better understand the clinical management of this unusual internal hernia, a description of the anatomy of the supravesical fossa is included in this case report.
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Affiliation(s)
- L Schwarz
- Department of Digestive Surgery, Rouen University Hospital, Rouen Cedex, France
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Tuech JJ, Bridoux V, Kianifard B, Schwarz L, Tsilividis B, Huet E, Michot F. Natural orifice total mesorectal excision using transanal port and laparoscopic assistance. Eur J Surg Oncol 2011; 37:334-5. [PMID: 21266304 DOI: 10.1016/j.ejso.2010.12.016] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 12/23/2010] [Indexed: 12/19/2022] Open
Abstract
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an emerging concept which has been recently applied to the field of rectal excision. The authors describe a case of total mesorectal excision using a transanal port and laparoscopic assistance. We described a procedure performed in a 45-year-old for a rectal adenocarcinoma (1 cm wide, T1sm3) 3 cm above the dentate line. The procedure is described in the text and in a didactic video.
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Affiliation(s)
- J-J Tuech
- Department of digestive surgery, Rouen University hospital, 1 rue Germont, 76031 Rouen 6, France.
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Abstract
Perforation of rectal cancer usually occurs intraperitoneally. Extraperitoneal perforation is rare and usually presents as perineal sepsis, leading to diagnosis and urgent surgical management plus antibiotic therapy. We report the case of a patient presenting with a perforated rectal carcinoma which presented as necrotizing fasciitis of the right thigh.
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Affiliation(s)
- H Khalil
- Service de chirurgie digestive, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen cedex, France
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Abstract
OBJECTIVES Although walking is a common physical activity, scientifically based training guidelines using standardised tests have not been established. Therefore this explorative study investigated the cardiovascular and metabolic load resulting from different walking intensities derived from maximal velocity (Vmax) during an incremental treadmill walking test. METHODS Oxygen uptake, heart rate (HR), blood concentrations of lactate and catecholamines, and rating of perceived exertion were recorded in 16 recreational athletes (mean (SD) age 53 (9) years) during three 30 minute walking trials at 70%, 80%, and 90% of Vmax (V70, V80, and V90) attained during an incremental treadmill walking test. RESULTS Mean (SD) oxygen uptake was 18.2 (2.3), 22.3 (3.1), and 29.3 (5.0) ml/min/kg at V70, V80, and V90 respectively (p<0.001). V70 led to a mean HR of 110 (9) beats/min (66% HRmax), V80 to 124 (9) beats/min (75% HRmax), and V90 to 152 (13) beats/min (93% HRmax) (p<0.001). Mean (SD) lactate concentrations were 1.1 (0.2), 1.8 (0.6), and 3.9 (2.0) mmol/l at V70, V80, and V90 respectively (p<0.001). There were no significant differences between catecholamine concentrations at the different intensities. Rating of perceived exertion was 10 (2) at V70, 12 (2) at V80, and 15 (2) at V90. Twelve subjects reported muscular complaints during exercise at V90 but not at V70 and V80. CONCLUSIONS Intensity and heart rate prescriptions for walking training can be derived from an incremental treadmill walking test. The cardiovascular and metabolic reactions observed suggest that V80 is the most efficient workload for training in recreational athletes. Further studies are needed to confirm these findings.
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Affiliation(s)
- M Schwarz
- Institute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany.
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