Gastric Cancer Surgery

Le cancer de l’estomac est l’une des principales causes de mortalité par cancer dans le monde. Même si des progrès dans les traitements non chirurgicaux ont été réalisés, avec l’avènement de la chimiothérapie périopératoire, la chirurgie reste au centre de la prise en charge de ces tumeurs, représentant la seule option curative à l’heure actuelle, si une résection complète dite « R0 » peut être obtenue. Des recommandations ont ainsi été émises par la Société Française de Chirurgie Digestive (SFCD) et l’Association de Chirurgie Hépato-Biliaire et Transplantation (ACHBT), recommandations labellisées par l’Institut National du Cancer (INCa). Le but de cet article est de discuter de l’étendue de la résection digestive et du curage ganglionnaire ainsi que de la technique de reconstruction digestive à effectuer, et de préciser la place de la chimiohyperthermie intrapéritonéale et de la chirurgie palliative dans la prise en charge des adénocarcinomes gastriques

Deltaic and Coastal Sediments as Recorders of Mediterranean Regional Climate and Human Impact Over the Past Three Millennia

International audienc

Development of a hifu treatment using a toroidal transducer for pancreatic adenocarcinoma: Preliminary in vivo study

International audiencePancreatic adenocarcinoma is one of the most aggressive cancer. Regardless of the treatment used, the survival rate after 5 years is lower than 6%. Toroidal transducers can treat up to 60 cm3 of tissues in 370 seconds without the need to displace the HIFU probe. In this study, which included fourteen pigs, we evaluated in vivo the use of this device for treating the pancreas and peripancreatic vessels. The device was used intra-operatively. The transducer, working at 2.5MHz, has a toroidal shape with a radius of curvature of 70 mm focusing on a circle of 30 mm. An ultrasound-imaging probe working at 7.5 MHz was placed in the center of the HIFU transducer. Ablations were created in 440 seconds using an acoustic power of 85 or 100 watts. In total eight pigs were included in this study. Eight lesions were created in the pancreas and around peri-pancreatic vessels and observed immediately after treatment. Homogenous ablations were obtained in all cases and were confirmed histologically. The average diameter of the pancreatic ablations was 33.1 � 5.0 mm. These ablations were also homogeneous all around the peripancreatic artery and without occlusion as confirmed by Doppler examination. Using this toroidal HIFU transducer it is possible to treat the most challenging region of the pancreas and its surrounding vessels without any occlusion. This may allow to treat locally advanced pancreatic tumors which are the main contra-indication to curative resection

Quantitative ultrasound techniques for assessing thermal ablation: Measurement of the backscatter coefficient from ex vivo human liver

Background: Understanding the changes occurring in biological tissue during thermal ablation is at the heart of many current challenges in both therapy and medical imaging research.Purpose: The objective of this work is to quantitatively interpret the scattering response of human liver samples, before and after thermal ablation. We report acoustic measurements performed involving n = 21 human liver samples. Thermal ablation is achieved at temperatures between 45 and 80°C and quantification of the irreversible changes in acoustic attenuation and Backscattering Coefficient (BSC) is reported, with a particular attention to the latter.Methods: Both attenuation coefficient and BSCs were measured in the frequency range from 10 to 52 MHz. Scans were performed before heating and after cooling down. Attenuation coefficients were calculated using spectral difference method and BSC estimated using the reference phantom method.Results: Strong increases of attenuation coefficients and BSCs with heating temperature were observed. Quantitative ultrasonic parameters obtained with the polydisperse structure factor model (poly‐SFM)are compared to histological observations and seen to be close to hepatocyte mean diameter (HMD). Conclusions: The results presented in this study provide a description of the impact of thermal ablation in human liver tissue on acoustic attenuation and the BSC. For the first time, quantitative agreement between the Effective Scatterer Diameter (ESD) estimated from BSC and HMD was shown, highlighting the important role of cellular network in the scattering response of the medium. This core result is an important step toward the determination of the nature of scattering sources in biological tissues

Portal blood pressure and hypoxemia: The 2 main mechanisms of liver regeneration?

International audienc

Intraoperative HIFU Ablation of the Pancreas Using a Toroidal Transducer in a Porcine Model. The First Step towards a Clinical Treatment of Locally Advanced Pancreatic Cancer

Apart from palliative chemotherapy, no other therapy has been proven effective for the treatment of locally advanced pancreatic tumors. In this study, an intraoperative high-intensity focused ultrasound (HIFU) device was tested in vivo to demonstrate the feasibility of treating the pancreatic parenchyma and tissues surrounding the superior mesenteric vessels prior to clinical translation of this technique. Twenty pigs were included and treated using a HIFU device equipped with a toroidal transducer and an integrated ultrasound imaging probe. Treatments were performed with energy escalation (from 30 kJ to 52 kJ). All treatments resulted in visible (macroscopically and in ultrasound images) homogeneous thermal damage, which was confirmed by histology. The dimensions of thermal lesions measured in ultrasound images and those measured macroscopically were correlated (r = 0.82, p < 0.05). No arterial spasms or occlusion were observed at the lowest energy setting. Temporary spasm of the peripancreatic artery was observed when using an energy setting greater than 30 kJ. The possibility of treating the pancreas and tissues around mesenteric vessels without vascular thrombosis holds great promise for the treatment of locally advanced pancreatic cancers. If clinically successful, chemotherapy followed by HIFU treatment could rapidly become a novel treatment option for locally advanced pancreatic cancer

Pancreatic Ductal Adenocarcinoma: Current and Emerging Therapeutic Uses of Focused Ultrasound

Pancreatic ductal adenocarcinoma (PDAC) diagnosis accompanies a somber prognosis for the patient, with dismal survival odds: 5% at 5 years. Despite extensive research, PDAC is expected to become the second leading cause of mortality by cancer by 2030. Ultrasound (US) has been used successfully in treating other types of cancer and evidence is flourishing that it could benefit PDAC patients. High-intensity focused US (HIFU) is currently used for pain management in palliative care. In addition, clinical work is being performed to use US to downstage borderline resectable tumors and increase the proportion of patients eligible for surgical ablation. Focused US (FUS) can also induce mechanical effects, which may elicit an anti-tumor response through disruption of the stroma and can be used for targeted drug delivery. More recently, sonodynamic therapy (akin to photodynamic therapy) and immunomodulation have brought new perspectives in treating PDAC. The aim of this review is to summarize the current state of those techniques and share our opinion on their future and challenges