Limited Resection Versus Pancreaticoduodenectomy for Duodenal Gastrointestinal Stromal Tumors? Enucleation Interferes in the Debate: A European Multicenter Retrospective Cohort Study

Background The optimal surgical procedure for duodenal gastrointestinal stromal tumors (D-GISTs) remains poorly defined. Pancreaticoduodenectomy (PD) allows for a wide resection but is associated with a high morbidity rate. Objectives The aim of this study was to compare the short- and long-term outcomes of PD versus limited resection (LR) for D-GISTs and to evaluate the role of tumor enucleation (EN). Methods In this retrospective European multicenter cohort study, 100 patients who underwent resection for D-GIST between 2001 and 2013 were compared between PD (n = 19) and LR (n = 81). LR included segmental duodenectomy (n = 47), wedge resection (n = 21), or EN (n = 13). The primary objective was to evaluate disease-free survival (DFS) between the groups, while the secondary objectives were to analyze the overall morbidity and mortality, radicality of resection, and 5-year overall survival (OS) and recurrence rates between groups. Furthermore, the short- and long-term outcomes of EN were evaluated. Results Baseline characteristics were comparable between the PD and LR groups, except for a more frequent D2 tumor location in the PD group (68.3% vs. 29.6%; p = 0.016). Postoperative morbidity was higher after PD (68.4% vs. 23.5%; p < 0.001). OS (p = 0.70) and DFS (p = 0.64) were comparable after adjustment for D2 location and adjuvant therapy rate. EN was performed more in American Society of Anesthesiologists (ASA) stage III/IV patients with tumors < 5 cm and was associated with a 5-year OS rate of 84.6%, without any disease recurrences. Conclusions For D-GISTs, LR should be the procedure of choice due to lower morbidity and similar oncological outcomes compared with PD. In selected patients, EN appears to be associated with equivalent short- and long-term outcomes. Based on these results, a surgical treatment algorithm is proposed

Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial - the MIRO trial

<p>Abstract</p> <p>Background</p> <p>Open transthoracic oesophagectomy is the standard treatment for infracarinal resectable oesophageal carcinomas, although it is associated with high mortality and morbidity rates of 2 to 10% and 30 to 50%, respectively, for both the abdominal and thoracic approaches. The worldwide popularity of laparoscopic techniques is based on promising results, including lower postoperative morbidity rates, which are related to the reduced postoperative trauma. We hypothesise that the laparoscopic abdominal approach (laparoscopic gastric mobilisation) in oesophageal cancer surgery will decrease the major postoperative complication rate due to the reduced surgical trauma.</p> <p>Methods/Design</p> <p>The MIRO trial is an open, controlled, prospective, randomised multicentre phase III trial. Patients in study arm A will receive laparoscopic-assisted oesophagectomy, i.e., a transthoracic oesophagectomy with two-field lymphadenectomy and laparoscopic gastric mobilisation. Patients in study arm B will receive the same procedure, but with the conventional open abdominal approach. The primary objective of the study is to evaluate the major postoperative 30-day morbidity. Secondary objectives are to assess the overall 30-day morbidity, 30-day mortality, 30-day pulmonary morbidity, disease-free survival, overall survival as well as quality of life and to perform medico-economic analysis. A total of 200 patients will be enrolled, and two safety analyses will be performed using 25 and 50 patients included in arm A.</p> <p>Discussion</p> <p>Postoperative morbidity remains high after oesophageal cancer surgery, especially due to major pulmonary complications, which are responsible for 50% of the postoperative deaths. This study represents the first randomised controlled phase III trial to evaluate the benefits of the minimally invasive approach with respect to the postoperative course and oncological outcomes in oesophageal cancer surgery.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00937456">NCT00937456</a> (ClinicalTrials.gov)</p

Recherche de marqueurs moléculaires pronostiques de survie dans les cancers du rectum sur une cohorte de 119 patients (étude clinique et biologie moléculaire.)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Intervention selon Knight pour le traitement des cancers du rectum (à propos de 301 cas (1980-2000))

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Chimiothérapie Hyperthermique Intra-Péritonéale (CHIP) dans la prise en charge des cancers de l'ovaire (à propos de notre expérience sur 13 cas.)

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Le ganglion sentinelle dans le cancer du côlon (étude prospective)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Cancer de l'oesophage (étude de survie après stérilisation de la pièce opératoire par le traitement néo-adjuvant)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Bountîles, dix années d’observatoire de la fréquentation : contributions et limites de la recherche

International audienc

Endothelial Semaphorin 7A promotes neutrophil migration during hypoxia

The project to restore the maritime setting of the Mont-Saint-Michel and to improve visitor access and experience has led to a major change in how the site can be accessed and visited. To better manage and control tourist flows in a sustainable manner, the local tourism association is in need of decision-making tools. To address this issue, two complementary tools based on observation and modelling approaches were developed. First, an observatory identifies and monitors the main elements of this tourism system. Second, a dynamic model is based on the data generated by the observatory and reveals links among the elements of this system. This site-scale tool, based on multi-agent simulation, was applied to the Mont-Saint-Michel before and after restoration of the visitor access. It simulated visitor itineraries and practices, and it pinpointed areas and periods likely to be problematical for visitors and tourism managers