Malignant Rhabdoid Tumour of the Liver in the Young Adult: Report of First Two Cases

Few cases of malignant rhabdoid tumour (MRT) of the liver are reported in literature and always in paediatric patients. We report the first two cases of young adults submitted to hepatic resection for MRT of the liver. A major liver resection was performed in both cases. The histology showed round or fusiform, loosely cohesive cells. The cytoplasm contained abundant eosinophilic inclusions, which caused the nuclei to be located in eccentric locations, giving the characteristic rhabdoid appearance. The immunohistochemical study was performed, and characteristic lack of nuclear INI1 protein expression was found. In a case surgery was associated to chemoradiotherapy. One patient died at 48 months followup for tumour recurrence. The other is still alive at 25 months followup. MRTs are rare tumours of pediatric age with poor prognosis. Hypothetical less malignant behaviour in the young adults could be supposed. Therefore an aggressive surgical and oncological treatment seems justified

CHIRURGIE PANCREATIQUE: EVALUATION ET REDUCTION DES RISQUES

Pancreaticoduodenectomy (PD) is the only potentially curative technique for managing head pancreatic cancer. The presenting symptoms of this disease often include jaundice. Surgery in jaundiced patients carries an increased risk of postoperative complications. Some experimental studies report beneficial effects of biliary drainage, but this benefit remains controversial in clinical studies. The aim of our first study was to examine the influence of preoperative biliary drainage on postoperative global and infectious complication after PD. PD was introduced and popularized by Whipple in 1935. Since then, many centres reported mortality rate less than 4% but morbidity rate remains high, about 50%. The aim of our second study was to determine which independent factors influence the development of pancreatic fistula and delayed gastric emptying after PD. PD in the elderly is still debated in the literature: is curative resection justified in the elderly given the high operative morbidity rates and the short life expectancies? The aim of our third study was to determine whether PD is associated with higher mortality and morbidity in patients' ≥ 70 years old. All this work allowed us to better comprehension of the consequences of PD. Moreover it is necessary for any surgeon to know the complications of any surgical procedure in order to prevent them and to inform the patient.La duodenopancréatectomie céphalique (DPC) représente le seul traitement potentiellement curateur des adénocarcinomes de la tête du pancréas, qui sont souvent révélés par un ictère. La chirurgie chez le patient ictérique est grevée d'une morbi-mortalité conséquente. Dans des études animales il a été retrouvé un bénéfice au drainage biliaire pré-opératoire ; bénéfice qui reste controversé chez l'homme. Le but de notre premier travail était d'analyser l'impact du drainage biliaire préopératoire sur les complications globales et infectieuses après DPC. C'est en 1935 que Whipple a rapporté les premiers résultats de l'intervention qui porte son nom. Depuis le taux de mortalité opératoire est inférieur à 4% dans la plupart des grandes séries, mais le taux de complication reste élevé, avoisinant les 50%. Notre deuxième travail s'est intéressé aux facteurs de risques des deux principales complications après DPC, la fistule pancréatique et la gastroparésie. Le bénéfice de la DPC chez le sujet âgé est une question récurrente dans la littérature : est-il licite de proposer une intervention chirurgicale avec un taux de complications non négligeable et dont le bénéfice attendu est faible chez un groupe de patients ayant une espérance de vie limitée ? Le but de notre troisième travail était de déterminer si un âge supérieur à 70 ans pouvait influencer les suites opératoires de la DPC. L'ensemble de ce travail nous a permis de mieux comprendre les conséquences d'une technique chirurgicale particulière. Par ailleurs il est nécessaire à tout chirurgien de connaître les complications inhérentes à tout geste chirurgical afin d'en prévenir la survenue et surtout d'en informer le patient

Efficacité à long terme de la radiofréquence hépatique pour le traitement du CHC et facteurs pronostiques de récidive

But : Evaluer la survie à long terme et les facteurs pronostiques de survie et de récidive de la radiofréquence (RF) pour le traitement du CHC.Patients et méthode : 139 patients (113 hommes) d'âge moyen 70+/-9 ans, avec 228 nodules de CHC traités ont été inclus. La survie a été calculée à partir de la1ière séance de RF. Les facteurs pronostiques de récidive et de survie ont été recherchés en analyse uni puis multivariée. Résultats : La morbidité précoce était de 7,2% et la mortalité de 1,2%. La survie globale était de 88%, 73%, 56%, 43% et 35% à 1 an, 2 ans, 3 ans, 4 ans et 5 ans. Les facteurs pronostics de survie favorable, en analyse univariée, étaient: un score Child Pugh A, le nombre de lésions, le taux d alpha-foetoprotéine < 20ng/ml et la RF par laparotomie; en analyse multivariée, seul le score Child Pugh A était lié à la survie. En analyse univariée et multivariée, seule la taille de la lésion était liée à la récidive. Conclusion : La radiofréquence dans le traitement du CHC est une technique mature. La survie demeure liée à l'hépatopathie sous jacente.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

The Socioeconomic Impact of Surgical Site Infections.

Surgical site infections are an ever-increasing phenomenon worldwide due to different factors. This brief report aimeds to highlight at a glance, for both physicians and political and institutional leaders, the economic burden of surgical site infections. This brief report aimed to highlight the economic burden of surgical site infections (SSIs). A narrative review focusing on this subject has been carried out. Surgical site infections are responsible for generating important costs. In 2017, a French cohort highlighted a mean cost of each SSI treatment to be around €1,814; the same year, the Centers for Disease Control and Prevention guidelines evaluated the mean cost caused by SSI treatment to be from $10,443 to$25,546 per SSI. This cost depends on many factors including the patient himself and the type of surgery. Prevention of the risk of infection is, therefore, a profitable concept for surgery that must be integrated within all healthcare managements worldwide

Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma.

PURPOSE: The treatment of acutely obstructed carcinoma of the left colon still represents a matter of controversy. The aim of the study was to evaluate the results of its management by emergency subtotal or total colectomy with immediate anastomosis without diversion. METHODS: An emergency subtotal/total colectomy was performed in 72 patients (mean age 74.9 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively distended colon of dubious viability, and likely to contain ischemic lesions, signs of impending cecal perforation, and masses suggesting synchronous colonic cancers. RESULTS: Postoperative mortality was 9.7% (7 patients). An 83-year-old woman died as a result of an anastomotic dehiscence; the six other deaths resulted of cardiopulmonary complications. Postoperative morbidity was 15% (11 patients) including two fistulas, which recovered without surgery. There were eight synchronous colon carcinomas. Six months after surgery, the mean daily stool frequency was two following subtotal colectomy and three after total colectomy. CONCLUSION: Emergency subtotal colectomy achieves in one-stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions and serous tears on the cecum. It ensures restoration of gut contiguity via a safe ileocolonic anastomosis and removes occasional lesions proximal to the index cancer

Intraoperative Contrast-Enhanced Ultrasound in Colorectal Liver Metastasis Surgery Improves the Identification and Characterization of Nodules

International audienceINTRODUCTION: The sensitivity of preoperative assessment of colorectal liver metastases (CRLM) ranges from 74 to 80%. Intraoperative ultrasound (IOUS) associated with contrast-enhanced intraoperative ultrasound (CE-IOUS) may be able to improve this. Thus, the aims of this study were to assess the value of IOUS and CE-IOUS for the surgical approach and to determine risk factors both for the detection of new nodules and for the modification of the surgical strategy.MATERIALS AND METHODS: Forty-three patients who underwent CRLM surgery were included. These patients had an MRI in the 8 weeks preceding surgery and benefited from intraoperative IOUS and CE-IOUS.RESULTS AND DISCUSSION: The use of IOUS/CE-IOUS permitted the identification of 43 additional lesions and an improved characterization of nodules in 23 patients with a resulting modification of surgical strategy. Lesions were down-staged in six patients and up-staged in six patients. Chemotherapy (p = 0.02) and the presence of nodules in the left lobe (p = 0.04) were predictive factors for finding new nodules at IOUS/CE-IOUS. The discovery of a new nodule systematically modified surgical management. IOUS/CE-IOUS improved intraoperative management of liver metastases. The techniques enable pertinent modification of surgical resections and a reduction of residual lesions.</p

Visceral surgeon and intraoperative cholangiography: Survey about French Wild West surgeons

International audienceCholecystectomy is one of the most common abdominal surgical procedures. No formal agreement has been reached about the routine practice of intraoperative cholangiography (IOC). The purpose of this survey was to describe the practices and the opinions of surgeons in western France. A survey was conducted among 300 visceral surgeons practicing in western France who were asked to respond to a questionnaire with objective and subjective items. One hundred forty-eight answers were interpretable. Among these 148 surgeons, 125 (83.4%) performed IOC routinely (IOCr group) and 23 (15.4%) selectively (IOCs group). Mean age of responding surgeons was 49.3 years. Groups IOCr and IOCs were not significantly different concerning surgical experience. Surgeons in both groups responded that IOC effectively screens for intraoperative bile duct injury. In our survey, routine practice of IOC was more common than reported by our English-speaking colleagues. The routine users responded that IOC can screen for intraoperative bile duct injury or choledocholithiasis. The selective users responded that IOC has its own morbidity. IOC is commonly performed in France during laparoscopic cholecystectomy. Although it may not be indispensable, it allows rapid screening for intraoperative bile duct injury. It also provides documented proof of good surgical practice in the event of a litigation claim after bile duct injury.</p

Proposal of a new classification of postoperative ileus based on its clinical impact-results of a global survey and preliminary evaluation in colorectal surgery

IF 2.426International audiencePURPOSE: There is no consensual definition of postoperative ileus (POI), which leads to a lack of reproducibility. The aims of this study were (i) to propose and evaluate a classification of postoperative ileus based on its consequences and (ii) to assess the reproducibility of the classification.METHODS: A national global survey was carried out according to the DELPHI method in order to create a classification of primary POI. The classification was subsequently tested on a cohort of patients who underwent colorectal surgery. Finally, a reproducibility test was performed in five teaching hospitals with junior and senior surgeons.RESULTS: A five-stage classification was proposed: grade A (least) to grade E (worst). For better differentiation, subcategories (D1/D2) were included. Overall, 173 patients were included who underwent colorectal surgery. Forty of them experienced primary postoperative ileus (23.1%). Grade A occurred in 10 cases, grade B in 10 cases, grade C in 14 cases, grade D1 in 2 cases, and grade D2 in 2 cases. POI-related death (grade E) occurred in 2 cases. Patients with grade A POI recovered their gastrointestinal function significantly faster than those with higher grades (p = 0.01), and were more likely to undergo laparoscopic surgery (p = 0.04). The Intraclass Correlation Coefficient (ICC) was 0.83 in the overall population, and 0.83 and 0.82 respectively in the junior and senior surgeon populations.CONCLUSION: This classification is easy to both use and reproduce. It will improve the reproducibility, evaluation, and assessment of POI. These preliminary results should be confirmed in a multi-centric international study

The combination of everolimus and zoledronic acid increase the efficacy of gemcitabine in a mouse model of pancreatic adenocarcinoma

International audienceBackground: Gemcitabine is a standard treatment for pancreatic adenocarcinoma. Many mechanisms are involved in gemcitabine resistance, such as reduced expression of the human equilibrative nucleoside transporter 1 (hENT1) membrane transporter, deoxycytidine kinase deficiency, and changes in the signal transmission of mitogen-activity protein kinase (MAPK) and the phosphoinositide 3-kinase (PI3K) pathways.Aim:To evaluate the anti-tumor efficiency of blocking signaling pathways using combined action of gemcitabine, everolimus and zoledronic acid versus gemcitabine alone in a mouse subcutaneous xenograft.Methods: Implantations of two human pancreatic adenocarcinoma cells lines (PANC1, K-ras mutated and gemcitabine-resistant; and BxPc3, wild-type K-ras and gemcitabine-sensitive) were performed on male athymic nude mice. The mice received different treatments: gemcitabine, gemcitabine plus everolimus, everolimus, gemcitabine plus zoledronic acid, everolimus plus zoledronic acid, or gemcitabine plus everolimus and zoledronic acid, for 28 days. We measured the tumor volume and researched the expression of the biomarkers involved in the signaling pathways or in gemcitabine resistance.Results: In wild-type K-ras tumors, the combinations of gemcitabine plus everolimus; zoledronic acid plus everolimus; and gemcitabine plus zoledronic acid and everolimus slowed tumor growth, probably due to caspase-3 overexpression and reduced Annexin II expression. In mutated K-ras tumors, gemcitabine plus everolimus and zoledronic acid, and the combination of zoledronic acid and everolimus, decreased tumor volume as compared to gemcitabine alone, inhibiting the ERK feedback loop induced by everolimus.Conclusion: The combination of zoledronic acid and everolimus has an antitumor effect and could increase gemcitabine efficacy

Prospective evaluation of the quality of laparoscopic sigmoid resection for diverticular disease.

BACKGROUND/AIMS: There were no studies comparing whether the same principles as those in conventional surgery have been applied to the laparoscopic procedure. The aim of this study was to compare the quality of open sigmoid colectomy (OSC) with laparoscopic sigmoid colectomy (LSC) for diverticular disease. Specific measurements made were of the level of anastomosis from sacral promontory, distance from anal verge, specimen length and recurrence rates. METHODOLOGY: Comparison was made between 72 consecutive patients who underwent an elective LSC to a control group of 22 patients who had previously undergone an OSC in the same institution. All patients had proctoscopy to measure the distance from the anal verge. A computed tomography without injection of contrast medium was performed in all cases to measure the distance from the sacral promontory to the top of the staple row. Length of fresh resected specimen and recurrence rates of diverticulitis were used for comparison. RESULTS: There was no statistical difference between the two groups in terms of distance of anastomosis from anal verge (p=0.78) and distance from sacral promontory (p=0.65) in LSC and OSC patients respectively. Specimen length was more extensive in the OSC group than in the LSC group (p=0.02). After a mean follow-up of 43.5 (+/- 14.8) months in the LSC group and 62.4 (+/- 7.4) months in the OSC group, there was no difference in recurrent attack\u27s rates of diverticulitis. CONCLUSIONS: This study suggested that laparoscopic procedure applied the same principles as those used in conventional surgery