Perforation et rupture de l'oesophage (à propos de 36 cas et revue de la littérature)

Objectifs : Le but de ce travail est de définir les éléments du diagnostic, les facteurs pronostiques et de proposer une conduite à tenir devant une perforation de l'œsophage, à partir d'une série monocentrique et d'une revue de la littérature. Méthodes : Cette étude rétrospective porte sur 36 patients (21 hommes et 15 femmes), d'un âge moyen de 62.47 ans +- 16.25 ans, atteints d'une perforation de l'œsophage cervical (n=14), thoracique (n=16), ou abdominale (n=6) entre janvier 1983 et mai 2003. Résultats : L'étiologie était spontanée (n=10), iatrogène (n=22), traumatique (n=1) ou sur corps étrangers (n=3). Le délai diagnostique était supérieur à 24 heures dans 22 cas (61.11%). Le traitement primaire a consisté en 14 sutures primaires, 7 drainages au contact, 5 exclusions oesophagiennes et 6 oesophagectomies. La mortalité péri-opératoire était de 16.67% et la morbidité globale de 52.78%. Les facteurs retenus influençant cette morbidité sont le caractère spontané de la perforation, la présence d'un sepsis majeur à la prise en charge et la localisation thoracique de la perforation (p<0.05). La mortalité globale, en incluant le traitement secondaire est de 22.22%. Conclusions : Le traitement conservateur doit être privilégié même pour les perforations vues tardivement et en fonction de l'état septique du patient. Le traitement médical est possible pour des cas sélectionnés. Les oesophagectomies restent indiquées pour les perforations sur œsophages tumoraux, en cas d'échec d'un traitement conservateur et dès que la contamination septique impose un débridement médiastinal. La suture est le traitement de référence.ST ETIENNE-BU Médecine (422182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Douleurs abdominales aigues avec perturbations des tests hépatiques et pancréatiques après Bypass gastrique pour obésité morbide

ST ETIENNE-BU Médecine (422182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Laparoscopy could be the best approach to treat colorectal cancer in selected patients aged over 80 years: Outcomes from a multicenter study

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Specificities of Hepatocellular Carcinoma Developed on Non Alcoholic Fatty Liver Disease in Absence of Cirrhosis Revealed by Tissue 1H-NMR Spectroscopy

SESSION 6 - CANCER-RELATED MALNUTRITION, METABOLISM, DYSIMMUNITYBackground and aims:Epidemiologic studies suggest that NAFLD increases the risk of Hepato-Cellular Carcinoma (HCC),even in non-cirrhotic NAFLD. This underlying disease is reported in up to 40% HCC.To get insights into the biology of HCC in non-cirrhotic NAFLD and seek for putative cancer pathways, we performed metabolomics in HCC associated with cirrhosis and non-cirrhotic NAFLD.Methods:Metabolomics was performed using 1H-NMR Spectroscopy. The analysis included 28 pairs of HCC tissue and distant Non-Involved Tissue (NIT) collected from patients undergoing hepatectomy. HCC was associated with cirrhosis (n = 9), normal liver (n=6) or NAFLD (n = 13).Results:In HCC versus NIT, statistical analyses showed high level of lactate and phosphocholine and low level of glucose. Multivariate analysis of HCC groups showed increased level of β-hydroxybutyrate in HCC-Cirrhosis and increased level of glutamine in HCC-NAFLD. OPLS-DA models of HCC-cirrhosis vs NIT (either normal tissue or cirrhosis) and HCC-NAFLD vs NIT (either normal tissue or NAFLD) were constructed before comparing them in shared and unique structure (SUS) plots. From SUS-plots, HCC-Cirrhosis was characterized by high levels of β-hydroxybutyrate, tyrosine and phenylalanine, whereas HCC-NAFLD was characterized by high levels of glutamine/glutamate. Glutamine Synthetase (GS) immuno-staining was correlated with the NMR-spectroscopy glutamine quantification.Conclusion:This study provides evidence of metabolic specificities of HCC associated with non-cirrhotic NAFLD versus HCC associated with cirrhosis. These alterations could suggest activation of glutamine synthetase pathway in HCC-NAFLD and mitochondrial dysfunction in HCC-cirrhosis, that may be part of specific carcinogenic processe

Peritoneal carcinomatosis treated with cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for advanced ovarian carcinoma: A French multicentre retrospective cohort study of 566 patients.

International audienceBACKGROUND: Despite a high response rate to front-line therapy, prognosis of epithelial ovarian carcinoma (EOC) remains poor. Approaches that combine Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have been developed recently. The purpose of this study was to assess early and long-term survival in patients treated with this strategy. PATIENTS AND METHODS: A retrospective cohort multicentric study from French centres was performed. All consecutive patients with advanced and recurrent EOC treated with CRS and HIPEC were included. RESULTS: The study included 566 patients from 13 centres who underwent 607 procedures between 1991 and 2010. There were 92 patients with advanced EOC (first-line treatment), and 474 patients with recurrent EOC. A complete cytoreductive surgery was performed in 74.9% of patients. Mortality and grades 3 to 4 morbidity rates were 0.8% and 31.3%, respectively. The median overall survivals were 35.4 months and 45.7 months for advanced and recurrent EOC, respectively. There was no significant difference in overall survival between patients with chemosensitive and with chemoresistant recurrence. Peritoneal Cancer Index (PCI) that evaluated disease extent was the strongest independent prognostic factor for overall and disease-free survival in all groups. CONCLUSION: For advanced and recurrent EOC, curative therapeutic approach combining optimal CRS and HIPEC should be considered as it may achieve long-term survival in patients with a severe prognosis disease, even in patients with chemoresistant disease. PCI should be used for patient's selection

Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study

International audienceAims: The aims of this study were to compare short-and long-term outcomes for clinical T2N0 oesophageal cancer with analysis of (i) primary surgery (S) versus neoadjuvant therapy plus surgery (NS), (ii) squamous cell carcinoma and adenocarcinoma subsets; and (iii) neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy.Methods: Data were collected from 30 European centres from 2000 to 2010. Among 2944 included patients, 355 patients (12.1%) had cT2N0 disease; 285 (S) and 70 (NS), were compared in terms of short-and long-term outcomes. Propensity score matching analyses were used to compensate for differences in baseline characteristics.Results: No significant differences between the groups were shown in terms of in hospital morbidity and mortality. Nodal disease was observed in 50% of S-group at the time of surgery, with 20% pN2/N3. Utilisation of neoadjuvant therapy was associated with significant tumour downstaging as reflected by increases in pT0, pN0 and pTNM stage 0 disease, this effect was further enhanced with neoadjuvant chemoradiotherapy. After adjustment on propensity score and confounding factors, for all patients and subset analysis of squamous cell and adenocarcinoma, neoadjuvant therapy had no significant effect upon survival or recurrence (overall, loco-regional, distant or mixed) compared to surgery alone. There were no significant differences between neoadjuvant chemotherapy and chemoradiotherapy in short-or long-term outcomes.Conclusion: The results of this study suggest that a surgery alone treatment approach should be recommended as the primary treatment approach for cT2N0 oesophageal cancer despite 50% of patients having nodal disease at the time of surgery

Ovarian and peritoneal psammocarcinoma: Results of a multicenter study on 25 patients

International audiencePurpose: Psammocarcinoma (PK) is a rare disease of unknown origin. We aimed to report the characteristics, management and survival of patients operated on for PK within the French Network for Rare Peritoneal Malignancies (RENAPE) expert centers.Patients and methods: All consecutive cases of PK operated within all 26 RENAPE centers between 1997 and 2018 were retrospectively analyzed.Results: Twenty-five patients were identified. The median age was 53 years [range 17–78]. None of the patients had extra peritoneal metastases at diagnosis. A median of 6 cycles of carboplatin-based systemic chemotherapy was delivered in 52% preoperatively (n = 13) and 56% postoperatively (n = 14); associated with placlitaxel for 12 patients. All patients were operated on. The median PCI was 23 [0–33]. Eighty-four percent had a complete cytoreductive surgery through digestive (n = 7), spleen (n = 3), pancreas (n = 1) resections and/or multiple peritonectomies (n = 11). Five patients (20%) had intraperitoneal chemotherapy. Morbidity (Dindo-Clavien ≥3) was 12%. No postoperative death occurred. After a median follow-up of 42 months (range [2–194]), the median overall (OS) and progression-free (DFS) survival times were respectively 128 months and 31 months. Eighteen patients recurred (72%), mainly in the peritoneum (n = 16). Four of them (22%) were reoperated. The 5 and 10-year DFS rates were both 20.3%. The 5 and 10-year OS rates were 62% and 51.7%, respectively. A complete cytoreductive surgery was associated with a better OS and DFS in a univariate analysis.Conclusion: Complete cytoreductive surgery is the cornerstone of the PK's management as a primary treatment. Recurrence remains common and new adjuvant strategies seem needed

Incidence and Risk Factors Related to Symptomatic Venous Thromboembolic Events After Esophagectomy for Cancer

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