Pancreatic head cancer in patients with chronic pancreatitis

International audienceBACKGROUND: Chronic pancreatitis (CP) is a risk factor of pancreatic adenocarcinoma (PA). The discovery of a pancreatic head lesion in CP frequently leads to a pancreaticoduodenectomy (PD) which preceded by a multidisciplinary meeting (MM). The aim of this study was to evaluate the relevance between this indication of PD and the definitive pathological results. METHODS: Between 2000 and 2010, all patients with CP who underwent PD for suspicion of PA without any histological proof were retrospectively analyzed. The operative decision has always been made at an MM. The definitive pathological finding was retrospectively confronted with the decision made at an MM, and patients were classified in two groups according to this concordance (group 1) or not (group 2). Clinical and biological parameters were analyzed, preoperative imaging were reread, and confronted to pathological findings in order to identify predictive factors of malignant degeneration. RESULTS: During the study period, five of 18 (group 1) patients with CP had PD were histologically confirmed to have PA, and the other 13 (group 2) did not have PA. The median age was 52.5+/-8.2 years (gender ratio 3.5). The main symptoms were pain (94.4%) and weight loss (72.2%). There was no patient's death. Six (33.3%) patients had a major complication (Clavien-Dindo classification ≥ 3). There was no statistical difference in clinical and biological parameters between the two groups. The rereading of imaging data could not detect efficiently all patients with PA. CONCLUSIONS: Our results confirmed the difficulty in detecting malignant transformation in patients with CP before surgery and therefore an elevated rate of unnecessary PD was found. A uniform imaging protocol is necessary to avoid PD as a less invasive treatment could be proposed

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

TGFβ signaling pathway in intrahepatic cholangiocarcinoma

Le cholangiocarcinome intra hépatique (CCI) est une tumeur hépatique primitive développée aux dépens des canaux biliaires. Son pronostic est mauvais avec les traitements actuels qui augmentent peu la survie des patients. Sa cancérogénèse est complexe impliquant de nombreuses voies de signalisation dont la voie TGFβ. L’hypothèse du projet est l’implication des ARN longs non-codants (ARNlnc) comme médiateurs de la voie TGFβ dans le développement du CCI. Les objectifs de notre travail étaient d’identifier des ARNlnc régulés par le TGFβ et potentiels biomarqueurs diagnostiques ou pronostiques. Nous avons identifié une signature transcriptomique spécifique du TGFβ après stimulation de lignées cellulaires de CCI. Parmi les nouveaux gènes cibles, plusieurs ARNlnc ont été identifiés dont CASC15 renommé TLINC pour TGFβ-induced long intergenic non-coding RNA. TLINC aurait un rôle dans le remodelage du microenvironnement impliqué dans la cancérogénèse du CCI notamment par la régulation de l’IL8. Ce rôle pourrait s’exercer par l’interaction avec d’autres ARNlnc déjà identifiés dans le CCI e.g. NEAT1. TLINC est surexprimé dans les tumeurs humaines de CCI et pourrait constituer un biomarqueur diagnostique. Des isoformes circulaires de TLINC mises en évidence dans les tumeurs pourraient être détectables dans le sérum et constituer des biomarqueurs non invasifs. L’analyse transcriptomique d’une cohorte de patients divisée en 2 sous-groupes de pronostic différent a identifié une signature d’ARNlnc prédictive de la survie. L’ARNlnc ANRIL, déjà connu dans d’autres cancers, est un des ARNlnc qui pourrait constituer un biomarqueur pronostique.Intrahepatic cholangiocarcinoma (ICC) is a primary liver tumor developed from bile ducts. ICC prognosis is poor with current treatments that slightly increase patient survival. ICC carcinogenesis is complex and involves multiple signaling pathways including TGFβ pathway. Our hypothesis relies on the involvement of long non-coding RNA (lncRNA) as mediators of TGFβ pathway in the development of ICC. The aim of the study was to identify and to characterize TGFβ regulated lncRNA as ICC potential diagnostic or prognostic biomarkers. We identified a specific transcriptomic signature after stimulation of ICC cell lines with TGFβ. Among the novel TGFβ target genes, several lncRNAs were identified including CASC15 renamed TLINC standing for TGFβ-induced long intergenic non-coding RNA. TLINC may play a role in the remodeling of an inflammatory microenvironment involved in ICC carcinogenesis, including the regulation of IL8. This role could be exerted by the interaction with other lncRNAs already identified in the ICC e.g. NEAT1. TLINC is overexpressed in human ICC tumors and may represent a relevant diagnostic biomarker. Circular isoforms of TLINC found in tumors may be detectable in serum and be noninvasive biomarkers. Transcriptomic analysis of tumors from a cohort of patients divided into 2 prognostic groups identified a lncRNAs signature predictive for survival. LncRNA ANRIL, already known to be upregulated in other cancers, is one of the lncRNAs that could be a prognostic biomarker in ICC

Etude de la voie TGFβ dans le cholangiocarcinome intrahépatique : implication des ARN longs non-codants

Intrahepatic cholangiocarcinoma (ICC) is a primary liver tumor developed from bile ducts. ICC prognosis is poor with current treatments that slightly increase patient survival. ICC carcinogenesis is complex and involves multiple signaling pathways including TGFβ pathway. Our hypothesis relies on the involvement of long non-coding RNA (lncRNA) as mediators of TGFβ pathway in the development of ICC. The aim of the study was to identify and to characterize TGFβ regulated lncRNA as ICC potential diagnostic or prognostic biomarkers. We identified a specific transcriptomic signature after stimulation of ICC cell lines with TGFβ. Among the novel TGFβ target genes, several lncRNAs were identified including CASC15 renamed TLINC standing for TGFβ-induced long intergenic non-coding RNA. TLINC may play a role in the remodeling of an inflammatory microenvironment involved in ICC carcinogenesis, including the regulation of IL8. This role could be exerted by the interaction with other lncRNAs already identified in the ICC e.g. NEAT1. TLINC is overexpressed in human ICC tumors and may represent a relevant diagnostic biomarker. Circular isoforms of TLINC found in tumors may be detectable in serum and be noninvasive biomarkers. Transcriptomic analysis of tumors from a cohort of patients divided into 2 prognostic groups identified a lncRNAs signature predictive for survival. LncRNA ANRIL, already known to be upregulated in other cancers, is one of the lncRNAs that could be a prognostic biomarker in ICC.Le cholangiocarcinome intra hépatique (CCI) est une tumeur hépatique primitive développée aux dépens des canaux biliaires. Son pronostic est mauvais avec les traitements actuels qui augmentent peu la survie des patients. Sa cancérogénèse est complexe impliquant de nombreuses voies de signalisation dont la voie TGFβ. L’hypothèse du projet est l’implication des ARN longs non-codants (ARNlnc) comme médiateurs de la voie TGFβ dans le développement du CCI. Les objectifs de notre travail étaient d’identifier des ARNlnc régulés par le TGFβ et potentiels biomarqueurs diagnostiques ou pronostiques. Nous avons identifié une signature transcriptomique spécifique du TGFβ après stimulation de lignées cellulaires de CCI. Parmi les nouveaux gènes cibles, plusieurs ARNlnc ont été identifiés dont CASC15 renommé TLINC pour TGFβ-induced long intergenic non-coding RNA. TLINC aurait un rôle dans le remodelage du microenvironnement impliqué dans la cancérogénèse du CCI notamment par la régulation de l’IL8. Ce rôle pourrait s’exercer par l’interaction avec d’autres ARNlnc déjà identifiés dans le CCI e.g. NEAT1. TLINC est surexprimé dans les tumeurs humaines de CCI et pourrait constituer un biomarqueur diagnostique. Des isoformes circulaires de TLINC mises en évidence dans les tumeurs pourraient être détectables dans le sérum et constituer des biomarqueurs non invasifs. L’analyse transcriptomique d’une cohorte de patients divisée en 2 sous-groupes de pronostic différent a identifié une signature d’ARNlnc prédictive de la survie. L’ARNlnc ANRIL, déjà connu dans d’autres cancers, est un des ARNlnc qui pourrait constituer un biomarqueur pronostique

Cancer de la tête du pancréas sur pancréatite chronique (un diagnostic toujours difficile)

Objectif: Evaluation de la concordance entre l'indication de duodénopancréatectomie céphalique (DPC) pour suspicion d'adénocarcinome (ADK) de la tête du pancréas sur pancréatite chronique (PC), et le résultat histologique définitif. Méthodes: Analyse rétrospective entre 2000 et 2010 des patients atteints de PC opérés d'une DPC pour suspicion d'ADK sans preuve histologique: répartition des patients en 2 groupes selon le résultat histologique, analyse uni-variée des données cliniques et biologiques à la recherche de facteurs prédictifs d'ADK et relecture de l'imagerie préopératoire. Résultats: 18 patients ont été inclus. La présence d'un ADK a été confirmée chez 5 patients. La morbidité était de 61.1% (33,3% de complications majeures). L'analyse uni-variée n'a pas montré de différence. La relecture de l'imagerie n'a pas permis de détecter tous les patients atteints de cancer. Conclusion: Les résultats confirment la difficulté rencontrée pour détecter la transformation maligne chez les patients atteints de PC. Un protocole d'imagerie uniforme est nécessaire pour éviter la réalisation d'une DPC alors qu'un traitement moins invasif peut être proposé.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Ileal-J-Pouch Volvulus After Restorative Proctocolectomy

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A weird polyp, 8 years after the Whipple procedure

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Expression of long non-coding RNA ANRIL predicts a poor prognosis in intrahepatic cholangiocarcinoma

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Venous stent in liver transplant candidates: Dodging the top tip traps

International audienceTransjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment for refractory ascites, upper gastrointestinal bleeding, or hepatorenal syndrome in liver transplant candidates.

Surgical treatment of esophageal perforations: the importance of a primary repair.

International audiencePURPOSE: The aim of the current study was to evaluate the outcome after primary repair in comparison to other surgical treatments and the advantage of reinforcing the sutures with an absorbable polyglactin 910 prosthesis. METHODS: All esophageal perforations surgically managed in this institution from January 1985 through April 2009 (n = 40) were retrospectively analyzed. Patients that underwent surgery with primary sutures (group A, n = 24) were compared with patients that received other surgical procedures (group B, n = 16). The time to initiate treatment (within or after the first 24 h) and if the suture was reinforced with a polyglactin 910 mesh were also analyzed in group A patients. RESULTS: The outcome was more favorable in group A than group B in terms of time in the intensive care unit (p = 0.005), and rate of reoperation (p = 0.005). There was no difference in the outcome after the primary suture with or without mesh reinforcement, although the rate of fistulization was lower in patients with a mesh (17 vs. 50 %, p = 0.19). CONCLUSIONS: Primary repair has a better outcome than other surgical treatment, even when performed more than 24 h after symptom onset, but not later than 48 h. Reinforcing the sutures with an absorbable polyglactin 910 mesh therefore seems to improve the outcome