Laparoscopic Spleen-Preserving Distal Pancreatectomy Followed by Intramuscular Autologous Islet Transplantation for Traumatic Pancreatic Transection in a Young Adult

Context Pancreatic injuries caused by blunt trauma are often treated conservatively, except for the highest grades of these. Case report We report a case of complete transection of the distal pancreas in a young adult which was successfully managed by spleen-preserving laparoscopic distal pancreatectomy followed by an islet autotransplantation in the patient’s forearm striated muscle. Conclusion We describe a mini-invasive approach for pancreatectomy with restoration of resected islets to the patient

Prolonged Complete Response after GEMOX Chemotherapy in a Patient with Advanced Fibrolamellar Hepatocellular Carcinoma

The only currently validated treatment for advanced hepatocellular carcinoma (HCC) is sorafenib. However, sorafenib has been mainly studied in patients with HCC developed in cirrhotic liver. Chemotherapy might be more suitable for patients with HCC in non-cirrhotic liver. We report the case of a young woman with fibrolamellar HCC in a non-cirrhotic liver, with histologically proven metastatic ganglionary relapse after surgical resection of the primary tumour. Chemotherapy with gemcitabine and oxaliplatin (GEMOX regimen) achieved a complete response without relapse five years after discontinuation of chemotherapy. This exceptional case raises the question of clinical trials specifically designed for patients with HCC in non-cirrhotic liver

Pancreatic Serous Cystadenoma with Compression of the Main Pancreatic Duct: An Unusual Entity

Serous cystadenoma is a common benign neoplasm that can be managed without surgery in asymptomatic patients provided that the diagnosis is certain. We describe a patient, whose pancreatic cyst exhibited a radiological appearance distinct from that of typical serous cystadenoma, resulting in diagnostic difficulties. CT and MRI showed a 10 cm-polycystic tumor with upstream dilatation of the main pancreatic duct (MPD), suggestive of intraductal papillary mucinous tumor (IPMT). Ultrasonographic aspect and EUS-guided fine-needle aspiration gave arguments for serous cystadenoma. ERCP showed a communication between cysts and the dilated MPD, compatible with IPMT. The patient underwent left pancreatectomy with splenectomy. Pathological examination concluded in a serous cystadenoma, with only a ductal obstruction causing proximal dilatation

Tumour biology of colorectal liver metastasis is a more important factor in survival than surgical margin clearance in the era of modern chemotherapy regimens

AbstractBackgroundThe aim of the authors was to reassess the impact of a positive surgical margin (R1) after a liver resection for colorectal liver metastases (CLMs) on survival in the era of modern chemotherapy, through their own experience and a literature review.MethodsInclusion criteria were: R1 or R0 resection with no local treatment modalities, extra‐hepatic metastases or other cancer.ResultsAmong 337 patients operated between 2000 and 2010, 273 patients were eligible (214 R0/59 R1). The mean follow‐up was 43 ± 29 months. Compared with a R0 resection, a R1 resection offered a lower 5‐year overall (39.1% versus 54.2%, P = 0.010), disease‐free (15.2% versus 31.1%, P = 0.021) and progression‐free (i.e. time to the first non‐curable recurrence; 33.1% versus 47.3%, P = 0.033) survival rates. Metastases in the R1 group were more numerous, larger and more frequently synchronous. Independent factors of poor survival were: number, size and short‐time interval of CLM occurrence, N status, rectal primary, absence of adjuvant chemotherapy, but not a R1 resection. With the more‐systematic administration of chemotherapy since 2005, the intergroup difference in progression‐free survival disappeared (P = 0.264).ConclusionA R1 resection had no prognostic value per se but reflected a more severe disease. The recent change in the prognostic value of a R1 resection may be linked to the beneficial effect of chemotherapy

Le ratio volume du lobe gauche sur poids du patient > 0,5 (un nouveau mode de calcul du volume de foie fonctionnel résiduel après lobectomie droite)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les sténoses biliaires après transplantation hépatique

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La prise en charge des traumatismes fermés du foie au CHRU de Lille (analyse de 111 cas de 1998 à 2002)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Is Centralization Needed for Patients Undergoing Distal Pancreatectomy?

International audienceObjective The centralization of complex surgical procedures is associated with better postoperative outcomes. However, little is known about the impact of hospital volume on the outcome after distal pancreatectomy. Methods Using the French national hospital discharge database, we identified all patients having undergone distal pancreatectomy in France between 2012 and 2015. A spline model was applied to determine the caseload cut-off in annual distal pancreatectomy that influenced 90-day postoperative mortality. Results A total of 3314 patients were identified. Use of a spline model did not reveal a cut-off in the annual distal pancreatectomy caseload. By taking the median number of distal pancreatectomy (n = 5) and the third quartile (n = 15), we stratified centers into low, intermediate, and high hospital volume groups. The overall postoperative mortality rate was 3.0% and did not differ significantly between these groups. In a multivariable analysis, age, Charlson comorbidity score, septic complications, hemorrhage, shock, and reoperation were independently associated with a greater overall risk of death. However, hospital volume had no impact on mortality after distal pancreatectomy (odds ratio, 0.954; 95% confidence interval, 0.552–1.651, P = 0.867). Conclusions Hospital volume does not seem to influence mortality after distal pancreatectomy in France, and centralization may not necessarily improve outcomes

The Conservative Management of Severe Caustic Gastric Injuries

International audienc