Tumeurs bénignes hépatocellulaires du foie (prise en charge dans 2 centres chirurgicaux français)

Cette étude est rétrospective et bi-centrique (Grenoble, Lille) portant sur 144 patients, tous opérés d une tumeur bénigne hépatocytaire, définie sur la base de l anatomopathologie définitive. Soixante-dix sept patients étaient porteurs d au moins un AH (groupe AH), 67 patients d au moins une HNF (groupe HNF). Au total, la radiologie a classé correctement 49 patients sur 143 (34 %). Des analyses extemporanées ont été réalisées 15 fois en coelioscopie et 38 fois en laparotomie. Cinquante-sept patients ont été opérés par coelioscopie (1 hépatectomie majeure, 19 mineures, 20 tumorectomies et 17 biopsies), et 87 par laparotomie (22 hépatectomies majeures, 42 mineures, 16 tumorectomies, 7 biopsies). La mortalité était nulle, et la morbidité était de 43%. Le suivi moyen des patients était de 15+-19 mois dans le groupe AH et 18+-20 mois dans le groupe HNF. Les analyses immuno-histochimiques et les données de biologie moléculaire récentes ont permis de reclasser 9 patients (7 HNF en AH et 2 HNF télangiectasiques en HNF) et de connaitre les sous-types d AH. Les AH étaient classés en 5 sous-types selon la classification de Zucman-Rossi : 20 types 1 (AH mutés HNF1a, LFABP-), 4 types 2 (AH mutés b-caténine), 38 types 3 (AH inflammatoires, SAA+), 8 types 4 (AH inclassables), et 7 non classés. Les hémorragies ont concerné 40% des AH. Le seul facteur prédictif indépendant en analyse multivariée était la taille radiologique des lésions (p=0.008). Neuf lésions hémorragiques mesuraient moins de 5 cm en histologie. A la lumière de notre étude, nous proposons de discuter la résection chirurgicale des AH dès 3 cm en prenant en compte la simplicité de l éventuelle intervention.This study is retrospective and bi-centric (Grenoble, Lille) about 144 operated patients of a benign liver tumour, based on the pathologic diagnosis. Seventy-seven patients had at least 1 hepatic adenoma (AH group), 67 patients had at least 1 focal nodular hyperplasia (HNF group). Finally, radiologic examination has correctly classed 49 patients on 143 (34 %). Frozen section examinations were done 15 times in laparoscopic group, 38 times in the laparotomy group. Fifty seven patients were operated by laparoscopy (1 major hepatectomy, 19 minor, 20 tumorectomies and 17 biopsies), and 87 by laparotomy (22 major hepatectomies, 42 minor, 16 tumorectomies, 7 biopsies). There were no mortality and morbidity was 43%. Mean follow-up was 15+-19 months in the AH group and 18+-20 months in the HNF group. Immunohistochemistry and molecular biology analysis had permitted to better classify 9 patients (7 HNF to AH group, and 2 telangiectatic HNF in HNF) and to know exactly the sub-type of AH. AH were classified in 5 sub-types (Zucman-Rossi classification): 20 type 1 (HNF1a mutated, LFABP-), 4 type 2 (b-catenine mutated), 38 type 3 (inflammatory AH, SAA+), 8 type 4 (No mutations) and 7 non classified. Hemorrhages have concerned 40% of AH. The only independent factor in multivariate analysis was lesion radiologic size (P=0.008). Nine hemorrhagic lesions measured less than 5 cm on histologic examination. With this study, we propose to discuss surgical resection of AH from 3 cm taking in account the simplicity of the procedure.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Energy vessel sealing systems versus mechanical ligature of the inferior mesenteric artery in laparoscopic sigmoidectomy

International audienc

Peritoneal Carcinomatosis Risk and Long-Term Survival Following Hepatectomy for Spontaneous Hepatocellular Carcinoma Rupture: Results of a Multicenter French Study (FRENCH—AFC)

International audienceBackground: Spontaneous rupture of hepatocellular carcinoma (HCC) remains a life-threatening complication, with a reported mortality rate of between 16 and 30% and an incidence rate of approximately 3% in Europe. Survival data and risk factors after ruptured HCC are lacking, especially for peritoneal metastasis (PM).Objectives: The aims of this study were to evaluate the pattern of recurrence and mortality after hepatectomy for ruptured HCC, and to focus on PM.Methods: We retrospectively reviewed the files of patients admitted to 14 French surgical centers for spontaneous rupture of HCC between May 2000 and May 2012.Results: Overall, 135 patients were included in this study. The median disease-free survival and overall survival (OS) rates were 16.1 (11.0-21.1) and 28.7 (26.0-31.5) months, respectively, and the median follow-up period was 29 months. At last follow-up, recurrences were observed in 65.1% of patients (n = 88). The overall rate of PM following ruptured HCC was 12% (n = 16). Surgical management of PM was performed for six patients, with a median OS of 36.6 months. An α-fetoprotein level > 30 ng/mL (p = 0.0009), tumor size at rupture > 70 mm (p = 0.0009), and vascular involvement (p < 0.0001) were found to be independently associated with an increased likelihood of recurrence. No risk factor for PM was observed.Conclusion: This large-cohort French study confirmed that 12% of patients had PM after ruptured HCC. A curative approach may be an option for highly selected patients with exclusive PD because of the survival benefit it could provide