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ABSTRACT: Endometriosis is a dissemination of endometrial-like tissue outside the uterine cavity, responsible for pain and impaired fertility in women of childbearing age. Although endometriosis generally occurs in the pelvis, it can be located further away. We describe the case of a 35-year-old woman who was admitted for further evaluation of a cystic mass of the liver that had invaded the right ventricle and caused pain. Serum levels of the tumor markers CA 125, CA 15-3 and CA 19-9 were elevated. The tumor was resected with a small part of the right ventricle free wall, the diaphragm and the left liver lobe. A histological analysis confirmed that the mass was a benign endometrial cyst. The postoperative course was uneventful and the patient remains asymptomatic with 5year follow-up. A diagnosis of endometriosis should be considered for thoraco-abdominal cystic masses associated with menses-related pain in women of childbearing age.
Gastroentérologie Clinique et Biologique 04/2013; · 0.80 Impact Factor
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ABSTRACT: Hepatectomy remains the only curative treatment for many primary and secondary liver cancers. Portal vein embolization (PVE) has been used to increase the volume of the future liver remnant and thus lower the risk of small-for-size syndrome and postoperative liver failure. This technique has proven its safety, with a low post-procedure morbidity rate. Here, we describe a very rare case in which a young patient suffered a glue embolism to the right atrial cavity following PVE in preparation for a major hepatectomy for colorectal metastasis. The foreign body was withdrawn from the heart with a femoral, percutaneous device and trapped against the wall of the femoral vein with a self-expanding metal stent. Our report shows that this previously unknown complication of PVE can be resolved without recourse to sternotomy and open heart surgery.
World journal of hepatology. 12/2012; 4(12):412-4.
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ABSTRACT: : The objective was to determine the liver regeneration capacity and morbidity and mortality rates after major hepatectomy for colorectal metastases in patients having undergone bevacizumab-based chemotherapy (bev+).
: Between 2006 and 2011, 41 patients underwent major hepatectomy within 3 months of bevacizumab and were matched with 41 patients operated on following systemic chemotherapy without bevacizumab (bev-). The matching criteria were the following: number of courses of chemotherapy, chemotherapy-free interval, age, and type of hepatectomy. After measurements of remnant liver volume (RLV) preoperatively and at 1 month (RLV1M), volumetric gain was calculated as absolute (RLV1M-RLV) or relative regeneration [(RLV1M-RLV/RLV)]. Ninety-day morbidity was rated according to the Clavien-Dindo classification.
: There were 21 right, 9 extended right, and 11 left hepatectomies in each group. Groups were comparable in terms of matching criteria, body mass index, American Society of Anesthesiologists score, and RLV. No mortalities were observed. There were no intergroup differences in overall morbidity (56% in bev+ vs 34.1%; P = 0.075) or postoperative liver failure. A severe complication occurred in 5 bev+ (4 eviscerations) and 4 bev- (bile leakages) (P = 0.95). The median hospital stay was similar in both groups as were the degrees of absolute and relative liver regeneration (143% in bev+ vs 114%; P = 0.20). Liver regeneration was not influenced by the type of hepatectomy, the number of courses of chemotherapy, or age more than 65 years.
: In a methodologically robust trial in the largest cohort reported up to date, bevacizumab did not impair liver regeneration after major hepatectomy-even in elderly patients or those with high exposure to chemotherapy.
Annals of surgery 11/2012; 256(5):755-62. · 7.90 Impact Factor
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ABSTRACT: Background/Aims: Management of post-cholecystectomy bile duct injuries may, in certain cases, require hepatectomy. In the literature, indications for hepatectomy in this setting are not clear. Methodology: A retrospective review of our database for patients referred for post-cholecystectomy bile duct injuries from January 2003 to January 2008 was performed. Results: We present three cases of hepatectomy among 45 patients (6.7%) referred for post-cholecystectomy bile duct injuries. Two of these patients had been referred after one or more previous attempts at operative repair in an outside hospital. In one patient, the decision to perform hepatectomy was based on the proximal pattern of biliary stricture aggravated by disruption of the right hepatic artery, leading to irreversible secondary sclerosing cholangitis. Biliary stricture also involved bifurcation and was complicated by liver atrophy in the 2 other patients. Despite complication(s) in 2 out of 3 patients, the long-term outcome was good in all cases.
Hepato-gastroenterology 11/2012; 59(120):2403-6. · 0.66 Impact Factor
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ABSTRACT: Pancreatic injuries caused by blunt trauma are often treated conservatively, except for the highest grades of these.
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.
We describe a mini-invasive approach for pancreatectomy with restoration of resected islets to the patient.
JOP: Journal of the pancreas 01/2012; 13(3):285-8.
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Archives of surgery (Chicago, Ill.: 1960) 06/2011; 146(6):755-6. · 4.32 Impact Factor
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ABSTRACT: To determine the safety of a conservative approach to treating severe caustic injury in patients lacking clinical and biochemical signs of transmural necrosis.
Esophagogastrectomy is thought to limit the progression of severe caustic injury in the upper gastrointestinal tract observed upon initial endoscopic examination. However, endoscopic evaluation of the depth and spread of necrosis is challenging and may lead to unnecessary gastrectomy.
From January 2002 to December 2008, 70 patients were classified as having stage III gastric injury in an initial digestive tract endoscopic examination. When patients had no signs of peritonitis, their treatment was determined by 6 clinical and biochemical factors of severity (abdominal rebound tenderness, neuropsychiatric troubles, cardiovascular shock, metabolic acidosis, disseminated intravascular coagulation, and kidney failure) in addition to endoscopic staging. If one of these clinical and biochemical factors was present, the patient underwent emergency laparotomy. Patients with isolated stage III gastric injury were kept under close observation.
Twenty-four of the 70 endoscopic stage III patients required emergency surgery. Conservative treatment was initiated in the remaining 46. There were 4 postoperative deaths (5.7%). Fifteen patients required subsequent surgery: distal gastrectomy with Billroth I anastomosis (n = 7) for distal stricture and esophagoplasty for nondilatable esophageal stricture (n = 8). At the end of the follow-up period, total or partial gastric conservation was achieved in all 46 patients (65.7%) and the esophagus was conserved in 38 patients (54.3%).
In the absence of clinical and biological signs of severity, conservative management of stage III gastric injury is clinically feasible, precludes gastrectomy and has a low mortality rate.
Annals of surgery 04/2011; 253(4):684-8. · 7.90 Impact Factor
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ABSTRACT: 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.
HPB Surgery 01/2011; 2011:574378.
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Antoine Hollebecque,
Olivier Bouché,
Olivier Romano,
Elodie Scaglia,
Stéphane Cattan, Philippe Zerbib,
Alexandra Heurgue,
Stéphanie Lagarde,
Christophe Mariette,
Jean-Pierre Triboulet,
François-René Pruvot,
Mohamed Hebbar
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ABSTRACT: The combination gemcitabine-oxaliplatin (GEMOX) is frequently used in patients with advanced biliary tract carcinoma (BTC). However, this is only based on phase II studies performed in selected patients.We assessed the efficacy and safety of the GEMOX regimen in non-selected patients with advanced BTC.
All consecutive patients with advanced BTC received the GEMOX regimen in a setting outside a study: gemcitabine 1,000 mg/m(2) on day 1, and oxaliplatin 100 mg/m(2) on day 2, treatment repeated every 2 weeks until progression or unacceptable toxicity.
Forty-four patients were enrolled. Efficacy: 1 complete and 6 partial responses (objective response rate = 16.3%), 18 tumour stabilizations (41.9%, disease control rate = 58.1%), median progression-free survival was 5.0 months and median overall survival was 11.0 months. Toxicity: grade 3 neuropathy in 4 patients, grade 3 asthenia in 5 patients.
The GEMOX combination was well tolerated, with a modest activity in non-selected patients with advanced BTC. This regimen should be compared to the new standard gemcitabine-cisplatin combination.
Chemotherapy 01/2010; 56(3):234-8. · 1.82 Impact Factor
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ABSTRACT: Our objectives were to clarify the management of isolated spontaneous dissection of the superior mesenteric artery (DSMA).
We reviewed seven patients diagnosed as having DSMA from 2002 to 2007 (group A). Simultaneously, we analyzed 50 cases of DSMA previously reported in the literature between 2000 and 2008 (group B). In each group, clinical presentation, Sakamoto's classification, imaging appearances, need for emergent surgery, failure of medical management, and long-term outcome were analyzed.
In group A, according to Sakamoto's classification, there were two type I, two type II, and three type III. Two patients needed surgery (one type II, one type III). In group B, according to Sakamoto's classification, there were seven type I, five type II, 14 type III, and six type IV. Intestinal revascularization was necessary for 21 patients, especially for types II and III, while medical management was more frequent for types I and IV. We identified four indications for intestinal revascularization: acute mesenteric ischemia with mesenteric thrombosis, arterial rupture, chronic mesenteric ischemia with superior mesenteric artery (SMA) stenosis, and SMA dissecting aneurysm of at least 2 cm in diameter. If abdominal pain lasts for more than 1 week, types I and IV were able to be medically managed, whereas intestinal revascularization has to be considered in types II and III.
Patients with symptoms lasting for more than 1 week, aneurysmal dilatation more than 2 cm in diameter, and SMA stenosis are suitable candidates for surgical management.
Langenbeck s Archives of Surgery 08/2009; 395(4):437-43. · 1.81 Impact Factor
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ABSTRACT: We report two cases of iatrogenic occlusion of the superior mesenteric artery (SMA) and celiac axis (CA) during left nephrectomy. A patient with a urothelial carcinoma (open surgery) and one with coralliform calculi (laparoscopy) experienced injury to both the SMA and/or CA due to bulky perihilar adenopathy and kidney adherence to surrounding tissue. The cancer patient survived after fast repair. Repair was delayed in the second patient who subsequently died. It is essential to identify each arterial branch carefully on the preoperative CT-scan to identify any duplicate renal arteries and avoid mistaking the SMA and/or CA for the renal artery.
Journal of endourology / Endourological Society 11/2008; 22(11):2571-4. · 1.75 Impact Factor
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David Fuks,
Guillaume Piessen,
Emmanuel Huet,
Marion Tavernier, Philippe Zerbib,
Francis Michot,
Michel Scotte,
Jean-Pierre Triboulet,
Christophe Mariette,
Laurence Chiche,
Ephraïm Salame,
Philippe Segol,
François-René Pruvot,
François Mauvais,
Horace Roman,
Pierre Verhaeghe,
Jean-Marc Regimbeau
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ABSTRACT: Pancreatic fistula (PF) is one of the most common postoperative complications of pancreatoduodenectomy (PD). A recent International Study Group on Pancreatic Fistula (ISGPF) definition grades the severity of PF according to the clinical impact on the patient's hospital course. Although PF is generally treated conservatively (grade A), some cases may require interventional procedures (grade B) or may be life-threatening and necessitate emergency reoperation (grade C). The aim of the present study was to evaluate the incidence of postoperative grade C PF after PD and to assess the prognosis and risk factors for this life-threatening condition.
Between January 2000 and December 2006, 680 consecutive patients underwent PD in 5 digestive surgery departments in the northwest region of France (Lille, Amiens, Rouen, and Caen). PF was defined as drain output of any measurable volume of fluid on or after postoperative day 3 with amylase content greater than 3 times the serum amylase activity (ISGPF guidelines). To identify possible risk factors for grade C PF, we reviewed the records of 111 (16.3%) patients with postoperative PF and compared grade C cases with grade A+B cases.
The median age was 59 years (range 22-87). The male-to-female ratio was 1.6:1. Fifty-six (50.4%) PDs were performed via pancreaticogastrostomy and 55 via pancreaticojejunostomy. Overall mortality was 2% (n = 14). Grade C PF was observed in 36 (32%) patients, of whom 17 (47%) had sepsis due to an abdominal collection, 16 (44%) had postoperative bleeding, 10 (27.7%) had bleeding associated with abdominal collection, and 3 (9%) had multi-organ failure due to other causes. Of these 36 patients, 35 (97%) underwent reoperation. The mortality rate in grade C PF patients was 38.8%. The major causes of death were sepsis (n = 6) and recurrent bleeding after reoperation (n = 5). Grade C PF increased the duration of postoperative hospitalization (46 vs 29 days, P < .001). Univariate analysis showed that peroperative soft pancreatic parenchyma, peroperative blood transfusion, and postoperative bleeding were significant risk factors for grade C PF, with P values of .011, .003, and .001, respectively. No risk factors for grade C PF were identified in a multivariate analysis. The sensibility, specificity, positive predictive value, and negative predictive value of the presence of the 3 risk factors for grade C PF were 13.89%, 100%, 100%, and 70.75%, respectively.
Sixteen percent of patients had PF after PD. Among them, 30% had grade C PF, with a mortality rate of about 40%. Achievement of a 100% predictive positive value for grade C PF after PD in individuals with 3 discriminant risk factors (peroperative soft pancreatic parenchyma, peroperative transfusion, and postoperative bleeding) is a first step towards the identification of high-risk patients who should be managed differently from other patients with PF during or after PD.
American journal of surgery 09/2008; 197(6):702-9. · 2.36 Impact Factor
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Philippe Zerbib,
Alexandre Grimonprez,
Delphine Corseaux,
Frederic Mouquet,
Bertrand Nunes,
Lars C Petersen,
Sophie Susen,
Alexandre Ung,
Mohamed Hebbar,
François René Pruvot,
Jean Pierre Chambon,
Brigitte Jude
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ABSTRACT: Expression of the principal initiator of coagulation, tissue factor (TF), by colorectal cancer (CRC) cells is involved in tumoral angiogenesis and metastasis progression, after binding of factor VIIa (FVIIa) to TF and generation of TF-FVIIa activity. We thus hypothesized that inhibition of the TF pathway by active site-blocked FVIIa (FFR-FVIIa) may prevent the development of hepatic metastasis in CRC.
Rat tumoral cells (DHDK12 proB cells) expressing high levels of TF were injected in the portal vein in syngenic BDIX rats. Rats received intraperitoneal injection of either FFR-FVIIa, from d 3 to d 7 (adjuvant treatment) (n = 19), or solvent buffer (n = 18) (control group). Additionally, cancer cells were infused subcutaneously in 20 other rats, which were assigned to FFR-FVIIa adjuvant treatment (n = 10), or buffer treatment (n = 10). Macroscopic and histological analysis was performed at d 14.
In the control group, infusion of cancer cells resulted in development of macroscopic hepatic tumors in 17/18 rats. In the adjuvant FFR-FVIIa group, macroscopic hepatic tumors were visible on the liver surface in 3/19 rats (P = 0.002 versus control). All rats with subcutaneous injection of proB cells exhibited macroscopic tumors, with no significant difference between the control and the treated ones.
Inhibition of the proteolytic activity of TF-FVIIa complex blunted hematogenous hepatic metastasis, suggesting that TF-FVIIa is a relevant target for the prevention of hepatic metastasis in CRC. TF-blocking agents should be investigated as adjuvant treatment in this setting.
Journal of Surgical Research 07/2008; 153(2):239-45. · 2.25 Impact Factor
