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ABSTRACT: The aim of this prospective study is to report our experience in the multimodal management of locally advanced esophageal squamous cell carcinoma (LAESC; stage III cTNM), focusing on the results of chemoradiotherapy followed by surgery. These findings were compared to the results of a standard group of patients with locally advanced esophageal carcinoma (LAEC; stage III pTNM) treated in our center with surgery alone. Sixty-one patients with LAESC underwent preoperative chemoradiotherapy (5-fluorouracil + cisplatin) with concomitant 45 Gray radiotherapy in a 5-week course. Transthoracic esophagectomy was performed 4 to 5 weeks after the end of the neoadjuvant therapy. Thirty-eight patients underwent surgery, and 37 of them had resections (resectability: 97% in the multimodal group; 84% in the standard surgical series; p = 0.07). The R0 (complete) resection rate was 78% compared to 56% in the standard surgical group (p <0.03). Eleven patients had no residual tumor in the resected specimen (pathologic complete response: pCR: 30%). The operative mortality rate was 19% compared with 8.8% in the standard series. The overall median survival of the resected patients was 21 months, with a 5-year survival rate of 11% (14% in the surgical group; NS). The 3-year and 5-year survival rates were 34% for the pCR group and respectively 5% and 0% for the group with pathologic incomplete response (pIR; p <0.05). The median survival was 28 months for the pCR patients and 19 months for the pIR group. In this non-randomized trial, preoperative chemoradiotherapy in LAESC seems to increase the resectability and R0 resection rates, to allow a higher pCR rate and a longer survival only in the pCR group, at the expense of an inadequate increase in operative mortality. This multimodal treatment cannot be proposed as a standard procedure unless less toxic regimens are developed, increasing the benefits with better local and distant failure control and decreasing operative mortality.
World Journal of Surgery 02/2002; 26(1):72-8. · 2.36 Impact Factor
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ABSTRACT: During the years 1978–1990, 401 patients with esophageal cancer were evaluated for curative resection.A retrospective study was undertaken to estimate the efficacy of surgery and select criteria for long-term survival.After investigation, 187 patients (47%) underwent surgery. To evaluate the long-term results, 101 curative esophageal resections classified into stage I (11 patients), II (24 patients), and III, pathological TNM (66 patients), with at least 2 years' follow-up, were considered. Esophagogastrectomy was performed in 91% of the cases and gastric transposition was achieved in 96% of the patients.The anastomoses were intrathoracic (98%) and at the apex of the right thorax for tumors of the middle third of the esophagus. Staplers were used in 76% of sutures. Postoperative hospital mortality was 5.9%. Specific morbidity included strictures 11%, esophagitis 12%, and anastomotic leak 2%.Actuarial 5-year survival was 90.9% in stage I, 52.3% in stage II, and 17.7% in stage III. The overall 5-year survival rate was 34.2%, 64.8% for the No patients, and decreased to 17.7% when node involvement was observed. Five- to 8-year survival is also considered.It is concluded from this study that esophagectomy is actually the appropriate treatment in patients with nonmetastatic resectable carcinoma with an overall 34.2% 5-year survival.The operation can be performed with a low morbidity and mortality rate if done in experienced centers.En el perodo 1987–1990 fueron evaluados 401 pacientes con cncer del esfago en cuanto a reseccin curativa. Se realiz un estudio retrospectivo con el fin de determinar la eficacia de la ciruga y de seleccionar criterios para lograr sobrevida a largo plazo. Luego de la exploracin clnica, 187 (47%) fueron sometidos a ciruga; 101 resecciones curativas fueron clasificadas segn los estados PTNM: I (11 pacientes), II (24 pacientes) y III (66 pacientes), con no menos de dos aos de seguimiento.Se prtico esofagogastrectoma en 91% de los casos; la transposicin gstrica fue practicada en 96% de los pacientes. Las anastomosis fueron intratorcicas en 98% de los casos y a nivel del pex del trax derecho en los tumores del tercio medio del esfago. Se utilizaron grapas (suturas) mecnicas en 76% de los pacientes. La mortalidad hospitalaria fue 5.9%. La morbilidad especfica incluy: estenosis 11%; esofagitis, 12%; y fuga anastomtica, 2%. La supervivenvia actuarial fue 90.9% para el estado I, 52.3% para el estado II y 17.7% para el estado III. La tasa global de sobrevida a 5 aos fue 34.28%, 64.8% para paciente No y disminuy a 17.7% cuando haba invasin ganglionar.Pendant les annes 1978–1990, les dossiers de 401 patients ayant un cancer de l'oesophage ont t analyss rtrospectivement dans le but d'valuer l'efficacit de la chirurgie vise curative et de dterminer les critres prdictifs d'une survie long terme. Aprs un bilan propratoire classique, 187 (47%) patients avaient t jugs oprables. Pour valuer les rsultats long terme, on a analys seulement les rsultats de 101 patients ayant survcu 2 ans: 11 patients classs stade I (classification pTNM), 24 patients classs stade II et 66 patients classs stade III. Une esophagogastrectomie a t pratique chez 91% des patients. Une interposition gastrique a t ralise chez 96%. L'anastomose tait intrathoracique chez 98% et, pour les tumeurs du tiers moyen de l'esophage, ralise au sommet du poumon droit. L'agraffeuse mcanique a t utilise pour 76% des anastomoses. La mortalit postopratoire a t de 5.9%. La morbidit a comport des stnoses chez 11%, de l'esophagite chez 12% et une fuite anastomotique chez 2% des patients. La survie actuarielle a t de 90.9% chez les patients stade I, de 52.3% chez les patients stade II et de 17.7% chez les patients stade III. La survie globale 5 ans a t de 34.2%. De 64.8% pour les patients No, celle-ci est passe 17.7% lorsque les ganglions lymphatiques taient envahis. On conclue que l'esophagectomie est le traitement appropri des cancers non mtastatiques, rsecables de l'esophage et que la survie globale 5 ans est de 34.2%. La morbidit et la mortalit sont basses lorsque l'intervention est ralise par une quipe exprimente.
World Journal of Surgery 01/1993; 17(6):760-764. · 2.36 Impact Factor
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ABSTRACT: Interleukin-10 (IL-10) is currently being extensively studied in clinical trials for the treatment of Crohn's disease (CD). Only marginal effects have, however, been reported, and the dose-response curve was bell-shaped contrasting with the reported data from in vitro experiments.
To use another in vitro model to analyze the effect of rhIL-10 and rhIL-4 on the spontaneous mucosal TNF-alpha secretion in patients with CD, and to characterize the phenotype of the cells targeted by rhIL-10.
Non-inflamed colon biopsies from CD patients were cultured for 16 hours in presence of different concentrations of rhIL-10 or rhIL-4. The numbers of TNF-alpha-secreting cells among isolated lamina propria mononuclear cells (LPMNC) were estimated by Elispot.
Both rhIL-10 and rhIL-4 down-regulate TNF-alpha secretion by LPMNC from CD patients, with a more pronounced effect with rhIL-10. These effects were closely linked to the cytokine concentrations used, with a bell-shaped dose-response curve. Residual TNF-alpha secretion, in the presence of optimal rhIL-10 concentration was mainly attributable to CD3+ T cells. In contrast, at higher rhIL-10 concentrations, CD3- cells contributed significantly to the TNF-alpha secretion.
The in vitro model we used, demonstrates that IL-4, but mostly IL-10, efficiently suppresses TNF-alpha secretion in LPMNC from CD patients, with a dose-response curve similar to results obtained in vivo. Resistance at high rhIL-10 concentrations was associated with a change in the phenotype of TNF-alpha-secreting cells.
European cytokine network 13(3):298-305. · 1.73 Impact Factor
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ABSTRACT: Splenic cysts are rarely observed in young patients. We report three cases of splenic cysts. The management and the surgical procedure, if needed, are discussed. If the splenic cyst is symptomatic or if its size reaches a diameter of 4-6cm, it requires surgical management. This treatment would be performed by laparoscopic approach and is intended to spare splenic tissue as much as possible. A prophylactic anti-pneumococcal vaccination is recommended before surgical treatment.
Hepato-gastroenterology 55(81):286-8. · 0.66 Impact Factor
