Publications (30)137.35 Total impact
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Article: Influence of larger graft weight to recipient weight on the post-liver transplantation course.
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ABSTRACT: Size matching between recipient and donor livers is an important factor in organ allocation in the context of liver transplantation (LT). The aim of this study was to determine whether a large graft for recipient size influenced the post-transplant course. One hundred and sixty-two successive LT recipients were included and retrospectively divided into two groups: 25 (15%) had a graft-to-recipient weight ratio (GWRW) ≥2.5% and 137 (85%) had a GWRW <2.5%. Postoperative complications and outcomes were recorded. In the GWRW >2.5% group, more end-to-end caval replacement (72% vs. 38%, p = 0.003) and veno-venous bypass (48% vs. 23%, p = 0.01) were used. Peak AST/ALT values were higher in the GWRW >2.5% group (AST: 596 [70-5876] vs. 453 [29-5132] IU/l, p = 0.03; ALT: 773 [101-5025] vs. 383 [36-4921] IU/l, p = 0.02). Among postoperative complications, the rate of respiratory failure was higher in the GWRW >2.5% group (32% vs. 14%, p = 0.04). The rates of other complications did not differ between the two groups. Both groups had similar graft and patient survival rates at one yr. Using large grafts for recipient size did not impair liver function and did not modify graft and patient outcomes at one yr. However, a GWRW >2.5% appeared to be a determining factor for respiratory morbidity following LT.Clinical Transplantation 01/2013; · 1.67 Impact Factor -
Article: Portal stenting for hepatocellular carcinoma extending into the portal vein in cirrhotic patients.
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ABSTRACT: BACKGROUND AND AIMS: Macroscopic portal vein invasion complicating hepatocellular carcinoma in the setting of cirrhosis is associated with a very low survival. To prevent the malignant progression from a portal branch to the main portal trunk, we have placed noncovered metallic stents extending from the portal trunk to the contralateral tumor free portal pedicle. METHODS: Fifty-Four patients (age: 60 ± 11 years) were treated. Thirty-four (60%) patients were Child A and 20 (40%) were Child B-C. Tumoral thrombosis involved 1st or 2nd order branches in 41 (82%) patients and partially the main trunk in 13 (24%). Open surgical insertion (via ileal vein) as an alternative to a percutaneous approach was used in 14 (24%) patients. RESULTS: Early mortality (<30 days) was 7%. Following stent insertion, a transarterial chemoembolization was performed in 26 (48%) patients. After stenting, overall survival at 6, 12, and 24 months were 47%, 44%, and 36%, respectively. Bilirubin > 30 µmol/L and open surgical insertion were predictive of short-term mortality. In the good group, overall survival at 6, 12, and 24 months were 69%, 61%, and 46%, respectively. CONCLUSIONS: The transhepatic deployment of metallic stent seems to improve survival of patients with hepatocellular carcinoma complicated by portal vein tumoral thrombosis and could allow subsequent treatments. J. Surg. Oncol © 2012 Wiley Periodicals, Inc.Journal of Surgical Oncology 12/2012; · 2.10 Impact Factor -
Article: New Paradigms in Post-hepatectomy Liver Failure.
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ABSTRACT: INTRODUCTION: Liver failure after hepatectomy remains the most feared postoperative complication. Many risk factors are already known, related to patient's comorbidities, underlying liver disease, received treatments and type of resection. Preoperative assessment of functional liver reserve must be a priority for the surgeon. METHODS: Physiopathology of post-hepatectomy liver failure is not comparable to fulminant liver failure. Liver regeneration is an early phenomenon whose cellular mechanisms are beginning to be elucidated and allowing most of the time to quickly recover a functional organ. In some cases, microscopic and macroscopic disorganization appears. The hepatocyte hyperproliferation and the asynchronism between hepatocytes and non-hepatocyte cells mitosis probably play a major role in this pathogenesis. RESULTS: Many peri- or intra-operative techniques try to prevent the occurrence of this potentially lethal complication, but a better understanding of involved mechanisms might help to completely avoid it, or even to extend the possibilities of resection. CONCLUSION: Future prevention and management may include pharmacological slowing of proliferation, drug or physical modulation of portal flow to reduce shear-stress, stem cells or immortalized hepatocytes injection, and liver bioreactors. Everything must be done to avoid the need for transplantation, which remains today the most efficient treatment of liver failure.Journal of Gastrointestinal Surgery 11/2012; · 2.83 Impact Factor -
Article: Importance of conserving middle hepatic vein distal branches for homogeneous regeneration of the left liver after right hepatectomy.
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ABSTRACT: Background: Liver regeneration enables repeat surgical procedures to achieve a potential cure in liver cancer patients. However, data regarding segmental regeneration and liver anatomy after liver resection are scarce. This study examined left liver regeneration after right hepatectomy and the impact of hepatic venous drainage on the regeneration of the paramedian sector (Couinaud's segment IV). Methods: Twenty patients in whom right hepatectomy with conservation of the middle hepatic vein (MHV) on healthy liver had been performed were analysed for segmental volumes and vascular anatomy. Volumetric analysis of left liver segments and three-dimensional MHV reconstruction were conducted using pre- and postoperative computed tomography. The volumetric proportions represented by each segment within the left liver were compared and MHV anatomy was analysed to determine its potential role in the regeneration of left liver segments. Results: After right hepatectomy, the proportion represented by segment IV within the left liver decreases by 13%, whereas the proportion represented by segments II and III increases by 15%. This heterogeneous regeneration is particularly observed in patients in whom a venous branch for segment IVb is sacrificed, leading to an altered outflow similar to that observed in MHV deprivation. The risk for venous branch deprivation in IVb is correlated to the depth of the bifurcation of the MHV in liver parenchyma. Conclusions: It is crucial to conserve the MHV in its distal part if homogeneous left liver regeneration after right hepatectomy that will allow potential repeat liver resection is to be achieved.HPB 11/2012; 14(11):746-53. · 1.60 Impact Factor -
Article: Resection or Transplantation for Early Hepatocellular Carcinoma in a Cirrhotic Liver: Does Size Define the Best Oncological Strategy?
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ABSTRACT: BACKGROUND:: Resection and liver transplantation (LT) are the only curative options for hepatocellular carcinoma in cirrhotic patients (HCC-cirr). OBJECTIVE:: We tried to define the best primary intention-to-treat strategy in patients undergoing either resection or LT for early single HCC-cirr (≤5 cm). METHODS:: From 1990 to 2010, 198 patients with early HCC-cirr underwent either resection (group R, n = 97) or LT (group T, n = 101) as the primary procedure. Our policy was to prioritize Childs A patients with peripheral lesions for resection rather than LT. Patient and tumor characteristics, and outcomes (recurrence-free survival [RFS] and overall survival [OS]), were studied. RESULTS:: A longer diagnosis-to-surgery interval, more Child Pugh B/C patients, and more tumor nodules (on histopathological examination) were found in group T patients. The postoperative mortality (4.1% vs 3.0%, P = 0.72) and rate of major complications (19.1% vs 24.7%, P = 0.35) were similar in groups R and T, respectively, whereas tumor recurrence was higher in group R (62% vs 10% in group T, P < 0.0001). The 5-year OS (75% vs 52%, P = 0.0008) and RFS (72% vs 20%, P < 0.0001) were better in group T; similarly, more patients were disease free at last follow-up (27% vs 62%, P < 0.0001). Resection as the surgical procedure, tumor diameter 3 cm or more on histology, and microvascular tumor invasion were poor prognostic factors for OS and RFS. Including dropout patients from LT list in the analysis, the outcomes in group T were still better (70% and 61% vs 51% and 36% at 5 and 10 years, P = 0.01). CONCLUSIONS:: On an intention-to-treat basis, LT is associated with the best survival outcomes in patients with early HCC-cirr. Resection may achieve comparable OS in patients with single HCC-cirr of size smaller than 3 cm; however, the RFS still remains lower than that in patients of group T. This study could serve as a guide for HCC-cirr patients who are candidates for either resection or LT.Annals of surgery 10/2012; · 7.90 Impact Factor -
Article: Treatment of failed Roux-en-Y hepaticojejunostomy after post-cholecystectomy bile ducts injuries.
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ABSTRACT: BACKGROUND: Roux-en-Y hepaticojejunostomy (RYHJ) is the most well-accepted treatment for most post-cholecystectomy bile duct injuries (BDI). RYHJ failure is a complex situation that requires expert planning and the possibility of using a combination of operative, radiologic, and endoscopic techniques. The aim of this study was to report our experience with a multidisciplinary approach to failed RYHJ after post-cholecystectomy BDI. METHODS: Between January 1996 and March 2008, 44 consecutive patients were managed for RYHJ failure in our department. They presented with recurrent cholangitis in 40 patients (91%) and/or jaundice in 9 (20%). First-line treatment consisted of primary revisionary surgery in 26 cases (59%; repeat RYHJ in 22 and hepatectomy in 4) and a percutaneous approach in 18 cases (41%; biliary interventions in 16 and portal vein embolization in 2). RESULTS: Postoperative mortality was nil. Postoperative morbidity was 11% after repeat RYHJ without hepatectomy, 80% (bile leaks) after hepatectomy, and 10% (mild cholangitis and hemobilia) after a percutaneous approach. Delayed revisionary surgery with the intent to wait for bile duct dilation failed in all 5 patients. With a mean follow-up of 49 ± 40 months, second- or third-line treatment was attempted in 7 patients (16%). One patient (2%) died because of suicide. Overall clinical success defined by the absence of incapacitating biliary symptoms after treatment was achieved in 39 patients (89%). CONCLUSION: An immediate, multidisciplinary approach including repeat biliary surgery and/or a percutaneous approach in a tertiary hepatobiliary center is required to obtain good, long-term results when treating the failure of RYHJ post-cholecystectomy BDI.Surgery 10/2012; · 3.10 Impact Factor -
Article: Pulmonary Complications After Elective Liver Transplantation-Incidence, Risk Factors, and Outcome.
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ABSTRACT: : After liver transplantation (LT), postoperative pulmonary complications (PPC) occur in approximately 35% to 50% of the recipients. Among these PPC, pneumonia is the most frequently encountered. Pulmonary dysfunction has also been widely reported among patients awaiting LT. The links between this dysfunction and PPC have not been clearly established. In this present cohort study, we evaluated the incidence and profile of post-LT pneumonia and identified potential preoperative risk factors. METHODS: The postoperative clinical course of 212 liver transplant recipients between January 2008 and April 2010 was analyzed. These patients were treated in a single intensive care unit and received standardized postoperative care. RESULTS: During the postoperative period, 47 (22%) patients developed pneumonia, of whom 20 (43%) developed respiratory failure requiring mechanical ventilation. Univariate analysis showed that several preoperative factors (age of recipient, model for end-stage liver disease score, indication for LT, platelet count, and restrictive lung pattern revealed by preoperative pulmonary function tests) and the transfusion (blood units and fresh frozen plasma units) during the operative period were associated with pneumonia. Using multivariate analysis by logistic regression, only a restrictive lung pattern (odds ratio=3.14; 95% confidence interval, 1.51-6.51; P=0.002) and the international normalized ratio measured prior LT (OR=4.95; 95% confidence interval, 1.86-8.59; P=0.0004) were independent predictors of pneumonia after LT. CONCLUSION: Pneumonia is common among patients undergoing LT and is a major cause of morbidity. A restrictive pattern on preoperative pulmonary testing and a higher international normalized ratio measured prior LT were associated with more risk of postoperative pneumonia.Transplantation 08/2012; 94(5):532-538. · 4.00 Impact Factor -
Article: Impact of reversible cardiac arrest in the brain-dead organ donor on the outcome of adult liver transplantation.
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ABSTRACT: Several donor and graft characteristics are associated with higher failure rates for deceased donor liver transplantation (LT). The influence of reversible cardiac arrest in the donor on these failure rates is unclear because of scarce and inconsistent data. The aim of this study was to determine whether reversible cardiac arrest in the donor could affect the early postoperative outcome of LT. From January 2008 to February 2010, 165 patients underwent LT, and they were retrospectively divided into 2 groups: a cardiac arrest group (34 patients who received grafts from donors who had experienced reversible cardiac arrest before organ procurement) and a control group (131 patients who received grafts from donors without a history of reversible cardiac arrest). The postoperative complications and the graft and recipient outcomes were prospectively recorded for all the patients. Graft failure was defined as death or the need for retransplantation within 90 days of LT. Donors in the cardiac arrest group displayed higher serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels than donors in the control group [AST: 104 (19-756) versus 42 IU/L (10-225 IU/L), P < 0.001; ALT: 73 (13-869) versus 29 IU/L (6-549 IU/L), P < 0.001]. However, no difference in the graft failure rates was found between the 2 groups (11.8% versus 8.4%, P = 0.51). The biological parameters 5 and 7 days after LT and the peak AST/ALT levels were similar for the 2 groups. Furthermore, the 2 groups had similar graft and patient survival rates at the 6-month mark (87% and 88%, respectively). In conclusion, our study shows that brief and reversible cardiac arrest in organ donors does not affect post-LT allograft survival and function, even though liver function test values are higher for these donors. However, the risk of using these grafts needs to be balanced against the potential benefits for the recipients.Liver Transplantation 07/2011; 17(10):1159-66. · 3.39 Impact Factor -
Article: Reply:.
Hepatology 06/2011; 53(6):2138-9. · 11.66 Impact Factor -
Article: Intention-to-treat analysis of liver transplantation for hepatocellular carcinoma: living versus deceased donor transplantation.
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ABSTRACT: For patients who have cirrhosis with hepatocellular carcinoma (HCC), living donor liver transplantation (LDLT) reduces waiting time and dropout rates. We performed a comparative intention-to-treat analysis of recurrence rates and survival outcomes after LDLT and deceased donor liver transplantation (DDLT) in HCC patients. Our study included 183 consecutive patients with HCC who were listed for liver transplantation over a 9-year period at our institution. Tumor recurrence was the primary endpoint. At listing, patient and tumor characteristics were comparable in the two groups (LDLT, n = 36; DDLT, n = 147). Twenty-seven (18.4%) patients dropped out, all from the DDLT waiting list, mainly due to tumor progression (19/27 [70%] patients). The mean waiting time was shorter in the LDLT group (2.6 months versus 7.9 months; P = 0.001). The recurrence rates in the two groups were similar (12.9% and 12.7%, P = 0.78), and there was a trend toward a longer time to recurrence after LDLT (38 ± 27 months versus 16 ± 13 months, P = 0.06). Tumors exceeding the University of California, San Francisco (UCSF) criteria, tumor grade, and microvascular invasion were independent predictive factors for recurrence. On an intention-to-treat basis, the overall survival (OS) in the two groups was comparable. Patients beyond the Milan and UCSF criteria showed a trend toward worse outcomes with LDLT compared with DDLT (P = 0.06). CONCLUSION: The recurrence and survival outcomes after LDLT and DDLT were comparable on an intent-to-treat analysis. Shorter waiting time preventing dropouts is an additional advantage with LDLT. LDLT for HCC patients beyond validated criteria should be proposed with caution.Hepatology 05/2011; 53(5):1570-9. · 11.66 Impact Factor -
Article: Answer to Fabrizio Di Benedetto et al. about HEP-10-0910.R2 "liver transplantation for hepatocellular carcinoma: The impact of human immunodeficiency virus infection"
Hepatology 02/2011; · 11.66 Impact Factor -
Article: Liver transplantation for hepatocellular carcinoma: the impact of human immunodeficiency virus infection.
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ABSTRACT: Liver transplantation (LT) has become an accepted therapy for end-stage liver disease in human immunodeficiency virus-positive (HIV+) patients, but the specific results of LT for hepatocellular carcinoma (HCC) are unknown. Between 2003 and 2008, 21 HIV+ patients and 65 HIV- patients with HCC were listed for LT at a single institution. Patient characteristics and pathological features were analyzed. Univariate analysis for overall survival (OS) and recurrence-free survival (RFS) after LT was applied to identify the impact of HIV infection. HIV+ patients were younger than HIV- patients [median age: 48 (range = 41-63 years) versus 57 years (range = 37-72 years), P < 0.001] and had a higher alpha-fetoprotein (AFP) level [median AFP level: 16 (range = 3-7154 μg/L] versus 13 μg/L (range = 1-552 μg/L), P = 0.04]. There was a trend toward a higher dropout rate among HIV+ patients (5/21, 23%) versus HIV- patients (7/65, 10%, P = 0.08). Sixteen HIV+ patients and 58 HIV- patients underwent transplantation after median waiting times of 3.5 (range = 0.5-26 months) and 2.0 months (range = 0.5-24 months, P = 0.18), respectively. No significant difference was observed in the pathological features of HCC. With median follow-up times of 27 (range = 5-74 months) and 36 months (range = 3-82 months, P = 0.40), OS after LT at 1 and 3 years reached 81% and 74% in HIV+ patients and 93% and 85% in HIV- patients, respectively (P = 0.08). RFS rates at 1 and 3 years were 69% and 69% in HIV+ patients and 89% and 84% in HIV- patients, respectively (P = 0.09). In univariate analysis, HIV status did not emerge as a prognostic factor for OS or RFS. CONCLUSION: Because of a higher dropout rate among HIV+ patients, HIV infection impaired the results of LT for HCC on an intent-to-treat basis but had no significant impact on OS and RFS after LT.Hepatology 02/2011; 53(2):475-82. · 11.66 Impact Factor -
Article: Results of percutaneous manoeuvres in biliary disease: the Paul Brousse experience.
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ABSTRACT: Percutaneous manoeuvres are alternatives to the endoscopic approach in the management of complex biliary disease. We retrospectively reviewed our experience with 1,014 percutaneous interventions performed between 1980 and 2005 at a tertiary-level hepatobiliary centre. The main outcome measures were the success rate of percutaneous manoeuvres and the procedure-related morbidity and mortality. Eight hundred seventy-two patients who underwent 1,014 percutaneous procedures were divided into four groups according to the indication and goal of therapy: Group A: percutaneous manoeuvres aimed at improving the patient's general condition (worsened by severe jaundice, pruritus, or cholangitis); Group B: cancer patients receiving chemotherapy who required biliary drainage as jaundice was a contraindication for continuing chemotherapy; Group C: manoeuvres performed to confirm diagnosis of biliary obstruction; and Group D: manoeuvres performed with the goal of complete treatment of calculus disease. Interno-external drainage (526 procedures) was the most common intervention and dilatation the most frequently associated manoeuvre (456 procedures). Mean duration of biliary drainage was 159±152 days. Overall success rate (total+partial success) was 86%; the best and worst results were in Groups C (95% success) and A (70% success), respectively. The mortality rate was 7.5%; 29 (37%) deaths were procedure-related (cholangitis being the principal cause). End-stage malignancy was the major cause of mortality (58%). Procedure-related morbidity rate was 17%, and Group C (0%) and Group D (5%) patients had the least number of complications. In complex biliary disease, the percutaneous approach is a feasible and safe therapeutic option and should be added to the armamentarium of experienced hepatobiliary teams. A well-planned strategy consisting of repeated interventions, prolonged biliary drainage, and optimal antibiotic therapy are prerequisites for success with this approach.Surgical Endoscopy 12/2010; 25(6):1858-65. · 4.01 Impact Factor -
Article: Concomitant extrahepatic disease in patients with colorectal liver metastases: when is there a place for surgery?
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ABSTRACT: To evaluate the impact of the location of extrahepatic disease (EHD) on survival and to determine patient outcome in a consecutive series of patients with both intrahepatic and extrahepatic colorectal metastases treated by an oncosurgical approach, combining repeat surgery and chemotherapy. Although recognized as poor prognostic factor, concomitant EHD is no more considered an absolute contraindication to surgery in patients with colorectal liver metastases (CLM). However, the impact of the location of EHD on survival and the benefit in patient outcome is still diversely appreciated. From 840 patients resected for CLM between 1990 and 2006, 186(22%) also had resectable EHD. Sequential surgery was routinely combined with perioperative chemotherapy. Survival was compared with that of patients without EHD, prognostic factors were identified, and a predictive model was designed to better select surgical candidates. Patients resected for CLM with concomitant EHD experienced a lower 5-year survival than those without EHD (28% vs 55%, P < 0.001). Five poor prognostic factors were identified at multivariate analysis: EHD-location other than lung metastases (5-year survival: 23% vs 33%, P = 0.02), EHD concomitant to CLM recurrence (14% vs 34%, P < 0.001), carcinoembryonic antigen level at least 10 ng/mL (16% vs 37%, P=0.02), at least 6 CLM(9% vs 32%, P = 0.02), and right colon cancer (P = 0.02). Five-year survival ranged from 64% (0 factors) to 0% (>3 factors). In the EHD group, patients with an EHD-recurrence experienced better outcomes when resected than those treated by chemotherapy alone (5-year survival: 38% vs 21%, P = 0.05). Although sequential surgery is warranted for patients with 5 or less CLM with isolated lung metastases, low carcinoembryonic antigen levels,and no right colon primary tumor, it should be questioned in the presence of more than 3 of these prognostic factors.Annals of surgery 12/2010; 253(2):349-59. · 7.90 Impact Factor -
Article: Oncologic results of laparoscopic versus open hepatectomy for colorectal liver metastases in two specialized centers.
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ABSTRACT: Compare oncologic results of laparoscopic versus open hepatectomy for resection of colorectal metastases to the liver. Open hepatectomy (OH) is the current standard of care for the management of colorectal liver metastases. Although the feasibility of laparoscopic hepatectomy (LH) has been established, only select centers have used this technique as their primary modality. At present there is no study comparing the oncologic outcomes for colorectal liver metastases patients undergoing LH versus OH. Two groups composed of 60 patients each were obtained from 2 specialized liver units performing either OH or LH as their primary modality. Cohorts of 215 LH cases and 1783 OH were used to establish the study population. Patients were compared on an intention to treat basis using 9 preoperative prognostic criteria obtained from LiverMetSurvey. These included sex, age, primary tumor localization, number of tumors, diameter of tumor, distribution of metastases, presence of extrahepatic disease, initial respectability, and the use of prehepatectomy chemotherapy. Overall survival and disease-free survival were compared between OH and LH for a follow-up of 36 months. The median follow-up for the LH group is 30 months and 33 months for the OH group (P = 0.75). One-, 3-, and 5-year patient survival for LH was 97%, 82%, and 64% and 97%, 70%, and 56% in the OH group, respectively (P = 0.32). One-, 3-, and 5-year disease-free survival was 70%, 47%, and 35% and 70%, 40%, and 27% (P = 0.32), respectively for the 2 groups. In a highly specialized center, first line application of laparoscopic liver resection in selected patients can provide comparable oncologic results to treatment with open liver resection for patients with colorectal liver metastases.Annals of surgery 10/2009; 250(5):849-55. · 7.90 Impact Factor -
Article: Management of excluded segmental bile duct leakage following liver resection.
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ABSTRACT: Postoperative bile leak secondary to a fistula is a known complication of hepatic surgery. Four different biliary fistula sub-types have been described: type A refers to minor leakage from the bile duct stump; type B to major leakage caused by insufficient closure of the bile duct stump; type C to major leakage caused by injury to the bile duct, and type D (the rarest) to the division and exclusion of a bile duct. This complication results from functional liver parenchyma in which bile drainage is excluded from the main duct. A retrospective review of the database for 163 patients diagnosed with post-hepatic surgery bile leak from April 1992 to June 2007 was performed. Three patients were found to have type D biliary fistula, with durations of 3-21 months. The bile leak developed after a right hepatectomy in two patients and a right hepatectomy extending to segment IV in one patient. All three patients were rescheduled for surgical exploration, following failure of medical treatment. The procedure consisted of repeat resection of the independent liver parenchyma containing the fistula. One patient developed a postoperative leak from a hepaticojejunal anastomosis (treated conservatively) and the other two patients had an uneventful recovery. No recurrence of bile leak was encountered during their follow-up. Our experience indicates that conservative treatment is deceptive and not efficacious. For this condition, surgical intervention is the treatment of choice because it is very effective and is associated with a low morbidity.HPB 02/2009; 11(4):364-9. · 1.60 Impact Factor -
Article: Long-term results of two-stage hepatectomy for irresectable colorectal cancer liver metastases.
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ABSTRACT: To assess feasibility, risks, and long-term outcome of 2-stage hepatectomy as a means to improve resectability of colorectal liver metastases (CLM). Two-stage hepatectomy uses compensatory liver regeneration after a first noncurative hepatectomy to enable a second curative resection. Between October 1992 and January 2007, among 262 patients with initially irresectable CLM, 59 patients (23%) were planned for 2-stage hepatectomy. Patients were eligible when single resection could not achieve complete treatment, even in combination with chemotherapy, portal embolization, or radiofrequency, but tumors could be totally removed by 2 sequential resections. Feasibility and outcomes were prospectively evaluated. Two-stage hepatectomy was feasible in 41 of 59 patients (69%). Eighteen patients failed to complete the second hepatectomy because of disease progression (n = 17) or bad performance status (n = 1). The 41 successfully treated patients had a mean number of 9.1 metastases (mean diameter, 48.5 mm at diagnosis). Chemotherapy was delivered before (95%), in between (78%), and after (78%) the 2 hepatectomies. Mean delay between the 2 liver resections was 4.2 months. Postoperative mortality was 0% and 7% (3/41) after the first and second hepatectomy, respectively. Morbidity rates were also higher after the second procedure (59% vs. 20%) (P < 0.001). Five-year survival was 31% on an intention to treat basis, and all but 2 patients who did not complete the 2-stage strategy died within 19 months. After a median follow-up of 24.4 months (range, 3.7-130.3), overall 3- and 5-year survivals for patients that completed both hepatectomies were 60% and 42%, respectively, after the first hepatectomy (median survival, 42 months from first hepatectomy and 57 months from metastases diagnosis). Disease-free survivals were 26% and 13% at 3 and 5 years, respectively. Two-stage hepatectomy provides a 5-year survival of 42% and a hope of long-term survival for selected patients with extensive bilobar CLM, irresectable by any other means.Annals of surgery 12/2008; 248(6):994-1005. · 7.90 Impact Factor -
Article: Molecular tools and hepatocellular carcinoma: Adding help or confusion in liver transplantation?
Journal of Hepatology 11/2008; 49(4):498-501. · 9.26 Impact Factor -
Article: Surgical treatment of liver metastases of gynecological cancer: local treatment of a systemic disease.
Onkologie 10/2008; 31(8-9):425-6. · 0.87 Impact Factor -
Article: [Gallstones and their complications].
La Revue du praticien 03/2008; 58(3):333-9.
Top co-authors
Top Journals
- Hepatology (4)
- Annals of surgery (4)
- HPB (2)
- Bulletin de l'Académie nationale de médecine (1)
- Annales de Chirurgie (1)
Institutions
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2012
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Vanderbilt University
Nashville, MI, USA
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2009–2012
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Assistance Publique – Hôpitaux de Paris
Paris, Ile-de-France, France
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2003–2012
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Hôpital Paul-Brousse – Hôpitaux universitaires Paris-Sud
Villejuif, Ile-de-France, France
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2011
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Institut national de la santé et de la recherche médicale
Paris, Ile-de-France, France
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2007
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Université Paris-Sud 11
Paris, Ile-de-France, France
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2003–2004
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Institute Mutualiste Montsouris
Paris, Ile-de-France, France
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