Guillaume Piessen

University of Lille Nord de France, Lille, Nord-Pas-de-Calais, France

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Publications (109)401.13 Total impact

  • The Lancet Oncology 08/2015; DOI:10.1016/S1470-2045(15)00127-8 · 24.73 Impact Factor
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    ABSTRACT: Over the last two decades, many surgical teams have developed programs to treat peritoneal carcinomatosis with extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, there are no specific recommendations for HIPEC procedures concerning environmental contamination risk management, personal protective equipment (PPE), or occupational health supervision. A survey of the institutional practices among all French teams currently performing HIPEC procedures was carried out via the French network for the treatment of rare peritoneal malignancies (RENAPE). Thirty three surgical teams responded, 14 (42.4%) which reported more than 10 years of HIPEC experience. Some practices were widespread, such as using HIPEC machine approved by the European Community (100%), individualized or centralized smoke evacuation (81.8%), "open" abdominal coverage during perfusion (75.8%), and maintaining the same surgeon throughout the procedure (69.7%). Others were more heterogeneous, including laminar flow air circulation (54.5%) and the provision of safety protocols in the event of perfusate spills (51.5%). The use of specialized personal protective equipment is ubiquitous (93.9%) but widely variable between programs. Protocols regarding cytoreductive surgery/HIPEC and the associated professional risks in France lack standardization and should be established. Copyright © 2015 Elsevier Ltd. All rights reserved.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 07/2015; DOI:10.1016/j.ejso.2015.07.012 · 2.89 Impact Factor
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  • The Annals of thoracic surgery 06/2015; 99(6):2253-2254. DOI:10.1016/j.athoracsur.2014.11.031 · 3.65 Impact Factor
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    ABSTRACT: Perioperative oncologic treatments provide a survival benefit for junctional and gastric adenocarcinoma (JGA) and esophageal cancer (EC). Whether neoadjuvant therapy toxicity (NTT) correlates with increased perioperative risk remains unclear. We aimed to evaluate the impact of grade III/IV NTT on postoperative and oncologic outcomes in resected upper gastrointestinal malignancies. A multicenter retrospective analysis was performed on consecutive patients who benefited from neoadjuvant chemo(radio)therapy followed by surgery between 1997 and 2010 for JGA (first cohort, n = 653) and for EC (second cohort, n = 640). Data between patients who experienced NTT were compared to those who did not. NTT was associated with higher postoperative mortality after resection of JGA (P = 0.001) and after esophagectomy (P < 0.001), more non-R0 resections (JGA P = 0.019, EC P = 0.024), a decreased administration of adjuvant treatment among the JGA cohort (P = 0.012), and higher surgical morbidity (JGA P = 0.005, EC P = 0.020). Median survival was reduced in patients who experienced NTT in both cohorts (JGA P = 0.018, EC P = 0.037). After adjustment on confounding variables, NTT was independently associated with postoperative mortality in both cohorts (P ≤ 0.007). NTT is a predictor of postoperative mortality, correlates with higher postoperative morbidity, and negatively affects oncologic outcomes for upper gastrointestinal carcinomas.
    Annals of Surgical Oncology 02/2015; DOI:10.1245/s10434-015-4423-5 · 3.94 Impact Factor
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    ABSTRACT: Self-expanding metallic stents (SEMSs) have been used as a bridge to surgery, relieving dysphagia and maintaining nutrition, in patients with operable but obstructive esophageal cancer (EC). However, the impact of SEMSs on oncologic outcomes is unknown. The aim of this study was to evaluate the impact of SEMS insertion before EC surgery on oncologic outcomes. From 2000 to 2010, two thousand nine hundred and forty-four patients who underwent an operation for EC with a curative intent were included in a multicenter European cohort. Through propensity score analysis, patients who underwent SEMS insertion (SEMS group, n = 38) were matched 1:4 to control patients who did not undergo SEMS insertion (control group, n = 152). The SEMS and control groups were comparable according to age, sex, tumor location, clinical stage, American Society of Anesthesiologists score, dysphagia, malnutrition, neoadjuvant treatment administration, histology, and surgical procedure. Self-expanding metallic stent insertion was complicated by tumoral perforation in 2 patients. The in-hospital postoperative mortality and morbidity rates for the SEMS vs control groups were 13.2% vs 8.6% (p = 0.370) and 63.2% vs 59.2% (p = 0.658), respectively. The R0 resection rate (71.0% vs 85.5%; p = 0.041), median time to recurrence (6.5 vs 9.0 months; p = 0.040), and 3-year overall survival (25% vs 44%; p = 0.023) were significantly reduced in the SEMS group, and the 3-year locoregional recurrence rate was increased (62% vs 34%; p = 0.049). The results remained significant after excluding SEMS-related esophageal perforations. After adjusting for confounding factors, SEMS insertion was a predictor of poor prognosis (hazard ratio = 1.6; p = 0.038). Self-expanding metallic stent insertion, as a bridge to surgery, has a negative impact on oncologic outcomes in EC. Clinicaltrials.gov ID: NCT 01927016. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
    Journal of the American College of Surgeons 12/2014; 220(3). DOI:10.1016/j.jamcollsurg.2014.11.028 · 4.45 Impact Factor
  • G. Piessen
    12/2014; 151(6). DOI:10.1016/j.jchirv.2014.07.010
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    ABSTRACT: La fistule anastomotique est une complication majeure en chirurgie digestive, responsable d’une augmentation de la morbidité postopératoire, et première cause de mortalité après chirurgie d’exérèse. L’identification des facteurs de risque est un prérequis indispensable à la prévention de la fistule. La fistule peut se manifester par différents tableaux cliniques, allant de l’absence de symptômes, au choc septique avec mise en jeu du pronostic vital. Le scanner injecté avec opacification est l’examen le plus exhaustif pour l’exploration de tout type de fistule et de ses répercussions. Un diagnostic précoce et une prise en charge optimale multidisciplinaire de la fistule permettent de diminuer la morbi-mortalité postopératoire. Elle est basée sur trois options : médicale, interventionnelle de type radiologique ou endoscopique, ou chirurgicale, dont le choix dépend de l’état septique du malade. Si le patient est asymptomatique, le traitement peut être exclusivement médical avec une surveillance rapprochée. Un traitement interventionnel est entrepris pour une fistule symptomatique si le pronostic vital n’est pas engagé. Si par contre le pronostic vital est mis en jeu, une réintervention chirurgicale en urgence est nécessaire, associée à une réanimation intensive. Plus que leur prévention, c’est la précocité et la qualité de la prise en charge des fistules anastomotiques qui en diminuent leur retentissement.
    11/2014; 151(6). DOI:10.1016/j.jchirv.2014.08.006
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    ABSTRACT: Objectives: To assess the impact of neoadjuvant chemoradiotherapy (NCRT) on anastomotic leakage (AL) and other postoperative outcomes after esophageal cancer (EC) resection. Background: Conflicting data have emerged from randomized studies regarding the impact of NCRT on AL. Methods: Among 2944 consecutive patients operated on for EC between 2000 and 2010 in 30 European centers, patients treated by NCRT after surgery (n = 593) were compared with those treated by primary surgery (n = 1487). Multivariable analyses and propensity score matching were used to compensate for the differences in some baseline characteristics. Results: Patients in the NCRT group were younger, with a higher prevalence of male sex, malnutrition, advanced tumor stage, squamous cell carcinoma, and surgery after 2005 when compared with the primary surgery group. Postoperative AL rates were 8.8% versus 10.6% (P = 0.220), and 90-day postoperative mortality and morbidity rates were 9.3% versus 7.2% (P = 0.110) and 33.4% versus 32.1% (P = 0.564), respectively. Pulmonary complication rates did not differ between groups (24.6% vs 22.5%; P = 0.291), whereas chylothorax (2.5% vs 1.2%; P = 0.020), cardiovascular complications (8.6% vs 0.1%; P = 0.037), and thromboembolic events (8.6% vs 6.0%; P = 0.037) were higher in the NCRT group. After propensity score matching, AL rates were 8.8% versus 11.3% (P = 0.228), with more chylothorax (2.5% vs 0.7%; P = 0.030) and trend toward more cardiovascular and thromboembolic events in the NCRT group (P = 0.069). Predictors of AL were high American Society of Anesthesiologists scores, supracarinal tumoral location, and cervical anastomosis, but not NCRT. Conclusions: Neoadjuvant chemoradiotherapy does not have an impact on the AL rate after EC resection (NCT 01927016).
    Annals of Surgery 11/2014; 260(5):764-771. DOI:10.1097/SLA.0000000000000955 · 8.33 Impact Factor
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    ABSTRACT: Anastomotic leakage represents a major complication of gastrointestinal surgery, leading to increased postoperative morbidity; it the foremost cause of mortality after intestinal resection. Identification of risk factors is essential for the prevention of AL. AL can present with various clinical pictures, ranging from the absence of symptoms to life-threatening septic shock. Contrast-enhanced CT scan is the most complete investigation to define AL and its consequences. Early and optimal multidisciplinary management is based on three options: medical management, radiologic or endoscopic intervention, or surgical re-intervention. Prompt treatment should help decrease postoperative morbidity and mortality, with the choice depending on the septic status of the patient. If the patient is asymptomatic, treatment can be medical only, coupled with close surveillance. Interventional management is indicated when the fistula is symptomatic but not life-threatening. On the other hand, when the vital prognosis is engaged, surgery is indicated, emergently, associated with intensive care. Even more than their prevention, early and appropriate management counts most to decrease their consequences. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Journal of Visceral Surgery 10/2014; 151(6). DOI:10.1016/j.jviscsurg.2014.10.004 · 1.32 Impact Factor
  • G. Piessen
    Journal of Visceral Surgery 10/2014; 151(6). DOI:10.1016/j.jviscsurg.2014.09.001 · 1.32 Impact Factor
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    ABSTRACT: Objectives. - To report the setting-up of a new educational program in the teaching of female pelvic and breast examinations and to investigate and compare the views and experience of undergraduate medical students and teachers on the program. Patients and methods. - Prospective evaluation of the teaching program through completion of a satisfaction questionnaire including items related to the educational value of the session by the students and the teachers. Results. The educational program included an online preparation for the session, 3 workshops on training models (breast examination, pelvic examination, cervical snear procedure) and a video clip. In total, 419 (80.6%) of 520 second study year students (and 15 [50%] of 30 teachers [13 doctors and 17 midwifes] responded to the questionnaire). The students and the teachers were either very satisfied (56.6% and 13.4%, respectively) or satisfied (43.2% and 86.6%, respectively). On average, 89.7% of students wanted more lessons of this type and all teachers felt these useful or very useful training for students. Discussion and conclusion. Teaching sessions for pelvic and breast examination, which make combined use of videos and training models, are associated with a high degree of satisfaction from teachers and students in their second student's year.
    Gynécologie Obstétrique & Fertilité 08/2014; 42(9). DOI:10.1016/j.gyobfe.2014.07.004 · 0.58 Impact Factor
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    ABSTRACT: MUC1 is a membrane-bound mucin known to participate in tumor proliferation. It has been shown that MUC1 pattern of expression is modified during esophageal carcinogenesis, with a progressive increase from metaplasia to adenocarcinoma. The principal cause of development of esophageal adenocarcinoma is gastro-esophageal reflux and MUC1 was previously shown to be upregulated by several bile acids present in reflux. In this report, our aim was thus to determine whether MUC1 plays a role in biological properties of human esophageal cancer cells. For that, a stable MUC1-deficient esophageal cancer cell line was established using a shRNA approach. In vitro (proliferation, migration and invasion) and in vivo (tumor growth following subcutaneous xenografts in SCID mice) biological properties of MUC1-deficient cells were analyzed. Our results show that esophageal cancer cells lacking MUC1 were less proliferative and had decreased migration and invasion properties. These alterations were accompanied by a decreased activity of NFKB p65, Akt and MAPK (p44/42, JNK and p38) pathways. MCM6 and TSG101 tumor-associated markers were also decreased. Subcutaneous xenografts showed a significant decrease in tumor size when cells did not express MUC1. Altogether, the data indicate that MUC1 plays a key role in proliferative, migrating and invasive properties of esophageal cancer cells as well as in tumor growth promotion. MUC1 mucin appears thus as a good therapeutic target to slow down esophageal tumor progression.
    Biochimica et Biophysica Acta (BBA) - Molecular Cell Research 07/2014; 1843(11). DOI:10.1016/j.bbamcr.2014.06.021 · 5.30 Impact Factor
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    ABSTRACT: The incidence of oesogastric (OG) signet ring cell adenocarcinoma (SRC) is increasing in Western countries. The differential characteristics between oesophageal and gastric SRC tumours are unknown. We aimed to investigate the role of tumour location on prognosis in OG SRC.
    European Journal of Surgical Oncology 06/2014; 40(12). DOI:10.1016/j.ejso.2014.04.019 · 2.89 Impact Factor
  • Christophe Mariette · William B Robb · Guillaume Piessen
    Annals of surgery 03/2014; DOI:10.1097/SLA.0000000000000668 · 7.19 Impact Factor
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    ABSTRACT: To date, for esophageal cancer (EC), the optimal timing of surgical procedures after neoadjuvant chemoradiation (nCRT) is not well defined. Data in rectal cancer suggest that a prolonged interval between treatment and operation may improve tumoral pathologic response, R0 resection rate, and survival. The aims of this study were to evaluate whether delaying operation after nCRT in EC increases pathologic response and has an impact on oncologic outcome or postoperative course. A total of 257 consecutive EC patients (n = 161 squamous cell carcinomas and n = 96 adenocarcinomas) undergoing nCRT followed by operation between 1997 and 2011 were retrospectively analyzed by the use of prospectively collected data. The patients were divided into two groups according to the median delay between nCRT and operation (<7 weeks, n = 122; ≥7 weeks, n = 135). The impact of surgical delay on outcomes was studied through univariable and multivariable analyses. The groups were comparable regarding patient and tumor characteristics (p ≥ 0.074). The ypT0 and R0 resection rates were similar between the two groups, as were postoperative course, median survivals, and incidence and patterns of recurrence (p ≥ 0.332). Multivariable analysis failed to identify any impact of the surgical delay on the endpoints. Subgroup analysis according to the histologic type found similar results. After nCRT for EC, delaying operation does not affect the ypT0 rate, postoperative course, or oncologic outcome and cannot therefore be justified by these aims.
    The Annals of thoracic surgery 02/2014; 97(4). DOI:10.1016/j.athoracsur.2013.12.026 · 3.65 Impact Factor
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    ABSTRACT: Day-case laparoscopic Nissen-Rossetti fundoplication (LF) has been demonstrated to be safe in small, prospective cohorts. The purpose of the study was to compare postoperative course, functional results, quality of life, and healthcare costs in patients undergoing LF in a day-case surgical unit with same-day discharge and patients undergoing LF as an inpatient. All consecutive patients in our department who underwent a primary LF for symptomatic uncomplicated gastroesophageal reflux disease from 2004 to 2011 were entered into a prospective database (n = 292). From 101 same-day discharge patients (day-case group), control inpatient procedures were randomly matched by age, gender, body mass index, American Society of Anesthesiologists classification, and presence of a hiatal hernia (inpatient group, n = 101). No postoperative deaths occurred and postoperative morbidity occurred in 9.4 % of patients. When comparing day-case and inpatient groups, postoperative morbidity rates were 9.9 vs. 8.9 % (p = 0.81) with median hospital stays and readmission rates of 1 vs. 4 days (p < 0.001) and 7.9 vs. 0 % (p < 0.001), respectively. Gastrointestinal Quality of Life Index was significantly enhanced due to surgery (p < 0.001) and comparable in the two groups. Estimated direct healthcare costs per patient were 2,248 euros in the day-case group vs. 6,569 euros in the inpatient group (p < 0.001), equivalent to a cost saving of 3,921 euros. Day-case and inpatient approaches after LF give similar results in terms of postoperative mortality and morbidity, functional outcomes and quality of life, with a substantial cost saving in favor of a day-case procedure.
    Surgical Endoscopy 02/2014; 28(7). DOI:10.1007/s00464-014-3448-3 · 3.31 Impact Factor
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    ABSTRACT: Malgré la fréquence des éventrations complexes (EC), leurs modalités de réparation y compris la place des prothèses sont mal codifiées, particulièrement en situation contaminée. Notre objectif était de connaître les pratiques des chirurgiens universitaires français prenant en charge ces EC pour ce qui est des indications, des techniques les plus adaptées, du type de prothèse éventuelle utilisée, et des complications observées.
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    ABSTRACT: Objective: The primary objective was to evaluate the feasibility of surgical enucleation of esophageal gastrointestinal stromal tumors (E-GISTs). Secondary objectives evaluated (i) the impact of tumor enucleation on oncological outcomes, (ii) the effect of pretherapeutic biopsy on the feasibility of E-GIST enucleation, and (iii) the impact of mucosal ulceration on outcome. Background: E-GISTs are very rare tumors and esophageal resection has been the recommended approach. The feasibility and impact on outcomes of tumor enucleation are unknown. Methods: Through a large national multicenter retrospective study, 19 patients with E-GISTs were identified between 2001 and 2010. Patients who underwent either enucleation or esophagectomy were compared. Results: Of over 19 patients identified with E-GISTs, curative treatment was surgical for 16 patients, with enucleation in 8 and esophagectomy in 8. In the enucleation group, median tumoral diameter was 40 mm (18-65 mm), without any mucosal ulceration, preoperative capsular ruptures, or incomplete resections. In the esophagectomy group, the median tumoral diameter was 85 mm (55-250 mm), with mucosal ulceration in 4 patients, preoperative capsular rupture in 1, and no incomplete resections. Severe postoperative complication rates were 50% and 25% in the esophagectomy and enucleation groups, respectively, with 2 postoperative deaths after esophagectomy. After a median follow-up of 6.4 years, 2 recurrences were observed after esophagectomy versus 0 after enucleation. Endoscopic biopsies did not expose patients to complications or local recurrence after enucleation. Endoscopic mucosal ulceration was associated with more aggressive tumors. Conclusions: E-GIST enucleation seems safe for tumors of less than 65 mm in diameter.
    Annals of Surgery 01/2014; 261(1). DOI:10.1097/SLA.0000000000000505 · 8.33 Impact Factor

Publication Stats

1k Citations
401.13 Total Impact Points

Institutions

  • 2007–2015
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 2003–2015
    • Centre Hospitalier Régional Universitaire de Lille
      • • General and Digestive Surgery Service
      • • Institute of Biochemistry and Molecular Biology
      Lille, Nord-Pas-de-Calais, France
  • 2006–2013
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2011
    • Université de Versailles Saint-Quentin
      Versailles, Île-de-France, France
  • 2003–2011
    • CHRU de Strasbourg
      Strasburg, Alsace, France