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 · 3.01 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] 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.
Journal de Chirurgie Viscerale 11/2014; 151(6). DOI:10.1016/j.jchirv.2014.08.006
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] 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.
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.
[Show abstract][Hide abstract] 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 · 5.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aims 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. Methods Among 924 OG SRC resected in 21 centres from 1997 to 2010, consecutive patients who had oesophageal tumours (group OESO, n = 136) were matched to randomly selected patients who had gastric tumours (group GASTRIC, n = 363). Matching variables were gender, age, American Society of Anaesthesiologists score, malnutrition, pretherapeutic clinical TNM stage and neoadjuvant treatment. Patients and tumour characteristics were compared between groups and prognostic factors were identified. Results The two groups were well matched. Tumours in group GASTRIC were more advanced at surgical exploration, with higher rates of linitis plastica (P < 0.001), peritoneal carcinomatosis (P = 0.001), and advanced pTNM stages (P = 0.034). Radicality of resection and recurrence rates were similar (P > 0.480). Recurrences were more frequently distant (P < 0.001) and peritoneal (P < 0.001) in group GASTRIC. After adjustment on confounding variables, gastric location (P = 0.034) was independently associated with a better prognosis than oesophageal location. Conclusion Gastric and oesophageal SRC tumours are distinct diseases. Despite similar pretherapeutic factors, gastric tumours were more advanced with a greater propensity for the peritoneal surface at the diagnosis and recurrence and associated with a better prognosis.
European Journal of Surgical Oncology 06/2014; 40(12). DOI:10.1016/j.ejso.2014.04.019 · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction:
The signet ring cell (SRC) histological subtype is a factor of poor prognosis in advanced gastric adenocarcinomas, but its prognostic value in early gastric cancer is unclear. The aim of this study was to evaluate the prognostic impact of SRC in superficial gastric adenocarcinomas, based on a comparison of patients with SRC and non SRC histologies.
Patients and methods:
From a large national cohort of 3,010 patients operated on for gastric adenocarcinoma between January 1997 and January 2010, we selected patients with pTis or pT1 tumors and compared those with SRC and non SRC histology on the basis of demographic, surgical and histologic factors and outcomes. The primary endpoint was the 3-year survival rate.
Among 421 patients with a pTis or pT1 tumor, 104 (24.7%) had the SRC subtype and 317 (75.3%) a non SRC subtype. Median age was significantly lower in the SRC group than in the non SRC group (59.6 vs 68.8 years, p<0.001). Other demographic variables were similar in the two groups. Extensive surgical resection was more frequent in the non SRC group (31.9% vs 12.5%, p<0.001), but R0 resection rates were similar (97.5% vs 98.1%, p=0.900). The submucosa was more frequently involved in the SRC group (94.2% vs 84.9%, p=0.043), while lymph node involvement and the number of invaded nodes were similar in the two groups. Recurrences (5.8% vs 8.8%, p=0.223) and sites of recurrence (especially peritoneal carcinomatosis, 1.9% vs 1.6% ; p=0.838) were similar in the two groups. The 3-year survival rate was similar in the SRC and non SRC groups (94.1% vs 89.9%, p=0. 403), although the median survival time had not been reached
SRC is not a prognostic factor in superficial gastric adenocarcinoma.
Bulletin de l'Académie nationale de médecine 06/2014; 197(2):443-55; discussion 455-6. · 0.22 Impact Factor
[Show abstract][Hide abstract] 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 · 3.85 Impact Factor
[Show abstract][Hide abstract] 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.