Philippe Compagnon

Assistance Publique – Hôpitaux de Paris, Lutetia Parisorum, Île-de-France, France

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Publications (64)166.65 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives Appropriate patient selection is important to achieving good outcomes and obviating futile surgery in patients with huge (≥10 cm) hepatocellular carcinoma (HCC). The aim of this study was to identify independent predictors of futile outcomes, defined as death within 3 months of surgery or within 1 year from early recurrence following hepatectomy for huge HCC.Methods The outcomes of 149 patients with huge HCCs who underwent resection during 1995–2012 were analysed. Multivariate logistic regression analysis was performed to identify preoperative independent predictors of futility.ResultsIndependent predictors of 3-month mortality (18.1%) were: total bilirubin level >34 μmol/l [P = 0.0443; odds ratio (OR) 16.470]; platelet count of <150 000 cells/ml (P = 0.0098; OR 5.039), and the presence of portal vein tumour thrombosis (P = 0.0041; OR 5.138). The last of these was the sole independent predictor of 1-year recurrence-related mortality (17.2%). Rates of recurrence-related mortality at 3 months and 1 year were, respectively, 6.3% and 7.1% in patients with Barcelona Clinic Liver Cancer (BCLC) stage A disease, 12.5% and 14% in patients with BCLC stage B disease, and 37.8% (P = 0.0002) and 75% (P = 0.0002) in patients with BCLC stage C disease.Conclusions According to the present data, among patients submitted to hepatectomy for huge HCC, those with a high bilirubin level, low platelet count and portal vein thrombosis are at higher risk for futile surgery. The presence of portal vein tumour thrombosis should be regarded as a relative contraindication to surgery.
    HPB 05/2015; DOI:10.1111/hpb.12416 · 2.05 Impact Factor
  • 03/2015; 20(1). DOI:10.1016/S1283-0801(15)70593-5
  • 03/2015; DOI:10.1016/j.anrea.2014.12.012
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    Journal of Visceral Surgery 01/2015; 259(1). DOI:10.1016/j.jviscsurg.2014.09.008 · 1.32 Impact Factor
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    01/2015; 259(1). DOI:10.1016/j.jchirv.2014.07.012
  • Hepatology 01/2015; 61(1). DOI:10.1002/hep.27133 · 11.19 Impact Factor
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    ABSTRACT: Abstract Objectives: The aim of the study was to compare the long-term oncologic results of laparoscopic liver resection (LLR) versus open liver resection (OLR) for colorectal liver metastasis (CRLM) using a propensity score analysis. Subjects and Methods: This propensity score matching (PSM) study was based on a prospective database of a single tertiary-care center. Patients with primarily resectable CRLM were selected for a 1:1 PSM between LLR and OLR. Covariates for PSM estimation were age, gender, body mass index, American Society of Anesthesiologists score, primary tumor location, CRLM presentation, location, size, and number. Moreover, the year of surgery was included in the PSM model. Operative, postoperative, and survival rates were compared between groups. Results: From 2000 to 2013, in total, 339 liver resections for CRLM met the selection criteria. Among these, 52 LLR patients were matched with 52 OLR patients. The two surgical approaches showed similar postoperative morbidity and mortality rates. LLR was associated with significantly less blood loss, less frequent need for and shorter duration of pedicle clamping, faster recovery, and shorter hospital stay. Moreover, the overall 3- and 5-year survival rates were, respectively, 83% and 76% for LLR and 87% and 62% for OLR (P=.51). The 3- and 5-year disease-free survival rates were, respectively, 28% and 21% for LLR and 31% and 21% for OLR (P=.71). Conclusions: The LLR achieves similar oncological results to those of the standard open surgery for CRLM, with the additional benefit of significantly faster recovery.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2014; 25(1). DOI:10.1089/lap.2014.0477 · 1.19 Impact Factor
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    ABSTRACT: Accessory liver lobes are a rare condition and appear to be due to excessive development of the liver. The presence of an accessory hepatic lobe is often diagnosed incidentally and sometimes revealed if it develops torsion, especially in pedunculated forms. In most cases, the accessory lobe is located below the liver, i.e., infrahepatic. Riedel's lobe is the best-known example of an accessory lobe, corresponding to hypertrophy of segments V and VI. While accessories lobes can simulate tumors, there have also been reports of hepatocellular tumor(s) that developed in these accessory lobes. Based on a review of the literature, this update focuses on accessory hepatic lobes. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Journal of Visceral Surgery 10/2014; 151(6). DOI:10.1016/j.jviscsurg.2014.09.013 · 1.32 Impact Factor
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    ABSTRACT: Le lobe accessoire du foie est une variation morphologique rare et semble être lié à un développement excessif du foie. La présence d’un lobe hépatique accessoire est souvent diagnostiquée fortuitement et parfois révélée par une torsion, notamment dans les formes pédiculées. La plupart des lobes accessoires sont sous-hépatiques. Le lobe de Riedel est le plus connu des lobes accessoires du foie et correspond à une hypertrophie des segments V et VI. Les lobes accessoires peuvent simuler des tumeurs. À l’inverse, il a été rapporté des cas de tumeurs hépatocytaires situées sur ces lobes accessoires. Par une revue de la littérature, nous avons fait une mise au point sur les lobes accessoires du foie.
    10/2014; DOI:10.1016/j.jchirv.2014.09.005
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    ABSTRACT: Primary hyperoxaluria type 1 (PH1) is a hepatic metabolic defect leading to end stage renal failure (ESRF). Post-transplant recurrence of kidney disease incites to propose combined liver-kidney transplantation (LKT). However, the risk of LKT procedure is theoretically far higher than kidney alone transplantation (KAT).An unselected consecutive series of 54 patients with PH1 was analyzed according to the type of transplantation initially performed from May 1979 to June 2010 in 10 French centers.Duration of dialysis, extra-renal lesions, age and follow-up were similar between groups. Post-operative morbi-mortality did not differ between groups. Ten-year patient's survival was similar between LKT (n=33) and KAT (n=21) groups (78% vs. 70%). Kidney graft survival at 10 years was better after LKT (87 % vs. 13%; p<0.0001). Four patients (12.1%) lost their first kidney graft in LKT group vs. 19 (90%) in KAT group (p<0.0001). Recurrence of oxalosis occurred in 11 renal grafts (52%) of the KAT group vs. none in LKT group (p< 0.0001). ESRF due to rejection was also higher in the KAT group (19% vs. 9%; p<0.0001). A second kidney transplantation was performed in 15 patients (71%) in the KAT group versus 4 patients (12%) in the LKT group (P < 0.001).LKT for PH1 provides better kidney graft survival, lesser rejection, a similar long-term patient survival and is not associated with an increased short-term mortality risk. LKT must be the first-line treatment for PH1 patients with end stage renal disease. Liver Transpl , 2014. © 2014 AASLD.
    Liver Transplantation 09/2014; DOI:10.1002/lt.24009 · 3.79 Impact Factor
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    ABSTRACT: Objective: To evaluate the prevalence of sarcopenia among European patients with resectable hepatocellular carcinoma (HCC) and to assess its prognostic impact on overall and disease-free survival. Background: Identification of preoperative prognostic factors in liver surgery for HCC is required to better select patients and improve survival. Recent studies have shown that preoperative discrimination of patients with low skeletal muscle mass (sarcopenic patients) using computed tomography was associated with morbidity and mortality after liver and colorectal surgery. Assessment of sarcopenia could be used to evaluate patients before hepatectomy for HCC. Methods: All consecutive patients who underwent hepatectomy for HCC in our institution, between February 2006 and September 2012, were included. Univariate and multivariate analyses evaluating prognostic factors of postoperative mortality and cancer recurrence were performed, including preoperative, surgical, and histopathological factors. Results: Among 198 patients who underwent hepatectomy for HCC, 109 patients had an available computed tomographic scan and represent the study cohort. After a median follow-up of 21.23 months, 27 patients (24.8%) died. There were 20 deaths among the 59 patients who had sarcopenia and only 7 deaths in the nonsarcopenic group. Sarcopenic patients had significantly shorter median overall survival than nonsarcopenic patients (52.3 months vs 70.3 months; P = 0.015). On multivariate analysis, sarcopenia was found to be an independent predictor of poor overall survival (hazard ratio = 3.19; P = 0.013) and disease-free survival (hazard ratio = 2.60; P = 0.001). Conclusions: Sarcopenia was found to be a strong and independent prognostic factor for mortality after hepatectomy for HCC in European patients and could be used to evaluate eligibility of patients with HCC before surgery.
    Annals of Surgery 06/2014; 261(6). DOI:10.1097/SLA.0000000000000743 · 7.19 Impact Factor
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    ABSTRACT: Laparoscopic liver resection is considered a safe and feasible alternative to open surgery for malignant liver lesions. However, laparoscopic surgery in cirrhotic patients remains challenging. The aim of this retrospective case-control study was to compare morbidity, mortality, and long-term patient survival between laparoscopic liver resections (LLR) and open liver resections (OLR) for hepatocellular carcinoma (HCC) in patients with histologically proven cirrhosis. A total of 45 patients treated with LLR were matched by cause of cirrhosis, Child-Pugh score, type of surgical resection (subsegmentectomy, segmentectomy, and bisegmentectomy), tumor number, tumor size, and alpha-fetoprotein value with 45 patients treated with OLR. Pre-, intra-, and post-operative variables were compared between groups. Compared with OLR, the LLR group displayed a significantly shorter operative time (140 vs. 180 min; p = 0.02), shorter hospital stay (7 vs. 12 days; p < 0.0001), and lower morbidity rate (20 vs. 45 % of patients; p = 0.01). A higher rate of R0 resection was observed in the LLR group than in the OLR group (95 vs. 85 %; p = 0.03). Postoperative ascites was more frequently observed in the OLR group (18 vs. 2 %; p = 0.01). Mortality, patient, and disease-free survival rates were similar between groups. The 1-, 5-, and 10-year survival rates were 88, 59, and 12 %, respectively, in the LLR group and 63, 44, and 22 % in the OLR group (p = 0.27). Significantly shorter operative times, better resection margins, lower postoperative complications, and shorter hospital stay were observed in the LLR group compared with the OLR group. LLR and OLR have similar overall and disease-free survival rates in cirrhotic HCC patients.
    World Journal of Surgery 06/2014; 38(11). DOI:10.1007/s00268-014-2659-z · 2.35 Impact Factor
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    ABSTRACT: Infections remain a major cause of morbidity and mortality after liver transplantation. One possible cause of infection is preservation fluid contamination. Donor-derived pathogens, such as Candida albicans, have occasionally produced life-threatening complications in organ recipients, already described in renal transplantation. In the present case, we report the loss of a liver graft secondary to vascular complications because of C. albicans found in the preservation fluid. Our case report raises the question of implementing procedures, similar to those in renal transplantation, including early antifungal treatment and repeated radiological monitoring for the prevention and detection of vascular complications.
    Transplant Infectious Disease 06/2014; 16(5). DOI:10.1111/tid.12260 · 1.98 Impact Factor
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    ABSTRACT: Standard total vascular exclusion (TVE) of the liver is indicated for resection of tumors involving or adjacent to the vena cava and/or the confluence of the hepatic veins. The duration of liver ischemia can be prolonged by combined portal hypothermic perfusion of the liver (in or ex situ). The use of a venovenous bypass (VVB) during standard TVE maintains stable hemodynamics as well as optimal renal and splanchnic venous drainage. When the hepatic veins can be controlled, TVE preserving the caval flow negates the need for VVB. However this technique remains limited in duration as it is performed under warm ischemia (so-called normothermia) of the liver. To prolong the ischemia time, we have designed a modification of TVE with preservation of the caval flow including the use of temporary porta-caval shunt (PCS) and hypothermic perfusion of the liver. We describe here the first two cases of this new technique. Two patients underwent left hepatectomy extended to segments 5 and 8 (also called extended left hepatectomy) for large centrally located tumors. TVE lasted seventy-two and seventy-nine minutes, respectively. The postoperative course was uneventful and both patients were discharged on day ten and day twenty-five respectively. Both are alive without recurrence at ten and seven months following surgery. Provided the roots of the hepatic veins can be controlled, this technique combines the advantages of standard TVE with in situ hypothermic perfusion and VVB and obviates the need and the subsequent risks of the latter.
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    ABSTRACT: Background Hepatocellular adenoma (HCA) is a rare benign liver epithelial tumour that can require surgery. This retrospective study reports a 23-year experience of open and laparoscopic resections for HCA.Methods Patients with a histological diagnosis of HCA were included in this analysis. Surgical resection was performed in all symptomatic patients and in those with lesions measuring > 5 cm.ResultsBetween 1989 and 2012, 62 patients, 59 of whom were female, underwent surgery for HCA (26 by open surgery and 36 by laparoscopic surgery). Overall, 96.6% of female patients had a history of contraceptive use; 54.8% of patients presented with abdominal pain and 11.2% with haemorrhage; the remaining patients were asymptomatic. Patients who underwent laparoscopy had smaller lesions (mean ± standard deviation diameter: 68.3 ± 35.2 mm versus 91.9 ± 42.5 mm; P = 0.022). Operatively, laparoscopic and open liver resection did not differ except in the number of pedicle clamps, which was significantly lower in the laparoscopic group (27.8% versus 57.7% of patients; P = 0.008). Postoperative variables did not differ between the groups. Mortality was nil. Two surgical specimens were classified as HCA/borderline hepatocellular carcinoma. At the 3-year follow-up, all patients were alive with no recurrence of HCA.Conclusions Open and laparoscopic liver resections are both safe and feasible approaches for the surgical management of HCA. However, laparoscopic liver resections may be limited by lesion size and location and require advanced surgical skills.
    HPB 06/2014; 16(9). DOI:10.1111/hpb.12257 · 2.05 Impact Factor
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    ABSTRACT: En materia de trasplantes, el órgano es el quid de la cuestión. Sin él, no hay injerto. Cuando está disponible, debe ser perfecto desde los puntos de vista anatómico y funcional, pues la vida del receptor depende de ello. Esto requiere una extracción y conservación minuciosas. En el 90% de los casos, los órganos se extraen de un donante en estado de muerte encefálica y en dos tercios de los casos se trata de una extracción multiorgánica: corazón, pulmones, hígado, riñones, páncreas, intestino, hueso, córneas, vasos y, a veces, piel o incluso cara. La operación es compleja y en ella se reúnen varios equipos, por lo que hay que ser muy rápido. Por fortuna, está perfectamente sistematizada. Cualquier cirujano debe conocer sus detalles, porque es probable que algún día tenga que participar en una, con independencia de dónde ejerza. Evitar la pérdida de un órgano debido a un error técnico o a un desconocimiento de las reglas comunes es una de las misiones de esta exposición. Un artículo de técnicas quirúrgicas debe leerse intentando vivir la atmósfera que rodea al procedimiento. En este caso, hay que imaginar que la intervención tiene una dimensión especial. Una familia está en estado de duelo y un ser humano ha aceptado donar. La intervención del médico, que se realiza sobre un «muerto» va a dar la vida. Por último, hay que recordar que un «buen extractor» suele reconocerse por el conocimiento que tiene de la extracción de los órganos que no trasplanta.
    04/2014; 14(1):1–18. DOI:10.1016/S1634-7080(14)67434-6
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    ABSTRACT: Recurrent hepatitis C after liver transplantation (LT) is associated with rapid fibrosis progression. The aim of this study was to evaluate the cumulative risk for severe fibrosis and the factors influencing it. Two hundred and fifty LT patients were included 1 to 15years after LT. Recurrence of chronic hepatitis C on liver graft was classified according to Metavir score. Kaplan-Meyer estimates for actuarial progression to severe fibrosis (Metavir>F3) showed a probability of 15.2% and 44.5% at 5 and 10years, respectively. Predictive factors for progression to severe fibrosis were: use of tacrolimus as main CNI, recipient age at time of biopsy<55, donor age ≥45, graft HCV re-infection<3months, biologically suspected graft re-infection and lack of response to antiviral treatment after LT. Multivariate analysis disclosed that only donor age ≥45 (hazard ratio 2.243, 95%CI 1.264-3.983, P=0.0058) and lack of response to antiviral treatment (hazard ratio 2.816, 95%CI 1.227-6.464, P=0.0146) were associated to severe fibrosis. Our study confirms that donor age ≥45 and lack of response to antiviral treatment after LT are major predictive factors of progression of HCV recurrence on liver graft.
    Gastroentérologie Clinique et Biologique 03/2014; 38(3). DOI:10.1016/j.clinre.2014.02.007 · 1.98 Impact Factor
  • Annals of surgery 03/2014; DOI:10.1097/SLA.0000000000000639 · 7.19 Impact Factor
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    ABSTRACT: Intermittent clamping of the portal trial is an effective method to avoid excessive blood loss during hepatic resection, but this procedure may cause ischemic damage to liver. Intermittent selective clamping of the lobes to be resected may represent a good alternative as it exposes the remnant liver only to the reperfusion stress. We compared the effect of intermittent total or selective clamping on hepatocellular injury and liver regeneration. Entire hepatic lobes or only lobes to be resected were subjected twice to 10 min of ischemia followed by 5 min of reperfusion before hepatectomy. We provided evidence that the effect of intermittent clamping can be damaging or beneficial depending to its mode of application. Although transaminase levels were similar in all groups, intermittent total clamping impaired liver regeneration and increased apoptosis. In contrast, intermittent selective clamping improved liver protein secretion and hepatocyte proliferation when compared with standard hepatectomy. This beneficial effect was linked to better adenosine-5'-triphosphate (ATP) recovery, nitric oxide production, antioxidant activities and endoplasmic reticulum adaptation leading to limit mitochondrial damage and apoptosis. Interestingly, transient and early chaperone inductions resulted in a controlled activation of the unfolded protein response concomitantly to endothelial nitric oxide synthase, extracellular signal-regulated kinase-1/2 (ERK1/2) and p38 MAPK activation that favors liver regeneration. Endoplasmic reticulum stress is a central target through which intermittent selective clamping exerts its cytoprotective effect and improves liver regeneration. This procedure could be applied as a powerful protective modality in the field of living donor liver transplantation and liver surgery.
    Cell Death & Disease 03/2014; 5:e1107. DOI:10.1038/cddis.2014.65 · 5.18 Impact Factor
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    ABSTRACT: In trapiantologia, il trapianto è il protagonista. Senza organo da trapiantare, non vi è nessun trapianto. E, quando esso è disponibile, deve essere anatomicamente e funzionalmente perfetto. Ne dipende la vita del ricevente. Ciò sottolinea la minuziosità con la quale esso deve essere prelevato e conservato. Nove volte su dieci, i trapianti sono prelevati da un donatore in stato di morte encefalica e due volte su tre la procedura riguarda prelievi multiorgano: cuore, polmoni, fegato, reni, pancreas, intestino, osso, cornee, vasi e, a volte, cute o, anche, faccia. L’intervento è complesso. Esso riunisce diverse equipe e deve avvenire molto rapidamente. È, fortunatamente, regolato perfettamente. Ogni chirurgo deve conoscerne il dettaglio, poiché vi si troverà probabilmente di fronte un giorno, quale che sia il luogo dove esercita. Evitare la perdita di un organo la cui origine era un errore tecnico o un misconoscimento delle regole comuni rappresenta una delle missioni di questa esposizione. Un capitolo di tecniche chirurgiche si legge tentando di vivere l’atmosfera che circonda la procedura. Allora, immaginate che il vostro gesto abbia una dimensione inusuale. Una famiglia è in lutto, un uomo ha accettato di donare e il vostro coinvolgimento, che certamente riguarda una «morte», donerà la vita. Per terminare, tenete a mente che un «buon prelevatore» si riconosce spesso per la comprensione che ha del prelievo degli organi che non trapianterà lui stesso.
    03/2014; 19(1):1–16. DOI:10.1016/S1283-0801(14)66962-4

Publication Stats

460 Citations
166.65 Total Impact Points

Institutions

  • 2014–2015
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • University of Paris-Est
      La Haye-Descartes, Centre, France
  • 2013–2014
    • Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor)
      Créteil, Île-de-France, France
  • 2001–2012
    • Université de Rennes 1
      • Faculty of Medicine
      Roazhon, Brittany, France
  • 2010
    • Université de Rennes 2
      Roazhon, Brittany, France
  • 2007
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France
  • 2005
    • Centre Hospitalier Universitaire de Rennes
      Roazhon, Brittany, France
  • 2002
    • University of Wisconsin–Madison
      • Department of Surgery
      Madison, Wisconsin, United States
  • 1996
    • Hôpital Universitaire Necker
      Lutetia Parisorum, Île-de-France, France