Philippe Compagnon

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

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Publications (56)137.67 Total impact

  • [Show abstract] [Hide abstract]
    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. Part A. 11/2014;
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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; · 1.17 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.
    Journal de Chirurgie Viscérale. 10/2014;
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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; · 3.94 Impact Factor
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    ABSTRACT: 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.
    Annals of surgery. 06/2014;
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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.
    World journal of surgery. 06/2014;
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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; · 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.
    Hepatobiliary surgery and nutrition. 06/2014; 3(3):149-53.
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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; · 1.94 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.
    EMC - Cirugía General. 04/2014; 14(1):1–18.
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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; · 0.80 Impact Factor
  • Annals of surgery 03/2014; · 7.90 Impact Factor
  • Hepatology 03/2014; · 12.00 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. · 6.04 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.
    EMC - Tecniche Chirurgiche Vascolare. 03/2014; 19(1):1–16.
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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.
    EMC - Técnicas Quirúrgicas - Aparato Digestivo. 01/2014; 30(2):1–18.
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    ABSTRACT: Many substances, drugs or not, can be responsible for acute hepatitis. Nevertheless, toxic etiology, except when that is obvious like in acetaminophen overdose, is a diagnosis of elimination. Major causes, in particular viral etiologies, must be ruled out. Acetaminophen, antibiotics, antiepileptics and antituberculous drugs are the first causes of drug-induced liver injury. Severity assessment of the acute hepatitis is critical. Acute liver failure (ALF) is defined by the factor V, respectively more than 50% for the mild ALF and less than 50% for the severe ALF. Neurological examination must be extensive to the search for encephalopathy signs. According to the French classification, fulminant hepatitis is defined by the presence of an encephalopathy in the two first weeks and subfulminant between the second and 12th week after the advent of the jaundice. During acetaminophen overdose, with or without hepatitis or ALF, intravenous N-acetylcysteine must be administered as soon as possible. In the non-acetaminophen related ALF, N-acetylcysteine improves transplantation-free survival. Referral and assessment in a liver transplantation unit should be discussed as soon as possible.
    Annales francaises d'anesthesie et de reanimation 06/2013; 32(6):416–421. · 0.77 Impact Factor
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    ABSTRACT: Many substances, drugs or not, can be responsible for acute hepatitis. Nevertheless, toxic etiology, except when that is obvious like in acetaminophen overdose, is a diagnosis of elimination. Major causes, in particular viral etiologies, must be ruled out. Acetaminophen, antibiotics, antiepileptics and antituberculous drugs are the first causes of drug-induced liver injury. Severity assessment of the acute hepatitis is critical. Acute liver failure (ALF) is defined by the factor V, respectively more than 50% for the mild ALF and less than 50% for the severe ALF. Neurological examination must be extensive to the search for encephalopathy signs. According to the French classification, fulminant hepatitis is defined by the presence of an encephalopathy in the two first weeks and subfulminant between the second and 12th week after the advent of the jaundice. During acetaminophen overdose, with or without hepatitis or ALF, intravenous N-acetylcysteine must be administered as soon as possible. In the non-acetaminophen related ALF, N-acetylcysteine improves transplantation-free survival. Referral and assessment in a liver transplantation unit should be discussed as soon as possible.
    Annales francaises d'anesthesie et de reanimation 05/2013; · 0.77 Impact Factor
  • Liver Transplantation 03/2013; · 3.94 Impact Factor
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    ABSTRACT: BACKGROUND: Since March 2007, priority access to liver transplantation in France has been given to patients with the highest MELD scores. OBJECTIVE: To undertake an intent-to-treat comparison of center-based vs. MELD-based liver graft allocation. METHODS: Retrospective cohort analysis (patients listed 6th March 2007 to 5th March 2009; MELD period) with a matched historical cohort (patients listed 6th March 2005 to 5th March 2007; pre-MELD period) in a single high-volume center. Analysis was on an intent-to-treat basis, i.e. starting on the day of wait listing. RESULTS: Compared to pre-MELD, fewer patients with a MELD score less or equal to 14 (P=0.002), and more patients with a MELD greater or equal to 24 (P<0.05) were transplanted during the MELD period. For HCC candidates, median waiting time increased (121 vs. 54 days, P=0.01), transplantation rate halved (35% vs. 73.5%, P<0.001) and dropouts due to tumor progression increased (16% vs. 0%, P<0.001). Moreover, postoperative course did not change significantly except for infectious complications (35% vs. 24%, P=0.02); overall patient survival was 69.8±3.1% vs. 76±2.9% (P=0.29) and overall graft survival was 77.6±3.4% vs. 82.8±2.9% (P=0.29). Transplant failures were mainly due to deaths on the waiting list in the previous system, but to dropouts related to disease progression in the new system. Cirrhotic patient survival rate did not change (78.1±4.4% vs. 73.5±4.5%, P=0.42), while that of HCC patients decreased (65.3±5.3% vs. 86.8±4.4%, P=0.01). Post-transplant survival worsened significantly according to pre-transplant MELD score (P=0.009). CONCLUSION: The MELD-based graft allocation system introduced discrimination against HCC patients, whose incidence has increased dramatically, and should be reevaluated.
    Gastroentérologie Clinique et Biologique 09/2012; · 0.80 Impact Factor

Publication Stats

340 Citations
137.67 Total Impact Points

Institutions

  • 2014
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2013
    • Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor)
      Créteil, Île-de-France, France
    • University of Paris-Est
      Centre, France
  • 2008–2012
    • Université de Rennes 1
      Roazhon, Brittany, France
  • 2005–2012
    • Centre Hospitalier Universitaire de Rennes
      • Service de chirurgie hépatobiliaire et digestive
      Roazhon, Brittany, France
    • Centre Hospitalier Universitaire de Nantes
      Naoned, Pays de la Loire, France
  • 2010
    • Université de Rennes 2
      Roazhon, Brittany, France
  • 2002
    • University of Wisconsin, Madison
      • Department of Surgery
      Madison, MS, United States