F. Bretagnol

Paris Diderot University, Lutetia Parisorum, Île-de-France, France

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Publications (132)259.52 Total impact

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    ABSTRACT: The most serious complication of acute mesenteric vein thrombosis (MVT) is acute intestinal ischemia requiring intestinal resection or causing death. Risk factors for this complication are unknown. to identify risk factors for severe intestinal ischemia leading to intestinal resection in patients with acute MVT. We retrospectively analysed consecutive patients seen between 2002 and 2012 with acute MVT in 2 specialized units. Patients with cirrhosis were excluded. We compared patients who required intestinal resection to patients who did not. Among 57 patients, a local risk factor was identified in 14 (24%) patients, oral contraceptive use in 16 (29%), and at least one or more other systemic pro-thrombotic condition in 25 (44%). Five (9%) patients had diabetes mellitus (DM), 33 (58%) had overweight or obesity, 9 (18%) had hypertriglyceridemia, 10 (19%) had arterial hypertension. Eleven patients (19%) underwent intestinal resection. DM was significantly associated with intestinal resection (p=0.02) while local factors or pro-thrombotic conditions were not. Computed tomography (CT) scans performed at diagnosis found that occlusion of second order radicles of the superior mesenteric vein was more frequently observed in patients who underwent intestinal resection (p=0.009). n acute MVT, patients with underlying DM have an increased risk of requiring intestinal resection. Neither local factors nor systemic pro-thrombotic conditions are associated to intestinal resection. When CT scan shows the preservation of second order radicles of the superior mesenteric vein, the risk of severe resection is low. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 11/2013; · 3.87 Impact Factor
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    ABSTRACT: A pathologic complete response (pCR) can be observed in up to 25% of patients after preoperative chemoradiotherapy for rectal cancer and is associated with an improved long-term prognosis. However, few data are available regarding the effect of pCR on postoperative morbidity. This study aimed to assess the impact of the pCR on postoperative outcomes after laparoscopic total mesorectal excision (TME). A prospectively maintained database (2006-2011) was reviewed for all consecutive patients (n = 143) undergoing laparoscopic TME for mid or low rectal cancer after neoadjuvant chemoradiotherapy. Postoperative data were compared for pCR-group and non-pCR-group. A pCR was defined as the absence of gross and microscopic tumor in the specimen, irrespective of the nodal status (ypT0). Thirty-three patients (23%) had a pCR. Median operating time was greatly shorter in the pCR-group (230 minutes, 180-360), compared with the non-pCR-group (240 minutes, 130-420, P = .02). Lymph node involvement was noted for 12% of the patients in the pCR-group and 33% of the patients in the non-pCR-group (P = .91). Clavien Dindo grade 3 and 4 complications (6% vs 22%, P = .04), infection related morbidity (47% vs 76%, P = .04), and clinical anastomotic leakage rates (9% vs 29%, P = .02) were lesser in the pCR group compared with the non-pCR group. Mean duration of hospital stay was lesser in the pCR-group (9 vs 12 days, P = .01). This study showed that Clavien Dindo grade 3 and 4 complications, including anastomosis leakage, and infection related complications rates were lesser in patients with pathologic complete response after RCT and laparoscopic TME for rectal cancer.
    Surgery 10/2013; · 3.37 Impact Factor
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    ABSTRACT: Postoperative computed tomography (CT) scan patterns after colorectal resection are difficult to analyze for both clinicians and radiologists. This study aimed to assess the role of single CT scan on postoperative day 5 in predicting postoperative morbidity. From October 2007 to August 2009, 78 patients undergoing laparoscopic colorectal resection were enrolled in a research study involving a routine contrast-enhanced multi-detector CT scan on postoperative day 5. Two groups were defined: patients with intra-abdominal postoperative morbidity requiring specific management, i.e., surgical or radiological procedure, and/or antibiotic therapy ("complications" group), and patients with uneventful postoperative outcome ("uneventful" group). CT findings were compared between the two groups with Fisher's exact test or chi-square test. Postoperative abdominal complications occurred in 16 patients (21 %). Of the CT findings on day 5, pneumonia, pulmonary embolism, portal or mesenteric thrombosis, operative area fat infiltration, peritoneal effusion, pneumoperitoneum, intra-abdominal collection, parietal inflammation or collection, and subcutaneous emphysema were observed in both groups without any significant difference. Only small bowel distension [25 % (4/16) in the "complications" group vs. 5 % (3/62) in the "uneventful" group; p = 0.029] and pleural effusion [81 % (13/16) vs. 48 % (30/62); p = 0.024, respectively] were observed significantly more often in the "complications" group. This study suggested that abdominal complications cannot be predicted by a CT scan on day 5 after laparoscopic colorectal resection. Thus, it cannot be recommended for routine use.
    Techniques in Coloproctology 07/2013; · 1.54 Impact Factor
  • L Maggiori, F Bretagnol, M Ferron, Y Panis
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    ABSTRACT: BACKGROUND: Laparoscopic ventral rectopexy for rectal prolapse combines the advantages of a minimally invasive approach with the low recurrence rate observed after abdominal procedures. To date, only a few long-term functional studies and no quality of life assessment are available. The aim of this study was to assess long-term functional outcomes and quality of life after laparoscopic ventral rectopexy. METHODS: Between January 2007 and December 2008, patients who underwent laparoscopic ventral rectopexy for full-thickness external rectal prolapse and/or rectocele were prospectively included. Fecal incontinence and constipation were scored (Wexner score and Rome II criteria). Quality of life was assessed using the gastrointestinal quality of life form (GIQLI). RESULTS: Thirty-three patients were included and 30 (91 %) completed all the questionnaires. There was no morbidity or mortality. The mean length of hospital stay was 5 ± 1 days (range 3-7 days). After a mean follow-up of 42 ± 7 months (range 32-52 months), recurrence of rectocele was observed in two patients (6 %). At the end of follow-up, constipation was improved in 13/18 patients (72 %) and two patients (7 %) presented de novo constipation. The patients' Wexner score improved between preoperative status and end of follow-up (12 ± 7 vs. 4 ± 3, p = 0.002). Compared to the preoperative score, quality of life significantly improved over time: 77 ± 21 preoperatively versus 107 ± 17 at 1 year versus 109 ± 18 at the end of follow-up (p < 0.001). CONCLUSIONS: This prospective study showed that laparoscopic ventral rectopexy was associated with excellent postoperative outcomes and a low long-term recurrence rate. Long-term functional results were excellent in terms of continence, with significant improvement of quality of life and without worsening constipation.
    Techniques in Coloproctology 01/2013; · 1.54 Impact Factor
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    ABSTRACT: This study aimed to develop a new model of colorectal liver metastases (LM) in the rat. Both single macroscopic and multiple bilobar microscopic LM were investigated, as this closely resembled the human situation, before right hepatectomy was performed for 'single' right LM. The single macroscopic LM was elicited by direct injection of DHD/K12 colorectal cancer cells under the capsule of the median liver lobe in immunocompetent BDIX rats. The bilobar micrometastases were elicited by intraportal injection of DHD/K12 cells. A preliminary protocol was conducted to assess the dose of cells required to inject in to the portal vein, using 10(6) , 2 × 10(6) and 3 × 10(6) DHD/K12 cells (n = 15 rats). The resultant protocol for the experimental model used intraportal injection of 10(6) DHD/K12 cells and direct injections of 0.5 × 10(6) , 10(6) and 1.5 × 10(6) DHD/K12 cells (n = 15 rats). For both protocols, BDIX rats were sacrificed at day 30 after injection. The preliminary protocol showed that intraportal injection of 10(6) DHD/K12 cells was associated with bilobar micrometastases of 0.8 mm mean diameter at day 30. The main protocol assessed that direct injection of 0.5 × 10(6) under the liver median lobe capsule and intraportal injection of 10(6) DHD/K12 cells were associated at day 30 with a single macroscopic metastasis confined to a liver lobe and bilobar micrometastases, without peritoneal carcinomatosis or lung metastasis. Thus we have developed a new experimental model of bilobar colorectal LM including both macro- and microscopic colorectal LMs, which mimics the human situation and which will be useful in preclinical studies.
    International Journal of Experimental Pathology 12/2012; 93(6):414-20. · 2.04 Impact Factor
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    ABSTRACT: BACKGROUND: Segmental reversal of the small bowel (SRSB) is proposed in patients with short-bowel syndrome (SBS) as a rehabilitative therapy, but its effects on absorption have not been studied. OBJECTIVE: We aimed to determine intestinal macronutrient absorption and home parenteral nutrition (HPN) dependence in SBS patients with intestinal failure. DESIGN: We included in a retrospective study all consecutive patients who had an SRSB between 1985 and 2010 and underwent a study of macronutrient absorption. Patients were matched to SBS controls with the same digestive characteristics. Energy and macronutrient absorption were measured. The dependence on HPN was expressed by the number of infusions per week and by the calories infused daily divided by the basal energy expenditure multiplied by 1.5. RESULTS: Seventeen patients who had an SRSB were matched to 17 control patients. Intestinal absorption was higher in the SRSB group for total calories (69.5% compared with 58.0%), fat (48.4% compared with 33.2%), and protein (62.7% compared with 53.4%) (P < 0.05). Median oral autonomy was 100% ± 38.4% in the SRSB group, whereas it was 79% ± 39.6% in the control group (P < 0.05). The number of calories infused was lower in the SRSB group (500 ± 283 compared with 684 ± 541; P < 0.05), as was HPN dependence (33% ± 20% compared with 48% ± 38%; P < 0.05) at the time of the study. CONCLUSION: SRSB allows a gain in macronutrient absorption, which is associated with a lower HPN dependence. To our view, SRSB should be integrated in intestinal rehabilitative adult programs.
    American Journal of Clinical Nutrition 11/2012; · 6.50 Impact Factor
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    ABSTRACT: INTRODUCTION: Management of chronic radiation enteritis is often controversial, particularly due to the risk of short bowel syndrome. METHODS: One hundred and seven chronic radiation enteritis patients with short bowel syndrome were studied retrospectively between 1980 and 2009. Survival and home parenteral nutrition dependence rates were evaluated with univariate and multivariate analysis. RESULTS: The survival probabilities were 93%, 67% and 44.5% at 1, 5 and 10 years, respectively. On multivariate analysis, survival was significantly decreased with residual neoplastic disease (HR=0.21 [0.11-0.38], p<0.001), an American Society of Anesthesiologists score >3 (HR=0.38 [0.20-0.73], p=0.004) and an age of chronic radiation enteritis diagnosis >60 years (HR=0.45 [0.22-0.89], p=0.02). The actuarial home parenteral nutrition dependence probabilities were 66%, 55% and 43% at 1, 2 and 3 years, respectively. On multivariate analysis, this dependence was significantly decreased when there was a residual small bowel length >100cm (HR=0.35 [0.18-0.68], p=0.002), adaptive hyperphagia (HR=0.39 [0.17-0.87], p=0.02) and the absence of a definitive stoma (HR=0.48 [0.27-0.84], p=0.01). CONCLUSION: The survival of patients with diffuse chronic radiation enteritis after extensive intestinal resection was good and was mainly influenced by underlying comorbidities. Almost two-thirds of patients were able to be weaned off home parenteral nutrition.
    Digestive and Liver Disease 11/2012; · 3.16 Impact Factor
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    ABSTRACT: Intestinal transplantation (IT) can involve small bowel transplantation alone, or be associated with liver or multivisceral transplantation. Although IT is the radical treatment for intestinal failure, home parenteral nutrition (PN) remains the treatment of choice for this disease. Indications for IT are still debated. A recent study showed that early referral for IT is recommended for patients with life-threatening combined liver and intestinal failure or for patients with invasive intra-abdominal desmoid tumors. In the same study, no survival benefit was shown for patients undergoing IT for ultra-short bowel or major complications related to the PN catheter; indications still need to be fully assessed. While short-term outcomes for IT have improved dramatically (one-year survival for small bowel-alone IT is now 80% versus 0-28% in the 1980s), long-term outcomes have not improved much since the introduction of Tacrolimus in the 1990s: five-year survival still does not exceed 60%. Some prospective developments could improve these results: the use of multivisceral grafts, the use of Sirolimus and Thymoglobulins in the immunosuppressive treatment, or the use of new biochemical markers for early diagnosis of graft rejection.
    Journal of Visceral Surgery 11/2012; · 1.17 Impact Factor
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    ABSTRACT: : This study aimed to assess the results of segmental reversal of the small bowel (SRSB) in patients with short bowel syndrome (SBS) who were "permanently" dependent on parenteral nutrition (PN) and to identify possible prognostic factors for weaning. : SRSB is a nontransplant surgical option for patients with SBS who require long-term PN. Few studies have reported outcomes in humans. : All patients who were permanently dependent on PN and underwent a SRSB between 1985 and 2010 for SBS were included. The data were retrospectively retrieved. : Thirty-eight patients underwent SRSB. The median age was 55.5 years (range, 18-76). The median length of the small bowel remnant was 49 cm (20-140), including a reversed segment of 10 cm (6-15). The median follow-up was 57.7 months (1-304). At the 5-year follow-up, 17 patients had been weaned from PN (45%). In the remaining patients, PN dependency had decreased from 7 ± 1 to 4 ± 1 days per week. The survival rate was 84%. The prognostic factors for weaning were a short time between subtotal enterectomy and SRSB (P = 0.036), a longer than typical stay in the nutrition unit (P = 0.035), and an SRSB longer than 10 cm (P = 0.024). : SRSB has a role as a conservative alternative to small bowel transplantation in patients with SBS permanently dependent on PN. With a segmental reversal of 10 to 12 cm, almost half of the patients can be expected to be weaned from PN.
    Annals of surgery 11/2012; 256(5):739-45. · 7.90 Impact Factor
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    ABSTRACT: BACKGROUND & AIMS: Acute mesenteric ischemia (AMI) is an emergency with high mortality; survivors have high rates of intestinal failure. We performed a prospective study to assess a multidisciplinary and multi-modal management approach, focused on intestinal viability. METHODS: We developed a multi-modal management strategy involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists; it was tested in a pilot study on 18 consecutive patients with occlusive AMI, admitted to a tertiary center from July 2009 to November 2011. Patients with left ischemic colitis, non-occlusive AMI, chronic mesenteric ischemia and other emergencies were excluded. Patients received specific medical management, revascularization of viable small bowel, and/or resection of non-viable small bowel; 12 patients received arterial revascularization. We evaluated the percentages of patients that survived for 30 days or 2 years, the number with permanent intestinal failure, and morbidities. Lengths and rates of intestinal resection were compared with or without revascularization, and in patients with early- or late-stage disease. RESULTS: Patients were followed for a mean of 497 days (range, 7-2085 days); 95% survived for 30 days, 89% survived for 2 years, and 28% had morbidities within 30 days. Intestinal resection was necessary for 7 cases (39%), with mean lengths of intestinal resection of 30 cm and 207 cm, with or without revascularization, respectively (P=.03). Among patients with early- or late-stage AMI, rates of resection were 18% and 71%, respectively (P=.049). Patients with early-stage disease had shorter lengths of intestinal resection than those with late-stage disease (7 vs 94 cm, P=.02), and spent less time in intensive care (49.8 vs 2.5 days, P=.02). CONCLUSION: A multidisciplinary and multimodal management approach might increase survival times of patients with AMI, preventing intestinal failure in acute mesenteric ischemia.
    Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 10/2012; · 5.64 Impact Factor
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    ABSTRACT: Aim:  This prospective case-matched study was conducted to compare the outcome of laparoscopic colorectal surgery in patients with and without prior abdominal open surgery (PAOS). Method:  From June 1997 to December 2010, 167 patients with a PAOS (including midline, Pfannenstiel, subcostal, right upper quadrant or transverse incision) were manually matched to all identical patients without PAOS from our prospective laparoscopic colorectal surgery database. Matching criteria included age, gender, ASA score, BMI, diagnosis, and surgical procedure performed. Primary endpoints were postoperative 30-day mortality and morbidity. Secondary endpoints included operating time, conversion rate, and length of stay. Results:  A total of 367 patients (167 with PAOS and 200 without PAOS) were included in this study. PAOS was associated with a significantly increased mean operating time (229 ± 66 vs. 216 ± 71 min, p=0.044). The conversion rate was significantly higher in patients with PAOS, compared with patients without PAOS (22% vs. 13%, p=0.017). There was on (0.3%) postoperative death. The overall postoperative morbidity rate was similar in both groups (22% vs. 19%, p=0.658), including grade 3 or 4 morbidity according to Dindo's classification (5% vs. 5%, p=0.694). Mean hospital stay showed no difference between both groups (10 ± 7 vs. 9 ± 5 days, p=0.849). Conclusion:  This large case-control study suggests that PAOS does not affect postoperative outcomes. For this reason, a systematic laparoscopic approach in patients with PAOS, even with midline incision, should be considered in colorectal surgery. © 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.
    Colorectal Disease 06/2012; · 2.08 Impact Factor
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    ABSTRACT: Aim  Single-incision laparoscopy for colorectal surgery is of growing importance. The experience of colorectal resection through single-incision laparoscopic surgery was assessed, including the patient outcomes. Method  A meta-analysis was performed of studies comparing single-incision laparoscopic with multiport laparoscopy. Endpoints included conversion to laparotomy, operation time, postoperative morbidity, length of skin incision and length of hospital stay. The MEDLINE database was searched and only comparative studies were included in the meta-analysis. Data were retrieved from full-text manuscripts. Meta-analysis was performed according to the Mantel-Haenszel method for random effects. Results  From October 2008 to December 2011, 1026 colorectal resections including 921 colonic and 105 rectal procedures using single-incision laparoscopic surgery were reported in 64 studies. Meta-analysis of the 15 comparative studies, including a total of 1075 procedures (494 single-incision and 581 multiport laparoscopies), showed no difference in conversion to open laparotomy [odds ratio (OR) 0.58 (0.24, 1.38); P = 0.22], morbidity [OR 0.84 (0.61, 1.15); P = 0.27] or operation time [weighted mean difference (WMD) -0.27 (-6.50, 5.95); P = 0.93], but a significantly shorter total skin incision [WMD -0.52 (-0.79, -0.25); P < 0.001] and a significantly shorter postoperative length of stay [WMD -0.75 (-1.30, -0.20); P = 0.008] after single-incision laparoscopic surgery compared with a multiport laparoscopic approach. Conclusion  Although only 15 nonrandomized comparative studies of varying methodology have been reported, this systematic review and meta-analysis of more than 1000 colorectal procedures suggest that single-incision laparoscopic colorectal surgery is feasible and safe.
    Colorectal Disease 05/2012; 14(10):e643-54. · 2.08 Impact Factor
  • F. Bretagnol
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    ABSTRACT: L’exérèse rectale avec exérèse du mésorectum est le traitement de référence du cancer du rectum. Si l’exérèse locale constitue une alternative séduisante avec des résultats opératoires excellents sans risque de séquelles fonctionnelles digestives, elle fait l’impasse pourtant sur un éventuel envahissement ganglionnaire. Ainsi, il faut impérativement rechercher sur la pièce opératoire les critères histopronostiques défavorables (c’est-à-dire corrélés à un risque élevé de métastase ganglionnaire): infiltration profonde de la sous muqueuse (T1sm3), marges de résection envahies, emboles vasculaires et/ou lymphatiques. Une proctectomie complémentaire doit être proposée en cas de présence d’au moins un ou plusieurs critères défavorables. La microchirurgie endoscopique (TEM) permet l’exérèse locale de tumeurs du moyen et haut rectum, inaccessibles par voie transanale conventionnelle avec une meilleure qualité d’exérèse chirurgicale.
    Côlon & Rectum 05/2012; 6(2).
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    ABSTRACT: Aim  A poor functional outcome is often reported after total mesorectal excision (TME) for rectal cancer, especially when sphincter-saving resection with intersphincteric dissection is performed for low tumours. Anal sphincter rehabilitation is widely proposed for faecal incontinence. Very few studies have reported results to improve anal dysfunction following rectal surgery. This prospective study aimed to assess the benefits of sphincter training after TME in terms of functional outcome and quality of life. Methods  Anal sphincter training was performed in patients undergoing laparoscopic sphincter-saving TME for rectal cancer. Rehabilitation was performed after ileostomy closure. This group was compared with 24 matched patients. Assessment included one functional and two quality of life questionnaires (SF-36 Health Status and Faecal Incontinence Quality of Life score). Results  From 2007 to 2009, 22 patients underwent laparoscopic TME. The median follow-up after stoma closure was 21.2 (range 8-46) months. The mean stool frequency per day was significantly lower after sphincter training (2.6 in the training group vs 4.0 in the control group, P = 0.025). Following rehabilitation, patients complained significantly less about dyschezia (22 vs 63%, P = 0.008). Both groups had similar continence (Wexner score 8.3 after training vs 9.9 in controls, NS). Quality of life was significantly improved by sphincter training as measured by the vitality (P = 0.004) and mental functioning (P = 0.02) subscales on the SF-36 Health Status questionnaire and by the depression and self-perception (P = 0.005) categories of the Faecal Incontinence Quality of Life score. Conclusion  This study suggests that anal sphincter training following TME could decrease stool frequency and improve both general and specific quality of life.
    Colorectal Disease 01/2012; 14(10):1231-7. · 2.08 Impact Factor
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    ABSTRACT: Portal vein embolization (PVE) has been proposed to induce hypertrophy of liver before major resection. Because there are some concerns about the effect on tumor growth, experimental research is needed, requiring reliable small animal model. The aim was to assess technical feasibility of PVE model in rat and to report colorectal liver metastases (LM) tumor growth. LM were induced in 40 rats by injecting DHDK12 cells into the left liver lobe. At d 7, a portography was performed through a laparotomy in 20 rats allowing the left PVE. Twenty rats without PVE served as control. All rats were sacrificed at d 30. Liver and tumor volume were calculated. Mortality rate was 20% (n=8). PVE was successful in 15/19 rats (79%). Compared with control rats, the left PVE induced both significant atrophy of the left lobe (3.5±0.8 versus 7.4±0.9 mm3, P<0.0001) and contralateral hypertrophy (5.8±1.1 versus 3.6±0.7 mm3, P<0.0001). LM tumor volume in the left liver was significantly decreased in PVE group compared to control, 124.4±95.7 mm3versus 231.1±90.1 mm3, P=0.008. PVE is feasible in rats with a 79% success rate. Significant hypertrophy of the remnant liver and atrophy of the embolized liver were noted suggesting the efficacy of PVE. LM tumor growth decreased significantly in the embolized lobe. Our model can be used for experimental studies evaluating tumor growth and effects of new drugs against LM in a situation that mimics the human situation before partial hepatectomy.
    Journal of Surgical Research 12/2011; 171(2):669-74. · 2.02 Impact Factor
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    ABSTRACT: Feasibility of single port access (SPA) colorectal surgery has been established for various procedures from ileocecal resection to proctectomy. Nevertheless, its benefits compared to conventional laparoscopy still need to be assess. The aim of this study was to compare SPA to conventional colorectal laparoscopic surgery in a single institutional case-matched study. From July 2009 to July 2010, 25 SPA colorectal resections were matched on main predictive risk factors of postoperative complications, in a one to two fashion, with patient having the same procedure for the same indication by conventional laparoscopy. Patient characteristics were comparable between both groups. SPA was successfully performed in 24 of 25 patients, with a need to conversion to standard laparoscopy in one case (4%). SPA was associated with a significantly shorter median operative time (130 vs 180 min, p = 0.04) and hospital stay (6 vs 7 days, p = 0.005). Postoperative morbidity rates were similar between the two groups (4% vs 16%, p = 0.25). SPA colorectal resection can be safely performed in selected patients with results comparable to those observed after conventional laparoscopic surgery. However, larger studies including randomized controlled trail are needed to demonstrate possible benefits of SPA colorectal resection over conventional colorectal laparoscopic surgery.
    Journal of Gastrointestinal Surgery 11/2011; 16(3):629-34. · 2.36 Impact Factor
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    ABSTRACT: The hypoxia-inducible factor pathway regulates the expression of a diverse group of molecules such as CA9 and CXCR4. Our aim was to investigate the expression of these markers in a series of patients with an ileal neuroendocrine tumour (IET) at various stages of tumorigenesis. The immunohistochemical expression of CA9 and CXCR4 was examined in 51 patients with a resected IET. A 'hypoxic score' was calculated, integrating the expression of both CA9 and CXCR4 (hypoxic score 0: absence of expression of both molecules; hypoxic score 1: expression of CXCR4 and/or CA9). Results were compared to histoprognostic factors (including tumour size, stage and grade, WHO and TNM classifications, presence of vascular or perineural invasion, presence of a fibrotic stroma and microvascular density) and to survival. All tumours were well differentiated. 69% of tumours were less than 25 mm. 46% of tumours largely infiltrated the intestinal wall (≥T3, subserosa and serosa) and 90% were classified as N1 and/or 63% as M1. 57% of tumours were of grade G1, 43% of grade G2. Grade G2 (p=0.004) and larger tumour infiltration (≥T4; p=0.03) correlated with lower survival. Hypoxic score 1 correlated with a greater tumour size (p=0.034), larger tumour infiltration (T3 or T4; p=0.001), grade G2 (p=0.046), presence of lymph node metastasis (p=0.0066) and with lower survival of patients (p=0.03). The hypoxia-inducible factors CA9 and CXCR4 were found associated to the malignant progression of neuroendocrine tumours of the ileum. Their expression may reflect higher tumour aggressivity.
    Neuroendocrinology 11/2011; 95(3):214-22. · 3.54 Impact Factor
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    ABSTRACT: This study aimed to identify risk factors of postoperative 30-day mortality (POM) after colorectal cancer resection. Meta-analyses have failed to demonstrate any significant benefit of laparoscopy in terms of postoperative mortality. This could be explained by the lack of a large sample size. All patients who underwent colorectal resection for cancer between 2006 and 2008 in France were included. Data were extracted from the French National Health Service Database. A multivariate analysis evaluating risk factors for POM was performed including the following factors: age, gender, tumor location, associated comorbidities, emergency surgery, synchronous liver metastasis, malnutrition, and surgical approach. During the 3-year period, a total of 84,524 colorectal resections for colorectal cancer were performed: 22,359 through laparoscopy (26%) and 62,165 through laparotomy (74%). From 2006 to 2008, laparoscopic approach rate increased from 23% to 29% (P < 0.001). POM was 5.0%: 2% after laparoscopy and 6% after laparotomy (P < 0.001). In multivariate analysis, 7 independent factors were significantly associated with a higher POM: age 70 years or more [P < 0.001, odds ratio (OR): 3.28; (3.00-3.59)], respiratory comorbidity [P < 0.001, OR: 3.16; (2.91-3.37)], vascular comorbidity [P < 0.001, OR: 2.66; (2.48-2.85)], neurologic comorbidity [P < 0.001, OR: 1.78; (1.51-2.09)], emergency surgery [P < 0.001, OR: 2.68; (2.48-2.90)], synchronous liver metastasis [P < 0.001, OR: 2.63; (2.41-2.86)], and preoperative malnutrition [OR: 1.33; (1.19-1.50)]. Laparoscopic surgery [P < 0.001, OR: 0.59; (0.54-0.65)] was independently associated with a significant decreased POM. This all-inclusive national study showed that POM after colorectal cancer surgery is significantly reduced in case of age less than 70 years, elective surgery, and absence of synchronous liver metastasis, malnutrition, respiratory, neurologic, or vascular comorbidity. Furthermore, it is suggested that a laparoscopic surgery is independently associated with a decreased POM. This result, observed at a national level, must be considered when choosing the best surgical approach for colorectal cancer treatment.
    Annals of surgery 11/2011; 254(5):738-43; discussion 743-4. · 7.90 Impact Factor
  • J H Lefevre, A Amiot, F Joly, F Bretagnol, Y Panis
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    ABSTRACT: Approximately one-third of patients with chronic radiation enteritis (CRE) require surgery, which is associated with a high morbidity rate and a high risk of reoperation. The aim of this study was to report outcome after surgery for CRE. Patients with CRE who underwent operation with extensive small bowel resection between 1980 and 2009 were included in the study. Postoperative morbidity and mortality, reoperation for recurrent enteritis and risk factors for reoperation were analysed. Of 107 patients (94 women; 87·8 per cent) with CRE included in the study, the main indication for surgery was symptomatic stricture (82 patients; 76·6 per cent). Forty-nine ileocaecal resections (45·8 per cent) were performed. Overall and surgical morbidity rates were 74·8 per cent (80 patients) and 28·0 per cent (30) respectively. Fourteen patients (13·1 per cent) underwent reoperation for complications. Reoperation rates for CRE at 1 and 3 years of follow-up were 37 and 54 per cent respectively. Risk factors for reoperation for recurrent enteritis were: emergency surgery (odds ratio (OR) 2·72, 95 per cent confidence interval 1·57 to 4·86), anastomotic leakage (OR 2·53, 1·54 to 4·42) and male sex (OR 3·57, 1·82 to 7·29). The only protective factor for reoperation was ileocaecal resection during the first surgical procedure (OR 4·48, 2·52 to 8·31). Ileocaecal resection was the only factor that protected against reoperation for recurrent CRE, demonstrating the importance of resecting all damaged tissue in these patients. These results suggest that there is little place for intestinal bypass surgery or adhesiolysis.
    British Journal of Surgery 09/2011; 98(12):1792-7. · 4.84 Impact Factor
  • C. Hatwell, M. Zappa, F. Bretagnol, Y. Panis
    Journal De Chirurgie - J CHIR. 09/2011; 148(4):345-351.

Publication Stats

1k Citations
259.52 Total Impact Points

Institutions

  • 2011–2013
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
  • 2006–2013
    • Assistance Publique – Hôpitaux de Paris
      • Department of Radiology
      Lutetia Parisorum, Île-de-France, France
  • 2012
    • Assistance Publique Hôpitaux de Marseille
      Marsiglia, Provence-Alpes-Côte d'Azur, France
  • 2009
    • Hôpital Beaujon – Hôpitaux Universitaires Paris Nord Val de Seine
      Clicy, Île-de-France, France
  • 2008
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 2007
    • Oxford University Hospitals NHS Trust
      • Department of Colorectal Surgery
      Oxford, England, United Kingdom
  • 2005
    • Centre Hospitalier Régional Universitaire de Lille
      • General and Digestive Surgery Service
      Lille, Nord-Pas-de-Calais, France
    • CHRU de Strasbourg
      Strasburg, Alsace, France