B Lelong

Institut Paoli Calmettes, Marsiglia, Provence-Alpes-Côte d'Azur, France

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Publications (72)217.06 Total impact

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    PLoS ONE 05/2015; 10(5):e0123768. DOI:10.1371/journal.pone.0123768 · 3.53 Impact Factor
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    ABSTRACT: Previous publications have suggested that endoscopic transanal proctectomy (ETAP) is a promising technique and may be an alternative to conventional low anterior resection for rectal cancer. The aim of this study was to evaluate the technical feasibility of ETAP, with a particular focus on postoperative and oncological results and on functional outcomes.
    Annals of Surgery 10/2014; 261(2). DOI:10.1097/SLA.0000000000000994 · 7.19 Impact Factor
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    ABSTRACT: Aggressive angiomyxoma (AA) is a rare benign soft tissue tumour usually affecting the pelvis and perineum of young women. Magnetic resonance imaging (MRI) is crucial in the management of AA patients for its diagnostic contribution and for the preoperative assessment of the actual tumour extension. Given the current development of less aggressive therapeutics associated with a higher risk of recurrence, close follow-up with MRI is fundamental after treatment. In this context, diffusion-weighted (DW) imaging has already shown high efficacy in the detection of early small relapses in prostate or rectal cancer. We report here a case of pelvic AA in a 51-year-old woman examined with dynamic contrast enhancement and DW-MRI, including apparent diffusion coefficient mapping and calculation. To our knowledge, this is the first description of DW-MRI in AA reported in the literature. Here, knowledge about imaging features of AA will be reviewed and expanded.
    Case Reports in Oncology 05/2013; 6(2):373-81. DOI:10.1159/000353487
  • Cancer/Radiothérapie 09/2012; 16(5-6):557-558. DOI:10.1016/j.canrad.2012.07.116 · 1.11 Impact Factor
  • BJA British Journal of Anaesthesia 08/2011; 107(2):277-8. DOI:10.1093/bja/aer214 · 4.35 Impact Factor
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    ABSTRACT: This study retrospectively describes the outcome of a series of 38 patients (pts) with T4 anal carcinoma exclusively treated by radio and chemotherapy. From 1992 to 2007, 38 pts with UST4-N0-2-M0 anal carcinoma were treated with exclusive radiotherapy and chemotherapy. All patients received external beam radiotherapy (EBRT) (median dose 45 Gy) with a concomitant chemotherapy (5-fluorouracil-cisplatin). Eleven patients received neo-adjuvant chemotherapy (5-fluorouracil-cisplatin). After 2-8 weeks, a 15-20 Gy boost was delivered either with EBRT (20 pts) or interstitial (192)Ir brachytherapy (18 pts). Mean follow-up was 66 months. After chemoradiation therapy (CRT), 13 pts (34%) had a complete response, 23 pts (60%) a response >50% (2 pts were not evaluated). The 5-year-disease-free survival was 79.2 ± 6.5%, and the 5-year overall survival was 83.9 ± 6%. Eight patients developed tumor progression (mean delay 8.8 months), six of them requiring a salvage surgery with definitive colostomy for local relapse. Late severe complication requiring colostomy was observed in 2 pts. The 5-year-colostomy-free survival was 78 ± 6.9%. Patients who received primary chemotherapy had a statistically significant better 5-year colostomy-free survival (100% vs. 38 ± 16.4%, P = 0.0006). T4 anal carcinoma can be treated with a curative intent using a sphincter-sparing approach of CRT, and neo-adjuvant chemotherapy should be considered prior to radiotherapy.
    Journal of Surgical Oncology 07/2011; 104(1):66-71. DOI:10.1002/jso.21866 · 2.84 Impact Factor
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    ABSTRACT: Neoadjuvant chemoradiation followed by surgery is the standard of care for locally advanced rectal cancer. The aim of this study was to correlate tumour response to survival and to identify predictive factors for tumour response after chemoradiation. From 1998 to 2008, 168 patients with histologically-proven locally advanced adenocarcinoma treated by preoperative chemoradiation before total mesorectal excision were retrospectively studied. They received a radiation dose of 45 Gy with a concomitant 5-fluoro-uracil-based chemotherapy. Analysis of tumour response was based on the lowering of T stage between pre-treatment endorectal ultrasound and pathologic specimens. Overall and progression-free survival was correlated with tumour response. Tumour response was analysed with predictive factors. The median follow-up was 34 months. Five-year disease-free survival and overall survival were respectively of 44.4% and 74.5% in the whole population, 83.4% and 83.4% in patients with pathological complete response, 38.6% and 71.9% in patients with tumour downstaging, 29.1% and 58.9% in patients with absence of response. A pre-treatment concentration of carcinoembryonnic antigen below 5 ng/mL was significantly associated with tumour downstaging and significantly independently associated with pathologic complete tumour response (P = 0.019). Downstaging and complete response after chemoradiation improved progression-free survival and overall survival of locally advanced rectal adenocarcinoma. In multivariate analysis, a pre-treatment concentration of carcinoembryonnic antigen below 5 ng/mL was associated with complete tumour response, hence with tumour downstaging.
    Cancer/Radiothérapie 04/2011; 15(4):279-86. DOI:10.1016/j.canrad.2011.01.005 · 1.11 Impact Factor
  • Endoscopy 03/2011; 43(03). DOI:10.1055/s-0031-1273163 · 5.20 Impact Factor
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    ABSTRACT: Neoadjuvant chemoradiation followed by surgery is the standard of care for locally advanced rectal cancer. The aim of this study was to correlate tumor response to survival and to identify predictive factors for tumor response after chemoradiation. From 1998 to 2008, 168 patients with histologically proven locally advanced adenocarcinoma treated by preoperative chemoradiation before total mesorectal excision were retrospectively studied. They received a radiation dose of 45 Gy with a concomitant 5-fluorouracil (5-FU)-based chemotherapy. Analysis of tumor response was based on lowering of the T stage between pretreatment endorectal ultrasound and pathologic specimens. Overall and progression-free survival rates were correlated with tumor response. Tumor response was analyzed with predictive factors. The median follow-up was 34 months. Five-year disease-free survival and overall survival rates were, of 44.4% and 74.5% in the whole population, 83.4% and 83.4%, respectively, in patients with pathological complete response, 38.6% and 71.9%, respectively, in patients with tumor downstaging, and 29.1 and 58.9% respectively, in patients with absence of response. A pretreatment carcinoembryonic antigen (CEA) level of <5 ng/ml was significantly independently associated with pathologic complete tumor response (p = 0.019). Pretreatment small tumor size (p = 0.04), pretreatment CEA level of <5 ng/ml (p = 0.008), and chemotherapy with capecitabine (vs. 5-FU) (p = 0.04) were significantly associated with tumor downstaging. Downstaging and complete response after CRT improved progression-free survival and overall survival of locally advanced rectal adenocarcinoma. In multivariate analysis, a pretreatment CEA level of <5 ng/ml was associated with complete tumor response. Thus, small tumor size, a pretreatment CEA level of < 5 ng/ml, and use of capecitabine were associated with tumor downstaging.
    International journal of radiation oncology, biology, physics 11/2010; 80(2):483-91. DOI:10.1016/j.ijrobp.2010.02.025 · 4.18 Impact Factor
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    ABSTRACT: Introduction Le traitement standard des cancers du bas et moyen rectum localement avancés est la radio-chimiothérapie (RCT) néo-adjuvante suivie d’une proctectomie avec exérèse totale du mésorectum. Le but de cette étude était a) de corréler la réponse tumorale (RT) au pronostic des patients en termes de survie et de récidive et b) d’identifier des facteurs prédictifs de RT après RCT néo-adjuvante. Méthode Entre 1998 et 2007, 417 patients porteurs d’un adénocarcinome du rectum ont été traités dans notre centre par une radiothérapie ± chimiothérapie, suivie d’une chirurgie carcinologique. Ont été inclus dans notre étude rétrospective, 168 patients présentant une tumeur localement avancée (T3/T4) des 2/3 inférieurs du rectum traités par RCT concomitante néo-adjuvante suivie d’une proctectomie avec exérèse totale du mésorectum. La réponse complète (RC) était définie histologiquement (ypT0). La comparaison entre le « T » (TNM) du bilan initial et celui de l’analyse histologique de la pièce d’exérèse permettait de classer les malades en non répondeurs (NR, pas de modification du T) ou ayant une réponse partielle (RP, diminution du T). Les survies globale et sans récidive et le mode de récidive, locale ou à distance, ont été étudiés. Plusieurs facteurs ont été évalués en analyse uni- et multivariée afin de déterminer leur capacité à prédire une RT à la RCT. Résultats Dix patients ont été exclus de l’étude car la réponse n’était pas évaluable. Trente et un patients (19 %) avaient une réponse complète (RC), 58 (37 %) une réponse partielle (RP) et 69 (44 %) étaient non répondeurs (NR). Parmi les patients ayant une RC (ypT0), 42 % étaient bien évalués (usT0) à l’écho endoscopie pré-opératoire mais 33 % étaient surévalués (usT3 ou T4). Le suivi médian était de 34 mois. La survie sans récidive à 5 ans était significativement meilleure chez les patients ayant une RC en comparaison aux patients chez qui persistait un résidu histologique (RP+ NR) : 83,4 % vs 38,6 % (p = 0,006). La survie globale à 5 ans était identique : 83,4 % vs 71,9 % (p = 0,5). La survie sans récidive à 5 ans était significativement meilleure chez les patients ayant une RT (RC+ RP) en comparaison aux patients NR : 63,6 % vs 29,1 % (p = 0,001). La survie globale à 5 ans était aussi significativement meilleure : 87,7 % vs 58,9 % (p = 0,02). Le taux de récidive locale à 5 ans était de 4 % en cas de RC vs 19 % en cas de résidu histologique (RP+NR) (p = 0,19). Le taux de récidive à distance à 5 ans était significativement plus faible en cas de RC qu’en cas de résidu histologique (RP+NR) 14 % vs 53 % (p = 0,015). Le taux de récidive à distance à 5 ans était également significativement plus faible en cas de RT (RC+RP) qu’en cas de non réponse (NR) : 31 % vs 65 % (p < 0,001). Un taux d’ACE initial normal (p = 0,008) et une chimiothérapie potentialisatrice par capécitabine (vs 5-FU) (p = 0,04) étaient prédictifs d’une RT (RC+ RP) à la RCT ; un taux d’ACE initial normal était le seul facteur prédictif indépendant de RC (p = 0,02). Conclusion La RT à la RCT néo-adjuvante est un facteur pronostic pour les patients présentant un adénocarcinome rectal localement avancé. Elle est difficile à évaluer en pré-opératoire. Hors protocole, une chirurgie carcinologique reste indispensable même lorsque l’écho endoscopie post RCT évoque une RC. Notre étude a montré qu’un taux d’ACE initial normal ainsi que le type de chimiothérapie seraient prédictifs de la RT voire de réponse complète. Ces résultats demandent à être confirmés.
    09/2010; 147(4):21-21. DOI:10.1016/S1878-786X(10)70047-4
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    ABSTRACT: Major cancer surgery is a high-risk situation for sepsis in the post-operative period. The aim of this study was to assess the relation between the monocyte production of IL-12 and the development of post-operative sepsis in patients undergoing major cancer surgery. In 19 patients undergoing major cancer surgery, the production of cytokines by basal and lipolysaccharide (LPS)-stimulated monocytes was measured before and after (from day 1 to day 3 and day 7) surgery. Seven of them developed a post-operative sepsis. Ten healthy volunteers were used as controls for the assessment of pre-operative values. Before surgery, the production of interleukin (IL)-12 p40 by LPS-stimulated monocytes was similar in the patients and the healthy volunteers. The production of IL-12 p40 by unstimulated monocytes was higher in the patients than in the healthy volunteers. IL-12 production did not differ between the septic and the non-septic patients. After surgery, the production of IL-12 p40 was dramatically reduced in the LPS-stimulated monocytes of the septic patients from day 1 to day 3, as compared with that of the non-septic patients. Before surgery, the production of IL-6, IL-10, and IL-1 receptor antagonist (IL-1ra) in the patients was significantly higher than that of the healthy volunteers for both stimulated and unstimulated monocytes. After surgery, the production of these cytokines by both stimulated and unstimulated monocytes of the septic patients was similar to that of the non-septic patients. Intragroup analysis showed significant changes for IL-6, IL-10, and IL-1ra under all conditions, with the exception of changes in unstimulated monocytes of septic patients that were not significant for IL-10 release. After surgery, the septic patients showed drastic failure to up-regulate monocyte LPS-stimulated production of IL-12 p40.
    Acta Anaesthesiologica Scandinavica 02/2010; 54(5):643-8. DOI:10.1111/j.1399-6576.2010.02218.x · 2.31 Impact Factor
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    ABSTRACT: We aimed to determine the most sensitive markers of the learning process for laparoscopic conservative mesorectal excision (LCME) for rectal cancer to (1) generate a relevant training program for junior surgeons and (2) define appropriate settings for prospective trials. The learning process for the laparoscopic approach to treating rectal cancer has not yet been clearly described. Over a 42-month period, 127 patients received LCME at our institution. The procedure was performed or supervised by a single referent surgeon. The operative time, conversion to open procedure postoperative morbidity, microscopic margins, and local recurrence were thought to be the most relevant parameters related to the learning process. To give a comprehensive view of success, a single hybrid variable was generated. Curves were drawn using the moving average method for continuous variables and the CUSUM analysis was used for binary variables. A slow but continuous decrease in operative time was observed over all the study period. The overall and surgical morbidities were the most sensitive markers. The conversion rate and R0-resection rate remained stable at 14.9% and 91%, respectively. The overall local recurrence rate was 4.7% at a median follow-up time of 40 months and was not affected by the learning process. The success rate reached a steady state after 50 patients. Despite surgeons' early command of the conversion rate, the learning process for LCME affects morbidity for the first 50 patients operated on, but does not adversely affect the oncological results. Much emphasis should therefore be placed on technical training.
    Annals of surgery 02/2010; 251(2):249-53. DOI:10.1097/SLA.0b013e3181b7fdb0 · 7.19 Impact Factor
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    ABSTRACT: The most accepted treatment for locally advanced pancreatic adenocarcinoma (LAPA) is chemoradiotherapy (CRT). We sought to determine the benefit of pancreaticoduodenectomy (PD) in patients with LAPA initially treated by neoadjuvant CRT. From January 1996 to December 2006, 64 patients with LAPA (borderline, n=49; unresectable, n=15) received 5-fluorouracil-cisplatin-based CRT. Of the 64 patients, 47 had progressive disease at restaging. Laparotomy was performed for 17 patients, and PD was performed in 9 patients (resected group). Fifty-five patients had CRT followed by gemcitabine-based chemotherapy (unresected group). The median survival and overall 5 years survival duration of all 64 patients were 14 months and 12%, respectively. The mean delay between diagnosis and surgical resection was 5.5 months. Mortality and morbidity from PD were 0% and 33%, respectively. The median survival of the resected group vs. the unresected group was 24 months vs. 13 months. Three specimens presented a major pathological response at histological examination. No involved margins were found and positive lymph nodes were found in one patient. Resected patients developed distant metastases. PD after CRT was safe and resected patients had interesting survival rates. However, resected patients developed metastatic disease and new neoadjuvant regimens are needed to improve the survival of these patients.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 08/2009; 35(12):1306-11. DOI:10.1016/j.ejso.2009.06.005 · 2.89 Impact Factor
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    ABSTRACT: The influence of obesity [body mass index (BMI) >or= 30 kg/m(2)] on the outcome of laparoscopic colorectal surgery remains controversial. The complexity of rectal laparoscopic resections requires a specific assessment of the impact of obesity on the feasibility and short-term results of the surgery. Between February 2002 and May 2007, 210 laparoscopic mesorectal excisions were performed. Demographic, oncologic and perioperative data were entered in a prospective database. Twenty-four patients (11.4%) with BMI over 30 kg/m(2) formed the obese group (OG). The outcomes in the OG and the nonobese group (NOG) were compared. There were significantly more American Society of Anesthesiologists (ASA) score 3 patients (26% in OG versus 9% in NOG; p = 0.03) in the obese group. Obese patients experienced longer operative times (513 min in OG vs. 421 min in NOG; p < 0.01) and more frequent conversion to laparotomy (46% in OG vs. 12% in NOG; p < 0.001). Morbidity grade 1 was higher in the obese group (29.2% vs. 9.7% in NOG; p = 0.01), but there was no difference in regards to morbidity grade 2 or more (33.3% in OG vs. 32.3% in NOG). In addition, conversion to laparotomy among the obese did not increase significantly morbidity grade 2 or higher (5 of 11 for OG converted vs. 3 of 13 for OG nonconverted; p = 0.39). Regarding the oncological parameters (e.g. number of lymph nodes removed, distal and lateral margins) there was no difference between groups. Obesity increases operative duration and conversion rate of rectal laparoscopic resection for cancer. Although obesity is associated with a worse preoperative evaluation, there is no increase in relevant morbidity and no impairment of oncological safety.
    Surgical Endoscopy 07/2009; 23(7):1460-4. DOI:10.1007/s00464-008-0266-5 · 3.31 Impact Factor
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    ABSTRACT: Local recurrence of pelvic cancer is a therapeutic challenge. Medical history retrieve frequently high dose radiotherapy and multiple pelvic surgery. Thus, surgical resection is complex and leads to hazardous postoperative courses. We report a case of radiofrequency thermoablation (RFTA) of an isolated pelvic recurrence. A 53-year-old woman presented in 2006 with a small (20 mm) pelvic recurrence of an anal canal cancer initially treated by radiochemotherapy and amputation of the rectum. The recurrence was localized in the left vaginal wall, involving the obturator internus muscle. Treatment consisted on primary chemotherapy followed by RFTA under real time endovaginal sonography with cooling of the bladder. Small vaginal wall necrosis occurred in postoperative courses and rapidly cicatrized. The patient was still alive without evolution 22 months after the treatment. RFTA is a feasible therapeutic option for some selected small isolated pelvic cancer recurrence. It allows good local control with survival improvement.
    Surgical laparoscopy, endoscopy & percutaneous techniques 05/2009; 19(2):e41-2. DOI:10.1097/SLE.0b013e31819c8801 · 0.94 Impact Factor
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    ABSTRACT: Combining conventional systemic chemotherapy with the angiogenesis inhibitor bevacizumab is now recommended as a first treatment for metastatic colorectal neoplasms. The risk for short-term postoperative complications related to bevacizumab has been assessed. Late postoperative complications related to bevacizumab have also been suggested by preliminary reports. We reviewed a cohort of 142 patients with previous surgery for primary colonic or rectal tumor and without evidence of local recurrence, receiving bevacizumab for metastatic disease. Four patients experienced a late surgical site complication related to bevacizumab. Common features were rectal location, low anastomosis, and preoperative irradiation. Combining these three factors, the risk of a bevacizumab-related complication was 4 in 27 (14.8%); if previous history of postoperative leakage was reported, the risk was raised to 2 in 4. No complications occurred in colonic location or the non-irradiated patients. The mechanism of these complications could be ischemic lesion in post-irradiated tissues involving anastomoses. We conclude that angiogenesis inhibitors should be carefully considered for patients having low colorectal anastomosis and previous irradiation.
    Annals of Surgical Oncology 02/2009; 16(4):856-60. DOI:10.1245/s10434-008-0279-2 · 3.94 Impact Factor
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    ABSTRACT: It is the aim of this study to assess the outcome of patients who received neoadjuvant 5-fluorouracil-cisplatin chemoradiation (CRT) for stage I/III pancreatic adenocarcinoma. Eligible patients (n = 101) received radiation therapy (45 Gy) associated with continuous infusion of 5-fluorouracil accompanied by a cisplatin bolus. Of the 102 patients enrolled in the study, 26 patients had progression of cancer during treatment and were deemed unresectable; 1 patient died during CRT of septic shock. Sixty-two of 75 remaining patients underwent pancreaticoduodenectomy. The overall median survival of all 102 patients in the study was 17 months, with a 5-year survival of 10%. For patients who underwent resection, the median survival was 23 months. Correspondingly, the median survival was 11 months for the 40 unresected patients (p = 0.002). The 5-year survivals for resected and unresected patients were 18 and 0% (p = 0.01), respectively. A complete pathological response to neoadjuvant CRT was noted for 8 patients (13%). Margin and lymph node positivity was present in 5 (8%) and 15 (24%) patients, respectively. There was documented local recurrence in 8 (13%) and distant recurrence in 36 (58%) patients, with the liver being the most common site. Neoadjuvant 5-fluorouracil-based CRT had a limited impact on survival but appeared to be associated with improved local control.
    Oncology 02/2009; 76(6):413-9. DOI:10.1159/000215928 · 2.61 Impact Factor
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    ABSTRACT: To compare the volumetric increase of segments 2 and 3, segment 4, and the caudate lobe after portal vein ligation (PVL) and portal vein embolization (PVE). The small size of the remnant liver and chemotherapy-induced liver injury increase the risk of postoperative hepatic insufficiency after major hepatic resection for colorectal liver metastases. Portal vein ligation has been suggested to be less effective than embolization in inducing hypertrophy of the remnant liver. Design, Setting, and We retrospectively reviewed 48 patients with colorectal liver metastases who underwent PVL (n = 17) or PVE (n = 31) at the Istituto per la Ricerca e la Cura del Cancro or the Institut Paoli-Calmette from March 1, 2000, through August 31, 2006. To compare the volume increase of segments 2 and 3, segment 4, and of the caudate lobe in patients who have undergone PVL or PVE in preparation for a major hepatic resection. There were no deaths related to PVE or PVL. Portal vein ligation was associated with resection of synchronous colorectal cancer in 16 patients. Resection of a liver metastasis in the remnant liver was performed in 11 patients. The median estimated baseline volume of segments 2 and 3 was 17.7% in the PVL group and 17.5% in the PVE group (P = .72). After PVL or PVE, it increased to 26.9% and 24.7%, respectively (P = .95), for volumetric increases of 43.1% and 53.4%, respectively (P = .39). The volumetric increases of segment 4 and the caudate lobe were similar. Portal vein ligation is as effective as PVE in inducing hypertrophy of the remnant liver volume.
    Archives of surgery (Chicago, Ill.: 1960) 11/2008; 143(10):978-82; discussion 982. DOI:10.1001/archsurg.143.10.978 · 4.30 Impact Factor
  • Journal de Chirurgie 08/2008; 145(4):396. DOI:10.1016/S0021-7697(08)74325-4 · 0.50 Impact Factor
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    ABSTRACT: Temporary faecal diversion is recommended with a low colorectal, coloanal or ileoanal anastomosis (LA). This randomized study evaluated early (EC; 8 days) versus late (LC; 2 months) closure of the temporary stoma. Patients undergoing rectal resection with LA were eligible to participate. If there was no radiological sign of anastomotic leakage after 7 days, patients were randomized to EC or LC. The primary endpoints were postoperative morbidity and mortality 90 days after the initial resection. Some 186 patients were analysed. There were no deaths within 90 days and overall morbidity rates were similar in the EC and LC groups (31 versus 38 per cent respectively; P = 0.254). Overall surgical complication (both 15 per cent; P = 1.000) and reoperation (both 8 per cent; P = 1.000) rates were similar, but wound complications were more frequent after EC (19 versus 5 per cent; P = 0.007). Small bowel obstruction (3 versus 16 per cent; P = 0.002) and medical complications (5 versus 15 per cent; P = 0.021) were more common with LC. Median (range) hospital stay was reduced by EC (16 (6-59) versus 18 (9-262) days; P = 0.013). Early stoma closure is feasible in selected patients, with reduced hospital stay, bowel obstruction and medical complications, but a higher wound complication rate. Registration number: NCT00428636 (http://www.clinicaltrials.gov).
    British Journal of Surgery 06/2008; 95(6):693-8. DOI:10.1002/bjs.6212 · 5.21 Impact Factor