Emmanuel Boleslawski

Emmanuel Boleslawski
Centre Hospitalier Régional Universitaire de Lille · Digestive Surgery and Transplantation Service

About

166
Publications
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Publications

Publications (166)
Article
Background and Aims Combined Hepatocellular-Cholangiocarcinoma (cHCC-CCA) is a rare primary liver cancer (PLC) associated with a poor prognosis. Given the challenges in its identification and its clinical implications, biomarkers are critically needed. We aimed to investigate the diagnostic and prognostic value of the immunohistochemical expression...
Article
Alcohol-related liver disease (ARLD) remains one of the leading causes of chronic liver disease and the prevalence of alcohol-related cirrhosis is still increasing worldwide. Thus, ARLD is one of the leading indications for liver transplantation worldwide especially after the arrival of direct-acting antivirals for chronic hepatitis C infection. De...
Article
Short bowel syndrome (SBS) is the consequence of an extensive small intestine resection ranging from 50% to 80% of its length. This results in major hydro electrolyte disorders and severe malabsorption without specific management. The resulting pharmacokinetic/dynamic modifications could lead to erratic and inconsistent immunosuppressive blood trou...
Article
Full-text available
Background Biliary complications (BC) following liver transplantation (LT) are responsible for significant morbidity. No technical procedure during reconstruction has been associated with a risk reduction of BC. The placement of an intraductal removable stent (IRS) during reconstruction followed by its endoscopic removal showed feasibility and safe...
Article
Full-text available
Liver transplant (LT) candidates with a body mass index (BMI) over 40 kg/m2 have lower access to a liver graft without clear explanation. Thus, we studied the impact of obesity on the waiting list (WL) and aimed to explore graft proposals and refusal. Method: Data between January 2007 and December 2017 were extracted from the French prospective n...
Article
Background Hepatocellular carcinoma is a frequent consequence of alcohol-related liver disease, with variable incidence among heavy drinkers. We did a genome-wide association study (GWAS) to identify common genetic variants for alcohol-related hepatocellular carcinoma. Methods We conducted a two-stage case-control GWAS in a discovery cohort of 210...
Article
Background: HCC are known to have satellite nodules and microvascular invasions requiring sufficient margins. An alpha-fetoprotein (AFP) level >100 ng/mL is associated with worse pathological features in HCC. In practice, large resection margins, particularly >1 cm, are infrequently retrieved on the specimens. Methods: 397 patients from 5 centre...
Article
Full-text available
Photodynamic Therapy (PDT) relies on local or systemic administration of a light-sensitive dye, called photosensitizer, to accumulate into the target site followed by excitation with light of appropriate wavelength and fluence. This photo-activated molecule reacts with the intracellular oxygen to induce selective cytotoxicity of targeted cells by t...
Article
Objective: The aim of this study was to build a predictive model of operative difficulty in open liver resections (LRs). Summary background data: Recent attempts at classifying open-LR have been focused on postoperative outcomes and were based on predefined anatomical schemes without taking into account other anatomical/technical factors. Metho...
Article
Background & Aims Alcoholic hepatitis (AH) is a life-threatening disease with limited therapeutic options, because understanding of the molecular drivers leading to death are not well understood. This study evaluates the Hippo/Yes-associated protein (YAP) pathway which has been shown to play a role in liver regeneration. Method The Hippo/YAP pathw...
Article
Full-text available
Purpose: To compare the agreement for the criteria on the explant and the results of liver transplantation (LT) before and after adoption of the AFP (α-fetoprotein) model. Methods: 523 patients consecutively listed in five French centers were reviewed to compare results of the Milan criteria period (MilanCP, n = 199) (before 2013) and the AFP sc...
Article
Background The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND). Methods Patients undergoing LLR or OLR for ICC were included from two F...
Article
La chirurgie est le seul traitement curatif du CCAi. La résection par cœlioscopie (LLR) est validée dans l’indication de métastases hépatiques et carcinome hépatocellulaire, mais pas pour CCAi. Le but de cette étude était de comparer morbi-mortalité, qualité de la résection chirurgicale et résultats oncologiques de l’approche LLR vs ouverte (OLR) e...
Article
Contexte Les critères de récupération fonctionnelle en chirurgie digestive et hépatique permettent de minimiser le risque de sortie prématurée et de jours d’hospitalisation inutiles. De tels critères ne sont pas encore décrits en transplantation hépatique (TH). Objectif Obtenir un consensus sur la définition de critères de récupération fonctionnel...
Article
Standardized discharge criteria are critical to reduce premature discharge and avoid unnecessary hospital stays. No such criteria exist for patients undergoing liver transplantation (LT). To achieve a consensus‐based checklist of criteria for safe patient discharge after LT, this mixed‐method study included the following: a systematic literature re...
Article
Background Mycophenolate mofetil (MMF) monotherapy following liver transplantation (LT) remains controversial due to a risk of acute rejection. The aim of this study was to report the largest multicenter experience of the use a MMF monotherapy guided by therapeutic drug monitoring using pharmacoslope modeling and Bayesian estimations of the MPA int...
Article
Severe aortic stenosis is a widespread valve disease, constituting a contraindication to organ transplantation due to cardiovascular morbidity and projected mortality. Mortality after conventional surgical aortic valve replacement in cirrhotic patients depends upon the Child Pugh’s class. In the past few years, trans‐catheter aortic valve replaceme...
Article
Background Spontaneous rupture of hepatocellular carcinoma (HCC) remains a life-threatening complication, with a reported mortality rate of between 16 and 30% and an incidence rate of approximately 3% in Europe. Survival data and risk factors after ruptured HCC are lacking, especially for peritoneal metastasis (PM).Objectives The aims of this study...
Article
This multicenter study compares the outcomes of patients with cirrhosis undergoing liver transplantation (LT) or liver resection (LR) between January 2002 and July 2015 who had intrahepatic cholangiocarcinoma (iCCA) or combined hepatocellular-cholangiocarcinoma (cHCC-CCA) found incidentally in the native liver. A total of 49 (65%) LT and 26 (35%) L...
Article
Background: The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. Methods: This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term...
Article
Background: Biliary fistula is one of the most common complications after hepatectomy. This study evaluated the effect of transcystic biliary drainage during hepatectomy on the occurrence of postoperative biliary fistula. Methods: This multicentre RCT was carried out from 2009 to 2016 in nine centres. Patients were randomized to transcystic bili...
Article
Introduction/Objectifs Le prélèvement multi-organe (PMO) est un maillon indispensable dans la chaîne de la transplantation réalisé chez plus de 34 000 donneurs par année dans le monde [1]. La technique est standardisée mais la courbe d’apprentissage, liée au début d’expérience d’une majorité des chirurgiens préleveurs, se traduit par un allongement...
Article
Résumé But de l’étude Le but de l’étude était d’évaluer le rôle pronostique de 4 solutions de conservation en transplantation hépatique (TH). Patients et méthodes Il s’agit d’une étude rétrospective à partir de toutes les TH de tous les centres français (n = 22) enregistrées dans la base de données prospective de l’Agence de la Biomédecine (Crist...
Article
Background: The kinetics of remnant liver (RL) function is unknown after major hepatectomy (MH), especially in case of post-hepatectomy liver failure (PHLF). This study investigated the change in RL function after MH using 99mTc-labelled-mebrofenin SPECT-scintigraphy and its correlation with RL volume and PHLF. Methods: From 2011 to 2015, 125 pa...
Article
Objective: The goal of this study was to evaluate the prognostic role of four preservation solutions in liver transplantation (LT). Patients and methods: This is a retrospective study originating from 22 French centers performing LT, registered in the prospective databank of the Cristal Biomedicine Agency between 2008 and 2013. The preservation...
Article
Background & aims: Selection criteria for hepatectomy in patients with cirrhosis are controversial. In this study we aimed to build prognostic models of symptomatic post-hepatectomy liver failure (PHLF) in patients with cirrhosis. Methods: This was a cohort study of patients with histologically proven cirrhosis undergoing hepatectomy in 6 French...
Article
Background: During hepatectomy, intermittent portal triad clamping (IPC) reduces ischemia-reperfusion injuries. Pharmacological preconditioning with sevoflurane revealed similar properties. The aim of the study was to evaluate the combination of a sevoflurane preconditioning regimen with IPC on ischemia-reperfusion injuries. Methods: Three regim...
Article
Objective: To perform a retrospective root-cause analysis of the causes of postoperative mortality after hepatectomy. Background: Mortality after liver resection has not decreased over the past decade. Methods: The study population was a prospective cohort of hepatectomies performed at hepatic, pancreatic, and biliary (HPB) centers between Oct...
Article
International Liver Congress (ILC) of the European-Association-for-the-Study-of-the-Liver (EASL), Paris, FRANCE, APR 11-15, 2018
Article
Background: Biliary leakage is a major contributor to morbidity after hepatectomy. A score to predict severe posthepatectomy biliary leakage (PHBL) was recently developed by the French Association of Hepatopancreatobiliary Surgery and Transplantation (ACHBT). The aim of the study was to validate and optimize the score upon an external cohort. Stu...
Article
Background: The operative risk of hepatectomy under antiplatelet therapy is unknown. This study sought to assess the outcomes of elective hepatectomy performed with or without aspirin continuation in a well balanced matched cohort. Methods: Data were retrieved from a multicentre prospective observational study. Aspirin and control groups were co...
Article
Background: Biliary leakage remains a major cause of morbidity after liver resection. Previous prognostic studies of posthepatectomy biliary leakage (PHBL) lacked power, population homogeneity, and model validation. The present study aimed to develop a risk score for predicting severe PHBL. Methods: In this multicentre observational study, patie...
Article
Objective: Investigate if involving surgeons in outcome prediction-research and having them use a dedicated Electronic-Health-Record that provides feedback, improves patients' outcome. Background: Improvement of clinical outcome mainly relies on the declaration of adverse events, identification of their predictors, self-assessment, and feedback....
Article
Background & aims: Liver transplantation (LT) for the most severely ill patients with cirrhosis, with multiple organ dysfunction (accurately assessed by the acute-on-chronic liver failure [ACLF] classification) remains controversial. We aimed to report the results of LT in patients with ACLF grade 3 and to compare these patients to non-transplante...
Article
Full-text available
Background: Posthepatectomy liver failure (PHLF) is the leading cause of posthepatectomy mortality. This study aimed to revisit the etiology and pattern of PHLF and its role in posthepatectomy morbidity and mortality. Methods: The pattern and etiology of PHLF and subsequent morbidity and mortality were analysed in the subgroup of patients withou...
Article
Introduction La greffe combinée foie et rein est une prise en charge rare de deux défaillances d’organe qui peuvent être indépendantes ou les conséquences l’une de l’autre. L’hétérogénéité des indications rend difficile toute interprétation des résultats des larges études de cohorte en vue de l’appliquer à un cas particulier. Cependant, savoir pose...
Article
Our objective was to investigate the predictive value of fractional nitric oxide (NO) concentration in exhaled breath (FeNO) and aerobic capacity (peak VO2) for postoperative sepsis in liver transplantation candidates. Patients were identified and charts of all consecutive patients were prospectively reviewed. Bacterial sepsis represented the commo...
Article
Full-text available
Liver transplantation for hilar cholangiocarcinoma (hCCA) has regained attention since the Mayo Clinic reported their favorable results with the use of a neo-adjuvant chemoradiation protocol. However, debate remains whether the success of the protocol should be attributed to the neo-adjuvant therapy or to the strict selection criteria that are bein...
Data
Questionnaire to the participating ELTR centers. (PDF)
Data
Study approval by the ELITA board. (PDF)
Data
Study approval by the Medical Ethics Review Board of the University Medical Center Groningen. (PDF)
Article
Full-text available
The incidence of biliary complications following liver transplantation (LT) remains high, ranging from 10 to 50 % of patients, especially when the diameter of the bile duct is smaller than 7 mm. Biliary reconstruction is most often performed by duct-to-duct anastomosis. In a preliminary study (n = 20), we previously reported a technique of biliary...
Article
Objectives: To determine the influence of patient depression (and anxiety) on postoperative outcome and surgeons' consideration of it. Background: Patients' mental state influences the course of nonpsychiatric diseases. Evidence in the surgical setting comes mainly from cardiac-surgery patients and no predictive-model of postoperative outcome co...
Article
Objectives: To test the prognostic impact of arterial lactate concentration at the end-of-surgery (LCT-EOS) on postoperative outcome after elective liver-resections and to identify the predictors of an increase in LCT-EOS. Background data: A recent systematic-review of risk-prediction-models for liver resections has evidenced their poor accuracy...
Article
Introduction Lors des hépatectomies (HE), le clampage intermittent (CI) du pédicule hépatique réduit les lésions d’ischémie-reperfusion (IR). Les halogénés utilisés en anesthésie ont révélé des propriétés similaires ou préconditionnement (PC). L’objectif de ce travail est d’évaluer l’intérêt du PC au sévoflurane au cours des HE avec CI. Observatio...
Article
Introduction L’épanchement pleural est une complication fréquente post hépatectomie. Nous nous proposons d’étudier l’intérêt de l’application de colle de fibrine après hépatectomie sur foie droit dans la prévention de cet l’épanchement pleural. Patients et méthode Entre le 1er mai 2013 et le 30 mars 2015, 49 malades ont été randomisés dans deux gr...
Article
66th Annual Meeting of the American-Association-for-the-Study-of-Liver-Diseases (AASLD). San Francisco, CA, nov 2015
Article
Only 20% of patients with colorectal liver metastases are eligible for liver resection, which is the only potentially curative treatment. The main reason for non resectability is related to insufficient volume of the future remnant liver. Several strategies have been proposed to increase the resectability rate: portal vein embolization/ligation and...
Article
Objective In alcoholic hepatitis (AH), development of targeted therapies is crucial and requires improved knowledge of cellular and molecular drivers in liver dysfunction. The unique opportunity of using explanted livers from patients with AH having undergone salvage liver transplantation allowed to perform more in-depth molecular translational stu...
Conference Paper
Introduction Depression is one of the main causes of disability in the Western countries. This evidence presents new challenges for somatic medicine, such as surgery. Objectives To determine the influence of patients’ depression on (i) length of hospital stay (LOS, which is a proxy of recovery) after major surgery, and (ii) LOS anticipated by surg...
Article
Background: Standardised measurement of remnant liver volume (RLV), where total liver volume (TLV) is calculated from patients' body surface area (RLV-sTLV), has been advocated. Extrapolating the model of living donor liver transplantation, we showed in a pilot study that the simplified RLV/body weight ratio (RLVBWR) was accurate in assessing the...