Author
Philippe Bachellier
Other affiliations: Aix-Marseille University, University of Franche-Comté, Imperial College London ...read more
Bio: Philippe Bachellier is an academic researcher from University of Strasbourg. The author has contributed to research in topics: Hepatectomy & Liver transplantation. The author has an hindex of 52, co-authored 267 publications receiving 10978 citations. Previous affiliations of Philippe Bachellier include Aix-Marseille University & University of Franche-Comté.
Papers published on a yearly basis
Papers
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TL;DR: Five‐year survival rates after resection of liver metastases from colorectal carcinoma are close to 25%, and selection of patients likely to benefit from surgery remains controversial and subjective.
Abstract: BACKGROUND
Five-year survival rates after resection of liver metastases from colorectal carcinoma are close to 25%. Recurrences occur in two-thirds of the patients after surgery. Selection of patients likely to benefit from surgery remains controversial and subjective.
METHODS
Data from 1568 patients with resected liver metastases from colorectal carcinoma were collected. The prognostic value of different factors was studied through uni- and multivariate analyses. A scoring system was developed including the most relevant factors.
RESULTS
Two- and 5-year survival rates were 64% and 28%, respectively, and were affected by: age; size of largest metastasis or CEA level; stage of the primary tumor; disease free interval; number of liver nodules; and resection margin. Giving one point to each factor, the population was divided into three risk groups with different 2-year survival rates: 0–2 (79%), 3–4 (60%), 5–7 (43%).
CONCLUSIONS
A simple prognostic scoring system was proposed to evaluate the chances for cure of patients after resection of liver metastases from colorectal carcinoma. The comparison between expected survival and estimated operative risk can help determine on an objective basis whether surgery is worthwhile. This system needs further prospective validation. Cancer 1996;77:1254-62.
1,652 citations
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TL;DR: This procedure may be able to overcome the shortcomings of “conventional” two-stage hepatectomy and result in an increased number of patients who could benefit from surgical treatment despite initially unresectable hepatic malignancies due to too small future liver remnant volume.
Abstract: W e read with great interest the original article by Schnitzbauer et al,1 introducing a novel surgical procedure in oncological liver resection. This surgical approach has been devised for patients with initially unresectable liver malignancies because of too small future liver remnant. Using this procedure, the future liver remnant volume considerably increased only in a mean of 9 days (the median increased future liver remnant volume of 74%) and all patients (n = 25) succeeded in completion of the extended major hepatectomy. Thus, this procedure may be able to overcome the shortcomings of “conventional” two-stage hepatectomy.2–4 It has been known that the major reason for failure of two-stage hepatectomy is tumor progression during a waiting period of future liver remnant hypertrophy after portal vein occlusion. 5, 6 Therefore, this may be a groundbreaking surgical procedure resulting in an increased number of patients who could benefit from surgical treatment despite initially unresectable hepatic malignancies due to too small future liver remnant volume. Owing to the complexity of this procedure, however, it should be used with caution in clinical practice. The incidence of severe morbidity after this procedure is considerably high (27 events occurred in 9 of 25 patients; 36%), and a particularly high incidence rate of postoperative biliary fistula requiring percutaneous drainage is worthy of special mention (5 of 25 patients; 20%). Furthermore, 20% of patients who underwent hepaticojejunostomy required relaparotomy because of biliary leakage. Such a high rate of biliary complications may result from the complexity of procedures, suggesting that this procedure may not be applicable to patients requiring biliary reconstruction. In patients with hep-
543 citations
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TL;DR: In selected patients with Initially unresectable MBCLM, a TSHP combined with PVE can be achieved safely with long-term survival similar to that observed in patients with initially resectable liver metastases.
Abstract: Liver resection has been recognized as the treatment of choice for patients with colorectal liver metastases (CLM), offering long-term survival and the only hope for cure.1–3 However, hepatectomy can be performed only in approximately 10% to 20% of patients with CLM.4 In the majority of cases, liver surgery is contraindicated due to too small future remnant liver (FRL).5–7 During the last years, new multidisciplinary therapies have been proposed to increase safely the resectability rate in patients with initially nonresectable CLM. They include portal vein embolization (PVE),8–10 systemic or arterial hepatic neoadjuvant chemotherapy,11,12 transarterial neoadjuvant immunochemotherapy,13 and local tumoral destruction.14,15 However, these adjuvant therapies do not allow to achieve a curative resection in all patients and particularly in patients with multiple bilobar CLM (MBCLM). In these patients, the resection of MBCLM would result in a too small FRL. A 2-stage hepatectomy procedure (TSHP) without PVE was advocated to treat patients with unresectable multiple metastases.16 However, after resection of MBCLM, high mortality (9%–15%) was reported.16,17 Liver failure due to insufficient functional volume of the FRL is the main cause of postoperative mortality. Preoperative PVE has been proposed to induce compensatory hypertrophy of the FRL.8,9 Some successful cases undergoing right hepatectomy and simultaneous left hemiliver wedge resections after PVE have been reported in patients with MBCLM.18 However, growth of metastatic nodules in the FRL after PVE can be more rapid than that of the nontumoral remnant hepatic parenchyma.19 Therefore, metastases located in the FRL should be ideally resected before PVE in a first-stage hepatectomy; a major hepatic resection can then be performed, after PVE, in a second-stage hepatectomy. Therefore, a new strategy design has been developed to treat patients with initially unresectable MBCLM. Our preliminary results were previously reported.20
The present study reports feasibility, surgical outcome, recurrence rate, and long-term survival of patients presenting initially unresectable MBCLM undergoing a TSHP combined with PVE.
514 citations
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TL;DR: The present study suggests that SI resulted in a poorer liver functional reserve and in a higher complication rate after major hepatectomy, and female patients who received 6 cycles or more of OBC, or presenting with abnormal preoperative aspartate aminotransferase and ICG-R15 values should be carefully selected before deciding to undertake a major hepATEctomy.
Abstract: Objective:To investigate whether sinusoidal injury (SI) was associated with a worse outcome after hepatectomy in patients with colorectal liver metastases (CRLM).Background:Correlation between SI and oxaliplatin-based chemotherapy (OBC) was recently shown in patients with CRLM. However, it has yet t
417 citations
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TL;DR: Characteristics of patients who survived more than 5 years after liver resection of colorectal metastases are analyzed to find out whether these characteristics are related to survival and disease progression.
Abstract: Aim The aim of this study was to analyse characteristics of patients who survived more than 5 years after liver resection of colorectal metastases.
Methods A multicentre retrospective study collected 1818 patients who underwent curative resection of hepatic metastases between 1959 and 1991. Among the 747 patients operated on before 1987, 102 survived longer than 5 years, and were compared with patients who survived less than 5 years.
Results Three risk factors proved independently significant in multivariate analysis between the two groups: serosa infiltration (P = 0·003), involvement of peritumoral lymph nodes around the primary colorectal tumour (P = 0·04), and a liver resection margin of less than 1 cm (P = 0·02). There was no significant difference for other parameters studied (location of primary tumour, location, number and size of metastases, type of resection). A trend towards a shorter survival of patients with increased carcinoembryonic antigen serum level was observed.
Conclusion Resection of colorectal hepatic metastases can provide long-term survival even in patients with poor prognostic factors. It seems justified to undertake resection of colorectal liver metastases whenever it may be performed safely as a curative treatment.
334 citations
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TL;DR: There is, I think, something ethereal about i —the square root of minus one, which seems an odd beast at that time—an intruder hovering on the edge of reality.
Abstract: There is, I think, something ethereal about i —the square root of minus one. I remember first hearing about it at school. It seemed an odd beast at that time—an intruder hovering on the edge of reality.
Usually familiarity dulls this sense of the bizarre, but in the case of i it was the reverse: over the years the sense of its surreal nature intensified. It seemed that it was impossible to write mathematics that described the real world in …
33,785 citations
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TL;DR: This 5-year evaluation provides strong evidence that the classification of complications is valid and applicable worldwide in many fields of surgery, and subjective, inaccurate, or confusing terms such as “minor or major” should be removed from the surgical literature.
Abstract: Background and Aims:The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the co
7,537 citations
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TL;DR: There is a need for clearly defined and widely applicable clinical criteria for the selection of patients who may benefit from hepatic resection for metastatic colorectal cancer and studies of preoperative staging techniques or of adjuvant therapies should consider using such a score for stratification of patients.
Abstract: ObjectiveThere is a need for clearly defined and widely applicable clinical criteria for the selection of patients who may benefit from hepatic resection for metastatic colorectal cancer. Such criteria would also be useful for stratification of patients in clinical trials for this disease.MethodsCli
3,441 citations