Showing papers by "Philippe Bachellier published in 2009"

Long-term survival after liver resection for colorectal liver metastases in patients with hepatic pedicle lymph nodes involvement in the era of new chemotherapy regimens.

Abstract: Summary and Background:Survival benefit, in patients with colorectal liver metastases (CLM) and hepatic pedicle lymph nodes (HPLN) involvement along the common hepatic artery and celiac axis (area 2 or distal) has not been observed. However, these results are based on historical series, using subopt

Preliminary experience with the hanging maneuver for pancreaticoduodenectomy

Abstract: Background Malignant periampullary tumours often invade retroperitoneal peripancreatic tissues and a positive resection margin following pancreaticoduodenectomy (PD) is associated with a poor survival. The margin most frequently invaded is the retroperitoneal margin (RM). Among the different steps of PD one of the most difficult and less codified is the resection of the RM with high risk of bleeding. We have developed a surgical technique – “hanging maneuver” – which allows at the same time a standardization of this step, a complete resection of the RM, and an optimal control of bleeding. Patients/Methods We described the surgical technique, and we reported our preliminary experience. Surgical data, postoperative outcome and pathological results of patients submitted to PD for pancreatic carcinoma using “hanging maneuver” technique between January 2007 and December 2007 were reviewed. Results The hanging maneuver was performed in 20 patients without any intraoperative complication and massive bleeding. No patient required blood transfusion. After had inked the surgical margins, retroperitoneal peripancreatic tissue was invaded in 12 out of 17 patients with malignant diseases (70.5%). In only one case (6%), the retroperitoneal margin was involved by the tumour (R1 resection). Conclusion The “hanging maneuver” is a useful and safe technical variant and should be considered in the armamentarium of the pancreatic surgeons in order to achieve negative retroperitoneal margins.

Malignant rhabdoid tumour of the liver in the young adult: report of first two cases.

Abstract: Few cases of malignant rhabdoid tumour (MRT) of the liver are reported in literature and always in paediatric patients. We report the first two cases of young adults submitted to hepatic resection for MRT of the liver. A major liver resection was performed in both cases. The histology showed round or fusiform, loosely cohesive cells. The cytoplasm contained abundant eosinophilic inclusions, which caused the nuclei to be located in eccentric locations, giving the characteristic rhabdoid appearance. The immunohistochemical study was performed, and characteristic lack of nuclear INI1 protein expression was found. In a case surgery was associated to chemoradiotherapy. One patient died at 48 months followup for tumour recurrence. The other is still alive at 25 months followup. MRTs are rare tumours of pediatric age with poor prognosis. Hypothetical less malignant behaviour in the young adults could be supposed. Therefore an aggressive surgical and oncological treatment seems justified.

P.206 Conséquences cliniques, biologiques et histologiques du cetuximab et du bevacizumab après hépatectomie pour métastases d’origine colo-rectale : étude cas-témoin

Abstract: Introduction Des atteintes histologiques du parenchyme hepatique (trouble vasculaire, steatose et steatohepatite) ont ete rapportees apres administration d’une chimiotherapie entrainant une augmentation de la morbidite apres hepatectomie. Le but de ce travail etait de determiner les effets du cetuximab (Cetu) et du bevacizumab (Beva), sur le parenchyme hepatique non tumoral et de rapporter les consequences cliniques et biologiques apres hepatectomie. Patients et Methodes A partir d’une base de donnees prospective des hepatectomies pour metastases colo-rectales, tous les patients ayant recu une chimiotherapie neo-adjuvante ont ete identifies. De janvier 2005 a decembre 2007, 15 patients ont recu du Cetu et 21 du Beva. Ces 2 groupes de patients ont ete apparies (selon l’âge, le sexe, le type d’hepatectomie, le nombre de cycle et le type de chimiotherapie) chacun a un groupe controle de patients n’ayant pas recu de therapie ciblee. L’analyse histologique a ete realisee par un consensus de 2 pathologistes aveugles des donnees cliniques. Resultats Les differents groupes etaient comparables. Le taux de mortalite etait nul. Il n’y avait pas de difference entre les differents groupes concernant le taux de morbidite, d’insuffisance hepato-cellulaire, de pertes sanguines, et la duree d’hospitalisation. La prevalence des dilatations sinusoidales et de la fibrose etait plus faible dans le groupe Cetu (p = 0,04). La prevalence de la steato-hepatite etait plus faible dans le groupe Beva (p = 0,04). Dans le groupe Cetu et Beva, les γGT et phosphatases alcalines augmentaient plus rapidement que dans les groupes controles. Dans le groupe Beva, le taux de bilirubine totale etait plus eleve aux 1er (p = 0,001) et 3eme (p = 0,01) jour postoperatoire (JPO), le taux d’ASAT etait plus eleve au 1er JPO (p = 0,004), et le taux de prothrombine etait plus bas au 5eme JPO (p = 0,02). Conclusion L’adjonction de Cetu ou de Beva aux chimiotherapies neoadjuvantes n’entraine pas d’augmentation de la morbidite et de la mortalite apres hepatectomie. Sans conclure a un effet protecteur, elles n’entrainent pas plus de lesions au niveau du parenchyme hepatique non tumoral.

A new technique for reconstruction of the middle hepatic vein without graft interposition: "the digging technique".

Abstract: Ill-located liver metastases close to the cavo-hepatic confluence often require resection and reconstruction of hepatic veins. However, most of the current techniques for reconstruction of the hepatic veins require graft interposition or complex venoplasty. The present case report describes a new surgical procedure which allows reconstructing the middle hepatic vein (MHV) by direct end-to-end anastomosis after a right hepatectomy for colorectal liver metastases invading the right and middle hepatic veins. This technique is called the "digging technique", in which an additional atypical resection of a part of segment 4a "digging" around the distal end of the MHV in order to further mobilize the liver and to achieve, with an upward lifting of the remnant liver, a tension-free end-to-end reconstruction of the MHV. The immediate postoperative course was uneventful. After 6 months of follow-up the patient was well and the MHV was patent. In selected patients with liver metastases close to the MHV-inferior vena cava confluence, requiring a right hepatectomy, the "digging technique" allows a safe direct end-to-end anastomosis avoiding graft interposition.