Showing papers by "Philippe Bachellier published in 2010"

Prediction of Mortality Rate After Major Hepatectomy in Patients Without Cirrhosis

Abstract: Objective To assess the ability of preoperative biological parameters to predict a fatal outcome after a major liver resection in patients without cirrhosis. Design Retrospective descriptive cohort study. Setting Department of Digestive Surgery and Transplantation, University of Strasbourg. Patients From January 1, 2004, through December 31, 2007, 67 consecutive patients underwent resection of at least 4 contiguous liver segments. Main Outcome Measures Perioperative data were prospectively recorded, and predictors of postoperative mortality rate and liver failure were analyzed. Results Five patients (7%) died after a mean (SD) of 32.4 (11.8) postoperative days. The overall morbidity was 73% (49 patients). Univariate analysis revealed that a preoperative alanine aminotransferase blood level greater than 40 U/L (to convert to microkatals per liter, multiply by 0.0167), a preoperative prothrombin ratio less than 70%, a preoperative Indocyanine green retention rate at 15 minutes of greater than 15%, preoperative biliary drainage, and performance of extrahepatic bile duct resection significantly predict the occurrence of in-hospital death. The number of preoperative biological parameters in each patient significantly increased the mortality rate. Indeed, the mortalities were 0%, 3%, and 67% in patients presenting with none, 1, and 2 or more risk factors, respectively. Conclusions This study shows that preoperative liver tests and function can predict postoperative fatal outcome in patients presenting with biliary carcinomas and requiring a major liver resection. On the basis of these preoperative biological parameters, a decision-making algorithm is provided.

Targeted molecular therapies (cetuximab and bevacizumab) do not induce additional hepatotoxicity: Preliminary results of a case–control study

Abstract: Aims To analyse the effects of the preoperative targeted molecular therapy (cetuximab (cetu) or bevacizumab (beva)) on non-tumorous liver parenchyma, and the clinical and biological outcome after liver resection for colorectal liver metastases (CLM). Methods Between January 2005 and December 2007, 36 patients receiving preoperatively cetu ( n = 15) or beva ( n = 21) were, respectively, matched to a control group of patients who did not receive targeted molecular therapy. They were matched on the basis of age, gender, body mass index, extent of hepatectomy, and type and number of neoadjuvant chemotherapy. Liver function tests, postoperative outcome and histopathology of the resected liver were compared. Results There was no mortality. Postoperative morbidity and perioperative bleeding rates were similar in both groups. In the beva group, liver function tests showed higher serum bilirubin level on postoperative day (POD) 1 ( p = 0.001) and POD 3 ( p = 0.01), higher serum aspartate aminotransferase on POD 1 ( p = 0.004), and lower prothrombin time on POD 5 ( p = 0.02). In both groups, cetu and beva, the postoperative peaks of γ-glutamyl transpeptidase and alkaline phosphatase were statistically higher than in the control groups. Interestingly, the prevalence of sinusoidal injury and fibrosis was lower in patients receiving cetu ( p = 0.04), while the prevalence of steatohepatitis was lower in patients receiving beva ( p = 0.04). Conclusion The addition of beva or cetu to the neoadjuvant chemotherapy regimens does not appear to increase the morbidity rates after hepatectomy for CLM. The pathological examination did not show additional injury to the non-tumorous liver parenchyma.

Laparoscopic treatment of biliary peritonitis following nonoperative management of blunt liver trauma

Abstract: Introduction: Nonoperative management (NOM) of hemodynamically stable patients with blunt hepatic injuries is considered the current standard of care. However, it is associated with several in-hospital complications. In selected cases laparoscopy could be proposed as diagnostic and therapeutic means. Case report: A 28 years-old male was admitted in the Emergency Unit following a motor vehicle crash. CT-scan showed an isolated stade II hepatic injury at the level of the segment IV. Firstly a NOM was decided. Laparoscopic exploration was then performed at day 4 due to a biliary peritonitis. Intraoperative trans-cystic duct cholangiography showed a biliary leaks of left hepatic biliary tract, involving sectioral pedicle to segment III. Cholecystectomy, trans-cystic biliary drainage, application of surgical tissue sealing patch and abdominal drainage were performed. Postoperative outcome was uneventful, with fast patient recovery. Conclusion: Laparoscopy has gained a role as diagnostic and therapeutic means in treatment of complications following NOM of blunt liver trauma. This approach seems feasible and safety, with satisfactory postoperative outcome. Background Nowadays nonoperative management of blunt hepatic injuries is considered the treatment of choice in about 70% of cases. This attitude lead to appearance of otherwise unknown complications including bleeding, biliary, infectious and abdominal compartement syndrome. In selected cases, laparoscopy could be considered a valid option to treat these complications.

Histological and Immediate Postoperative Outcome after Preoperative Cetuximab: Case-Matched Control Study

Abstract: The aim of this study was to analyze the effects of preoperative cetuximab (cetu) on nontumorous liver parenchyma and the clinical and biological outcomes after liver resection for colorectal liver metastases (CLM). Between January 2005 and June 2009, 26 patients who received preoperative cetu were matched to a control group of 26 patients who did not receive cetu. They were matched on the basis of age, gender, body mass index, extent of hepatectomy, and type and number of cycles of neoadjuvant chemotherapy. Liver function tests, postoperative outcome, and histopathology of the resected liver were compared. There was no mortality. Postoperative morbidity and perioperative bleeding rates were similar in both groups. Serum aspartate aminotransferase and serum alanine aminotransferase were higher on postoperative day 5 in the control group (p = 0.02 and p = 0.04, respectively). In the cetu group, the postoperative peaks of γ-glutamyl transpeptidase and alkaline phosphatase were statistically higher than in the control group. Interestingly, pathological review of the nontumorous liver parenchyma revealed no significant difference between patients who received cetu and those treated without cetu with respect to prevalence of steatosis, steatohepatitis, sinusoidal obstructive syndrome, and fibrosis. The addition of cetu to the neoadjuvant chemotherapy regimens does not appear to increase the morbidity rate after hepatectomy for CLM, and also in cases of major hepatectomy. The pathological examination did not show additional injury to the nontumorous liver parenchyma.

Sarcome primitif du pancréas avec métastases hépatiques : place d’une chirurgie radicale ?

Abstract: Pancreatic leiomyosarcomas are a rare neoplasm that accounts for 1/1000 of pancreatic cancers. In the literature, 23 cases of pancreatic leiomyosarcoma have been reported and the majority being diagnosed on autopsy. It has never been reported any radical curative surgery in presence of synchronous hepatic metastasis. We reported a case of a patient affected by a primitive pancreatic leiomyosarcoma with bilobar hepatic metastasis, who underwent distal splenopancreatectomy associated with the resection of multiple liver metastases.