Showing papers by "Philippe Bachellier published in 2011"
TL;DR: In pN0 patients, R1 resection is the strongest independent predictor of poor outcome and a margin of at least 5 mm should be created, while in patients undergoing surgery for IHCC, the survival benefits of resection in pN+ patients and R1 surgery in general are very low.
Abstract: Objective:Define the optimal surgical margin in patients undergoing surgery for intrahepatic cholangiocarcinoma (IHCC).Background Data:Surgery is the most effective treatment for IHCC. However, the influence of R1 resection on outcome is controversial and that of margin width has not been evaluated.
202 citations
TL;DR: This year, the 7th edition of the AJCC staging manual has for the first time attributed a unique pTNM staging to intrahepatic cholangiocarcinoma (IHCC) that is intended to replace the 2 Western and ideally also the 2 Eastern systems currently in use.
Abstract: BACKGROUND:
This year, the 7th edition of the AJCC staging manual has for the first time attributed a unique pTNM staging to intrahepatic cholangiocarcinoma (IHCC) that is intended to replace the 2 Western and ideally also the 2 Eastern systems currently in use. This proposal, which has not yet been validated, was tested in the current study.
METHODS:
Among 522 patients operated on with curative intent for an IHCC between 1994 and 2008 in tertiary hepatobiliary centers, those with mass-forming-type IHCCs, an R0 resection, and accurate pathological node staging were retained for evaluation. The distribution of these patients and their actuarial survival in the new TNM stages (as well as in the 4 previous ones) were compared.
RESULTS:
Only 163 patients fulfilled the inclusion criteria, mainly because of the lack of routine lymphadenectomy, but patients and tumors characteristics of this population were representative. These patients were evenly distributed between AJCC 7th edition stages (stage I, 28%; stage II, 32%; stage III, 35%), which was not the case for the other systems. With an average follow-up of 34 months in survivors, the AJCC 7th edition was more discriminating than the others in predicting survival (median for stage I not reached; for stage II, 53 months, P = .01; for stage III, 16 months, P < .0001). Survival of these patients according to the 2 Japanese classifications was identical to that anticipated.
CONCLUSIONS:
The 7th edition is clinically relevant and may be applicable worldwide, provided routine lymphadenectomy at the time of surgery for IHCC becomes the standard of care. Cancer 2011. © 2010 American Cancer Society.
186 citations
TL;DR: This study validates the concept of re-resection in T2 and T3 GBC, with minor liver resection and no common bile duct resection, and increases postoperative morbidity but does not improve survival.
Abstract: Incidental gallbladder cancer (GBC) is frequently discovered on the specimen when cholecystectomy for a benign disease is performed. The objective of the present study was to assess the management of incidental GBC patients in a French registry. Data on patients with GBC treated between 1998 and 2008 were retrospectively collated in a French, multicenter database. The registry contained 218 patients with incidental GBC (67 men and 151 women; median age = 64 years; age range = 31-88). One hundred forty-eight (68%) patients underwent re-resection after a median time interval of 48 days (range = 2–245). The most common complete procedure (66% of cases) was 4b + 5 segmentectomy with lymphadenectomy but not bile duct resection. Port-site excision was performed in 54 patients. The mortality and morbidity rates were 3 and 37%, respectively. Resection of the common bile duct (43%) increased postoperative complications (60 vs. 23%, p = 0.0001). Local residual tumor was found in 83 (56%) patients; it was significantly correlated with the T stage and influenced long-term survival. R0 was obtained in 143 (97%) patients and port-site invasion was histologically confirmed in one patient (1.8%). After a median follow-up period of 34 months, the 1-, 3-, and 5-year survival rates for the 148 patients with re-resection were 76, 54, and 41%, respectively. Re-resection significantly increased survival in patients with T2 (p = 0.0001) and T3 (p = 0.04) disease. Resection of the common bile duct increased neither R0 resection nor overall survival (p = 0.06). This study validates the concept of re-resection in T2 and T3 GBC. Bile duct resection increases postoperative morbidity but does not improve survival. There is currently a modification in the surgical management of incidental GBC, with minor liver resection and no common bile duct resection.
130 citations
TL;DR: The long‐term outcome, safety and efficacy of two‐stage hepatectomy (TSH) for CLM in a large cohort of patients is evaluated.
Abstract: Background: As surgical resection of colorectal liver metastases (CLM) remains the only treatment for cure, efforts to extend the surgical indications to include patients with multiple bilobar CLM have been made. This study evaluated the long-term outcome, safety and efficacy of two-stage hepatectomy (TSH) for CLM in a large cohort of patients. Methods: Patients undergoing surgery between December 1996 and December 2009 were reviewed. The early postoperative and long-term outcomes as well as the patterns of failure to complete TSH and its clinical implications were analysed. Results: Eighty patients were scheduled to undergo TSH. Sixty-one patients had completion of TSH combined with (58 patients), or without (3) portal vein embolization/ligation (PVE/PVL). Five patients were excluded after first-stage hepatectomy and 14 after PVE/PVL. The 5-year overall survival rate and median survival in patients who completed TSH were 32 per cent and 39·6 months respectively, and corresponding recurrence-free values were 11 per cent and 9·4 months respectively. Six patients were alive beyond 5 years after TSH. Multivariable logistic regression analysis showed that failure to complete TSH was driven by two independent prognostic scenarios: three or more CLM in the future remnant liver (FRL) combined with age over 70 years predicted tumour progression after first-stage hepatectomy, and three or more CLM in the FRL combined with carcinomatosis at the time of first-stage hepatectomy predicted the development of additional FRL metastases after PVE/PVL. Conclusion: A therapeutic strategy using TSH provided acceptable long-term survival with no postoperative mortality. Further efforts are needed to increase the number of patients who undergo TSH successfully.
123 citations
TL;DR: The objective was to evaluate if pancreatic resection with AR was worthwhile and to establish a protocol for selecting patients suitable for AR treatment.
Abstract: institution. The final study population (n ¼ 52) included two groups of patients: the study group AR þ¼ 26 and the control group ARS ¼ 26. Results: The 1- and 3-year survival rates were similar in the two groups (65.9% and 22.1%, median 17 months for the group AR þ , versus 50.0% and 17.6%, median 12 months, for the group ARS; P ¼ 0.581). The multivariate analysis showed that: arterial wall invasion at the site of AR, the total number of resected lymph nodes of � 15, and perineural invasion were independent prognostic factors for survival. Conclusion:PancreaticresectionswithARforadenocarcinomaallowedtoobtaina3-survivalratesimilartothatofamatchedgroupofpatientsnot requiring AR. J. Surg. Oncol 2011;103:75–84. 2010 Wiley-Liss, Inc.
69 citations
TL;DR: It is confirmed that jaundice is a poor prognostic factor in patients with gallbladder cancer, however, the presence of jaundICE does not preclude resection, especially in highly selected patients (N0).
Abstract: Introduction Jaundice is frequent in patients with gallbladder cancer (GBC) and indicates advanced disease and, according to some teams, precludes routine operative exploration. The present study was designed to re-assess the prognostic value of jaundice in patients with GBC. Methods Patients with GBC operated from 1998 to 2008 were included in a retrospective multicenter study (AFC). The main outcome measured was the prognostic value of jaundice in patients with GBC focusing on morbidity, mortality and survival. Results A total of 110 of 429 patients with GBC presented with jaundice, with a median age of 66 years (range: 31–88). The resectability rate was 45% ( n =50) and the postoperative mortality and morbidity rates were 16% and 62%, respectively; 71% had R0 resection and 46% had lymph node involvement. Overall 1- and 3-year survivals of the 110 jaundiced patients were 41% and 15%, respectively. For the 50 resected patients, 1- and 3-year survivals were 48% and 19%, respectively (real 5-year survivors n =4) which were significantly higher than that of the 60 non-resected patients (31%, 0%, p =0.001). Among the resected jaundiced patients, T-stage, N and M status were found to have a significant impact on survival. R0 resection did not increase the overall survival in all resected patients, but R0 increased median survival in the subgroup of N0 patients (20 months versus 6 months, p =0.01). Conclusion This series confirms that jaundice is a poor prognostic factor. However, the presence of jaundice does not preclude resection, especially in highly selected patients (N0).
55 citations
TL;DR: Curative resection for HC is associated with a high rate of R0 resection, however, surgery isassociated with high levels of morbidity and mortality, despite intensive perioperative management.
52 citations
TL;DR: Sinusoidal obstruction syndrome inhibits FRL hypertrophy after PVE and induces postoperative liver failure, and an alternative strategy is needed to perform TSH safely in the presence of SOS.
Abstract: Purpose
Several factors have been reported to affect liver regeneration after portal vein embolization (PVE); however, the effect of sinusoidal obstruction syndrome (SOS) has not been evaluated. Therefore, we assessed the effect of SOS on liver regeneration after PVE in patients with multiple bilobar colorectal liver metastases scheduled to undergo two-stage hepatectomy (TSH) combined with PVE.
47 citations
TL;DR: Early assessment shows that SV-IMV anastomosis is as feasible and as safe as the preservation of a natural SV- IMV confluence in patients undergoing pancreaticoduodenectomy with vascular resection for pancreatic head adenocarcinoma.
Abstract: Hypothesis A splenic vein (SV)–inferior mesenteric vein (IMV) anastomosis reduces congestion of the stomach and spleen after pancreaticoduodenectomy with resection of the SV–mesenteric vein confluence but carries a risk of left-sided venous hypertension. Design Comparative retrospective study. Setting Department of Digestive Surgery and Transplantation, University of Strasbourg, Strasbourg, France. Patients From January 1, 2002, to February 28, 2010, 39 patients underwent pancreaticoduodenectomy with resection of the SV–mesenteric vein confluence for pancreatic adenocarcinoma. All patients had a terminoterminal portal vein–superior mesenteric vein anastomosis. The SV blood flow into the portal vein was preserved in 11 patients by reimplantation of the SV into the portal vein. Sixteen patients underwent surgical reconstruction of the SV-IMV confluence by anastomosis (group 1), and in 12 patients the natural SV-IMV confluence was preserved (group 2). Main Outcome Measures Preoperative and postoperative spleen volume and platelet count. Results Demographic characteristics, preoperative tumor staging, pathological outcome, and postoperative complications were comparable in both groups. There was no difference in platelet count between groups 1 and 2 preoperatively (mean [SD], 293.13 [125.37] vs 241.09 [49.12] × 10 3 /μL [to convert to ×10 9 /L, multiply by 1.0], respectively; P = .21) or postoperatively (mean [SD], 231.75 [156.39] vs 164.31 [76.46] × 10 3 /μL, respectively; P = .32). Likewise, no difference was found in the spleen volume preoperatively (mean [SD], 258.96 [179.23] vs 237.31 [122.46] mL, respectively; P = .76) and on postoperative day 15 (mean [SD], 279.08 [158.10] vs 299.12 [153.11] mL, respectively; P = .78). Conclusion Early assessment shows that SV-IMV anastomosis is as feasible and as safe as the preservation of a natural SV-IMV confluence in patients undergoing pancreaticoduodenectomy with vascular resection for pancreatic head adenocarcinoma.
46 citations
TL;DR: The present study confirmed that major or extended hepatic resection with PVR can be performed with acceptable overall morbidity and mortality rates and should be carefully considered in patients with liver steatosis due to the high risk of postoperative mortality.
Abstract: Objective:To report the postoperative outcome of hepatectomy associated with portal vein resection (PVR) and to identify risk factors of clinical value for predicting postoperative liver failure and mortality.Summary Background Data:Resection of the portal vein during hepatectomy allows an increase
38 citations
TL;DR: This article describes the standardized strategy of two-stage hepatectomy combined with portal vein embolization used over the last 15 years and discusses the alternative procedures as well as their respective advantages and drawbacks.
Abstract: A two-stage hepatectomy procedure is a therapeutic strategy for patients presenting with initially unresectable multiple and bilobar colorectal liver metastases in order to achieve a curative R0 resection. The main goal of this approach is to minimize the risk of postoperative liver failure resulting from a too small remnant liver after completing a curative resection. This procedure combines two sequential liver resections that involve perioperative chemotherapy and portal vein embolization. This article describes our standardized strategy of two-stage hepatectomy combined with portal vein embolization used over the last 15 years and discusses the alternative procedures as well as their respective advantages and drawbacks.
TL;DR: A step‐by‐step technique for robotic CP is described and a literature review provided for this minimally invasive approach.
Abstract: Background
Central pancreatectomy (CP) is increasingly being used to treat selected lesions of the central pancreatic segment. A step-by-step technique for robotic CP is described and a literature review provided for this minimally invasive approach.
Methods
A 55-year-old woman was referred to the authors' center for the treatment of a single 4 cm lesion located at the proximal part of the pancreatic body. The da Vinci Robotic surgical system® with a five trocar technique was used. The pancreatic neck was transected using an endoscopic stapler. The pancreatic body was progressively dissected from the splenic vessels right to left and sectioned with an appropriate oncologic margin. A pancreaticogastrostomy protected by a transanastomotic external stent was constructed to the distal pancreatic stump.
Results
Surgery lasted 450 min (8 min docking time) with minimal blood loss. Pathology showed a 28 mm well-differentiated neuroendocrine pancreatic tumor with tumor-free resection margins. The patient was discharged home on postoperative day 15 in good condition.
Conclusions
Robotic surgery can be safely used for complex pancreatic resection requiring pancreaticoenteric reconstruction. The experience reported so far is still limited but the results are encouraging; robotics shows the potential to bridge the gap between minimally invasive surgery and advanced pancreatic surgery. Copyright © 2011 John Wiley & Sons, Ltd.
TL;DR: Gastroduodenal artery preserving pancreaticoduodenectomy can serve as an additional option in the armamentarium of a pancreatic surgeon as an interesting technical option that ensures optimal vascular supply to the gastric remnant after previous esophagectomy.
Abstract: Purpose
Division of the gastroduodenal artery is commonly performed during pancreaticoduodenectomy for both malignant and benign disease. We describe here a technical modification of pylorus preserving pancreaticoduodenectomy with gastroduodenal artery preservation performed in a patient who previously underwent subtotal esophagectomy with gastric pull-up discussing advantages and drawbacks of the technique.
TL;DR: The data presented in this study show that a large heterogeneity exists in the molecular patterns of alterations in precancerous colon lesions, favoring different modes of tumor initiation.
TL;DR: A case of a 69-year-old patient who underwent DEB for HCC and who developed a liver abscess requiring urgent left liver lobectomy is described, where efficacy of DEB embolization was histologically proved as a large ischemic zone with complete tumor necrosis.
Abstract: Doxorubicin-eluting-bead embolization (DEB) is considered a safe and efficient treatment of hepatocellular carcinoma (HCC) with a low complication rate and an increased tumor response compared with conventional transarterial chemoembolization. We describe a case of a 69-year-old patient who underwent DEB for HCC and who developed a liver abscess requiring urgent left liver lobectomy. Despite this severe complication, efficacy of DEB embolization was histologically proved as a large ischemic zone with complete tumor necrosis.
01 Jan 2011
TL;DR: The aim of these strategies is to achieve a complete tumoral resection in a curative intent, to increase safely the indications of liver resection for patients presenting with initially unresectable liver metastases, and to offer to them similar results in term of short- and long-term outcome to that observed in patients with initially resectable Liver metastases.
Abstract: Liver surgery can only be offered to approximately 20% of patients with colorectal liver metastases, provided that the primary tumor is controlled. Currently, a selected subgroup of the remaining 80% of the patients, who were initially considered as unresectable and were assigned to receive palliative chemotherapy, may benefit from liver surgery and often require a multidisciplinary approach in order to achieve a curative liver resection. This multidisciplinary approach may also use additional methods such as radiofrequency, portal vein embolization, and downsizing or conversion chemotherapy. The combination of these different therapies resulted in the development of nontraditional liver resection techniques including the so-called two-stage hepatectomy procedure. The aim of these strategies is to achieve a complete tumoral resection in a curative intent, to increase safely the indications of liver resection for patients presenting with initially unresectable liver metastases, and to offer to them similar results in term of short- and long-term outcome to that observed in patients with initially resectable liver metastases.