Showing papers by "Philippe Bachellier published in 2014"
TL;DR: Pancreaticoduodenectomy requiring PV-SMVR was associated with a higher risk for R1 resection and the standardization of histopathological analysis has a clinically relevant impact on PFS data.
Abstract: Objectives
This study aimed to determine the impact of a standardized pathological protocol on resection margin status after pancreaticoduodenectomy (PD) for ductal adenocarcinoma.
150 citations
TL;DR: A soft pancreatic parenchyma, the absence of pre-operative diabetes, PJ and low-volume centre are independent risk factors for PF after PD for ductal adenocarcinoma.
Abstract: Backgrounds
A pancreatic fistula (PF) is the most relevant complication after a pancreaticoduodenectomy (PD). This retrospective multicentric study attempts to elucidate the risk factors and complications of a PF in a large cohort of patients undergoing a PD for ductal adenocarcinoma.
131 citations
TL;DR: 18F-FDOPA PET appears to be a sensitive functional imaging tool for the detection of primary neuroendocrine tumors occult on SRS, especially tumors with a well-differentiated pattern and serotonin secretion.
Abstract: This work was performed to evaluate the performance of 18F-fluorodihydroxyphenylalanine (18F-FDOPA) PET/CT in detecting primary neuroendocrine tumors (NETs) occult on morphologic and functional imaging, in relation to tumor origin and differentiation. Methods: A retrospective study of NET patients who were investigated with 18F-FDOPA PET/CT imaging in 2 academic endocrine tumor centers was conducted. Only patients with negative conventional and somatostatin receptor scintigraphy (SRS) results were studied. Results: Twenty-seven patients were evaluated with 18F-FDOPA PET/CT, 23 at their initial staging and 4 during their follow-up. The primary occult NET was localized by 18F-FDOPA PET/CT in 12 patients (overall sensitivity, 44%; 52% in patients evaluated at initial diagnosis), leading to tumor resection in all cases. The primary tumors were distributed and graded as follows: 1 duodenum G2 lesion, 7 ileum G2 lesions, 2 terminal ileum G1 lesions, 1 pancreas G2 lesion, and 1 gallbladder G3 lesion. Patients with positive 18F-FDOPA PET/CT results had higher values of serum chromogranin A (100% vs. 20%, P = 0.0003), serotonin, or urinary 5-hydroxyindolacetic acid (83% vs. 20%, P = 0.003). Two false-negative results were related to poorly differentiated duodenal and prostatic NETs (G3). 18F-FDOPA PET/CT showed more metastatic anatomic regions than SRS in 17 patients. Conclusion:18F-FDOPA PET appears to be a sensitive functional imaging tool for the detection of primary NETs occult on SRS, especially tumors with a well-differentiated pattern and serotonin secretion.
50 citations
TL;DR: The use of this form of TMPS allowed us to achieve PD or total pancreatectomy in patients with locally advanced pancreatic ductal adenocarcinoma and PH without postoperative mortality but with increased morbidity.
30 citations
TL;DR: In Western countries, combined liver and pancreatic resections (CLPR) are performed rarely because of the perceived high morbidity and mortality rates.
Abstract: Background
In Western countries, combined liver and pancreatic resections (CLPR) are performed rarely because of the perceived high morbidity and mortality rates. This study evaluated the safety and outcomes of CLPR at a tertiary European centre for hepatopancreatobiliary surgery.
Methods
A review of two prospectively maintained databases for pancreatic and liver resections was undertaken to identify patients undergoing CLPR between January 1994 and January 2012. Clinicopathological and surgical outcomes were analysed. Univariable and multivariable analyses for postoperative morbidity were performed.
Results
Fifty consecutive patients with a median age of 58 (range 20–81) years underwent CLPR. Indications for surgery were neuroendocrine carcinoma (16 patients), biliary cancer (15), colonic cancer (5), duodenal cancer (1) and others (13). The type of pancreatic resection included pancreaticoduodenectomy (30), distal pancreatectomy (17), spleen-preserving distal pancreatectomy (2) and total pancreatectomy (1). Twenty-three patients had associated major hepatectomies, 27 underwent minor liver resections and 11 had associated vascular resections. Mortality and morbidity rates were 4 and 46 per cent respectively. Univariable and multivariable analysis showed no differences in postoperative morbidity in relation to extent of liver resection or type of pancreatic resection. Use of preoperative chemotherapy was the only independent risk factor associated with postoperative morbidity (P = 0·021).
Conclusion
CLPR can be performed with fairly low morbidity and mortality rates. Postoperative outcomes were not affected by the extent of liver resection or the type of pancreatic resection. Patients receiving chemotherapy should be evaluated carefully before surgery is considered.
19 citations
TL;DR: A 61-year-old woman was referred to the center for a 24-mm lesion of the pancreatic body as discussed by the authors, which was incidentally detected by total body computed tomography performed during the periodic follow-up after breast cancer.
15 citations
TL;DR: It is shown that the variability in CYP3A contribution for compounds having multiple metabolic pathways cannot be predicted from inhibition experiments using ketoconazole as inhibitor, and it is recommended to estimate the average CLint and fmCYP3A for a given test compound in a series of individual human hepatocyte batches.
Abstract: 1. It has previously been demonstrated that metabolism of drugs via a single enzymatic pathway, particularly CYP3A4, is associated with increased risk for drug-drug interactions (DDI). Quantitative experimental systems as well as integrated prediction models to assess such risk during the preclinical phase are highly warranted.2. The present study was designed to systematically investigate the performance of human cryopreserved hepatocytes in suspension to predict fraction metabolized via CYP3A (fmCYP3A) by assessing the ketoconazole sensitive intrinsic clearance (CLint) for five prototypical CYP3A substrates with varying degree of CYP3A dependent CLint in twelve individual hepatocyte batches.3. We demonstrate that in contrast to well predicted mean hepatic metabolic clearance (CLH) and mean fmCYP3A data, the variability in CYP3A contribution for compounds having multiple metabolic pathways cannot be predicted from inhibition experiments using ketoconazole as inhibitor. Instead, data in the pre...
12 citations
TL;DR: Mycotic arteritis is one of the possible complications of yeast contamination of PF and surgeons involved in the care of LT patients should be aware of this potentially lethal complication and adopt all the available means for early detection.
Abstract: Background Fungal infections remain among the main causes of mortality in the chronically immunosuppressed liver transplant (LT) patient. Bacterial and fungal contamination of preservation fluid (PF), in which grafts are stored, represents a potential source of infection for recipients. Case report A 54-year-old patient underwent LT for chronic alcoholic cirrhosis. Mycological culture of the liver PF was positive for Candida albicans. The patient received antimycotic prophylaxis for 4 weeks in absence of clinical and serological signs of infection. He was urgently readmitted 4 months later with hemobilia caused by an arterial pseudoaneurysm that was fistulized in the biliary anastomosis. After an unsuccessful embolization, arterial resection and reconstruction and a biliodigestive anastomosis were performed, with an uneventful postoperative course. Pathology found a mycotic arteritis of the graft artery. Mycotic culture of the arterial segment confirmed the presence of the same Candida albicans genotype previously isolated in the PF. Conclusions Mycotic arteritis is one of the possible complications of yeast contamination of PF. Surgeons and physicians involved in the care of LT patients should be aware of this potentially lethal complication and adopt all the available means for early detection.
10 citations
TL;DR: Transplanted human hepatocytes acted as if they modified nude mouse liver responses to Jo2 by stimulating liver regeneration, leading to an increased survival rate, suggesting a selective advantage in these animals.
3 citations
01 Jan 2014
2 citations
TL;DR: An unusual case of anti-Hu-associated brainstem encephalitis responsible for sensorineural deafness and cerebellar ataxia in a young adult preceding the identification of non-secreting ganglioneuroblastoma is reported.
Abstract: Brainstem encephalomyelitis due to anti-Hu antibodies, directed against intracellular RNA binding proteins (HuD, HuC, Hel-N1 and Hel-N2), may be encountered in paraneoplastic syndrome (PS), or non-PS. In the presence of anti-Hu antibodies, a tumor is found in 83–94 % of cases [1, 2]. Small cell lung carcinoma in adults and neuroblastoma in young children are the most frequent cancer [3]. We report an unusual case of anti-Hu-associated brainstem encephalitis responsible for sensorineural deafness and cerebellar ataxia in a young adult preceding the identification of non-secreting ganglioneuroblastoma. A 19-year-old woman of Caucasian origin with no medical history presented sub-acute, severe bilateral sensorineural deafness (60 dB at 1,000 Hz) leading to a hearing aid. Eight months later, she developed cerebellar ataxia with gait difficulties (SARA score 8/40), downbeat nystagmus, horizontal ophthalmoparesis and dysgueusia. Injected brain MRI revealed enhanced 3rd, 5th, 6th and 7th cranial nerves without brain or cerebellar atrophy (Fig. 1a, b). Extensive laboratory investigations, including accessory salivary gland biopsy, C-reactive protein, antinuclear, anti-gangliosides, anti-thyroperoxydase, anti-cochlea and anti-neutrophil cytoplasmic were negative while anti-Hu antibodies were present in both serum and CSF with oligoclonal bands in CSF. Gynecological examination, mammography, pelvic ultrasonography, total body CT and 18 fluorodeoxyglucose PET scan were normal. Intravenous methylprednisolone (1 g/day for 3 days) followed by 1 mg/kg/day of prednisolone were administered. A month later, intravenous polyclonal immunoglobulins then plasmapheresis were performed, but no clinical advantage except hearing loss improvement (?10 dB). S. Montaut and M. Mallaret contributed equally to the work and should be considered as co-first authors.