Regis Souche

Bio: Regis Souche is an academic researcher from University of Montpellier. The author has contributed to research in topics: Medicine & Surgery. The author has an hindex of 9, co-authored 36 publications receiving 259 citations. Previous affiliations of Regis Souche include French Institute of Health and Medical Research & University of Strasbourg.

Robotic versus laparoscopic distal pancreatectomy: a French prospective single-center experience and cost-effectiveness analysis

Abstract: Benefits and cost-effectiveness of robotic approach for distal pancreatectomy (DP) remain debated In this prospective study, we aim to compare the short-term results and real costs of robotic (RDP) and laparoscopic distal pancreatectomy (LDP) From 2011 until 2016, all consecutive patients underwent minimally invasive DP were included and data were prospectively collected Patients were assigned in two groups, RDP and LDP, according to the availability of the Da Vinci® Surgical System for our Surgical Unit A minimally invasive DP was performed in 38 patients with a median age of 61 years old (44–83 years old) and a BMI of 26 kg/m2 (20–31 kg/m2) RDP group (n = 15) and LDP group (n = 23) were comparable concerning demographic data, BMI, ASA score, comorbidities, malignant lesions, lesion size, and indication of spleen preservation Median operative time was longer in RDP (207 min) compared to LDP (187 min) (p = 0047) Conversion rate, spleen preservation failure, and perioperative transfusion rates were nil in both groups Pancreatic fistula was diagnosed in 40 and 43% (p = 0832) of patients and was grade A in 83 and 80% (p = 1000) in RDP and LDP groups, respectively Median postoperative hospital stay was similar in both groups (RDP: 8 days vs LDP: 9 days, p = 0310) Major complication occurred in 7% in RDP group and 13% in LDP group (p = 1000) Ninety-days mortality was nil in both groups No difference was found concerning R0 resection rate and median number of retrieved lymph nodes Total cost of RDP was higher than LDP (13611 vs 12509 €, p < 0001) The difference between mean hospital incomes and costs was negative in RDP group contrary to LDP group (− 1269 vs 1395 €, p = 0040) Short-term results of RDP seem to be similar to LDP but the high cost of RDP makes this approach not cost-effective actually

Early Hepatic Artery Thrombosis After Liver Transplantation: What is the Impact of the Arterial Reconstruction Type?

Abstract: Hepatic artery thrombosis (HAT) is the most severe vascular complication occurring after liver transplantation, with an incidence ranging from 2 to 9% in adults. Although the ideal arterial reconstruction is often described as a short and non-redundant anastomosis fashioned between the recipient and donor hepatic arteries, there is no strong evidence about this ideal reconstruction in the literature. The aim of this study was to assess the impact of the type of arterial reconstruction on early HAT after primary liver transplantation. We retrospectively reviewed a contemporary MELD era cohort of 282 patients who underwent deceased donor primary liver transplantation from 2007 to 2012. Graft artery was classified as “short” when the section was located at the proper/common hepatic artery or “long” when the celiac trunk was used for anastomosis. Recipient arterial sites for arterial anastomosis were classified in three sites: (1) “distal” (proper hepatic artery or common hepatic artery/gastro-duodenal bifurcation), (2) “intermediate” (common hepatic artery) and (3) “proximal” (celiac trunk–splenic artery–aorta). We used univariate and multivariate analyses to assess the impact of different types of arterial reconstruction on early HAT. Of 282 primary liver transplantations, 17 patients (6%) developed early HAT. Patients with and without early HAT had comparable demographic and operative data. The main anastomotic combination was short graft artery on the recipient-common hepatic artery (n = 111, 39%). A long graft artery was used in 91 patients (32%) and was associated with hepatic artery variations (56%; n = 51; p = 0.001). Arterial reconstructions using a long graft artery (p = 0.003), a recipient proximal site as celiac trunk–splenic artery–aorta (p = 0.02) and the combination of a long graft artery on the recipient distal hepatic artery (p = 0.02) were significantly associated with early HAT. The early HAT rate in patients with a long graft artery was not significantly different between patients with or without donor arterial variation (respectively, 12% (n = 6/51) vs. 12% (n = 5/40); p = 1). In multivariate analysis, the use of a long graft artery, whatever the recipient anastomosis site, was an independent risk factor of early HAT (OR 3.2; 95% CI 1.2–9; p = 0.02). The type of arterial reconstruction used for arterial anastomosis during primary liver transplantation has an impact on the occurrence of early HAT. The use of a long graft artery is an independent risk factor of early HAT. Thereby, we recommend the use of a short graft artery with a direct path when feasible to reduce the occurrence of early HAT after primary liver transplantation.

Double purse-string telescoped pancreaticogastrostomy: an expedient, safe, and easy technique.

Abstract: Received October 8, 2012; Revised November 26, 2 November 27, 2012. From Hepato-Pancreato-Biliary Surgery and Liver Transp des Pathologies Digestives, Hepatiques et de la Transplan de Hautepierre-Hopitaux Universitaires de Strasbourg, Uni bourg, Strasbourg, France (Addeo, Rosso, Oussoultzoglou, Jaeck, Bachellier) and the Department of Surgery, The Perm Group, Walnut Creek, CA (Fuchshuber). Correspondence address: Philippe Bachellier, MD, PhD, He Biliary Surgery and Liver Transplantation, Pole des Patholo Hepatiques et de la Transplantation, Hopital de Hautepierre versitaires de Strasbourg, Universite de Strasbourg, 1, Avenue Strasbourg, France. email: philippe.bachellier@chru-strasbou

First and repeat liver resection for primary and recurrent intrahepatic cholangiocarcinoma.

Abstract: Background Recurrence after resection of intrahepatic cholangiocarcinoma (ICC) remains common. The present study sought to evaluate risk factors for recurrence and the results of repeat liver resection (RLR) for recurrent ICC. Methods Between 1997 and 2012, clinical data and outcomes of 125 consecutive patients undergoing liver resection for ICC were retrospectively analyzed. Results The rate of R0 resection was 89% (n = 110). Overall median survival was 35 months, and 1-, 3-, and 5-year actuarial survival rates were 80%, 48%, and 28%, respectively. Recurrence occurred in 76 patients (63.5%) and was intrahepatic only for 39 patients (51%). Tumor size greater than 5 cm was identified as an independent risk factor for recurrence ( P ≤ .0001). RLR for recurrent ICC was feasible in 10 patients (25%) with a median survival after recurrence of 25 months (16 to 76). Conclusions Tumor size more than 5 cm represents an independent risk factor for recurrence after resection of ICC. RLR in case of recurrent ICC, when feasible, is associated with longer overall survival.

How I Do It

Abstract: There are two preferred ways of sharing medical information. One is data centered and for very good reasons has dominated our epistemology for almost a century. The other is empirical, based on a motley collection of hunch and experience. Both ways complement each other, both are important for our growth as physicians and surgeons dedicated to walk with our patients to their recovery. For some reason that I am not able to explain the wonderful and experienced colleagues from Latin America and Africa are shy about telling their experience and opinion. Perhaps it is because in Latin America academic and professional promotions do not depend on the number of peer reviewed publications. In any case we at Surgical Neurology International feel that those voices need to be heard. Thus, we have launched this series that has been called “How I do it”. We asked four Pediatric Neurosurgeons from Latin America and asked them to tell us about their approach to a prevalent condition neglected by the designers of public health strategies, neural tube defects. The original text is in Spanish accompanied by an English translation that while short in nuances manages to be loyal to the intentions of the authors. The papers are short, it could not be otherwise, and the authors have almost never published before. But the papers are dense in technical insight. In all the papers the reader will hear the undercurrent of devotion to the most forgotten of the patients, the malformed born in a low and middle-income country. I praise James Ausman, M.D. the editor for accepting, supporting and encouraging this initiative. As I ready the papers for submission I recognize my shortcomings in polishing the message of my colleagues. And while coming contributions on “How I do it” will better the previous, this first series has the charm and innocence of a great dream.

International consensus statement on robotic pancreatic surgery

Abstract: The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO Handbook for Guideline Development, a Consensus Steering Group* and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.

Outcomes After Minimally-invasive Versus Open Pancreatoduodenectomy: A Pan-European Propensity Score Matched Study

Abstract: OBJECTIVE: To assess short-term outcomes after minimally invasive (laparoscopic, robot-assisted, and hybrid) pancreatoduodenectomy (MIPD) versus open pancreatoduodenectomy (OPD) among European centers. BACKGROUND: Current evidence on MIPD is based on national registries or single expert centers. International, matched studies comparing outcomes for MIPD and OPD are lacking. METHODS: Retrospective propensity score matched study comparing MIPD in 14 centers (7 countries) performing ≥10 MIPDs annually (2012-2017) versus OPD in 53 German/Dutch surgical registry centers performing ≥10 OPDs annually (2014-2017). Primary outcome was 30-day major morbidity (Clavien-Dindo ≥3). RESULTS: Of 4220 patients, 729/730 MIPDs (412 laparoscopic, 184 robot-assisted, and 130 hybrid) were matched to 729 OPDs. Median annual case-volume was 19 MIPDs (interquartile range, IQR 13-22), including the first MIPDs performed in 10/14 centers, and 31 OPDs (IQR 21-38). Major morbidity (28% vs 30%, P = 0.526), mortality (4.0% vs 3.3%, P = 0.576), percutaneous drainage (12% vs 12%, P = 0.809), reoperation (11% vs 13%, P = 0.329), and hospital stay (mean 17 vs 17 days, P > 0.99) were comparable between MIPD and OPD. Grade-B/C postoperative pancreatic fistula (POPF) (23% vs 13%, P < 0.001) occurred more frequently after MIPD. Single-row pancreatojejunostomy was associated with POPF in MIPD (odds ratio, OR 2.95, P < 0.001), but not in OPD. Laparoscopic, robot-assisted, and hybrid MIPD had comparable major morbidity (27% vs 27% vs 35%), POPF (24% vs 19% vs 25%), and mortality (2.9% vs 5.2% vs 5.4%), with a fewer conversions in robot-assisted- versus laparoscopic MIPD (5% vs 26%, P < 0.001). CONCLUSIONS: In the early experience of 14 European centers performing ≥10 MIPDs annually, no differences were found in major morbidity, mortality, and hospital stay between MIPD and OPD. The high rates of POPF and conversion, and the lack of superior outcomes (ie, hospital stay, morbidity) could indicate that more experience and higher annual MIPD volumes are needed.

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy for Unresectable Hepatitis B Virus-related Hepatocellular Carcinoma: A Single Center Study of 45 Patients.

Abstract: OBJECTIVE The aim of the study is to assess the efficacy and safety of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in patients with hepatitis B virus-related hepatocellular carcinoma (HCC). BACKGROUND ALPSS allows curative resection of conventionally-unresectable liver tumors. However, its role in HCC is largely unknown. METHODS Consecutive HCC patients who underwent ALPPS at our center between April 2013 and September 2017 were retrospectively studied. The oncological results were compared with patients receiving transcatheter arterial chemoembolization (TACE), and patients undergoing one-stage resection by using propensity score matching (PSM) analysis. RESULTS The median tumor diameter was 13 cm (range: 6-22 cm) in patients with a single tumor (n = 28), whereas the median total tumor diameter was 12 cm (range: 9-31 cm) in patients with multiple tumors (n = 17). After stage-1 ALPPS, the median future liver remnant (FLR) increased by 56.8%. The stage-2 ALPPS was completed in 41 patients (91.1%) after a median of 12 days. The 90-day mortality rate was 11.1% (5/45). The overall survival (OS) rates at 1- and 3-year were 64.2% and 60.2%, whereas the disease-free survival (DFS) rates at 1 and 3 years were 47.6% and 43.9%, respectively. On PSM analysis, the long-term survival of patients undergoing ALPPS was significantly better than those receiving TACE (OS, P = 0.004; DFS, P < 0.0001) and similar to those subjected to one-stage liver resection (OS, P = 0.514; DFS, P = 0.849). CONCLUSIONS The long-term survival after ALPPS was significantly better than TACE, and similar to those after one-stage liver resection. ALPPS is a viable treatment option for patients with unresectable HCC in selected patients.