Showing papers by "René Adam published in 2001"

Five-Year Survival Following Hepatic Resection After Neoadjuvant Therapy for Nonresectable Colorectal [Liver] Metastases

Abstract: Background: Surgical resection is the most effective treatment for colorectal liver metastases but only a minority of patients are candidates for a potentially curative resection. Our experience with neoadjuvant chemotherapy followed by resection and five years survival analysis of the patients treated is presented. Methods: Between February of 1988 and September of 1996, 701 patients with unresectable colorectal liver metastases were treated with neoadjuvant chemotherapy. Four categories of nonresectable disease were defined: large size, ill location, multinodularity, and extrahepatic disease. Liver resection was performed in those patients whose disease became resectable. After resection, the patients were followed up every 3 months. A 5-year survival analysis by the different categories described was performed. Results: Ninety-five patients (13.5%) were found to be resectable on reevaluation and underwent a potentially curative resection. There was no perioperative mortality, and the complication rate was 23%. As of December of 1999, 87 patients have completed 5 years of follow-up. The overall 5-year survival is 35% from the time of resection and 39% from the onset of chemotherapy. Respective 5-year survival rates are 60% for large tumors, 49% for ill-located lesions, 34% for multinodular disease, and 18% for liver metastases with extrahepatic disease. In this latter category, however, a 35% 5-year survival was found when all the patients with extrahepatic disease were analyzed rather than only those for whom extrahepatic disease was the main cause of nonresectability. Conclusions: Neoadjuvant chemotherapy enables liver resection in some patients with initially unresectable colorectal metastases. Long-term survival is similar to that reported for a priori surgical candidates.

Split-liver transplantation for two adult recipients: feasibility and long-term outcomes.

Abstract: The gap between the supply of livers for transplantation and the demand continues to widen as new indications are added, with adult potential recipients accounting for more than 95% of waiting list deaths. 1 The development of new guidelines for accepting potential recipients has been recommended to limit this proportion, ensuring that available organs go to patients whose condition has not deteriorated during the waiting time and who are more likely to enjoy longer-term survival. 2 However, we believe that there is still scope for increasing the graft pool for adults through split-liver transplantation (SLT). Split-liver procedures that divide a cadaver organ into a small left graft for a child and a larger right graft for an adult have reduced the graft shortage for children 3 and could even eliminate the need for elective living donors in this population. 4,5 Split-liver procedures for two adult recipients, however, are still uncommon. They pose technical challenges, in particular that of obtaining an adequate mass of functional parenchyma in the left graft. Our earlier report on SLT 6 described three split-liver procedures for two adults. Since then, we have extended our experience using techniques such as ex situ splitting of cadaver donors and in situ splitting of livers from patients with familial amyloid polyneuropathy (FAP) undergoing domino liver transplantation. 7 In this article, we compare the outcomes of split-liver procedures for two adults with those of whole-liver transplantation from similar donors and discuss the technical and logistical feasibility, including criteria for donor and recipient selection.

Auxiliary Partial Orthotopic Versus Standard Orthotopic Whole Liver Transplantation for Acute Liver Failure: A Reappraisal From a Single Center by a Case-Control Study

Abstract: ObjectiveTo reappraise the results of auxiliary partial orthotopic liver transplantation (APOLT) compared with those of standard whole-liver transplantation (OLT) in terms of postoperative death and complications, including neurologic sequelae.Summary Background DataCompared with OLT, APOLT preserve

Prospective phase II trial of iriontecan, 5-fluorouracil, and leucovorin in combination as salvage therapy for advanced colorectal cancer.

Abstract: Irinotecan (CPT11) has established activity in the treatment of advanced colorectal cancer without cross-resistance with established 5-fluorouracil/folinic acid-based therapy. This phase II study was conducted to establish the efficacy and tolerance of combination treatment with irinotecan and 5-fluorouracil as salvage treatment for this disease. Open phase II trial of CPT1 I 180 mg/m 2 on day 1, leucovorin 200 mg/m 2 on days 1 and 2, and 5-fluorouracil 400 mg/m 2 loading dose followed by 600 mg/m 2 infusion on days I and 2. Treatment was continued until progression or limiting toxicity. Responders could proceed to surgical resection of residual disease. Thirty-nine patients from 2 institutions received a total of 287 cycles of therapy (median 7 cycles/patient). Eight patients achieved an objective response (7 for liver metastasis and 1 for lung metastasis), and an additional 12 obtained stabilization of disease or minor responses (MR); of these patients, 8 with liver metastasis (7 partial response and 1 MR) underwent hepatic resection of metastases and all them obtained a complete response. The median duration of response was 14 months, and the median survival was 11 months. Hematologic toxicity (neutropenia) was the most common serious side effect (29% of patients in 2% of cycles), but significant fever developed in only 4 patients. Grade III diarrhea was experienced in at least I cycle by 10% of patients. The results of this schedule compare favorably with previously reported experience of a phase I study designed to establish the dose of CPTI 1. Efficacy in this poor prognosis group of patients is very encouraging, and the schedule is well tolerated by even previously treated patients.

The anterior approach: the right way for right massive hepatectomy.

Abstract: Although the use of an anterior approach for right hepatectomies for massive tumors has been reported, the technique of anterograde hepatectomy has not yet been described in full. The aim of this paper is to give a detailed, illustrated report of our anterograde technique. Alternative techniques are also discussed so as to provide the surgeon with other tested options. The technique described here is the right hepatectomy extended to segments 4 and 1, but it may be slightly modified for other large hepatectomies, including left-sided hepatectomies.

[Adult to adult living-related liver transplantation. The Paul-Brousse Hospital preliminary experience].

Abstract: Objectif - La penurie de greffons cadaveriques justifie le developpement de la transplantation hepatique adulte a donneur vivant. L'experience initiale de cette technique a l'Hopital Paul-Brousse est rapportee. Patients et methodes - De janvier a juillet 2000, 7 transplantations d'adultes avec donneur vivant apparente ont ete effectuees. Les donneurs etaient 5 femmes et 2 hommes âges de 20 a 53 ans (mediane : 41 ans). Le greffon preleve etait le foie droit dans les 7 cas. Les receveurs etaient 5 hommes et 2 femmes, âges de 17 a 58 ans (mediane : 50 ans) transplantes pour cirrhose virale (4 cas dont 2 avec carcinome hepatocellulaire), hepatite sub-fulminante (1 cas), carcinome hepatocellulaire sur foie sain (1 cas) et hemangioendotheliome epithelioide (1 cas). Le recul etait de 41 a 157 jours (mediane : 1 17 jours). Resultats - Chez un donneur, une fistule biliaire s'est tarie spontanement. Un donneur a eu un asterixis resolutif en 24 heures. Les 7 donneurs sont vivants a domicile sans complication tardive. Un malade a ete retransplante au 2 e jour apres la greffe en raison d'une thrombose de l'artere hepatique et 2 malades ont eu une fistule biliaire tarie spontanement. Les 7 receveurs sont vivants a domicile avec une fonction hepatique normale. Conclusion - Notre experience et celle rapportee montrent que la transplantation d'adulte a partir de donneur vivant est faisable avec une mortalite exceptionnelle et une morbidite faible chez le donneur. Les resultats chez les receveurs rejoignent ceux de la transplantation a greffon cadaverique. Pour un malade donne la possibilite de donneur vivant pourrait elargir les indications de transplantation hepatique sans penaliser les malades en attente de transplantation a donneur cadaverique.

Mehrzeitige Leberresektionen bei colorectalen Lebermetastasen Das Paul Brousse-Konzept

Abstract: Die Leberresektion ist haufig die einzige Behandlungsform, die eine Chance zu langfristigem Uberleben bietet, mit Raten von 25–39 %. Aber nur bei 10 % der Patienten mit colorectalen Metastasen in der Leber kann eine kurative Operation durchgefuhrt werden. Wir sind grundsatzlich darum bemuht, die Zahl der Patienten, die von einer Leberresektion profitieren konnen, zu erhohen. Lebermetastasen sind hauptsachlich in drei Erkrankungssituationen (die manchmal in Kombination auftreten) als irresektabel anzusehen: 1) grose und/oder schlecht lokalisierte Tumoren, 2) bilaterale Tumoren in beiden Leberlappen, 3) technisch resektable, aber wegen zu kleiner verbleibender Leber mit dem (zu grosen) Risiko eines schweren postoperativen Leberversagens inoperable Tumoren. Der folgende Beitrag soll die Strategie unseres Zentrums erlautern, mit der angestrebt wird, in den genannten Situationen trotz initialer Kontraindikation kurative Resektionen durchzufuhren.

Phase I-II study of irinotecan in combination with mitomycin C in patients with advanced gastrointestinal cancer.

Abstract: This phase I-II study was conducted to determine the maximum tolerated dose and optimal schedule of a combination of irinotecan (CPT 11) and mitomycin C (MMC) in a population of previously treated patients with gastrointestinal malignancies. Four cohorts of patients were recruited with MMC given at 8 mg/m2 for the first 3 levels together with irinotecan at 300 mg/m2, 325 mg/m2, and 350 mg/m2; the fourth dose level was given with MMC at 10 mg/m2 and irinotecan at 325 mg/m2. All treatment was repeated at 21-day intervals. The dose-limiting toxicity was hematologic (thrombocytopenia at level 4), and the recommended doses for subsequent phase II studies are MMC 8 mg/m2 with irinotecan 325 mg/m2. Evidence of efficacy was seen at all dose levels examined and justifies further exploration of this combination in a less heavily pretreated patient population.

Multistage liver resections in colorectal liver metastases. The Paul Brousse concept

Abstract: Hepatic resection is currently the only form of treatment that offers a chance of long-term survival, with rates ranging from 25% to 39%. However, a curative operation can be performed in only 10% of patients with colorectal metastases to the liver. Our policy is to increase the number of patients that can benefit from liver resection. Liver metastases can be considered as irresectable mainly in three different situations (sometimes associated): (I) large and/or poorly located tumors; (II) bilateral tumors in both liver lobes; (III) tumors technically resectable, but not operable because the liver remnant is too small, which is associated with a prohibitive risk of postoperative severe liver failure. The aim of this paper is to report the strategies we use in our center to achieve curative resection in these three schematic situations despite initial contraindications.