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1. Effectiveness of Surgeon-Performed Paravertebral Block Analgesia for Minimally Invasive Thoracic Surgery: A Randomized Clinical Trial

Author

Chenesseau, Josephine, Fourdrain, Alex, Pastene, Bruno, Charvet, Aude, Rivory, Adrien, Baumstarck, Karine, Bouabdallah, Ilies, Trousse, Delphine, Boulate, David, Brioude, Geoffrey, Gust, Lucile, Vasse, Matthieu, Braggio, Cesare, Mora, Pierre, Labarriere, Ambroise, Zieleskiewicz, Laurent, Leone, Marc, Thomas, Pascal Alexandre, and D’Journo, Xavier-Benoit

Abstract

IMPORTANCE: In minimally invasive thoracic surgery, paravertebral block (PVB) using ultrasound (US)–guided technique is an efficient postoperative analgesia. However, it is an operator-dependent process depending on experience and local resources. Because pain-control failure is highly detrimental, surgeons may consider other locoregional analgesic options. OBJECTIVE: To demonstrate the noninferiority of PVB performed by surgeons under video-assisted thoracoscopic surgery (VATS), hereafter referred to as PVB-VATS, as the experimental group compared with PVB performed by anesthesiologists using US-guided technique (PVB-US) as the control group. DESIGN, SETTING, AND PARTICIPANTS: In this single-center, noninferiority, patient-blinded, randomized clinical trial conducted from September 8, 2020, to December 8, 2021, patients older than 18 years who were undergoing a scheduled minimally invasive thoracic surgery with lung resection including video-assisted or robotic approaches were included. Exclusion criteria included scheduled open surgery, any antalgic World Health Organization level greater than 2 before surgery, or a medical history of homolateral thoracic surgery. Patients were randomly assigned (1:1) to an intervention group after general anesthesia. They received single-injection PVB before the first incision was made in the control group (PVB-US) or after 1 incision was made under thoracoscopic vision in the experimental group (PVB-VATS). INTERVENTIONS: PVB-VATS or PVB-US. MAIN OUTCOMES AND MEASURES: The primary end point was mean 48-hour post-PVB opioid consumption considering a noninferiority range of less than 7.5 mg of opioid consumption between groups. Secondary outcomes included time of anesthesia, surgery, and operating room occupancy; 48-hour pain visual analog scale score at rest and while coughing; and 30-day postoperative complications. RESULTS: A total of 196 patients were randomly assigned to intervention groups: 98 in the PVB-VATS group (mean [SD] age, 64.6 [9.5] years; 53 female [54.1%]) and 98 in the PVB-US group (mean [SD] age, 65.8 [11.5] years; 62 male [63.3%]). The mean (SD) of 48-hour opioid consumption in the PVB-VATS group (33.9 [19.8] mg; 95% CI, 30.0-37.9 mg) was noninferior to that measured in the PVB-US group (28.5 [18.2] mg; 95% CI, 24.8-32.2 mg; difference: −5.4 mg; 95% CI, −∞ to −0.93; noninferiority Welsh test, P ≤ .001). Pain score at rest and while coughing after surgery, overall time, and postoperative complications did not differ between groups. CONCLUSIONS AND RELEVANCE: PVB placed by a surgeon during thoracoscopy was noninferior to PVB placed by an anesthesiologist using ultrasonography before incision in terms of opioid consumption during the first 48 hours. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04579276

Published
2023
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2. IASLC Lung Cancer Staging Project: The New Database to Inform Revisions in the Ninth Edition of the TNM Classification of Lung Cancer

Author

Asamura, Hisao, Nishimura, Katherine K., Giroux, Dorothy J., Chansky, Kari, Hoering, Antje, Rusch, Valerie, Rami-Porta, Ramón, Asamura, Hisao, Rusch, Valerie, Rami-Porta, Ramón, Araujo, Luiz Henrique, Beer, David, Bertoglio, Pietro, Beyruti, Ricardo, Billè, Andrea, Boubia, Souheil, Brambilla, Elisabeth, Cangir, A.K., Carbone, David, Cilento, Vanessa, Connolly, Casey, Darling, Gail, Detterbeck, Frank, Dibaba, Daniel, D’Journo, Xavier Benoit, Donington, Jessica, Eberhardt, Wilfried, Edwards, John, Erasmus, Jeremy, Fang, Wentao, Fennell, Dean, Fong, Kwun, Galateau-Sallé, Françoise, Gautschi, Oliver, Gill, Ritu R., Giroux, Dorothy, Giuliani, Meredith, Goo, Jin Mo, Hasegawa, Seiki, Hirsch, Fred, Hoffman, Hans, Hofstetter, Wayne, Huang, James, Joubert, Philippe, Kernstine, Kemp, Kerr, Keith, Kim, Young Tae, Kim, Dong Kwan, Kindler, Hedy, Lievens, Yolande, Liu, Hui, Low, Donald E., Lyons, Gustavo, MacMahon, Heber, Mahar, Alyson, Marino, Mirella, Marom, Edith M., Matilla, José-María, van Meerbeeck, Jan, Montuenga, Luis M., Nicholson, Andrew, Nishimura, Katie, Nowak, Anna, Opitz, Isabelle, Okumura, Meinoshin, Osarogiagbon, Raymond U., Pass, Harvey, de Perrot, Marc, Prosch, Helmut, Rice, David, Rimner, Andreas, Rosenthal, Adam, Ruffini, Enrico, Sakai, Shuji, Van Schil, Paul, Singh, Navneet, Suárez, Francisco, Terra, Ricardo M., Travis, William D., Tsao, Ming S., Ugalde, Paula, Watanabe, Shun-ichi, Wistuba, Ignacio, Wynes, Murry, and Yatabe, Yasushi

Abstract

In the past 20 years, the International Association for the Study of Lung Cancer (IASLC) has been working on a global project to revise the TNM classification of lung cancer. The first and second phases of the staging projects proposed recommendations for revision of the TNM classification, which were adopted by the Union for International Cancer Control and the American Joint Committee on Cancer as their seventh and eighth editions of the TNM classifications of lung cancer. For the third phase of the IASLC Staging Project, a new database of lung cancer cases diagnosed between January 2011 and December 2019 has been established. The Staging and Prognostic Factors Committee of the IASLC is in charge of the process of proposing new recommendations. The newly established database consisted of 124,581 cases. The data were obtained from Asia and Australia (56.0%), Europe (24.7%), North America (15.7%), South/Central America (3.4%), and Africa and the Middle East (0.1%). After cases with incomplete data are excluded, 87,043 cases were enrolled in the analysis, of which 52,069 (59.8%) were invasive adenocarcinoma and 15,872 (18.2%) were squamous cell carcinoma. Both clinical and pathologic stages were available in 44,831 (51.5%) cases. Analyses of this database are expected to provide proposals for changing the TNM classification toward the ninth edition, which is scheduled to be in use in January 2024. This newly established global database on lung cancer is described to provide fundamental elements for revisions of the TNM rules for staging lung cancer.

Published
2023
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3. The effect of enhanced recovery after minimally invasive esophagectomy: a randomized controlled trial

Author

Shen, Yaxing, Chen, Xiaosang, Hou, Junyi, Chen, Youwen, Fang, Yong, Xue, Zhanggang, D’Journo, Xavier Benoit, Cerfolio, Robert J., Fernando, Hiran C., Fiorelli, Alfonso, Brunelli, Alessandro, Cang, Jing, Tan, Lijie, and Wang, Hao

Abstract

Background: The purpose of this randomized controlled trial was to determine if enhanced recovery after surgery (ERAS) would improve outcomes for three-stage minimally invasive esophagectomy (MIE). Methods: Patients with esophageal cancer undergoing MIE between March 2016 and August 2018 were consecutively enrolled, and were randomly divided into 2 groups: ERAS+group that received a guideline-based ERAS protocol, and ERAS- group that received standard care. The primary endpoint was morbidity after MIE. The secondary endpoints were the length of stay (LOS) and time to ambulation after the surgery. The perioperative results including the Surgical Apgar Score (SAS) and Visualized Analgesia Score (VAS) were also collected and compared. Results: A total of 60 patients in the ERAS+ group and 58 patients in the ERAS- group were included. Postoperatively, lower morbidity and pulmonary complication rate were recorded in the ERAS+ group (33.3% vs. 51.7%; p= 0.04, 16.7% vs. 32.8%; p= 0.04), while the incidence of anastomotic leakage remained comparable (11.7% vs. 15.5%; p= 0.54). There was an earlier ambulation (3 [2–3] days vs. 3 [3–4] days, p= 0.001), but comparable LOS (10 [9–11.25] days vs. 10 [9–13] days; p= 0.165) recorded in ERAS+ group. The ERAS protocol led to close scores in both SAS (7.80 ± 1.03 vs. 8.07 ± 0.89, p= 0.21) and VAS (1.74 ± 0.85 vs. 1.78 ± 1.06, p= 0.84). Conclusions: Implementation of an ERAS protocol for patients undergoing MIE resulted in earlier ambulation and lower pulmonary complications, without a change in anastomotic leakage or length of hospital stay. Further studies on minimizing leakage should be addressed in ERAS for MIE.

Published
2022
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4. Risk Prediction Model of 90-Day Mortality After Esophagectomy for Cancer

Author

D’Journo, Xavier Benoit, Boulate, David, Fourdrain, Alex, Loundou, Anderson, van Berge Henegouwen, Mark I., Gisbertz, Suzanne S., O’Neill, J. Robert, Hoelscher, Arnulf, Piessen, Guillaume, van Lanschot, Jan, Wijnhoven, Bas, Jobe, Blair, Davies, Andrew, Schneider, Paul M., Pera, Manuel, Nilsson, Magnus, Nafteux, Philippe, Kitagawa, Yuko, Morse, Christopher R., Hofstetter, Wayne, Molena, Daniela, So, Jimmy Bok-Yan, Immanuel, Arul, Parsons, Simon L., Larsen, Michael Hareskov, Dolan, James P., Wood, Stephanie G., Maynard, Nick, Smithers, Mark, Puig, Sonia, Law, Simon, Wong, Ian, Kennedy, Andrew, KangNing, Wang, Reynolds, John V., Pramesh, C.S., Ferguson, Mark, Darling, Gail, Schröder, Wolfgang, Bludau, Marc, Underwood, Tim, van Hillegersberg, Richard, Chang, Andrew, Cecconello, Ivan, Ribeiro, Ulysses, de Manzoni, Giovanni, Rosati, Riccardo, Kuppusamy, MadhanKumar, Thomas, Pascal Alexandre, and Low, Donald E.

Abstract

IMPORTANCE: Ninety-day mortality rates after esophagectomy are an indicator of the quality of surgical oncologic management. Accurate risk prediction based on large data sets may aid patients and surgeons in making informed decisions. OBJECTIVE: To develop and validate a risk prediction model of death within 90 days after esophagectomy for cancer using the International Esodata Study Group (IESG) database, the largest existing prospective, multicenter cohort reporting standardized postoperative outcomes. DESIGN, SETTING, AND PARTICIPANTS: In this diagnostic/prognostic study, we performed a retrospective analysis of patients from 39 institutions in 19 countries between January 1, 2015, and December 31, 2019. Patients with esophageal cancer were randomly assigned to development and validation cohorts. A scoring system that predicted death within 90 days based on logistic regression β coefficients was conducted. A final prognostic score was determined and categorized into homogeneous risk groups that predicted death within 90 days. Calibration and discrimination tests were assessed between cohorts. EXPOSURES: Esophageal resection for cancer of the esophagus and gastroesophageal junction. MAIN OUTCOMES AND MEASURES: All-cause postoperative 90-day mortality. RESULTS: A total of 8403 patients (mean [SD] age, 63.6 [9.0] years; 6641 [79.0%] male) were included. The 30-day mortality rate was 2.0% (n = 164), and the 90-day mortality rate was 4.2% (n = 353). Development (n = 4172) and validation (n = 4231) cohorts were randomly assigned. The multiple logistic regression model identified 10 weighted point variables factored into the prognostic score: age, sex, body mass index, performance status, myocardial infarction, connective tissue disease, peripheral vascular disease, liver disease, neoadjuvant treatment, and hospital volume. The prognostic scores were categorized into 5 risk groups: very low risk (score, ≥1; 90-day mortality, 1.8%), low risk (score, 0; 90-day mortality, 3.0%), medium risk (score, –1 to –2; 90-day mortality, 5.8%), high risk (score, −3 to −4: 90-day mortality, 8.9%), and very high risk (score, ≤−5; 90-day mortality, 18.2%). The model was supported by nonsignificance in the Hosmer-Lemeshow test. The discrimination (area under the receiver operating characteristic curve) was 0.68 (95% CI, 0.64-0.72) in the development cohort and 0.64 (95% CI, 0.60-0.69) in the validation cohort. CONCLUSIONS AND RELEVANCE: In this study, on the basis of preoperative variables, the IESG risk prediction model allowed stratification of an individual patient’s risk of death within 90 days after esophagectomy. These data suggest that this model can help in the decision-making process when esophageal cancer surgery is being considered and in informed consent.

Published
2021
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5. Effect of early hyperoxemia on the outcome in servere blunt chest trauma: A propensity score-based analysis of a single-center retrospective cohort

Author

Duclos, Gary, Rivory, Adrien, Rességuier, Noémie, Hammad, Emmanuelle, Vigne, Coralie, Meresse, Zoé, Pastène, Bruno, D'journo, Xavier-Benoit, Jaber, Samir, Zieleskiewicz, Laurent, and Leone, Marc

Abstract

Our study aimed to explore the association between early hyperoxemia of the first 24 h on outcomes in patients with severe blunt chest trauma.

Published
2021
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6. The IASLC Lung Cancer Staging Project: Proposals for Revision of the Classification of Residual Tumor after Resection for the Forthcoming (9th) Edition of the TNM Classification of Lung Cancer

Author

Detterbeck, Frank C., Ostrowski, Marcin, Hoffmann, Hans, Rami-Porta, Ramón, Osarogiagbon, Ray U., Donnington, Jessica, Infante, Maurizio, Marino, Mirella, Marom, Edith M., Nakajima, Jun, Nicholson, Andrew G., van Schil, Paul, Travis, William D., Tsao, Ming S., Edwards, John G., Asamura, Hisao, Asamura, Hisao, Rusch, Valerie, Rami-Porta, Ramón, Araujo, Luiz Henrique, de Janeiro, Rio, Beer, David, Arbor, Ann, Bertoglio, Pietro, Beyruti, Ricardo, Bille, Andrea, Boubia, Souheil, Brambilla, Elisabeth, Cangir, A.K., Carbone, David, Cilento, Vanessa, Connolly, Casey, Darling, Gail, Detterbeck, Frank, Dibaba, Daniel, D’Journo, Xavier Benoit, Donington, Jessica, Eberhardt, Wilfried, Edwards, John, Eisele, Megan, Erasmus, Jeremy, Fang, Wentao, Fennell, Dean, Fong, Kwun, Galateau-Salle, Françoise, Gill, Ritu R., Giroux, Dorothy, Giuliani, Meredith, Goo, Jin Mo, Hasegawa, Seiki, Goren, Emily, Hirsch, Fred, Hoering, Antje, Hoffman, Hans, Hofstetter, Wayne, Huang, James, Joubert, Philippe, Kernstine, Kemp H., Kerr, Keith, Kim, Young Tae, Kim, Hong Kwan, Kindler, Hedy, Lievens, Yolande, Liu, Hui, Low, Donald E., Lyons, Gustavo, MacMahon, Heber, Mahar, Alyson, Marino, Mirella, Marom, Edith M., Matilla, José-María, van Meerbeeck, Jan, Montuenga, Luis M., Nicholson, Andrew G., Nishimura, Katie, Nowak, Anna, Opitz, Isabelle, Okumura, Meinoshin, Osarogiagbon, Raymond U., Pass, Harvey, de Perrot, Marc, Prosch, Helmut, Rice, David, Rimner, Andreas, Rosenthal, Adam, Ruffini, Enrico, Sakai, Shuji, Van Schil, Paul, Singh, Navneet, Suárez, Francisco, Terra, Ricardo M., Travis, William D., Tsao, Ming S., Ugalde, Paula, Watanabe, Shun-ichi, Wistuba, Ignacio, Wynes, Murry, Yatabe, Yasushi, Armato, Samuel, Berzenji, Lawek, Brunelli, Alex, Cardillo, Giuseppe, Chang, Jason, Chen, Keneng, Cooper, Wendy, Filosso, Pier Luigi, Jiang, Liyan, Karim, Nagla, Kneuertz, Peter, Krasnik, Mark, Labbe, Catherine, Lee, Ho Yun, Lim, Eric, Liu, Geoffrey, Liu, Hongxu, Mack, Philip, Naidich, David, Nishino, Mizuki, Ostrowski, Marcin, Powell, Charles, Presley, Carolyn, Putora, Paul Martin, Rekhtman, Natasha, Ren, Harry, Rivera, M Patricia, Hill, Chapel, Rocco, Gaetano, Ruiz Tzukazan, Maria Teresa, Soon, Yu Yang, Suda, Kenichi, Tammemägi, Martin, Tanoue, Lynn, Turna, Akif, Weksler, Benny, Williams, Terence, Yang, Dawei, Yang, Jeff, Yotsukura, Masaya, Ahmad, Usman, Appel, Sarit, Brambilla, Cecilia, Falkson, Conrad B., Filosso, Pier Luigi, Giaccone, Giuseppe, Guerrera, Francesco, Infante, Maurizio, Kim, Dong Kwan, Lucchi, Marco, Roden, Anja, Simone, Charles B., Ferguson, Mark, Sauter, Jennifer, and Wolf, Andrea

Abstract

The goal of surgical resection is to completely remove a cancer; it is useful to have a system to describe how well this was accomplished. This is captured by the residual tumor (R) classification, which is separate from the TNM classification that describes the anatomic extent of a cancer independent of treatment. The traditional R-classification designates as R0 a complete resection, as R1 a macroscopically complete resection but with microscopic tumor at the surgical margin, and as R2 a resection that leaves gross tumor behind. For lung cancer, an additional category encompasses situations in which the presence of residual tumor is uncertain. This paper represents a comprehensive review of evidence regarding these R categories and the descriptors thereof, focusing on studies published after the year 2000 and with adjustment for potential confounders. Consistent discrimination between complete, uncertain, and incomplete resection is demonstrated with respect to overall survival. Evidence regarding specific descriptors is generally somewhat limited and only partially consistent; nevertheless, the data suggests retaining all descriptors but with clarifications to address ambiguities. Based on this review, the R-classification for the 9thedition of stage classification of lung cancer is proposed to retain the same overall framework and descriptors, with more precise definitions of descriptors. These refinements should facilitate application as well as further research.

Published
2024
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7. Léiomyomatose œsophagienne diffuse et syndrome d’Alport : rapport d’un cas

Author

Delteil, Clemence, Macagno, Nicolas, Daniel, Laurent, D’Journo, Xavier Benoit, Guisiano, Sophie, Garcia, Stephane, and Secq, Veronique

Abstract

La léiomyomatose œsophagienne diffuse est une tumeur rare de l’œsophage caractérisée par un épaississement circonférentiel des couches musculaires lisses. La léiomyomatose œsophagienne diffuse peut être isolée ou associée au syndrome d’Alport. Le syndrome d’Alport est une maladie héréditaire habituellement définie par l’association d’une néphropathie glomérulaire et d’une surdité de perception. Nous décrivons ici la prise en charge d’une jeune femme atteinte d’une léiomyomatose œsophagienne diffuse et présentant un antécédent de léiomyome utérin. Le traitement chirurgical dépend de l’étendue œsophagienne de la maladie. L’association entre la léiomyomatose œsophagienne diffuse et les léiomyomes utérins précoces doit faire suspecter le diagnostic du syndrome d’Alport, malgré l’absence d’anomalies rénales.

Published
2024
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8. Health-related Quality of Life Following HybridMinimally Invasive Versus Open Esophagectomy for Patients With Esophageal Cancer, Analysis of a Multicenter, Open-label, Randomized Phase III Controlled Trial: The MIRO Trial.

Author

Mariette, Christophe, Markar, Sheraz, Dabakuyo-Yonli, Tienhan Sandrine, Meunier, Bernard, Pezet, Denis, Collet, Denis, D'Journo, Xavier Benoit, Brigand, Cécile, Perniceni, Thierry, Carrere, Nicolas, Mabrut, Jean Yves, Msika, Simon, Peschaud, Frédérique, Prudhomme, Michel, Bonnetain, Franck, and Piessen, Guillaume

Abstract

Background: Hybrid minimally invasive esophagectomy (HMIE) has been shown to reduce major postoperative complications compared with open esophagectomy (OE) for esophageal cancer. Objectives: The aim of this study was to compare short- and long-term health-related quality of life (HRQOL) following HMIE and OE within a randomized controlled trial. Methods: We performed a multicenter, open-label, randomized controlled trial at 13 study centers between 2009 and 2012. Patients aged 18 to 75 years with resectable cancers of the middle or lower third of the esophagus were randomized to undergo either transthoracic OE or HMIE. Patients were followed-up every 6 months for 3 years postoperatively and global health assessed with EORTC-QLQC30 and esophageal symptoms assessed with EORTC-OES18. Results: The short-term reduction in global HRQOL at 30 days specifically role functioning [-33.33 (HMIE) vs -46.3 (OE); P = 0.0407] and social functioning [-16.88 (HMIE) vs -35.74 (OE); P = 0.0003] was less substantial in the HMIE group. At 2 years, social functioning had improved following HMIE to beyond baseline (+5.37) but remained reduced in the OE group (-8.33) (P = 0.0303). At 2 years, increases in pain were similarly reduced in the HMIE compared with the OE group [+6.94 (HMIE) vs +14.05 (OE); P = 0.018]. Postoperative complications in multivariate analysis were associated with role functioning, pain, and dysphagia. Conclusions: Esophagectomy has substantial effects upon short-term HRQOL. These effects for some specific parameters are, however, reduced with HMIE, with persistent differences up to 2 years, and maybe mediated by a reduction in postoperative complications. [ABSTRACT FROM AUTHOR]

Published
2020

9. Health-related Quality of Life Following Hybrid Minimally Invasive Versus Open Esophagectomy for Patients With Esophageal Cancer, Analysis of a Multicenter, Open-label, Randomized Phase III Controlled Trial

Author

Mariette, Christophe, Markar, Sheraz, Dabakuyo-Yonli, Tienhan Sandrine, Meunier, Bernard, Pezet, Denis, Collet, Denis, D’Journo, Xavier Benoit, Brigand, Cécile, Perniceni, Thierry, Carrere, Nicolas, Mabrut, Jean Yves, Msika, Simon, Peschaud, Frédérique, Prudhomme, Michel, Bonnetain, Franck, and Piessen, Guillaume

Abstract

Supplemental Digital Content is available in the text

Published
2020
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10. The IASLC Lung Cancer Staging Project: Analysis of Resection Margin Status and Proposals for Residual Tumor Descriptors for Non–Small Cell Lung Cancer

Author

Edwards, John G., Chansky, Kari, Van Schil, Paul, Nicholson, Andrew G., Boubia, Souheil, Brambilla, Elisabeth, Donington, Jessica, Galateau-Sallé, Françoise, Hoffmann, Hans, Infante, Maurizio, Marino, Mirella, Marom, Edith M., Nakajima, Jun, Ostrowski, Marcin, Travis, William D., Tsao, Ming-Sound, Yatabe, Yasushi, Giroux, Dorothy J., Shemanski, Lynn, Crowley, John, Krasnik, Marc, Asamura, Hisao, Rami-Porta, Ramón, Asamura, Hisao, Rusch, Valerie, Rami-Porta, Ramón, Araujo, Luiz Henrique, Beer, David, Bertoglio, Pietro, Beyruti, Ricardo, Bille, Andrea, Bolejack, Vanessa, Boubia, Souheil, Brambilla, Elisabeth, Brierley, James D., Cangir, A.K., Carbone, David, Chansky, Kari, Crowley, John, Darling, Gail, Detterbeck, Frank, D’Journo, Xavier Benoit, Donnington, Jessica, Eberhardt, Wilfried, Edwards, John, Erasmus, Jeremy, Falkson, Conrad, Fang, Wentao, Fennell, Dean, Fong, Kwun, Galateau-Salle, Françoise, Gautschi, Oliver, Gill, Ritu, Giroux, Dorothy, Giuliani, Meredith, Goo, Jin Mo, Hasegawa, Seiki, Hirsch, Fred, Hoffman, Hans, Hofstetter, Wayne, Huang, James, Joubert, Philippe, Kernstine, Kemp, Kerr, Keith, Kim, Young Tae, Kim, Hong Kwan, Kindler, Hedy, Lievens, Yolande, Liu, Hui, Low, Donald E., Lyons, Gustavo, MacMahon, Heber, Marino, Mirella, Marom, Edith, Matilla, José-María, van Meerbeeck, Jan, Montuenga, Luis M., Nicholson, Andrew, Nishimura, Katie, Nowak, Anna, Opitz, Isabelle, Okumura, Meinoshin, Osarogiagbon, Raymond U., Pass, Harvey, de Perrot, Marc, Prosch, Helmut, Rice, David, Rimner, Andreas, Ruffini, Enrico, Sakai, Shuji, Van Schil, Paul, Singh, Navneet, Stoll-D’Astice, Amy, Su´rez, Francisco, Terra, Ricardo M., Travis, William D., Tsao, Ming S., Ugalde, Paula, Waller, David, Watanabe, Shun-ichi, Wiens, Jacinta, Wistuba, Ignacio, Yatabe, Yasushi, Jiang, Liyan, Kubota, Kaoru, Turna, Akif, Weksler, Benny, Tzukazan, Maria Teresa, Tammemägi, Martin, Powell, Charles, Naidich, David, Liu, Hongxu, Turna, Akif, Armato, Samuel, Brunelli, Alex, Cardillo, Giuseppe, David, Elizabeth, Fournier, Brigitte, Krasnik, Mark, Kubota, Kauro, Labbe, Catherine, Lim, Eric, Putora, Paul Martin, Rocco, Gaetano, Filosso, Pier Luigi, Filosso, Pier Luigi, Kondo, Kazuya, Kim, Dong Kwan, Giaccone, Giuseppe, Lucchi, Marco, Infante, Maurizio, Rice, Thomas, Ferguson, Mark, Adsusmilli, Prasad, Asamura, Hisao, Van Schil, Paul, Kernstine, Kemp, Asamura, Hisao, Cangir, A.K., Liu, Hui, Lievens, Yolande, Donnington, Jessica, Fang, Wentao, Lyons, Gustavo, Travis, William, Kim, Young Tae, Sakai, Shuji, Ugalde, Paula, Bertoglio, Pietro, Huang, James, Kernstine, Kemp, Osarogiagbon, Raymond U., Suárez, Francisco, Rusch, Valerie, Rice, David, Beyruti, Ricardo, Kim, Hong Kwan, Van Schil, Paul, Watanabe, Shun-ichi, Prosch, Helmut, Marom, Edith, Putora, Paul Martin, Lievens, Yolande, Bille, Andrea, Cardillo, Giuseppe, Kubota, Kaura, Lim, Eric, Rocco, Gaetano, Fong, Kwun, Singh, Navneet, Eberhardt, Wilfried, Lievens, Yolande, Marino, Mirella, Erasmus, Jeremy, Putora, Paul Martin, Marom, Edith, Suárez, Francisco, Travis, William, Shun-ichi, Hisao Asamura, Watanabe, Sakai, Shuji, Yatabe, Yasushi, Prosch, Helmut, Hoffman, Hans, Edwards, John, Joubert, Philippe, Gill, Ritu, Goo, Jin Mo, Nicholson, Andrew G., Kim, Young Tae, MacMahon, Heber, Detterbeck, Frank, Ramón, Edith Marom, Rami-Porta, Rusch, Valerie, Cardillo, Giuseppe, Naidich, David, Tsao, Ming, Nicholson, Andrew G., Eberhardt, Wilfried, Beyruti, Ricardo, Yatabe, Yasushi, Travis, William, Matilla, José-María, Lievens, Yolande, Detterbeck, Frank, Lim, Eric, Filosso, Pier Luigi, Asamura, Hisao, Rami-Porta, Ramón, Huang, James, Fong, Kwun, Travis, William, Shun-ichi, Ming Tsao, Watanabe, Nicholson, Andrew G., Detterbeck, Frank, Edwards, John, Guiliani, Meredith, Van Schil, Paul, Kernstine, Kemp, Marom, Edith, Cardillo, Giuseppe, David, Elizabeth, Watanabe, Shun-ichi, Asamura, Hisao, Rusch, Valerie, Rami-Porta, Ramón, Hoffman, Hans, Van Schil, Paul, Kernstine, Kemp, Osarogiagbon, Raymond U., Goo, Jin Mo, Detterbeck, Frank, Brierley, James, Osarogiagbon, Raymond U., Marino, Mirella, Asamura, Hisao, Rusch, Valerie, Detterbeck, Frank, Nicholson, Andrew G., Fong, Kwun, Kim, Young Tae, Huang, James, van Meerbeeck, Jan, Tsao, Ming, Turna, Akif, Singh, Navneet, Terra, Ricardo, Osarogiagbon, Ray, Montuenga, Luis, Brierley, James, Rusch, Valerie, Wang, Hongwei, Nishimura, Katie, Tammemägi, Martin, Krasnik, Mark, Brunelli, Alex, Edwards, John, Hoffman, Hans, Boubia, Souheil, Nakajima, Jun, Van Schil, Paul, Donnington, Jessica, Brambilla, Elisabeth, Marom, Edith, Nicholson, Andrew G., Marino, Mirella, Galateau, Françoise, Travis, William, Yatabe, Yasushi, Tsao, Ming, Infante, Maurizio, Ostrowski, Marcin, MacMahon, Heber, Marom, Edith, Goo, Jim Mo, Gill, Ritu, Van Schil, Paul, Travis, Bill, Powell, Charles, Armato, Samuel, Naidich, David, Detterbeck, Frank, Marom, Edith, Nicholson, Andrew G., Travis, William, Ugalde, Paula, Terra, Ricardo M., Lim, Eric, Carbone, David, Hirsch, Fred, Wistuba, Ignacio, Kerr, Keith, Brambilla, Elisabeth, Gautschi, Oliver, Yatabe, Yasushi, Araujo, Luiz Henrique, Pass, Harvey, Tsao, Ming, Rami-Porta, Ramón, Travis, William, Detterbeck, Frank, Nicholson, Andrew G., Asamura, Hisao, Montuenga, Luis, Terra, Ricardo M., Osarogiagbon, Raymond U., Matilla, José-María, Fennell, Dean, Beer, David, Ugalde, Paula, Joubert, Philippe, Lyons, Gustavo, Terra, Ricardo, Bertoglio, Pietro, Matilla, Jose Maria, Labbe, Catherine, Fournier, Brigitte, St. Pierre, Carolle, Weksler, Benny, Liu, Hongxu, Tzukazan, Ma Teresa, Ruffini, Enrico, Huang, James, Fang, Wentao, Detterbeck, Frank, Marom, Edith, Marino, Mirella, Boubia, Souheil, Cangir, A.K., Bille, Andrea, Rimner, Andreas, Okumura, Meinoshin, Nicholson, Andrew, Girard, Nicholas, Infante, Maurizio, Giaccone, Giuseppe, Filosso, Pier Luigi, Kondo, Kazuya, Lucchi, Marco, Falkson, Conrad, Kim, Dong Kwan, Rusch, Valerie, Nowak, Anna, Opitz, Isabelle, Bille, Andrea, de Perrot, Marc, Rimmer, Andreas, Gill, Ritu, Kim, Hong Kwan, Rice, David, Kindler, Hedy, Fennell, Dean, van Meerbeeck, Jan, Galateau, Francoise, Hasegawa, Seiki, Bertoglio, Pietro, Tsao, Ming, Pass, Harvey, Adusumilli, Prasad, Darling, Gail, D’Journo, Xavier, Low, Donald, Hofstetter, Wayne, Kim, Hong Kwan, Fang, Wentao, Erasmus, Jeremy, Ugalde, Paula, Ferguson, Mark, Crowley, John, Chansky, Kari, Giroux, Dorothy, Bolejack, Vanessa, Stoll-D’Astice, Amy, Nishimura, Katie, and Rosenthal, Adam

Abstract

Our aim was to validate the prognostic relevance in NSCLC of potential residual tumor (R) descriptors, including the proposed International Association for the Study of Lung Cancer definition for uncertain resection, referred to as R(un).

Published
2020
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11. Benchmarking Complications Associated with Esophagectomy.

Author

Low, Donald E., Kuppusamy, Madhan Kumar, Alderson, Derek, Cecconello, Ivan, Chang, Andrew C., Darling, Gail, Davies, Andrew, D'Journo, Xavier Benoit, Gisbertz, Suzanne S., Griffin, S. Michael, Hardwick, Richard, Hoelscher, Arnulf, Hofstetter, Wayne, Jobe, Blair, Kitagawa, Yuko, Law, Simon, Mariette, Christophe, Maynard, Nick, Morse, Christopher R., and Nafteux, Philippe

Abstract

Supplemental Digital Content is available in the text Objective: Utilizing a standardized dataset with specific definitions to prospectively collect international data to provide a benchmark for complications and outcomes associated with esophagectomy. Summary of Background Data: Outcome reporting in oncologic surgery has suffered from the lack of a standardized system for reporting operative results particularly complications. This is particularly the case for esophagectomy affecting the accuracy and relevance of international outcome assessments, clinical trial results, and quality improvement projects. Methods: The Esophageal Complications Consensus Group (ECCG) involving 24 high-volume esophageal surgical centers in 14 countries developed a standardized platform for recording complications and quality measures associated with esophagectomy. Using a secure online database (ESODATA.org), ECCG centers prospectively recorded data on all resections according to the ECCG platform from these centers over a 2-year period. Results: Between January 2015 and December 2016, 2704 resections were entered into the database. All demographic and follow-up data fields were 100% complete. The majority of operations were for cancer (95.6%) and typically located in the distal esophagus (56.2%). Some 1192 patients received neoadjuvant chemoradiation (46.1%) and 763 neoadjuvant chemotherapy (29.5%). Surgical approach involved open procedures in 52.1% and minimally invasive operations in 47.9%. Chest anastomoses were done most commonly (60.7%) and R0 resections were accomplished in 93.4% of patients. The overall incidence of complications was 59% with the most common individual complications being pneumonia (14.6%) and atrial dysrhythmia (14.5%). Anastomotic leak, conduit necrosis, chyle leaks, recurrent nerve injury occurred in 11.4%, 1.3%, 4.7%, and 4.2% of cases, respectively. Clavien-Dindo complications ≥ IIIb occurred in 17.2% of patients. Readmissions occurred in 11.2% of cases and 30- and 90-day mortality was 2.4% and 4.5%, respectively. Conclusion: Standardized methods provide contemporary international benchmarks for reporting outcomes after esophagectomy. [ABSTRACT FROM AUTHOR]

Published
2019
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12. Neoadjuvant Chemoradiotherapy Followed by Surgery Versus Surgery Alone for Locally Advanced Squamous Cell Carcinoma of the Esophagus (NEOCRTEC5010): A Phase III Multicenter, Randomized, Open-Label Clinical Trial.

Author

Yang, Hong, Liu, Hui, Chen, Yuping, Zhu, Chengchu, Fang, Wentao, Yu, Zhentao, Mao, Weimin, Xiang, Jiaqing, Han, Yongtao, Chen, Zhijian, Yang, Haihua, Wang, Jiaming, Pang, Qingsong, Zheng, Xiao, Yang, Huanjun, Li, Tao, Lordick, Florian, D'Journo, Xavier Benoit, Cerfolio, Robert J., and Korst, Robert J.

Published
2018
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14. Trimodality therapy with carboplatin/paclitaxel (CP) or FOLFOX (FFX) for esophageal/esogastric junctional cancer (EC/EGJ): Expanded safety and efficacy data from PROTECT.

Author

Adenis, Antoine, Piessen, Guillaume, Le Sourd, Samuel, Bogart, Emilie, Paumier, Amaury, Vendrely, Veronique, Glehen, Olivier, Dahan, Laetitia, Simmet, Victor, Bergeat, Damien, Samalin, Emmanuelle, Chauvenet, Marion, d'Journo, Xavier Benoit, Hiret, Sandrine, Gronnier, Caroline, Baty, Manon, Pannier, Diane, Veziant, Julie, Le Deley, Marie-Cecile, and Mirabel, Xavier

Published
2023
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15. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation

Author

Giroux, Dorothy J., Van Schil, Paul, Asamura, Hisao, Rami-Porta, Ramón, Chansky, Kari, Crowley, John J., Rusch, Valerie W., Kernstine, Kemp, Asamura, Hisao, Rusch, Valerie, Rami-Porta, Ramón, Araujo, Luiz Henrique, Beckett, Paul, Beer, David, Bertoglio, Pietro, Beyruti, Ricardo, Bille, Andrea, Bolejack, Vanessa, Boubia, Souheil, Brambilla, Elisabeth, Brierley, James D., Cangir, A.K., Carbone, David, Chansky, Kari, Crowley, John, Darling, Gail, Detterbeck, Frank, D’Journo, Xavier Benoit, Donnington, Jessica, Eberhardt, Wilfried, Edwards, John, Erasmus, Jeremy, Fang, Wentao, Fennell, Dean, Fong, Kwun, Galateau-Salle, Françoise, Gautschi, Oliver, Gill, Ritu, Giroux, Dorothy, Goo, Jin Mo, Hasegawa, Seiki, Hirsch, Fred, Hoffman, Hans, Hofstetter, Wayne, Huang, James, Joubert, Philippe, Kernstine, Kemp, Kerr, Keith, Kim, Young Tae, Kim, Hong Kwan, Kindler, Hedy, Lievens, Yolande, Liu, Hui, Low, Donald E., Lyons, Gustavo, MacMahon, Heber, Marino, Mirella, Marom, Edith, Matilla, José-María, van Meerbeeck, Jan, Montuenga, Luis M., Nicholson, Andrew, Nowak, Anna, Opitz, Isabelle, Okumura, Meinoshin, Osarogiagbon, Raymond U., Pass, Harvey, de Perrot, Marc, Prosch, Helmut, Rice, David, Rimner, Andreas, Ruffini, Enrico, Sakai, Shuji, Van Schil, Paul, Singh, Navneet, Stoll-D’Astice, Amy, Suárez, Francisco, Terra, Ricardo M., Travis, William D., Tsao, Ming S., Ugalde, Paula, Watanabe, Shun-ichi, Wiens, Jacinta, Wistuba, Ignacio, Yatabe, Yasushi, Jiang, Liyan, Kubota, Kaoru, Lim, Eric, Putora, Paul Martin, Turna, Akif, Filosso, Pier Luigi, Kondo, Kazuya, Kim, Dong Kwan, Giaccone, Giuseppe, Lucchi, Marco, Blackwell, Eugene, Rice, Thomas, Asamura, Hisao, Van Schil, Paul, Kernstine, Kemp, Asamura, Hisao, Cangir, A.K., Liu, Hui, Donnington, Jessica, Fang, Wentao, Lyons, Gustavo, Travis, William, Kim, Young Tae, Sakai, Shuji, Ugalde, Paula, Bertoglio, Pietro, Huang, James, Kernstine, Kemp, Osarogiagbon, Raymond U., Suárez, Francisco, Rusch, Valerie, Rice, David, Beyruti, Ricardo, Kim, Hong Kwan, Van Schil, Paul, Watanabe, Shun-ichi, Prosch, Helmut, Marom, Edith, Fong, Kwun, Singh, Navneet, Fennell, Dean, Eberhardt, Wilfried, Lievens, Yolande, Marino, Mirella, Erasmus, Jeremy, Putora, Paul Martin, Marom, Edith, Suárez, Francisco, Travis, William, Asamura, Hisao, Watanabe, Shun-ichi, Sakai, Shuji, Yatabe, Yasushi, Prosch, Helmut, Hoffman, Hans, Edwards, John, Joubert, Philippe, Gill, Ritu, Goo, Jin Mo, Nicholson, Andrew G., Kim, Young Tae, MacMahon, Heber, Detterbeck, Frank, Marom, Edith, Tsao, Ming, Nicholson, Andrew G., Eberhardt, Wilfried, Beyruti, Ricardo, Yatabe, Yasushi, Travis, William, Matilla, José-María, Lievens, Yolande, Detterbeck, Frank, Lim, Eric, Asamura, Hisao, Rami-Porta, Ramón, Huang, James, Fong, Kwun, Travis, William, Tsao, Ming, Watanabe, Shun-ichi, Nicholson, Andrew G., Detterbeck, Frank, Edwards, John, Brierley, James, Van Schil, Paul, Kernstine, Kemp, Marom, Edith, Watanabe, Shun-ichi, Asamura, Hisao, Rusch, Valerie, Rami-Porta, Ramón, Hoffman, Hans, Van Schil, Paul, Kernstine, Kemp, Osarogiagbon, Raymond U., Goo, Jin Mo, Marom, Edith, Detterbeck, Frank, Brierley, James, Osarogiagbon, Raymond U., Beckett, Paul, Marino, Mirella, Asamura, Hisao, Rusch, Valerie, Lim, Eric, Detterbeck, Frank, Nicholson, Andrew G., Fong, Kwun, Kim, Young Tae, Huang, James, van Meerbeeck, Jan, Tsao, Ming, Edwards, John, Hoffman, Hans, Boubia, Souheil, Nakajima, Jun, Van Schil, Paul, Donnington, Jessica, Brambilla, Elisabeth, Marom, Edith, Nicholson, Andrew G., Marino, Mirella, Galateau, Françoise, Travis, Bill, Yatabe, Yasushi, Tsao, Ming, MacMahon, Heber, Marom, Edith, Goo, Jim Mo, Gill, Ritu, Detterbeck, Frank, Marom, Edith, Nicholson, Andrew G., Travis, William, Ugalde, Paula, Terra, Ricardo M., Lim, Eric, Carbone, David, Hirsch, Fred, Wistuba, Ignacio, Kerr, Keith, Brambilla, Elisabeth, Gautschi, Oliver, Yatabe, Yasushi, Araujo, Luiz Henrique, Pass, Harvey, Tsao, Ming, Rami-Porta, Ramón, Travis, William, Detterbeck, Frank, Nicholson, Andrew G., Asamura, Hisao, Joubert, Philippe, Montuenga, Luis, Terra, Ricardo M., Osarogiagbon, Raymond U., Matilla, José-María, Fennell, Dean, Beer, David, Wiens, Jacinta, Lim, Eric, Crowley, John, Chansky, Kari, Giroux, Dorothy, Bolejack, Vanessa, Stoll-D’Astice, Amy, Wang, Hong Wei, and Nishimura, Katie

Abstract

Over the past two decades, the International Association for the Study of Lung Cancer (IASLC) Staging Project has been a steady source of evidence-based recommendations for the TNM classification for lung cancer published by the Union for International Cancer Control and the American Joint Committee on Cancer. The Staging and Prognostic Factors Committee of the IASLC is now issuing a call for participation in the next phase of the project, which is designed to inform the ninth edition of the TNM classification for lung cancer. Following the case recruitment model for the eighth edition database, volunteer site participants are asked to submit data on patients whose lung cancer was diagnosed between January 1, 2011, and December 31, 2019, to the project by means of a secure, electronic data capture system provided by Cancer Research And Biostatistics in Seattle, Washington. Alternatively, participants may transfer existing data sets. The continued success of the IASLC Staging Project in achieving its objectives will depend on the extent of international participation, the degree to which cases are entered directly into the electronic data capture system, and how closely externally submitted cases conform to the data elements for the project.

Published
2018
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16. International Consensus on Standardization of Data Collection for Complications Associated With Esophagectomy.

Author

Low, Donald E., Alderson, Derek, Cecconello, Ivan, Chang, Andrew C., Darling, Gail E., D'Journo, Xavier Benoit, Griffin, S. Michael, Hölscher, Arnulf H., Hofstetter, Wayne L., Jobe, Blair A., Kitagawa, Yuko, Kucharczuk, John C., Ying, Simon, Lerut, Toni E., Maynard, Nick, Pera, Manuel, Peters, Jeffrey H., Pramesh, C. S., Reynolds, John V., and Smithers, B. Mark

Published
2015
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17. Incidence and Management of Anastomotic Complications After Bronchial Resection: A Retrospective Study.

Author

Bylicki, Olivier, Vandemoortele, Thomas, Orsini, Bastien, Laroumagne, Sophie, D’Journo, Xavier Benoit, Astoul, Philippe, Thomas, Pascal-Alexandre, and Dutau, Hervé

Abstract

Background Bronchial resection and reimplantation in surgical management of lung cancer is intended to spare lung parenchyma, with curative intent. We studied the incidence and management of anastomotic complications after such procedures. Methods We retrospectively reviewed charts of patients referred to our center for lung tumors who underwent bronchial resection and reimplantation from 1992 to 2011. Results A total of 108 patients were included. Sixty-eight percent were male, and mean age was 58 years. Sleeve lobectomies were performed in 100 patients, bronchial resections without lung parenchymal resection in 8 patients. Squamous cell carcinoma represented 46.3% of cases, carcinoid tumors 22.2%, and adenocarcinoma 18.5%. Mean time between surgery and first bronchoscopic examination was 4.47 days. During the follow-up, anastomotic abnormalities were detected in 23 patients (21.3%): malacic or fibrotic bronchial stenoses in 9 cases (39.1%), dehiscences in 7 (30.4%), obstructive granulomas in 4 (17.4%), and bronchopleural fistulas in 3 (13.0%). Endoscopic treatment was indicated in 14 patients (13%) and consisted of stent placement in 6 cases (26%), mechanical dilations in 3 (13%), laser treatment for 1 case of bronchomalacia (4.3%), and resection of granulomas in 4 (17.4%). No risk factors were identified as predisposing for bronchial complications. There was a trend toward lower 1-year survival in patients with bronchial complications compared with those without (71.9% versus 83.4%; p = 0.114). Conclusions Bronchial resection and reimplantation is a surgical procedure associated with an anastomotic complication rate of 21.3%, but only 13% required endoscopic management. Regular endoscopic surveillance is advised to detect and treat early complications. [ABSTRACT FROM AUTHOR]

Published
2014
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18. International Consensus on Standardization of Data Collection for Complications Associated With Esophagectomy

Author

Low, Donald E., Alderson, Derek, Cecconello, Ivan, Chang, Andrew C., Darling, Gail E., D'Journo, Xavier Benoit, Griffin, S. Michael, Hölscher, Arnulf H., Hofstetter, Wayne L., Jobe, Blair A., Kitagawa, Yuko, Kucharczuk, John C., Law, Simon Ying Kit, Lerut, Toni E., Maynard, Nick, Pera, Manuel, Peters, Jeffrey H., Pramesh, C. S., Reynolds, John V., Smithers, B. Mark, and Lanschot, J. Jan B. van

Abstract

Perioperative complications influence long- and short-term outcomes after esophagectomy. The absence of a standardized system for defining and recording complications and quality measures after esophageal resection has meant that there is wide variation in evaluating their impact on these outcomes.

Published
2015
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19. Bronchogenic Cyst: Best Time for Surgery?

Author

Fievet, Lucile, D'Journo, Xavier Benoit, Guys, Jean Michel, Thomas, Pascal A., and De Lagausie, Pascal

Subjects
CYSTS (Pathology), MEDIASTINUM diseases, GENETIC disorders, RETROSPECTIVE studies, TUMOR surgery, SURGICAL complications, PRENATAL diagnosis
Abstract

Background: Bronchogenic cyst (BC) is a benign congenital mediastinal tumor whose natural course remains unclear. In adults, most BCs are removed by thoracotomy after complications. Currently, prenatal diagnosis is generally feasible and allows an early thoracoscopic intervention. The purpose of this retrospective study was to ascertain the best time for the operation. Methods: Reviewed were 36 patients (11 children, 25 adults) with a BC managed from 2000 to 2011. Clinical history, cyst size, duration of hospitalization, preoperative and postoperative complications, and detection of inflammatory elements were compared (Student t tests) between pediatric and adult patients. Results: In the pediatric group, diagnosis was made prenatally in 7 patients, during the neonatal period in 2, and later in 2. Nine were asymptomatic. In the adult group, 20 patients were treated for complications. Thoracotomy was performed in 2 children and thoracoscopy in 9 (no conversion). A thoracoscopic operation was performed in 9 adults (2 conversions), and 17 adults required additional procedures (4 pericardial and 9 lung resections, 3 bronchial, and 1 esophageal sutures). The average length of hospitalization was 4.45 days for children (3.33 days in the thoracoscopic subgroup) and 8 days for adults. Mean maximal cyst diameter was 2.2 cm in children and 6.5 cm in adults (p < 0.10). Pathologic study revealed inflammatory reaction in 2 children (18%) vs 21 adults (84%; p < 0.001). Conclusions: Early surgical resection of BCs provides better conservation of pulmonary parenchyma, a lower incidence of inflammatory lesions, and a reduced rate of complications, and should be proposed after prenatal diagnosis, between the 6th and 12th month of life. [ABSTRACT FROM AUTHOR]

Published
2012
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20. Molecular Detection of Microorganisms in Distal Airways of Patients Undergoing Lung Cancer Surgery.

Author

D'Journo, Xavier Benoit, Bittar, Fadi, Trousse, Delphine, Gaillat, Francoise, Doddoli, Christophe, Dutau, Herve, Papazian, Laurent, Raoult, Didier, Rolain, Jean Marc, and Thomas, Pascal Alexandre

Subjects
AIRWAY (Anatomy), LUNG cancer, LUNG surgery, POSTOPERATIVE care, SURGICAL complications, MICROORGANISMS, SURGICAL excision, CYTOMEGALOVIRUSES
Abstract

Background: Whereas proximal airways of patients undergoing lung cancer surgery are known to present specific microbiota incriminated in the occurrence of postoperative respiratory complications, little attention has been paid to distal airways and lung parenchyma considered to be free from bacteria. We have hypothesized that molecular culture-independent techniques applied to distal airways should allow identification of uncultured bacteria, virus, or emerging pathogens and predict the occurrence of postoperative respiratory complications. Methods: Microbiological assessments were obtained from the distal airways of resected lung specimens from a prospective cohort of patients undergoing major lung resections for cancer. Microorganisms were detected using real-time polymerase chain reaction (PCR) assays targeting the bacterial 16s ribosomal RNA gene and Herpesviridae, cytomegalovirus (CMV), and herpesvirus simplex. All postoperative microbiological assessments were compared with the PCR results. Results: In all, 240 samples from 87 patients were investigated. Colonizing agents were exclusively Herpesviridae (CMV, n = 13, and herpesvirus simplex, n = 1). All 16s ribosomal RNA PCR remained negative. Thirteen patients (15%) had a positive CMV PCR (positive-PCR group), whereas the remaining 74 patients constituted the negative-PCR group. Postoperative pneumonia occurred in 24% of the negative-PCR group and in 69% of the positive-PCR group (p = 0.003). Upon stepwise logistic regression, performance status, percent of predicted diffusion lung capacity for carbon monoxide, and positive PCR were the risk factors of postoperative respiratory complications. The CMV PCR had a positive predictive value of 0.70 in prediction of respiratory complications. Conclusions: When tested by molecular techniques, lung parenchyma and distal airways are free of bacteria, but CMV was found in a high proportion of the samples. Molecular CMV detection in distal airways should be seen as a reliable marker to identify patients at risk for postoperative respiratory complications. [Copyright &y& Elsevier]

Published
2012
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21. Elongation gastroplasty with transverse fundoplasty: The Jeyasingham repair.

Author

D'Journo, Xavier Benoit, Martin, Jocelyne, Bensaidane, Soufiane, Ferraro, Pasquale, and Duranceau, André

Subjects
STOMACH surgery, FUNDOPLICATION, HERNIA surgery, GASTROESOPHAGEAL reflux treatment, ESOPHAGOGASTRIC junction, BARRETT'S esophagus, METAPLASIA, PATIENTS
Abstract

Objective: Surgical management of massive hernias and complex gastroesophageal reflux disease requires a tension-free repair with reliable reflux control. The aim of this observation was to evaluate the functional results of a modified Collis-Nissen gastroplasty with a transverse widening fundoplasty. Methods: Between 1995 and 2007, 26 patients underwent a 3-cm cut elongation gastroplasty with a transverse widening of the fundus followed by a 3-cm total (n = 24) or partial (n = 2) fundoplication. Indications for the operation were symptomatic massive hiatal hernias (n = 4), hiatal hernias with Barrett''s esophagus (n = 8), or correction of previously failed antireflux fundoplications (n = 14). Barrett''s esophagus was documented in 19 of the 26 patients. Pre- and postoperative assessment included symptoms, barium swallow, endoscopy, manometry, and 24-hour pH monitoring. Results: There was no postoperative mortality. Complications were recorded in 6 patients. Median follow-up was 105 months. Reflux symptoms present in all patients before the operation were found in 5 patients postoperatively (P < .001). Radiologic assessment documented an intact fundoplication in all patients. Lower esophageal sphincter gradient increased from a mean of 7.5 to 15 mm Hg (P = .003). Acid exposure (17% preoperatively) decreased significantly to 1% postoperatively (P < .001). Endoscopically, mucosal damage quantification decreased (3.1 preoperatively to 1.5 postoperatively; P < .001). All mucosal breaks healed but the columnar-lined metaplasia persisted. Conclusions: This modified elongation gastroplasty provided a reliable repair for massive hernias, shortened Barrett''s esophagus, and reoperations. The lower esophageal sphincter gradient was restored and remained stable. Reflux exposure was reduced, and acute mucosal damage disappeared. Columnar-lined metaplasia remained unchanged. [Copyright &y& Elsevier]

Published
2009
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22. Roux-en-Y Diversion for Intractable Reflux After Esophagectomy.

Author

D'Journo, Xavier Benoit, Martin, Jocelyne, Gaboury, Louis, Ferraro, Pasquale, and Duranceau, André

Subjects
GASTROESOPHAGEAL reflux, ESOPHAGECTOMY, METAPLASTIC ossification, ETIOLOGY of diseases
Abstract

Background: Reflux esophagitis is a significant problem after esophagectomy and gastric reconstruction. When mixed reflux damages the esophageal remnant or results in aspiration problems, appropriate medical management is in order. If medical management fails, a surgical option is available. This study reports results of a Roux-en-Y diversion in postesophagectomy patients affected by debilitating reflux complications. Methods: Between 1990 and 2006, 4 of 223 esophagectomy patients required surgical correction for mucosal damage to their esophageal remnant or repeat aspirations. Patient, clinical, operative, histopathologic, and postoperative data were collected. Results: Two of 3 patients with a substernal reconstruction underwent antrectomy with a 60-cm Roux-en-Y diversion. One patient with significant reflux disease and aspiration episodes also had a gastrobronchial fistula. The gastric interposition was defunctionalized, and a staged reconstruction with antrectomy and a Roux-en-Y diversion was completed. One patient with a prevertebral reconstruction had a Roux-en-Y diversion without antrectomy. There was no mortality and minimal morbidity. Two patients are asymptomatic and 2 are improved. Endoscopic assessment documented normal mucosa in the esophageal remnant for 2 of the 4 patients postoperatively; in 2 others, metaplastic columnar mucosa persisted. Active inflammation regressed in all 4 patients. Conclusions: Complete duodenal diversion with a 60-cm Roux-en-Y gastrojejunostomy is an effective operation to correct debilitating reflux complications after esophagectomy. Reflux symptoms are corrected and the mucosa is allowed to heal. The surgical approach is influenced by the position of the gastric transplant. Protection of the vascular supply to the gastric tube is the challenge of the operation. [Copyright &y& Elsevier]

Published
2008
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23. Long-Term Observation and Functional State of the Esophagus After Primary Repair of Spontaneous Esophageal Rupture.

Author

D’Journo, Xavier Benoit, Doddoli, Christophe, Avaro, Jean Philippe, Lienne, Pascal, Giovannini, Marc A., Giudicelli, Roger, Fuentes, Pierre A., and Thomas, Pascal A.

Subjects
ESOPHAGEAL surgery, SURGERY, GASTROESOPHAGEAL reflux, CANCER treatment, MEDICAL research
Abstract

Background: Long-term outcome of patients treated for a spontaneous esophageal rupture (Boerhaave’s syndrome) is seldom reported. Methods: From 1989 to 2004, 62 esophageal perforations were treated in a single institution. Eighteen patients presented with a spontaneous esophageal rupture. Among them, 15 could be treated with a transthoracic primary repair and constituted the material of the present study. A chart review was performed with special attention to survival, residual symptoms, and anatomic and motility disorders. Results: Three patients died postoperatively (20%). At last follow-up, 10 patients were alive and 2 had died from unrelated causes. At a median delay of 13 months (3 to 74), 7 patients accepted to undergo complementary investigations. None of them had any anatomic abnormality as checked by barium swallow. Six patients complained of mild symptoms from gastroesophageal reflux. Six patients (85%) presented with esophageal motility disorders on manometry and 4 (54%) had nocturne chronic reflux disease on pH monitoring. Two patients underwent endoscopic ultrasonography, of which one presented with a focal absence of one layer of the esophageal wall within the area of the suture. With time, no patient experienced recurrence, but one developed a cancer in the cervical esophagus. Conclusions: These results suggest that esophageal functional disorders are the rule after primary repair of a Boerhaave’s syndrome. Whether or not these findings are causal, coincidental, or related to the surgical treatment remains unclear. However, performance of routine postoperative explorations is strongly encouraged for a better understanding of this challenging condition. [Copyright &y& Elsevier]

Published
2006
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24. Early Onset Pneumonia in Severe Chest Trauma A Risk Factor Analysis

Author

Michelet, Pierre, Couret, David, Brégeon, Fabienne, Perrin, Gilles, D'Journo, Xavier-Benoit, Pequignot, Véronique, Vig, Véronique, and Auffray, Jean-Pierre

Abstract

The development of an early-onset pneumonia (EOP), occurring within the first 72 hours after admission, represents a critical event in severe thoracic trauma population. The aim of this study was to determine risk factors associated with the occurrence of this complication in this specific population.

Published
2010
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27. Necrotizing fasciitis of the chest wall.

Author

Birnbaum, David J, D'Journo, Xavier Benoit, Casanova, Dominique, and Thomas, Pascal A

Abstract

Necrotizing fasciitis (NF) is an uncommon infection caused by microorganisms called 'flesh eating bacteria'. It remains a life-threatening condition associated with high mortality rate. Its location to the chest wall is exceptional. Herein, we report the case of a 39-year-old female, without comorbidity, presenting a NF of the chest wall complicating an empyema. We describe the surgical management with a three-step procedure: antibiotherapy-debridement, vacuum-assisted closure and delayed surgical reconstruction.

Published
2010
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28. Sternal Dehiscence After Clamshell Incision in Lung Transplantation Treated With the STRAsbourg Thoracic Osteosyntheses System (STRATOS).

Author

Orsini, Bastien, D'Journo, Xavier Benoit, Reynaud-Gaubert, Martine, and Thomas, Pascal Alexandre

Abstract

Clamshell incision with transverse sternotomy is the approach of choice for bilateral lung transplantation when cardiopulmonary bypass becomes necessary or to improve exposure. Sternal dehiscence is a well-known complication of this approach. This results in chronic thoracic pain and contributes to a delayed pulmonary rehabilitation. Sternal dehiscence can be treated with conservative therapy, but severe dehiscence requires secondary surgical closure. Several techniques of osteosynthesis have been reported with conflicting results. We describe the first use of the STRAsbourg Thoracic Osteosyntheses System (STRATOS) devices in three cases of secondary sternal closure without infection after bilateral lung transplantation. [Copyright &y& Elsevier]

Published
2014
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