101 results on '"Department of Digestive Surgery"'
Search Results
2. Innovative perfused cadaveric model for complete mesocolic excision.
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Jarry C, Vela J, Varas J, Soza F, Corvetto M, Heriot A, Warrier S, and Larach JT
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- Humans, Colectomy methods, Mesocolon surgery, Cadaver
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- 2024
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3. Updated European guidelines for clinical management of familial adenomatous polyposis (FAP), MUTYH-associated polyposis (MAP), gastric adenocarcinoma, proximal polyposis of the stomach (GAPPS) and other rare adenomatous polyposis syndromes: a joint EHTG-ESCP revision.
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Zaffaroni G, Mannucci A, Koskenvuo L, de Lacy B, Maffioli A, Bisseling T, Half E, Cavestro GM, Valle L, Ryan N, Aretz S, Brown K, Buttitta F, Carneiro F, Claber O, Blanco-Colino R, Collard M, Crosbie E, Cunha M, Doulias T, Fleming C, Heinrich H, Hüneburg R, Metras J, Nagtegaal I, Negoi I, Nielsen M, Pellino G, Ricciardiello L, Sagir A, Sánchez-Guillén L, Seppälä TT, Siersema P, Striebeck B, Sampson JR, Latchford A, Parc Y, Burn J, and Möslein G
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- Humans, Neoplastic Syndromes, Hereditary genetics, Neoplastic Syndromes, Hereditary therapy, Neoplastic Syndromes, Hereditary diagnosis, Europe, Adenomatous Polyps genetics, Adenomatous Polyps therapy, Polyps, Adenomatous Polyposis Coli genetics, Adenomatous Polyposis Coli therapy, Adenomatous Polyposis Coli diagnosis, Stomach Neoplasms genetics, Stomach Neoplasms therapy, Stomach Neoplasms diagnosis, Adenocarcinoma genetics, Adenocarcinoma therapy, Adenocarcinoma diagnosis, DNA Glycosylases genetics
- Abstract
Background: Hereditary adenomatous polyposis syndromes, including familial adenomatous polyposis and other rare adenomatous polyposis syndromes, increase the lifetime risk of colorectal and other cancers., Methods: A team of 38 experts convened to update the 2008 European recommendations for the clinical management of patients with adenomatous polyposis syndromes. Additionally, other rare monogenic adenomatous polyposis syndromes were reviewed and added. Eighty-nine clinically relevant questions were answered after a systematic review of the existing literature with grading of the evidence according to Grading of Recommendations, Assessment, Development, and Evaluation methodology. Two levels of consensus were identified: consensus threshold (≥67% of voting guideline committee members voting either 'Strongly agree' or 'Agree' during the Delphi rounds) and high threshold (consensus ≥ 80%)., Results: One hundred and forty statements reached a high level of consensus concerning the management of hereditary adenomatous polyposis syndromes., Conclusion: These updated guidelines provide current, comprehensive, and evidence-based practical recommendations for the management of surveillance and treatment of familial adenomatous polyposis patients, encompassing additionally MUTYH-associated polyposis, gastric adenocarcinoma and proximal polyposis of the stomach and other recently identified polyposis syndromes based on pathogenic variants in other genes than APC or MUTYH. Due to the rarity of these diseases, patients should be managed at specialized centres., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)
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- 2024
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4. Recurrence-free survival as a surrogate endpoint for overall survival after neoadjuvant chemotherapy and surgery for oesophageal squamous cell carcinoma.
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Okui J, Nagashima K, Matsuda S, Sato Y, Okamura A, Kawakubo H, Muto M, Kakeji Y, Kono K, Takeuchi H, Watanabe M, Doki Y, Bamba T, Fukuda T, Fujiwara H, Sato S, Noma K, Miyata H, Fujita T, and Kitagawa Y
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- Humans, Cisplatin therapeutic use, Neoadjuvant Therapy, Retrospective Studies, Antineoplastic Combined Chemotherapy Protocols, Treatment Outcome, Biomarkers, Fluorouracil therapeutic use, Esophageal Squamous Cell Carcinoma drug therapy, Esophageal Squamous Cell Carcinoma surgery, Esophageal Neoplasms drug therapy, Esophageal Neoplasms surgery
- Abstract
Background: Overall survival is considered as one of the most important endpoints of treatment efficacy but often requires long follow-up. This study aimed to determine the validity of recurrence-free survival as a surrogate endpoint for overall survival in patients with surgically resectable advanced oesophageal squamous cell carcinoma (OSCC)., Methods: Patients with OSCC who received neoadjuvant cisplatin and 5-fluorouracil, or docetaxel, cisplatin and 5-fluorouracil, at 58 Japanese oesophageal centres certified by the Japan Esophageal Society were reviewed retrospectively. The correlation between recurrence-free and overall survival was assessed using Kendall's τ., Results: The study included 3154 patients. The 5-year overall and recurrence-free survival rates were 56.6 and 47.7% respectively. The primary analysis revealed a strong correlation between recurrence-free and overall survival (Kendall's τ 0.797, 95% c.i. 0.782 to 0.812) at the individual level. Subgroup analysis showed a positive relationship between a more favourable pathological response to neoadjuvant chemotherapy and a higher τ value. In the meta-regression model, the adjusted R2 value at the institutional level was 100 (95% c.i. 40.2 to 100)%. The surrogate threshold effect was 0.703., Conclusion: There was a strong correlation between recurrence-free and overall survival in patients with surgically resectable OSCC who underwent neoadjuvant chemotherapy, and this was more pronounced in patients with a better response to neoadjuvant chemotherapy., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.)
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- 2024
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5. Long-term oncological outcomes of robotic versus laparoscopic gastrectomy for gastric cancer: multicentre cohort study.
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Li ZY, Wei B, Zhou YB, Li TY, Li JP, Zhou ZW, She JJ, Qin XG, Hu JK, Li YX, Qian F, Shi Y, Cui H, Tian YL, Gao GM, Gao RZ, Liang CC, Shi FY, Yu LJ, Yang K, Zhang SX, Yu PW, and Zhao YL
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- Humans, Treatment Outcome, Cohort Studies, Gastrectomy, Propensity Score, Retrospective Studies, Postoperative Complications etiology, Postoperative Complications surgery, Robotic Surgical Procedures, Stomach Neoplasms surgery, Laparoscopy, Levamisole analogs & derivatives
- Abstract
Background: The aim of this multicentre cohort study was to compare the long-term oncological outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for patients with gastric cancer., Methods: Patients with gastric cancer who underwent radical gastrectomy by robotic or laparoscopic approaches from 1 March 2010 to 31 December 2018 at 10 high-volume centres in China were selected from institutional databases. Patients receiving RG were matched 1 : 1 by propensity score with patients undergoing LG. The primary outcome was 3-year disease-free survival. Secondary outcomes were overall survival and disease recurrence., Results: Some 2055 patients who underwent RG and 4309 patients who had LG were included. The propensity score-matched cohort comprised 2026 RGs and 2026 LGs. Median follow-up was 41 (i.q.r. 39-58) months for the RG group and 39 (38-56) months for the LG group. The 3-year disease-free survival rates were 80.8% in the RG group and 79.5% in the LG group (log rank P = 0.240; HR 0.92, 95% c.i. 0.80 to 1.06; P = 0.242). Three-year OS rates were 83.9 and 81.8% respectively (log rank P = 0.068; HR 0.87, 0.75 to 1.01; P = 0.068) and the cumulative incidence of recurrence over 3 years was 19.3% versus 20.8% (HR 0.95, 0.88 to 1.03; P = 0.219), with no difference between groups., Conclusion: RG and LG in patients with gastric cancer are associated with comparable disease-free and overall survival., (© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2024
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6. Prognostic impact of tumour location in stage II/III ulcerative colitis-associated colon cancer: subgroup analysis of a nationwide multicentre retrospective study in Japan.
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Mizuuchi Y, Nagayoshi K, Nakamura M, Ikeuchi H, Uchino M, Futami K, Okamoto K, Mizushima T, Nagahara H, Watanabe K, Okabayashi K, Yamada K, Ohge H, Tanaka S, Okita Y, Sato Y, Ueno H, Maemoto A, Itabashi M, Kimura H, Hida K, Kinugasa Y, Takahashi K, Koyama F, Hanai T, Maeda K, Noake T, Shimada Y, Yamamoto T, Arakaki J, Mastuda K, Okuda J, Sunami E, Akagi Y, Kastumata K, Uehara K, Yamada T, Sasaki S, Ishihara S, Ajioka Y, and Sugihara K
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- Humans, Prognosis, Retrospective Studies, Japan epidemiology, Colitis-Associated Neoplasms, Colonic Neoplasms pathology, Colitis, Ulcerative complications
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- 2024
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7. Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients.
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Greijdanus NG, Wienholts K, Ubels S, Talboom K, Hannink G, Wolthuis A, de Lacy FB, Lefevre JH, Solomon M, Frasson M, Rotholtz N, Denost Q, Perez RO, Konishi T, Panis Y, Rutegård M, Hompes R, Rosman C, van Workum F, Tanis PJ, and de Wilt JHW
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- Humans, Cohort Studies, Anastomosis, Surgical methods, Rectum surgery, Retrospective Studies, Anastomotic Leak etiology, Anastomotic Leak surgery, Rectal Neoplasms surgery, Rectal Neoplasms complications
- Abstract
Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied., Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1)., Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days)., Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding., (© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.)
- Published
- 2023
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8. Comment on: Oncological outcomes after transanal total mesorectal excision for rectal cancer.
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Gachabayov M, Bergamaschi R, Wasmuth H, Faerden A, Javadov M, Cianchi F, Nasseri Y, Barnajian M, Popa DE, and Lee H
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- 2023
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9. Artificial intelligence-based decision-making: can ChatGPT replace a multidisciplinary tumour board?
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Vela Ulloa J, King Valenzuela S, Riquoir Altamirano C, and Urrejola Schmied G
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- 2023
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10. Evidence mapping of randomized clinical trials in hepatobiliary surgery.
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Majlesara A, Aminizadeh E, Ramouz A, Khajeh E, Borges F, Goncalves G, Carvalho C, Golriz M, and Mehrabi A
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- Humans, Randomized Controlled Trials as Topic, Digestive System Diseases surgery
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- 2023
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11. Reusable cloth masks in operating theatre.
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Collard MK, Vaz A, Irving H, Khan MF, Mullis D, Brady D, Nolan K, and Cahill R
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- Humans, SARS-CoV-2, Textiles, COVID-19
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- 2023
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12. E-AHPBA-ESSO-ESSR Innsbruck consensus guidelines for preoperative liver function assessment before hepatectomy.
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Primavesi F, Maglione M, Cipriani F, Denecke T, Oberkofler CE, Starlinger P, Dasari BVM, Heil J, Sgarbura O, Søreide K, Diaz-Nieto R, Fondevila C, Frampton AE, Geisel D, Henninger B, Hessheimer AJ, Lesurtel M, Mole D, Öllinger R, Olthof P, Reiberger T, Schnitzbauer AA, Schwarz C, Sparrelid E, Stockmann M, Truant S, Aldrighetti L, Braunwarth E, D'Hondt M, DeOliveira ML, Erdmann J, Fuks D, Gruenberger T, Kaczirek K, Malik H, Öfner D, Rahbari NN, Göbel G, Siriwardena AK, and Stättner S
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- Humans, Hepatectomy methods, Liver, Indocyanine Green, Retrospective Studies, Postoperative Complications etiology, Liver Neoplasms surgery, Liver Failure
- Abstract
Background: Posthepatectomy liver failure (PHLF) contributes significantly to morbidity and mortality after liver surgery. Standardized assessment of preoperative liver function is crucial to identify patients at risk. These European consensus guidelines provide guidance for preoperative patient assessment., Methods: A modified Delphi approach was used to achieve consensus. The expert panel consisted of hepatobiliary surgeons, radiologists, nuclear medicine specialists, and hepatologists. The guideline process was supervised by a methodologist and reviewed by a patient representative. A systematic literature search was performed in PubMed/MEDLINE, the Cochrane library, and the WHO International Clinical Trials Registry. Evidence assessment and statement development followed Scottish Intercollegiate Guidelines Network methodology., Results: Based on 271 publications covering 4 key areas, 21 statements (at least 85 per cent agreement) were produced (median level of evidence 2- to 2+). Only a few systematic reviews (2++) and one RCT (1+) were identified. Preoperative liver function assessment should be considered before complex resections, and in patients with suspected or known underlying liver disease, or chemotherapy-associated or drug-induced liver injury. Clinical assessment and blood-based scores reflecting liver function or portal hypertension (for example albumin/bilirubin, platelet count) aid in identifying risk of PHLF. Volumetry of the future liver remnant represents the foundation for assessment, and can be combined with indocyanine green clearance or LiMAx® according to local expertise and availability. Functional MRI and liver scintigraphy are alternatives, combining FLR volume and function in one examination., Conclusion: These guidelines reflect established methods to assess preoperative liver function and PHLF risk, and have uncovered evidence gaps of interest for future research., (© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.)
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- 2023
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13. Outcomes of surgical resection in microsatellite instable colorectal cancer after immune checkpoint inhibitor treatment.
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Challine A, Karoui M, De La Fouchardière C, André T, Svrcek M, Meeus P, Dupré A, Paye F, Benoit S, Denet C, Eveno C, Lefèvre JH, and Parc Y
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- Humans, Microsatellite Instability, Microsatellite Repeats genetics, Immune Checkpoint Inhibitors therapeutic use, Colorectal Neoplasms drug therapy, Colorectal Neoplasms genetics, Colorectal Neoplasms surgery
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- 2023
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14. Developing a core set of patient-reported outcomes and patient-reported experience measures for peritoneal surface malignancies (COMETE).
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Taibi A, Sgarbura O, Villeneuve L, Eveno C, Pocard M, Bakrin N, Economos G, Odin C, Durand Fontanier S, Bardet SM, Goere D, Brigand C, Glehen O, and Hübner M
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- Humans, Patient Reported Outcome Measures, Consensus, Peritoneal Neoplasms therapy
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- 2023
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15. Laparoscopic lavage for Hinchey III perforated diverticulitis: factors for treatment failure in two randomized clinical trials.
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Azhar N, Lambrichts D, Lange J, Yaqub S, Øresland T, Schultz J, Bemelman W, and Buchwald P
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- Humans, Adrenal Cortex Hormones, Peritoneal Lavage adverse effects, Randomized Controlled Trials as Topic, Reoperation adverse effects, Treatment Failure, Treatment Outcome, Diverticulitis, Diverticulitis, Colonic complications, Diverticulitis, Colonic surgery, Intestinal Perforation surgery, Intestinal Perforation complications, Laparoscopy adverse effects, Peritonitis etiology, Peritonitis surgery
- Abstract
Background: The Scandinavian Diverticulitis (SCANDIV) trial and the LOLA arm of the LADIES trial randomized patients with Hinchey III perforated diverticulitis to laparoscopic peritoneal lavage or sigmoid resection. The aim of this analysis was to identify risk factors for treatment failure in patients with Hinchey III perforated diverticulitis., Methods: This was a post hoc analysis of the SCANDIV trial and LOLA arm. Treatment failure was defined as morbidity requiring general anaesthesia (Clavien-Dindo grade IIIb or higher) within 90 days. Age, sex, BMI, ASA fitness grade, smoking status, previous episodes of diverticulitis, previous abdominal surgery, time to surgery, and surgical competence were all tested in univariable and multivariable logistic regression analyses using an interaction variable., Results: The pooled analysis included 222 patients randomized to laparoscopic lavage and primary resection (116 and 106 patients respectively). Univariable analysis found ASA grade to be associated with advanced morbidity in both groups, and the following factors in the laparoscopic lavage group: smoking, corticosteroid use, and BMI. Significant factors for laparoscopic lavage morbidity in multivariable analysis were smoking (OR 7.05, 95 per cent c.i. 2.07 to 23.98; P = 0.002) and corticosteroid use (OR 6.02, 1.54 to 23.51; P = 0.010)., Conclusion: Active smoking status and corticosteroid use were risk factors for laparoscopic lavage treatment failure (advanced morbidity) in patients with perforated diverticulitis., (© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.)
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- 2023
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16. Outcomes of bariatric surgery in patients with inflammatory bowel disease from a French nationwide database.
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Corbière L, Scanff A, Desfourneaux V, Merdrignac A, Ingels A, Thibault R, Bouguen G, and Bergeat D
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- Humans, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases surgery, Crohn Disease complications, Crohn Disease surgery, Colitis, Ulcerative surgery, Bariatric Surgery methods
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Background: The outcomes of bariatric surgery (BS) in patients with chronic inflammatory bowel disease (IBD) remain rarely described. We aimed to evaluate the 90-day morbidity and mortality rates, and the risk of IBD complications 2 years after BS., Method: Patients from the French Programme de Médicalisation des Systèmes d'Information (PMSI) database who underwent a primary BS between 2016 and 2018 were included. We identified patients with a previous diagnosis of IBD. Postoperative 90-day (POD90) morbidity and mortality rates were compared between the two groups. The evolution of IBD was followed 2 years after BS., Results: Between 2016 and 2018, 138 980 patients underwent primary BS, including 587 patients with IBD: 326 (55.5 per cent) with Crohn's disease (CD) and 261 (44.5 per cent) with ulcerative colitis (UC). The preferred surgical technique was sleeve gastrectomy, especially in the IBD group (81.1 per cent), followed by gastric bypass (14.6 per cent). Patients with IBD had more comorbidities (Charlson Comorbidity Index of 1 or more, hypertension, and diabetes; P < 0.001) than those without IBD. The POD90 mortality rate did not differ between the two groups (0.049 per cent in the IBD group versus 0 per cent in the non-IBD group), but more unscheduled rehospitalizations at POD90 were observed in patients with IBD (6.0 per cent versus 3.7 per cent; P = 0.004). Two years after BS, 86 patients (14.6 per cent) in the IBD group had at least one unplanned readmission for the management of their IBD; 15 patients stayed for 3 or more days. After multivariable analysis, patients with CD had an independent elevated risk of IBD-related unplanned readmissions 2 years after BS versus UC (adjusted odds ratio 1.90, 95 per cent c.i. 1.22 to 2.97; P = 0.005)., Conclusion: In a highly selected cohort of patients with well-controlled IBD, BS did not result in added mortality or morbidity. A point of vigilance must be underlined regarding BS in patients with CD., (© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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17. Life expectancy and likelihood of surgery in multiple endocrine neoplasia type 1: AFCE and GTE cohort study.
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Gaujoux S, Martin GL, Mirallié E, Regenet N, Le Bras M, Pattou F, Carnaille B, Cardot-Bauters C, Groussin L, Faron M, Chanson P, Najah H, Tabarin A, Sauvanet A, Ruszniewski P, Lifante JC, Walter T, Carrère N, Caron P, Deguelte S, Delemer B, Binquet C, Jannot AS, and Goudet P
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- Cohort Studies, Humans, Life Expectancy, Mutation, Probability, Multiple Endocrine Neoplasia Type 1 genetics, Multiple Endocrine Neoplasia Type 1 surgery, Pancreatic Neoplasms surgery
- Abstract
Background: The overall natural history, risk of death and surgical burden of patients with multiple endocrine neoplasia type 1 (MEN1) is not well known., Methods: Patients with MEN1 from a nationwide cohort were included. The survival of patients with MEN1 was compared with that of the general population using simulated controls. The cumulative probabilities of MEN1-specific operations and postoperative mortality were assessed, and surgical sequences were analysed using sunburst charts and Venn diagrams., Results: A total of 1386 patients with MEN1 were included. Life expectancy was significantly reduced in patients with MEN1 compared with simulated controls from the general population, with a lifetime difference of 15 years. Mutations affecting the JunD interaction domain had a significant negative impact on survival. Survival for patients with MEN1 compared with the general population improved over time. The probability of experiencing at least one specific MEN1 operation was above 95 per cent after 75 years, and most patients had surgery at least twice during their lifetime. Time to a 50 per cent risk of MEN1 surgery was 30.5 years for patients born after 1960, compared with 47.9 years for those born before 1960. Sex and mutations affecting the JunD interacting domain had no impact on time to first surgery. There was considerable heterogeneity in surgical sequences, with no specific clinical pathway., Conclusion: Life expectancy was significantly lower among patients with MEN1 compared with the general population, and further decreased in patients with mutations affecting the JunD interacting domain. Almost all patients underwent at least one MEN1-specific operation during their lifetime, but there was no standardized sequence of surgery., (© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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18. Personalized surgery for the splenic flexure cancer: new frontiers.
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Andersen BT, Kazaryan AM, Stimec BV, Edwin B, Rancinger P, and Ignjatovic D
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- Colectomy, Humans, Retrospective Studies, Colon, Transverse surgery, Colonic Neoplasms surgery, Laparoscopy
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- 2022
- Full Text
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19. Low-pressure versus standard pressure laparoscopic colorectal surgery (PAROS trial): a phase III randomized controlled trial.
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Celarier S, Monziols S, Célérier B, Assenat V, Carles P, Napolitano G, Laclau-Lacrouts M, Rullier E, Ouattara A, and Denost Q
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- Adult, Aged, Aged, 80 and over, Double-Blind Method, Female, Follow-Up Studies, France epidemiology, Humans, Male, Middle Aged, Morbidity trends, Pressure, Prospective Studies, Treatment Outcome, Young Adult, Colectomy methods, Colorectal Neoplasms surgery, Laparoscopy methods, Postoperative Complications epidemiology
- Abstract
Trial Design: This is a phase III, double-blind, randomized, controlled trial., Methods: In this trial, patients with laparoscopic colectomy were assigned to either low pressure (LP: 7 mmHg) or standard pressure (SP: 12 mmHg) at a ratio of 1 : 1. The aim of this trial was to assess the impact of low-pressure pneumoperitoneum during laparoscopic colectomy on postoperative recovery. The primary endpoint was the duration of hospital stay. The main secondary endpoints were postoperative pain, consumption of analgesics and postoperative morbidity., Results: Some 138 patients were enrolled, of whom 11 were excluded and 127 were analysed: 62 with LP and 65 with SP. Duration of hospital stay (3 versus 4 days; P = 0.010), visual analog scale (0.5 versus 2.0; P = 0.008) and analgesic consumption (level II: 73 versus 88 per cent; P = 0.032; level III: 10 versus 23 per cent; P = 0.042) were lower with LP. Morbidity was not significantly different between the two groups (10 versus 17 per cent; P = 0.231)., Conclusion: Using low-pressure pneumoperitoneum in laparoscopic colonic resection improves postoperative recovery, shortening the duration of hospitalization and decreasing postoperative pain and analgesic consumption. This suggests that low pressure should become the standard of care for laparoscopic colectomy., Trial Registration: NCT03813797., (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2021
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20. Comment on: Safety and efficacy of low pressure pneumoperitoneum in laparoscopic colorectal surgery.
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Slim K and Joris J
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- Humans, Pneumoperitoneum, Artificial adverse effects, Colorectal Surgery, Digestive System Surgical Procedures, Laparoscopy, Pneumoperitoneum etiology
- Published
- 2021
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21. Decrease in operative volume in general surgery residents in Chile: effects of the COVID-19 pandemic.
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Inzunza M, Besser N, and Bellolio F
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- Chile, Humans, Pandemics, COVID-19, General Surgery education, Internship and Residency organization & administration, Personnel Staffing and Scheduling, Surgical Procedures, Operative statistics & numerical data
- Published
- 2021
- Full Text
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22. Prognostic grade for resecting hepatocellular carcinoma: multicentre retrospective study.
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Takayama T, Yamazaki S, Matsuyama Y, Midorikawa Y, Shiina S, Izumi N, Hasegawa K, Kokudo N, Sakamoto M, Kubo S, Kudo M, Murakami T, and Nakashima O
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- Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Carcinoma, Hepatocellular surgery, Decision Trees, Female, Hepatectomy methods, Humans, Liver pathology, Liver surgery, Liver Neoplasms mortality, Liver Neoplasms pathology, Liver Neoplasms surgery, Male, Middle Aged, Neoplasm Grading methods, Prognosis, Retrospective Studies, Survival Analysis, Carcinoma, Hepatocellular diagnosis, Liver Neoplasms diagnosis
- Abstract
Background: Surgical treatment for hepatocellular carcinoma (HCC) is advancing, but a robust prediction model for survival after resection is not available. The aim of this study was to propose a prognostic grading system for resection of HCC., Methods: This was a retrospective, multicentre study of patients who underwent first resection of HCC with curative intent between 2000 and 2007. Patients were divided randomly by a cross-validation method into training and validation sets. Prognostic factors were identified using a Cox proportional hazards model. The predictive model was built by decision-tree analysis to define the resection grades, and subsequently validated., Results: A total of 16 931 patients from 795 hospitals were included. In the training set (8465 patients), four surgical grades were classified based on prognosis: grade A1 (1236 patients, 14.6 per cent; single tumour 3 cm or smaller and anatomical R0 resection); grade A2 (3614, 42.7 per cent; single tumour larger than 3 cm, or non-anatomical R0 resection); grade B (2277, 26.9 per cent; multiple tumours, or vascular invasion, and R0 resection); and grade C (1338, 15.8 per cent; multiple tumours with vascular invasion and R0 resection, or R1 resection). Five-year survival rates were 73.9 per cent (hazard ratio (HR) 1.00), 64.7 per cent (HR 1.51, 95 per cent c.i. 1.29 to 1.78), 50.6 per cent (HR 2.53, 2.15 to 2.98), and 34.8 per cent (HR 4.60, 3.90 to 5.42) for grades A1, A2, B, and C respectively. In the validation set (8466 patients), the grades had equivalent reproducibility for both overall and recurrence-free survival (all P < 0.001)., Conclusion: This grade is used to predict prognosis of patients undergoing resection of HCC., (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2021
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23. Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis.
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Hobeika C, Cauchy F, Fuks D, Barbier L, Fabre JM, Boleslawski E, Regimbeau JM, Farges O, Pruvot FR, Pessaux P, Salamé E, Soubrane O, Vibert E, and Scatton O
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- Aged, Bile Duct Neoplasms mortality, Bile Duct Neoplasms pathology, Bile Ducts pathology, Bile Ducts surgery, Blood Transfusion statistics & numerical data, Cholangiocarcinoma mortality, Cholangiocarcinoma pathology, Female, France, Humans, Length of Stay statistics & numerical data, Lymph Node Excision, Male, Middle Aged, Propensity Score, Retrospective Studies, Survival Analysis, Treatment Outcome, Bile Duct Neoplasms surgery, Cholangiocarcinoma surgery, Laparoscopy methods
- Abstract
Background: The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND)., Methods: Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching., Results: In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012)., Conclusion: The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC., (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2021
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24. Double prevalence of appendicular peritonitis during COVID times.
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Riveros S, Artigas G, Inzunza M, Rebolledo R, Brañes A, Crovari F, and Achurra P
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- Adolescent, Adult, Aged, Aged, 80 and over, Appendicitis surgery, Chile epidemiology, Cohort Studies, Communicable Disease Control, Female, Humans, Male, Middle Aged, Pandemics, Peritonitis surgery, Prevalence, Severity of Illness Index, Young Adult, Appendicitis epidemiology, COVID-19 epidemiology, Peritonitis epidemiology
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- 2021
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25. Author response to: Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial.
- Author
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Muscari F and Maulat C
- Subjects
- Drainage, Hepatectomy adverse effects, Humans, Biliary Fistula etiology, Biliary Fistula prevention & control
- Published
- 2021
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- View/download PDF
26. Author response to: Comment on: COVID 19 and the race to publish: an ethical issue.
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Kassir R
- Subjects
- Humans, Publishing, SARS-CoV-2, COVID-19
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- 2021
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27. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy: 5-year outcomes of merged data from two randomized clinical trials (SLEEVEPASS and SM-BOSS).
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Wölnerhanssen BK, Peterli R, Hurme S, Bueter M, Helmiö M, Juuti A, Meyer-Gerspach AC, Slawik M, Peromaa-Haavisto P, Nuutila P, and Salminen P
- Subjects
- Female, Humans, Male, Middle Aged, Obesity, Morbid surgery, Treatment Outcome, Weight Loss, Gastrectomy methods, Gastric Bypass methods, Laparoscopy methods
- Abstract
Background: Laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) are both effective surgical procedures to achieve weight reduction in patients with obesity. The trial objective was to merge individual-patient data from two RCTs to compare outcomes after LSG and LRYGB., Methods: Five-year outcomes of the Finnish SLEEVEPASS and Swiss SM-BOSS RCTs comparing LSG with LRYGB were analysed. Both original trials were designed to evaluate weight loss. Additional patient-level data on type 2 diabetes (T2DM), obstructive sleep apnoea, and complications were retrieved. The primary outcome was percentage excess BMI loss (%EBMIL). Secondary predefined outcomes in both trials included total weight loss, remission of co-morbidities, improvement in quality of life (QoL), and overall morbidity., Results: At baseline, 228 LSG and 229 LRYGB procedures were performed. Five-year follow-up was available for 199 of 228 patients (87.3 per cent) after LSG and 199 of 229 (87.1 per cent) after LRYGB. Model-based mean estimate of %EBMIL was 7.0 (95 per cent c.i. 3.5 to 10.5) percentage points better after LRYGB than after LSG (62.7 versus 55.5 per cent respectively; P < 0.001). There was no difference in remission of T2DM, obstructive sleep apnoea or QoL improvement; remission for hypertension was better after LRYGB compared with LSG (60.3 versus 44.9 per cent; P = 0.049). The complication rate was higher after LRYGB than LSG (37.2 versus 22.5 per cent; P = 0.001), but there was no difference in mean Comprehensive Complication Index value (30.6 versus 31.0 points; P = 0.859)., Conclusion: Although LRYGB induced greater weight loss and better amelioration of hypertension than LSG, there was no difference in remission of T2DM, obstructive sleep apnoea, or QoL at 5 years. There were more complications after LRYGB, but the individual burden for patients with complications was similar after both operations., (© The Author(s) 2020. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
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- 2021
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28. International variation in managing locally advanced or recurrent rectal cancer: prospective benchmark analysis.
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Denost Q, Solomon M, Tuech JJ, Ghouti L, Cotte E, Panis Y, Lelong B, Rouanet P, Faucheron JL, Jafari M, Lefevre JH, Rullier E, Heriot A, Austin K, Lee P, Brown W, Maillou-Martinaud H, Savel H, Quintard B, Broc G, and Saillour-Glénisson F
- Subjects
- Adult, Aged, Australia, Female, France, Healthcare Disparities standards, Humans, Magnetic Resonance Imaging statistics & numerical data, Male, Middle Aged, Neoplasm Recurrence, Local diagnostic imaging, Neoplasm Recurrence, Local psychology, Neoplasm Recurrence, Local surgery, Neoplasm Staging, Practice Patterns, Physicians' standards, Proctectomy statistics & numerical data, Prospective Studies, Qualitative Research, Quality of Life, Rectal Neoplasms pathology, Rectal Neoplasms psychology, Benchmarking, Clinical Decision-Making methods, Healthcare Disparities statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data, Rectal Neoplasms diagnostic imaging, Rectal Neoplasms surgery
- Abstract
Background: Tumour extension beyond the mesorectal plane (ymrT4) occurs in 5-10 per cent of patients with rectal cancer and 10 per cent of patients develop locally recurrent rectal cancer (LRRC) after primary surgery. There is global variation in healthcare delivery for these conditions., Methods: An international benchmark trial of the management of ymrT4 tumours and LRRC was undertaken in France and Australia between 2015 and 2017. Heterogeneity in management and operative decision-making were analysed by comparison of surgical resection rates, blinded intercountry reading of pelvic MRI, quality-of-life assessment and qualitative evaluations., Results: Among 154 patients (97 in France and 57 in Australia), 31·8 per cent had ymrT4 disease and 68·2 per cent LRRC. The surgical resection rates were 88 and 79 per cent in France and Australia respectively (P = 0·112). The concordance in operative planning was low (κ = 0·314); the rate of pelvic exenteration was lower in France than Australia both in clinical practice (36 of 78 versus 34 of 40; P < 0·001) and in theoretical conditions (10 of 25 versus 50 of 57; P = 0·002). The R0 resection rate was lower in France than Australia for LRRC (25 of 49 versus 18 of 21; P = 0·007) but not for ymrT4 tumours (21 of 26 versus 15 of 15; P = 0·139). Morbidity rates were similar. Patients who underwent non-exenterative procedures had higher scores on the mental functioning subscale at 12 months (P = 0·047), and a lower level of distress at 6 months (P = 0·049). Qualitative analysis highlighted five categories of psychosocial factors influencing treatment decisions: patient, strategy, specialist, organization and culture., Conclusion: This international benchmark trial has highlighted the differences in worldwide treatment of locally advanced and LRRC. Standardized care should improve outcomes for these patients., (© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.)
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- 2020
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29. Gastrectomy with or without omentectomy for cT3-4 gastric cancer: a multicentre cohort study.
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Ri M, Nunobe S, Honda M, Akimoto E, Kinoshita T, Hori S, Aizawa M, Yabusaki H, Isobe Y, Kawakubo H, and Abe T
- Subjects
- Aged, Female, Humans, Male, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local prevention & control, Postoperative Complications epidemiology, Propensity Score, Retrospective Studies, Stomach Neoplasms mortality, Survival Analysis, Treatment Outcome, Gastrectomy methods, Omentum surgery, Stomach Neoplasms surgery
- Abstract
Background: Omentectomy is performed widely for locally advanced gastric cancer to prevent disease recurrence. However, its clinical benefit is unknown., Methods: This retrospective cohort study compared the outcome of gastrectomy with preservation of the omentum (GPO) and gastrectomy with resection of the omentum (GRO) among patients with cT3-T4 gastric cancer who underwent gastrectomy between 2006 and 2012 in one of five participating institutions. A consensus conference identified 28 variables potentially associated with outcome after gastrectomy for the estimation of propensity scores, and propensity score matching (PSM) was undertaken to control for possible confounders. Postoperative surgical outcomes, overall survival and disease recurrence were compared between GPO and GRO., Results: A total of 1758 patients were identified, of whom 526 remained after PSM, 263 in each group. Median follow-up was 4·9 (i.q.r. 3·1-5·9) years in the GRO group and 5·0 (2·5-6·8) years in the GPO group. The incidence of postoperative complications of Clavien-Dindo grade III or more was significantly higher in the GRO group (17·5 versus 10·3 per cent; P = 0·016). Five-year overall survival rates were 77·1 per cent in the GRO group and 79·4 per cent in the GPO group (P = 0·749). There were no significant differences in recurrence rate or pattern of recurrence between the groups., Conclusion: Overall survival and disease recurrence were comparable in patients with cT3-4 gastric cancer who underwent GPO or GRO., (© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.)
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- 2020
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30. New challenges to surgery due to the COVID-19 pandemic: from tension to attention.
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Kassir R, Sauvat F, and Dargai F
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- COVID-19 psychology, Comorbidity, Humans, Attention, COVID-19 epidemiology, General Surgery standards, Pandemics, SARS-CoV-2, Surgical Procedures, Operative standards
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- 2020
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31. Surgical training during COVID-19: a validated solution to keep on practicing.
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Jarry Trujillo C, Achurra Tirado P, Escalona Vivas G, Crovari Eulufi F, and Varas Cohen J
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- COVID-19 epidemiology, Chile, Humans, Internship and Residency, Latin America, Pandemics, Education, Distance, Feedback, General Surgery education, Laparoscopy education
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- 2020
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32. Role of tumour location and surgical extent on prognosis in T2 gallbladder cancer: an international multicentre study.
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Kwon W, Kim H, Han Y, Hwang YJ, Kim SG, Kwon HJ, Vinuela E, Járufe N, Roa JC, Han IW, Heo JS, Choi SH, Choi DW, Ahn KS, Kang KJ, Lee W, Jeong CY, Hong SC, Troncoso AT, Losada HM, Han SS, Park SJ, Kim SW, Yanagimoto H, Endo I, Kubota K, Wakai T, Ajiki T, Adsay NV, and Jang JY
- Subjects
- Adult, Aged, Aged, 80 and over, Chile, Cholecystectomy, Disease-Free Survival, Female, Gallbladder Neoplasms pathology, Hepatectomy, Humans, Japan, Lymph Node Excision, Male, Middle Aged, Neoplasm Metastasis, Neoplasm Recurrence, Local, Prognosis, Republic of Korea, Risk Factors, United States, Gallbladder Neoplasms mortality, Gallbladder Neoplasms surgery
- Abstract
Background: In gallbladder cancer, stage T2 is subdivided by tumour location into lesions on the peritoneal side (T2a) or hepatic side (T2b). For tumours on the peritoneal side (T2a), it has been suggested that liver resection may be omitted without compromising the prognosis. However, data to validate this argument are lacking. This study aimed to investigate the prognostic value of tumour location in T2 gallbladder cancer, and to clarify the adequate extent of surgical resection., Methods: Clinical data from patients who underwent surgery for gallbladder cancer were collected from 14 hospitals in Korea, Japan, Chile and the USA. Survival and risk factor analyses were conducted., Results: Data from 937 patients were available for evaluation. The overall 5-year disease-free survival rate was 70·6 per cent, 74·5 per cent for those with T2a and 65·5 per cent among those with T2b tumours (P = 0·028). Regarding liver resection, extended cholecystectomy was associated with a better 5-year disease-free survival rate than simple cholecystectomy (73·0 versus 61·5 per cent; P = 0·012). The 5-year disease-free survival rate was marginally better for extended than simple cholecystectomy in both T2a (76·5 versus 66·1 per cent; P = 0·094) and T2b (68·2 versus 56·2 per cent; P = 0·084) disease. Five-year disease-free survival rates were similar for extended cholecystectomies including liver wedge resection versus segment IVb/V segmentectomy (74·1 versus 71·5 per cent; P = 0·720). In multivariable analysis, independent risk factors for recurrence were presence of symptoms (hazard ratio (HR) 1·52; P = 0·002), R1 resection (HR 1·96; P = 0·004) and N1/N2 status (N1: HR 3·40, P < 0·001; N2: HR 9·56, P < 0·001). Among recurrences, 70·8 per cent were metastatic., Conclusion: Tumour location was not an independent prognostic factor in T2 gallbladder cancer. Extended cholecystectomy was marginally superior to simple cholecystectomy. A radical operation should include liver resection and adequate node dissection., (© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.)
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- 2020
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33. Author response to: Comment on: Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial.
- Author
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Muscari F and Maulat C
- Subjects
- Drainage, Hepatectomy adverse effects, Humans, Biliary Fistula etiology, Biliary Fistula prevention & control
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- 2020
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34. Is the use of laparoscopy in a COVID-19 epidemic free of risk?
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Schwarz L and Tuech JJ
- Subjects
- COVID-19, Coronavirus Infections prevention & control, Humans, Pandemics prevention & control, Pneumonia, Viral prevention & control, Risk, SARS-CoV-2, Betacoronavirus, Coronavirus Infections transmission, Infectious Disease Transmission, Patient-to-Professional prevention & control, Laparoscopy, Pneumonia, Viral transmission
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- 2020
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35. Our challenge is to adapt the organization of our system to the six stages of the epidemic to go beyond the COVID-19 crisis.
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Tuech JJ, Gangloff A, and Schwarz L
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- COVID-19, Humans, Pandemics, SARS-CoV-2, Betacoronavirus, Coronavirus Infections, Pneumonia, Viral
- Published
- 2020
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36. Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial.
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Maulat C, Regimbeau JM, Buc E, Boleslawski E, Belghiti J, Hardwigsen J, Vibert E, Delpero JR, Tournay E, Arnaud C, Suc B, Pessaux P, and Muscari F
- Subjects
- Bile Ducts surgery, Biliary Fistula etiology, Female, Hepatectomy methods, Humans, Male, Middle Aged, Postoperative Complications etiology, Postoperative Complications prevention & control, Risk Factors, Biliary Fistula prevention & control, Drainage methods, Hepatectomy adverse effects
- Abstract
Background: Biliary fistula is one of the most common complications after hepatectomy. This study evaluated the effect of transcystic biliary drainage during hepatectomy on the occurrence of postoperative biliary fistula., Methods: This multicentre RCT was carried out from 2009 to 2016 in nine centres. Patients were randomized to transcystic biliary drainage or no transcystic drainage (control). Patients underwent hepatectomy (more than 2 segments) of non-cirrhotic livers. The primary endpoint was the occurrence of biliary fistula after surgery. Secondary endpoints were morbidity, postoperative mortality, duration of hospital stay, reoperation, readmission to hospital, and complications caused by catheters. Intention-to-treat and per-protocol analyses were performed., Results: A total of 310 patients were randomized. In intention-to-treat analysis, there were 158 patients in the transcystic group and 149 in the control group. Seven patients were removed from the per-protocol analysis owing to protocol deviations. The biliary fistula rate was 5·9 per cent in intention-to-treat and 6·0 per cent in per-protocol analyses. The rate was similar in the transcystic and control groups (5·7 versus 6·0 per cent; P = 1·000). There were no differences in terms of morbidity (49·4 versus 46·3 per cent; P = 0·731), mortality (2·5 versus 4·7 per cent; P = 0·367) and reoperations (4·4 versus 10·1 per cent; P = 1·000). Median duration of hospital stay was longer in the transcystic group (11 versus 10 days; P = 0·042). The biliary fistula risk was associated with the width and length of the hepatic cut surface., Conclusion: This randomized trial did not demonstrate superiority of transcystic drainage during hepatectomy in preventing biliary fistula. The use of transcystic drainage during hepatectomy to prevent postoperative biliary fistula is not recommended. Registration number: NCT01469442 ( http://www.clinicaltrials.gov)., (© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.)
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- 2020
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37. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society.
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Henriksen NA, Montgomery A, Kaufmann R, Berrevoet F, East B, Fischer J, Hope W, Klassen D, Lorenz R, Renard Y, Garcia Urena MA, and Simons MP
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- Europe, Humans, Surgical Mesh, United States, Hernia, Abdominal surgery, Hernia, Umbilical surgery, Herniorrhaphy methods, Laparoscopy methods, Practice Guidelines as Topic, Plastic Surgery Procedures methods, Societies, Medical
- Abstract
Background: Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias., Methods: The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, the Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists, and the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument were used. A systematic literature search was done on 1 May 2018, and updated on 1 February 2019., Results: Literature reporting specifically on umbilical and epigastric hernias was limited in quantity and quality, resulting in a majority of the recommendations being graded as weak, based on low-quality evidence. The main recommendation was to use mesh for repair of umbilical and epigastric hernias to reduce the recurrence rate. Most umbilical and epigastric hernias may be repaired by an open approach with a preperitoneal flat mesh. A laparoscopic approach may be considered if the hernia defect is large, or if the patient has an increased risk of wound morbidity., Conclusion: This is the first European and American guideline on the treatment of umbilical and epigastric hernias. It is recommended that symptomatic umbilical and epigastric hernias are repaired by an open approach with a preperitoneal flat mesh., (© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.)
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- 2020
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38. Comparison of oncological outcomes after open and laparoscopic re-resection of incidental gallbladder cancer.
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Vega EA, De Aretxabala X, Qiao W, Newhook TE, Okuno M, Castillo F, Sanhueza M, Diaz C, Cavada G, Jarufe N, Munoz C, Rencoret G, Vivanco M, Joechle K, Tzeng CD, Vauthey JN, Vinuela E, and Conrad C
- Subjects
- Adult, Aged, Aged, 80 and over, Chile epidemiology, Female, Follow-Up Studies, Gallbladder Neoplasms diagnosis, Gallbladder Neoplasms mortality, Humans, Incidental Findings, Male, Middle Aged, Reoperation, Retrospective Studies, Survival Rate trends, Young Adult, Cholecystectomy, Laparoscopic methods, Gallbladder Neoplasms surgery, Laparotomy methods, Neoplasm Staging methods, Propensity Score
- Abstract
Background: The safety and oncological efficacy of laparoscopic re-resection of incidental gallbladder cancer have not been studied. This study aimed to compare laparoscopic with open re-resection of incidentally discovered gallbladder cancer while minimizing selection bias., Methods: This was a multicentre retrospective observational cohort study of patients with incidental gallbladder cancer who underwent re-resection with curative intent at four centres between 2000 and 2017. Overall survival (OS) and recurrence-free survival (RFS) were analysed by intention to treat. Inverse probability of surgery treatment weighting using propensity scoring was undertaken., Results: A total of 255 patients underwent re-resection (190 open, 65 laparoscopic). Nineteen laparoscopic procedures were converted to open operation. Surgery before 2011 was the only factor associated with conversion. Duration of hospital stay was shorter after laparoscopic re-resection (median 4 versus 6 days; P < 0·001). Three-year OS rates for laparoscopic and open re-resection were 87 and 62 per cent respectively (P = 0·502). Independent predictors of worse OS were residual cancer found at re-resection (hazard ratio (HR) 1·91, 95 per cent c.i. 1·17 to 3·11), blood loss of at least 500 ml (HR 1·83, 1·23 to 2·74) and at least four positive nodes (HR 3·11, 1·46 to 6·65). In competing-risks analysis, the RFS incidence was higher for laparoscopic re-resection (P = 0·038), but OS did not differ between groups. Independent predictors of worse RFS were one to three positive nodes (HR 2·16, 1·29 to 3·60), at least four positive nodes (HR 4·39, 1·96 to 9·82) and residual cancer (HR 2·42, 1·46 to 4·00)., Conclusion: Laparoscopic re-resection for selected patients with incidental gallbladder cancer is oncologically non-inferior to an open approach. Dissemination of advanced laparoscopic skills and timely referral of patients with incidental gallbladder cancer to specialized centres may allow more patients to benefit from this operation., (© 2019 BJS Society Ltd Published by John Wiley & Sons Ltd.)
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- 2020
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39. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey.
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Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, and Patrice D
- Subjects
- Aged, Disease-Free Survival, Female, Humans, Liver Cirrhosis etiology, Male, Middle Aged, Population Surveillance, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Carcinoma, Hepatocellular surgery, Hepatectomy adverse effects, Laparoscopy adverse effects, Liver Cirrhosis diagnosis, Liver Neoplasms surgery, Postoperative Complications diagnosis, Propensity Score
- Abstract
Background: The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study., Methods: This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection., Results: Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010)., Conclusion: Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres., (© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd.)
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- 2020
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40. Significance of the surgical hepatic resection margin in patients with a single hepatocellular carcinoma.
- Author
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Aoki T, Kubota K, Hasegawa K, Kubo S, Izumi N, Kokudo N, Sakamoto M, Shiina S, Takayama T, Nakashima O, Matsuyama Y, Murakami T, and Kudo M
- Subjects
- Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular pathology, Disease-Free Survival, Humans, Japan epidemiology, Kaplan-Meier Estimate, Liver Neoplasms mortality, Liver Neoplasms pathology, Margins of Excision, Prospective Studies, Tumor Burden, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery
- Abstract
Background: The impact of a wide surgical margin on the outcome of patients with hepatocellular carcinoma (HCC) has not been evaluated in relation to the type of liver resection performed, anatomical or non-anatomical. The aim of this study was to evaluate the impact of surgical margin status on outcomes in patients undergoing anatomical or non-anatomical resection for solitary HCC., Methods: Data from patients with solitary HCC who had undergone non-anatomical partial resection (Hr0 group) or anatomical resection of one Couinaud segment (HrS group) between 2000 and 2007 were extracted from a nationwide survey database in Japan. Overall and recurrence-free survival associated with the surgical margin status and width were evaluated in the two groups., Results: A total of 4457 patients were included in the Hr0 group and 3507 in the HrS group. A microscopically positive surgical margin was associated with poor overall survival in both groups. A negative but 0-mm surgical margin was associated with poorer overall and recurrence-free survival than a wider margin only in the Hr0 group. In the HrS group, the width of the surgical margin was not associated with patient outcome., Conclusion: Anatomical resection with a negative 0-mm surgical margin may be acceptable. Non-anatomical resection with a negative 0-mm margin was associated with a less favourable survival outcome., (© 2019 BJS Society Ltd Published by John Wiley & Sons Ltd.)
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- 2020
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41. BRAF mutation is not associated with an increased risk of recurrence in patients undergoing resection of colorectal liver metastases.
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Bachet JB, Moreno-Lopez N, Vigano L, Marchese U, Gelli M, Raoux L, Truant S, Laurent C, Herrero A, Le Roy B, Deguelte Lardiere S, Passot G, Hautefeuille V, De La Fouchardiere C, Artru P, Ameto T, Mabrut JY, Schwarz L, Rousseau B, Lepère C, Coriat R, Brouquet A, Sa Cunha A, and Benoist S
- Subjects
- Aged, Case-Control Studies, Colorectal Neoplasms mortality, Colorectal Neoplasms pathology, Colorectal Neoplasms surgery, Disease-Free Survival, Female, Hepatectomy, Humans, Liver Neoplasms genetics, Liver Neoplasms mortality, Liver Neoplasms surgery, Male, Middle Aged, Mutation genetics, Survival Analysis, Colorectal Neoplasms genetics, Liver Neoplasms secondary, Neoplasm Recurrence, Local genetics, Proto-Oncogene Proteins B-raf genetics
- Abstract
Background: BRAF mutation is associated with a poor prognosis in patients with metastatic colorectal cancer. For patients with resectable colorectal liver metastases (CRLMs), the prognostic impact of BRAF mutation is unknown and the benefit of surgery debated. This nationwide intergroup (ACHBT, FRENCH, AGEO) study aimed to evaluate the oncological outcome of patients undergoing liver resection for BRAF-mutated CRLMs., Methods: The study included patients who underwent resection for BRAF-mutated CRLMs in 24 centres between 2012 and 2016. A case-matched comparison was made with 183 patients who underwent resection of CRLMs with wild-type BRAF during the same interval., Results: Sixty-six patients who underwent resection for BRAF-mutated CRLMs in 24 centres were compared with 183 patients with wild-type BRAF. The 1- and 3-year disease-free survival (DFS) rates were 46 and 19 per cent for the BRAF-mutated group, and 55·4 and 27·8 per cent for the group with wild-type BRAF (P = 0·430). In multivariable analysis, BRAF mutation was not associated with worse DFS (hazard ratio 1·16, 95 per cent c.i. 0·72 to 1·85; P = 0·547). The 1- and 3-year overall survival rates after surgery were 94 and 54 per cent respectively among patients with BRAF mutation, and 95·8 and 82·9 per cent in those with wild-type BRAF (P = 0·004). Median survival after disease progression was 23·0 (95 per cent c.i. 11·0 to 35·0) months among patients with mutated BRAF and 44·3 (35·9 to 52·6) months in those with wild-type BRAF (P = 0·050). Multisite disease progression was more common in the BRAF-mutated group (48 versus 29·8 per cent; P = 0·034)., Conclusion: These results support surgical treatment for resectable BRAF-mutated CRLM, as BRAF mutation by itself does not increase the risk of relapse after resection. BRAF mutation is associated with worse survival in patients whose disease relapses after resection of CRLM, as for non-metastatic colorectal cancer., (© 2019 BJS Society Ltd. Published by John Wiley & Sons Ltd.)
- Published
- 2019
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42. Development and validation of a staging system for gastric adenocarcinoma after neoadjuvant chemotherapy and gastrectomy with D2 lymphadenectomy.
- Author
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Lin JX, Yoon C, Desiderio J, Yi BC, Li P, Zheng CH, Parisi A, Huang CM, Strong VE, and Yoon SS
- Subjects
- Adenocarcinoma diagnosis, Adenocarcinoma mortality, Adenocarcinoma therapy, Antineoplastic Agents administration & dosage, Combined Modality Therapy, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Reproducibility of Results, Stomach Neoplasms diagnosis, Stomach Neoplasms mortality, Stomach Neoplasms therapy, Survival Analysis, Adenocarcinoma pathology, Antineoplastic Agents therapeutic use, Gastrectomy methods, Lymph Node Excision methods, Neoadjuvant Therapy, Neoplasm Staging methods, Stomach Neoplasms pathology
- Abstract
Background: Neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy is commonly used for patients with locally advanced gastric adenocarcinoma. The eighth AJCC ypTNM staging system was validated based on patients undergoing more limited lymphadenectomy (less than D2). The aim of this study was to develop a system for accurate staging of patients with locally advanced gastric adenocarcinoma who receive neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy., Methods: A modified system of ypTNM was developed, based on overall survival (OS) of patients receiving neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy at Memorial Sloan Kettering Cancer Center, and validated using data from an international cohort of patients who had similar treatment., Results: Of 325 patients in the derivation cohort, 33 (10·2 per cent) had ypT0 N0/+ tumours, which are not classifiable under the AJCC system. The 5-year OS rate for modified ypTNM stages I, II, IIIA and IIIB was 89, 71, 42·3 and 10 per cent respectively, compared with 82, 65·2 and 24·1 for AJCC stages I, II and III respectively. The concordance index (0·730 versus 0·709), estimated area under the curve (0·765 versus 0·740) and time-dependent receiver operating characteristic (ROC) curve throughout the observation period were all superior for modified ypTNM staging. For the validation cohort of 186 patients, the modified system was again better at separating patients into prognostic groups for OS., Conclusion: The modified ypTNM staging system improves the accuracy of OS prediction for patients treated with neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy., (© 2019 BJS Society Ltd. Published by John Wiley & Sons Ltd.)
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- 2019
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43. Morbidity and oncological outcomes of rectal cancer impaired by previous prostate malignancy.
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Lakkis Z, Vernerey D, Mege D, Faucheron JL, Panis Y, Tuech JJ, Lefevre JH, Brouquet A, Dumont F, Borg C, Woronoff AS, Meurisse A, Heyd B, and Rullier E
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma surgery, Aged, Humans, Male, Middle Aged, Neoplasm Recurrence, Local epidemiology, Neoplasms, Second Primary mortality, Neoplasms, Second Primary surgery, Proportional Hazards Models, Prostatectomy, Prostatic Neoplasms mortality, Prostatic Neoplasms radiotherapy, Prostatic Neoplasms surgery, Rectal Neoplasms mortality, Rectal Neoplasms surgery, Retrospective Studies, Survival Analysis, Treatment Outcome, Adenocarcinoma epidemiology, Neoplasms, Second Primary epidemiology, Prostatic Neoplasms epidemiology, Rectal Neoplasms epidemiology
- Abstract
Background: Specific surgical and oncological outcomes in patients with rectal cancer surgery after a previous diagnosis of prostate cancer have not been well described. The aim of this study was to compare surgical outcomes in patients with rectal cancer with or without a history of prostate cancer., Methods: Patients who had surgery for rectal cancer with (PC group) or without (no-PC group) previous curative treatment for prostate cancer were enrolled between January 2001 and December 2015. Comparisons between the two groups were performed by multivariable Cox analysis, and after propensity score matching in a 3 : 1 ratio for demographic and tumour characteristics, and surgical and oncological outcomes., Results: A total of 944 patients with rectal cancer were enrolled, of whom 10·8 per cent had a history of prostate cancer. After matching, 83 patients who had received treatment for prostate cancer were compared with 249 who had not. The PC and no-PC groups were similar regarding patient characteristics. Extended total mesorectal excision, conversion to open surgery, transfusion and tumour perforation were more frequent in the PC group than in the no-PC group. Major surgical morbidity (28 versus 17·2 per cent; P = 0·036), anastomotic leakage (25 versus 13·7 per cent; P = 0·019) and permanent stoma (41 versus 12·4 per cent; P < 0·001) occurred more frequently in the PC group. Local recurrence was increased significantly in the PC group (17 versus 8·0 per cent; P = 0·019), and resulted in a significant decrease in disease-free and overall survival., Conclusion: Prostate cancer treatment increases short- and long-term surgical morbidity in patients with rectal cancer, and impairs oncological outcomes., (© 2019 BJS Society Ltd Published by John Wiley & Sons Ltd.)
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- 2019
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44. Multicentre study of laparoscopic or open assessment of the peritoneal cancer index (BIG-RENAPE).
- Author
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Passot G, Dumont F, Goéré D, Arvieux C, Rousset P, Regimbeau JM, Elias D, Villeneuve L, and Glehen O
- Subjects
- Adult, Aged, Colorectal Neoplasms surgery, Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local diagnosis, Neoplasm Recurrence, Local surgery, Peritoneal Neoplasms diagnosis, Peritoneal Neoplasms surgery, Prognosis, Prospective Studies, Colorectal Neoplasms pathology, Laparoscopy methods, Laparotomy methods, Neoplasm Recurrence, Local secondary, Peritoneal Neoplasms secondary
- Abstract
Background: The peritoneal cancer index (PCI) is a comparative prognostic factor for colorectal peritoneal metastasis (CRPM). The ability of laparoscopy to determine the PCI in consideration of cytoreductive surgery remains undetermined, and this study was designed to compare it with laparotomy., Methods: A prospective multicentre study was conducted for patients with no known CRPM, but at risk of peritoneal disease. Surgery began with laparoscopic exploration followed by open exploration to determine the PCI. Concordance between laparoscopic and open assessment was evaluated for the diagnosis of CRPM and for the PCI., Results: Among 50 patients evaluated, CRPM recurrence was found in 29 (58 per cent) and 34 (68 per cent) at laparoscopic and open surgery respectively. Laparoscopy was feasible in 88 per cent (44 of 50) and deemed satisfactory by the surgeon in 52 per cent (26 of 50). Among the 25 evaluable patients with satisfactory laparoscopy, there was concordance of 96 per cent (24 of 25 patients) and 38 per cent (10 of 25) for laparoscopic and open assessment of CRPM and the PCI respectively. Where there were discrepancies, it was laparoscopy that underestimated the PCI., Conclusion: Laparoscopy may underestimate the extent of CRPM., (© 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.)
- Published
- 2018
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45. Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy.
- Author
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Cosse C, Rebibo L, Brazier F, Hakim S, Delcenserie R, and Regimbeau JM
- Subjects
- Adult, Anastomotic Leak economics, Cost-Benefit Analysis, Female, France, Gastrectomy economics, Gastroscopy methods, Humans, Laparoscopy economics, Length of Stay trends, Male, Obesity, Morbid economics, Prosthesis Implantation methods, Reoperation economics, Retrospective Studies, Anastomotic Leak surgery, Gastrectomy methods, Gastroscopy economics, Laparoscopy methods, Obesity, Morbid surgery, Prosthesis Implantation economics, Stents
- Abstract
Background: Gastric leak is the most feared surgical postoperative complication after sleeve gastrectomy. An endoscopic procedure is usually required to treat the leak. No data are available on the cost-effectiveness of different stent types in this procedure., Methods: Between April 2005 and July 2016, patients with a confirmed gastric leak undergoing endoscopic treatment using a covered stent (CS) or double-pigtail stent (DPS) were included. The primary objective of the study was to assess overall costs of the stent types after primary sleeve gastrectomy. Secondary objectives were the cost-effectiveness of each stent type expressed as an incremental cost-effectiveness ratio (ICER); the incremental net benefit; the probability of efficiency, defined as the probability of being cost-effective at a threshold of €30 000, and identification of the key drivers of ICER derived from a multivariable analysis., Results: One hundred and twelve patients were enrolled. The overall mean costs of gastric leak were €22 470; the mean(s.d.) cost was €24 916(12 212) in the CS arm and €20 024(3352) in the DPS arm (P = 0·018). DPS was more cost-effective than CS (ICER €4743 per endoscopic procedure avoided), with an incremental net benefit of €25 257 and a 27 per cent probability of efficiency. Key drivers of the ICER were the inpatient ward after diagnosis of gastric leak (surgery versus internal medicine), type of institution (private versus public) and duration of hospital stay per endoscopic procedure., Conclusion: DPS for the treatment of gastric leak is more cost-effective than CS and should be proposed as the standard regimen whenever possible., (© 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.)
- Published
- 2018
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46. Preoperative imaging and prediction of oesophageal conduit necrosis after oesophagectomy for cancer.
- Author
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Lainas P, Fuks D, Gaujoux S, Machroub Z, Fregeville A, Perniceni T, Mal F, Dousset B, and Gayet B
- Subjects
- Aged, Constriction, Pathologic diagnostic imaging, Esophagectomy methods, Female, Humans, Male, Middle Aged, Multidetector Computed Tomography, Necrosis diagnostic imaging, Retrospective Studies, Celiac Artery diagnostic imaging, Celiac Artery pathology, Esophageal Neoplasms surgery, Esophagectomy adverse effects, Postoperative Complications pathology, Preoperative Care
- Abstract
Background: Oesophageal conduit necrosis following oesophagectomy is a rare but life-threatening complication. The present study aimed to assess the impact of coeliac axis stenosis on outcomes after oesophagectomy for cancer., Methods: The study included consecutive patients who had an Ivor Lewis procedure with curative intent for middle- and lower-third oesophageal cancer at two tertiary referral centres. All patients underwent preoperative multidetector CT with arterial phase to detect coeliac axis stenosis. The coeliac artery was classified as normal, with extrinsic stenosis due to a median arcuate ligament or with intrinsic stenosis caused by atherosclerosis., Results: Some 481 patients underwent an Ivor Lewis procedure. Of these, ten (2·1 per cent) developed oesophageal conduit necrosis after surgery. Coeliac artery evaluation revealed a completely normal artery in 431 patients (91·5 per cent) in the group without conduit necrosis and in one (10 per cent) with necrosis (P < 0·001). Extrinsic stenosis of the coeliac artery due to a median arcuate ligament was found in two patients (0·4 per cent) without conduit necrosis and five (50 per cent) with necrosis (P < 0·001). Intrinsic stenosis of the coeliac artery was found in 11 (2·3 per cent) and eight (80 per cent) patients respectively (P < 0·001). Eight patients without (1·7 per cent) and five (50 per cent) with conduit necrosis had a single and thin left gastric artery (P < 0·001)., Conclusion: This study suggests that oesophageal conduit necrosis after oesophagectomy for cancer may be due to pre-existing coeliac axis stenosis., (© 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.)
- Published
- 2017
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47. Randomized clinical trial comparing two vessel-sealing devices with crush clamping during liver transection.
- Author
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Ichida A, Hasegawa K, Takayama T, Kudo H, Sakamoto Y, Yamazaki S, Midorikawa Y, Higaki T, Matsuyama Y, and Kokudo N
- Subjects
- Adult, Aged, Aged, 80 and over, Blood Loss, Surgical prevention & control, Constriction, Female, Hemostasis, Surgical methods, Hepatectomy methods, Humans, Male, Middle Aged, Surgical Instruments, Treatment Outcome, Hemostasis, Surgical instrumentation, Hepatectomy instrumentation, Liver Neoplasms surgery
- Abstract
Background: Previous RCTs have failed to demonstrate the usefulness of combining energy devices with the conventional clamp crushing method to reduce blood loss during liver transection. Here, the combination of an ultrasonically activated device (UAD) and a bipolar vessel-sealing device (BVSD) with crush clamping was investigated., Methods: Patients scheduled to undergo hepatectomy at the University of Tokyo Hospital or Nihon University Itabashi Hospital were eligible for this parallel-group, single-blinded randomized study. Patients were assigned to a control group (no energy device used), an UAD group or a BVSD group. The primary endpoint was the volume of blood loss during liver transection. Outcomes of the control group and the combined energy device groups (UAD plus BVSD) were first compared. Pairwise comparisons among the three groups were made for outcomes for which the combined energy device group was superior to the control group., Results: A total of 380 patients were enrolled between July 2012 and May 2014; 116 patients in the control group, 122 in the UAD group and 123 in the BVSD group were included in the final analysis. Median blood loss during liver transection was lower in the combined energy device group (245 patients) than in the control group (116 patients): median 190 (range 0-3575) versus 230 (range 3-1570) ml (P = 0·048). Pairwise comparison revealed that blood loss was lower in the BVSD group than in the control group (P = 0·043)., Conclusion: The use of energy devices combined with crush clamping reduced blood loss during liver transection. Registration number: C000008372 (www.umin.ac.jp/ctr/index.htm)., (© 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.)
- Published
- 2016
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48. Multicentre study of neoadjuvant chemotherapy for stage I and II oesophageal cancer.
- Author
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Bekkar S, Gronnier C, Renaud F, Duhamel A, Pasquer A, Théreaux J, Gagnière J, Meunier B, Collet D, and Mariette C
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Adenocarcinoma therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell therapy, Case-Control Studies, Chemotherapy, Adjuvant, Disease-Free Survival, Esophageal Neoplasms pathology, Europe epidemiology, Female, Hospital Mortality, Humans, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Esophageal Neoplasms mortality, Esophageal Neoplasms therapy, Neoadjuvant Therapy
- Abstract
Background: The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease., Methods: Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics., Results: Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017)., Conclusion: NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity., (© 2016 BJS Society Ltd Published by John Wiley & Sons Ltd.)
- Published
- 2016
- Full Text
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49. Long-term outcomes of sacral nerve stimulation for faecal incontinence (Br J Surg 2015; 102: 407-415).
- Author
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Norderval S
- Subjects
- Female, Humans, Male, Electric Stimulation Therapy methods, Fecal Incontinence therapy, Lumbosacral Plexus
- Published
- 2015
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50. Distal pancreatectomy for pancreatic carcinoma in the era of multimodal treatment.
- Author
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Paye F, Micelli Lupinacci R, Bachellier P, Boher JM, and Delpero JR
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Adult, Aged, Aged, 80 and over, Chemoradiotherapy, Adjuvant, Combined Modality Therapy methods, Female, France epidemiology, Humans, Male, Middle Aged, Pancreatic Fistula etiology, Pancreatic Fistula mortality, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology, Postoperative Complications etiology, Postoperative Complications mortality, Risk Factors, Survival Analysis, Treatment Outcome, Young Adult, Adenocarcinoma therapy, Pancreatectomy methods, Pancreatic Neoplasms therapy
- Abstract
Background: Recent publications have suggested improvements in the outcome of distal pancreatectomy (DP) for cancer, but the series were small and heterogeneous. The aim of the present study was to assess perioperative and long-term outcomes of DP for pancreatic adenocarcinoma in the era of multimodal treatment in a major European country., Methods: This was a nationwide study of all patients undergoing DP for pancreatic adenocarcinoma between 2004 and 2009 in 28 centres in France. Postoperative and long-term outcomes were assessed retrospectively and outcome predictors were explored by multivariable analysis., Results: A total of 278 patients were enrolled. Multivisceral resections were performed in 58 patients (20·9 per cent), venous resections in 33 (11·9 per cent) and arterial resections in 11 (4·0 per cent). Neoadjuvant chemoradiotherapy was used in 20 patients. Postoperative complications occurred in 96 patients (34·5 per cent) and pancreatic fistulas developed in 76 (27·3 per cent). The postoperative 90-day mortality rate was 5·0 per cent. In univariable analysis, multivisceral resection was the only factor associated with postoperative morbidity (P = 0·048). Age 65 years or less, body mass index of at least 30 kg/m(2) and absence of preoperative chemoradiotherapy were associated with an increased risk of pancreatic fistula in multivariable analysis. Overall survival rates at 3 and 5 years were 44·9 and 29·5 per cent respectively. In multivariable analysis, only the presence of lymph node metastases was associated with poorer overall survival., Conclusion: Postoperative morbidity and mortality associated with pancreatic fistula remain considerable after DP, but both short- and long-term survival have improved markedly., (© 2014 BJS Society Ltd. Published by John Wiley & Sons, Ltd.)
- Published
- 2015
- Full Text
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