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Background Disease of the pilonidal sinus is a common condition that affects mainly young adults. Options for management include excision of the sinus tracts, leaving the wound open to heal by secondary intention. The aim of this study was to compare wound healing with dialkylcarbamoyl chloride (DACC)‐coated dressings versus alginate dressings. Methods This multicentre trial randomized consecutive patients undergoing surgery for pilonidal disease to postoperative wound care with either DACC‐coated or alginate dressings. The primary outcome was the proportion of wounds healed after 75 days. Secondary outcomes were the local status of wounds during the healing process, the quality assessment of the dressings by the patient, and the time needed to return to usual activities. Results A total of 246 patients were included: 120 in the DACC‐coated group and 126 in the alginate group. In per‐protocol analysis, there were significantly more patients with completely healed wounds after 75 days in the DACC group than in the alginate group: 78 of 103 (75·7 per cent) versus 58 of 97 (60 per cent) respectively (odds ratio 2·55, 95 per cent c.i. 1·12 to 5·92; P = 0·023). During follow‐up, wounds with alginate dressings had more fibrin than those with DACC‐coated dressings, but the difference was not significant (P = 0·079). There was no difference between the two arms in patients' assessment of the dressings. Conclusion The number of wounds completely healed at 75 days was significantly higher for DACC‐coated compared with alginate dressings. However, the preplanned, clinically significant improvement in healing of 20 per cent was not reached. Registration number: NCT02011802 ( https://clinicaltrials.gov/)., This multicentre RCT compared the efficacy of dialkylcarbamoyl chloride (DACC)‐coated dressings with alginate dressings for wound healing after pilonidal sinus excision. In per‐protocol analysis, significantly more patients had completely healed wounds at 75 days in the DACC group than in the alginate group: 78 of 103 (75·7 per cent) versus 58 of 97 (60 per cent) respectively (odds ratio 2·55, 95 per cent c.i. 1·12 to 5·92; P = 0·023). No clinically important difference

International audience; Gastric adenocarcinoma (GA) is the 5th most common cancer in the world; in France, however, its incidence has been steadily decreasing. Twenty-five experts brought together under the aegis of the French Association of Surgery collaborated in the drafting of a series of recommendations for surgical management of GA. As concerns preoperative evaluation and work-up, echo-endoscopy aimed at clarifying lymph node status should be performed in all candidates for surgical resection and exploratory laparoscopy in cases of GA cT3/T4 and/or N+ for peritoneal carcinomatosis. On the other hand, PET-scan should not be performed systematically, but only when the other modalities for diagnosis prove insufficient. Laparotomy remains the route of choice to achieve total or partial gastrectomy with D2 lymph node lymphadenectomy for advanced lesions (> T2N0). To limit the risk of dumping syndrome and esophageal reflux and as a way of reestablishing continuity, construction of a jejunal pouch on Roux-en-Y following total gastrectomy is recommended. In cases of peritoneal carcinosis in GA with a low peritoneal cancer index (PCI) (

BackgroundThe prognostic value of the primary neoplasm responsible for pseudomyxoma peritonei (PMP) remains poorly studied. The aim of this study was to determine the prognosis for patients with extra-appendicular PMP (EA-PMP) treated optimally with complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).MethodsAll patients treated for PMP with CCRS and HIPEC between 1994 and 2016 were selected retrospectively from a French multicentre database. Patients with EA-PMP had pathologically confirmed non-neoplastic appendices and were matched in a 1 : 4 ratio with patients treated for appendicular PMP (A-PMP), based on a propensity score.ResultsSome 726 patients were identified, of which 61 (EA-PMP group) were matched with 244 patients (A-PMP group). The origins of primary tumours in the EA-PMP group included the ovary (45 patients), colon (4), urachus (4), small bowel (1), pancreas (1) and unknown (6). The median peritoneal carcinomatosis index was comparable in EA-PMP and A-PMP groups (15·5 versus 18 respectively; P = 0·315). In-hospital mortality (3 versus 2·9 per cent; P = 1·000) and major morbidity 26 versus 25·0 per cent; P = 0·869) were also similar between the two groups. Median follow-up was 66·9 months. The 5-year overall survival rate was 87·8 (95 per cent c.i. 83·2 to 92·5) per cent in the A-PMP group and 87 (77 to 96) per cent in the EA-PMP group. The 5-year disease-free survival rate was 66·0 (58·7 to 73·4) per cent and 70 (53 to 83) per cent respectively.ConclusionOverall and disease-free survival following treatment with CCRS and HIPEC is similar in patients with pseudomyxoma peritonei of appendicular or extra-appendicular origin.

Purpose: Diffuse malignant peritoneal mesothelioma (DMPM) is a severe disease with mainly locoregional evolution. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the reported treatment with the longest survival. The aim of this study was to evaluate the impact of perioperative systemic chemotherapy strategies on survival and postoperative outcomes in patients with DMPM treated with curative intent with CRS-HIPEC, using a multi-institutional database: the French RENAPE network. Patients and methods: From 1991 to 2014, 126 DMPM patients underwent CRS-HIPEC at 20 tertiary centres. The population was divided into four groups according to perioperative treatment: only neoadjuvant chemotherapy (NA), only adjuvant chemotherapy (ADJ), perioperative chemotherapy (PO) and no chemotherapy before or after CRS-HIPEC (NoC). Results: All groups (NA: n Z 42; ADJ: n Z 16; PO: n Z 16; NoC: n Z 48) were comparable regarding clinicopathological data and main DMPM prognostic factors. After a median follow-up of 61 months, the 5-year overall survival (OS) was 40%, 67%, 62% and 56% in NA, ADJ, PO and NoC groups, respectively (P Z 0.049). Major complications occurred for 41%, 45%, 35% and 41% of patients from NA, ADJ, PO and NoC groups, respectively (P Z 0.299). In multivariate analysis, NA was independently associated with worse OS (hazard ratio, 2.30; 95% confidence interval, 1.07e4.94; P Z 0.033). Conclusion: This retrospective study suggests that adjuvant chemotherapy may delay recurrence and improve survival and that NA may impact negatively the survival for patients with DMPM who underwent CRS-HIPEC with curative intent. Upfront CRS and HIPEC should be considered when achievable, waiting for stronger level of scientific evidence.

Background Peritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy. Objective To evaluate the impact on survival of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC. Material and methods A prospective multicenter international database was retrospectively searched to identify all patients with PMC treated with a potentially curative CRS/HIPEC (CRS/HIPEC group). The overall survival (OS) was compared to patients with PMC treated with palliative chemotherapy (systemic chemotherapy group). Survival was analyzed using Kaplan-Meier method and compared with Log-Rank test. Results Between 1995 and 2015, 34 patients were included in the surgical group, and compared to 21 in the systemic chemotherapy group. In the surgical group, median peritoneal cancer index was 9 (range 3–26), macroscopically complete resection was obtained for 25 patients (73%). There was more gallbladder localization in the surgical group compared to the chemotherapy group (35% vs. 18%, p = 0.001). Median OS was 21.4 and 9.3 months for surgical and chemotherapy group, respectively (p=0.007). Three-year overall survival was 30% and 10% for surgical and chemotherapy group, respectively. Conclusion Treatment with CRS and HIPEC for biliary carcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy.

International audience; ObjectiveAbdominal tuberculosis is a rare disease. The clinical and radiological manifestations are non-specific and the diagnosis is difficult. Our objective was to describe the characteristics and treatment of patients presenting with abdominal tuberculosis in a low-incidence country.Patients and methodsWe reviewed the clinical, diagnostic, treatment, and outcome features of patients presenting with abdominal tuberculosis diagnosed by bacteriological and/or histological results and managed in five French university hospitals from January 2000 to December 2009.ResultsWe included 21 patients. The mean diagnostic delay was 13 months. Twelve patients (57%) came from a low-incidence area and only two had a known immunosuppressed condition. Eighteen patients (86%) presented with abdominal symptoms. The main organs involved were the peritoneum (n = 14, 66%), the mesenteric lymph nodes (n = 13, 62%), and the bowel (n = 7, 33%). Sixteen patients (76%) underwent surgery, including two in an emergency setting. Seventeen patients (81%) received six months or more of anti-tuberculosis treatment. Finally, 16 patients (76%) had a positive outcome.ConclusionNew diagnostic procedures, and especially molecular biology, may help diagnose unusual clinical presentations of tuberculosis. Invasive procedures are frequently necessary to obtain samples but also for the treatment of digestive involvement.; ObjectifsLa tuberculose abdominale est rare, le tableau clinico-radiologique aspécifique et le diagnostic difficile. Notre objectif était de décrire les caractéristiques et la prise en charge thérapeutique de patients présentant une tuberculose abdominale dans un pays où la prévalence de cette infection est faible.Patients et méthodesNous avons recueilli les données cliniques, diagnostiques, thérapeutiques et le suivi des patients atteints de tuberculose abdominale, diagnostiquée sur des arguments bactériologiques et/ou anatomopathologiques, et pris en charge dans cinq hôpitaux universitaires français de janvier 2000 à décembre 2009.RésultatsVingt et un patients ont été inclus. Le délai diagnostique moyen était de 13 mois. Douze patients (57 %) étaient originaires d’une zone de faible prévalence de la tuberculose et seulement deux patients étaient immunodéprimés. Dix-huit patients (86 %) présentaient des symptômes abdominaux. Les principaux organes atteints étaient le péritoine (n = 14, 66 %), les ganglions mésentériques (n = 13, 62 %) et le tube digestif (n = 7, 33 %). Une intervention chirurgicale a été nécessaire chez 16 patients (76 %), en urgence pour deux d’entre eux. Dix-sept patients (81 %) ont reçu au moins six mois de quadri-thérapie antituberculeuse. Au final, 16 patients (76 %) présentaient une évolution favorable.ConclusionLes nouvelles techniques diagnostiques, notamment la biologie moléculaire, peuvent être utiles pour le diagnostic des formes cliniques inhabituelles de tuberculose. Des explorations invasives sont souvent nécessaires pour obtenir des prélèvements, mais aussi pour la prise en charge thérapeutique de l’atteinte digestive.

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.

Colorectal cancer is one of the most frequent and most lethal forms of cancer in the western world. The aim of this study is to characterize by 1H high resolution magic angle spinning NMR spectroscopy (HRMAS) the metabolic fingerprint of both tumoral and healthy tissue samples obtained from a cohort of patients affected by primary colorectal adenocarcinoma. By analyzing HRMAS data using multivariate statistical analysis (PLS-DA), the two types of tissues could be discriminated with a high level of confidence. The identification of the metabolites at the origin of this discrimination revealed that adenocarcinomas are richer in taurine, glutamate, aspartate, and lactate whereas healthy tissues contain a higher amount of myo-inositol and β-glucose. The statistical model resulting from the PLS-DA analysis was subsequently used to perform a blind test on tumoral and healthy colon biopsies. The results of the classification showed that the HRMAS analysis has very high sensitivity and specificity.

Background Cricopharyngeal myotomy for oropharyngeal dysphagia is designed to improve symptoms, but the operation can result in significant morbidity and even death. Methods A retrospective analysis was carried out of all complications and deaths among 253 patients who had cricopharyngeal myotomy performed by a single surgeon. Results A single wound infection developed among 15 patients with neurological dysphagia. The same patient subsequently required laryngeal exclusion and tracheostomy. Of 139 patients treated for dysphagia secondary to muscular dystrophy, haematoma formation or infection occurred in four, and eight patients developed postoperative pulmonary complications, four of whom died from respiratory distress syndrome. Two patients with myogenic dysphagia required laryngeal exclusion with a permanent tracheostomy. Infection of the wound or retropharyngeal space was the main problem in 90 patients with a pharyngo-oesophageal diverticulum, affecting 9 per cent of the patients. Fistula was documented in three patients overall (1·2 per cent). Systemic morbidity unrelated to the technique occurred in 26 patients (10·3 per cent). Conclusion Pulmonary aspiration and lethal respiratory distress occurred only in patients with myogenic dysphagia. Local infection was the main complication in those with pharyngo-oesophageal diverticulum. Persistent aspiration can lead to laryngeal exclusion or resection with permanent tracheostomy.

SUMMARY. This report describes the clinical course of a patient with complications of esophageal intramural pseudodiverticulosis. The condition led to fistulization and abscess formation in the mediastinum. The initial presentation was for the septic process and appropriate antibiotic therapy led to infection control while the abscess drained spontaneously back into the esophageal lumen. A long stricture affecting the distal half of the esophagus became evident after a few months and could not be managed by repeat dilatations. After appropriate preparation, subtotal esophagectomy was offered to the patient with an initial right thoracic approach followed by laparotomy and left cervical reconstruction. A total gastric tube was used for reconstruction and placed in a substernal position. An uneventful postoperative evolution led to normal swallowing comfort.

Resume Propos. – La carcinose peritoneale, en particulier d'origine digestive, a ete longtemps consideree comme une diffusion ineluctablement terminale chez les patients atteints de cancers abdominaux. Actualites et points forts. – Au cours de la derniere decennie, de nouveaux traitements locoregionaux associant chirurgie de cytoreduction, peritonectomies et chimiotherapie intraperitoneale perioperatoire (avec ou sans hyperthermie) ont ete developpes au sein d'equipes specialisees. Du fait d'une mortalite et d'une morbidite elevee mais acceptable, cette prise en charge therapeutique agressive necessite une stricte selection des patients au sein d'equipes multidisciplinaires specialisees. Elle permet d'envisager des survies prolongees ou des guerisons en cas de pseudomyxome peritoneal, de mesotheliome peritoneal et de carcinose d'origine colorectale ou gastrique. La selection des indications necessite l'utilisation de facteurs pronostiques qualitatifs et quantitatifs comme l'histopathologie tumorale, l'evaluation de l'etendue de la carcinose ou de la radicalite de la cytoreduction qui apparait etre le facteur pronostique le plus important. Perspectives et projets. – L'association d'une chirurgie de cytoreduction et d'une chimiotherapie intraperitoneale perioperatoire apparait etre une approche therapeutique adaptee chez des patients soigneusement selectionnes, presentant une carcinose peritoneale. Des etudes de phase III sont necessaires a present pour la validation et l'evaluation du type de chimiotherapie intraperitoneale.

Resume But de l'etude. – Etudier l'efficacite a long terme du traitement laparoscopique du reflux gastro-œsophagien. Patients et methodes. – Entre le 1er janvier 1992 et le 31 decembre 1996, 161 patients etaient operes pour un reflux gastro-œsophagien (RGO) par une fundoplicature laparoscopique complete ou partielle ; les techniques utilisees etaient la fundoplicature complete de Nissen-Rossetti (123 cas) ou de Nissen (26 cas) et la fundoplicature partielle de type Toupet (12 cas) ; le recul minimal etait de cinq ans. Cent quarante et un patients ont ete suivis a trois mois, deux ans et cinq ans ; il y avait quatre deces de causes non reliees a la chirurgie et 16 perdus de vue (10 %). Une pHmetrie et une manometrie ont ete realisees en preoperatoire et a trois mois de distance. A deux ans et a cinq ans la reevaluation etait realisee par un questionnaire telephonique. Resultats. – La mortalite postoperatoire etait nulle, la morbidite de 1,2 % et le taux de conversion de 5 %. La dysphagie postoperatoire etait de 23,4 % a trois mois et de 12 % a cinq ans. Les recidives a cinq ans etaient de 12 %. Conclusion. – Le taux global de satisfaction subjective etait de 91,4 % a cinq ans. L'intervention de Nissen-Rossetti enregistre les meilleurs resultats a cinq ans, en terme de dysphagie postoperatoire et de recidive.

Pseudomyxoma peritonei is a rare disease, usually diagnosed after the discover of "jelly belly" by laparotomy. With the progress of immunohistochemistry, most authors now acknowledge the appendix to be the principal origin of this disease. Pseudomyxoma peritonei need to considered as border line malignant disease because of its inevitable persistence and progression without adapted therapeutic approach: cytoreductive surgery combined with perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy) into specialized centres. The principal prognostic factors are the prior surgical history, the completeness of cytoreduction and especially the histopathologic grade.

Resume Objectif. – L’anastomose transsuturaire facilite le retablissement de la continuite digestive au fond du pelvis, mais represente une anastomose a risque. Le but de l’etude etait l’evaluation de ce risque en termes de resultats immediats et de recidive tumorale dans le cadre du traitement des cancers du rectum. Patients et methode. – Les dossiers de 301 patients operes consecutivement selon cette technique entre 1980 et 2000 ont ete analyses retrospectivement afin d’analyser les indications operatoires, l’intervention et les complications peroperatoires, les complications postoperatoires immediates et le taux de recidive. Resultats. – Parmi les 301 patients (192 hommes et 109 femmes), d’un age median de 66 ans, seuls 19 (6,3 %) ont ete operes en urgence pour occlusion. Il s’agissait d’un adenocarcinome du rectum situe dans le haut rectum dans 132 cas (43,8 %), dans le moyen rectum dans 141 cas (46,8 %) et dans le bas rectum dans 19 cas (9,4 %). Une radiotherapie preoperatoire etait realisee dans 148 cas (49 %), avec une dose de 30 Grays (Gy) entre 1987 et 1996, de 39 Gy ensuite et de 45 Gy dans 12 cas. A partir de 1990, 113 patients ont eu une chimiotherapie adjuvante pour des tumeurs de stade III et IV et quelques cas particuliers de stade II. La resection laissait une marge de securite sous la tumeur de moins de 2 cm dans 59 cas (19,6 %) et l’anastomose siegeait a 5 cm et moins de la marge anale dans 178 cas (59 %). Une stomie de derivation etait associee dans 39 cas (13 %). Un defaut de l’anastomose etait note pendant l'intervention dans 18 cas (6 %) et 23 fistules sont survenues dans les suites operatoires (7,6 %), significativement associees au niveau de l’anastomose par rapport a la marge anale ( p = 0,0009). La mortalite hospitaliere etait de 8 cas (2,6 %). Les stenoses etaient rares : 11 cas (3,6 %), significativement associees a la realisation d’une radiotherapie preoperatoire ( p = 0,02). Le taux de recidive locale etait de 12 % (37 cas) dans un delai median de 16 mois, essentiellement lie au stade initial du cancer ( p = 0,004). Conclusion. – L’anastomose transsuturaire colorectale apres resection anterieure du rectum pour cancer est une technique sure avec un faible taux de complication et de recidive tumorale, le traitement chirurgical s’inscrivant dans le cadre d’une prise en charge multimodale du cancer.

Peritoneal carcinomatosis may occur after curative surgery of any gastrointestinal carcinoma, but it is however the most frequent form of evolution after curative resection of gastric carcinoma and is present at the time of surgery in many cases. This locoregional extension of cancer has a poor prognosis, with a great mortality and a poor quality of life. It is sometimes considered of such a poor prognosis that patients do not go through any resection or palliative procedure. Techniques of radiotherapy, chemotherapy and intraperitoneal chemotherapy have been used with moderate clinical efficacy. Since the 1990s, intraoperative hyperthermic peritoneal chemotherapy combined with comprehensive cytoreductive surgery has been proposed to improve prognosis of patients with peritoneal carcinomatosis from gastric origin as well as carcinomatosis from colorectal origin or pseudomyxoma peritonei.

Intraperitoneal chemohyperthermia (IPCH) with Cytoreductive surgery (CS) has been used in Centre Hospitalier et Universitaire Lyon Sud (CHLS) since 1989. Up to 2005, 420 patients were involved in different phase II studies for peritoneal carcinomatosis (PC) from colorectal, gastric or ovarian origin, as well as for pseudomyxoma peritonei and peritoneal mesothelioma. Encouraging results were achieved in case of optimal PC cytoreduction. The CHLS experience, as well as the Dutch randomized trial and the international registration, underline the advantage of such an aggressive combined therapy for selected patients in experienced multidisciplinary centers.

Materials/Methods: From 2000 to 2008, 185 patients older than 65 years with T3-4 M0 rectal cancer received either a preoperative radiotherapy with conventional (45 to 50.4 Gy in 1.8-2 Gy daily fractions) or an hypofractionated (39 Gy in 3 Gy daily fractions) protocol. Fifty-five patients received concomitant chemotherapy in the conventional group and none in the hypofractionated group. Both groups were equivalent in terms of characteristics. Median follow-up was 35,7 months.