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1. Comparison of a robotic surgery program for rectal cancer: short- and long-term results from a comparative, retrospective study between two laparoscopic and robotic reference centers.

Author

Rogier-Mouzelas, Fabien, Piquard, Arnaud, Karam, Elias, Dussart, David, Michot, Nicolas, Saint-Marc, Olivier, Thebault, Baudouin, Artus, Alice, Bucur, Petru, Pabst-Giger, Urs, Salame, Ephrem, and Ouaissi, Mehdi

Subjects
SURGICAL robots, CANCER treatment, T-test (Statistics), LAPAROSCOPIC surgery, QUESTIONNAIRES, FISHER exact test, FUNCTIONAL status, TREATMENT effectiveness, RETROSPECTIVE studies, DESCRIPTIVE statistics, MINIMALLY invasive procedures, HEALTH surveys, CHI-squared test, MANN Whitney U Test, RECTUM tumors, DISEASES, SURGICAL complications, QUALITY of life, DEFECATION disorders, ANALYSIS of variance, COMPARATIVE studies, TUMOR classification, LENGTH of stay in hospitals, PERIOPERATIVE care, SPECIALTY hospitals
Abstract

Background: It is assumed that robotic-assisted surgery (RAS) may facilitate complex pelvic dissection for rectal cancer compared to the laparoscopic-assisted resection (LAR). The aim of this study was to compare perioperative morbidity, short- and long-term oncologic, and functional outcomes between the RAS and LAR approaches. Methods: Between 2015 and 2021, all rectal cancers operated on by (LAR) or (RAS) were retrospectively reviewed in two colorectal surgery centers. Results: A total of 197 patients were included in the study, with 70% in the LAR group and 30% in the RAS group. The tumor location and stage were identical in both groups (not significant = NS). The overall postoperative mortality rate was not significantly different between the two groups. (0% LAR; 0.5% RAS; NS). The postoperative morbidity was similar between the two groups (60% LAR vs 57% RAS; NS). The number of early surgical re-interventions within the first 30 days was similar (10% for the LAR group and 3% for the RAS group; NS). The rate of complete TME was similar (88% for the LAR group and 94% for the RAS group; NS). However, the rate of circumferential R1 was significantly higher in the LAR group (13%) compared to the RAS group (2%) (p = 0.009). The 3-year recurrence rate did not differ between the two groups (77% for both groups; NS). After a mean follow-up of three years, the incidence of anterior resection syndrome was significantly lower in the LAR group compared to the RAS group (54 vs 76%; p = 0.030). Conclusions: The use of a RAS was found to be reliable for oncologic outcomes and morbidity. However, the expected benefits for functional outcomes were not observed. Therefore, the added value of RAS for rectal cancer needs to be reassessed in light of new laparoscopic technologies and patient management options. [ABSTRACT FROM AUTHOR]

Published
2024
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2. Surgical Management of Retrorectal Tumors: A French Multicentric Experience of 270 Consecutives Cases

Author

Aubert, Mathilde, Mege, Diane, Parc, Yann, Rullier, Eric, Cotte, Eddy, Meurette, Guillaume, Zerbib, Philippe, Trilling, Bertrand, Lelong, Bernard, Sabbagh, Charles, Lakkis, Zaher, Ouaissi, Mehdi, Lebreton, Gil, Rouanet, Philippe, Manceau, Gilles, Tuech, Jean-Jacques, Piessen, Guillaume, Bresler, Laurent, Beyer-Berjot, Laura, Denost, Quentin, Lefevre, Jeremie H., Panis, Yves, Gr, French Res Grp Rectal Canc Surg, Aix-Marseille Université - École de médecine (AMU SMPM MED), Aix-Marseille Université - Faculté des sciences médicales et paramédicales (AMU SMPM), Aix Marseille Université (AMU)-Aix Marseille Université (AMU), Hôpital de la Timone [CHU - APHM] (TIMONE), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, Service de Chirurgie Digestive, Centre hospitalier universitaire de Nantes (CHU Nantes), CHU Lille, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP ), Université Grenoble Alpes (UGA), Département de chirurgie digestive et de l'urgence, CHU Grenoble-Hôpital Michallon, CHU Pontchaillou [Rennes], CHU Amiens-Picardie, Simplification des soins chez les patients complexes - UR UPJV 7518 (SSPC), Université de Picardie Jules Verne (UPJV), Service de Chirurgie Digestive [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Institut du Cancer de Montpellier (ICM), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Service de chirurgie digestive [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital Nord [CHU - APHM], Sorbonne Université (SU), and Sorbonne Université - Faculté de Médecine (SU FM)

Subjects
Adult, Male, medicine.medical_specialty, Postoperative ileus, Adolescent, [SDV]Life Sciences [q-bio], Young Adult, medicine, Humans, Surgical treatment, Laparoscopy, Rectal fistula, Aged, Retrospective Studies, Mean diameter, Laparotomy, Surgical approach, medicine.diagnostic_test, business.industry, Rectal Neoplasms, Incidence, Significant difference, Robotics, Middle Aged, Combined approach, Surgery, Treatment Outcome, Female, France, business
Abstract

International audience; Objective: To report the largest multicentric experience on surgical management of retrorectal tumors (RRT). Background: Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT. Methods: Patients operated for RRT in 18 academic French centers were retrospectively included (2000-2019). Results: A total of 270 patients were included. Surgery was performed through abdominal (n = 72, 27%), bottom (n = 190, 70%), or combined approach (n = 8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, P = 0.02), larger [mean diameter = 60.5 +/- 24 (range, 13-107) vs 51 +/- 26 (20-105) mm, P = 0.02] and located above S3 vertebra (n = 3/42, 7% vs 0%, P = 0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n = 4/53, 7.5% vs 0%, P = 0.002) and rectal fistula (n = 3/53, 6% vs 0%, P=0.01) but less wound abscess (n = 1/53, 2% vs 24/169, 14%, P = 0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 +/- 39 (1-221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; P = 0.3). Conclusions: Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.

Published
2021

3. Are colorectal cancer patients at risk for COVID-19 infection during the postoperative period? The Covid-GRECCAR study

Author

Tuech, Jean-Jacques, Manceau, Gilles, Ouaissi, Mehdi, Denet, Christine, Chau, Amélie, Kartheuser, Alex, Desfourneaux, Véronique, Duchalais, Emilie, Bertrand, Martin, Badic, Bogdan, Alves, Arnaud, Ceribelli, Cecilia, Venara, Aurelien, Mege, Diane, Mauvais, François, Dumont, Fréderic, Mabrut, Jean-Yves, Lakkis, Zaher, Cotte, Eddy, Meillat, Helene, French Research Group of Rectal Cancer Surgery (GRECCAR), UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service de chirurgie et transplantation abdominale, Département de chirurgie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service de Chirurgie Digestive, Hépato-Bilio-pancréatique et Transplantation Hépatique [CHU Pitié-Salpétrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Institut Mutualiste de Montsouris (IMM), Université Catholique de Louvain = Catholic University of Louvain (UCL), CHU Pontchaillou [Rennes], Institut des Maladies de l'Appareil Digestif, Université de Nantes (UN), Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Universitaire Carémeau [Nîmes] (CHU Nîmes), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers (ANTICIPE), CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-UNICANCER, Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Hôpital de la Timone [CHU - APHM] (TIMONE), Institut de Cancérologie de l'Ouest [Angers/Nantes] (UNICANCER/ICO), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Gestionnaire, Hal Sorbonne Université, Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN)-Centre Régional de Lutte contre le Cancer François Baclesse [Caen] (UNICANCER/CRLC), Normandie Université (NU)-UNICANCER-Tumorothèque de Caen Basse-Normandie (TCBN)-UNICANCER-Institut National de la Santé et de la Recherche Médicale (INSERM), Chirurgie digestive [CHU Amiens], CHU Amiens-Picardie, Simplification des soins chez les patients complexes - UR UPJV 7518 (SSPC), and Université de Picardie Jules Verne (UPJV)

Subjects
Adult, Male, medicine.medical_specialty, COVID-19 outbreak, Colorectal cancer, Short Communication, [SDV]Life Sciences [q-bio], Population, Comorbidity, Risk Assessment, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Colorectal surgery, Internal medicine, Humans, Medicine, Anal cancer, Postoperative Period, Elective surgery, education, Aged, Retrospective Studies, Cancer, Aged, 80 and over, education.field_of_study, Pandemic, business.industry, Gastroenterology, COVID-19, Retrospective cohort study, Middle Aged, medicine.disease, 3. Good health, [SDV] Life Sciences [q-bio], Oncology, Elective Surgical Procedures, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, France, Colorectal Neoplasms, business, Cohort study
Abstract

International audience; Introduction: During the COVID-19 pandemic, cancer patients have been regarded as having a high risk of severe events if they are infected with SARS-CoV-2, particularly those under medical or surgical treatment. The aim of this study was to assess the posttreatment risk of infection by SARS-CoV-2 in a population of patients operated on for colorectal cancer 3 months before the COVID-19 outbreak and who after hospitalization returned to an environment where the virus was circulating.Materials and methods: This French, multicenter cohort study included consecutive patients undergoing elective surgery for colorectal cancer between January 1 and March 31, 2020, at 19 GRECCAR hospitals. The outcome was the rate of COVID-19 infection in this group of patients who were followed until June 15, 2020.Results: This study included 448 patients, 262 male (58.5%) and 186 female (41.5%), who underwent surgery for colon cancer (n = 290, 64.7%), rectal cancer (n = 155, 34.6%), or anal cancer (n = 3, 0.7%). The median age was 68 years (19-95). Comorbidities were present in nearly half of the patients, 52% were at least overweight, and the median BMI was 25 (12-42). At the end of the study, 448 were alive. Six patients (1.3%) developed COVID-19 infection; among them, 3 were hospitalized in the conventional ward, and none of them died.Conclusion: The results are reassuring, with only a 1.3% infection rate and no deaths related to COVID-19. We believe that we can operate on colorectal cancer patients without additional mortality from COVID-19, applying all measures aimed at reducing the risk of infection.

Published
2021

4. Available prediction scores of conversion for laparoscopic rectal cancer surgery seem to be unsuitable for nowadays rectal cancer management.

Author

Sekkat, Hamza, Souadka, Amine, Courtot, Lise, Rafik, Ali, Amrani, Laila, Benkabbou, Amine, Peyrafort, Pierre, Giger-Pabst, Urs, Karam, Elias, Mohsine, Raouf, Majbar, Anass M., and Ouaissi, Mehdi

Subjects
RECTAL surgery, RECTAL cancer, LAPAROSCOPIC surgery, ONCOLOGIC surgery, RECTUM tumors, GOODNESS-of-fit tests, OPERATIVE surgery, RETROSPECTIVE studies, TREATMENT effectiveness, LAPAROSCOPY, LOGISTIC regression analysis
Abstract

Introduction: This study aimed to externally evaluate the accuracy of four predictive scores for conversion to open surgery after rectal laparoscopic resection. None of the four scores achieved external validation previously.Methods: This was a retrospective analysis of two prospectively maintained databases from two academic centers in France and Morocco. All consecutive patients who underwent laparoscopic resection for rectal adenocarcinoma between 2005 and 2020 were included. Logistic regression was used to assess the association between the factors present in the four scores and conversion. The accuracy of each score was assessed using the area under the curve (AUC). Observed and predicted conversion rates were compared for each score using the Chi-square goodness-of-fit test.Results: Four hundred patients were included. There were 264 men (66%) with a mean age of 65.95 years (standard deviation 12.2). The median tumor height was 7 cm (quartiles 4-11) and 29% of patients had low rectal tumors. Conversion rate was 21.75%. The accuracy to predict conversion was low with an AUC lower than 0,62 for the four models. The observed conversion rates were significantly different from the predicted rates, except for one score.Conclusions: The four models had low accuracy in predicting the conversion to open surgery for laparoscopic rectal resection. There is a need for new well-designed studies, analyzing more specific variables, in a multicentric design to ensure generalizability of the results for daily surgical practice. [ABSTRACT FROM AUTHOR]

Published
2022
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5. Pancreatico-jejunostomy decreases post-operative pancreatic fistula incidence and severity after central pancreatectomy

Author

Borel, Frédéric, Ouaissi, Mehdi, Merdrignac, Aude, Venara, Aurélien, De Franco, Valéria, Sulpice, Laurent, Hamy, Antoine, Régenet, Nicolas, Clinique de Chirurgie Digestive et Endocrinienne [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Chirurgie Digestive et Générale, Hôpital de la Timone [CHU - APHM] (TIMONE), Service de Chirurgie Hépatobiliaire et Digestive [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de chirurgie viscérale, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Laboratoire de Physiologie et Génomique des Poissons (LPGP), Institut National de la Recherche Agronomique (INRA)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Centre de Recherches en Oncologie biologique et Oncopharmacologie (CRO2), Aix Marseille Université (AMU)- Hôpital de la Timone [CHU - APHM] (TIMONE)-Institut National de la Santé et de la Recherche Médicale (INSERM), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], and CHU Pontchaillou [Rennes]

Subjects
Gastrostomy, Male, Pancreatic Neoplasms, Pancreatic Fistula, Pancreatectomy, Pancreaticojejunostomy, Incidence, [SDV]Life Sciences [q-bio], Humans, Female, Length of Stay, Middle Aged, Retrospective Studies
Abstract

International audience; BACKGROUNDS: Central pancreatectomy (CP) is an alternative to pancreaticoduodenectomy and distal pancreatectomy in benign tumours of pancreatic isthmus management. It is known for a high post-operative pancreatic fistula (POPF) rate. The purpose of this study was to compare POPF incidence between pancreatico-jejunostomy (PJ) and pancreatico-gastrostomy (PG).METHODS: Fifty-eight patients (mean age 53.9 ± 1.9 years) who underwent a CP in four French University Hospitals from 1988 to 2011 were analysed. The distal pancreatic remnant was either anastomosed to the stomach (44.8%, n = 25) or to a Roux-en-Y jejunal loop (55.2%, n = 35) with routine external drainage allowing a systematic search for POPF. POPF severity was classified according to the International Study Group on Pancreatic Fistula (ISGPF) and Clavien-Dindo classifications.RESULTS: The groups were similar on sex ratio, mean age, ASA score, pancreas texture, operative time and operative blood loss. Mean follow-up was 36.2 ± 3.9 months. POPF were significantly more frequent after PG (76.9 versus 37.5%, P = 0.003). PG was associated with significantly higher grade of POPF both when graded with ISGPF classification (P = 0.012) and Clavien-Dindo classification (P = 0.044). There was no significant difference in post-operative bleeding (0.918) and delayed gastric emptying (0.877) between the two groups. Hospital length of stay was increased after PG (23.6 ± 3.5 days versus 16.5 ± 1.9 days, P = 0.071). There was no significant difference in incidence of long-term exocrine (3.8 versus 19.2%, P = 0.134) and endocrine (7.7 versus 9.4%, P = 0.575) pancreatic insufficiencies.CONCLUSION: PG was associated with a significantly higher POPF incidence and severity in CP. We recommend performing PJ especially in older patients to improve CP outcomes.

Published
2018

6. Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for the treatment of malignant mesothelioma.

Author

Giger-Pabst, Urs, Demtröder, Cédric, Falkenstein, Thomas A., Ouaissi, Mehdi, Götze, Thorsten O., Rezniczek, Günther A., and Tempfer, Clemens B.

Subjects
MESOTHELIOMA, CANCER chemotherapy, CISPLATIN, PEMETREXED, DOXORUBICIN, THERAPEUTICS, ANTINEOPLASTIC agents, COMPUTED tomography, LUNG tumors, MAGNETIC resonance imaging, PLEURA cancer, PLEURAL effusions, TREATMENT effectiveness, RETROSPECTIVE studies, PARENTERAL infusions, DIAGNOSIS
Abstract

Background: Patients with recurrent malignant epithelioid mesothelioma (MM) after surgery and standard chemotherapy with cisplatin and pemetrexed have limited treatment options.Methods: We performed a retrospective cohort study of patients with recurrent MM undergoing Pressurized IntraPeritoneal/Thoracal Aerosol Chemotherapy (PIPAC/PITAC) with doxorubicin 1.5 mg/m2 and cisplatin 7.5 mg/m2. Data were retrospectively collected in a prospective registry of patients undergoing PIPAC/PITAC. Study outcomes were microscopic tumor regression grade (TRG), survival and adverse events (v4.0 CTCAE).Results: A total of 29 patients (m/f = 17/12) with MM with a mean age of 62.4 (range: 42 to 84) years were analyzed. A total of 74 PIPAC and 5 PITAC procedures were performed. The mean number of PIPAC applications was 2.5 (range: 0 to 10) per patient. Twenty patients (69%) had > 2 PIPAC procedure and were eligible for TRG analysis. TRG 1 to 4 was observed in 75% (15/20) of patients. Major regression (TRG 3) or complete regression (TRG 4) was observed in 20% and 10%, respectively. PIPAC induced significant tumor regression in 51.7% (15/29) of patients with a cumulative effect after repetitive PIPACs (PIPAC #1 vs. PIPAC #2: p = 0.001; PIPAC #1 vs. PIPAC #3: p = 0.001; PIPAC #1 vs. PIPAC #4: p = 0.001). Postoperative CTCAE grade 4 complications were observed in two patients (6.9%) who had cytoreductive surgery (CC2) and intraoperative PIPAC. One patient (3.4%) died due to postoperative kidney insufficiency. After a follow up of 14.4 (95% CI: 8.1 to 20.7) months after the last PIPAC/PITAC application, median overall survival was 26.6 (95% CI: 9.5 to 43.7) months (from the first application).Conclusion: After prior abdominal surgery and systemic chemotherapy, repetitive PIPAC applications are feasible and safe for patients with end-stage MM. Furthermore, PIPAC induces significant histological regression of malignant mesothelioma in the majority of patients. PITAC is feasible, but its safety and efficacy to control malignant pleural effusion remain unclear. [ABSTRACT FROM AUTHOR]

Published
2018
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7. Long term outcome of anastomotic leakage in patients undergoing low anterior resection for rectal cancer.

Author

Artus, Alice, Tabchouri, Nicolas, Iskander, Othman, Michot, Nicolas, Muller, Olivier, Giger-Pabst, Urs, Bourlier, Pascal, Bourbao-Tournois, Céline, Kraemer-Bucur, Aurore, Lecomte, Thierry, Salamé, Ephrem, and Ouaissi, Mehdi

Subjects
RECTAL cancer, RECTAL surgery, ONCOLOGIC surgery, SURGICAL excision, LEAKAGE, PROGRESSION-free survival, SURGICAL anastomosis, RECTUM tumors, SURGICAL complications, CANCER relapse, PROGNOSIS, RETROSPECTIVE studies, OSTOMY, RECTUM, SYMPTOMS, COMBINED modality therapy, RADIOTHERAPY, LONGITUDINAL method
Abstract

Background: The influence of anastomotic leakage (AL) on local recurrence rates and survival in rectal cancer remains controversial. The aim of this study was to analyze the effect of asymptomatic anastomotic leakage (AAL) and symptomatic anastomotic leakage (SAL) on short- and long-term outcome after curative rectal cancer resection.Methods: All patients who underwent surgical resection of non-metastatic rectal cancer with curative intent from January 2005 to December 2017 were retrospectively analyzed. Short-term morbidity, long-term functional and oncological outcomes were compared between patients with SAL, AAL and without AL (WAL).Results: Overall, 200 patients were included and AL was observed in 39 (19.5%) patients (10 AAL and 29 SAL) with a median follow-up of 38.5 months. Rectal cancer location and preoperative neoadjuvant treatment was similar between the three groups. Postoperative 30-day mortality rate was nil. The permanent stoma rate was higher in patients with SAL or AAL compared to WAL patients (44.8 and 30% vs 9.3%, p < 0.001). The mean wexner continence grading scale was significantly different between AAL (11,4 ± 3,8), SAL (10,3 ± 0,6) and WAL (6,4 ± 4,7) groups (p = 0.049). The 3 and 5-year overall and disease-free survival rates were similar between the 3 groups (86.6% /84% vs 100%/100% vs 76%/70 and 82.9%/77% vs 100%/100% vs 94.7%/88.3% for patients with SAL, AAL, and WAL, p = 0.480 and p = 0.527).Conclusion: The permanent stoma rate was significant higher in patients with SAL or AAL compared to WAL patients. AL did not impair long-term oncological outcome. [ABSTRACT FROM AUTHOR]

Published
2020
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8. Todani Type II Congenital Bile Duct Cyst

Author

François Paye, François-René Pruvot, Ahmet Ayav, Emilia Ragot, Laurent Dugué, Nicolas Demartines, Mustapha Adham, Gilles Mentha, Jacques Belghiti, Jean Yves Mabrut, Mehdi Ouaissi, Jean-François Gigot, Gennaro Nuzzo, Massimo Falconi, Reza Kianmanesh, Roberto Troisi, Ouaissi, M., Kianmanesh, R., Belghiti, J., Ragot, E., Mentha, G., Adham, M., Troisi, Roberto., Pruvot, F. -R., Dugue, L., Paye, F., Ayav, A., Nuzzo, G., Falconi, M., Demartines, N., Mabrut, J. -Y., Gigot, J. -F., Ouaissi, Mehdi, Kianmanesh, Reza, Belghiti, Jacque, Ragot, Emilia, Mentha, Gille, Adham, Mustapha, Troisi Roberto, Ivan, Pruvot Francois, Rene, Dugue, Laurent, Paye, Francoi, Ayav, Ahmet, Nuzzo, Gennaro, Falconi, Massimo, Demartines, Nicola, Mabrut Jean, Yve, and Gigot Jean, Francois

Subjects
Adult, Male, medicine.medical_specialty, Treatment outcome, digestive system, medicine, Carcinoma, Humans, Cyst, Child, Aged, Retrospective Studies, ddc:617, Bile duct, business.industry, Retrospective cohort study, Congenital biliary disease, Middle Aged, medicine.disease, Surgery, Europe, Treatment Outcome, medicine.anatomical_structure, Multicenter study, Todani type II bile duct cyst, Child, Preschool, Choledochal Cyst, Managment, Female, Long term outcome, Presentation (obstetrics), business, Diverticulum
Abstract

Objective: The purpose of the study was to analyze clinical presentation, surgical management, and long-term outcome of patients suffering from biliary diverticulum, namely Todani type II congenital bile duct cyst (BDC). Background: The disease incidence ranges between 0.8% and 5% of all reported BDC cases with a lack of information about clinical presentation, management, and outcome. Methods: A multicenter European retrospective study was conducted by the French Surgical Association. The patients' medical records were included in a Web site database. Diagnostic imaging studies, operative and pathology reports underwent central revision. Results: Among 350 patients with congenital BDC, 19 type II were identified (5.4%), 17 in adults (89.5%) and 2 in children. The biliary diverticulum was located at the upper, middle, and lower part of the extrahepatic biliary tree in 11, 4, and 4 patients (58%, 21%, and 21%, respectively). Complicated presentation occurred in 6 patients (31.6%), including one case of synchronous carcinoma. Surgical techniques included diverticulum excision in all patients. Associated resection of the extrahepatic biliary tree was required in 11 cases (58%) and could be predicted by the presence of complicated clinical presentation. There was no mortality. Long-term outcome was excellent in 89.5% of patients (median follow-uptime: 52 months). Conclusions: According to the present largest Western series of Todani type II BDC, the type of clinical presentation rather than BDC location, was able to guide the extent of biliary resection. Excellent long-term outcome can be achieved in expert centers.

Published
2015

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