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research support, non-u.s. gov't letter 2023 Mar 2022 12 07 imported

International audience; Background: Spontaneous rupture of hepatocellular carcinoma (HCC) remains a life-threatening complication, with a reported mortality rate of between 16 and 30% and an incidence rate of approximately 3% in Europe. Survival data and risk factors after ruptured HCC are lacking, especially for peritoneal metastasis (PM).Objectives: The aims of this study were to evaluate the pattern of recurrence and mortality after hepatectomy for ruptured HCC, and to focus on PM.Methods: We retrospectively reviewed the files of patients admitted to 14 French surgical centers for spontaneous rupture of HCC between May 2000 and May 2012.Results: Overall, 135 patients were included in this study. The median disease-free survival and overall survival (OS) rates were 16.1 (11.0-21.1) and 28.7 (26.0-31.5) months, respectively, and the median follow-up period was 29 months. At last follow-up, recurrences were observed in 65.1% of patients (n = 88). The overall rate of PM following ruptured HCC was 12% (n = 16). Surgical management of PM was performed for six patients, with a median OS of 36.6 months. An α-fetoprotein level > 30 ng/mL (p = 0.0009), tumor size at rupture > 70 mm (p = 0.0009), and vascular involvement (p < 0.0001) were found to be independently associated with an increased likelihood of recurrence. No risk factor for PM was observed.Conclusion: This large-cohort French study confirmed that 12% of patients had PM after ruptured HCC. A curative approach may be an option for highly selected patients with exclusive PD because of the survival benefit it could provide.

Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients where surgical resection is possible, outcome is influenced by perioperative morbidity and lymph node status. Laparoscopic liver resection is associated with improved clinical and oncological outcomes in primary and metastatic liver cancer compared with open liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient. The primary aim of this study was to compare overall survival for a large series of patients treated for intrahepatic cholangiocarcinoma by open or laparoscopic approach. Secondary objectives were to compare disease-free survival, predictors of death, and recurrence.Patients treated with laparoscopic or open liver resection for intrahepatic cholangiocarcinoma from 2000 to 2018 from 3 large international databases were analyzed retrospectively. Each patient in the laparoscopic resection group (case) was matched with 1 open resection control (1:1 ratio), through a propensity score calculated on clinically relevant preoperative covariates. Overall and disease-free survival were compared between the matched groups. Predictors of mortality and recurrence were analyzed with Cox regression, and the Textbook Outcomes were described.During the study period, 855 patients met the inclusion criteria (open liver resection = 709, 82.9%; laparoscopic liver resection = 146, 17.1%). Two groups of 89 patients each were analyzed after propensity score matching, with no significant difference regarding pre- and postoperative variables. Overall survival at 1, 3, and 5 years was 92%, 75%, and 63% in the laparoscopic liver resection group versus 92%, 58%, and 49% in the open liver resection group (P = .0043). Adjusted Cox regression revealed severe postoperative complications (hazard ratio: 10.5, 95% confidence interval [1.01-109] P = .049) and steatosis (hazard ratio: 13.8, 95% confidence interval [1.23-154] P = .033) as predictors of death, and transfusion (hazard ratio: 19.2, 95% confidence interval [4.04-91.4] P.001) and severe postoperative complications (hazard ratio: 4.07, 95% confidence interval [1.15-14.4] P = .030) as predictors of recurrence.The survival advantage of laparoscopic liver resection over open liver resection for intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data.

Background In patients undergoing major liver resection, portal vein embolization (PVE) has been widely used to induce hypertrophy of the non-embolized liver in order to prevent post-hepatectomy liver failure. PVE is a safe and effective procedure, but does not always lead to sufficient hypertrophy of the future liver remnant (FLR). Hepatic vein(s) embolization has been proposed to improve FLR regeneration when insufficient after PVE. The sequential right hepatic vein embolization (HVE) after right PVE demonstrated an incremental effect on the FLR but it implies two different procedures with no time gain as compared to PVE alone. We have developed the so-called liver venous deprivation (LVD), a combination of PVE and HVE during the same intervention, to optimize the phase of liver preparation before surgery. The main objective of this randomized phase II trial is to compare the percentage of change in FLR volume at 3 weeks after LVD or PVE. Methods Patients eligible to this multicenter prospective randomized phase II study are subjects aged from 18 years old suffering from colo-rectal liver metastases considered as resectable and with non-cirrhotic liver parenchyma. The primary objective is the percentage of change in FLR volume at 3 weeks after LVD or PVE using MRI or CT-Scan. Secondary objectives are assessment of tolerance, post-operative morbidity and mortality, post-hepatectomy liver failure, rate of non-respectability due to insufficient FLR or tumor progression, per-operative difficulties, blood loss, R0 resection rate, post-operative liver volume and overall survival. Objectives of translational research studies are evaluation of pre- and post-operative liver function and determination of biomarkers predictive of liver hypertrophy. Sixty-four patients will be included (randomization ratio 1:1) to detect a difference of 12% at 21 days in FLR volumes between PVE and LVD. Discussion Adding HVE to PVE during the same procedure is an innovative and promising approach that may lead to a rapid and major increase in volume and function of the FLR, thereby increasing the rate of resectable patients and limiting the risk of patient’s drop-out. Trial registration This study was registered on clinicaltrials.gov on 15th February 2019 (NCT03841305).

Arterial perfusion defects are a risk factor for anastomotic leakage (AL) following colorectal surgery. Measuring arterial stiffness using pulse wave velocity (PWV) is known to reflect the performance of the arterial network. The objective of this study was to assess the predictive value of PWV for AL after colorectal surgery. A prospective monocentric study was conducted on all consecutive patients who underwent colorectal surgery scheduled between March 1, 2016 and May 1, 2017. Patients were divided into two groups according to the PWV which was measured preoperatively using the pOpmetre® device: PWV+ (PWV > 10 m/s) and PWV− (PWV ≤ 10 m/s). We then compared the PWV+ and PWV− groups. The primary endpoint was the AL rate. A total of 96 patients were studied, including 60 in the PWV− group and 36 in the PWV+ group. Patients in the PWV+ group were more at risk of presenting with AL than those in the PWV− group (6.25 vs 0%) (p = 0.002). There was no difference in immediate postoperative complications between the two groups apart from the length of hospital stay. PWV predicted the appearance of AL with a sensitivity of and a negative predictive value of 100%. Measuring PWV could be a used as a predictive examination in the early detection of AL after colorectal surgery.

International audience; Background: Gemcitabine is a standard treatment for pancreatic adenocarcinoma. Many mechanisms are involved in gemcitabine resistance, such as reduced expression of the human equilibrative nucleoside transporter 1 (hENT1) membrane transporter, deoxycytidine kinase deficiency, and changes in the signal transmission of mitogen-activity protein kinase (MAPK) and the phosphoinositide 3-kinase (PI3K) pathways.Aim:To evaluate the anti-tumor efficiency of blocking signaling pathways using combined action of gemcitabine, everolimus and zoledronic acid versus gemcitabine alone in a mouse subcutaneous xenograft.Methods: Implantations of two human pancreatic adenocarcinoma cells lines (PANC1, K-ras mutated and gemcitabine-resistant; and BxPc3, wild-type K-ras and gemcitabine-sensitive) were performed on male athymic nude mice. The mice received different treatments: gemcitabine, gemcitabine plus everolimus, everolimus, gemcitabine plus zoledronic acid, everolimus plus zoledronic acid, or gemcitabine plus everolimus and zoledronic acid, for 28 days. We measured the tumor volume and researched the expression of the biomarkers involved in the signaling pathways or in gemcitabine resistance.Results: In wild-type K-ras tumors, the combinations of gemcitabine plus everolimus; zoledronic acid plus everolimus; and gemcitabine plus zoledronic acid and everolimus slowed tumor growth, probably due to caspase-3 overexpression and reduced Annexin II expression. In mutated K-ras tumors, gemcitabine plus everolimus and zoledronic acid, and the combination of zoledronic acid and everolimus, decreased tumor volume as compared to gemcitabine alone, inhibiting the ERK feedback loop induced by everolimus.Conclusion: The combination of zoledronic acid and everolimus has an antitumor effect and could increase gemcitabine efficacy.

International audience; BACKGROUND: The incidence of spontaneous rupture of hepatocellular carcinoma (HCC) is low in Europe, at less than 3%. HCC rupture remains a life-threatening complication, with mortality reported between 16 and 30%. The risk of bleeding recurrence has never been clearly evaluated in such clinical situation. The objectives of this study were to evaluate the current risk of mortality related to HCC rupture and to focus on the risk of bleeding recurrence following interventional management. METHODS: All patients admitted to 14 French-Italian surgical centers for spontaneous rupture of HCC between May 2000 and May 2012 were retrospectively included. Clinical data, imaging features, relevant laboratory data, treatment strategies, and prognoses were analyzed. RESULTS: Overall, 58 of the 138 included patients (42%) had cirrhosis. Thirty-five patients (25%) presented with hemorrhagic shock, and 19% with organ(s) dysfunction. Bleeding control was obtained by interventional hemostasis, emergency liver resection, and conservative medical management in 86 (62%), 24 (18%), and 21 (15%) patients, respectively. Best supportive care was chosen for 7 (5%) patients. The mortality rate following rupture was 24%. The bleeding recurrence rate was 22% with related mortality of 52%. In multivariate analysis, a bilirubin level \textgreater17 micromol/L (HR 3.768; p~=~0.006), bleeding recurrence (HR 5.400; p~\textless~0.0001), and ICU admission after initial management (HR 8.199; p~\textless~0.0001) were associated with in-hospital mortality. CONCLUSION: This European, multicenter, large-cohort study confirmed that the prognosis of ruptured HCC is poor with an overall mortality rate of 24%, despite important advances in endovascular techniques. Overall, the rate of bleeding recurrence was more than 20%, with a related high risk of mortality.

Resume Introduction Si l’interet de la rehabilitation amelioree apres chirurgie colorectale a pu etre prouve sur la morbidite et la duree d’hospitalisation postoperatoire, son impact sur la duree de reprise du transit est peu documente. Les objectifs etaient d’evaluer l’impact de la rehabilitation amelioree sur la reprise du transit, et d’evaluer l’importance de la definition de l’ileus et son incidence rapportee dans la litterature. Materiel et methodes Il s’agit d’une etude observationnelle prospective monocentrique portant sur tous les patients consecutifs operes d’une resection-anastomose colorectale sur 17 mois. La reprise d’un transit global etait definie par la recuperation d’un transit de matiere associe a la tolerance a l’alimentation solide. Resultats Cent trente et un patients etaient inclus avec une adhesion mediane de 14 (13 ; 16) items suivis sur les 19 items traceurs. Le delai median de reprise du transit gazeux etait de 2 jours alors que le delai de reprise d’un transit de matiere etait de 3 jours. Le delai de reprise d’un transit gazeux ainsi que d’un transit global diminuait quand l’observance au protocole augmentait (respectivement p r 2 = 0,11 et p = 0,04 ; r 2 = 0,06). L’incidence de l’ileus etait de 1,5 a 61,8 % en fonction de la definition de l’ileus ( cut-off de 1 a 7 jours). Une observance au protocole ≥ 85 % protegeait de l’apparition d’un ileus ≥ 4 jours (OR = 0,35 ; IC 95 % = 0,15–0,83). Conclusion La mise en place et l’observance d’un protocole de rehabilitation amelioree apres chirurgie permettait une diminution du delai de reprise du transit mais une definition consensuelle de l’ileus est necessaire.

Malignant large bowel obstructions frequently require emergency surgery. Compliance with enhanced recovery after surgery programmes is significantly reduced due to non-removal of the nasogastric tube in the postoperative period. The first aim of the present study was to research factors associated with the failure of immediate nasogastric tube removal in patients who had undergone emergency surgery for malignant large bowel obstruction. The second aim was to assess the morbidity linked to nasogastric tube reinsertion. This retrospective and monocentric study included all consecutive patients admitted for acute malignant large bowel obstruction who underwent emergency surgery. Patients who were not primarily operated on were excluded (n = 178; 69.3%). The group of patients requiring nasogastric tube (NGT) reinsertion was compared with the group that did not require NGT reinsertion. Seventy-nine patients underwent emergency surgery, of which 18 (22.8%) required nasogastric tube reinsertion. There was no difference between the two groups with regard to (a) immediate nasogastric tube removal (p = 0.87) and (b) inclusion in an enhanced recovery programme (p = 0.75). However, preoperative small bowel dilatation was associated with a reduction in the need for NGT reinsertion (p = 0.04). A left-sided tumour was also associated with the need for NGT reinsertion in uni- (p = 0.034) and multivariate analysis (OR = 8; p

Medical management for perforated diverticulitis without abscess or peritonitis (PDwAP) has a success rate of 40-70%. Identifying patients with a risk of medical treatment failure would improve outcomes. The aim of this study was to identify the risk factors for failure of medical treatment in patients admitted with PDwAP.This multicenter retrospective observational study included all consecutive patients admitted for PDwAP and not surgically treated over a 7-year period. Peritonitis classified on the Hinchey scale was excluded. Potential clinical, biological and radiological risk factors for medical treatment failure were collected and compared between the group of patient with a failure of medical treatment (F) and the group in which treatment did not fail. Data were collected at referral.Ninety-one patients were included, and 29 had a failure of treatment (31.9%). The median heart rate was different between the two groups (p 0.001), at approximately 100/min in the F group. A blood level of C-reactive protein (CRP) ≥150 mg/mL was associated with a higher rate of failure (p = 0.021), but it was not confirmed in multivariate analysis. Pneumoperitoneum ≥5 mm and intraperitoneal liquid located in the pouch of Douglas were more likely to be present in the F group (respectively, p = 0.001 and p 0.001). A multivariate analysis showed independent risk factors as being the highest pneumoperitoneum diameter5 mm (OR 5.193; p = 0.015) and peritoneal fluid location in the pouch of Douglas (OR 4.103; p = 0.036).The severity of sepsis (tachycardia and CRP ≥150 mg/mL) and of imaging signs (pneumoperitoneum ≥5 mm and peritoneal fluid in the pouch of Douglas) were risk factors for medical treatment failure of PDwAP requiring special supervision so as not to lose time in undertaking surgical management.

Objective The primary objective of this non-randomised phase II study was to evaluate the combination of systemic chemotherapy plus cetuximab after complete cytoreductive surgery (CCS) for treatment of isolated colorectal peritoneal carcinoma (CRPC). This multicentre, prospective phase II clinical trial was conducted in seven national cancer referral centres, however research published during study recruitment indicated cetuximab treatment as ineffective in patients with mutated KRAS genes, leading to an additional exclusion criterion to the current protocol, excluding patients with mutated KRAS genes. This significantly impacted recruitment and the study did not achieve the necessary recruitment of 46 patients. Results Fourteen patients underwent CCS and were included in the study, however one did not provide informed consent and another received only one cycle of chemotherapy leading to 12 patients in the per protocol population for analysis. Adjuvant Folfox Cetuximab was administered when CCS was achieved for patients > 18 years with histologically proven CRPC and no other metastatic disease (liver, lungs, lymphadenopathy, etc.). CRPC median index was 5.00 (range: 1–17). Median PFS was 12.3 months [95% CI (3.7–28.2)] with 8.3% [95% CI (0.5–31.1)] and 0% PFS at 3 and 5 years respectively. Median OS was 43.4 months [95% CI (16.8–60)]. Trial registration Clinical Trials NCT00766142, October 3, 2008. Retrospectively registered

Splenic arterial embolization (SAE) improves the rate of spleen rescue, yet the advantage of prophylactic SAE (pSAE) compared with surveillance and then embolization only if necessary (SURV) for patients at high risk of spleen rupture remains controversial.To determine whether the 1-month spleen salvage rate is better after pSAE or SURV.In this randomized clinical trial conducted between February 6, 2014, and September 1, 2017, at 16 institutions in France, 133 patients with splenic trauma at high risk of rupture were randomized to undergo pSAE or SURV. All analyses were performed on a per-protocol basis, as well as an intention-to-treat analysis for specific events.Prophylactic SAE, preferably using an arterial approach via the femoral artery, or SURV.The primary end point was an intact spleen or a spleen with at least 50% vascularized parenchyma detected on an arterial computed tomography scan at 1 month after trauma, assessed by senior radiologists masked to the treatment group. Secondary end points included splenectomy and pseudoaneurysm, secondary SAE after inclusion, complications, length of hospital stay, quality-of-life score, and length of time off work or studies during the 6-month follow-up.A total of 140 patients were randomized, and 133 (105 men [78.9%]; median age, 30 years [interquartile range, 23-47 years]) were retained in the study. For the primary end point, data from 117 patients (57 who underwent pSAE and 60 who underwent SURV) could be analyzed. The number of patients with at least a 50% viable spleen detected on a computed tomography scan at month 1 was not significantly different between the pSAE and SURV groups (56 of 57 [98.2%] vs 56 of 60 [93.3%]; difference, 4.9%; 95% CI, -2.4% to 12.1%; P = .37). By the day 5 visit, there were significantly fewer splenic pseudoaneurysms among patients in the pSAE group than in the SURV group (1 of 65 [1.5%] vs 8 of 65 [12.3%]; difference, -10.8%; 95% CI, -19.3% to -2.1%; P = .03), significantly fewer secondary embolizations among patients in the pSAE group than in the SURV group (1 of 65 [1.5%] vs 19 of 65 [29.2%]; difference, -27.7%; 95% CI, -41.0% to -15.9%; P .001), and no difference in the overall complication rate between the pSAE and SURV groups (19 of 65 [29.2%] vs 27 of 65 [41.5%]; difference, -12.3%; 95% CI, -28.3% to 4.4%; P = .14). Between the day 5 and month 1 visits, the overall complication rate was not significantly different between the pSAE and SURV groups (11 of 59 [18.6%] vs 12 of 63 [19.0%]; difference, -0.4%; 95% CI, -14.4% to 13.6%; P = .96). The median length of hospitalization was significantly shorter for patients in the pSAE group than for those in the SURV group (9 days [interquartile range, 6-14 days] vs 13 days [interquartile range, 9-17 days]; P = .002).Among patients with splenic trauma at high risk of rupture, the 1-month spleen salvage rate was not statistically different between patients undergoing pSAE compared with those receiving SURV. In view of the high proportion of patients in the SURV group needing SAE, both strategies appear defendable.ClinicalTrials.gov Identifier: NCT02021396.

OBJECTIVE Splanchnic vein thrombosis (SVT) is a potentially severe complication of pancreatitis. The aim of this single-center, retrospective cohort study was to investigate the incidence of SVT and to determine the connected risk factors. METHODS All consecutive patients with acute pancreatitis (AP) managed in our hospital were included. The primary outcome was the occurrence of SVT and data was collected in accordance with Ranson's criteria. RESULTS A total of 318 patients were included, of whom 124 (39.0%) were women. Biliary lithiasis was the main cause of pancreatitis (n = 156, 49.1%). A total of 19 (6.0%) SVT were identified. In univariate analysis, alcohol intake, smoking and male gender were associated with SVT (P = 0.005, 0.003 and 0.007, respectively). Biological parameters significantly associated with thrombosis were lactate dehydrogenase (LDH) 75% was a protective factor against thrombosis (OR 0.148, P = 0.019). Leukocytes >10 × 10(9)/L (OR 6.397, P = 0.034), hyperglycemia (≥ 10 mmol/L) (OR 6.845, P = 0.023), LDH

Background and aims: Early rehabilitation protocols should be assessed in elderly. We aimed to study the outcomes of colorectal surgery and the observance of the modalities of an early rehabilitation protocol in patients over 80 years. Material and Methods: All consecutive patients who underwent surgery for colorectal cancer in our center over a 19-month period were included. All of these patients were managed using the same early rehabilitation protocol. Patients older than 80 were compared to younger patients. Results: A total of 173 patients were included and 36 were ≥80 years (20.8%). Patients aged ≥80 years had a significantly higher ASA score and were operated on in emergency. In the peroperative period, patients aged ≥80 years were more likely to undergo laparotomy than patients Conclusion: Although age or comorbidities may affect observance for certain modalities such as chewing gum use and vascular catheter ablation, an early rehabilitation protocol can be used after colorectal cancer surgery in patients ≥80 years old, where it would improve functional results and postoperative outcomes.

Resume Background Les stenoses diverticulaires sont peu renseignees dans la litterature. Elles devraient constituer une indication chirurgicale car il existe un risque de cancer et car il n’y a pas d’augmentation de la morbidite de la colectomie dans cette indication. Le premier but de ce travail etait d’etudier la morbidite de la chirurgie et la qualite de vie des patients apres sigmoidectomie en cas de stenose sigmoidienne liee a des diverticules. Le second objectif etait de faire l’etat de l’actuelle prise en charge des stenoses sigmoidiennes d’origine diverticulaire. Methode Il s’agit d’une etude retrospective monocentrique observationnelle incluant tous les patients consecutifs avec un diagnostic preoperatoire de stenose sigmoidienne d’origine diverticulaire et operes entre le 01.01.2007 et le 31.12.2013. L’index de qualite de vie gastro-intestinale etait utilise pour evaluer la satisfaction des patients. Resultats Seize patients etaient inclus et 9 etaient des femmes (52,6 %). L’âge median etait 69,5 (46–84) et l’indice de masse corporelle median etait de 23,55 kg/m2 (17,2–28,4). La sigmoidectomie a pu etre realisee de maniere programmee dans 100 % des cas. Le taux de complication global etait de 31,2 % (n = 5) (4 complications mineures et 1 complication majeur). Aucun patient n’est decede. L’analyse anatomopathologique a retrouve 2 adenocarcinomes (12,5 %). La moyenne de l’index de qualite de vie gastro-intestinale etait de 122 (67–144) et 91 % se referaient reoperer. Conclusion La stenose sigmoidienne est generalement un obstacle a la realisation d’une coloscopie complete et la malignite de la stenose ne peut pas etre eliminee (12,5 % d’adenocarcinomes). La chirurgie ne reduisait pas la qualite de vie et avait une morbidite egale a d’autres indications de sigmoidectomie. Pour ces raisons, la stenose due a une diverticulite devrait rester une indication a une sigmoidectomie avec curage lymphatique.

International audience; PURPOSE: Water-enema multidetector computed tomography (WE-MDCT) is a technique for the localization and preoperative T- and N-stage assessments of colon cancer. It may be a useful tool for planning surgery. The primary aim of this study was to evaluate the diagnostic accuracy of WE-MDCT for T-staging and its ability to locate tumors for laparoscopy planning. The secondary aim was to assess reading reproducibility and diagnostic accuracy for the preoperative determination of N-stage.METHODS: We performed a study to evaluate preoperative WE-MDCT for surgical planning in patients with symptomatic colon adenocarcinomas who underwent surgery between June 2010 and January 2014. A radiologist and a surgeon read the WE-MDCTs separately. Results were compared with colonoscopy and the surgical specimen.RESULTS: Seventy-one patients (42 men (59.1%); mean age 73.1 years (range 45 to 95)) were included. Seventy-six tumors were assessed. The intraclass correlation coefficient (ICC) for location as determined by surgery and that determined by WE-MDCT was 1, and the ICC for location between colonoscopy and WE-MDCT was 0.85 (95% CI 0.75-0.91). For T-stage determination, sensitivity was 96 and 94% and specificity 83 and 88% for readers 1 and 2, respectively. The T-stage assessment allowed for the programing of surgical access and showed good sensitivity and specificity for the assessment of invasion in adjacent organs.CONCLUSION: WE-MDCT is relatively easy to perform, and its results can be read effectively by radiologists and surgeons. WE-MDCT indicated the location of tumors perfectly and permitted a good determination of their T-stage. The technique is thus pertinent for the planning of laparoscopic surgery for colon cancer.

Resume Le gold standard dans le traitement de la cholecystite aigue est la chirurgie associee a un traitement antibiotique. Dans certaines situations, une alternative a la chirurgie est representee par la cholecystostomie percutanee. Cette cholecystostomie est habituellement realisee par le radiologue sous anesthesie locale, sous guidage par echographie ou scanner. Le drainage peut suivre 2 voies, la voie transhepatique ou la voie transperitoneale. Les complications, qui surviennent dans environ 10 % des cas, sont representees selon la voie utilisee respectivement par l’hemorragie, l’hemobilie ou le pneumothorax, d’une part, et la fuite biliaire, d’autre part. Les indications de la cholecystostomie percutanee sont principalement la resistance a un traitement medical bien conduit et les patients hospitalises en reanimation. Le drain doit rester en place en principe 3 a 6 semaines avant d’etre ote. Chez les patients en bon etat general (ASA I-II), une cholecystectomie a distance semble recommandee pour eviter toute recidive.

IF 2.426; International audience; PURPOSE: There is no consensual definition of postoperative ileus (POI), which leads to a lack of reproducibility. The aims of this study were (i) to propose and evaluate a classification of postoperative ileus based on its consequences and (ii) to assess the reproducibility of the classification.METHODS: A national global survey was carried out according to the DELPHI method in order to create a classification of primary POI. The classification was subsequently tested on a cohort of patients who underwent colorectal surgery. Finally, a reproducibility test was performed in five teaching hospitals with junior and senior surgeons.RESULTS: A five-stage classification was proposed: grade A (least) to grade E (worst). For better differentiation, subcategories (D1/D2) were included. Overall, 173 patients were included who underwent colorectal surgery. Forty of them experienced primary postoperative ileus (23.1%). Grade A occurred in 10 cases, grade B in 10 cases, grade C in 14 cases, grade D1 in 2 cases, and grade D2 in 2 cases. POI-related death (grade E) occurred in 2 cases. Patients with grade A POI recovered their gastrointestinal function significantly faster than those with higher grades (p = 0.01), and were more likely to undergo laparoscopic surgery (p = 0.04). The Intraclass Correlation Coefficient (ICC) was 0.83 in the overall population, and 0.83 and 0.82 respectively in the junior and senior surgeon populations.CONCLUSION: This classification is easy to both use and reproduce. It will improve the reproducibility, evaluation, and assessment of POI. These preliminary results should be confirmed in a multi-centric international study.

Liver resection is the curative treatment for patients with colorectal liver metastases (CRLMs), with five-year survival rates of 30-50%. Radiofrequency ablation (RFA) is a local and useful alternative for patients with non-resectable CRLMs to obtain complete tumor clearance. The aim of this study was to analyze survival rates with this local treatment.All patients who underwent RFA and resection or RFA alone for unresectable CRLMs between 2001 and 2012 were included in a retrospective study. Descriptive and survival statistics were calculated. Morbidity, mortality, and recurrence were also analyzed.The study involved 72 patients and 179 lesions. RFA was performed in 109 procedures. Mortality was 2.7% and morbidity was 25.7%. Local recurrence concerned 25.7% of lesions. Independent risk factors for recurrence were more than one CRLM (p= 0.0427) and size of largest CRLM greater than 3 cm (p= 0.0139). The five-year overall survival rate was 45.5% and the five-year disease-free survival (DFS) was 9.9%.This study shows RFA has good oncological outcomes. The combination of RFA and resection is considered as a curative treatment for patients with unresectable CRLMs.

Esophageal stricture is a major secondary complication of ingesting caustic agents. We examined our experiences with caustic injuries with a view to finding clinical and biological risk factors of esophageal strictures secondary to caustic ingestion. Records were retrieved for 58 adults admitted consecutively to our intensive care unit for caustic ingestion. Fifty cases were managed conservatively and therefore retained for analyses. Patients were grouped according to whether they developed strictures or not during the follow-up period. Mucosal damage was assessed by emergency endoscopy. Eleven patients (22%) developed a stricture. At referral, dysphagia, epigastric pain, and hematemesis were associated with secondary stricture (respectively P = 0.047, P = 0.008, P = 0.02). A high Zargar endoscopic grade (above IIa; P = 0.02), the ingestion of strong acids or alkalis (P = 0.006), hyperleukocytosis (P = 0.02), and a low prothrombin ratio (P = 0.002) were associated with a higher risk of developing a stricture. The median delay of stricture diagnosis was 12 (8;16) days after ingestion, with extreme values from 4 to 26 days. Initial symptoms such as dysphagia or hematemesis, early endoscopy showing >IIa grade esophagitis, and certain laboratory results should draw the physician's attention to a high risk of esophageal stricture.

Summary Introduction While enhanced recovery after surgery (ERAS) has been proven to improve results in colorectal operations with regard to morbidity and duration of hospital stay, its impact on recovery of bowel motility is poorly documented. The aims of this study were to assess the impact of ERAS on bowel motility recovery, and to assess the consequences of the definition of postoperative ileus on its reported incidence in the literature. Material and methods This is a single-center prospective observational study of consecutive patients who underwent colorectal resection with anastomosis over a period of 17 months. Global resumption of intestinal transit (GROT) was defined as passage of stool combined with alimentary tolerance of solid food. Results One hundred and thirty-one patients were included. A median of 14 items (range: 13–16) was complied out of 19 observable items in the protocol. Median time to passage of flatus (MTPF) was 2 days and the GROT was 3 days. The time interval to MTPF as well as to GROT decreased as adherence to the ERAS protocol increased (respectively P 2 = 0.11 and P = 0.04, r 2 = 0.06). The incidence of postoperative “ileus” varied from 1.5% to 61.8% depending on the interval chosen to define ileus (cut-off from 1 to 7 days). Adherence to ≥ 85% of the items in the ERAS protocol protected patients from “prolonged ileus”, i.e., lasting ≥ 4 days (OR = 0.35; 95% CI = 0.15 to 0.83). Conclusion The implementation of and compliance with an ERAS protocol allowed a reduction in the time to GROT. There is a need for a consensual definition of postoperative ileus.

International audience; OBJECTIVE:The aim of this study is to evaluate whether a parenchymal-sparing strategy provides similar results in terms of morbidity, mortality, and oncological outcome of non-PSH hepatectomies in a propensity score matched population (PSMP) in case of multiple (>3) bilobar colorectal liver metastases (CLM).BACKGROUND:The surgical treatment of bilobar liver metastasis is challenging due to the necessity to achieve complete resection margins and a sufficient future remnant liver. Two approaches are adaptable as follows: parenchymal-sparing hepatectomies (PSH) and extended hepatectomies (NON-PSH).METHODS:A total of 3036 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were matched in a 1:1 propensity score analysis in order to compare PSH versus NON-PSH resections.RESULTS:PSH was associated with a lower number of complications (≥1) (25% vs. 34%, p = 0.04) and a lower grade of Dindo-Clavien III and IV (10 vs. 16%, p = 0.03). Liver failure was less present in PSH (2 vs. 7%, p = 0.006), with a shorter ICU stay (0 day vs. 1 day, p = 0.004). No differences were demonstrated in overall and disease-free survival.CONCLUSION:In conclusion, PSH resection for bilobar multiple CLMs represents a valid alternative to NON-PSH resection in selected patients with a reduced morbidity and comparable oncological results.

Resume Introduction Les tumeurs pancreatiques benignes sont de plus en plus traitees par pancreatectomie centrale (PC) en alternative aux pancreatectomies elargies. En effet, leur morbidite est moindre mais elles sont toutefois grevees d’un taux de fistules postoperatoires importantes. Le but de notre etude est de comparer les anastomoses pancreaticojejunales et pancreaticogastriques. Patients et methode Ce travail bicentrique etait realise de maniere retrospective. Vingt-cinq PC etaient incluses et classees selon deux groupes en fonction de l’anastomose pancreaticodigestive (groupe 1 pour les anastomoses pancreaticojejunales et groupe 2 pour les anastomoses pancreaticogastriques). La PC etait realisee selon un protocole uniformise dans les deux centres et les complications etaient classees selon la classification de Clavien et Dindo et les fistules selon la classification de Bassi. Resultats Les deux groupes etaient comparables. La duree operatoire et les pertes sanguines etaient equivalentes dans les deux groupes. Il existait une difference significative (p = 0,014) en ce qui concerne le taux de fistule. Les anastomoses pancreaticogastriques se compliquaient plus souvent d’une fistule de bas grade. Toutefois, dans les deux groupes, le traitement etait majoritairement medical. Nos resultats etaient comparables avec ceux releves dans la litterature et confirmaient les avantages de la PC par rapport a la duodenopancreatectomie cephalique (DPC) ou a la pancreatectomie distale. Toutefois, dans la litterature, une meta-analyse ne rapportait pas de difference entre les deux types d’anastomoses, mais celle-ci ne portait que sur les DPC. Conclusions Notre travail montrait donc une incidence moins importante de fistule de bas grade apres anastomose pancreaticojejunale au decours d’une PC. Ce resultat devrait etre confirme par une etude ulterieure sur un echantillon plus important de PC.

Resume Introduction La cholecystectomie est l’une des interventions abdominales les plus frequentes. Il n’existe aujourd’hui aucun consensus en ce qui concerne la realisation systematique ou non de la cholangiographie peroperatoire (CPO). Le but de cette etude est de decrire les habitudes et l’opinion des chirurgiens du Grand Ouest en ce qui concerne la CPO. Materiel et methode L’enquete portait sur 300 chirurgiens du Grand Ouest de la France. Un questionnaire comportant une partie objective et une partie subjective leur etait adresse. Cent quarante-huit reponses etaient interpretables. Resultats Sur les 148 chirurgiens, 125 realisaient systematiquement la CPO (groupe CPOS) (83,4 %) et 23 ne la realisaient pas systematiquement (groupe CPONS) (15,6 %). Leur moyenne d’âge etait de 49,3 ans. Il n’existait pas de difference d’experience ni de secteur d’activite entre les deux groupes. Les deux groupes de chirurgiens estiment que la CPO permet un depistage precoce des plaies. Discussion Selon notre etude, la pratique de la CPO systematique est plus importante que celle relatee dans la litterature anglo-saxonne. Les defenseurs de la CPO arguent un depistage precoce des plaies et de la lithiase choledocienne alors que les detracteurs arguent notamment une morbidite propre. Conclusion La CPO est plus frequemment pratiquee en France. Bien que non indispensable, elle permettrait le depistage des plaies des voies biliaires. Elle pourrait aussi constituer une preuve de la mise en œuvre de l’obligation de moyen en cas de poursuite medicolegale faisant suite a une plaie des voies biliaires.

International audience; PURPOSE: Liver metastases develop in 50 percent of patients with colorectal carcinoma. Recurrent liver disease is usual. Repeat liver resection remains the only curative treatment. The aim of this study was to review our data on repeat hepatectomy and to analyze potential prognostic factors of survival.METHOD: Patients who underwent repeat liver resection for metastases of colorectal carcinoma between January 1992 and August 2007 were identified from a prospective database and their medical records were analyzed. RESULTS: Of 62 patients who underwent a second hepatectomy, 15 underwent a third hepatectomy, and two underwent a fourth hepatectomy. There was no perioperative mortality. Morbidity was less than 20 percent for the first and second hepatectomies. Overall 5-year survival rate after first hepatectomy was 40 percent. Univariate analysis identified three risk factors confirmed by log-rank test and multivariate Cox regression analysis: serum carcinoembryonic antigen concentrations >5 ng/ml at first hepatectomy (HR = 2.265; CI = 1.140-4.497; P = 0.020), anatomic resection (HR = 2.124; CI = 1.069-4.218; P = 0.031), and tumors ≥3 cm at the second resection (HR = 2.039; CI = 1.013-4.103; P = 0.046). CONCLUSION: Our study shows that repeat hepatectomy for liver metastases of colorectal carcinoma may be performed with low mortality and morbidity. Preoperative concentration of carcinoembryonic antigen at first hepatectomy, tumor size, and type of anatomic resection are independent prognostic factors.

Indications for pancreatic resections for metastatic disease have not yet been defined to date, and few guidelines exist for the management of these lesions. However, most authors recommend surgery as the treatment of choice for pancreatic metastasis (PM). Resection of the inferior vena cava (IVC) is rarely done during removal of peripancreatic cancer. This report presents the first case of metachronous PM from renal cell carcinoma (RCC) with IVC involvement successfully treated by en-bloc resection in a 70-year-old asymptomatic woman. The abdominal computed tomography (CT) scan showed a 4.0-cm mass in the tail and a 5.0-cm mass in the head of the pancreas with a suspected involvement of vena cava. An en-bloc total pancreatectomy was performed with excision of the involved portion of the cava vein. Histology confirmed the presence of two metastases from RCC with neoplastic infiltration of the IVC and without lymph node involvement. All surgical margins were tumor-free. At most recent follow-up 12 months after pancreatectomy, the patient has no evidence of disease. We believe that a multidisciplinary approach and careful evaluation and treatment of these patients is a mandatory component for patient selection. IVC resection should be performed only when a margin-negative resection is expected to be achieved.

The basic principle of radiofrequency ablation is that the deposit of electromagnetic energy in a tumor causes heat ("cooks the tumor") and thereby destroys it. In the liver, this ablation may be performed percutaneously (by needles) or surgically (laparotomy, laparoscopy). Guidance by an imaging technique is necessary: ultrasound, CT or magnetic resonance imaging. The principal hepatic indications are hepatocellular carcinoma and hepatic metastases smaller than

International audience; INTRODUCTION: The sensitivity of preoperative assessment of colorectal liver metastases (CRLM) ranges from 74 to 80%. Intraoperative ultrasound (IOUS) associated with contrast-enhanced intraoperative ultrasound (CE-IOUS) may be able to improve this. Thus, the aims of this study were to assess the value of IOUS and CE-IOUS for the surgical approach and to determine risk factors both for the detection of new nodules and for the modification of the surgical strategy.MATERIALS AND METHODS: Forty-three patients who underwent CRLM surgery were included. These patients had an MRI in the 8 weeks preceding surgery and benefited from intraoperative IOUS and CE-IOUS.RESULTS AND DISCUSSION: The use of IOUS/CE-IOUS permitted the identification of 43 additional lesions and an improved characterization of nodules in 23 patients with a resulting modification of surgical strategy. Lesions were down-staged in six patients and up-staged in six patients. Chemotherapy (p = 0.02) and the presence of nodules in the left lobe (p = 0.04) were predictive factors for finding new nodules at IOUS/CE-IOUS. The discovery of a new nodule systematically modified surgical management. IOUS/CE-IOUS improved intraoperative management of liver metastases. The techniques enable pertinent modification of surgical resections and a reduction of residual lesions.

Splanchnic vein thrombosis (SVT) is a potentially severe complication of pancreatitis. The aim of this single-center, retrospective cohort study was to investigate the incidence of SVT and to determine the connected risk factors.All consecutive patients with acute pancreatitis (AP) managed in our hospital were included. The primary outcome was the occurrence of SVT and data was collected in accordance with Ranson's criteria.A total of 318 patients were included, of whom 124 (39.0%) were women. Biliary lithiasis was the main cause of pancreatitis (n = 156, 49.1%). A total of 19 (6.0%) SVT were identified. In univariate analysis, alcohol intake, smoking and male gender were associated with SVT (P = 0.005, 0.003 and 0.007, respectively). Biological parameters significantly associated with thrombosis were lactate dehydrogenase (LDH) 500 U/L and hyperglycemia (≥ 10 mmol/L) (P = 0.009 and 0.016, respectively). In multivariate analysis, prothrombin time 75% was a protective factor against thrombosis (OR 0.148, P = 0.019). Leukocytes10 × 10(9)/L (OR 6.397, P = 0.034), hyperglycemia (≥ 10 mmol/L) (OR 6.845, P = 0.023), LDH 500 U/L ((OR 22.61, P = 0.001) and alcoholic etiology (OR 8.960, P = 0.041) were risk factors for SVT.Alcohol intake, male gender and smoking should focus the physician's attention on the risk of SVT. When further associated with certain biological parameters, the physicians should consider therapeutic anticoagulation to prevent SVT.

BACKGROUNDS/AIMS: The aim of this study was to describe clinical and biological changes in a group of patients who underwent pancreaticoduodenectomy (PD) without any complication during the postoperative period. These changes reflect the "natural history" of PD, and a deviation should be considered as a warning sign. METHODS: Between January 2000 and December 2009, 131 patients underwent PD. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. Postoperative variables were validated using an external prospective database of 158 patients. RESULTS: The mean postoperative length of hospital stay was 20.3+/-4 days. The mean number of days until removal of nasogastric tube was 6.3+/-1.6 days. The maximal fall in hemoglobin level occurred on day 3 and began to increase after postoperative day (POD) 5, in patients with or without transfusions. The white blood cell count increased on POD 1 and persisted until POD 7. There was a marked rise in aminotransferase levels at POD 3. The peak was significantly higher in patients with hepatic pedicle occlusion (866+/-236 IU/L versus 146+/-48 IU/L; p

International audience; BACKGROUND: The literature concerning stricture secondary to diverticulitis is poor. Stricture in this setting should be an indication for surgery because (a) of the potential risk of cancer and (b) morbidity is not increased compared to other indications for colectomy. The goal of this report is to study the post-surgical morbidity and the quality of life in patients after sigmoidectomy for sigmoid stricture associated with diverticular disease.METHOD: This is a monocenter retrospective observational study including patients with a preoperative diagnosis of sigmoid stricture associated with diverticular disease undergoing operation between Jan 1, 2007 and Dec 31, 2013. The GastroIntestinal Quality of Life Index was used to assess patient satisfaction.RESULTS: Sixteen patients were included of which nine were female. Median age was 69.5 (46-84) and the median body mass index was 23.55kg/m(2) (17.2-28.4). Elective sigmoidectomy was performed in all 16 patients. Overall, complications occurred in five patients (31.2%) (4 minor complications and 1 major complication according to the Dindo and Clavien Classification); none resulted in death. Pathology identified two adenocarcinomas (12.5%). The mean GastroIntestinal Quality of Life Index was 122 (67-144) and 10/11 patients were satisfied with their surgical intervention.CONCLUSION: Sigmoid stricture prevents endoscopic exploration of the entire colon and thus it may prove difficult to rule out a malignancy. Surgery does not impair the quality of life since morbidity is similar to other indications for sigmoidectomy. For these reasons, we recommend that stricture associated with diverticular disease should be an indication for sigmoidectomy including lymph node clearance.; BackgroundLes sténoses diverticulaires sont peu renseignées dans la littérature. Elles devraient constituer une indication chirurgicale car il existe un risque de cancer et car il n’y a pas d’augmentation de la morbidité de la colectomie dans cette indication. Le premier but de ce travail était d’étudier la morbidité de la chirurgie et la qualité de vie des patients après sigmoïdectomie en cas de sténose sigmoïdienne liée à des diverticules. Le second objectif était de faire l’état de l’actuelle prise en charge des sténoses sigmoïdiennes d’origine diverticulaire.MéthodeIl s’agit d’une étude rétrospective monocentrique observationnelle incluant tous les patients consécutifs avec un diagnostic préopératoire de sténose sigmoïdienne d’origine diverticulaire et opérés entre le 01.01.2007et le 31.12.2013. L’index de qualité de vie gastro-intestinale était utilisé pour évaluer la satisfaction des patients.RésultatsSeize patients étaient inclus et 9étaient des femmes (52,6%). L’âge médian était 69,5 (46–84) et l’indice de masse corporelle médian était de 23,55kg/m2 (17,2–28,4). La sigmoïdectomie a pu être réalisée de manière programmée dans 100% des cas. Le taux de complication global était de 31,2% (n=5) (4complications mineures et 1complication majeur). Aucun patient n’est décédé. L’analyse anatomopathologique a retrouvé 2adénocarcinomes (12,5%). La moyenne de l’index de qualité de vie gastro-intestinale était de 122 (67–144) et 91% se referaient réopérer.ConclusionLa sténose sigmoïdienne est généralement un obstacle à la réalisation d’une coloscopie complète et la malignité de la sténose ne peut pas être éliminée (12,5% d’adénocarcinomes). La chirurgie ne réduisait pas la qualité de vie et avait une morbidité égale à d’autres indications de sigmoïdectomie. Pour ces raisons, la sténose due à une diverticulite devrait rester une indication à une sigmoïdectomie avec curage lymphatique.

Identification of subgroups of patients at high and low risk for global infectious complications (GIC) after inguinal hernia repair without mesh.A database of 1254 patients who underwent inguinal hernia repair without mesh, issued from 3 prospective multicenter randomized trials, has been established (group A). After multivariate analysis, a score for GIC was calculated and tested using data from a similar prospective randomized multicenter study (group B).A risk score for GIC was constructed: -4.7 + (0.95 x ageor =75 years) + (1.1 obesity) + (2.1 x urinary catheter). In case of score less than -4.2 (low-risk group), the GIC rate was 2.7%; therefore, in case of score more than -4.2 (high-risk score), the GIC rate was 14.3% (P.001). In the low-risk group, the administration of antibiotic prophylaxis did not reduce the infectious complication rate, while in high-risk group the administration of antibiotic prophylaxis significantly reduced the rates of surgical site infection, GIC, and urinary infection by 72%, 67%, and 76.8%, respectively.This study demonstrates the efficacy of antibiotic prophylaxis in inguinal hernia surgery in the subgroup of high-risk patients.

Summary Aim of the study Cystic dystrophy in heterotopic pancreas (CDHP) is rare. The aim of this study was to evaluate the diagnosis, management, and follow-up of the CDHP. Patients and methods Between August 1990 and March 2004, 12 patients with CDHP underwent a duodenopancreatectomy. The patients were retrospectively reviewed. Results There were 11 men and 1 woman with a mean age of 42.4 years (range: 34-54 years). Nine patients (75%) were alcoholic and 8 patients had chronic pancreatitis. The diagnosis of CDHP was performed in 8 patients (66.6%) after the preoperative workup. Seven patient had a medical treatment with octreotid and endoscopic cystic ponction (N = 3) or cystic fenestration (N = 1). Recurrence of pain was noted after a mean period of 5 months. Three patients had recurrent acute pancreatitis. Duodenopancreatectomy was performed in all cases. The mortality and morbidity rate were respectively 8.3% (N = 1) and 25% (N = 3). Mean follow-up was 64 months (ranges: 6 - 158 months). One patient was seen 70 months later with epigastric pain and features of acute pancreatitis of the pancreatic stump due to anastomotic stenosis. The other patients were asymptomatic. Conclusions Diagnosis of CDHP is difficult. After failure of medical treatment, duodenopancreatectomy can be proposed.

Resume Objectifs Le but de cette etude etait d’etudier la faisabilite de la radiofrequence dans le traitement de tumeurs hepatiques malignes. Les taux de mortalite, de morbidite, de recidive et les survies avec et sans recidive a moyen terme ont ete evalues. Methodes Tous les malades, hommes ou femmes, âges de plus de 18 ans, porteurs d’une ou plusieurs lesions hepatiques (maximum 4 lesions), dont la preuve de la nature tumorale avait pu etre faite, ont ete inclus dans cette etude. Le traitement chirurgical seul de ces lesions ne pouvait etre envisage pour des imperatifs techniques ou lies au malade. Etaient exclus les malades ayant une fonction hepatique alteree (Child-Pugh > B9), ceux ayant des troubles de la crase sanguine (plaquettes ∞50.10 3 /mm 3 , taux de prothrombine ∞50 %) et les femmes enceintes. Resultats Entre le 13 juillet 2001 et le 1 er juin 2004, 51 malades ont ete inclus. Soixante et une seances de radiofrequence ont ete realisees permettant de traiter 82 lesions. Il y avait 13 femmes et 38 hommes d’un âge moyen de 66 +/- 9 ans. Il y avait 44 carcinomes hepatocellulaires, un cholangiocarcinome et 37 metastases d’origine diverses. Le taux de mortalite etait de 2 % et le taux de morbidite hospitaliere etait de 11,5 %. Le taux de recidive a 3 ans etait de 20,6 %. En analyse multivariee le seul facteur de risque de recidive retrouve etait une taille tumorale superieure a 3 cm (P = 0,03). Le taux de survie globale a 1, 2 et 3 ans etait de 84,7 %, 57,7 %, et 34,6 % pour le groupe carcinome hepatocellulaire (N = 31). Pour les malades porteurs de metastases d’adenocarcinome colorectal (N = 14) le taux de survie globale a 1, 2 et 3 ans etait respectivement de 90 %, 54 % et 54 % (P = 0,72). Conclusion La radiofrequence est un traitement efficace des tumeurs hepatiques de moins de 3 cm de diametre. Ce traitement peu invasif permet l’epargne du parenchyme hepatique, rendant son association avec la chirurgie interessante. Cependant en l’absence d’etudes randomisees la comparant au traitement de reference qui est la chirurgie, ses indications sont a l’heure actuelle mal definies.

The treatment of acutely obstructed carcinoma of the left colon still represents a matter of controversy. The aim of the study was to evaluate the results of its management by emergency subtotal or total colectomy with immediate anastomosis without diversion.An emergency subtotal/total colectomy was performed in 72 patients (mean age 74.9 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively distended colon of dubious viability, and likely to contain ischemic lesions, signs of impending cecal perforation, and masses suggesting synchronous colonic cancers.Postoperative mortality was 9.7% (7 patients). An 83-year-old woman died as a result of an anastomotic dehiscence; the six other deaths resulted of cardiopulmonary complications. Postoperative morbidity was 15% (11 patients) including two fistulas, which recovered without surgery. There were eight synchronous colon carcinomas. Six months after surgery, the mean daily stool frequency was two following subtotal colectomy and three after total colectomy.Emergency subtotal colectomy achieves in one-stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions and serous tears on the cecum. It ensures restoration of gut contiguity via a "safe" ileocolonic anastomosis and removes occasional lesions proximal to the index cancer.

International audience; The gold standard in treatment of acute cholecystitis is cholecystectomy associated with antibiotics. In certain circumstances, percutaneous cholecystostomy is an interventional alternative. Percutaneous cholecystostomy is usually performed under local anesthesia by the radiologist using ultrasonographic or CT guidance. A drain can be inserted either through a trans-hepatic or a trans-peritoneal approach. Complications occur in nearly 10% of cases including hemorrhage, hemobilia, pneumothorax or bile leaks, depending on whether the approach was trans-hepatic or trans-peritoneal. The main indications for percutaneous cholecystostomy are resistance to medical treatment or severely-ill patients in intensive care. Drains should be maintained 3 to 6 weeks before removal. In patients with good general condition (ASA score I-II), secondary cholecystectomy can be recommended to avoid recurrence.; Le gold standard dans le traitement de la cholécystite aiguë est la chirurgie associée à un traitement antibiotique. Dans certaines situations, une alternative à la chirurgie est représentée par la cholécystostomie percutanée. Cette cholécystostomie est habituellement réalisée par le radiologue sous anesthésie locale, sous guidage par échographie ou scanner. Le drainage peut suivre 2voies, la voie transhépatique ou la voie transpéritonéale. Les complications, qui surviennent dans environ 10% des cas, sont représentées selon la voie utilisée respectivement par l’hémorragie, l’hémobilie ou le pneumothorax, d’une part, et la fuite biliaire, d’autre part. Les indications de la cholécystostomie percutanée sont principalement la résistance à un traitement médical bien conduit et les patients hospitalisés en réanimation. Le drain doit rester en place en principe 3à 6semaines avant d’être ôté. Chez les patients en bon état général (ASA I-II), une cholécystectomie à distance semble recommandée pour éviter toute récidive.

The authors report a case of hydatid cyst of the pancreas in a 29-year-old man. Biology and computed tomography contributed to the preoperative diagnosis. The intervention consisted in a left pancreatectomy with spleen ablation. In the light of this case and the literature review, the authors discuss diagnostic issues raised by hydatid cyst of the pancreas.

Les causes les plus frequentes des metastases de l'intestin grele sont d'origine digestive, en particulier colique, ou d'origine gynecologique (cancer du col de l'uterus ou de l'ovaire). Rarement, ces metastases ont une origine extra abdominale [1]. Nous rapportons ici deux cas de metastases de l'intestin grele de carcinomes broncho-pulmonaires avec une presentation clinique differente.

Postoperative pain is a major obstacle in hernia repair surgery, and the choice of clinically efficacious surgical technique should also result in the least postoperative pain and patients' quality of life (QoL). The aim of this prospective randomized study was to compare two surgical techniques for open inguinal hernia repair by assessing the patients' QoL. Men (18-to-75 years old) with primary unilateral inguinal hernia underwent Mesh Plug (MP; n = 156; Bard (PerFix Plug, CR Bard Inc, Murray Hill, NJ) and Shouldice (S; n = 144) techniques. We evaluated: 1) Intensity of postoperative pain (visual analog scale [VAS]) and 2) quality of life (QoL; Medical Outcomes Study Short-Form 36 [SF-36]). Patients undergoing MP had significantly lower VAS scores on postoperative days (POD) 1 (22.1 vs 27.4, p = .003) and 2 (13.2 vs 21.4, p.0001) compared to those in the S group. The QoL was also improved in patients undergoing MP on PODs 8 and 45. Total duration of operation, length of hospital stay, and cessation of normal activities were significantly shorter in the MP group. Compared to the S technique, the MP technique results in significantly less postoperative pain and improved QoL.

International audience; BACKGROUND: Although mortality after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) has decreased, morbidity still remains high. The aim of this review article is to present, define, predict, prevent, and manage the main complications after pancreatic resection (PR).METHODS: A non-systematic literature search on morbidity and mortality after PR was undertaken using the PubMed/MEDLINE and Embase databases.RESULTS: The main complications after PR are delayed gastric emptying (DGE), pancreatic fistula (PF), and bleeding, as defined by the International Study Group on Pancreatic Surgery. PF occurs in 10% to 15% of patients after PD and in 10% to 30% of patients after DP. The different techniques of pancreatic anastomosis and pancreatic remnant closure do not show significant advantages in the prevention of PF, nor does the perioperative use of somatostatin and its analogues. The trend is for conservative or interventional radiology therapy for PF (with enteral nutrition), which achieves a success rate of approximately 80%. DGE after PD occurs in 20% to 50% of patients. Prophylactic erythromycin may reduce the incidence of DGE. Gastric aspiration with erythromycin is usually effective in one to three weeks. Bleeding (gastrointestinal and intraabdominal) occurs in 4% to 16% of patients after PD and in 2% to 3% of patients after DP. Endovascular treatment can only be used for a haemodynamically stable patient. In cases of haemodynamic instability or associated septic complications, surgical treatment is necessary. In expert centres, the mortality rates can be less than 1% after DP and less than 3% after PD.CONCLUSION: There is a need for improved strategies to prevent and treat complications after PR.

Pancreaticoduodenectomy (PD) is indicated in benign or malignant pancreatic head diseases. It is a difficult operation with high morbidity especially in elderly patients. The aim of our study was to determine whether pancreaticoduodenectomy is associated with higher morbidity and mortality in patients ≥ 70 years old.During 17 years, 173 patients were operated by Whipple intervention, whatever the disease. From a prospective database, patients were divided in 2 groups (Group A ≥ 70 years old, Group B70).Postoperative mortality was not significantly higher in elderly (12% vs. 4.1%; p=0.06). However, re-intervention and morbidity were more important in univariate analysis (p=0.03 and p=0.002 respectively). In multivariate analysis, age ≥ 70 years old was not an independent prognostic factor of mortality (p=0.27) and re-intervention (p=0.07). Whereas age (p=0.04) and preoperative morbidity (p=0.02) were independent prognostic factors of morbidity.PD requires careful patient selection. However, age should not be a limiting factor.

International audience; We reported the case of a 61-year-old woman, who has been hospitalized in ICU because of an extensive mesenteric ischaemia, involving the small bowel, secondary to a naratriptan overuse. This mesenteric ischaemia was complicated by multiple organ failure and was responsible for extensive small bowel resection and left colectomy. A concomitant abundant absorption of grapefruit juice, a well-known P450 inhibitor, may have enhanced this naratriptan toxicity. This case underscore that an abdominal pain occurring in the context of headache treatment may be related to a mesenteric ischaemia.; Nous rapportons le cas d’une patiente âgée de 61ans hospitalisée en réanimation pour une ischémie mésentérique étendue, prédominant sur l’intestin grêle, dont la cause est une prise excessive de naratriptan, vasoconstricteur cérébral. Cette ischémie mésentérique a été compliquée par une défaillance multiviscérale et a conduit à une résection étendue de grêle et à une colectomie gauche. La toxicité du naratriptan a probablement été accrue par un surdosage secondaire à une importante prise concomitante de jus de pamplemousse, connue pour être un inhibiteur des cytochromes P450. La survenue d’une douleur abdominale dans un contexte de prise de triptans doit faire craindre l’ischémie mésentérique, en particulier, en présence de facteurs de risque de surdosage.

International audience; Aortoesophageal fistula (AOF) is a rare pathology but often lethal disease with a high mortality rate [1]. No consensus exists about the management of this pathology but the current trend is in favour of an endovascular treatment. The limit of this approach is the need of a specific material and a trained and experimented practitioner, not available in every center. We reported the case of a patient who presented an AOF complicated by a hemorrhagic shock successfully treated by a simple aortic suture protected by a sternocleidomasoid muscle flap.