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1. Adenocarcinoma of the oesophagogastric junction Siewert II: An oesophageal cancer better cured with total gastrectomy

Author

Benjamin Mathieu, Renaud Flamein, Fédérique Peschaud, Kevin Kraft, Diane Goéré, Sylvain Fabre, Basile Tsilividis, Frederic Borie, Florence Vandois, Jean Pierre Arnaud, Damien Louis, Virginie Pichot-Delahaye, Manuel Fernandez, Frank Bonnetain, Marie Guilbert, Sophie Michalak, Marc Pocard, Denis Pezet, Bertrand Millat, Thibault Voron, Brigitte Gillet, Jeremie Thereaux, Jean Yves Mabrut, Emmanuelle Leteurtre, Xavier B. D’Journo, Nicolas Carrere, Michel Prudhomme, Olivier Glehen, Gil Lebreton, Jean-Marc Regimbeau, Arnaud Pasquer, Pascal Thomas, Jean Robert Delpero, Johan Gagnière, Timothée Thiébot, Denis Collet, Aude Glaise, N. Huten, Guillaume Piessen, Ariane Poisson, Cécile Brigand, Mohamed Hebbar, Bernard Meunier, Pierre Dechelotte, Caroline Gronnier, Dorothée Brachet, Jérôme Guiramand, Abdenaceur Dhari, Francis Michot, François Paye, Jean Michel Balon, Jérémie H. Lefevre, Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Hôpital Claude Huriez [Lille], CHU Lille, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO), Chirurgie digestive et hépatobiliaire, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Peuplements végétaux et bioagresseurs en milieu tropical (UMR PVBMT), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Institut National de la Recherche Agronomique (INRA)-Université de La Réunion (UR), Laboratoire de chimie de coordination (LCC), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Service de chirurgie digestive, CHU Bordeaux [Bordeaux], Université de Lille, Service de chirurgie générale et digestive [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Service de Chirurgie Digestive et Endocrinienne [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service Chirurgie Digestive et Endocrinienne [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service Biostatistiques et Informatique Médicale (CHU de Dijon) (DIM), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Département de chirurgie générale et digestive [CHU Strasbourg], Centre Hospitalier Universitaire de Strasbourg (CHU de Strasbourg ), Département de chirurgie digestive, [CHU Toulouse], Unité de Recherche sur les Maladies Infectieuses Tropicales Emergentes (URMITE), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Chirurgie digestive [CHU Amiens], CHU Amiens-Picardie, Éducation et scolarisation (ESCOL), Centre interdisciplinaire de recherche, culture, éducation, formation, travail (CIRCEFT), Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Université Paris 8 Vincennes-Saint-Denis (UP8)-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut de Recherche juridique de la Sorbonne André Tunc (IRJS), Université Paris 1 Panthéon-Sorbonne (UP1), Département de chirurgie digestive, CHU Clermont-Ferrand, Institut de Chimie des Substances Naturelles (ICSN), Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC), Département de chirurgie digestive, [CHU Montpellier], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Département de chirurgie générale [Gustave Roussy], Institut Gustave Roussy (IGR), Service de Chirurgie Générale et Digestive[Lille], Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre de Recherche en Cancérologie de Marseille (CRCM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Aix Marseille Université (AMU), Inserm UMR837 Team 5, Service d'oncologie médicale, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U1172 Inserm - U837 (JPArc), Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Service de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Biologie-Pathologie, Département de chirurgie digestive, [CHU Tours], Université d'Orléans (UO), Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques (HIFIH), Université d'Angers (UA), Department of Digestive Surgery, Rouen University Hospital, CHU de Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de chirurgie générale, digestive et oncologique [CHU Ambroise-Paré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Centre Hospitalier Lyon Sud, Service de Chirurgie Digestive, Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], CHU Pontchaillou [Rennes], AP-HM, Department of General and Digestive Surgery, North Hospital, Marseille, France, parent, Service de chirurgie digestive [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Institut de Chimie de Toulouse (ICT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Centre National de la Recherche Scientifique (CNRS), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service Chirurgie viscérale et digestive [CHU Toulouse], Pôle Maladies de l'appareil digestif [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Institut de Chimie de Toulouse (ICT-FR 2599), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire Estaing, Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie de Toulouse (ICT-FR 2599), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Sorbonne Université, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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], Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), and CCSD, Accord Elsevier

Subjects
Male, medicine.medical_specialty, Esophageal Neoplasms, medicine.medical_treatment, 030230 surgery, Adenocarcinoma, [SDV.BBM.BM] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, 03 medical and health sciences, 0302 clinical medicine, Oesophagogastric junction, Gastrectomy, Medicine, Humans, In patient, ComputingMilieux_MISCELLANEOUS, Neoplasm Staging, Retrospective Studies, Surgical approach, business.industry, Cancer, Retrospective cohort study, Cardia, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, General Medicine, Middle Aged, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Neoadjuvant Therapy, 3. Good health, Surgery, Survival Rate, Oncology, 030220 oncology & carcinogenesis, Female, Esophagogastric Junction, France, [SDV.MP.BAC] Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, business, Median survival
Abstract

Introduction Type II AEG is now considered as oesophageal cancer in the seventh and eighth edition of TNM classification but optimal surgical approach for these tumors remains debated. The objective of the study is to assess and compare surgical and oncological outcomes of two surgical approaches: superior polar oesogastrectomy (SPO) or total gastrectomy (TG) in patients with type II adenocarcinoma of the oesophagogastric junction (AEG). Material and methods 183 patients with type II AEG treated from 1997 to 2010 in 21 French centers by SPO or TG were included in a multicenter retrospective study. The surgical and oncological outcomes were compared between these two surgical approaches. Results A TG was performed in 64 (35%) patients whereas 119 (65%) patients were treated by SPO with transthoracic approach in 100 of them (83.2%) and transhiatal approach with cervicotomy in 19 (16.8%). Surgical outcomes were comparable between the two approaches with a postoperative mortality rate of 4.9% and a severe operative morbidity rate within 30 days of 15.3%. Median survival in patients operated on by TG was of 46 months compared to 27 months in patients treated by SPO (p = 0.118). At multivariate analysis, TG appears to be an independent good prognostic factor compared to SPO (HR = 1.847; p = 0.008). However, TG was also associated with a higher rate of incomplete resection, (12.5% vs 5.9%; p = 0.120). Conclusion When TG allows obtaining tumor-free resection margins, this approach should be preferred to SPO.

Published
2019
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2. NutriCancer: A French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer

Author

Emmanuel Gyan, Sébastien Salas, François Goldwasser, Brigitte Maget, Charles Couet, Jean-Michel Balon, Philippe Grandval, Jean Lacau St Guily, David Seguy, Éric Bouvard, Bérengère Narciso, Xavier Hébuterne, Damien Vansteene, Bruno Raynard, Olivier Romano, and Alain Prevost

Subjects
Counseling, Male, Pediatrics, medicine.medical_specialty, Cross-sectional study, Visual analogue scale, health care facilities, manpower, and services, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Weight loss, Neoplasms, Weight Loss, Prevalence, medicine, Humans, 030212 general & internal medicine, Gastrointestinal cancer, Aged, Aged, 80 and over, Nutritional Support, business.industry, Malnutrition, Age Factors, Cancer, social sciences, Middle Aged, Nutrition Surveys, medicine.disease, humanities, Cross-Sectional Studies, Parenteral nutrition, Oncology, 030220 oncology & carcinogenesis, Female, France, Geriatrics and Gerontology, medicine.symptom, business
Abstract

Objectives To compare the prevalence of malnutrition and nutritional management between elderly (≥70years old) and younger patients ( Patients and Methods This is a post-hoc analysis of NutriCancer 2012 study; a one-day cross-sectional nationwide survey conducted to assess malnutrition in adult patients with cancer in France. Patients diagnosed with cancer at the study date in both inpatient and outpatient settings were included. Data collection was performed by means of questionnaires completed by the physician, the patient and the caregiver. Results This post-hoc analysis compared 578 elderly patients (27.6%) vs . 1517 younger patients (72.4%). There were significant differences in cancer localization between the groups particularly in gastrointestinal cancer (27% in younger patients vs. 42% in elderly), breast cancer (17% vs 8% in elderly) and oropharyngeal (15% vs. 9% in elderly). Weight loss was significantly more reported in the elderly than in younger patients (73.6% vs. 67.6%, p=0.009). Elderly patients were more frequently malnourished than younger patients (44.9% vs. 36.7%, p=0.0006). Food intake was comparable between the groups; however, physicians overestimated the food intake, particularly in the elderly. The malnutrition management was more frequently proposed in elderly, as dietary advice and oral nutritional supplements, than in younger patients; however, enteral nutrition was significantly less undertaken in the elderly. Conclusion Malnutrition is prevalent in elderly patients with cancer, and more frequent than in younger patients. There is a need for an early integration of the nutritional counselling in patients with cancer, and particularly in the elderly.

Published
2018
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3. The Impact of Perioperative Chemotherapy on Survival in Patients With Gastric Signet Ring Cell Adenocarcinoma

Author

Mathieu Messager, Jérémie H. Lefevre, Virginie Pichot-Delahaye, Amine Souadka, Guillaume Piessen, Christophe Mariette, Jean Pierre Arnaud, Jean Michel Balon, Frank Bonnetain, Frédéric Borie, Dorothée Brachet, Cécile Brigand, Nicolas Carrere, Xavier Benoit D'Journo, Pierre Dechelotte, Jean Robert Delpero, Abdenaceur Dhari, Sylvain Fabre, Manuel Fernandez, Renaud Flamein, Brigitte Gillet, Aude Glaise, Olivier Glehen, Diane Goéré, Marie Guilbert, Jérôme Guiramand, Mohamed Hebbar, Noël Huten, Kevin Kraft, Emmanuelle Leteurtre, Damien Louis, Jean Yves Mabrut, Benjamin Mathieu, Bernard Meunier, Sophie Michalak, Francis Michot, Bertrand Millat, François Paye, Frédérique Peschaud, Denis Pezet, Marc Pocard, Ariane Poisson, Michel Prudhomme, Jean Marc Regimbeau, Timothée Thiébot, Pascal-Alexandre Thomas, Basile Tsilividis, and Florence Vandois

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Gastroenterology, Perioperative Care, Stomach Neoplasms, Internal medicine, medicine, Carcinoma, Humans, Stage (cooking), Retrospective Studies, Chemotherapy, Signet ring cell, business.industry, Standard treatment, Retrospective cohort study, Middle Aged, Prognosis, medicine.disease, Intention to Treat Analysis, Surgery, Regimen, Treatment Outcome, Chemotherapy, Adjuvant, Multivariate Analysis, Adenocarcinoma, Female, business, Carcinoma, Signet Ring Cell, hormones, hormone substitutes, and hormone antagonists
Abstract

The aim of this retrospective study was to evaluate the survival impact of perioperative chemotherapy (PCT) in patients with gastric signet ring cell (SRC) adenocarcinoma.PCT is a standard treatment for advanced resectable gastric adenocarcinoma (GA). SRC has a worse prognosis compared to non-SRC and the chemosensitivity of SRC is uncertain.Among 3010 patients registered in 19 French centers between January 1997 and January 2010, 1050 (34.9%) were diagnosed with SRC. Of those treated with curative intent (n = 924), 171 (18.5%) received PCT with surgery (PCT group), whereas 753 (81.5%) were treated with primary surgery (S group). PCT was based mainly on a fluorouracil-platinum doublet or triplet regimen.The groups were comparable regarding age, gender, American Society of Anesthesiologists (ASA) score, malnutrition, tumor location and cTNM stage. 60 patients did not undergo resection because of tumor progression (10) or metastases (50) found at operation. The R0 resection rates were 65.9% and 62.3% in the S and PCT groups, respectively (P = 0.308). Fewer patients received adjuvant chemotherapy in the S group than in the PCT group (35.2% vs. 66.5%, P0.001). At a median follow-up of 31.5 months, the median survival was shorter in the PCT group (12.8 vs. 14.0 months, P = 0.043). On multivariate analysis, PCT was found to be an independent predictor of poor survival (HR = 1.4, 95% CI 1.1-1.9, P = 0.042).PCT provides no survival benefit in patients with gastric SRC. Clinical Trial.gov record: ADCI001, Clinical Trial.gov identifier NCT01249859.

Published
2011
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4. The safety of the same-day discharge for selected patients after laparoscopic fundoplication: a prospective cohort study

Author

Jean Michel Balon, Guillaume Piessen, Gilles Lebuffe, J.-P. Triboulet, Anne Guidat, and Christophe Mariette

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Nausea, medicine.drug_class, Fundoplication, Patient satisfaction, Humans, Medicine, Antiemetic, Prospective Studies, Laparoscopy, Prospective cohort study, medicine.diagnostic_test, business.industry, Patient Selection, General Medicine, Middle Aged, Patient Discharge, Surgery, Ambulatory, Gastroesophageal Reflux, Vomiting, Feasibility Studies, Female, medicine.symptom, business, Cohort study
Abstract

Background We conducted a prospective cohort study to assess the acceptability, feasibility and safety of day-case laparoscopic fundoplication for gastroesophageal reflux disease in an university-based tertiary care center. Methods The procedure was proposed as routine for patients with proven symptomatic uncomplicated gastroesophageal reflux disease fulfilling predetermined inclusion criteria from September 2003 to December 2005. Standard anesthetic, surgical, analgesic, and antiemetic protocols were used. Acceptability, admission, complication, and reoperation rates and patient satisfaction were evaluated. Postoperative pain and nausea were assessed using an 11-point numeric rating scale (NRS). The Gastrointestinal Quality of Life Index (GIQLI) was administered before and after surgery. Results Among 100 patients screened, 40 (40%) were included. Seven patients were admitted because of inadequate pain control (n = 3), nausea or vomiting (n = 3), or anxiety (n = 1); 33 were discharged as planned 6 to 8 hours after operation. Only 1 patient was readmitted and reoperated because of fundoplicature migration following uncontrolled vomiting. At follow-up, 92.5% of patients were satisfied with the day-case treatment. If offered a similar operation in the future, 82.5% of patients would have accepted day-case treatment. The Gastrointestinal Quality of Life Index was 90.7 (±21.2) preoperatively compared with 105.8 (±21.8) postoperatively (P Conclusions Day-case laparoscopic fundoplication is feasible in selected patients. However, (1) strict control of postoperative nausea and pain is essential, and (2) preoperative standardized education program for ambulatory surgery might be useful in order to enhance patient acceptability and satisfaction rates.

Published
2007
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5. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease

Author

Guillaune Piessen, Jean-Pierre Triboulet, Christophe Mariette, Sylvain Fabre, Isabelle Van Seuningen, Jean-Michel Balon, Biologie et Physiopathologie des Cellules Mucipares (u377), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)

Subjects
Adult, Male, Cancer Research, medicine.medical_specialty, Esophageal Neoplasms, [SDV]Life Sciences [q-bio], medicine.medical_treatment, 03 medical and health sciences, 0302 clinical medicine, medicine, Recurrent disease, Carcinoma, Humans, Esophagus, Radical surgery, Neoplasm Metastasis, ComputingMilieux_MISCELLANEOUS, Aged, business.industry, Esophageal disease, Cancer, Middle Aged, medicine.disease, Prognosis, 3. Good health, Surgery, medicine.anatomical_structure, Oncology, Epidermoid carcinoma, Esophagectomy, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Neoplasm Recurrence, Local, business
Abstract

BACKGROUND Despite increasingly radical surgery for esophageal carcinoma, a large number of patients still experience recurrent disease soon after operation. The current study was undertaken to evaluate the pattern of recurrence after curative esophagectomy for cancer of the thoracic esophagus and to identify factors predictive of recurrent disease. METHODS A total of 439 consecutive patients discharged from the authors' institution following R0 resection between January 1982 and July 2002 were followed for evidence of recurrence over a mean interval of 37.3 (range, 1–207) months. RESULTS Overall 1-, 3- and 5-years survival rates were 91%, 54%, and 41%, respectively. Some 230 patients (52.4%) developed proven recurrence, of whom 24 were alive and 206 were dead at the time of writing. The median time to recurrence was 12.0 (range, 6–96) months, with a median survival thereafter of 7.0 (range, 0–83) months. The pattern of recurrence was local in 12.1%, regional in 20.5% (cervical 3.6%, mediastinal 14.8%, and abdominal 2.1%), and distant in 19.8%, respectively. The overall pattern of dissemination was significantly different according to the histologic subtype (P = 0.021). One hundred five (45.7%) of all recurrences occurred within 12 months of surgery, with local, regional, and distant recurrence occurring at a median of 14.0 (range, 6–77), 13.5 (range, 6–73), and 11.0 (range, 6–96) months, respectively; A factor predictive of recurrent disease was histologic tumor depth invasion (P = 0.001). CONCLUSIONS Depth of tumor invasion should be used to identify patients who will have recurrence within 12 months of operation, so that these patients may be either entered into trials of multimodality treatment or offered nonsurgical palliation. Cancer 2003;97:1616–23. © 2003 American Cancer Society. DOI 10.1002/cncr.11228

Published
2003
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6. [Factors predictive of complete resection of operable esophageal cancer: review of 746 patients]

Author

Christophe, Mariette, Sylvain, Fabre, Jean-Michel, Balon, Laetitia, Finzi, and Jean-Pierre, Triboulet

Subjects
Male, Survival Rate, Analysis of Variance, Esophageal Neoplasms, Radiotherapy, Preoperative Care, Humans, Antineoplastic Agents, Female, Middle Aged
Abstract

Surgery is the treatment of reference for early-stage esophageal cancer, but 5-year survival is only 20% to 25%. After complete resection (R0), survival is significantly longer than after incomplete resection, with microscopic (R1) or macroscopic (R2) penetration. The purpose of this work was to identify retrospectively the factors predictive of complete resection of operable esophageal cancers.Between January 1982 and March 2001, 746 patients with esophageal cancer underwent curative surgery. R0 resection was performed in 585 patients (78.4%), R1 in 61 (8.2%) and R2 in 100 (13.4%). Univariate and multivariate analysis included 28 preoperative, clinical, tumor and therapeutic parameters.Multivariate analysis showed that factors predictive of complete resection R0 were: absence of any modification of the esophageal axis on the barium swallow (P=0.054), a partial or complete response to preoperative radio-chemotherapy (P=0.042), tumor height10 cm (P=0.1) and tumor diameter30 mm (P=0.01). Three groups of patients were identified from the 2 most significant variables. Group 1: no deviation of the axis on the barium swallow (n=501). Group 2: deviation of the axis on the barium swallow and partial or complete response to radiochemotherapy (n=91). Group 3: deviation of the axis on the barium swallow and no response to radiochemotherapy or no preoperative treatment (n=126). For the three groups, rate of R0 resection was 82.6%, 80.1% and 61.1% and 5-year actuarial survival 36%, 27% and 14%, respectively. These rates were significantly different between groups (P10(- 4)) and two by two (P0.04).Complete resection of esophageal cancer is predictable. After validation with an independent population the findings presented here could be used to establish stratification criteria for future therapeutic trials.

Published
2002

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