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1. Screening for surgical nosocomial infections by crossing databases

Author: Alexis Hautemanière, Arnaud Florentin, Paul R. Hunter, Laurent Bresler, and Philippe Hartemann
Subjects: Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract: Summary: Surgical site infection (SSI) is a major cause of morbidity and mortality, and they are the third cause of nosocomial infections. It has been shown that surveillance can reduce the rate of these infections because the publication of the results that introduce a interrogation on her surgical pratices. However, surveillance requires considerable medical resources. Our objective is to validate a computer algorithm that uses microbiological results and the results of a C-reactive protein (CRP) assay and granulocyte count to detect SSIs. Materials and methods: All patients who underwent colorectal surgery between the 1st of January and the 30th of June 2009 were included. Administrative, surgical and microbiological data and the appearance of neutrophilia and CRP after surgery and during hospitalization were collected. The algorithm uses four biological variables: CRP, neutrophils, and the bacterium found on the positive sample. The CRP and neutrophil variables were coded in 0 or 1. CRP was coded as 1 if the sample was below 5 mg/l at the time of the operation and increased to more than 60 mg/l in the 30 days immediately after post-operation. Neutrophils were coded as 1 if the sample was normal at the time of the operation and increased to more than 12,000 cells/mm3 in the 30 days immediately after post-operation. The “type of sample” and “bacterium” variables were coded in categories. For the type of sample, we coded 3 if the sampling site was related to the surgical site, 2 if the sampling site was potentially linked to the surgical site, 1 if the sampling site was not directly or indirectly related to the surgical site and 0 if there was no sample. Regarding the bacteria, we coded 3 for bacteria found in over 5% of SSIs, 2 for bacteria found in 2–5% of SSIs, 1 for bacteria found in less than 2% of SSIs and 0 if there were no bacteria. The algorithm calculates a score from 1 to 5. Results: Our study included 195 operations, out of which it was possible to study 168. Following the operations, we found neutrophilia above 12,000 cells/mm3 in 41.5% of cases and CRP above 60 mg/l in 64.6% of cases. Thirty-seven operations (22%) were complicated by an SSI. The positive predictive values and the negative predictive values in our algorithm were 74.07% and 87.94%, respectively, and the number of records that remain to be investigated is 27 out of 168. Conclusions: Linking databases from bacteriology and biology with those containing the hospital records of surgical procedures is a simple method for identifying surgical nosocomial infections. Keywords: Surgical infection, Screening, Risk management, Procedure, Nosocomial infection
Published: 2013
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2. Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?

Author: C. Lemanski, Denis Pezet, Philippe Rouanet, François Dravet, Eric Rullier, Marc Pocard, Jean Luc Faucheron, Sophie Gourgou, Merhdad Jafari, Laurent Mineur, Jean Michel Fabre, Jacques Balosso, Bernard Lelong, Christophe Taoum, Laurent Bresler, Michel Rivoire, Institut du Cancer de Montpellier (ICM), Centre Léon Bérard [Lyon], Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), CHU Bordeaux [Bordeaux], Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Institut Sainte Catherine [Avignon], Service de Chirurgie d'Oncologie Digestive [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre René Gauducheau, CRLCC René Gauducheau, CHU Clermont-Ferrand, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and Centre Hospitalier Universitaire de Nancy (CHU Nancy)
Subjects: Male, [SDV]Life Sciences [q-bio], Anal Canal, law.invention, MESH: Aged, 80 and over, 0302 clinical medicine, Randomized controlled trial, intersphincteric resection, law, Prospective Studies, MESH: Aged, Aged, 80 and over, MESH: Middle Aged, Proctectomy, Abdominoperineal resection, MESH: Anal Canal, MESH: Follow-Up Studies, General Medicine, Middle Aged, Prognosis, neoadjuvant radiotherapy, Oncology, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Adult, medicine.medical_specialty, Randomization, Long term follow up, Adenocarcinoma, MESH: Prognosis, 03 medical and health sciences, Rectal carcinoma, Overall survival, medicine, Humans, ultra low rectal carcinoma, Aged, MESH: Humans, MESH: Organ Sparing Treatments, Rectal Neoplasms, business.industry, MESH: Proctectomy, MESH: Adenocarcinoma, MESH: Rectal Neoplasms, MESH: Adult, sphincter saving surgery, Intersphincteric resection, MESH: Male, MESH: Prospective Studies, Surgery, Sphincter saving surgery, business, MESH: Female, Organ Sparing Treatments, Follow-Up Studies
Abstract: International audience; Background: Rate of abdominoperineal resection (APR) varies from countries and surgeons. Surgical impact of preoperative treatment for ultra-low rectal carcinoma (ULRC) initially indicated for APR is debated. We report the 10-year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR).Methods: ULRC indicated for APR were included (n = 207). Randomization was between high-dose radiation (HDR, 45 + 18 Gy) and radiochemotherapy (RCT, 45 Gy + 5FU infusion). Surgical decision was based on tumour volume regression at surgery. SSR technique was standardized as mucosectomy (M) or partial (PISR)/complete (CISR) intersphincteric resection.Results: Overall SSR rate was 85% (72% ISR), postoperative morbidity 27%, with no mortality. There were no significant differences between the HDR and RCT groups: 10-year overall survival (OS10) 70.1% versus 69.4%, respectively, 10.2% local recurrence (9.2%/14.5%) and 27.6% metastases (32.4%/27.7%). OS and disease-free survival were significantly longer for SSR (72.2% and 60.1%, respectively) versus APR (54.7% and 38.3%). No difference in OS10 between surgical approaches (M 78.9%, PISR 75.5%, CISR 65.5%) or tumour location (low 64.8%, ultralow 76.7%).Conclusion: GRECCAR 1 demonstrates the feasibility of safely changing an initial APR indication into an SSR procedure according to the preoperative treatment tumour response. Long-term oncologic follow-up validates this attitude.
Published: 2020
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3. Surgery for Crohn’s disease during pregnancy: A nationwide survey

Author: Jérémie H. Lefevre, Laura Beyer-Berjot, Laurent Bresler, Aurelien Amiot, Anthony Buisson, P. Zerbib, Getaid Chirurgie, Adeline Germain, David Laharie, Carmen Stefanescu, Thomas Chateau, Stéphane Nancey, Laurent Peyrin-Biroulet, and Zaher Lakkis
Subjects: Adult, Pediatrics, medicine.medical_specialty, Clinical Decision-Making, MEDLINE, Gestational Age, Disease, Nationwide survey, Severity of Illness Index, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Crohn Disease, Pregnancy, Birth Weight, Humans, Medicine, Perinatal Mortality, Retrospective Studies, Crohn's disease, business.industry, Infant, Newborn, Pregnancy Outcome, Editorials, Gastroenterology, Colonoscopy, Original Articles, medicine.disease, Surgery, Pregnancy Complications, Expectant mothers, Maternal Mortality, Oncology, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, France, business
Abstract: BACKGROUND AND AIMS: Crohn’s disease (CD) frequently affects young women and may require surgery during pregnancy. Data regarding operation for CD in expectant mothers are scare. MATERIALS AND METHODS: This was a retrospective nationwide survey from the GETAID Chirurgie. Any woman with CD undergoing surgery during pregnancy was eligible. RESULTS: A total of 15 cases were collected between 1992 and 2015. Most operations were performed due to penetrating or stricturing complications. Mean gestational age at delivery was 34 weeks, with a mean birth weight of 2507 g. Maternal post-operative complications occurred in two-thirds of cases. Maternal mortality rate was 6.7% and neonatal mortality rate 9.1%. CONCLUSIONS: This is the largest case series of surgery for CD during pregnancy. This operation may have significant morbidity and mortality for mother, fetus, and newborn. Indication needs to be tailored to maternal status, disease severity, and gestational age. Surgery should be managed by experienced gynecologists, physicians, and surgeons. Active CD may be associated with a greater risk to the fetus than the surgical procedure itself.
Published: 2020
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4. Élaboration d’un programme d’enseignement pratique par simulation en chirurgie viscérale et digestive

Author: Michel Carretier, Jean-Pierre Faure, P. Frileux, Laura Beyer-Berjot, Laurent Bresler, J.Y. Mabrut, C. Perrenot, and Stéphane Berdah
Subjects: Surgery
Abstract: Resume Jusqu’en 2013, la formation pratique des internes inscrits au DES/DESC de chirurgie viscerale et digestive en France n’etait pas standardisee. Depuis 2017, le troisieme cycle des etudes medicales a ete restructure autour de deux axes : connaissances theoriques et competences techniques et non-techniques. Celui-ci comporte notamment un programme de formation pratique par simulation, hors bloc operatoire, national, structure, uniformise et standardise. Le developpement de ce programme de formation est le fruit d’un travail de consensus national sous l’egide du college francais de chirurgie viscerale et digestive permettant d’offrir un guide de formation a tous les futurs chirurgiens de la specialite. Quatre seances de conference de consensus reunissant une commission de 8 membres ont abouti a la redaction du « Livret de l’Interne pour l’Enseignement Pratique en Chirurgie Viscerale et Digestive ». Ce referentiel detaille en 272 pages les objectifs (phase I), les moyens d’apprentissage de chaque competence (phase II) et enfin les methodes d’evaluation (phase III) pour les phases socles et des phases d’approfondissement du DES de chirurgie viscerale et digestive. En complement de ce livret, nous avons mene une reflexion sur la structuration et la mise en place de ce programme a l’echelle nationale a compter de novembre 2017 qui est detaille a la fin de cet article.
Published: 2020
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5. Development of a program for teaching practical skills in visceral and digestive surgery by simulation

Author: Laura Beyer-Berjot, Laurent Bresler, Michel Carretier, Stéphane Berdah, Jean-Pierre Faure, C. Perrenot, J.Y. Mabrut, and P. Frileux
Subjects: Reference Document, education, Specialty, Commission, Phase (combat), 03 medical and health sciences, 0302 clinical medicine, Operating theater, Humans, Medicine, Computer Simulation, Curriculum, Digestive System Surgical Procedures, Medical education, business.industry, Internship and Residency, Cornerstone, General Medicine, Education, Medical, Graduate, General Surgery, 030220 oncology & carcinogenesis, Scale (social sciences), 030211 gastroenterology & hepatology, Clinical Competence, France, business
Abstract: Up until 2013 in France, practical training for DES/DESC (advanced level) residents in visceral and digestive surgery was not standardized. Since 2017, the third cycle of medical studies has been restructured around three major thematic axes: academic knowledge, and technical and non-technical skills. The curriculum now includes a practical training program by means of simulation outside the operating theater, and it is structured, uniformized and standardized nationwide. Development of this training program is derived from the deliberations of a national consensus panel working under the umbrella of the French college of visceral and digestive surgery, program presenting a training guide to all future surgeons in the specialty. Four consensus conference sessions bringing together an eight-member commission have led to the drafting of a "Resident's manual for practical teaching in visceral and digestive surgery". As a reference document, the manual details in 272 pages the objectives (phase I), the learning resources for each skill (phase II) and, lastly, the means of evaluation for the cornerstone phases as well as the in-depth phases of an advanced degree (DES) in visceral and digestive surgery. As a complement to the manual, we have conducted a review of the structuring and implementation of the program as of November 2017 on a nationwide scale; the conclusions of the review are detailed at the end of this article.
Published: 2020
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6. Place de la simulation dans l’apprentissage de la chirurgie robotique

Author: Jacques Hubert, Manuela Perez, Cyril Perrenot, J.P. Henry, and Laurent Bresler
Subjects: 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery
Abstract: Resume La simulation dans l’apprentissage de la chirurgie prend une place de plus en plus importante ces dernieres annees et la Haute Autorite de sante a rappele recemment cet objectif ethique prioritaire : « jamais la premiere fois sur le patient ». Des programmes de simulation ont ete valides pour la laparotomie et pour la laparoscopie mais il n’y a pas pour l’instant de programme specifique valide pour la chirurgie robotique. Du fait de l’essor important de cette nouvelle technologie, nous avons developpe a Nancy un programme dedie a l’enseignement hors bloc operatoire de la chirurgie avec le robot Da Vinci. Cet enseignement repose sur l’association d’un enseignement theorique (e-learning) et d’un enseignement pratique en utilisant des simulateurs virtuels (DV-Trainer, Robotic Mentor, DVSS), des simulateurs mecaniques (dome, simulateur abdominal Applied), de la microchirurgie et du wet lab. avec organes d’animaux, animaux anesthesies et cadavres sans oublier le team training. Cet enseignement s’adresse aux chirurgiens en formation avec integration dans la maquette du DES de chirurgie viscerale et digestive et a des chirurgiens diplomes qui peuvent integrer le DIU de robotique general pour acquerir les techniques de base et les DIU specialises (digestif et gynecologique) pour des utilisations du robot dans leur specialite. Ces cursus bases sur le concept du step by step et de la verification des competences permettent un passage a l’activite clinique en toute securite.
Published: 2020
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7. Long-term outcomes of robotic ventral mesh rectopexy for external rectal prolapse

Author: Cyrille Buisset, M.-L. Scherrer, Cyril Perrenot, Laurent Bresler, Adeline Germain, Agathe Postillon, Ahmet Ayav, and Laurent Brunaud
Subjects: Adult, Male, medicine.medical_specialty, Multivariate analysis, Constipation, Adolescent, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, Recurrence, Internal medicine, medicine, Humans, Fecal incontinence, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Gold standard, Retrospective cohort study, Rectal Prolapse, Middle Aged, Surgical Mesh, Hepatology, medicine.disease, Surgery, Rectal prolapse, 030220 oncology & carcinogenesis, Female, Laparoscopy, 030211 gastroenterology & hepatology, medicine.symptom, business, Fecal Incontinence, Abdominal surgery
Abstract: Nowadays in Europe, laparoscopic ventral mesh rectopexy is the gold standard treatment of external rectal prolapse (ERP). The benefits of robot ventral mesh rectopexy (RVMR) are not clearly defined. The primary objective of the study was to evaluate the long-term results of RVMR. The secondary objective was to determine predictive factors of recurrence. Monocentric, retrospective study. Data, both pre-operative and peri-operative, were collected, and follow-up data were assessed prospectively by a telephone questionnaire. The study was performed in a tertiary referral center. Between August 2007 and August 2017, we evaluate all consecutive patients who underwent RVMR for ERP by three different surgeons. The primary outcome was the recurrence rate perceived by patients. Secondary outcome were functional results based on Knowles–Eccersley–Scott-Symptom score for constipation and Wexner score for incontinence, compared before and after surgery. During the study period 96 patients (86 women) underwent RVMR. The mean age was 62.3 years (range 16–90). Twelve patients had a history of ERP repair. Sixty-nine patients were analyzed for long-term outcomes with a mean follow-up of 37 months (range 2.3–92 months). Recurrence rate was 12.5%. After surgery, constipation was significantly reduced: 44 patients were constipated before surgery versus 23 after surgery. Six patients described de novo constipation (6.25%). Fecal incontinence was significantly reduced: 59 patients were incontinent before surgery versus 14 after surgery. No predictive factor for recurrence was identified after multivariate analysis. No mesh related complications were related. In conclusion, RVMR presents good long-term functional result and a recurrence rate similar to LVMR as published in the literature. The rate of mesh related complications seems lower.
Published: 2019
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8. Sphincter-saving surgery after neoadjuvant therapy for ultra-low rectal cancer where abdominoperineal resection was indicated: 10-year results of the GRECCAR 1 trial

Author: Jean-Luc Faucheron, Philippe Rouanet, Laurent Bresler, Denis Pezet, L. Mineur, M. Jafari, C Lemanski, Jacques Balosso, Marc Pocard, B Lelong, E. Rullier, J M Fabre, François Dravet, Michel Rivoire, Sophie Gourgou, Institut du Cancer de Montpellier (ICM), Centre Léon Bérard [Lyon], Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), CHU Bordeaux [Bordeaux], Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER, Institut Sainte Catherine [Avignon], INSERM UMR-S 606, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, PRES Sorbonne Paris-Cité, and Université Paris Denis Diderot, Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre René Gauducheau, CRLCC René Gauducheau, CHU Clermont-Ferrand, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)
Subjects: medicine.medical_specialty, MESH: Margins of Excision, medicine.medical_treatment, [SDV]Life Sciences [q-bio], MESH: Neoadjuvant Therapy, MEDLINE, Anal Canal, Kaplan-Meier Estimate, Adenocarcinoma, Preoperative care, Disease-Free Survival, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, medicine, Humans, Neoadjuvant therapy, Survival analysis, health care economics and organizations, MESH: Kaplan-Meier Estimate, MESH: Humans, Rectal Neoplasms, business.industry, Abdominoperineal resection, MESH: Anal Canal, MESH: Adenocarcinoma, Margins of Excision, MESH: Rectal Neoplasms, Survival Analysis, Neoadjuvant Therapy, Surgery, Clinical trial, medicine.anatomical_structure, 030220 oncology & carcinogenesis, MESH: Survival Analysis, MESH: Disease-Free Survival, Sphincter, 030211 gastroenterology & hepatology, business
Abstract: This phase III trial included patients with ultra-low rectal adenocarcinoma that initially required abdominoperineal resection. The surgical decision was based on clinical tumour status after preoperative treatment. The overall sphincter-saving resection rate was 85 per cent, with 72 per cent rate of intersphincteric resection. Long-term results showed that changing the initial abdominoperineal resection indication into a sphincter-saving resection according to tumoral response is oncologically safe. Saving the sphincter
Published: 2021
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9. Feasibility, acceptability of enteral tube feeding and self-insertion of a nasogastric tube in the nutritional management of digestive cancers, impact on quality of life

Author: Ahmet Ayav, Didier Quilliot, Anthony Lopez, Laurent Bresler, Lucie Germain, Justine Krier, Aurélie Malgras, Niasha Michot, Phi-Linh Nguyen-Thi, Service d'Endocrinologie - Diabète - Nutrition [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service d'Evaluation et Information Médicales [CHRU Nancy], Service d'Hépato-gastro-entérologie [CHRU Nancy], and Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy]
Subjects: Male, 0301 basic medicine, Health Knowledge, Attitudes, Practice, Time Factors, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Pilot Projects, Digestive System Neoplasms, Critical Care and Intensive Care Medicine, Gastroenterology, 0302 clinical medicine, Quality of life, Weight loss, Prospective Studies, Intubation, Gastrointestinal, Digestive cancer, 2. Zero hunger, Nutrition and Dietetics, Middle Aged, 3. Good health, Mental Health, Treatment Outcome, Female, medicine.symptom, medicine.medical_specialty, Nutritional Status, 030209 endocrinology & metabolism, 03 medical and health sciences, Enteral Nutrition, Patient Education as Topic, Internal medicine, Weight Loss, medicine, Humans, Gastrointestinal cancer, Aged, Enteral Tube Feeding, Chemotherapy, 030109 nutrition & dietetics, business.industry, Malnutrition, Cancer, Patient Acceptance of Health Care, medicine.disease, Self Care, Functional Status, Quality of Life, Feasibility Studies, business, Gi cancer
Abstract: No study has evaluated the feasibility of enteral tube feeding (ETF) in undernourished patients with newly diagnosed gastrointestinal (GI) cancer.Evaluate the acceptability of ETF in patients unable to increase their dietary intake and with a weight loss10% or albuminemia30 g/L or BMI18.5 before surgery, or a weight loss5% during chemotherapy. The feasibility of self-insertion of a nasogastric tube was also assessed.A total of 308 patients were nutritionally screened during a one-year period. ETF was indicated in 123 cases. Overall acceptability was 78.9% and was higher when weight loss was10% (p 0.0001) and before surgery (p 0.0001), lower during chemotherapy (p 0.0001), while not influenced by dietary intake or location of the cancer. Forty patients managed a daily self-insertion of the feeding tube (45.5%) and 48 had a nasogastric tube maintained in place. All Quality of Life (QoL) parameters were significantly improved, notably physical role functioning (+20.9% ± 24.0, p 0.005) and mental health (+21.0% ± 17.7 p 0.005).According to the present algorithm, ETF was indicated in 39.9% of cases and accepted in 78.9% of newly diagnosed patients with primary GI cancer while improving QoL. This study strengthens the place of self-insertion of feeding tubes in clinical practise.
Published: 2020
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10. Residency training in robotic surgery: The role of simulation

Author: Cyril Perrenot, Jacques Hubert, J.P. Henry, Manuela Perez, Laurent Bresler, Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Chirurgie Générale et Urgences [CHRU Nancy], and Service d'Urologie [CHRU Nancy]
Subjects: medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], education, Specialty, 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, ComputingMilieux_COMPUTERSANDEDUCATION, medicine, Humans, Medical physics, Robotic surgery, Computer Simulation, Laparoscopy, Simulation Training, medicine.diagnostic_test, business.industry, Internship and Residency, General Medicine, Microsurgery, Surgical training, 3. Good health, Education, Medical, Graduate, 030220 oncology & carcinogenesis, General Surgery, Robot, 030211 gastroenterology & hepatology, Clinical Competence, business, Team training, Residency training
Abstract: Simulation has become increasingly important in surgical teaching in recent years and the French National Authority for Health (HAS) recently underlined the goal and ethical priority: "never the first time on the patient". Simulation programs have been tested and validated for laparotomy and for laparoscopy, but there is not yet a validated program specific for robotic surgery. Due to substantial advances in this new technology, we have developed a program in Nancy dedicated to outside-the-operating room (OR) teaching of robotic surgery using the Da Vinci robot. This teaching is based on a combined program of theoretical teaching (e-learning) and learning of practical skills using virtual simulators (DV-Trainer®, Robotic Mentor®, DVSS®), mechanical simulators (Dome, Applied® abdominal simulators), microsurgery and wet lab using ex vivo animal organs, anesthetized animals, and cadavers. This program also emphasizes team training. The course is intended for residents in surgical training and is integrated into the specialized study diploma (DES) program for Visceral and Digestive Surgery; it also can be used by qualified surgeons who can integrate it with the Inter-University Diploma (DIU) in General Robotic Surgery for basic techniques and also for DIUs in other surgical specialties (digestive and gynecologic surgery) for robotic uses within their specialty. These courses are based on the concept of step-by-step skills acquisition and verification allowing a transition to safe clinical activity.
Published: 2020
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11. Technique opératoire : surrénalectomie transpéritonéale robotique

Author: Laurent Bresler, S. Moog, Laurent Brunaud, and Claire Nomine-Criqui
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, Adrenalectomy, medicine.medical_treatment, medicine.disease, Surgery, Pheochromocytoma, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, medicine, 030211 gastroenterology & hepatology, business, Laparoscopy
Published: 2018
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12. Hemodynamic instability during surgery for pheochromocytoma: comparing the transperitoneal and retroperitoneal approach in a multicenter analysis of 341 patients

Author: Julien Thiery, Emily L. Postma, Laurent Bresler, Thomas J. Fahey, Mattan Lustgarten, Laurent Brunaud, Rocco Domenico Alfonso Bellantone, Wessel M.C.M. Vorselaars, Marco Raffaelli, Rasa Zarnegar, Menno R. Vriens, Eric Mirallié, and Jesse D. Pasternak
Subjects: Adult, medicine.medical_specialty, Mean arterial pressure, Adolescent, Settore MED/18 - CHIRURGIA GENERALE, medicine.medical_treatment, Endocrine Surgical Procedures, Adrenal Gland Neoplasms, Hemodynamics, Pheochromocytoma, Young Adult, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Child, Intraoperative Complications, Retroperitoneal approach, Aged, Retrospective Studies, business.industry, Child, Preschool, Hypertension, Middle Aged, Surgery, Adrenalectomy, Retrospective cohort study, medicine.disease, Blood pressure, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business, Hemodynamic instability
Abstract: Intraoperative hemodynamic instability is a major challenge during adrenalectomy for pheochromocytoma. Typically, pheochromocytoma is performed laparoscopically either through the retroperitoneal or transperitoneal approach. We aimed to determine if the operative approach affects intraoperative hemodynamic instability during surgery for pheochromocytoma in a large multicenter multicenter cohort.Retrospective, multicenter analysis of consecutive patients with pheochromocytoma who underwent total unilateral laparoscopic adrenalectomy without conversion were included. Statistical analysis was performed using established intraoperative criteria for intraoperative hemodynamic instability: 1) systolic blood pressure160 mm Hg; 2) systolic blood pressure200 mm Hg; 3) mean arterial pressure60 mm Hg; 4) systolic blood pressure160 mm Hg + mean arterial pressure60 mm Hg; and 5) systolic blood pressure200 mm Hg + mean arterial pressure60 mm Hg; and 6) intravenous vasopressor + vasodilator.In total, 341 patients met the inclusion criteria, 101 (29.6%) underwent retroperitoneal adrenalectomy and 240 (70.4%) transperitoneal adrenalectomy. Multivariate analysis showed that retroperitoneal adrenalectomy carries greater risk for mean arterial pressure60 mm Hg (odds ratio 6.255, confidence interval 1.134-34.235, P = .035) compared with transperitoneal adrenalectomy. Overall and cardiovascular morbidity rates were comparable between the 2 approaches. The medical center was a significant independent influencing factor for all 6 intraoperative hemodynamic instability definitions.Variability in institutional management of pheochromocytoma intraoperatively has significant impact on all 6 intraoperative hemodynamic instability definitions. Standardization of anesthesia should be considered to reduce this variability.
Published: 2018
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13. Value of cross-sectional imaging in assessing active Crohn’s disease before stoma reversal

Author: Valérie Laurent, P. Olivera, Laura Martelli, Cédric Baumann, Silvio Danese, Adeline Germain, Bastien Dirrenberger, Laurent Bresler, Laurent Peyrin-Biroulet, Isabelle Clerc-Urmès, Dirrenberger, B, Clerc-Urmes, I, Germain, A, Bresler, L, Olivera, P, Martelli, L, Danese, S, Baumann, C, Laurent, V, and Peyrin-Biroulet, L
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, digestive system, Disease activity, Cross-sectional imaging, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Crohn Disease, Stoma (medicine), Recurrence, Postoperative treatment, medicine, Humans, In patient, Retrospective Studies, Crohn's disease, Anatomy, Cross-Sectional, Hepatology, Tumor Necrosis Factor-alpha, business.industry, Gastroenterology, Surgical Stomas, Middle Aged, medicine.disease, Magnetic Resonance Imaging, digestive system diseases, Surgery, surgical procedures, operative, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, France, Tomography, X-Ray Computed, business, Immunosuppressive Agents
Abstract: Background There are currently no guidelines on the need to assess disease activity before stoma reversal in Crohn’s disease (CD). We sought to determine the value of cross-sectional imaging for detecting active CD before stoma reversal. Methods 38 CD patients underwent cross-sectional imaging before stoma reversal. CD activity was blindly evaluated by an independent radiologist. Postoperative outcomes were recorded. Results Before stoma reversal, cross-sectional imaging identified active CD in 20 of the 38 study participants (52.6%). In 9 out of 10 tested patients, radiologic and endoscopic assessments gave concordant findings with regard to CD recurrence before stoma reversal. Stoma reversal was delayed in half of the patients with active CD and in none of the patients without active CD. Before stoma reversal, tumor necrosis factor alpha antagonists or immunosuppressants were initiated in 45% of the patients with active CD and 5.6% of the patients without active CD. In the year following stoma reversal, the recurrence rate (in a radiologic assessment) was higher in patients with active CD than in patients without active CD (75.0% vs. 30.8%, respectively; p = 0.04). Conclusion Cross-sectional imaging revealed postoperative recurrence in about a quarter of patients before stoma reversal; this finding may influence the postoperative treatment strategy and outcomes.
Published: 2017
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14. Deep infiltrating endometriosis: Interest of the robotic approach for a fledgling team

Author: Philippe Judlin, Julie Poujois, Cécile Malartic, Nicolas Hubert, Oliver Morel, Laurent Bresler, Ronan Callec, Service d'Obstétrique et de Gynécologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maternité Régionale Adolphe Pinard [Nancy], Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Service d'Urologie [CHRU Nancy], Imagerie Adaptative Diagnostique et Interventionnelle (IADI), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)
Subjects: 2. Zero hunger, Infertility, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Medical treatment, Deep endometriosis, business.industry, General surgery, Endometriosis, [SDV.IB.MN]Life Sciences [q-bio]/Bioengineering/Nuclear medicine, medicine.disease, Deep infiltrating endometriosis, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, Medicine, Surgical treatment, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: Introduction: Mini-invasive surgery of deep endometriosis is challenging. Surgical difficulties related to the technical limitations of classical laparoscopic approach might be overcome with the use of robotic assistance. The aim of this study was to evaluate the safety and feasibility of robotic surgery for deep infiltrating endometriosis in the learning phase of our team. Methods: The 20 first cases of robotic-assisted laparoscopies for endometriosis were included over a 2-year period. Baseline characteristics of patients and surgical data were reviewed. Surgical outcomes and follow-up information of the patients were analyzed. Results: Twenty women were included. The mean age was 31.9 years (range: 25–44) and mean body mass index was 23 kg/m2 (range: 16–35). Ten patients had rectovaginal or uterosacral location only (50%) and nine women had deep infiltrating endometriosis with digestive or urinary tract lesions (45%). In addition to the gynecologic surgeon, urologic or visceral surgeons were required in 10 cases, and there were 3 cases where the three specialties were needed. The mean operative time was 183.9 min (range: 85–398) and no difference was observed between the first five cases and the last five cases. There was one laparoconversion, and only two urologic postoperative complications occurred. Conclusion: Thanks to the use of robotic surgical assistance and a multidisciplinary approach, and despite the start of the team for deep endometriosis care, no learning curve effect was observed regarding surgical procedures’ success, safety, or duration. The use of robotic assistance might improve the quality of care for women facing deep endometriosis.
Published: 2019
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15. Risk factors for postoperative complications in robotic general surgery

Author: Laurent Bresler, Giovanni Fantola, Laurent Brunaud, Adeline Germain, Phi-Linh Nguyen-Thi, and Ahmet Ayav
Subjects: Adult, Male, Reoperation, medicine.medical_specialty, Multivariate analysis, Future studies, Adolescent, Hematocrit, Contraindications, Procedure, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Robotic Surgical Procedures, Risk Factors, medicine, Humans, Laparoscopy, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, General surgery, Mortality rate, Retrospective cohort study, Middle Aged, Surgery, ROC Curve, General Surgery, 030220 oncology & carcinogenesis, Female, 030211 gastroenterology & hepatology, Observational study, business
Abstract: The feasibility and safety of robotically assisted procedures in general surgery have been reported from various groups worldwide. Because postoperative complications may lead to longer hospital stays and higher costs overall, analysis of risk factors for postoperative surgical complications in this subset of patients is clinically relevant. The goal of this study was to identify risk factors for postoperative morbidity after robotic surgical procedures in general surgery. We performed an observational monocentric retrospective study. All consecutive robotic surgical procedures from November 2001 to December 2013 were included. One thousand consecutive general surgery patients met the inclusion criteria. The mean overall postoperative morbidity and major postoperative morbidity (ClavienIII) rates were 20.4 and 6 %, respectively. This included a conversion rate of 4.4 %, reoperation rate of 4.5 %, and mortality rate of 0.2 %. Multivariate analysis showed that ASA score3 [OR 1.7; 95 % CI (1.2-2.4)], hematocrit value38 [OR 1.6; 95 % CI (1.1-2.2)], previous abdominal surgery [OR 1.5; 95 % CI (1-2)], advanced dissection [OR 5.8; 95 % CI (3.1-10.6)], and multiquadrant surgery [OR 2.5; 95 % CI (1.7-3.8)] remained independent risk factors for overall postoperative morbidity. It also showed that advanced dissection [OR 4.4; 95 % CI (1.9-9.6)] and multiquadrant surgery [OR 4.4; 95 % CI (2.3-8.5)] remained independent risk factors for major postoperative morbidity (ClavienIII). This study identifies independent risk factors for postoperative overall and major morbidity in robotic general surgery. Because these factors independently impacted postoperative complications, we believe they could be taken into account in future studies comparing conventional versus robot-assisted laparoscopic procedures in general surgery.
Published: 2016
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16. NOD2 gene variant is a risk factor for postoperative complications in patients with Crohn's disease: A genetic association study

Author: Laurent Peyrin-Biroulet, Patrick B Allen, Mathias Chamaillard, Rosa-Maria Guéant, Jean-Louis Guéant, Adeline Germain, Laurent Bresler, Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Department of Gastroenterology [Ulster Hospital], Ulster Hospital, Institut Pasteur de Lille, and Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, 0301 basic medicine, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Nod2 Signaling Adaptor Protein, Inflammatory bowel disease, Gastroenterology, Genome-Wide Association, Cohort Studies, Postoperative Complications, 0302 clinical medicine, Crohn Disease, Recurrence, Risk Factors, Susceptibility Loci, Medicine, Child, Aged, 80 and over, Crohn's disease, Number, Bowel resection, Metaanalysis, Middle Aged, 3. Good health, Child, Preschool, Cohort, Female, 030211 gastroenterology & hepatology, Cohort study, Adult, medicine.medical_specialty, Abdominal Abscess, Adolescent, Polymorphism, Single Nucleotide, Young Adult, 03 medical and health sciences, Intraabdominal Septic Complications, Internal medicine, Humans, Risk factor, Genetic Association Studies, Aged, business.industry, Postoperative complication, Odds ratio, Resection, medicine.disease, Surgery, 030104 developmental biology, Therapy, business, Inflammatory-Bowel-Disease
Abstract: International audience; Background. Postoperative complications are relatively frequent in Crohn's disease (CD) and several risk factors have been identified. The influence of genetic factors, however is unknown.Methods. CD patients who underwent CD-related bowel resection were identified from the "Nancy IBD cohort." Postoperative complications were defined as intraabdominal infectious complications and non intraabdominal infectious complications occurring within 90 days after operation. The influence of 203 single nucleotide polymorphisms on postoperative complication rates was analyzed.Results. Of the 137 patients who had undergone a CD-related bowel resection in our cohort, postoperative complications occurred in 34 cases (24.8 %). Postoperative intraabdominal infections occurred in 18 cases (13. 1%): 12 had anastomotic leakage and 6 had intraabdominal abscesses. In multivariate analysis, current smoker status (odds ratio [OR], 2.71; 95% CI, 1.18-6.21; P =.02) and homozygosity for the risk allele (T) Nucleotide-binding Oligomerization Domain-containing protein 2 (rs5743289; NOD2; OR, 2.07 [95% CI 1.15-3.72]; P =.01) were independent risk factors of postoperative intraabdominal infectious complications. Current smoker status NOD2 homozygosity for the risk allele (T) were not associated with non intraabdominal infectious complications.Conclusion. Current smoker status was associated with increased risk of postoperative intraabdominal infectious complications. A novel association between the NOD2 allele and an increased risk of postoperative intraabdominal infectious, complications was observed in this study.
Published: 2016
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17. Prevalence of hepatic lesion types defined by T2-weighted and dynamic gadolinium-enhanced MR imaging in patients with metastasized neuroendocrine tumors

Author: Laurent Bresler, S. Milin, Laurent Brunaud, Claire Bastien, Xavier Orry, Marc Klein, and Valérie Laurent
Subjects: Adult, Male, medicine.medical_specialty, Urology, Gadolinium, Contrast Media, chemistry.chemical_element, Neuroendocrine tumors, 030218 nuclear medicine & medical imaging, Lesion, 03 medical and health sciences, Meglumine, 0302 clinical medicine, Internal medicine, Organometallic Compounds, Prevalence, medicine, Humans, Radiology, Nuclear Medicine and imaging, Aged, Retrospective Studies, Radiological and Ultrasound Technology, biology, medicine.diagnostic_test, business.industry, Liver Neoplasms, Gastroenterology, Magnetic resonance imaging, Retrospective cohort study, Middle Aged, Hepatology, medicine.disease, Magnetic Resonance Imaging, Neuroendocrine Tumors, chemistry, 030220 oncology & carcinogenesis, Ki-67, biology.protein, Female, France, Radiology, medicine.symptom, business, medicine.drug
Abstract: Identifying liver metastases from neuroendocrine tumors (NETs) is a pretherapeutic challenge in patients who are candidates for liver resection. The aims of our study are to characterize and determine the frequency of different MRI characteristics of liver metastases caused by NETs in a lesion-by-lesion analysis and to determine the frequency of monomorphous and polymorphous metastases in a patient-by-patient analysis. This retrospective study involved 47 patients with liver metastases arising from histologically confirmed NETs. In a lesion-by-lesion analysis, we classified these metastases according to their MRI characteristics as follows: hypervascular lesions with homogeneous or peripheral enhancement, hypovascular lesions, pure cystic lesions, and mixed solid/cystic lesions. In the patient-by-patient analysis, we distinguished patients whose metastases had the same MRI characteristics from patients with mixed lesion characteristics. A total of 376 metastases were analyzed. Of these, 84.3% (n = 317) were hypervascular, with 51.9% showing homogeneous enhancement and 32.4% (n = 122) showing peripheral enhancement. Another 7.4% (n = 28) were hypovascular, 5.3% (n = 20) were pure cystic, and 2.9% (n = 11) were mixed solid/cystic. After excluding three patients with solitary lesions, 40.9% of patients (n = 18) had mixed-type lesions, consisting of hypervascular lesions with either homogeneous or peripheral enhancement in 27.3% of cases (n = 12), while 59.1% of patients (n = 26) had identical lesions. Approximately 15% of metastases have atypical MRI characteristics and are either hypovascular or cystic. Metastases with different MRI characteristics coexist in 40% of patients.
Published: 2016
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18. Traitement chirurgical des tumeurs rétro-rectales : une étude de cohorte multicentrique française de 236 patients

Author: Jean-Jacques Tuech, Guillaume Meurette, Guillaume Piessen, Gil Lebreton, Zaher Lakkis, Philippe Rouanet, Igor Sielezneff, Mathilde Aubert, D. Mege, Bernard Lelong, Yves Panis, Eddy Cotte, P. Zerbib, Bertrand Trilling, Laura Beyer-Berjot, Laurent Bresler, M. Ouaissi, Jérémie H. Lefevre, and Charles Sabbagh
Subjects: Surgery
Abstract: Objectif Rapporter l’experience francaise de la prise en charge chirurgicale des tumeurs retro-rectales (TRR). Methodes Tous les patients operes d’une TRR dans 17 centres francais etaient retrospectivement inclus (2000–2019). Les voies d’abord (anterieure, posterieure et combinee) etaient comparees. Resultats Deux cent trente-six patients (184 femmes, âge moyen 46 ± 17 ans) ont ete inclus. Le diagnostic etait fortuit pour 94 patients (40 %). Les TRR etaient malignes dans 10 % des cas. La chirurgie etait realisee par voie anterieure (n = 65, 27,5), posterieure (n = 161, 68 %) ou combinee (n = 10, 4 %). Les voies d’abord posterieure et combinee etaient associees a des abces de paroi (16 % et 20 % vs 1,5 %, p = 0,008), alors que l’ileus survenait uniquement apres une voie anterieure (8 %, p = 0,001). Apres un suivi median de 12 [1–221] mois, une recidive locale etait observee dans 10 % des cas. Les complications fonctionnelles etaient rares (douleurs chroniques 8 %, dysfonctions urinaires 3 %, sexuelles 2,5 %, incontinence anale 1 %). Le taux de recidive et les complications fonctionnelles etaient similaires selon la voie d’abord. Conclusions Les TRR constituent un challenge chirurgical car majoritairement benignes et potentiellement pourvoyeuses de complications per- et postoperatoires. Il ne semble pas y avoir de superiorite d’une voie d’abord sur l’autre.
Published: 2020
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19. Left Robotic Transperitoneal Adrenalectomy

Author: Cyrille Buisset, Laurent Brunaud, Laurent Bresler, and Claire Nomine-Criqui
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, Adrenal gland, Adrenalectomy, medicine.medical_treatment, Adrenal Gland Neoplasm, Urology, medicine.disease, Normal limit, Left adrenal gland, medicine.anatomical_structure, Medicine, business, Laparoscopy, Testosterone, hirsutism
Abstract: A 59-year-old woman underwent an adrenal screening for hirsutism (face, chest). She had no clinical signs of hypercorticism. Laboratory investigations demonstrated increased plasma testosterone levels (twice the upper normal limit) and a markedly increased SDHEA level (ten times upper normal limit). Urinary free cortisol level was normal. Imaging studies showed a left adrenal mass of about 5 cm consistent with a cortical tumor without aggressive imaging characteristics. Contralateral adrenal gland and ovaries were normal. FDG-PET scan showed a moderate uptake at the left adrenal gland (tumor/liver SUV ratio = 2.1).
Published: 2019
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20. Robotic-assisted unilateral adrenalectomy: risk factors for perioperative complications in 303 consecutive patients

Author: Laurent Bresler, Claire Nomine-Criqui, Rasa Zarnegar, Timothy M. Ullmann, Michaël Thy, Tristan Greilsamer, and Laurent Brunaud
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Databases, Factual, medicine.medical_treatment, 030230 surgery, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Postoperative Complications, Robotic Surgical Procedures, Risk Factors, Internal medicine, Laparotomy, Outcome Assessment, Health Care, medicine, Humans, Laparoscopy, Intraoperative Complications, Aged, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, business.industry, Adrenalectomy, Incidence (epidemiology), Incidence, Perioperative, Hepatology, Middle Aged, Surgery, 030211 gastroenterology & hepatology, Female, business, Body mass index, Abdominal surgery
Abstract: There is no consensus about the utility of using the robotic platform to perform a unilateral lateral transabdominal adrenalectomy in comparison with conventional laparoscopy. In some groups, obese patients (Body Mass Index > 30 kg/m2) and patients with tumor size > 5 cm have been considered as good candidates for robotic adrenalectomy. However, evaluation of incidence and risk factors for perioperative complications is currently lacking in large series of patients. The aim of this study was to evaluate incidence and predictive factors for intraoperative (conversion and capsular rupture) and postoperative complications (morbidity) after unilateral robotic-assisted transabdominal lateral adrenalectomy. From 2001 to 2016, consecutive patients undergoing unilateral lateral transabdominal robotic adrenalectomy were included in a prospectively maintained database and analyzed retrospectively (clinicaltrials.gov NCT03410394). A total of 303 consecutive patients were analyzed. Between the first and last 100 of patients, mean tumor size increased from 2.9 to 4.2 cm (p 5 cm remained the only predictive factor for conversion to laparotomy (OR 7.47, 95% CI 1.81–30.75; p = 0.005). History of upper gastrointestinal surgery was the only predictive factor for capsular rupture (OR 13.6, 95% CI 2.33–80.03; p = 0.004). Conversion to laparotomy (OR 8.35, 95% CI 1.99–35.05; p = 0.003) and patient age (OR 1.039, 95% CI 1.006–1.072; p = 0.019) remained independent predictive factors for postoperative complications. This study identified independent risk factors for perioperative complications after robotic-assisted unilateral adrenalectomy. These factors should be taken into account when evaluating robotic-assisted transabdominal lateral adrenalectomy.
Published: 2018

21. Operative technique: Transperitoneal robotic adrenalectomy

Author: S. Moog, Laurent Bresler, Laurent Brunaud, and Claire Nomine-Criqui
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Adrenal Gland Neoplasm, Treatment outcome, Operative Time, Adrenal Gland Neoplasms, Blood Loss, Surgical, Pheochromocytoma, Patient Positioning, 03 medical and health sciences, Peritoneal cavity, 0302 clinical medicine, Robotic Surgical Procedures, Medicine, Humans, Minimally Invasive Surgical Procedures, Laparoscopy, Peritoneal Cavity, medicine.diagnostic_test, business.industry, Adrenalectomy, General Medicine, Length of Stay, medicine.disease, Hemostasis, Surgical, Surgery, medicine.anatomical_structure, Treatment Outcome, 030220 oncology & carcinogenesis, Operative time, 030211 gastroenterology & hepatology, Female, business
Published: 2018

22. CARD8 gene variant is a risk factor for recurrent surgery in patients with Crohn's disease

Author: Jean-Louis Guéant, Laurent Peyrin-Biroulet, Mathias Chamaillard, Adeline Germain, Rosa-Maria Guéant, Laurent Bresler, Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d’Infection et d’Immunité de Lille - INSERM U 1019 - UMR 9017 - UMR 8204 (CIIL), Centre National de la Recherche Scientifique (CNRS)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Service d'Hépato-gastro-entérologie [CHRU Nancy], Institut Pasteur de Lille, and Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Centre National de la Recherche Scientifique (CNRS)
Subjects: Male, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Constriction, Pathologic, Disease, Cohort Studies, Postoperative Complications, Crohn Disease, Recurrence, Risk Factors, Medicine, Ileitis, Child, Digestive System Surgical Procedures, Aged, 80 and over, Crohn's disease, Homozygote, Smoking, Gastroenterology, Bowel resection, Middle Aged, Colitis, Prognosis, Neoplasm Proteins, 3. Good health, Child, Preschool, Cohort, Female, Cohort study, Adult, Reoperation, medicine.medical_specialty, CARD8, Adolescent, Genotype, Polymorphism, Single Nucleotide, Young Adult, Humans, Alleles, Aged, Proportional Hazards Models, Retrospective Studies, Hepatology, Proportional hazards model, business.industry, Retrospective cohort study, medicine.disease, Surgery, CARD Signaling Adaptor Proteins, Intestinal Perforation, Multivariate Analysis, Surgical recurrence, business
Abstract: Background and aims Post-operative recurrence is frequent in Crohn's disease. Genetic factors associated with post-operative recurrence remain poorly understood. Identification of genetic variants associated with repeat surgery would allow risk stratification of patients who may benefit from early aggressive therapy and/or post-operative prophylactic treatment. Methods Crohn's disease patients who had at least one bowel resection were retrospectively identified from the “Nancy IBD cohort”. Covariates and potential interactions were assessed using the Cox proportional hazard model. Kaplan–Meier curves for time to surgical recurrence were developed for 200 genetic variants and analyzed with the log-rank test. Results 137 patients had at least 1 resection in our cohort: 38 had a surgical recurrence (28%). In multivariate analysis, current smoker status (OR 6.97, 95% CI 1.85–26.22, p = 0.004), post-operative complications after prior surgery (OR 2.72, 95% CI 1.02–7.22, p = 0.044), and Caspase recruitment domain-containing protein 8 (CARD8) homozygosity for the risk allele (OR 7.56, 95% CI 1.13–50.37, p = 0.036) remained significantly and independently associated with surgical recurrence. Conclusion Current smoker status was associated with increased risk of surgical recurrence. A novel association between CARD8 and increased risk of surgical recurrence in Crohn's disease was observed. CARD8 could be a new marker for risk stratification and prevention of recurrent surgery.
Published: 2015
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23. Robotic lateral transabdominal adrenalectomy

Author: Laurent Brunaud, Thomas Cuny, Laurent Bresler, Adeline Germain, Ahmet Ayav, Claire Nomine-Criqui, and Marc Klein
Subjects: medicine.medical_specialty, Standard of care, Laparoscopic adrenalectomy, medicine.diagnostic_test, business.industry, Adrenalectomy, medicine.medical_treatment, technology, industry, and agriculture, General Medicine, Surgery, body regions, surgical procedures, operative, Robotic systems, Oncology, medicine, business, Laparoscopy, human activities
Abstract: Laparoscopic transabdominal adrenalectomy is considered to be the standard of care for adrnalectomy. Widespread adoption of robotic technology has positioned robotic adrenalectomy as an option in some medical centers. Many studies have compared laparoscopic versus robotic approaches to perform adrenalectomy and evaluated potential advantages to balance higher costs. This review summarizes current available data regarding the use of the robotic system to perform adrenalectomy (RA) and its comparison with laparoscopic adrenalectomy (LA).
Published: 2015
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24. The computed tomography adrenal wash-out analysis properly classifies cortisol secreting adrenocortical adenomas

Author: Jean-Michel Vignaud, Elodie Chevalier, Anne-Laure Humbert, Fehd Bouderraoui, Laurent Bresler, Marc Klein, Sophie Moog, Guillaume Lecoanet, Laurent Brunaud, and Thomas Cuny
Subjects: Adult, Male, Hydrocortisone, Endocrinology, Diabetes and Metabolism, Computed tomography, Ct attenuation, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Fluorodeoxyglucose F18, Hounsfield scale, Positron Emission Tomography Computed Tomography, Adrenocortical Carcinoma, Medicine, Humans, Statistical analysis, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Histopathological analysis, Middle Aged, University hospital, Adrenal Cortex Neoplasms, stomatognathic diseases, Positron emission tomography, 030220 oncology & carcinogenesis, Adrenocortical Adenoma, Female, Analysis of variance, business, Nuclear medicine
Abstract: Adrenocortical lesions are characterized through imaging, hormonal and histopathological analysis. Our aim was to compare the radiological features of adrenocortical lesions with their cortisol-secreting status and histopathological Weiss score. Seventy five patients operated between 2004 and 2016 in the University Hospital of Nancy for either adrenocortical carcinomas (ACC) or adrenocortical adenomas (ACA) were enrolled in this study. We collected cortisol parameters, Computed Tomography (CT) scans (unenhanced density, wash-out (WO) analysis) and 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) datas. The histopathological Weiss score ultimately differentiates ACA (score ≤ 2) from ACC (score ≥ 3). One-way ANOVA, Fisher’s exact and unpaired t tests were used for statistical analysis with significancy reached at p
Published: 2017

25. Face and content validity of Xperience™ Team Trainer: bed-side assistant training simulator for robotic surgery

Author: Manuela Perez, Jacques Hubert, Song Xu, Luca Sessa, Laurent Brunaud, Laurent Bresler, and Cyril Perrenot
Subjects: Surgical team, business.industry, Trainer, 030232 urology & nephrology, Reproducibility of Results, Workload, Usability, Communication skills training, 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, 030220 oncology & carcinogenesis, business.product_line, Content validity, Medicine, Humans, Surgery, Robotic surgery, France, business, Simulation Training, Simulation, Face validity
Abstract: In robotic surgery, the coordination between the console-side surgeon and bed-side assistant is crucial, more than in standard surgery or laparoscopy where the surgical team works in close contact. Xperience™ Team Trainer (XTT) is a new optional component for the dv-Trainer® platform and simulates the patient-side working environment. We present preliminary results for face, content, and the workload imposed regarding the use of the XTT virtual reality platform for the psychomotor and communication skills training of the bed-side assistant in robot-assisted surgery. Participants were categorized into "Beginners" and "Experts". They tested a series of exercises (Pick & Place Laparoscopic Demo, Pick & Place 2 and Team Match Board 1) and completed face validity questionnaires. "Experts" assessed content validity on another questionnaire. All the participants completed a NASA Task Load Index questionnaire to assess the workload imposed by XTT. Twenty-one consenting participants were included (12 "Beginners" and 9 "Experts"). XTT was shown to possess face and content validity, as evidenced by the rankings given on the simulator's ease of use and realism parameters and on the simulator's usefulness for training. Eight out of nine "Experts" judged the visualization of metrics after the exercises useful. However, face validity has shown some weaknesses regarding interactions and instruments. Reasonable workload parameters were registered. XTT demonstrated excellent face and content validity with acceptable workload parameters. XTT could become a useful tool for robotic surgery team training.
Published: 2017

26. Surgically treated oesophageal cancer developed in a radiated field: Impact on peri-operative and long-term outcomes

Author: Sheraz R. Markar, Caroline Gronnier, Arnaud Pasquer, Alain Duhamel, Hélène Behal, Jérémie Théreaux, Johan Gagnière, Gil Lebreton, Cécile Brigand, Bernard Meunier, Denis Collet, Christophe Mariette, Guillaume Luc, Magalie Cabau, Jacques Jougon, Bogdan Badic, Patrick Lozach, Serge Cappeliez, Arnaud Alves, Renaud Flamein, Denis Pezet, Federica Pipitone, Bogdan Stan Iuga, Nicolas Contival, Eric Pappalardo, Styliani Mantziari, Flora Hec, Marguerite Vanderbeken, Williams Tessier, Nicolas Briez, Fabien Fredon, Alain Gainant, Muriel Mathonnet, Jean-Marc Bigourdan, Salim Mezoughi, Christian Ducerf, Jacques Baulieux, Oussama Baraket, Gilles Poncet, Delphine Vaudoyer, Peggy Jourdan Enfer, Laurent Villeneuve, Olivier Glehen, Thibault Coste, Jean Michel Fabre, Frédéric Marchal, Romain Frisoni, Ahmet Ayav, Laurent Brunaud, Laurent Bresler, Charlotte Cohen, Olivier Aze, Nicolas Venissac, Daniel Pop, Jérôme Mouroux, Ion Donici, Michel Prudhomme, Emanuele Felli, Stéphanie Lisunfui, Marie Seman, Gaelle Godiris Petit, Mehdi Karoui, Christophe Tresallet, Fabrice Ménégaux, Laurent Hannoun, Brice Malgras, Denis Lantuas, Karine Pautrat, Marc Pocard, Patrice Valleur, Imperial College London, Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Site de Recherche Intégrée en Cancérologie (SIRIC-ONCOLille), Université de Lille, Sciences et Technologies-Université de Lille, Sciences Humaines et Sociales-Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER-Université de Lille-UNICANCER-Cancéropole Nord-Ouest-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), 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), Chirurgie digestive et hépatobiliaire, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Hôpital de Hautepierre [Strasbourg], Laboratoire de chimie de coordination (LCC), Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), 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), Hôpital Haut-Lévêque [CHU Bordeaux], CHU Bordeaux [Bordeaux], CIC-IT Bordeaux, Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie Générale et Viscérale (CGV - BREST), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), 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), Département de chirurgie digestive, CHU Clermont-Ferrand, CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Claude Huriez [Lille], CHU Lille, Service de Chirurgie Générale et Digestive[Lille], Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges], CHU Limoges, Homéostasie Cellulaire et Pathologies (HCP), Université de Limoges (UNILIM)-CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Ciblage thérapeutique en Oncologie (EA3738), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Service Médico-Chirurgical des Maladies de l'Appareil Digestif et de Transplantation Hépatique, Hôpital Saint Eloi (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy] (UNICANCER/ICL), UNICANCER, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre Hospitalier Universitaire de Nice (CHU Nice), Department of Thoracic Surgery, Louis Pasteur Hospital, Groupe de Recherche Angevin en Economie et Management (GRANEM), Université d'Angers (UA)-AGROCAMPUS OUEST-Institut National de l'Horticulture et du Paysage, Service de Chirurgie thoracique, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Service d'hépato-gastro-entérologie [APHP Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Department of Gastroenterological Surgery, 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 Digestive, 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), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U1172 Inserm - U837 (JPArc), Institut de Chimie de Toulouse (ICT-FR 2599), 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)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Service de Chirurgie Digestive, Hépato-Bilio-pancréatique et Transplantation Hépatique [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Carcinose Angiogenèse et Recherche Translationnelle, Angiogenese et recherche translationnelle (CART U965), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer (JPArc - U837 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université Lille 2 - Faculté de Médecine, Santé publique : épidémiologie et qualité des soins-EA 2694 (CERIM), Université de Lille, Sciences et Technologies-Université de Lille, Sciences Humaines et Sociales-CRLCC Oscar Lambret-Cancéropole Nord-Ouest-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Centre Hospitalier Universitaire Estaing, 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), 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-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB), UMR Peuplement Végétaux et Bioagresseurs en Milieu Tropical (UMR PVBMT - INRA), Institut National de la Recherche Agronomique (INRA), Hôpital Claude Huriez, Université de Limoges (UNILIM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-CHU Limoges, CHU Saint-Eloi, Université de Lorraine (UL), Faculté de Médecine [Nancy], Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Pitié-Salpêtrière [APHP], Service de chirurgie générale, Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Service de chirurgie digestive et hépato-bilio-pancréatique [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Centre de recherche Jean-Pierre Aubert-Neurosciences et Cancer, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Centre d'Etude et Recherche en Informatique Médicale, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Microbes, Intestin, Inflammation et Susceptibilité de l'Hôte - Clermont Auvergne (M2iSH), Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne (UCA)-Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne), Service de Chirurgie Hépatobiliaire et Digestive, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service de chirurgie digestive, Service de Médecine Interne, PRES Université Lille Nord de France-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Department of Digestive Surgery, University Medical Hospital, Unité de Chirurgie Colorectale, CHU Grenoble, Unité de Méthodologie en Recherche Clinique, Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Centre de recherche en éducation de Nantes (CREN), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Chelsea and Westminster Hospital, Service de Chirurgie Thoracique (NICE - Chirurgie Thoracique), West University of Timisoara [Roumanie] (UVT), Service d'endocrinologie-métabolisme [CHU Pitié-Salpêtrière], Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Hôpital Henri Mondor-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille, Université Lille Nord de France (COMUE)-UNICANCER-Université Lille Nord de France (COMUE)-UNICANCER-Cancéropole Nord-Ouest-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), 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), Institut National de l'Horticulture et du Paysage-AGROCAMPUS OUEST, Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Université d'Angers (UA), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Hôpital Henri Mondor-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Université de Brest (UBO), Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL), Université d'Angers (UA)-AGROCAMPUS OUEST, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de l'Horticulture et du Paysage
Subjects: Male, Cancer Research, medicine.medical_specialty, Neoplasms, Radiation-Induced, Esophageal Neoplasms, medicine.medical_treatment, [SDV]Life Sciences [q-bio], [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Adenocarcinoma, Eighty Nine, Radiated field, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Breast cancer, medicine, Humans, Hospital Mortality, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Aged, Radiotherapy, business.industry, Incidence (epidemiology), Cancer, Neoplasms, Second Primary, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, Chemoradiotherapy, Perioperative, Middle Aged, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, 3. Good health, Surgery, Radiation therapy, Treatment Outcome, Editorial, Oncology, 030220 oncology & carcinogenesis, Propensity score matching, Carcinoma, Squamous Cell, Female, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: The objectives of this study were to compare peri-operative and long-term outcomes from oesophageal cancer (EC) (i) that arose in a previously radiated field (ECRF) versus primary (PEC) and among ECRF patients and (ii) radiotherapy-induced (RIEC) versus non-radiotherapy-induced EC (NRIEC).Data were collected from 30 European centres from 2000 to 2010. Two thousand four hundred eighty nine EC patients surgically treated were included in the PEC group and 136 in the ECRF group, NRIEC group (n = 61) and RIEC group (n = 75). Propensity score matching analyses were used to compensate for differences in baseline characteristics.Compared to the PEC group, the ECRF group was characterised by less use of neoadjuvant chemoradiotherapy (0% versus 29.5%; P 0.001), less pathological stage III/IV (31.6% versus 39.2%, P = 0.036), greater incidence of R1/2 margins (21.3% versus 10.9%; P 0.001), increased in-hospital mortality (14.0% versus 7.1%; P = 0.003) and overall morbidity (68.4% versus 56.4%, P = 0.006). After matching, 5-year overall (28.8% versus 50.5%; hazard ratio [HR] = 1.53, 95% confidence interval [CI]: 1.15-2.04; P = 0.003) and event-free (32.2% versus 42.5%; HR = 1.56, 95% CI: 1.18-2.05; P = 0.002) survivals were significantly reduced in the ECRF group. There were no significant differences in incidence or pattern of tumour recurrence. Comparing RIEC and NRIEC groups, there were no significant differences in short- or long-term outcomes before and after matching.ECRF is associated with poorer long-term survival related to a reduced utilisation of neoadjuvant chemoradiotherapy and an increased incidence of tumour margin involvement at surgery. Outcomes appear to be dictated by the limitations related to previous radiotherapy administration more than the radiotherapy-induced carcinogenesis.
Published: 2017
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27. Effect of portal vein ligation on tumor growth and liver regeneration in rat cirrhotic liver lobes

Author: Rui Xu, Nguyen Tran, Laurent Bresler, Zhi‑Su Liu, Yu‑Feng Yuan, Chong‑Qing Jiang, and Ahmet Ayav
Subjects: Cancer Research, Pathology, medicine.medical_specialty, Cirrhosis, Muscle hypertrophy, Immunology and Microbiology (miscellaneous), Fibrosis, medicine, liver regeneration, skin and connective tissue diseases, Oncogene, biology, business.industry, cirrhosis, portal vein ligation, Articles, General Medicine, respiratory system, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, medicine.disease, Molecular medicine, Liver regeneration, tumor growth, Alanine transaminase, Apoptosis, biology.protein, bacteria, business
Abstract: The aim of the present study was to investigate the effect of portal vein ligation (PVL) on the tumor growth rate and liver regeneration in rat cirrhotic liver lobes. A total of 45 male Wistar rats were randomly divided into PVL, hepatic tumor (HT) and HT + PVL groups (n=15 per group). Liver regeneration and tumor growth in ligated and non-ligated lobes were evaluated prior to and following PVL. In addition, serum alanine transaminase, total bilirubin levels and liver tissue samples were evaluated. The results indicated that PVL induced apparent hypertrophy in normal and HT rats. However, the ratio of non-ligated lobes to total liver weight or body weight in the HT + PVL group was significantly lower when compared with the PVL group (P
Published: 2014
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28. Un chylothorax récalcitrant : le radiologue plus fort que le chirurgien

Author: J. Leclerc, Cyrille Buisset, M. Sole, Adeline Germain, Ahmet Ayav, and Laurent Bresler
Subjects: Surgery
Abstract: Le chylothorax apres oesogastrectomie polaire superieure est une complication rare (3,8 %) mais potentiellement mortelle. Nous rapportons le cas d’un chylothorax traite par lymphangiographie apres echec des traitements medico-chirurgicaux. Il s’agit d’une patiente de 58 ans presentant une recidive d’un carcinome epidermoide du bas œsophage ayant beneficie d’une oesogastrectomie polaire superieure par double voie avec ligature elective du canal thoracique. On constatait en post-operatoire immediat l’apparition d’un chylothorax estime a 2 litres/24H qui persistait apres mise a jeun et nutrition parenterale. Une reprise chirurgicale au 4e jour ne permettait pas de retrouver le canal thoracique. Un traitement medical par somatostatine etait ensuite entrepris mais sans succes. Au 14e jour, une lymphangiographie au Lipiodol etait realisee, remontant progressivement jusqu’a L2 sans opacifier la citerne de Pecquet (ne permettant pas l’embolisation du canal thoracique). Cependant, on observait un tarissement rapide de la fistule chyleuse autorisant le retrait des drains au 17e jour. Il n’existe pas de consensus dans le traitement du chylothorax compliquant une oesogastrectomie polaire superieure. L’embolisation percutanee du canal thoracique est une option therapeutique decrite. Cependant une lymphangiographie diagnostique meme incomplete peut s’averer efficace.
Published: 2019
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29. Robot-assisted adrenalectomy: indications and drawbacks

Author: Laurent Bresler, Adeline Germain, Claire Nomine-Criqui, Ahmet Ayav, and Laurent Brunaud
Subjects: medicine.medical_specialty, medicine.medical_treatment, Adrenal Gland Neoplasms, Malignancy, Adrenocortical adenoma, law.invention, Pheochromocytoma, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Robotic Surgical Procedures, law, medicine, Adrenocortical carcinoma, Humans, Robotic surgery, Laparoscopy, medicine.diagnostic_test, business.industry, Adrenalectomy, medicine.disease, Surgery, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, business
Abstract: Adrenal tumors can vary from a benign adrenocortical adenoma with no hormonal secretion to a secretory adrenocortical malignancy (adrenocortical carcinoma) or a hormone-secreting tumor of the adrenal medulla (pheochromocytoma). Currently, laparoscopic adrenalectomy is regarded as the preferred surgical approach for the management of most adrenal surgical disorders, although there are no prospective randomized trials comparing this technique with open adrenalectomy. However, widespread adoption of robotic technology has positioned robotic adrenalectomy as an option in some medical centers. Speculative advantages associated with the use of the robotic system have rarely been evaluated in clinical settings and cost increase remains an important drawback associated with robotic surgery. This review summarizes current available data regarding robotic transperitoneal adrenalectomy including its indications, advantages, limitations, and comparison with conventional laparoscopic adrenalectomy. We believe that the use of a robotic system seems to be useful especially in more difficult patients with larger tumors, truncal paragangliomas, and bilateral and/or partial adrenalectomies. Overall, we believe that overcosts due to robotic system use could be balanced by hospital stay decrease, patients' referral increase, improved postoperative outcomes in more difficult patients and ergonomics for the surgeon. However, we also believe that the current surgical intuitive business model is counterproductive, because there are no available strong clinical data that could balance overcosts associated with the use of the robotic system.
Published: 2017

30. Robotic transperitoneal left adrenalectomy for a 10cm pheochromocytoma (with video)

Author: Laurent Brunaud, Claire Nomine-Criqui, Luca Sessa, Laurent Bresler, Adeline Germain, and Ahmet Ayav
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Adrenal Gland Neoplasm, Tumor burden, Adrenal Gland Neoplasms, 030209 endocrinology & metabolism, Pheochromocytoma, 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, Medicine, Humans, Robotic surgery, Laparoscopy, medicine.diagnostic_test, business.industry, Adrenalectomy, General surgery, Left adrenalectomy, General Medicine, medicine.disease, Surgery, Tumor Burden, 030220 oncology & carcinogenesis, Peritoneum, business
Published: 2016

31. Comments on: Clinical predictors of prolonged postresection hypotension after laparoscopic adrenalectomy for pheochromocytoma

Author: Adeline Germain, Ahmet Ayav, Laurent Bresler, Laurent Brunaud, Claire Nomine-Criqui, Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service d'Hépato-gastro-entérologie [CHRU Nancy], and Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)
Subjects: medicine.medical_specialty, medicine.diagnostic_test, Laparoscopic adrenalectomy, business.industry, Adrenalectomy, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Adrenal Gland Neoplasm, 030230 surgery, medicine.disease, 3. Good health, Endoscopy, Surgery, Pheochromocytoma, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, medicine, business, Laparoscopy, ComputingMilieux_MISCELLANEOUS
Abstract: International audience; no abstract
Published: 2016
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32. Parenchymal-sparing hepatectomies (PSH) for bilobar colorectal liver metastases are associated with a lower morbidity and similar oncological results: a propensity score matching analysis

Author: Riccardo Memeo, Vito de Blasi, René Adam, Diane Goéré, Daniel Azoulay, Ahmet Ayav, Emilie Gregoire, Reza Kianmanesh, Francis Navarro, Antonio Sa Cunha, Patrick Pessaux, Cyril Cosse, Delphine Lignier, Jean Marc Regimbeau, Julien Barbieux, Emilie Lermite, Antoine Hamy, François Mauvais, Christophe Laurent, Irchid Al Naasan, Alexis Laurent, Philippe Compagnon, Mohammed Sbai Idrissi, Frédéric Martin, Jérôme Atger, Jacques Baulieux, Benjamin Darnis, Jean Yves Mabrut, Vahan Kepenekian, Julie Perinel, Mustapha Adham, Olivier Glehen, Michel Rivoire, Jean Hardwigsen, Anaïs Palen, Yves Patrice Le Treut, Jean Robert Delpero, Olivier Turrini, Astrid Herrero, Fabrizio Panaro, Laurent Bresler, Philippe Rauch, François Guillemin, Frédéric Marchal, Jean Gugenheim, Antonio Iannelli, Stéphane Benoist, Antoine Brouquet, Marc Pocard, Rea Lo Dico, David Fuks, Olivier Scatton, Olivier Soubrane, Jean-Christophe Vaillant, Tullio Piardi, Daniel Sommacale, Michel Comy, Philippe Bachellier, Elie Oussoultzoglou, Pietro Addeo, Dimitrios Ntourakis, Didier Mutter, Jacques Marescaux, Loïc Raoux, Bertrand Suc, Fabrice Muscari, Georges Elhomsy, Maximiliano Gelli, Denis Castaing, Daniel Cherqui, Gabriella PIttau, Oriana Ciacio, Eric Vibert, Dominique Elias, Fabrizio Vittadello, L'Institut hospitalo-universitaire de Strasbourg (IHU Strasbourg), Institut National de Recherche en Informatique et en Automatique (Inria)-l'Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD)-Les Hôpitaux Universitaires de Strasbourg (HUS)-La Fédération des Crédits Mutuels Centre Est (FCMCE)-L'Association pour la Recherche contre le Cancer (ARC)-La société Karl STORZ, Institut de Recherche Contre les Cancers de l'Appareil Digestif-European Institute of Telesurgery (IRCAD/EITS), CHU Strasbourg, Hôpital Paul Brousse, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse, Département de chirurgie générale [Gustave Roussy], Institut Gustave Roussy (IGR), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Hôpital de la Timone [CHU - APHM] (TIMONE), AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)
Subjects: Male, Time Factors, Hepatocellular carcinoma, medicine.medical_treatment, Treatment outcome, Kaplan-Meier Estimate, Remnant liver, Gastroenterology, Wedge resection, 0302 clinical medicine, Risk Factors, Cancer, Aged, 80 and over, education.field_of_study, Liver Neoplasms, Middle Aged, 3. Good health, Treatment Outcome, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, Original Article, France, Colorectal Neoplasms, Adult, medicine.medical_specialty, Disease free survival, Population, Risk Assessment, Disease-Free Survival, 03 medical and health sciences, Internal medicine, medicine, 2 stage hepatectomy, Hepatectomy, Humans, Laparoscopic resection, Systemic chemotherapy, Mortality, education, Propensity Score, Aged, Retrospective Studies, Chi-Square Distribution, Hepatology, business.industry, Liver failure, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, Retrospective cohort study, Length of Stay, Hepatic resection, Surgery, Logistic Models, Dysfunction, Propensity score matching, business, Chi-squared distribution, Liver Failure
Abstract: 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.
Published: 2016
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33. Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study

Author: Sheraz R. Markar, Caroline Gronnier, Arnaud Pasquer, Alain Duhamel, Hélène Beal, Jérémie Théreaux, Johan Gagnière, Gil Lebreton, Cécile Brigand, Bernard Meunier, Denis Collet, Christophe Mariette, Abdennahceur Dhahri, Delphine Lignier, Cyril Cossé, Jean-Marc Regimbeau, Magalie Cabau, Jacques Jougon, Bogdan Badic, Patrick Lozach, Jean Pierre Bail, Serge Cappeliez, Issam El Nakadi, Arnaud Alves, Renaud Flamein, Denis Pezet, Federica Pipitone, Bogdan Stan-Iuga, Nicolas Contival, Eric Pappalardo, Simon Msika, Styliani Mantziari, Nicolas Demartines, Flora Hec, Marguerite Vanderbeken, Williams Tessier, Nicolas Briez, Fabien Fredon, Alain Gainant, Muriel Mathonnet, Jean Marc Bigourdan, Salim Mezoughi, Christian Ducerf, Jacques Baulieux, Jean-Yves Mabrut, Oussama Baraket, Gilles Poncet, Mustapha Adham, Delphine Vaudoyer, Peggy Jourdan Enfer, Laurent Villeneuve, Olivier Glehen, Thibault Coste, Jean-Michel Fabre, Frédéric Marchal, Romain Frisoni, Ahmet Ayav, Laurent Brunaud, Laurent Bresler, Charlotte Cohen, Olivier Aze, Nicolas Venissac, Daniel Pop, Jérôme Mouroux, Ion Donici, Michel Prudhomme, Emanuele Felli, Stéphanie Lisunfui, Marie Seman, Gaelle Godiris Petit, Mehdi Karoui, Christophe Tresallet, Fabrice Ménégaux, Jean-Christophe Vaillant, Laurent Hannoun, Brice Malgras, Denis Lantuas, Karine Pautrat, Marc Pocard, Patrice Valleur, Najim Chafai, Pierre Balladur, Magalie Lefrançois, Yann Parc, François Paye, Emmanuel Tiret, Marius Nedelcu, Letizia Laface, Thierry Perniceni, Brice Gayet, Alexandre Filipello, Jack Porcheron, Olivier Tiffet, Noémie Kamlet, Rodrigue Chemaly, Amandine Klipfel, Patrick Pessaux, Cecile Brigand, Serge Rohr, Nicolas Carrère, Chiara Da Re, Frédéric Dumont, Diane Goéré, Dominique Elias, Claude Bertrand, Imperial College London, 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, Hôpital Claude Huriez [Lille], CHU Lille, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Site de Recherche Intégrée en Cancérologie (SIRIC-ONCOLille), Université de Lille, Sciences et Technologies-Université de Lille, Sciences Humaines et Sociales-Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER-Université de Lille-UNICANCER-Cancéropole Nord-Ouest-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Biostatistiques [CHRU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Chirurgie Générale et Viscérale (CGV - BREST), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), 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), Hôpital Côte de Nacre [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital de Hautepierre [Strasbourg], Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], CHU Pontchaillou [Rennes], Service de chirurgie digestive, CHU Bordeaux [Bordeaux], Ingénierie des Matériaux Polymères (IMP), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), CIC-IT Bordeaux, Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Brest (UBO), Département de chirurgie digestive, CHU Clermont-Ferrand, Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Chirurgie Générale et Digestive[Lille], Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges], CHU Limoges, Homéostasie Cellulaire et Pathologies (HCP), Université de Limoges (UNILIM)-CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Unité de Chirurgie Colorectale, CHU Grenoble, Environnement Ville Société (EVS), École normale supérieure - Lyon (ENS Lyon)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Université Lumière - Lyon 2 (UL2)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet [Saint-Étienne] (UJM)-École Nationale des Travaux Publics de l'État (ENTPE)-École nationale supérieure d'architecture de Lyon (ENSAL)-Centre National de la Recherche Scientifique (CNRS), Unité de Méthodologie en Recherche Clinique, Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Centre de recherche en éducation de Nantes (CREN), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Chelsea and Westminster Hospital, Service de Chirurgie Thoracique (NICE - Chirurgie Thoracique), Centre Hospitalier Universitaire de Nice (CHU Nice), West University of Timișoara [Roumanie] (WUT), Service de Chirurgie thoracique, Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Lab-STICC_UBS_CID_DECIDE, Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (UMR 3192) (Lab-STICC), Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (Lab-STICC), Université européenne de Bretagne - European University of Brittany (UEB)-École Nationale d'Ingénieurs de Brest (ENIB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-École Nationale d'Ingénieurs de Brest (ENIB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Centre National de la Recherche Scientifique (CNRS), Service d'hépato-gastro-entérologie [APHP Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'Endocrinologie, Métabolisme et Prévention des Maladies Cardio-vasculaires [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de Mathématiques Informatique et Applications (LAMIA), Université des Antilles et de la Guyane (UAG), Service de Chirurgie Digestive, Hépato-Bilio-pancréatique et Transplantation Hépatique [CHU Pitié-Salpétrière], Department of Gastroenterological Surgery, Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Carcinose Angiogenèse et Recherche Translationnelle, Angiogenese et recherche translationnelle (CART U965), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie Digestive, 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 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), 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), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut Mutualiste de Montsouris (IMM), Departement medico-chirurgical de pathologie digestive, Chirurgie digestive, Centre Hospitalier Universitaire de Saint-Etienne, Départment de Statistiques Bio-médicales, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service de chirurgie digestive [Strasbourg-Hautepierre], Département de chirurgie générale [Gustave Roussy], Institut Gustave Roussy (IGR), R&D, centre de Fresnes, Pfizer, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Lille Nord de France (COMUE)-Université de Lille, Université Lille Nord de France (COMUE)-UNICANCER-Université Lille Nord de France (COMUE)-UNICANCER-Cancéropole Nord-Ouest-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de biostatistiques [CHU Lille], Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Jean Monnet [Saint-Étienne] (UJM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (Lab-STICC), École Nationale d'Ingénieurs de Brest (ENIB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Université européenne de Bretagne - European University of Brittany (UEB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-École Nationale d'Ingénieurs de Brest (ENIB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Centre National de la Recherche Scientifique (CNRS), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Hôpital Henri Mondor-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d’Endocrinologie, Métabolisme et Prévention des Risques Cardio-Vasculaires [CHU Pitié-Salpêtrière], ONERA - The French Aerospace Lab [Châtillon], ONERA-Université Paris Saclay (COmUE), Centre de recherche Jean-Pierre Aubert-Neurosciences et Cancer, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Hôpital Claude Huriez, Université de Lille, Sciences et Technologies-Université de Lille, Sciences Humaines et Sociales-CRLCC Oscar Lambret-Cancéropole Nord-Ouest-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Universitaire Estaing, UMR Peuplement Végétaux et Bioagresseurs en Milieu Tropical (UMR PVBMT - INRA), Institut National de la Recherche Agronomique (INRA), Service de Chirurgie Hépatobiliaire et Digestive, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet [Saint-Étienne] (UJM)-Centre National de la Recherche Scientifique (CNRS), CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Hopital Louis Mourier - AP-HP [Colombes], École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-École Nationale des Travaux Publics de l'État (ENTPE)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-École nationale supérieure d'architecture de Lyon (ENSAL)-Centre National de la Recherche Scientifique (CNRS)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM), West University of Timisoara [Roumanie] (UVT), Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service d'endocrinologie-métabolisme [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Service de chirurgie digestive et hépato-bilio-pancréatique [CHU Pitié-Salpétrière], Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Centre de Recherche Saint-Antoine (CR Saint-Antoine), ONERA, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université de Limoges (UNILIM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-CHU Limoges, Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Environnement, Ville, Société (EVS), École normale supérieure de Lyon (ENS de Lyon)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-École Nationale des Travaux Publics de l'État (ENTPE)-École nationale supérieure d'architecture de Lyon (ENSAL)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Service de Chirurgie Hépatobiliaire et Digestive [Rennes], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Sorbonne Université, Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Lille, Droit et Santé, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Hospices Civils de Lyon ( HCL ), Site de Recherche Intégrée en Cancérologie ( SIRIC-ONCOLille ), Université de Lille, Sciences et Technologies-Université de Lille, Sciences Humaines et Sociales-CRLCC Oscar Lambret-Cancéropole Nord-Ouest-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Service de Chirurgie Générale et Viscérale ( CGV - BREST ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ) -Université de Brest ( UBO ), UMR Peuplement Végétaux et Bioagresseurs en Milieu Tropical ( UMR PVBMT - INRA ), Institut National de la Recherche Agronomique ( INRA ), Hôpital de la Côte de Nacre, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Ingénierie des Matériaux Polymères - Site Université Claude Bernard Lyon 1 ( IMP ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Institut National des Sciences Appliquées ( INSA ) -Université Jean Monnet [Saint-Étienne] ( UJM ) -Centre National de la Recherche Scientifique ( CNRS ), CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Bordeaux ( UB ), Université de Brest ( UBO ), Centre de recherche sur l'Inflammation ( CRI ), Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Homéostasie Cellulaire et Pathologies ( HCP ), Université de Limoges ( UNILIM ) -CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST FR CNRS 3503 ), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie ( UPMC ), Université Pierre et Marie Curie - Paris 6 ( UPMC ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Environnement Ville Société ( EVS ), École normale supérieure - Lyon ( ENS Lyon ) -Université Lumière - Lyon 2 ( UL2 ) -Université Jean Moulin - Lyon III-Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université Jean Monnet [Saint-Étienne] ( UJM ) -École Nationale des Travaux Publics de l'État ( ENTPE ) -Ecole Nationale Supérieure des Mines de Saint-Etienne-École nationale supérieure d'architecture de Lyon ( ENSAL ) -Centre National de la Recherche Scientifique ( CNRS ), Université de Lyon-Université de Lyon-Hospices Civils de Lyon ( HCL ), Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Centre de recherche en éducation de Nantes ( CREN ), Université de Nantes ( UN ), Centre de Recherche en Automatique de Nancy ( CRAN ), Université de Lorraine ( UL ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Nutrition-Génétique et Exposition aux Risques Environnementaux ( NGERE ), Université de Lorraine ( UL ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Chelsea and Westminster Hospital NHS Foundation Trust, Service de Chirurgie Thoracique ( NICE - Chirurgie Thoracique ), CHU Nice, West University of Timisoara [Roumanie], West University of Timisoara, Centre Hospitalier Régional Universitaire de Nîmes ( CHRU Nîmes ), Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (UMR 3192) ( Lab-STICC ), Université européenne de Bretagne ( UEB ) -Université de Bretagne Sud ( UBS ) -Université de Brest ( UBO ) -Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques ( IBNM ), Université de Brest ( UBO ) -Institut Mines-Télécom [Paris]-Centre National de la Recherche Scientifique ( CNRS ) -Université européenne de Bretagne ( UEB ) -Université de Bretagne Sud ( UBS ) -Université de Brest ( UBO ) -Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques ( IBNM ), Université de Brest ( UBO ) -Institut Mines-Télécom [Paris]-Centre National de la Recherche Scientifique ( CNRS ) -Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance ( Lab-STICC ), École Nationale d'Ingénieurs de Brest ( ENIB ) -Université de Bretagne Sud ( UBS ) -Université de Brest ( UBO ) -Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques ( IBNM ), Université de Brest ( UBO ) -Université européenne de Bretagne ( UEB ) -ENSTA Bretagne-Institut Mines-Télécom [Paris]-Centre National de la Recherche Scientifique ( CNRS ) -École Nationale d'Ingénieurs de Brest ( ENIB ) -ENSTA Bretagne-Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Laboratoire de Mathématiques Informatique et Applications ( LAMIA ), Université des Antilles et de la Guyane ( UAG ), Angiogenese et recherche translationnelle ( CART U965 ), Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 ( UPD7 ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Saint-Antoine [APHP], Centre de Recherche Saint-Antoine ( CR Saint-Antoine ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Institut Mutualiste de Montsouris ( IMM ), CHU Angers, ONERA - The French Aerospace Lab ( Chatillon ), Procédés Alimentaires et Microbiologiques [Dijon] ( PAM ), Université de Bourgogne ( UB ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Université Bourgogne Franche-Comté ( UBFC ), and Institut Gustave Roussy ( IGR )
Subjects: Oncology, Subset Analysis, Cancer Research, medicine.medical_specialty, Neoadjuvant treatment, Survival, medicine.medical_treatment, [SDV]Life Sciences [q-bio], [SDV.CAN]Life Sciences [q-bio]/Cancer, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Neoadjuvant therapy, [ SDV ] Life Sciences [q-bio], business.industry, Oesophageal cancer, Carcinoma, Phase-III Trial, Cancer, Retrospective cohort study, Chemoradiotherapy, cT2N0M0, medicine.disease, Resection, 3. Good health, Postoperative Mortality, Esophagectomy, 030220 oncology & carcinogenesis, Propensity score matching, Adenocarcinoma, 030211 gastroenterology & hepatology, Surgery, Therapy, business
Abstract: International audience; Aims: The aims of this study were to compare short-and long-term outcomes for clinical T2N0 oesophageal cancer with analysis of (i) primary surgery (S) versus neoadjuvant therapy plus surgery (NS), (ii) squamous cell carcinoma and adenocarcinoma subsets; and (iii) neoadjuvant chemoradiotherapy versus neoadjuvant chemotherapy.Methods: Data were collected from 30 European centres from 2000 to 2010. Among 2944 included patients, 355 patients (12.1%) had cT2N0 disease; 285 (S) and 70 (NS), were compared in terms of short-and long-term outcomes. Propensity score matching analyses were used to compensate for differences in baseline characteristics.Results: No significant differences between the groups were shown in terms of in hospital morbidity and mortality. Nodal disease was observed in 50% of S-group at the time of surgery, with 20% pN2/N3. Utilisation of neoadjuvant therapy was associated with significant tumour downstaging as reflected by increases in pT0, pN0 and pTNM stage 0 disease, this effect was further enhanced with neoadjuvant chemoradiotherapy. After adjustment on propensity score and confounding factors, for all patients and subset analysis of squamous cell and adenocarcinoma, neoadjuvant therapy had no significant effect upon survival or recurrence (overall, loco-regional, distant or mixed) compared to surgery alone. There were no significant differences between neoadjuvant chemotherapy and chemoradiotherapy in short-or long-term outcomes.Conclusion: The results of this study suggest that a surgery alone treatment approach should be recommended as the primary treatment approach for cT2N0 oesophageal cancer despite 50% of patients having nodal disease at the time of surgery.
Published: 2016
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34. Incidence of and impact of medications on colectomy in newly diagnosed ulcerative colitis in the era of biologics

Author: Nicolas Williet, Jean-Louis Guéant, Laurent Peyrin-Biroulet, Marc-André Bigard, Jean-Baptiste Chevaux, Abderrahim Oussalah, Laurent Bresler, Vincent Billioud, and Claire Pillot
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Gastroenterology, Young Adult, Internal medicine, medicine, Humans, Immunology and Allergy, Cumulative incidence, Prospective Studies, Mesalamine, Prospective cohort study, Referral and Consultation, Colectomy, Mercaptopurine, Tumor Necrosis Factor-alpha, business.industry, Incidence (epidemiology), Hazard ratio, Prognosis, medicine.disease, Combined Modality Therapy, Ulcerative colitis, Infliximab, Propensity score matching, Colitis, Ulcerative, Female, business, Follow-Up Studies, medicine.drug
Abstract: Background: The cumulative incidence of colectomy and the impact of 5-aminosalicylates (5-ASA), azathioprine, and antitumor necrosis factor (TNF) treatment on the long-term need for surgery are unknown in ulcerative colitis (UC) in the era of biologics. Methods: This was an observational study of a referral center cohort. The cumulative incidence of UC-related colectomy was estimated using the Kaplan–Meier method. Independent predictors of surgery were identified using Cox proportional hazards regression with propensity scores adjustment. The electronic charts of 151 incident cases of UC from Nancy University Hospital, France, diagnosed between 2000 and 2008, were reviewed through January 2010. Results: The median follow-up time per patient was 58 months. Twenty-one (14%) underwent surgery. The cumulative probabilities of colectomy were respectively 1.3% and 13.5% at 1 and 5 years from the time of diagnosis. The probability of receiving oral mesalamine at 5 years was 68.1%. The corresponding figures were 48.9% for azathioprine and 29.0% for infliximab. For corticosteroids, methotrexate, and cyclosporin these figures were 75%, 8.8%, and 11.5%, respectively. Using multivariate Cox proportional hazards regression analysis after propensity score adjustment, previous use of cyclosporin was the only independent predictor for colectomy (hazard ratio = 4.41; 95% confidence interval 1.75–1.13). Conclusions: About one-tenth of patients still require colectomy for UC at 5 years in the era of biologics. Oral 5-ASA, azathioprine, and anti-TNF therapy are not associated with a reduced need for colectomy. (Inflamm Bowel Dis 2012)
Published: 2012
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35. Outcome and Cost Analysis of Sacral Nerve Modulation for Treating Urinary and/or Fecal Incontinence

Author: Eric Rullier, Xavier Lenne, Emmanuel Chartier-Kastler, Eric Mourey, Henri Bensadoun, François Mion, Laurent Guy, Albert Leriche, Francis Michot, Jean-Luc Faucheron, Loïc Le Normand, P. Grise, Anne-Marie Leroi, Paul-Antoine Lehur, Jean-Pierre Sarramon, Karem Slim, Igor Sielezneff, P. Ballanger, Laurent Bresler, Xavier Barth, Henri Damon, Christian Saussine, François Haab, Brigitte Mauroy, Yann Parc, and Benoît Dervaux
Subjects: Adult, Male, medicine.medical_specialty, Cost-Benefit Analysis, Urinary system, Lumbosacral Plexus, Electric Stimulation Therapy, Urinary incontinence, Risk Assessment, Statistics, Nonparametric, Cohort Studies, Young Adult, Quality of life, medicine, Humans, Fecal incontinence, Prospective Studies, Prospective cohort study, Aged, Aged, 80 and over, business.industry, Health Care Costs, Middle Aged, Electrodes, Implanted, Surgery, Lumbosacral plexus, Treatment Outcome, Urinary Incontinence, Quality of Life, Cost analysis, Female, France, medicine.symptom, business, Fecal Incontinence, Follow-Up Studies, Cohort study
Abstract: Sacral nerve modulation (SNM) is an established treatment for urinary and fecal incontinence in patients for whom conservative management has failed.This study assessed the outcome and cost analysis of SNM compared to alternative medical and surgical treatments.Clinical outcome and cost-effectiveness analyses were performed in parallel with a prospective, multicenter cohort study that included 369 consecutive patients with urge urinary and/or fecal incontinence. The duration of follow-up was 24 months, and costs were estimated from the national health perspective. Cost-effectiveness outcomes were expressed as incremental costs per 50% of improved severity scores (incremental cost-effectiveness ratio).The SNM significantly improved the continence status (P0.005) and quality of life (P0.05) of patients with urge urinary and/or fecal incontinence compared to alternative treatments. The average cost of SNM for urge urinary incontinence was ∈8525 (95% confidence interval, ∈6686-∈10,364; P = 0.001) more for the first 2 years compared to alternative treatments. The corresponding increase in cost for subjects with fecal incontinence was ∈6581 (95% confidence interval, ∈2077-∈11,084; P = 0.006). When an improvement of more than 50% in the continence severity score was used as the unit of effectiveness, the incremental cost-effectiveness ratio for SNM was ∈94,204 and ∈185,160 at 24 months of follow-up for urinary and fecal incontinence, respectively.The SNM is a cost-effective treatment for urge urinary and/or fecal incontinence.
Published: 2011
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36. Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn's disease

Author: Claire Pillot, Abderrahim Oussalah, Laurent Peyrin-Biroulet, Nicolas Williet, Marc-André Bigard, and Laurent Bresler
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Adolescent, Azathioprine, Lower risk, Drug Administration Schedule, Young Adult, Crohn Disease, medicine, Humans, Cumulative incidence, Crohn's disease, Receiver operating characteristic, Tumor Necrosis Factor-alpha, business.industry, Gastroenterology, Middle Aged, Prognosis, medicine.disease, Combined Modality Therapy, Surgery, Cohort, Abdominal Surgical Procedure, Female, Epidemiologic Methods, business, Immunosuppressive Agents, Abdominal surgery, medicine.drug
Abstract: The aim of the study was to assess whether azathioprine and antitumour necrosis factor (TNF) treatment decrease the long-term need for surgery in patients with Crohn's disease.This was an observational study of a referral centre cohort. The cumulative incidence of the first Crohn's disease-related major abdominal surgery was estimated using the Kaplan-Meier method, and independent predictors of surgery were identified using Cox proportional hazards regression with propensity scores adjustment. Receiver operating characteristic (ROC) analysis was used to identify optimal cut-offs for duration of maintenance treatments. The electronic charts of 296 incident cases of Crohn's disease from Nancy University Hospital, France, diagnosed between 2000 and 2008, were reviewed through January 2010.The median follow-up time per patient was 57 months. Seventy-six patients (26%) underwent at least one major abdominal surgical procedure. The cumulative probabilities of the first Crohn's disease-related major abdominal surgery were 6.5, 25.9 and 44.3 at 1, 5 and 9 years, respectively. In the ROC analysis, the duration of anti-TNF and azathioprine treatment had significant cut-off values (≤ 475 days ~16 months and ≤ 45 days ~1.5 months, respectively) with positive likelihood ratios (PLRs) of 1.52 (p0.0001) and 1.51 (p = 0.003) for the first Crohn's disease-related major abdominal surgery. Using multivariate Cox proportional hazards regression analysis (after propensity score adjustment), independent positive predictors of major abdominal surgery were stricturing (HR = 12.01; 95% CI 5.97 to 24.17) or penetrating (HR = 10.77; 95% CI 4.87 to 23.80) disease behaviour at diagnosis, duration of anti-TNF treatment of16 months (HR = 3.86; 95% CI 1.77 to 8.45) and duration of azathioprine treatment of1.5 months (HR = 2.00; 95% CI 1.20 to 3.34).Non-complicated inflammatory disease behaviour and long-term anti-TNF treatment are associated with a lower risk for surgery whereas azathioprine only modestly lowers this risk.
Published: 2011
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37. Thyroïdectomie robotique par voie transaxillaire : intérêt esthétique ou amélioration de la qualité de dissection ?

Author: Rasa Zarnegar, Laurent Bresler, Marc Klein, Adeline Germain, Ahmet Ayav, and Laurent Brunaud
Subjects: Surgery
Abstract: Resume La chirurgie mini-invasive a pour le moment ete peu utilisee en chirurgie thyroidienne en raison des difficultes d’exposition, du risque de morbidite recurrentielle et parathyroidienne, et du manque d’instrumentation adaptee. L’arrivee de la technologie robotique permet de pallier certaines de ces difficultes grâce a l’utilisation d’un ordinateur jouant le role d’interface entre le patient et le chirurgien. Ce cas clinique a pour but de rapporter une thyroidectomie totale par voie transaxillaire robotique sans insufflation. Cette technique permet une thyroidectomie totale sans incision cervicale et d’obtenir un champ operatoire avec une bonne identification des nerfs recurrents et des glandes parathyroides. Plusieurs problemes sont cependant a evaluer : la selection des patients, la reproductibilite de cette technique asiatique chez des patients europeens ayant un morphotype et une taille tumorale moyenne differents, l’apprentissage de la technique, l’evaluation prospective de la morbidite recurrentielle et parathyroidienne, les resultats cosmetiques, fonctionnels et oncologiques a long terme. Nous pensons cependant que ce nouvel abord est un des moyens actuellement disponibles pour modifier les limites de la chirurgie thyroidienne mini-invasive.
Published: 2010
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38. Sacral nerve stimulation in faecal incontinence: position statement based on a collective experience

Author: Jean-Luc Faucheron, Guillaume Meurette, Gil Lebreton, Igor Sielezneff, Francis Michot, Eric Rullier, Anne-Marie Leroi, P. Orsoni, François Mion, J. Barbieux, Muriel Mathonnet, Club Nemo, N. Huten, Yann Parc, Henri Damon, Xavier Barth, Karem Slim, G. Portier, F. Zerbib, F. Borie, Véronique Desfourneaux, Pierre Goudet, Paul-Antoine Lehur, P. Mathieu, Laurent Siproudhis, Laurent Bresler, Homéostasie Cellulaire et Pathologies (HCP), Université de Limoges (UNILIM)-CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Université de Limoges (UNILIM), Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges], and CHU Limoges
Subjects: Position statement, medicine.medical_specialty, animal structures, MEDLINE, Anal Canal, MESH: Electric Stimulation Therapy, Electric Stimulation Therapy, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 03 medical and health sciences, 0302 clinical medicine, MESH: Practice Guidelines as Topic, Humans, Medicine, Fecal incontinence, In patient, Evidence-Based Medicine, MESH: Fecal Incontinence, MESH: Humans, Sacrococcygeal Region, business.industry, MESH: Anal Canal, Gastroenterology, Evidence-based medicine, Colorectal surgery, Electrodes, Implanted, 3. Good health, Patient management, Sacral nerve stimulation, MESH: Sacrococcygeal Region, 030220 oncology & carcinogenesis, Practice Guidelines as Topic, Physical therapy, MESH: Electrodes, Implanted, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], 030211 gastroenterology & hepatology, medicine.symptom, business, Fecal Incontinence, MESH: Evidence-Based Medicine
Abstract: International audience; OBJECTIVE: Since the first paper published by Matzel et al., in 1995, on the efficacy of sacral nerve stimulation (SNS) in patients with faecal incontinence, the indications, the contraindications, the stimulation technique and follow up of implanted patients have changed. The aim of this article was to provide a consensus opinion on the management of patients with faecal incontinence treated with SNS. METHOD: Recommendations were based on a critical review of the literature when available and on expert opinions in areas with insufficient evidence. RESULTS: We have reviewed the indications and contraindications, proposed an algorithm for patient management showing the place of SNS. The temporary test technique, the implantation technique, the patient follow up and the approach in case of treatment failure were discussed. CONCLUSION: We hope not only to provide a guide on patient management to clinical practitioners interested in SNS but also to harmonize our practices.
Published: 2009
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39. Pancréatite aiguë et hyperparathyroïdie primaire : étude multicentrique de l’Association francophone de chirurgie endocrinienne

Author: Frederic Sebag, Laurent Bresler, Laurent Brunaud, Eric Mirallié, Thibault Desurmont, Cécile Curto, Jean-Louis Kraimps, Jean-François Henry, C. Caillard, Muriel Mathonnet, and Antoine Hamy
Subjects: Parathyroidectomy, Hyperparathyroidism, medicine.medical_specialty, Pancreatic disease, endocrine system diseases, business.industry, medicine.medical_treatment, Metabolic disorder, medicine.disease, Gastroenterology, Group B, 3. Good health, Surgery, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, Medicine, Pancreatitis, Acute pancreatitis, 030211 gastroenterology & hepatology, business, Primary hyperparathyroidism
Abstract: BACKGROUND: Primary hyperparathyroidism is an unusual cause of acute pancreatitis. The aim of this study was to analyse data from multiple centers concerning patients with primary hyperparathyroidism and associated acute pancreatitis and to analyze potential predictive factors. METHODS: In this retrospective multicentric study, 19 patients were identified (Group A) with the associated diagnoses of acute pancreatitis and primary hyperparathyroidism. Their clinical data was compared to that of a control group of 65 patients (group B) with primary hyperparathyroidism without acute pancreatitis. RESULTS: Age, parathormone levels and pathology (uni/multiglandular disease) were similar between the two groups. The mean plasma calcium level was significantly higher in group A (12.64 mg/100ml) than in group B patients without pancreatitis (11.28 mg/100ml) (p
Published: 2009
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40. Prospective evaluation of 100 robotic-assisted unilateral adrenalectomies

Author: Rasa Zarnegar, Laurent Bresler, Laurent Brunaud, Marc Klein, Patrick Boissel, Anthony Rouers, and Ahmet Ayav
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Adenoma, Robotic assisted, medicine.medical_treatment, Adrenal Gland Diseases, Pheochromocytoma, Young Adult, medicine, Humans, Cyst, Prospective Studies, Young adult, Prospective cohort study, Aged, business.industry, Adrenalectomy, Mortality rate, Robotics, Middle Aged, medicine.disease, Surgery, Female, business
Abstract: Our aim was to determine the learning curve for robotic adrenalectomy and factors that influence operative time and cost.We prospectively evaluated of 100 consecutive patients who underwent robotic, unilateral, transperitoneal adrenalectomy.The mean operative time for robotic-assisted adrenalectomy was 95 minutes and conversion rate was 5%. Pathology was aldosteronoma (n = 39), pheochromocytoma (n = 24), nonfunctional adenoma (n = 19), Cushing adenoma or hyperplasia (n = 16), and cyst (n = 2). Morbidity and mortality rates were 10% and 0%, respectively. The mean operative time decreased by 1 minute every 10 cases. Operative time improved more for junior surgeons than for senior surgeons (P = .006) after the first 50 cases. By multiple regression analysis, surgeon's experience (-18.9 +/- 5.5), first assistant level (-7.8 +/- 3.2), and tumor size (3 +/- 1.4) were independent predictors of operative time (P.001 each). The robotic procedure was 2.3 times more costly than lateral transperitoneal laparoscopic adrenalectomy (euro4102 vs euro1799).Surgeon experience, resident training level, and tumor size are important variables for robotic-assisted, unilateral adrenalectomy and should be taken into account when this approach is evaluated. Controlled studies need to be performed to show potential relevant clinical benefits that could balance costs.
Published: 2008
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41. What is the Quality of Information About Bariatric Surgery on the Internet?

Author: Didier Quilliot, Laurent Bresler, Rasa Zarnegar, Patrick Boissel, T. Levan, Ahmet Ayav, Laurent Brunaud, and B. Makar
Subjects: Information Services, Internet, medicine.medical_specialty, Nutrition and Dietetics, medicine.diagnostic_test, Information Dissemination, business.industry, Endocrinology, Diabetes and Metabolism, education, Bariatric Surgery, Information quality, Surgery, Access to information, medicine, Humans, The Internet, Laparoscopy, business
Abstract: The purpose of this study was to evaluate the role of Internet on patients scheduled for bariatric procedures and the quality of information available on different websites.Between July 2003 to July 2005, patients undergoing bariatric surgical procedures completed a survey. Data were collected prospectively. One hundred valid surveys were returned. Independently, two bariatric surgeons evaluated available French and English websites using major search engines.Forty-two of 100 patients (42%) sought information about bariatric surgery on the Internet. Seventy-four percent of these patients (n = 31/42) used search engines with 81% visiting less than ten websites. According to the patient's evaluation, 58% of the websites visited did not provide technical details of any surgical bariatric procedures, and only 61% provided information regarding postoperative weight loss. Furthermore, 58% of websites did not provide information about the laparoscopic approach, and 54% did not give any information on potential postoperative complications. Bariatric surgeon's evaluation was similar except for two differences: laparoscopic approach and postoperative weight loss information were discussed in 90% (p0.001) and 43% (p0.1) of visited websites, respectively.When the Internet was used to search for information about bariatric surgery, search engines were preferentially used but search duration was short. Available Internet websites can be considered as moderately reliable; however, 25% of visited websites contain misleading information. Comparison between patients and surgeons views showed that patients were effective in detecting misleading information.
Published: 2008
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42. Robotic-assisted adrenalectomy: what advantages compared to lateral transperitoneal laparoscopic adrenalectomy?

Author: Georges Weryha, Anne-Laure Raphoz, Laurent Brunaud, Rasa Zarnegar, Ahmet Ayav, Than Levan, Patrick Boissel, and Laurent Bresler
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Robotic assisted, medicine.medical_treatment, Adrenal Gland Diseases, Adrenal Gland Neoplasms, Pheochromocytoma, Blood loss, Adrenal Glands, medicine, Humans, Prospective Studies, Laparoscopy, Prospective cohort study, Aged, Hyperplasia, medicine.diagnostic_test, Laparoscopic adrenalectomy, business.industry, Adrenalectomy, Robotics, General Medicine, Perioperative, Middle Aged, Endoscopy, Surgery, Female, Peritoneum, business
Abstract: This study evaluates the perioperative outcomes of robotic-assisted adrenalectomy (RA) compared with lateral transperitoneal laparoscopic adrenalectomy (LA).Prospective evaluation of 50 patients who underwent unilateral RA versus 59 patients who underwent unilateral LA.RA was associated with lower blood loss (49 mL) but longer operative times (104 minutes) (P.001). However, the difference in operative time was not significant after the learning curve of 20 cases. In patients with body mass index (BMI)or = 30 kg/m(2), mean operative time was longer in the LA group (90 vs 78 minutes, P = .03) but not in the RA group. In patients with large tumors (or = 55 mm), mean operative time was longer in the LA group (100 vs 80 minutes, P = .009) but not in the RA group. Conversion rate, morbidity, and hospital stay were similar in both groups.After a learning curve of 20 cases, RA has similar perioperative outcomes compared to lateral transperitoneal LA. Several criteria (previous laparoscopic expertise, first assistant's skill and tumor side) remain determinative on RA operative time.
Published: 2008
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43. Robot-Assisted Adrenalectomy

Author: Laurent Bresler, Adeline Germain, Ahmet Ayav, and Laurent Brunaud
Subjects: business.industry, Computer science, Adrenalectomy, medicine.medical_treatment, medicine, Robot, Computer vision, Artificial intelligence, business
Published: 2016
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44. Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients

Author: Rocco Domenico Alfonso Bellantone, Rasa Zarnegar, Brendan M. Finnerty, Phi-Linh Nguyen-Thi, Thomas J. Fahey, Wessel M. C. M. Vorselaars, Inne H.M. Borel Rinkes, Laurent Bresler, Pierre-Etienne Theveniaud, Laurent Brunaud, Myriam Boutami, Marco Raffaelli, Menno R. Vriens, Celestino Pio Lombardi, and Eric Mirallié
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Settore MED/18 - CHIRURGIA GENERALE, Adrenal Gland Neoplasms, Hemodynamics, Pheochromocytoma, 030230 surgery, Coronary artery disease, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Risk Factors, medicine, Humans, Aged, Retrospective Studies, Past medical history, business.industry, Incidence (epidemiology), Adrenalectomy, adrenalectomy, Perioperative, Middle Aged, medicine.disease, Surgery, Treatment Outcome, Blood pressure, 030220 oncology & carcinogenesis, Anesthesia, Female, Laparoscopy, business, Abdominal surgery
Abstract: Since the 1950s, preoperative medical preparation has been widely applied in patients with pheochromocytoma to improve intraoperative hemodynamic instability and postoperative complications. However, advancements in preoperative imaging, laparoscopic surgical techniques, and anesthesia have considerably improved management in patients with pheochromocytoma. In consequence, there is no validated consensus on current predictive factors for postoperative morbidity. The aim of this study was to determine perioperative factors which are predictive for postoperative morbidity in patients undergoing laparoscopic adrenalectomy for pheochromocytoma. It is a retrospective analysis of prospectively maintained databases in five medical centers from 2002 to 2013. Inclusion criteria were consecutive patients who underwent non-converted laparoscopic unilateral total adrenalectomy for pheochromocytoma. Two-hundred and twenty-five patients were included. All-cause and cardiovascular postoperative morbidity rates were 16 % (n = 36) and 4.8 % (n = 11), respectively. Preinduction blood pressure normalization after preoperative medical preparation had no impact on postoperative morbidity. However, past medical history of coronary artery disease (OR [CI95 %] = 3.39; [1.317–8.727]) and incidence of intraoperative hemodynamic instability episodes (both SBP ≥ 160 mmHg and MAP
Published: 2016

45. Incidence and Risk Factors Related to Symptomatic Venous Thromboembolic Events After Esophagectomy for Cancer

Author: Jean-Michel Fabre, Delphine Lignier, Claude Bertrand, Xaviéra Coueffé, Brice Gayet, Marie Seman, Peggy Jourdan Enfer, Gainant A, Christophe Trésallet, Magalie Cabau, Jacques Jougon, Magalie Lefrançois, Gil Lebreton, Emmanuel Tiret, Nicolas Contival, Styliani Mantziari, Bernard Meunier, Nicolas Demartines, Flora Hec, Alexandre Filipello, Denis Lantuas, Federica Pipitone, Chiara Da Re, Renaud Flamein, François Paye, Denis Collet, Patrick Pessaux, Karine Pautrat, Jean-Marc Bigourdan, Simon Msika, Michel Prudhomme, Johan Gagnière, Jérémie Thereaux, Mehdi Karoui, Patrice Valleur, Diane Goéré, Yann Parc, Mael Chalret du Rieu, Jean-Pierre Bail, Jacques Baulieux, Denis Pezet, Stéphanie Lisunfui, Williams Tessier, Laurent Brunaud, Ion Donici, Marguerite Vanderbeken, Fabien Fredon, N. Chafai, Gilles Poncet, Charlotte Cohen, Jérémie H. Lefevre, Guillaume Luc, Letizia Laface, Serge Rohr, Frédéric Dumont, Jean-Marc Regimbeau, Oussama Baraket, R Frisoni, Serge Cappeliez, Issam El Nakadi, Eric Pappalardo, Marius Nedelcu, Thibault Coste, Marc Pocard, Cécile Brigand, N. Briez, Patrick Lozach, Amandine Klipfel, Gaelle Godiris Petit, Olivier Tiffet, Daniel Pop, Arnaud Alves, Jack Porcheron, Christophe Mariette, Delphine Vaudoyer, Arnaud Pasquer, Frédéric Marchal, Bogdan Stan-Iuga, Thierry Perniceni, Nicolas Carrere, Laurent Villeneuve, Jean-Christophe Vaillant, Caroline Gronnier, Olivier Glehen, B. Malgras, Muriel Mathonnet, Nicolas Venissac, Pierre Balladur, Markus Schäfer, Noémie Kamlet, Olivier Aze, Laurent Bresler, C. Ducerf, Jérôme Mouroux, Dominique Elias, Cyril Cosse, Bogdan Badic, Salim Mezoughi, Jean-Yves Mabrut, Emanuele Felli, Abdennahceur Dhahri, Fabrice Menegaux, Laurent Hannoun, Kathleen Turner, Ahmet Ayav, Mustapha Adam, Rodrigue Chemaly, Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 (JPArc), Université Lille Nord de France (COMUE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Chirurgie digestive et hépatobiliaire, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), 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), Service de Chirurgie Générale et Viscérale (CGV - BREST), Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de Médecine Interne, PRES Université Lille Nord de France-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CIC-IT Bordeaux, Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Brest (UBO), 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), Département de chirurgie digestive, CHU Clermont-Ferrand, Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Sorbonne Paris Cité (USPC), Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Chirurgie Générale et Digestive[Lille], Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de Chirurgie digestive, endocrinienne et générale [CHU Limoges], CHU Limoges, Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Montreal Heart Institute, Ciblage thérapeutique en Oncologie (EA3738), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Centre de recherche en éducation de Nantes (CREN), Le Mans Université (UM)-Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN), Université de Lorraine (UL), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Interactions, Corpus, Apprentissages, Représentations (ICAR), École normale supérieure de Lyon (ENS de Lyon)-Université Lumière - Lyon 2 (UL2)-INRP-Ecole Normale Supérieure Lettres et Sciences Humaines (ENS LSH)-Centre National de la Recherche Scientifique (CNRS), Service de Chirurgie Thoracique (NICE - Chirurgie Thoracique), Centre Hospitalier Universitaire de Nice (CHU Nice), Institut national des sciences appliquées Rouen Normandie (INSA Rouen Normandie), Institut National des Sciences Appliquées (INSA)-Normandie Université (NU), Babes-Bolyai University [Cluj-Napoca] (UBB), Service de Chirurgie thoracique, Anthropologie bio-culturelle, Droit, Ethique et Santé (ADES), Aix Marseille Université (AMU)-EFS ALPES MEDITERRANEE-Centre National de la Recherche Scientifique (CNRS), Lab-STICC_UBS_CID_DECIDE, Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (UMR 3192) (Lab-STICC), Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (Lab-STICC), Université européenne de Bretagne - European University of Brittany (UEB)-École Nationale d'Ingénieurs de Brest (ENIB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-École Nationale d'Ingénieurs de Brest (ENIB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Laboratoire de Mathématiques Informatique et Applications (LAMIA), Université des Antilles et de la Guyane (UAG), Université des Antilles (Pôle Guadeloupe), Université des Antilles (UA), Service de Chirurgie Digestive, 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), Association Pro Pictura Antiqua (APPA-CEPMR), Ville de Soissons, CHU Saint-Antoine [AP-HP], 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), Laboratoire Hubert Curien (LHC), Institut d'Optique Graduate School (IOGS)-Université Jean Monnet - Saint-Étienne (UJM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Institut Mutualiste de Montsouris (IMM), Departement medico-chirurgical de pathologie digestive, Service de Chirurgie Hépatobiliaire et Digestive [Rennes] = Hepatobiliary and Digestive Surgery [Rennes], CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), CHU Strasbourg, Laboratoire brestois de mécanique et des systèmes (LBMS), École Nationale d'Ingénieurs de Brest (ENIB)-Université de Brest (UBO)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne), Département de chirurgie générale [Gustave Roussy], Institut Gustave Roussy (IGR), Chercheur indépendant, Hospices Civils de Lyon (HCL), Centre de recherche Jean-Pierre Aubert-Neurosciences et Cancer, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille, Droit et Santé, Centre Hospitalier Universitaire Estaing, Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), UMR Peuplement Végétaux et Bioagresseurs en Milieu Tropical (UMR PVBMT - INRA), Institut National de la Recherche Agronomique (INRA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Hopital Louis Mourier - AP-HP [Colombes], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), equipe 4, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL)-Centre de Recherche en Cancérologie de Lyon (CRCL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-INRP-Ecole Normale Supérieure Lettres et Sciences Humaines-Centre National de la Recherche Scientifique (CNRS), Normandie Université (NU)-Institut National des Sciences Appliquées (INSA), Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Université européenne de Bretagne - European University of Brittany (UEB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire des sciences et techniques de l'information, de la communication et de la connaissance (Lab-STICC), École Nationale d'Ingénieurs de Brest (ENIB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-Télécom Bretagne-Institut Brestois du Numérique et des Mathématiques (IBNM), Université de Brest (UBO)-Université européenne de Bretagne - European University of Brittany (UEB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Institut Mines-Télécom [Paris] (IMT)-Centre National de la Recherche Scientifique (CNRS)-École Nationale d'Ingénieurs de Brest (ENIB)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Centre National de la Recherche Scientifique (CNRS), Service de gastroentérologie et cancérologie digestive [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Service de chirurgie générale viscérale et endocrinienne [CHU Pitié-Sapêtrière], Service de chirurgie digestive et hépato-bilio-pancréatique [CHU Pitié-Salpétrière], Carcinose Angiogenèse et Recherche Translationnelle, Angiogenese et recherche translationnelle (CART U965), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7), Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Service de chirurgie générale et digestive [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Saint-Antoine [APHP], Centre de Recherche Saint-Antoine (CR Saint-Antoine), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Laboratoire Hubert Curien [Saint Etienne] (LHC), Institut d'Optique Graduate School (IOGS)-Université Jean Monnet [Saint-Étienne] (UJM)-Centre National de la Recherche Scientifique (CNRS), Service de Chirurgie Hépatobiliaire et Digestive, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Centre Hospitalier Universitaire de Saint-Etienne, Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U1172 Inserm - U837 (JPArc), 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)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Edouard Herriot [CHU - HCL], École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-INRP-Ecole Normale Supérieure Lettres et Sciences Humaines (ENS LSH)-Centre National de la Recherche Scientifique (CNRS), Service d'Hépato-Gastro-Entérologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Chirurgie Générale, Viscérale et Endocrinienne [CHU Pitié-Sapêtrière], Service de Chirurgie Digestive, Hépato-Bilio-pancréatique et Transplantation Hépatique [CHU Pitié-Salpétrière], 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), 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), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO), Université de Nantes - UFR Lettres et Langages (UFRLL), Université de Nantes (UN)-Université de Nantes (UN)-Le Mans Université (UM), Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université-Sorbonne Université, Service de Chirurgie Hépatobiliaire et Digestive [Rennes], FREGAT Working Group-FRENCH-AFC, Dhahri, A., Lignier, D., Cossé, C., Regimbeau, J.M., Luc, G., Collet, D., Cabau, M., Jougon, J., Badic, B., Lozach, P., Bail, J.P., Cappeliez, S., El Nakadi, I., Lebreton, G., Alves, A., Flamein, R., Pezet, D., Pipitone, F., Stan-Iuga, B., Coueffé, X., Contival, N., Pappalardo, E., Msika, S., Hec, F., Vanderbeken, M., Tessier, W., Briez, N., Fredon, F., Gainant, A., Mathonnet, M., Bigourdan, J.M., Mezoughi, S., Ducerf, C., Baulieux, J., Mabrut, J.Y., Pasquer, A., Baraket, O., Poncet, G., Adam, M., Vaudoyer, D., Enfer, P.J., Villeneuve, L., Glehen, O., Coste, T., Fabre, J.M., Marchal, F., Frisoni, R., Ayav, A., Brunaud, L., Bresler, L., Cohen, C., Aze, O., Venissac, N., Pop, D., Mouroux, J., Donici, I., Prudhomme, M., Felli, E., Lisunfui, S., Seman, M., Petit, G.G., Karoui, M., Tresallet, C., Ménégaux, F., Vaillant, J.C., Hannoun, L., Malgras, B., Lantuas, D., Pautrat, K., Pocard, M., Valleur, P., Lefevre, J., Chafai, N., Balladur, P., Lefranéois, M., Parc, Y., Paye, F., Tiret, E., Nedelcu, M., Laface, L., Perniceni, T., Gayet, B., Turner, K., Meunier, B., Filipello, A., Porcheron, J., Tiffet, O., Kamlet, N., Chemaly, R., Klipfel, A., Pessaux, P., Brigand, C., Rohr, S., Chalret du Rieu, M., Carrére, N., Da Re, C., Dumont, F., Goéré, D., Elias, D., and Bertrand, C.
Subjects: Pulmonary and Respiratory Medicine, Adult, Male, ARDS, medicine.medical_specialty, Esophageal Neoplasms, medicine.drug_class, medicine.medical_treatment, Low molecular weight heparin, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, 030204 cardiovascular system & hematology, Aged, Aged, 80 and over, Esophageal Neoplasms/surgery, Esophagectomy/adverse effects, Female, Hospital Mortality, Humans, Incidence, Length of Stay, Middle Aged, Postoperative Complications/etiology, Risk Factors, Venous Thromboembolism/epidemiology, Venous Thromboembolism/etiology, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Internal medicine, Medicine, cardiovascular diseases, ComputingMilieux_MISCELLANEOUS, business.industry, Incidence (epidemiology), Cancer, Venous Thromboembolism, Esophageal cancer, equipment and supplies, medicine.disease, 3. Good health, Pulmonary embolism, Surgery, Esophagectomy, Venous thrombosis, 030220 oncology & carcinogenesis, Cardiology and Cardiovascular Medicine, business
Abstract: Background Major oncologic surgery is associated with a high incidence of venous thromboembolic events (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE). However, the incidence and risk factors for symptomatic VTE during curative treatment for patients with esophageal cancer are poorly documented. Methods Data were collected from 30 European centers from 2000 to 2010. The incidence of in-hospital VTE was assessed in 2,944 patients with esophageal cancer having surgery with curative intent, and 50 clinically relevant parameters were assessed as potential risk factors for VTE. Patients received low molecular weight heparin prophylaxis during hospital stay and for 4 weeks after surgery. Results Eighty-four patients (2.9%) developed a symptomatic VTE; all of them had a DVT and 44 were also diagnosed with a PE. In the VTE group there were 19 postoperative deaths recorded, 5 of which (26.3%) were directly caused by PE at postoperative days 7, 10, 21, 45, and 48 despite VTE prophylaxis. In-hospital postoperative mortality was significantly higher in VTE patients (23% versus 7%, p 0.001) and mean hospital stay was also longer in this group (33 ± 24 versus 25 ± 21 days, p 0.001). Multivariable analysis showed that high American Society of Anesthesiologists (ASA) class ( p = 0.008), pneumopathy ( p = 0.002), or an acute respiratory distress syndrome (ARDS) ( p = 0.015) were significantly associated with VTE. Conclusions Patients with ASA class III or IV and those who present a postoperative pneumopathy or ARDS seem to be at higher risk for VTE. Thus, current VTE screening and thromboprophylaxis for these patients might be inadequate and needs further investigation.
Published: 2016
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46. Aspect IRM d’une pseudo tumeur rectale rare associée à des troubles dyschésiques : la « colitis cystica profunda »

Author: S. Ciprian-Corby, C. Barbary, Denis Régent, L. Meyer-Bisch, S. Béot, S. Corby, Laurent Bresler, and Valérie Laurent
Subjects: Gynecology, medicine.medical_specialty, Radiological and Ultrasound Technology, Anorectal disease, business.industry, Colitis cystica profunda, Medicine, Radiology, Nuclear Medicine and imaging, business
Abstract: a colitis cystica profunda est une masse benigne rectale rare qui peut parfois etre consideree a tort comme un authentique adenocarcinome mucineux rectal. Habituellement associee a des troubles de la statique pelvienne, elle s’integre dans le cadre du syndrome de l’ulcere solitaire du rectum. Les caracteres morphologiques de cette lesion sont evocateurs car elle se manifeste sous forme d’une lesion polypoide siege de multiples kystes mucoides situes dans la sous-muqueuse. Ces aspects doivent etre reconnus par l’imagerie afin d’eviter tout erreur diagnostique. A notre connaissance la place de l’IRM dans cette pathologie avec etude statique et dynamique n’a jamais ete decrite dans la litterature. Nous nous proposons dans cette observation de decrire l’aspect IRM avec correlation anatomopathologique.
Published: 2007
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47. Prospective evaluation of quality of life (SF-36v2) and nonspecific symptoms before and after cure of primary hyperparathyroidism (1-year follow-up)

Author: Joel Leborgne, Hélène Gibelin, Jean-Louis Kraimps, Antoine Hamy, Bernard Charbonnel, Muriel Mathonnet, Jean-Michel Nguyen, Coralie Loudot, Laurent Brunaud, Laurent Bresler, Jean-François Henry, Eric Mirallié, Frederic Sebag, and C. Caillard
Subjects: Adult, Male, Parathyroidectomy, medicine.medical_specialty, Nausea, medicine.medical_treatment, Quality of life, Internal medicine, medicine, Health Status Indicators, Humans, Prospective Studies, Prospective cohort study, Aged, Aged, 80 and over, Hyperparathyroidism, business.industry, Middle Aged, Hyperparathyroidism, Primary, medicine.disease, Surgery, Endocrine surgery, Treatment Outcome, Quality of Life, Female, medicine.symptom, Headaches, business, Primary hyperparathyroidism
Abstract: Background. Only a minority of patients with primary hyperparathyroidism (pHPT) present with the "classic" symptoms. Most patients have numerous nonspecific symptoms. The aim of this study was to evaluate patients' quality of life and nonspecific symptoms before and after cure for pHPT. Methods. This prospective, multicentric study, which took place from May 2003 to September 2004, included 100 patients. Six academic departments of Endocrine Surgery in France participated in the study: the University of Angers, Limoges, Nancy, Nantes, Marseille, and Poitiers. Only cured patients were included. All patients were given preoperative and postoperative questionnaires (the SF-36v2 Health Survey) at 3, 6, and 12 months to evaluate quality of life and nonspecific symptoms. Results. Preoperatively, the main nonspecific symptoms included the following: anxiety (89%); muscular, bone, or join pain (87%); abdominal distention (82%); forgetfulness (81% ); headaches (81 %); and mood swings (79%). Quality of life was significantly improved at 3 and 6 months (P < .05). At 1 year postoperatively, statistically significant improvement (P
Published: 2007
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48. Right robotic adrenalectomy for a 8cm pheochromocytoma (with video)

Author: Luca Sessa, Claire Nominé, Adeline Germain, Ahmet Ayav, Laurent Brunaud, Laurent Bresler, Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)
Subjects: medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Adrenal Gland Neoplasms, Pheochromocytoma, Inferior vena cava, Young Adult, Robotic Surgical Procedures, Minimally invasive surgery, Medicine, Humans, Robotic surgery, Laparoscopy, ComputingMilieux_MISCELLANEOUS, medicine.diagnostic_test, business.industry, Adrenalectomy, Right triangular ligament, General Medicine, Robotics, medicine.disease, 3. Good health, Surgery, Retractor, Dissection, medicine.anatomical_structure, medicine.vein, Female, business
Abstract: Please cite this article in press as: Sessa L, et al. Right robotic adrenalectomy for a 8 cm pheochromocytoma (with video). Journal of Visceral Surgery (2015), http://dx.doi.org/10.1016/j.jviscsurg.2015.06.010 Pheochromocytoma; Robotic surgery; Minimally invasive surgery; Robotics CT scan showed a 10 cm right adrenal tumor compatible with a pheochromocytoma. MIBG scintigraphy confirmed a right adrenal tumor single uptake. Routine biomolecular evaluation (SDHx and VHL genes) was negative for a familial disease. A totally robotic lateral transperitoneal right adrenalectomy was performed. The patient was placed in left lateral strict decubitus and flexed at the waist. An ‘‘open’’ right subcostal access was used to introduce a 12 mm optical trocar. Under laparoscopic vision (0◦ scope), 4 other trocars were introduced: two 8 mm right subcostal trocars, one 12 mm and one 10 mm trocars for the first-assistant’s left and right (liver retractor) hand, respectively. The robotic cart (da Vinci® Si Surgical System, Intuitive Surgical) was placed above the patient’s right shoulder and was docked. Intra-abdominal exploration confirmed the presence of a large retroperitoneal mass that completely modified the right suprarenal region. The right triangular ligament was divided and the liver was medially retracted. The right aspect of the vena cava was not initially accessible because of the large adrenal mass volume. Consequently, the tumor was first dissected, en bloc with the periadrenal fat, from the upper pole of the kidney and from lateral attachments to obtain an adequate mobilization of the adrenal mass allowing its rotation to better approach the right lateral and posterior aspects of the vena cava. Then, dissection was carried out progressively upward along the inferior vena cava on the medial margin of the tumor. Four large adrenal veins were consecutively dissected, clipped using nonabsorbable self-locking clips (Hem-o-lok®, Weck-Telefex Europe Ltd.), and divided. The adrenal mass was completely dissected and mobilized from its posterior aspect (iliopsoas muscle). Overall operative time was 90 minutes. No post-operative complication was observed hospitalization duration was 3 days. Pathology confirmed an adrenal pheochromocytoma, 8 cm in diameter with a PASS score 1 with R0 resection without capsular effraction.
Published: 2015
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49. Risk Factors for Postoperative Morbidity After Totally Robotic Gastric Bypass in 302 Consecutive Patients

Author: Rasa Zarnegar, Phi-Linh Nguyen-Thi, G. Fantola, Laurent Brunaud, M.-A. Sirveaux, N. Reibel, Laurent Bresler, Adeline Germain, Ahmet Ayav, Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), ESPRI-Biobase [CHRU Nancy] (Unité fonctionnelle de la plateforme d’aide à la recherche clinique), Unité médico-chirurgical de chirurgie de l’obésité [CHRU Nancy], Division of Endocrine and Minimally Invasive Surgery, Departments of Surgery and Public Health, Weill Medical College of Cornell University [New York]-Weill Medical College of Cornell University [New York], Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)
Subjects: Adult, Male, Reoperation, medicine.medical_specialty, Multivariate analysis, Adolescent, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Gastric Bypass, Hematocrit, Young Adult, Postoperative Complications, Risk Factors, medicine, Humans, Postoperative Period, Young adult, Aged, Retrospective Studies, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, Mortality rate, Postoperative complication, Retrospective cohort study, Robotics, Odds ratio, Middle Aged, Obesity, Morbid, 3. Good health, Surgery, Treatment Outcome, Concomitant, Female, Laparoscopy, business
Abstract: International audience; BACKGROUND:Totally robotic gastric bypass (robotic Roux-en-Y gastric bypass, R-RYGBP) has been adopted in some centers on the basis of large retrospective studies. In view of some data showing higher morbidity and higher costs, some authors have considered that robotic gastric bypass may no longer be justified with the existing system. Although low postoperative complication rates after R-RYGBP have been reported, risk factors for postoperative morbidity have never been evaluated. The goal of this study was to identify risk factors for postoperative morbidity after R-RYGBP.METHODS:A retrospective analysis of a prospectively maintained database was performed and included 302 consecutive patients after R-RYGBP performed between 2007 and 2013. This subset of patients represented 34 % of all gastric bypass procedures performed during this study period. Univariate and multivariate analyses were performed in order to identify risk factors for postoperative overall morbidity (Clavien scores 1-4 versus 0) and major morbidity (Clavien score ≥3 versus 0-1-2).RESULTS:Postoperative morbidity and mortality rates were 24.4 and 0.6 %, respectively. In multivariate analysis, independent risk factors for overall morbidity were American Society of Anesthesiologists (ASA) score ≥3 (odds ratio (OR) 2.0) and previous bariatric surgery (revisional gastric bypass) (OR 2.0). Independent risk factors for major morbidity (Clavien ≥3) were previous bariatric surgery (revisional gastric bypass) (OR 3.7), low preoperative hematocrit level (OR 0.9), and revisional gastric bypass procedure with concomitant gastric banding removal (OR 5.7).CONCLUSIONS:R-RYGBP is prone to increased complications in the setting of a high preoperative ASA score and revisional surgery. This should be taken into consideration by clinicians when evaluating R-RYGBP.
Published: 2015
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50. La scintigraphie thyroïdienne est-elle encore utile pour la prise en charge d'un nodule thyroïdien ? Le point de vue du chirurgien

Author: Patrick Boissel, Marc Klein, Laurent Brunaud, J. Chatelin, Ahmet Ayav, and Laurent Bresler
Subjects: Thyroid nodules, endocrine system, endocrine system diseases, business.industry, medicine.medical_treatment, Thyroid, Thyroidectomy, Nodule (medicine), medicine.disease, Preoperative care, medicine.anatomical_structure, medicine, Surgery, Radionuclide imaging, medicine.symptom, business, Nuclear medicine
Abstract: Preoperative management of thyroid nodule is still controversial. Since 25 years ago, preoperative evaluation of thyroid nodule has been modified and improved. The aim of this study was to review, from a surgical point of view, the role of radionuclide imaging results in the management of patients with thyroid nodules.
Published: 2006
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