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Resumen La cirugia gastrica clasica (antrectomia, gastrectomia 4/5, gastrectomia total) solo se realiza en la actualidad en la cirugia del cancer o en el marco de las complicaciones de la enfermedad ulcerosa. En cambio, la cirugia bariatrica esta en plena expansion para el tratamiento quirurgico de la obesidad tras el fracaso del tratamiento medico. Existen numerosos procedimientos, como las cirugias denominadas «restrictivas», como el anillo perigastrico y la gastrectomia longitudinal tubular o sleeve gastrectomy, y las cirugias denominadas «malabsortivas», como el bypass gastrico en Y de Roux y otros procedimientos de derivacion duodenal. La mortalidad se ha reducido estos ultimos anos, tanto en la cirugia gastrica clasica, mediante un mejor conocimiento de los factores de riesgo de morbimortalidad que permiten optimizar la condicion de los pacientes antes de la cirugia, como tambien en la cirugia bariatrica, debido a una mejora y estandarizacion de la tecnica quirurgica y del tratamiento perioperatorio. Sin embargo, a pesar de que existe tendencia a una disminucion de las complicaciones, siguen estando presentes y algunas son especificas del montaje quirurgico, mientras que otras son comunes al principio mismo de la cirugia de perdida de peso. Por todos estos motivos, es necesaria la vigilancia de los pacientes operados, que debe llevarse a cabo durante toda la vida de los pacientes.

Summary Aim of the study Evaluate the impact of social deprivation on morbidity and mortality in surgery for colorectal cancer. Methods The COINCIDE prospective cohort included nearly 2,000 consecutive patients operated on for colorectal cancer at the Assistance Publique-Hospitals of Paris (AP-HP) from 2008 to 2010. The data on these patients were crossed with the PMSI administrative database. The European Social Deprivation Index (EDI) was calculated for each patient and classified into five quintiles (quintiles 4 and 5 being the most disadvantaged patients). Thirty-day post-operative morbidity was determined according to the Dindo-Clavien classification, with a Had®Hoc re-analysis of each file. Statistical analysis was performed using the proprietary Q-finder® algorithm. Results One thousand two hundred and fifty nine curative colorectal resections were analyzed. Mortality was 2.7% and severe morbidity (Dindo-Clavien ≥ 3) occurred in 16.4%. Mortality was not statistically significantly increased among the most disadvantaged who made up almost two thirds of the population (64.2%). Patients in quintiles 4 and 5 had a statistically significant increase in severe morbidity. The relative risk remained 1.5 even after adjustment for the known risk factors found in the analysis: age > 70 years, ASA score, urgency, and laparotomy. Conclusions The EDI represents an independent risk factor for severe morbidity after carcinologic colorectal resection. This study suggests that the determinants of health are multidimensional and do not depend solely on the quality and performance of the care system. The inclusion of this index in our surgical databases is therefore necessary, as is its use in health policy for the distribution of resources.

Resume But du travail Evaluer l’impact de la deprivation sociale sur la morbi-mortalite en chirurgie colorectale carcinologique. Methodes La cohorte prospective COINCIDE a inclus de 2008 a 2010 pres de 2000 patients consecutifs operes d’un cancer colorectal, a l’AP–HP. Cette base etait croisee avec la base administrative PMSI. L’index europeen de defavorisation sociale (EDI) etait calcule pour chaque patient et classe en 5 quintiles (les quintiles 4 et 5 etant les patients les plus defavorises). La morbidite postoperatoire etait determinee a 30 jours selon la classification Dindo-Clavien, avec une re-analyse ad hoc de chaque dossier. L’analyse statistique etait realisee via l’algorithme proprietaire Q-finder®. Resultats Au total, 1259 resections colorectales a visee curative etaient analysees. La mortalite etait de 2,7 % et la morbidite severe (Dindo ≥ 3) de 16,4 %. La mortalite n’etait pas significativement augmentee chez les plus defavorises (Pres de 2/3 de la population [64,2 %]). La morbidite severe etait significativement correlee aux quintiles 4 et 5. Ce risque restait multiplie par 1,5 apres ajustement sur les facteurs de risques connus et retrouves dans l’analyse : âge > 70 ans, score ASA, urgence, et laparotomie. Conclusions L’EDI represente un facteur independant de risque de morbidite severe apres resection colorectale carcinologique. Cette etude suggere que les determinants de la sante sont multidimensionnels et ne relevent pas uniquement de la seule performance du systeme de soins. L’inclusion de cet indice dans nos bases de donnees chirurgicales est donc necessaire, tout comme son utilisation en politique de sante pour la repartition des ressources.

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

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

Background Epithelioid peritoneal malignant mesothelioma (EPMM) is the most common subtype of this aggressive tumor. We compared two antibodies against PD-L1, a recent theranostic biomarker, and evaluated the prognostic value of PD-L1 expression by mesothelial and immune cells in EPMM. Methods Immunohistochemistry was performed on 45 EPMM. Clinical and pathological data were extracted from the RENAPE database. Using E1L3N and SP142 clones, inter-observer agreement, PD-L1 expression by mesothelial and immune cells and inter-antibody agreement were evaluated. The prognostic relevance of PD-L1 expression was evaluated in 39 EPMM by univariate and multivariate analysis of overall survival (OS) and progression-free survival (PFS). Results Inter-observer agreement on E1L3N immunostaining was moderate for mesothelial and immune cells, and fair for mesothelial and poor for immune cells using SP142. Using E1L3N, 31.1% of mesothelial and 15.6% of immune cells expressed PD-L1, and 22.2% of mesothelial and 26.7% of immune cells using SP142. Inter-antibody agreement was moderate. In most positive cases, 1–5% of tumor cells were positive. Using E1L3N, PD-L1 expression by lymphocytes was associated with better OS and PFS by both univariate and multivariate analysis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy predicted better prognosis than other treatments. Solid subtype was an independent prognostic factor for worse OS. Conclusion E1L3N appeared easier to use than SP142 to evaluate PD-L1 expression. A minority of EPMM expressed PD-L1, and only a few cells were positive. PD-L1 expression by immune cells evaluated with E1L3N was an independent prognostic factor in EPMM.

Roux-en-Y gastric bypass (RYGB) is considered as the gold standard for surgical management of morbid obesity due to its good results on weight loss and correction of comorbidities related to obesity and its few complication rates. Here, we describe a present strategy for dealing with an unusual complication after RYGB, responsible for chronic pain, as a chronic dilatation of excluded stomach. The video shows our laparoscopic treatment of an excluded gastric fundus dilatation. A 21-year-old woman with history of RYGB was admitted in our center for recurrent abdominal pain. Many consultations have been performed before for the same reason and without explanation for this chronic abdominal pain. We found that a dilatation of the excluded gastric fundus was responsible for recurrent abdominal pain and thus required revisional surgery. An abdominal computed tomography with oral contrast study showed an atypical dilatation of the excluded stomach without gastro-gastric fistula or others abnormal findings. Intra-operative exploration then revealed multiple adhesions. During surgery, released of the excluded stomach allow to confirm a dilatation of the excluded fundus due to error in stapling when performing the vertical part of the gastric pouch of the RYGB. We resected the excluded dilated gastric fundus. An uneventful post-operative course enabled rapid discharge (post-operative day 3). Dilatation of the excluded gastric pouch due to staple line misfiring during RYGB is a rare complication and can explain chronic abdominal pain. Laparoscopy can be useful to confirm the diagnosis and allow treatment using gastric resection in our case.

Few series are available on the results of repeat sleeve gastrectomy (re-SG) and Roux-en-Y gastric bypass (RYGB) performed to manage the failure of primary sleeve gastrectomy (SG). The objective of this study was to compare the short- and medium-term outcomes of re-SG and RYGB after SG. Between January 2010 and December 2017, patients undergoing re-SG (n = 61) and RYGB (n = 83) for failure of primary SG were included in this study. Revisional surgery was proposed for patients with insufficient excess weight loss (EWL ≤ 50%) or weight regain. The primary endpoint was the comparison of weight loss in the re-SG group and the RYGB group at the 1-year follow-up. The secondary endpoints were overall mortality and morbidity, specific morbidity, length of stay, weight loss, and correction of comorbidities. The mean interval between SG and re-SG was 41.5 vs. 43.2 months between SG and RYGB (p = 0.32). The mean operative time was 103 min (re-SG group) vs. 129.4 min (RYGB group). One death (1.7%; re-SG group) and 25 complications (17.4%; 9 in the re-SG group, 16 in the RYGB group) were observed. At the 1 year, mean body mass index was 31.6 in the re-SG group and 32.5 in the RYGB group (p = 0.61) and excess weight loss was 69.5 vs. 61.2, respectively (p = 0.05). Re-SG and RYGB as revisional surgery for SG are feasible with acceptable outcomes and similar results on weight loss on the first postoperative year.

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

Introduction Le pyopneumothorax se definit par la presence d’air et de pus dans la cavite pleurale. Son etiologie est dominee par la tuberculose dans notre contexte. Methodes Nous rapportons une etude retrospective portant sur 55 dossiers colliges au service des maladies respiratoires entre janvier 2012 et juin 2020. Resultats La moyenne d’âge etait de 38,4 ans, avec une nette predominance masculine (65,5 %). Un diabete est note dans six cas et un post-partum dans trois cas. La symptomatologie est dominee par la douleur thoracique et la fievre dans 93 %. La radiographie thoracique a note une image hydroaerique dans tous les cas, associee a des opacites pulmonaires excavees dans 14 cas, et une miliaire dans quatre cas. L’origine tuberculeuse est retrouvee dans 49,6 % des cas, bacterienne dans 40 %, aspergillaire, hydatique et iatrogene dans un cas chacun. Le diagnostic est confirme par la positivite des bascilloscopies dans le pus pleural dans 21 cas, dans les expectorations dans 10 cas. L’isolement de germes pyogenes dans 17 cas et la ponction biopsie pleurale dans cinq cas. Le traitement local est base sur un drainage thoracique dans 61,5 % des cas, des ponctions pleurales evacuatrices dans 7 cas et une decortication pleurales dans 5 cas. Le traitement etiologique est base sur les antibacillaires dans 34 cas. Pour les pyoneumothorax bacteriens, une antibiotherapie est prescrite dans tous les cas. L’evolution est bonne dans 72 % des cas. Huit patients ont garde une pachypleurite sequellaire et on deplore quatre deces. Conclusion A travers cette etude, on insiste sur la necessite d’un diagnostic et d’une prise en charge precoce du pyopneumothorax dont l’etiologie reste dominee par la tuberculose dans notre contexte.

The sleeve gastrectomy (SG) can be performed with or without antral preservation (distance from the pylorus

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

Introduction Peritoneal metastasis (PM) of hepatocellular carcinoma (HCC) without distant spread are rare. The related prognosis is poor without standard treatment available. The role of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is poorly documented. Methods An international multicentric cohort was constituted by retrospective analysis of 21 patients undergoing CRS/HIPEC for PM of HCC between 1992 and 2016 from 10 reference centers of PSOGI. Data on clinical features, treatment strategies, and survival outcomes were analyzed. Results The median time interval from the diagnosis of PM to the procedure was 4.5 months. The median peritoneal cancer index was 14. Sixteen patients had complete cytoreduction (CCR0-1). Ten patients had grades 3 to 4 complications. The median duration of follow-up was 52.2 months. The median OS was 46.7 months. The projected 3y-OS and 5y-OS were 88.9 and 49.4% respectively. The median OS for patients with CCR0-1 resection was not reached whereas it was 5.9 months for those with CCR2-3 resection after CRS (p = 0.0005). The median RFS was 26.3 months and projected RFS at 3 years of 36.5 months Three prognostic factors were associated with improved RFS in the univariate analysis: preoperative chemotherapy (p = 0.0156), PCI >15 (p = 0.009), Number of chemotherapy agents used for HIPEC (p = 0.005). Conclusion CRS/HIPEC is a safe and effective approach in selected patients with PM of HCC. CRS/HIPEC gives the patient a chance for a good relapse free and overall survival and should be considered as an option.

Background The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease. Methods Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics. Results Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017). Conclusion NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.

International audience; Based on the importance of assessing the true extent of peritoneal disease, PeRitOneal MalIgnancy Stage Evaluation (PROMISE) internet application (www.e-promise.org) has been developed to facilitate tabulation and automatically calculate surgically validated peritoneal cancer index (PCI), and other surgically validated scores as Gilly score, simplified peritoneal cancer index (SPCI), Fagotti and Fagotti-modified scores. This application offers computer-assistance to produce simple, quick but precise and standardized pre, intra and postoperative reports of the extent of peritoneal metastases and may help specialized and non-specialized institutions in their current practice but also facilitate research and multicentre studies on peritoneal surface malignancies.

But L’utilisation des protheses biologiques de renfort parietal est croissante sans donnees de haut niveau de preuve sur leur benefice. Notre but etait d’analyser les resultats de ces traitements innovants sur une large cohorte de patients. Materiel et methodes Etude retrospective sur 3 marques de protheses biologiques implantees pour eventrations parietales considerees comme complexes dans 4 CHU de l’AP–HP sur une periode de 6 ans. Ont ete collectees : caracteristiques demographiques, classe de contamination de l’eventration selon la reference internationale VHWG, type de prothese, technique chirurgicale, complications specifiques, taux de recidive d’eventration a moyen terme. Resultats Quatre-vingt-cinq patients ont ete inclus et classes : VHWG 1 : 11 %, 2 : 41 %, 3 : 29,5 % ; 4 : 19 %. Les implantations etaient intraperitoneales : 60 %, retromusculaire : 40 %. La morbidite specifique etait de 26 % dont 25 % d’abces. La duree moyenne de suivi etait particulierement faible : 9 mois. Le taux de recidive etait de 15 % sans difference significative entre bioprotheses reticules ou non. Conclusion Le taux important de recidive a moyen terme avec les protheses biologiques ainsi que leur cout eleve doivent inciter a limiter leur utilisation dans les situations tres complexes d’eventration VHWG 3–4 avec un suivi a long terme plus rigoureux.

Savoir dire non en chirurgie bariatrique est un exercice difficile; il reclame beaucoup d’attention et de temps de la part de l’equipe pluridisciplinaire qui prend en charge le patient obese morbide. Les trois questions principales sont: a qui et pourquoi dire non ? Comment dire non ? Quand dire non ?

Bariatric surgery as laparoscopic Roux-en-Y gastric bypass (LRYGB) is increasing throughout the world and women represent the majority (70%) of patients. Most of them are of reproductive age. As a consequence, surgeons will have to treat more and more pregnant patients with a history of LRYGB for surgical abdominal pain. Reported incidence of small bowel obstruction (SBO) varies from 1.5% to 3.5% after LRYGB including internal hernias, intussusception and volvulus. As two cases of maternal postoperative death have been reported in the literature, diagnosis and surgical treatment shouldn’t be delayed especially during pregnancy. To underline the necessity of a rapid diagnosis and surgical treatment, we reported two cases of severe SBO during pregnancy.

To describe severe complications during pregnancy requiring surgery in patients with a history of obesity surgery.A retrospective study in a hospital with tertiary care perinatology and an obesity reference center, on all pregnancies following bariatric surgery over a 10-year period, analyzing all cases of surgical complications.There were 8 major complications related to the procedure in 141 pregnancies with bariatric surgery. The 2 complications in women with gastric banding were band slippage resulting in severe dysphagia, one of which leading to intractable vomiting and serious hydrolectric disorders. Among the 6 complications after bypass surgery, 4 were occlusions: 3 on internal hernias of which 2 with volvulus and 1 associated with intestinal invagination, as well as one with intestinal invagination only. One patient had a laparotomy for a suspected invagination which was not confirmed. The other surgical complications after gastric bypass were a hernia and an exploratory laparotomy for suspected intussusception which was overturned. There was no case of maternal or perinatal death.Pregnancies in patients with a history of bariatric surgery are at high risk, in particular for complications related to the surgery and thus require careful interdisciplinary surveillance, and determination of predictive factors.

Gastric cancer (GC) still remains a major cancer problem in the world. Its prognosis is poor with an overall 5-year survival rate less than 20%. Surgical resection is still the only curative treatment of GC. Curative resection depends on tumoral location and extension, particularly lymph node involvement. Proximal GC (fundus, body) are treated by total gastrectomy (TG). For distal GC (antrum, pylorus), the TG is no more the recommended treatment and distal sub-total gastrectomy can safely be performed when carcinologic rules are respected: 5-6 cm free margin for the remnant stomach and at least 2 cm resection of the proximal duodenum. Cardia cancers, upon to their tumoral extension toward the esophagus, can require either TG or proximal esophagogastrectomy by combined thoracic and abdominal approach. As demonstrated in the last controlled studies, D2 extensive lymphadenectomy, in spite of its contribution to a better prognostic staging, does not improve long term survival after curative surgery. TG extended to the spleen or to the pancreas should not be performed in curative surgery because of a high rate of postoperative complications. Limited gastric resections for superficial GC have to be evaluated in Western countries. Palliative exploratory laparotomies should be avoided by better preoperative explorations. Laparoscopic staging in GC could be indicated when palliative resection or bypass are possible. The results of adjuvant chemotherapy is still disappointing and new protocols have to be evaluated. Intraperitoneal chemotherapy with or without hyperthermia represents a serious hope in the treatment of GC, but its significative action on the survival is not well demonstrated, while its morbidity and mortality rate is high.

Introduction Cette annee les XVIII es journees de la Societe Francaise de Chirurgie Digestive (SFCD) se sont tenues a Lyon, capitale de la gastronomie, ou l’organisation scientifique comme culinaire a ete de tout premier ordre. En effet, si au cours de ce rapport « journalistique » les details des communications scientifiques et des controverses sont largement abordes, nous ne pourrons qu’evoquer un des points d’orgue de ces journees : le diner de gala chez Paul Bocuse a l’Abbaye de Collonges ! A cette occasion les surprises gustatives ont ete completees par une ambiance ou sons et lumieres etaient au premier plan… L’organisation generale en est revenue a Jacques Baulieux, aide de Bertrand Dousset, mais aussi des quatre Christians, Ducerf, Gouillat, Letoublon et Partensky.

Introduction Cette annee le 105 e Congres Francais de Chirurgie organise par l’Association Francaise de Chirurgie (AFC) du 2 au 4 octobre 2003 avait comme particularite d’accueillir en meme temps le premier Congres de Chirurgie de la Francophonie. Ainsi des chirurgiens francophones, aussi bien d’Europe, d’outre-atlantique, du Maghreb et d’Afrique etaient presents en grand nombre cette annee. Les rapports du congres ont porte sur l’adenocarcinome de la jonction oeso-gastrique et la mortalite et morbidite dans la chirurgie colorectale. Les rapporteurs en etaient respectivement Ch. Mariette, A. Sauvanet, et J-P. Triboulet ainsi que G. Mantion et Y. Panis.

L’obesite, en constante augmentation dans le monde occidental et y compris en France, entraine de nombreuses complications, responsables d’une reduction de l’esperance de vie. Les traitements conventionnels sont souvent decevants, et c’est dans ce contexte que la chirurgie de l’obesite (dite bariatrique) s’est progressivement developpee. En France, le nombre d’interventions n’a cesse d’augmenter depuis le debut des annees 90 pour atteindre un maximum de 17 000 patients operes en 2002 puis s’est stabilise aux alentours de 10000 interventions annuelles depuis 2003 [1].

Desmoplastic small round cell tumour (DSRCT) is a very rare, highly aggressive neoplasm. Most cases have been reported in adolescent and young male patients. These tumours occur mainly in the peritoneal cavity, with peritoneal and lymphatic dissemination. Their histologic features are unspecific and immunohistochemistry and cytogenetic or biomolecular techniques are required for their diagnosis. Involvement of the pancreas is exceptional and is difficult to differentiate from other pancreatic primary tumours. We report here the case of a 49-year-old woman who had a DSRCT of the pancreas with metastasis to the breast. She died within one year after the diagnosis despite an aggressive surgical strategy.