Christian Partensky - Academia.edu (original) (raw)
Papers by Christian Partensky
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for re... more Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for resectable localized pancreatic adenocarcinoma. However, there is to date no completed phase III study to validate this approach and treatment effects evaluation still remains an active area of investigation. From the mature results of the SFRO-FFCD 9704 trial, we explored the antitumoral effect of a 5-fluoro-uracil and cisplatin-based preoperative chemoradiation regimen, with a special highlight on the histopathological response and performed a literature review. Treatment consisted of concurrent radiotherapy (50 Gy within five weeks) and chemotherapy with 5-fluoro-uracil (300 mg/m(2)/day, five days/week, weeks 1-5) and cisplatin (20mg/m(2)/day, days 1-5 and 29-33), followed by surgical resection of the pancreatic tumour in patients without progression. In all, 41 patients were enrolled, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A...
Hepato-gastroenterology
The early diagnosis of posttraumatic diaphragmatic lesions is often difficult which explains the ... more The early diagnosis of posttraumatic diaphragmatic lesions is often difficult which explains the 30 to 50% of non diagnosed cases. This is due to the lack of sensitivity and specificity of the radiographic exams. Missed diaphragmatic lesions results in herniation of abdominal contents into the chest and may be revealed many years from the time of the original trauma. Symptoms such as dyspnea and chronic abdominal complaints are often observed and life-threatening complications, such as visceral strangulation or perforation, contribute to the late morbidity and mortality of the missed injury. Liver herniation is rare and few cases are described in the literature. We report two cases of delayed discovery of the diaphragmatic injury resulting in liver herniation. In one case, there was also an involvement of the duodeno-pancreas. The diagnosis was made 3 and 12 years after the original trauma, respectively, and respiratory embarrassment was the major presenting symptom. The surgical ap...
Intra-arterial lipiodol labeled with iodine 131 ((131)I-lipiodol) can be safely used as adjuvant ... more Intra-arterial lipiodol labeled with iodine 131 ((131)I-lipiodol) can be safely used as adjuvant therapy following curative liver resection for hepatocellular carcinoma (HCC). Phase 2 pilot study. Large teaching hospital. Twenty-eight patients (24 men and 4 women; median age, 61.5 years; range, 33-75 years) were treated from January 1991 to June 1997. The liver was cirrhotic in 7 cases and noncirrhotic in 21 cases. An equal number of 14 patients underwent a major and a minor resection, all with clear margins. Median diameter of solitary tumors or the larger tumor when multiple tumors occurred was 5.5 cm (range, 2.5-29 cm). Tumor encapsulation was present in 12 cases and absent in 16 cases. After informed consent, patients who had no evidence of residual or recurrent tumor on computed tomographic (CT) scan and no sign of liver failure 2 to 3 months after curative resection for HCC were included in the trial. Complete follow-up was obtained (median, 51 months; range, 5-93 months). A 1110-MBq dose of (131)I-lipiodol was administered into the hepatic artery using the Seldinger technique. Patients were kept in a radio-protected room for 5 days. Postinjection radioactive whole scintiscan was performed at 5 days and an abdominal CT scan at 1 month after the injection. A second injection was performed in 16 patients 2 years later using the same protocol. Procedure safety. All patients experienced transient fever during the first 12 hours following injection. There were no noted adverse clinical effects or significant alteration in hepatic function due to the procedure or at immediate and late follow-up. The radioactive scan demonstrated an intense liver uptake, which was homogeneous in 19 cases and heterogeneous in 9. Mild detectable thyroid and lung uptake occurred in 50% of cases. No lipiodol liver fixation was observed on the 1-month CT scan. At the time of follow-up, 6 patients had died and 12 had developed recurrences, with 5 of the 6 deaths belonging to the recurrent group. Sixteen patients remained disease free. The median time to detected recurrence was 28 months (range, 12-62 months). Overall survival rates were 86% at 3 years and 65% at 5 years. This pilot study failed to demonstrate any clinically significant adverse effect of adjuvant therapy by intra-arterial (131)I-lipiodol after curative liver resection for HCC. Long-term survival compares favorably with those undergoing only surgery and suggests a benefit in lowering tumor recurrence. A randomized, multicenter, prospective trial comparing patients treated with intra-arterial (131)I-lipiodol with a nontreated control group seems appropriate.
Hepato-gastroenterology
Portal vein aneurysm is a rare entity. We present two cases of extrahepatic portal vein aneurysms... more Portal vein aneurysm is a rare entity. We present two cases of extrahepatic portal vein aneurysms, which were incidentally discovered in patients with no evidence of liver disease. Those were assumed to be congenital lesions. Diagnosis was made by Doppler ultrasound. Both patients were managed expectantly.
Cancer/Radiothérapie, 1998
Cancer/Radiothérapie, 1997
![Research paper thumbnail of [New insights in oncology: epigenetics and cancer stem cells]](https://attachments.academia-assets.com/43857731/thumbnails/1.jpg)
](Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Cancer is a multi-etiologic, multistage disease with a prevalent genetic component, which happens... more Cancer is a multi-etiologic, multistage disease with a prevalent genetic component, which happens when a large number of genes, critical for cell growth, death, differentiation, migration, and metabolic plasticity are altered irreversibly, so as to either "gain" (oncogenes) or "lose" (tumour suppressors) their function. Recent discoveries have revealed the previously underestimated etiologic importance of multiple epigenetic, that is to say, reversible factors (histone modifications, DNA methylation, non-coding RNA) involved in the transcriptional and post-transcriptional regulation of proteins, indispensable for the control of cancerous phenotype. Stable alterations of epigenetic machinery ("epimutations") turn out to play a critical role at different steps of carcinogenesis. In addition, due to substantial recent progress in stem cell biology, the new concept of cancer stem cells has emerged. This, along with newly discovered epigenetic cancer mechani...
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for re... more Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for resectable localized pancreatic adenocarcinoma. However, there is to date no completed phase III study to validate this approach and treatment effects evaluation still remains an active area of investigation. From the mature results of the SFRO-FFCD 9704 trial, we explored the antitumoral effect of a 5-fluoro-uracil and cisplatin-based preoperative chemoradiation regimen, with a special highlight on the histopathological response and performed a literature review. Treatment consisted of concurrent radiotherapy (50 Gy within five weeks) and chemotherapy with 5-fluoro-uracil (300 mg/m(2)/day, five days/week, weeks 1-5) and cisplatin (20mg/m(2)/day, days 1-5 and 29-33), followed by surgical resection of the pancreatic tumour in patients without progression. In all, 41 patients were enrolled, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A...
Journal de chirurgie, 2009
The Committee for the Assessment of Devices and Health Technologies (CEPP), one of the specialist... more The Committee for the Assessment of Devices and Health Technologies (CEPP), one of the specialist committees of the French National Authority for Health (HAS), reassessed the use of prosthetic mesh for hernia repair in 2008. Mesh use is reimbursed by French national health insurance for use in adult and pediatric surgery. This reassessment had two primary purposes: (a) to define the indications and clinical situations justifying the use of mesh, and to describe the technical requirements; (b) to define the conditions of prescriptions and of use and to contribute to decisions for the renewal of inscription. We performed a systematic review of published data and manufacturers' licenses and applied the judgment of a multidisciplinary working group of involved healthcare professionals. The CEPP first analyzed the different sorts of prosthetic mesh according to operative indications; they then compared the performance of each prosthesis based on comparative data from the literature o...
Journal de chirurgie, 2009
Surgical laparoscopy, endoscopy & percutaneous techniques, 2008
We report the death of a young man during a laparoscopic partial splenectomy performed with an ar... more We report the death of a young man during a laparoscopic partial splenectomy performed with an argon plasma coagulator to remove a benign cyst. The report analyzes the very particular mechanism of a gas embolism, which caused death here. This analysis leads us to recommend a close attention on the use of argon coagulators during laparoscopy. The aim of this article is to draw surgeons' attention to the conclusions of a court-ordered expert assessment intended to elucidate the mechanisms responsible for the death of a 20-year-old man during a laparoscopic partial splenectomy performed with an argon plasma coagulator to remove a benign cyst.
Gastroentérologie clinique et biologique, 2006
Although complete surgical resection, when possible, leads to prolonged survival in pancreatic ca... more Although complete surgical resection, when possible, leads to prolonged survival in pancreatic cancer, if used alone, its results remain sub-optimal. Neoadjuvant strategies are recent in pancreatic cancer: in primary resectable tumors, they ensure that all patients obtain additional treatment to complete surgery; in locally advanced tumors, they allow a better selection of candidates for curative resection. By delaying surgery, neoadjuvant strategies modify the initial diagnostic process and the symptomatic treatment of pancreatic cancer. Several recent phase I-II studies have confirmed the feasibility and efficacy of the association of chemotherapy and radiotherapy, which is well-tolerated and is associated with better local control and survival. Due to the aggressiveness of pancreatic cancers, most recent cytotoxic agents should be associated with modern radiation techniques. Neoadjuvant chemoradiation is under evaluation in pancreatic cancers, and no randomized phase III trials c...
Gastroentérologie clinique et biologique
Auto-immune pancreatitis is rare and its evolution includes both the usual complications of chron... more Auto-immune pancreatitis is rare and its evolution includes both the usual complications of chronic pancreatites, such as diabetes and specific consequences and complications including extension of inflammatory lesions of the extra or intrahepatic biliary tract. One particular characteristic of these complications is that they are sensitive to cortisone therapy, as illustrated by the case we report here.
British journal of cancer, Jan 7, 2006
The safety and efficacy of gemcitabine and concurrent radiation to the upper abdomen followed by ... more The safety and efficacy of gemcitabine and concurrent radiation to the upper abdomen followed by weekly gemcitabine in patients with resected pancreatic cancer was determined. Patients with resected adenocarcinoma of the pancreas were treated with intravenous gemcitabine administered twice-weekly (40 mg m(-2)) for 5 weeks concurrent with upper abdominal radiation (50.4 Gy in 5(1/2) weeks). At the completion of the chemoradiation, patients without disease progression were given gemcitabine (1000 mg m(-2)) weekly for two cycles. Each cycle consisted of 3 weeks of treatment followed by 1 week without treatment. Forty-seven patients were entered, 46 of whom are included in this analysis. Characteristics: median age 61 years (range 35-79); 24 females (58%); 73% stage T3/T4; and 70% lymph node positive. Grade III/IV gastrointestinal or haematologic toxicities were infrequent. The median survival was 18.3 months, while the median time to disease recurrence was 10.3 months. Twenty-four perc...
Hepato-gastroenterology
Endocrine tumors of the extrahepatic bile ducts are an extremely rare clinical entity with only v... more Endocrine tumors of the extrahepatic bile ducts are an extremely rare clinical entity with only very few cases being reported to date. Two additional cases of extrahepatic endocrine tumors are presented and a review of the literature is analyzed to provide a comprehensive data collection. Thirty-four cases of extrahepatic endocrine tumor, including our 2 cases, have been reported; 16 (47%) being carcinoma. The mean age of presentation was 48.2 years with a male/female ratio of 0.36. Jaundice, the most common symptom, was found in 63% of the patients. The common bile duct and the hilar region were the two most frequent anatomic locations. The mean size of resectable tumors was 2.37cm (0.2- 5.5cm). Metastases were present in 11 patients (32.35%) and local invasion was found only in 6 patients (17.6%). Curative surgery was realized in the majority of the patients. Long-term disease-free survival as long as 20 years was reported when surgery was curative. Endocrine tumors of the extrahe...
Annales de chirurgie, 2002
Major complications following pancreaticoduodenectomy are thought to be chiefly associated with e... more Major complications following pancreaticoduodenectomy are thought to be chiefly associated with exocrine secretion of the pancreatic remnant which is not well known. This work aims to assess the exocrine secretion of the pancreatic remnant within the early post-operative period. Seventy-five patients undergoing pancreaticoduodenectomy for presumed tumour were included in a prospective multicentre study. A tube was inserted in the pancreatic duct at the time of construction of the pancreatic anastomosis. Peripancreatic drainage was routinely used. Pancreatic juice and peripancreatic drainage fluid were collected and measured and pancreatic enzyme monitored. For 7 days patients received total parenteral nutrition and continuous infusion of randomly Somatostatin 14 (S-14) at a dose of 6 mg/24 h (days 1-6) and 3 mg/24 h (day 7) or matching placebo. Pancreatic fistula was defined as a daily drainage of more than 100 cc of amylase-rich fluid after day 3, persisting after day 12 or associa...
Gastroentérologie clinique et biologique, 2001
Gastroentérologie clinique et biologique
Endocrine tumors of the ampulla of Vater and minor papilla are rare. This study describes the mod... more Endocrine tumors of the ampulla of Vater and minor papilla are rare. This study describes the mode of presentation and evaluates the correlation between pathological features and prognosis. Between 1982 and 1998, 6 patients (3 M, 3 F, mean age: 47.6 years, range: 36-58) for whom a diagnosis of endocrine tumor of the ampulla of Vater or minor papilla was made between 1982 and 1998 after histological examination of an operative specimen of pancreaticoduodenectomy. One patient was detected incidentally, two had a Zollinger-Ellison syndrome, two had pain and one had obstructive jaundice with pain. The tumor was located in the ampulla of Vater in 5 cases and at the minor papilla in 1 case. All patients underwent a pancreaticoduodenectomy, with histological examination showing tumor diameter varying from 5 to 40 mm and positive lymph nodes. Five patients had a well differentiated endocrine tumor and one a poorly differentiated tumor. All patients had positive Grimelius staining. The secre...
Gastroentérologie clinique et biologique, 1999
Solid pseudopapillary tumors of the pancreas are exceptional. The aims of our study were to reeva... more Solid pseudopapillary tumors of the pancreas are exceptional. The aims of our study were to reevaluate the mode of presentation of these tumors and to analyze the role of pathological examination in diagnostic assessment and prognostic evaluation. We report the clinical, radiological and pathological findings in a retrospective series of 13 patients in whom a diagnosis of solid pseudopapillary tumor of the pancreas was made between 1983 and 1997. There were 12 females (median age: 22.5 years) and one male, aged 73. The tumor was discovered incidentally (3 cases) or because of nonspecific digestive symptoms (10 cases). Biological data were uninformative. The tumor was pancreatic in 12 cases and duodenal in 1. In all cases, imaging techniques showed an heterogeneous lesion with no or poor vascularization. A cystic component was identified in 4 cases. Surgical resection was performed in all cases. Pathological examination showed an encapsulated tumor in 8 cases, a non-encapsulated but ...
Chirurgie; mémoires de l'Académie de chirurgie, 1998
To report a personal series of ten patients who underwent a medial pancreatectomy with pancreatic... more To report a personal series of ten patients who underwent a medial pancreatectomy with pancreaticogastrostomy for tumor of the pancreas. An equal number of five patients had solid and cystic tumors. The solid tumors were all endocrine and included two cases of insulinoma and solitary cases of VIPoma, glucagonoma, and non-secreting tumor. Five patients had a cystic tumor which was in two cases a serous cystadenoma, and in the other cases, a mucinous cystadenoma, a solid pseudopapillary tumor, and a solitary hydatid cyst of the pancreas. The operative procedure included a middle segment pancreatectomy, a suture of the proximal pancreatic stump, an anastomosis of the distal pancreatic stump with the stomach and an external transgastric drainage of the distal main pancreatic duct. In the postoperative course, a sero-hematic collection close to the anastomosis occurred in four patients and required external drainage in three cases. All patients recovered without sequela of pancreatic dys...
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for re... more Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for resectable localized pancreatic adenocarcinoma. However, there is to date no completed phase III study to validate this approach and treatment effects evaluation still remains an active area of investigation. From the mature results of the SFRO-FFCD 9704 trial, we explored the antitumoral effect of a 5-fluoro-uracil and cisplatin-based preoperative chemoradiation regimen, with a special highlight on the histopathological response and performed a literature review. Treatment consisted of concurrent radiotherapy (50 Gy within five weeks) and chemotherapy with 5-fluoro-uracil (300 mg/m(2)/day, five days/week, weeks 1-5) and cisplatin (20mg/m(2)/day, days 1-5 and 29-33), followed by surgical resection of the pancreatic tumour in patients without progression. In all, 41 patients were enrolled, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A...
Hepato-gastroenterology
The early diagnosis of posttraumatic diaphragmatic lesions is often difficult which explains the ... more The early diagnosis of posttraumatic diaphragmatic lesions is often difficult which explains the 30 to 50% of non diagnosed cases. This is due to the lack of sensitivity and specificity of the radiographic exams. Missed diaphragmatic lesions results in herniation of abdominal contents into the chest and may be revealed many years from the time of the original trauma. Symptoms such as dyspnea and chronic abdominal complaints are often observed and life-threatening complications, such as visceral strangulation or perforation, contribute to the late morbidity and mortality of the missed injury. Liver herniation is rare and few cases are described in the literature. We report two cases of delayed discovery of the diaphragmatic injury resulting in liver herniation. In one case, there was also an involvement of the duodeno-pancreas. The diagnosis was made 3 and 12 years after the original trauma, respectively, and respiratory embarrassment was the major presenting symptom. The surgical ap...
Intra-arterial lipiodol labeled with iodine 131 ((131)I-lipiodol) can be safely used as adjuvant ... more Intra-arterial lipiodol labeled with iodine 131 ((131)I-lipiodol) can be safely used as adjuvant therapy following curative liver resection for hepatocellular carcinoma (HCC). Phase 2 pilot study. Large teaching hospital. Twenty-eight patients (24 men and 4 women; median age, 61.5 years; range, 33-75 years) were treated from January 1991 to June 1997. The liver was cirrhotic in 7 cases and noncirrhotic in 21 cases. An equal number of 14 patients underwent a major and a minor resection, all with clear margins. Median diameter of solitary tumors or the larger tumor when multiple tumors occurred was 5.5 cm (range, 2.5-29 cm). Tumor encapsulation was present in 12 cases and absent in 16 cases. After informed consent, patients who had no evidence of residual or recurrent tumor on computed tomographic (CT) scan and no sign of liver failure 2 to 3 months after curative resection for HCC were included in the trial. Complete follow-up was obtained (median, 51 months; range, 5-93 months). A 1110-MBq dose of (131)I-lipiodol was administered into the hepatic artery using the Seldinger technique. Patients were kept in a radio-protected room for 5 days. Postinjection radioactive whole scintiscan was performed at 5 days and an abdominal CT scan at 1 month after the injection. A second injection was performed in 16 patients 2 years later using the same protocol. Procedure safety. All patients experienced transient fever during the first 12 hours following injection. There were no noted adverse clinical effects or significant alteration in hepatic function due to the procedure or at immediate and late follow-up. The radioactive scan demonstrated an intense liver uptake, which was homogeneous in 19 cases and heterogeneous in 9. Mild detectable thyroid and lung uptake occurred in 50% of cases. No lipiodol liver fixation was observed on the 1-month CT scan. At the time of follow-up, 6 patients had died and 12 had developed recurrences, with 5 of the 6 deaths belonging to the recurrent group. Sixteen patients remained disease free. The median time to detected recurrence was 28 months (range, 12-62 months). Overall survival rates were 86% at 3 years and 65% at 5 years. This pilot study failed to demonstrate any clinically significant adverse effect of adjuvant therapy by intra-arterial (131)I-lipiodol after curative liver resection for HCC. Long-term survival compares favorably with those undergoing only surgery and suggests a benefit in lowering tumor recurrence. A randomized, multicenter, prospective trial comparing patients treated with intra-arterial (131)I-lipiodol with a nontreated control group seems appropriate.
Hepato-gastroenterology
Portal vein aneurysm is a rare entity. We present two cases of extrahepatic portal vein aneurysms... more Portal vein aneurysm is a rare entity. We present two cases of extrahepatic portal vein aneurysms, which were incidentally discovered in patients with no evidence of liver disease. Those were assumed to be congenital lesions. Diagnosis was made by Doppler ultrasound. Both patients were managed expectantly.
Cancer/Radiothérapie, 1998
Cancer/Radiothérapie, 1997
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Cancer is a multi-etiologic, multistage disease with a prevalent genetic component, which happens... more Cancer is a multi-etiologic, multistage disease with a prevalent genetic component, which happens when a large number of genes, critical for cell growth, death, differentiation, migration, and metabolic plasticity are altered irreversibly, so as to either "gain" (oncogenes) or "lose" (tumour suppressors) their function. Recent discoveries have revealed the previously underestimated etiologic importance of multiple epigenetic, that is to say, reversible factors (histone modifications, DNA methylation, non-coding RNA) involved in the transcriptional and post-transcriptional regulation of proteins, indispensable for the control of cancerous phenotype. Stable alterations of epigenetic machinery ("epimutations") turn out to play a critical role at different steps of carcinogenesis. In addition, due to substantial recent progress in stem cell biology, the new concept of cancer stem cells has emerged. This, along with newly discovered epigenetic cancer mechani...
Cancer radiothérapie : journal de la Société française de radiothérapie oncologique, 2011
Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for re... more Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for resectable localized pancreatic adenocarcinoma. However, there is to date no completed phase III study to validate this approach and treatment effects evaluation still remains an active area of investigation. From the mature results of the SFRO-FFCD 9704 trial, we explored the antitumoral effect of a 5-fluoro-uracil and cisplatin-based preoperative chemoradiation regimen, with a special highlight on the histopathological response and performed a literature review. Treatment consisted of concurrent radiotherapy (50 Gy within five weeks) and chemotherapy with 5-fluoro-uracil (300 mg/m(2)/day, five days/week, weeks 1-5) and cisplatin (20mg/m(2)/day, days 1-5 and 29-33), followed by surgical resection of the pancreatic tumour in patients without progression. In all, 41 patients were enrolled, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A...
Journal de chirurgie, 2009
The Committee for the Assessment of Devices and Health Technologies (CEPP), one of the specialist... more The Committee for the Assessment of Devices and Health Technologies (CEPP), one of the specialist committees of the French National Authority for Health (HAS), reassessed the use of prosthetic mesh for hernia repair in 2008. Mesh use is reimbursed by French national health insurance for use in adult and pediatric surgery. This reassessment had two primary purposes: (a) to define the indications and clinical situations justifying the use of mesh, and to describe the technical requirements; (b) to define the conditions of prescriptions and of use and to contribute to decisions for the renewal of inscription. We performed a systematic review of published data and manufacturers' licenses and applied the judgment of a multidisciplinary working group of involved healthcare professionals. The CEPP first analyzed the different sorts of prosthetic mesh according to operative indications; they then compared the performance of each prosthesis based on comparative data from the literature o...
Journal de chirurgie, 2009
Surgical laparoscopy, endoscopy & percutaneous techniques, 2008
We report the death of a young man during a laparoscopic partial splenectomy performed with an ar... more We report the death of a young man during a laparoscopic partial splenectomy performed with an argon plasma coagulator to remove a benign cyst. The report analyzes the very particular mechanism of a gas embolism, which caused death here. This analysis leads us to recommend a close attention on the use of argon coagulators during laparoscopy. The aim of this article is to draw surgeons' attention to the conclusions of a court-ordered expert assessment intended to elucidate the mechanisms responsible for the death of a 20-year-old man during a laparoscopic partial splenectomy performed with an argon plasma coagulator to remove a benign cyst.
Gastroentérologie clinique et biologique, 2006
Although complete surgical resection, when possible, leads to prolonged survival in pancreatic ca... more Although complete surgical resection, when possible, leads to prolonged survival in pancreatic cancer, if used alone, its results remain sub-optimal. Neoadjuvant strategies are recent in pancreatic cancer: in primary resectable tumors, they ensure that all patients obtain additional treatment to complete surgery; in locally advanced tumors, they allow a better selection of candidates for curative resection. By delaying surgery, neoadjuvant strategies modify the initial diagnostic process and the symptomatic treatment of pancreatic cancer. Several recent phase I-II studies have confirmed the feasibility and efficacy of the association of chemotherapy and radiotherapy, which is well-tolerated and is associated with better local control and survival. Due to the aggressiveness of pancreatic cancers, most recent cytotoxic agents should be associated with modern radiation techniques. Neoadjuvant chemoradiation is under evaluation in pancreatic cancers, and no randomized phase III trials c...
Gastroentérologie clinique et biologique
Auto-immune pancreatitis is rare and its evolution includes both the usual complications of chron... more Auto-immune pancreatitis is rare and its evolution includes both the usual complications of chronic pancreatites, such as diabetes and specific consequences and complications including extension of inflammatory lesions of the extra or intrahepatic biliary tract. One particular characteristic of these complications is that they are sensitive to cortisone therapy, as illustrated by the case we report here.
British journal of cancer, Jan 7, 2006
The safety and efficacy of gemcitabine and concurrent radiation to the upper abdomen followed by ... more The safety and efficacy of gemcitabine and concurrent radiation to the upper abdomen followed by weekly gemcitabine in patients with resected pancreatic cancer was determined. Patients with resected adenocarcinoma of the pancreas were treated with intravenous gemcitabine administered twice-weekly (40 mg m(-2)) for 5 weeks concurrent with upper abdominal radiation (50.4 Gy in 5(1/2) weeks). At the completion of the chemoradiation, patients without disease progression were given gemcitabine (1000 mg m(-2)) weekly for two cycles. Each cycle consisted of 3 weeks of treatment followed by 1 week without treatment. Forty-seven patients were entered, 46 of whom are included in this analysis. Characteristics: median age 61 years (range 35-79); 24 females (58%); 73% stage T3/T4; and 70% lymph node positive. Grade III/IV gastrointestinal or haematologic toxicities were infrequent. The median survival was 18.3 months, while the median time to disease recurrence was 10.3 months. Twenty-four perc...
Hepato-gastroenterology
Endocrine tumors of the extrahepatic bile ducts are an extremely rare clinical entity with only v... more Endocrine tumors of the extrahepatic bile ducts are an extremely rare clinical entity with only very few cases being reported to date. Two additional cases of extrahepatic endocrine tumors are presented and a review of the literature is analyzed to provide a comprehensive data collection. Thirty-four cases of extrahepatic endocrine tumor, including our 2 cases, have been reported; 16 (47%) being carcinoma. The mean age of presentation was 48.2 years with a male/female ratio of 0.36. Jaundice, the most common symptom, was found in 63% of the patients. The common bile duct and the hilar region were the two most frequent anatomic locations. The mean size of resectable tumors was 2.37cm (0.2- 5.5cm). Metastases were present in 11 patients (32.35%) and local invasion was found only in 6 patients (17.6%). Curative surgery was realized in the majority of the patients. Long-term disease-free survival as long as 20 years was reported when surgery was curative. Endocrine tumors of the extrahe...
Annales de chirurgie, 2002
Major complications following pancreaticoduodenectomy are thought to be chiefly associated with e... more Major complications following pancreaticoduodenectomy are thought to be chiefly associated with exocrine secretion of the pancreatic remnant which is not well known. This work aims to assess the exocrine secretion of the pancreatic remnant within the early post-operative period. Seventy-five patients undergoing pancreaticoduodenectomy for presumed tumour were included in a prospective multicentre study. A tube was inserted in the pancreatic duct at the time of construction of the pancreatic anastomosis. Peripancreatic drainage was routinely used. Pancreatic juice and peripancreatic drainage fluid were collected and measured and pancreatic enzyme monitored. For 7 days patients received total parenteral nutrition and continuous infusion of randomly Somatostatin 14 (S-14) at a dose of 6 mg/24 h (days 1-6) and 3 mg/24 h (day 7) or matching placebo. Pancreatic fistula was defined as a daily drainage of more than 100 cc of amylase-rich fluid after day 3, persisting after day 12 or associa...
Gastroentérologie clinique et biologique, 2001
Gastroentérologie clinique et biologique
Endocrine tumors of the ampulla of Vater and minor papilla are rare. This study describes the mod... more Endocrine tumors of the ampulla of Vater and minor papilla are rare. This study describes the mode of presentation and evaluates the correlation between pathological features and prognosis. Between 1982 and 1998, 6 patients (3 M, 3 F, mean age: 47.6 years, range: 36-58) for whom a diagnosis of endocrine tumor of the ampulla of Vater or minor papilla was made between 1982 and 1998 after histological examination of an operative specimen of pancreaticoduodenectomy. One patient was detected incidentally, two had a Zollinger-Ellison syndrome, two had pain and one had obstructive jaundice with pain. The tumor was located in the ampulla of Vater in 5 cases and at the minor papilla in 1 case. All patients underwent a pancreaticoduodenectomy, with histological examination showing tumor diameter varying from 5 to 40 mm and positive lymph nodes. Five patients had a well differentiated endocrine tumor and one a poorly differentiated tumor. All patients had positive Grimelius staining. The secre...
Gastroentérologie clinique et biologique, 1999
Solid pseudopapillary tumors of the pancreas are exceptional. The aims of our study were to reeva... more Solid pseudopapillary tumors of the pancreas are exceptional. The aims of our study were to reevaluate the mode of presentation of these tumors and to analyze the role of pathological examination in diagnostic assessment and prognostic evaluation. We report the clinical, radiological and pathological findings in a retrospective series of 13 patients in whom a diagnosis of solid pseudopapillary tumor of the pancreas was made between 1983 and 1997. There were 12 females (median age: 22.5 years) and one male, aged 73. The tumor was discovered incidentally (3 cases) or because of nonspecific digestive symptoms (10 cases). Biological data were uninformative. The tumor was pancreatic in 12 cases and duodenal in 1. In all cases, imaging techniques showed an heterogeneous lesion with no or poor vascularization. A cystic component was identified in 4 cases. Surgical resection was performed in all cases. Pathological examination showed an encapsulated tumor in 8 cases, a non-encapsulated but ...
Chirurgie; mémoires de l'Académie de chirurgie, 1998
To report a personal series of ten patients who underwent a medial pancreatectomy with pancreatic... more To report a personal series of ten patients who underwent a medial pancreatectomy with pancreaticogastrostomy for tumor of the pancreas. An equal number of five patients had solid and cystic tumors. The solid tumors were all endocrine and included two cases of insulinoma and solitary cases of VIPoma, glucagonoma, and non-secreting tumor. Five patients had a cystic tumor which was in two cases a serous cystadenoma, and in the other cases, a mucinous cystadenoma, a solid pseudopapillary tumor, and a solitary hydatid cyst of the pancreas. The operative procedure included a middle segment pancreatectomy, a suture of the proximal pancreatic stump, an anastomosis of the distal pancreatic stump with the stomach and an external transgastric drainage of the distal main pancreatic duct. In the postoperative course, a sero-hematic collection close to the anastomosis occurred in four patients and required external drainage in three cases. All patients recovered without sequela of pancreatic dys...