Eddy Cotte - Academia.edu (original) (raw)
Papers by Eddy Cotte
Annals of surgery, Mar 14, 2016
To assess the effect of pelvic drainage after rectal surgery for cancer. Pelvic sepsis is one of ... more To assess the effect of pelvic drainage after rectal surgery for cancer. Pelvic sepsis is one of the major complications after rectal excision for rectal cancer. Although many studies have confirmed infectiveness of drainage after colectomy, there is still a controversy after rectal surgery. This multicenter randomized trial with 2 parallel arms (drain vs no drain) was performed between 2011 and 2014. Primary endpoint was postoperative pelvic sepsis within 30 postoperative days, including anastomotic leakage, pelvic abscess, and peritonitis. Secondary endpoints were overall morbidity and mortality, rate of reoperation, length of hospital stay, and rate of stoma closure at 6 months. A total of 494 patients were randomized, 25 did not meet the criteria and 469 were analyzed: 236 with drain and 233 without. The anastomotic height was 3.5 ± 1.9 cm from the anal verge. The rate of pelvic sepsis was 17.1% (80/469) and was similar between drain and no drain: 16.1% versus 18.0% (P = 0.58). ...
Gastroenterologie clinique et biologique, 2006
Spontaneous rupture of intrahepatic aneurysm is a rare life threatening condition because of the ... more Spontaneous rupture of intrahepatic aneurysm is a rare life threatening condition because of the risk of spontaneous rupture. A 33 year old female patient presented with hemorrhagic shock. Angio-CT-scan revealed an intrahepatic ruptured aneurysm with a massive central and subcapsular haematoma of the liver. Percutaneous embolisation under ultrasound control was not possible because of the size of the subcapsular haematoma. Angiography showed a main arterial supply of this aneurysm from the anterior sectorial branch of the right branch of hepatic artery and selective embolisation was not possible because of anatomical configuration. Because of persistent bleeding, surgery was performed with evacuation of liver haematoma and a highly selective ligature of the main aneurysmal arterial supply. Post-operative angio-CT-scan showed revascularisation of the aneurysm through retrograde intrahepatic arterial supply. Ultrasound identification of the aneurysm was then possible and percutaneous ...
International Journal of Colorectal Disease
World Journal of Surgery
Background There are no specific guidelines for ventral hernia management in Crohn’s disease (CD)... more Background There are no specific guidelines for ventral hernia management in Crohn’s disease (CD) patients. We aimed to assess the risk of septic morbidity after mesh repair in CD. Methods This was a retrospective multicentre study comparing CD and non-CD patients undergoing mesh repair for ventral hernia (primary or incisional hernia). Controls were matched 1:1 for the presence of a stoma, history of surgical sepsis, hernia size and Ventral Hernia Working Group (VHWG) score. All demographic, pre-, intra- and postoperative data were retrieved, including long-term data. Results We included 234 patients, with 114 CD patients. Both groups had comparable VHWG scores ( p = 0.12), hernia sizes ( p = 0.11), ASA scores ≥ 3 ( p = 0.70), body mass index values ( p = 0.14), presence of stoma (CD 21.9% vs. controls 15%, p = 0.16), history of sepsis (14% vs. 6.7%, p = 0.23), rates of malnutrition (4.4% vs. 1.7%, p = 0.46), rates of incisional hernia (93% vs. 95%, p = 0.68) and concomitant procedures (18.4% vs. 11.7%, p = 0.12). CD patients carried a higher risk of postoperative septic morbidity (18.4% vs. 5%, p = 0.001), entero-prosthetic fistula (7% vs. 0, p < 0.01) and mesh withdrawals (5.3% vs. 0, p = 0.011). Ventral hernia recurrence rates were similar (14% vs. 8.3%, p = 0.15). In the univariate analysis, the risk factors for septic morbidity were CD ( p = 0.001), malnutrition ( p = 0.004), use of biological mesh ( p < 0.0001) and concomitant procedure ( p = 0.004). The mesh position, the means used for mesh fixation as well as the presence of a stoma were not identified as risk factors. Conclusions CD seems to be a risk factor for septic morbidity after mesh repair.
Journal of Crohn's and Colitis
Background and Aims To compare perioperative characteristics and outcomes between primary ileocol... more Background and Aims To compare perioperative characteristics and outcomes between primary ileocolonic resection [PICR] and iterative ileocolic resection [IICR] for Crohn’s disease [CD]. Methods From 2013 to 2015, 567 patients undergoing ileocolonic resection were prospectively included in 19 centres of the GETAID chirurgie group. Perioperative characteristics and postoperative results of both groups [431 PICR, 136 IICR] were compared. Uni- and multivariate analyses of the risk factors of overall 30-day postoperative morbidity was carried out in the IICR group. Results IICR patients were less likely to be malnourished [27.2% vs 39.9%, p = 0.007], and had more stricturing forms [69.1% vs 54.3%, p = 0.002] and less perforating disease [19.9% vs 39.2%, p < 0.001]. Laparoscopy was less commonly used in IICR [45.6% vs 84.5%, p < 0.01] and was associated with increased conversion rates [27.4% vs 14.6%, p = 0.012]. Overall postoperative morbidity was 36.8% in the IICR group and 26.7% ...
International Journal of Colorectal Disease
Annals of Surgery
OBJECTIVE The aim of the study was to investigate whether patients who undergo surgery in hospita... more OBJECTIVE The aim of the study was to investigate whether patients who undergo surgery in hospitals experiencing significant length of stay (LOS) reductions over time are exposed to a higher risk of severe adverse events in the postoperative period. SUMMARY BACKGROUND DATA Surgical care innovation has encouraged hospitals to shorten LOS under financial pressures with uncertain impact on patient outcomes. METHODS We selected all patients who underwent elective colectomy or urgent hip fracture repair in French hospitals between 2013 and 2016. For each procedure, hospitals were categorized into 3 groups according to variations in their median LOS as follows: major decrease, moderate decrease, and no decrease. These groups were matched using propensity scores based on patients' and hospitals' potential confounders. Potentially avoidable readmission for severe adverse events and death at 6 months were compared between groups using Cox regressions. RESULTS We considered 98,713 patients in 540 hospitals for colectomy and 206,812 patients in 414 hospitals for hip fracture repair before matching. After colectomy, patient outcomes were not negatively impacted when hospitals reduced their LOS [hazard ratio (95% confidence interval): 0.93 (0.78-1.10)]. After hip fracture repair, patients in hospitals with major decreases in LOS had a higher risk of severe adverse events [1.22 (1.11-1.34)] and death [1.17 (1.04-1.32)]. CONCLUSIONS Patients who underwent surgical procedures in hospitals experiencing major decreases in LOS were demonstrated worse postoperative outcomes after urgent hip fracture repair and not after elective colectomy. Development of care bundles to enhance recovery after emergency surgeries may allow better control of LOS reduction and patient outcomes.
Annals of Surgical Oncology
Journal of Crohn's & colitis, Jan 21, 2017
Colectomy can be required in the management of ulcerative colitis (UC). While ileal pouch anal-an... more Colectomy can be required in the management of ulcerative colitis (UC). While ileal pouch anal-anastomosis (IPAA) is the recommended reconstruction technique, ileorectal anastomosis (IRA) is still performed and might present some advantages. However, the risk of rectal neoplasia might limit its indication. The aims of our study were to determine the incidence of rectal neoplasias following IRA for UC and to identify risk factors associated with rectal carcinomas. We performed a multicenter retrospective study including patients who underwent IRA for UC from 1960 to 2014 in 13 centers. Cox-proportional hazard models were used to determine carcinoma-associated risk factors. 343 patients were included with a median follow-up of 10.4 years after IRA. At the end of follow-up, 38 rectal neoplasias including 19 carcinomas were diagnosed and 7 patients (2%) had either died from rectal carcinoma or had a metastatic disease. Incidences of rectal carcinoma after IRA for UC were estimated at 3....
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Nov 18, 2016
A pathologic complete response (pCR; ypT0N0) of a rectal tumor after neoadjuvant radiochemotherap... more A pathologic complete response (pCR; ypT0N0) of a rectal tumor after neoadjuvant radiochemotherapy (RCT) is associated with an excellent prognosis. Several retrospective studies have investigated the effect of increasing the delay after RCT. The aim of this study was to evaluate the effect of increasing the interval between the end of RCT and surgery on the pCR rate. GRECCAR6 was a phase III, multicenter, randomized, open-label, parallel-group controlled trial. Patients with cT3/T4 or Tx N+ tumors of the mid or lower rectum who had received RCT (45 to 50 Gy with fluorouracil or capecitabine) were included. Patients were randomly included in the 7-week or the 11-week (11w) group. Primary end point was the pCR rate defined as a ypT0N0 specimen (NCT01648894). A total of 265 patients from 24 centers were enrolled between October 2012 and February 2015. The majority of the tumors were cT3 (82%). After RCT, surgery was not performed in nine patients (3.4%) because of the occurrence of dis...
Annals of Surgical Oncology, 2016
Complete cytoreductive surgery (CRS), combining organ resection and peritonectomy, is the only tr... more Complete cytoreductive surgery (CRS), combining organ resection and peritonectomy, is the only treatment that could offer cure for patients with peritoneal carcinomatosis. Initially, when the Glisson&amp;#39;s capsule was involved without deep liver parenchyma invasion, either electroevaporation or Glisson&amp;#39;s capsule resection was proposed. The objective of this study is to present and evaluate the safety of this standardized digital glissonectomy. Since 2009, the peritonectomy of the Glisson&amp;#39;s capsule, or digital glissonectomy, has been standardized at our institution. Among 655 patients who underwent a complete CRS between 2009 and 2014, 91 (14 %) glissonectomies were performed. Pseudomyxoma peritonei was the primary indication, and a glissonectomy was more frequently performed for patients with high peritoneal cancer index. The morbidity and mortality of CRS were not increased after glissonectomy (p = 0.069 and 0.949, respectively). Digital glissonectomy is feasible and safe, when proposed for superficial deposits on Glisson&amp;#39;s capsule.
Saudi Medical Journal, 2016
Annals of Surgical Oncology, 2016
Complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is in... more Complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is increasingly performed on patients with peritoneal carcinomatosis of various origins. Splenectomy often is required in these patients to achieve complete tumor removal. Although splenectomy has been associated with increased morbidity in many major abdominal surgeries, its effect in patients undergoing CRS + HIPEC is unknown. The purpose of this study was to evaluate the impact of splenectomy during CRS + HIPEC on postoperative outcomes. We retrospectively identified 39 patients who underwent CRS + HIPEC with splenectomy during a 3-year study period from a prospective database. We compared them to case controls (CRS + HIPEC without splenectomy) that were matched for the complexity of the procedure. We evaluated the complication rate and outcomes of patients in each group. During the study period, splenectomy was performed in 32 % of patients undergoing CRS + HIPEC procedure. Patients in the splenectomy group experienced more grade 3-4 complications than patients in the control group (59 vs. 35.9 %, p = 0.041) as well as more pulmonary complications (41 vs. 7.7 %, p = 0.0006). Multivariate analysis identified splenectomy as the only predictor of overall major complications (odds ratio = 2.57, 95 % confidence interval = 1.03-6.40). Mortality was similar in both groups. Splenectomy increases major complication rate in patients undergoing CRS + HIPEC and efforts should be made to preserve the spleen during the surgery.
Hepato Gastro Oncologie Digestive, Oct 1, 2014
Les tumeurs du peritoine regroupent les tumeurs du mesentere, de l’epiploon et de la sereuse peri... more Les tumeurs du peritoine regroupent les tumeurs du mesentere, de l’epiploon et de la sereuse peritoneale. Les tumeurs primitives du mesentere et du peritoine sont rares (pseudomyxomes et mesotheliomes peritoneaux, tumeurs desmoplastiques a petites cellules et psammocarcinomes). Les tumeurs secondaires de la sereuse peritoneale (carcinose peritoneale) sont plus frequentes et compliquent l’evolution de la plupart des cancers intra-abdominaux (cancers colorectal, gastrique, pancreatique, ovarien, appendiculaire). Leur pronostic repose sur la nature de la tumeur primitive et leur distribution ou extension appreciees par le Peritoneal Cancer Index (PCI). Le scanner abdomino-pelvien reste l’outil morphologique de reference pour ces maladies mais l’apport de l’imagerie fonctionnelle (IRM, TEP scanner) est en cours d’evaluation. La cœlioscopie est l’examen le plus utile pour apprecier l’extension et la resecabilite tout en permettant la realisation de biopsies diagnostiques. La carcinose peritoneale a ete consideree comme le stade terminal des cancers mais le developpement des approches therapeutiques pluridisciplinaires locoregionales combinant chirurgie de cytoreduction et chimiotherapie intraperitoneale avec ou sans hyperthermie ont bouleverse son pronostic et sa prise en charge pour permettre une intention curative en cas de carcinose limitee et surtout resecable. Le developpement de traitements prophylactiques des carcinoses gastriques et colorectales est en cours d’evaluation chez les patients a risque. Ces traitements doivent etre reserves a certains centres specialises mais imposent a tous de nouveaux reflexes diagnostiques et therapeutiques.
Hepato Gastro, 2010
Compte tenu de la difficulte et des consequences du diagnostic de dysplasie, toute dysplasie, qu&... more Compte tenu de la difficulte et des consequences du diagnostic de dysplasie, toute dysplasie, qu'elle soit de bas grade, de haut grade ou incertaine, doit etre confirmee par un second anatomopathologiste. La decouverte d'une dysplasie de haut grade sur une muqueuse colique plane ou apparemment plane en coloscopie conventionnelle doit conduire a pratiquer une proctocolectomie. La conduite a tenir en cas de decouverte d'une dysplasie de bas grade sur une muqueuse colique plane ou apparemment plane reste controversee, certains preconisant une proctocolectomie, d'autres une surveillance endoscopique rapprochee. Apres polypectomie ou, a defaut, biopsies, en cas de constatation d'une dysplasie sur une lesion polypoide siegeant dans une zone non atteinte actuellement ou anterieurement par la colite, la lesion doit etre consideree comme un adenome sporadique ne necessitant que la surveillance habituelle a ce type de lesion. Lorsque la lesion polypoide siege dans une zone atteinte ou prealablement atteinte par la colite, une polypectomie est suffisante, a condition que la lesion soit un simple adenome et ait ete enlevee totalement ou puisse l'etre ulterieurement, qu'il n'y ait pas de dysplasie a la base ou sur les marges du polype, ni d'autres zones dysplasiques dans le colon, que ce dernier puisse etre surveille facilement et, pour certains, que le patient soit âge de plus de 40 ans. Enfin, si la lesion dysplasique ne ressemble pas un polype adenomateux banal, si son exerese parait difficile et si de la dysplasie est trouvee egalement au pourtour de la lesion ou a distance sur le colon, la lesion doit etre consideree comme une dysplasia-associated lesion or mass (DALM) et necessite la realisation d'une proctocolectomie.
Journal of Crohn's & colitis, Jan 19, 2015
Evidence from mouse colitis models indicates that cytotoxic CD8(+) T cells (CTL) play a key role ... more Evidence from mouse colitis models indicates that cytotoxic CD8(+) T cells (CTL) play a key role in the initiation of gut lesions. We investigated whether changes in CD8(+) CTL in blood or lamina propria (LP) of the neoterminal ileum were associated with postoperative endoscopic recurrence of Crohn's disease (CD). Thirty-seven CD patients with ileocolonic resection were endoscopically followed up at six and twelve months post-surgery. CD8(+) T cells were analyzed by flow cytometry in blood and ileal LP. Granzyme B- and perforin-producing CD8(+) T cells were significantly increased at 6 months in blood and in ileum LP in patients with endoscopic recurrence, as compared to those in remission. At a cutoff point of 45% of CD8(+) CTL, the overall accuracies of the frequency of blood granzyme B(+) or perforin(+) CD8(+) T cells to identify patients with postoperative endoscopic recurrence were 77% and 83%, respectively. Interestingly, patients with endoscopic recurrence at 12 months we...
Gastroentérologie clinique et biologique, 2006
Inflammatory pseudo-tumors of the liver are rare and difficult to diagnose, mimicking malignant t... more Inflammatory pseudo-tumors of the liver are rare and difficult to diagnose, mimicking malignant tumors. We report a patient, 42 year old with hepatic pseudo-tumor who was suspected to have pseudotumoral hepatic tuberculosis without immunodepression and treated by major hepatic surgery because no sure diagnosis. Therapeutic approach of hepatic inflammatory pseudotumors is often medical and surgical and may need major hepatic surgery in case of sure etiologic diagnosis.
Revue De Medecine Interne, 2006
Purpose. – Peritoneal carcinomatosis and particularly those from digestive origin has long been c... more Purpose. – Peritoneal carcinomatosis and particularly those from digestive origin has long been considered as an automatically terminal disease in abdominal cancer patients.Current knowledge and key points. – Over the past decade, new locoregional treatments combining cytoreductive surgery, peritonectomy procedures with perioperative intraperitoneal chemotherapy (with or without hyperthermia) have been developed by specialized teams. Because of its high but acceptable
World Journal of Gastroenterology, 2014
Free cancer cells can be detected in peritoneal fluid at the time of colorectal surgery. Peritone... more Free cancer cells can be detected in peritoneal fluid at the time of colorectal surgery. Peritoneal lavage in colorectal surgery for cancer is not used in routine, and the prognostic significance of intraperitoneal free cancer cells (IPCC) remains unclear. Data concerning the technique of peritoneal lavage to detect IPCC and its timing regarding colorectal resection are scarce. However, positive IPCC might be the first step of peritoneal spread in colorectal cancers, which could lead to early specific treatments. Because of the important heterogeneity of IPCC determination in reported studies, no treatment have been proposed to patients with positive IPCC. Herein, we provide an overview of IPCC detection and its impact on recurrence and survival, and we suggest further multi-institutional studies to evaluate new treatment strategies.
Annales de Chirurgie, 2006
Rectal syndrome caused by locoregional evolution of low rectal cancers and anal cancers is preven... more Rectal syndrome caused by locoregional evolution of low rectal cancers and anal cancers is prevented and treated by surgical resection. But, for old patients with multiple tares, carcinologic surgical resection as abdominoperineal amputation can not be considered. Management of rectal syndrome becomes a therapeutic challenge. We reported a prospective serie of 5 patients more than 80 years old with multiple tares,
Annals of surgery, Mar 14, 2016
To assess the effect of pelvic drainage after rectal surgery for cancer. Pelvic sepsis is one of ... more To assess the effect of pelvic drainage after rectal surgery for cancer. Pelvic sepsis is one of the major complications after rectal excision for rectal cancer. Although many studies have confirmed infectiveness of drainage after colectomy, there is still a controversy after rectal surgery. This multicenter randomized trial with 2 parallel arms (drain vs no drain) was performed between 2011 and 2014. Primary endpoint was postoperative pelvic sepsis within 30 postoperative days, including anastomotic leakage, pelvic abscess, and peritonitis. Secondary endpoints were overall morbidity and mortality, rate of reoperation, length of hospital stay, and rate of stoma closure at 6 months. A total of 494 patients were randomized, 25 did not meet the criteria and 469 were analyzed: 236 with drain and 233 without. The anastomotic height was 3.5 ± 1.9 cm from the anal verge. The rate of pelvic sepsis was 17.1% (80/469) and was similar between drain and no drain: 16.1% versus 18.0% (P = 0.58). ...
Gastroenterologie clinique et biologique, 2006
Spontaneous rupture of intrahepatic aneurysm is a rare life threatening condition because of the ... more Spontaneous rupture of intrahepatic aneurysm is a rare life threatening condition because of the risk of spontaneous rupture. A 33 year old female patient presented with hemorrhagic shock. Angio-CT-scan revealed an intrahepatic ruptured aneurysm with a massive central and subcapsular haematoma of the liver. Percutaneous embolisation under ultrasound control was not possible because of the size of the subcapsular haematoma. Angiography showed a main arterial supply of this aneurysm from the anterior sectorial branch of the right branch of hepatic artery and selective embolisation was not possible because of anatomical configuration. Because of persistent bleeding, surgery was performed with evacuation of liver haematoma and a highly selective ligature of the main aneurysmal arterial supply. Post-operative angio-CT-scan showed revascularisation of the aneurysm through retrograde intrahepatic arterial supply. Ultrasound identification of the aneurysm was then possible and percutaneous ...
International Journal of Colorectal Disease
World Journal of Surgery
Background There are no specific guidelines for ventral hernia management in Crohn’s disease (CD)... more Background There are no specific guidelines for ventral hernia management in Crohn’s disease (CD) patients. We aimed to assess the risk of septic morbidity after mesh repair in CD. Methods This was a retrospective multicentre study comparing CD and non-CD patients undergoing mesh repair for ventral hernia (primary or incisional hernia). Controls were matched 1:1 for the presence of a stoma, history of surgical sepsis, hernia size and Ventral Hernia Working Group (VHWG) score. All demographic, pre-, intra- and postoperative data were retrieved, including long-term data. Results We included 234 patients, with 114 CD patients. Both groups had comparable VHWG scores ( p = 0.12), hernia sizes ( p = 0.11), ASA scores ≥ 3 ( p = 0.70), body mass index values ( p = 0.14), presence of stoma (CD 21.9% vs. controls 15%, p = 0.16), history of sepsis (14% vs. 6.7%, p = 0.23), rates of malnutrition (4.4% vs. 1.7%, p = 0.46), rates of incisional hernia (93% vs. 95%, p = 0.68) and concomitant procedures (18.4% vs. 11.7%, p = 0.12). CD patients carried a higher risk of postoperative septic morbidity (18.4% vs. 5%, p = 0.001), entero-prosthetic fistula (7% vs. 0, p < 0.01) and mesh withdrawals (5.3% vs. 0, p = 0.011). Ventral hernia recurrence rates were similar (14% vs. 8.3%, p = 0.15). In the univariate analysis, the risk factors for septic morbidity were CD ( p = 0.001), malnutrition ( p = 0.004), use of biological mesh ( p < 0.0001) and concomitant procedure ( p = 0.004). The mesh position, the means used for mesh fixation as well as the presence of a stoma were not identified as risk factors. Conclusions CD seems to be a risk factor for septic morbidity after mesh repair.
Journal of Crohn's and Colitis
Background and Aims To compare perioperative characteristics and outcomes between primary ileocol... more Background and Aims To compare perioperative characteristics and outcomes between primary ileocolonic resection [PICR] and iterative ileocolic resection [IICR] for Crohn’s disease [CD]. Methods From 2013 to 2015, 567 patients undergoing ileocolonic resection were prospectively included in 19 centres of the GETAID chirurgie group. Perioperative characteristics and postoperative results of both groups [431 PICR, 136 IICR] were compared. Uni- and multivariate analyses of the risk factors of overall 30-day postoperative morbidity was carried out in the IICR group. Results IICR patients were less likely to be malnourished [27.2% vs 39.9%, p = 0.007], and had more stricturing forms [69.1% vs 54.3%, p = 0.002] and less perforating disease [19.9% vs 39.2%, p < 0.001]. Laparoscopy was less commonly used in IICR [45.6% vs 84.5%, p < 0.01] and was associated with increased conversion rates [27.4% vs 14.6%, p = 0.012]. Overall postoperative morbidity was 36.8% in the IICR group and 26.7% ...
International Journal of Colorectal Disease
Annals of Surgery
OBJECTIVE The aim of the study was to investigate whether patients who undergo surgery in hospita... more OBJECTIVE The aim of the study was to investigate whether patients who undergo surgery in hospitals experiencing significant length of stay (LOS) reductions over time are exposed to a higher risk of severe adverse events in the postoperative period. SUMMARY BACKGROUND DATA Surgical care innovation has encouraged hospitals to shorten LOS under financial pressures with uncertain impact on patient outcomes. METHODS We selected all patients who underwent elective colectomy or urgent hip fracture repair in French hospitals between 2013 and 2016. For each procedure, hospitals were categorized into 3 groups according to variations in their median LOS as follows: major decrease, moderate decrease, and no decrease. These groups were matched using propensity scores based on patients' and hospitals' potential confounders. Potentially avoidable readmission for severe adverse events and death at 6 months were compared between groups using Cox regressions. RESULTS We considered 98,713 patients in 540 hospitals for colectomy and 206,812 patients in 414 hospitals for hip fracture repair before matching. After colectomy, patient outcomes were not negatively impacted when hospitals reduced their LOS [hazard ratio (95% confidence interval): 0.93 (0.78-1.10)]. After hip fracture repair, patients in hospitals with major decreases in LOS had a higher risk of severe adverse events [1.22 (1.11-1.34)] and death [1.17 (1.04-1.32)]. CONCLUSIONS Patients who underwent surgical procedures in hospitals experiencing major decreases in LOS were demonstrated worse postoperative outcomes after urgent hip fracture repair and not after elective colectomy. Development of care bundles to enhance recovery after emergency surgeries may allow better control of LOS reduction and patient outcomes.
Annals of Surgical Oncology
Journal of Crohn's & colitis, Jan 21, 2017
Colectomy can be required in the management of ulcerative colitis (UC). While ileal pouch anal-an... more Colectomy can be required in the management of ulcerative colitis (UC). While ileal pouch anal-anastomosis (IPAA) is the recommended reconstruction technique, ileorectal anastomosis (IRA) is still performed and might present some advantages. However, the risk of rectal neoplasia might limit its indication. The aims of our study were to determine the incidence of rectal neoplasias following IRA for UC and to identify risk factors associated with rectal carcinomas. We performed a multicenter retrospective study including patients who underwent IRA for UC from 1960 to 2014 in 13 centers. Cox-proportional hazard models were used to determine carcinoma-associated risk factors. 343 patients were included with a median follow-up of 10.4 years after IRA. At the end of follow-up, 38 rectal neoplasias including 19 carcinomas were diagnosed and 7 patients (2%) had either died from rectal carcinoma or had a metastatic disease. Incidences of rectal carcinoma after IRA for UC were estimated at 3....
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Nov 18, 2016
A pathologic complete response (pCR; ypT0N0) of a rectal tumor after neoadjuvant radiochemotherap... more A pathologic complete response (pCR; ypT0N0) of a rectal tumor after neoadjuvant radiochemotherapy (RCT) is associated with an excellent prognosis. Several retrospective studies have investigated the effect of increasing the delay after RCT. The aim of this study was to evaluate the effect of increasing the interval between the end of RCT and surgery on the pCR rate. GRECCAR6 was a phase III, multicenter, randomized, open-label, parallel-group controlled trial. Patients with cT3/T4 or Tx N+ tumors of the mid or lower rectum who had received RCT (45 to 50 Gy with fluorouracil or capecitabine) were included. Patients were randomly included in the 7-week or the 11-week (11w) group. Primary end point was the pCR rate defined as a ypT0N0 specimen (NCT01648894). A total of 265 patients from 24 centers were enrolled between October 2012 and February 2015. The majority of the tumors were cT3 (82%). After RCT, surgery was not performed in nine patients (3.4%) because of the occurrence of dis...
Annals of Surgical Oncology, 2016
Complete cytoreductive surgery (CRS), combining organ resection and peritonectomy, is the only tr... more Complete cytoreductive surgery (CRS), combining organ resection and peritonectomy, is the only treatment that could offer cure for patients with peritoneal carcinomatosis. Initially, when the Glisson&amp;#39;s capsule was involved without deep liver parenchyma invasion, either electroevaporation or Glisson&amp;#39;s capsule resection was proposed. The objective of this study is to present and evaluate the safety of this standardized digital glissonectomy. Since 2009, the peritonectomy of the Glisson&amp;#39;s capsule, or digital glissonectomy, has been standardized at our institution. Among 655 patients who underwent a complete CRS between 2009 and 2014, 91 (14 %) glissonectomies were performed. Pseudomyxoma peritonei was the primary indication, and a glissonectomy was more frequently performed for patients with high peritoneal cancer index. The morbidity and mortality of CRS were not increased after glissonectomy (p = 0.069 and 0.949, respectively). Digital glissonectomy is feasible and safe, when proposed for superficial deposits on Glisson&amp;#39;s capsule.
Saudi Medical Journal, 2016
Annals of Surgical Oncology, 2016
Complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is in... more Complete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is increasingly performed on patients with peritoneal carcinomatosis of various origins. Splenectomy often is required in these patients to achieve complete tumor removal. Although splenectomy has been associated with increased morbidity in many major abdominal surgeries, its effect in patients undergoing CRS + HIPEC is unknown. The purpose of this study was to evaluate the impact of splenectomy during CRS + HIPEC on postoperative outcomes. We retrospectively identified 39 patients who underwent CRS + HIPEC with splenectomy during a 3-year study period from a prospective database. We compared them to case controls (CRS + HIPEC without splenectomy) that were matched for the complexity of the procedure. We evaluated the complication rate and outcomes of patients in each group. During the study period, splenectomy was performed in 32 % of patients undergoing CRS + HIPEC procedure. Patients in the splenectomy group experienced more grade 3-4 complications than patients in the control group (59 vs. 35.9 %, p = 0.041) as well as more pulmonary complications (41 vs. 7.7 %, p = 0.0006). Multivariate analysis identified splenectomy as the only predictor of overall major complications (odds ratio = 2.57, 95 % confidence interval = 1.03-6.40). Mortality was similar in both groups. Splenectomy increases major complication rate in patients undergoing CRS + HIPEC and efforts should be made to preserve the spleen during the surgery.
Hepato Gastro Oncologie Digestive, Oct 1, 2014
Les tumeurs du peritoine regroupent les tumeurs du mesentere, de l’epiploon et de la sereuse peri... more Les tumeurs du peritoine regroupent les tumeurs du mesentere, de l’epiploon et de la sereuse peritoneale. Les tumeurs primitives du mesentere et du peritoine sont rares (pseudomyxomes et mesotheliomes peritoneaux, tumeurs desmoplastiques a petites cellules et psammocarcinomes). Les tumeurs secondaires de la sereuse peritoneale (carcinose peritoneale) sont plus frequentes et compliquent l’evolution de la plupart des cancers intra-abdominaux (cancers colorectal, gastrique, pancreatique, ovarien, appendiculaire). Leur pronostic repose sur la nature de la tumeur primitive et leur distribution ou extension appreciees par le Peritoneal Cancer Index (PCI). Le scanner abdomino-pelvien reste l’outil morphologique de reference pour ces maladies mais l’apport de l’imagerie fonctionnelle (IRM, TEP scanner) est en cours d’evaluation. La cœlioscopie est l’examen le plus utile pour apprecier l’extension et la resecabilite tout en permettant la realisation de biopsies diagnostiques. La carcinose peritoneale a ete consideree comme le stade terminal des cancers mais le developpement des approches therapeutiques pluridisciplinaires locoregionales combinant chirurgie de cytoreduction et chimiotherapie intraperitoneale avec ou sans hyperthermie ont bouleverse son pronostic et sa prise en charge pour permettre une intention curative en cas de carcinose limitee et surtout resecable. Le developpement de traitements prophylactiques des carcinoses gastriques et colorectales est en cours d’evaluation chez les patients a risque. Ces traitements doivent etre reserves a certains centres specialises mais imposent a tous de nouveaux reflexes diagnostiques et therapeutiques.
Hepato Gastro, 2010
Compte tenu de la difficulte et des consequences du diagnostic de dysplasie, toute dysplasie, qu&... more Compte tenu de la difficulte et des consequences du diagnostic de dysplasie, toute dysplasie, qu'elle soit de bas grade, de haut grade ou incertaine, doit etre confirmee par un second anatomopathologiste. La decouverte d'une dysplasie de haut grade sur une muqueuse colique plane ou apparemment plane en coloscopie conventionnelle doit conduire a pratiquer une proctocolectomie. La conduite a tenir en cas de decouverte d'une dysplasie de bas grade sur une muqueuse colique plane ou apparemment plane reste controversee, certains preconisant une proctocolectomie, d'autres une surveillance endoscopique rapprochee. Apres polypectomie ou, a defaut, biopsies, en cas de constatation d'une dysplasie sur une lesion polypoide siegeant dans une zone non atteinte actuellement ou anterieurement par la colite, la lesion doit etre consideree comme un adenome sporadique ne necessitant que la surveillance habituelle a ce type de lesion. Lorsque la lesion polypoide siege dans une zone atteinte ou prealablement atteinte par la colite, une polypectomie est suffisante, a condition que la lesion soit un simple adenome et ait ete enlevee totalement ou puisse l'etre ulterieurement, qu'il n'y ait pas de dysplasie a la base ou sur les marges du polype, ni d'autres zones dysplasiques dans le colon, que ce dernier puisse etre surveille facilement et, pour certains, que le patient soit âge de plus de 40 ans. Enfin, si la lesion dysplasique ne ressemble pas un polype adenomateux banal, si son exerese parait difficile et si de la dysplasie est trouvee egalement au pourtour de la lesion ou a distance sur le colon, la lesion doit etre consideree comme une dysplasia-associated lesion or mass (DALM) et necessite la realisation d'une proctocolectomie.
Journal of Crohn's & colitis, Jan 19, 2015
Evidence from mouse colitis models indicates that cytotoxic CD8(+) T cells (CTL) play a key role ... more Evidence from mouse colitis models indicates that cytotoxic CD8(+) T cells (CTL) play a key role in the initiation of gut lesions. We investigated whether changes in CD8(+) CTL in blood or lamina propria (LP) of the neoterminal ileum were associated with postoperative endoscopic recurrence of Crohn's disease (CD). Thirty-seven CD patients with ileocolonic resection were endoscopically followed up at six and twelve months post-surgery. CD8(+) T cells were analyzed by flow cytometry in blood and ileal LP. Granzyme B- and perforin-producing CD8(+) T cells were significantly increased at 6 months in blood and in ileum LP in patients with endoscopic recurrence, as compared to those in remission. At a cutoff point of 45% of CD8(+) CTL, the overall accuracies of the frequency of blood granzyme B(+) or perforin(+) CD8(+) T cells to identify patients with postoperative endoscopic recurrence were 77% and 83%, respectively. Interestingly, patients with endoscopic recurrence at 12 months we...
Gastroentérologie clinique et biologique, 2006
Inflammatory pseudo-tumors of the liver are rare and difficult to diagnose, mimicking malignant t... more Inflammatory pseudo-tumors of the liver are rare and difficult to diagnose, mimicking malignant tumors. We report a patient, 42 year old with hepatic pseudo-tumor who was suspected to have pseudotumoral hepatic tuberculosis without immunodepression and treated by major hepatic surgery because no sure diagnosis. Therapeutic approach of hepatic inflammatory pseudotumors is often medical and surgical and may need major hepatic surgery in case of sure etiologic diagnosis.
Revue De Medecine Interne, 2006
Purpose. – Peritoneal carcinomatosis and particularly those from digestive origin has long been c... more Purpose. – Peritoneal carcinomatosis and particularly those from digestive origin has long been considered as an automatically terminal disease in abdominal cancer patients.Current knowledge and key points. – Over the past decade, new locoregional treatments combining cytoreductive surgery, peritonectomy procedures with perioperative intraperitoneal chemotherapy (with or without hyperthermia) have been developed by specialized teams. Because of its high but acceptable
World Journal of Gastroenterology, 2014
Free cancer cells can be detected in peritoneal fluid at the time of colorectal surgery. Peritone... more Free cancer cells can be detected in peritoneal fluid at the time of colorectal surgery. Peritoneal lavage in colorectal surgery for cancer is not used in routine, and the prognostic significance of intraperitoneal free cancer cells (IPCC) remains unclear. Data concerning the technique of peritoneal lavage to detect IPCC and its timing regarding colorectal resection are scarce. However, positive IPCC might be the first step of peritoneal spread in colorectal cancers, which could lead to early specific treatments. Because of the important heterogeneity of IPCC determination in reported studies, no treatment have been proposed to patients with positive IPCC. Herein, we provide an overview of IPCC detection and its impact on recurrence and survival, and we suggest further multi-institutional studies to evaluate new treatment strategies.
Annales de Chirurgie, 2006
Rectal syndrome caused by locoregional evolution of low rectal cancers and anal cancers is preven... more Rectal syndrome caused by locoregional evolution of low rectal cancers and anal cancers is prevented and treated by surgical resection. But, for old patients with multiple tares, carcinologic surgical resection as abdominoperineal amputation can not be considered. Management of rectal syndrome becomes a therapeutic challenge. We reported a prospective serie of 5 patients more than 80 years old with multiple tares,