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C Partensky

Publications and source records attributed to C Partensky.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Megaduodenum in chronic intestinal pseudo-obstruction: management by duodenectomy-duodenoplasty].

BACKGROUND: Surgical management of primitive chronic intestinal pseudo-obstruction involving the duodenum (megaduodenum) is an uncommon but still difficult problem. PATIENTS AND METHODS: Six patients who experienced severe symptoms were managed by an original surgical procedure including partial duodenal resection and reconstruction of a duodenal tract using a large duodenal anastomosis (duodenectomy-duodenoplasty). RESULTS: There was no postoperative complication. All preoperative symptoms completely regressed in all but one patient who had previously undergone a vagotomy and experienced transient early post-operative gastric stasis. With a median follow-up of 6 years (range 4-9), all patients had good functional results without any evidence of other motility disorders. The mean weight gain was 10 kg (range 7-15). CONCLUSIONS: Duodenectomy-duodenoplasty is a safe procedure resulting in efficient symptom relief in patients suffering from megaduodenum.

Adolescent↗
PubMed2000

[Management of duodenal-pancreatic endocrine tumors].

Endocrine tumors of pancreas and duodenum have a common diagnostic and therapeutic approach. Surgery has a key role to play in the management of patients with such tumors. According to a particular patient, this role is to get under control a secretory syndrome which is refractory to medical therapy, to eradicate a malignant or a premalignant tumor, to produce cytoreduction by debulking, or to palliate complications due to massive regional extension of a malignant tumor.

Combined Modality Therapy↗
PubMed1999

[The Budd-Chiari syndrome (hepatic vein obstruction). The diagnostic and therapeutic management of acute and subacute forms].

EARLY DIAGNOSIS: The Budd-Chiari syndrome results from an obstruction of the suprahepatic venous drainage. The condition spontaneously evolves towards liver fibrosis and death. Early diagnosis is thus of prime importance to initiate adapted treatment promptly. EXPLORATIONS: Color-coded and pulsed Doppler coupled with ultrasonography is the key to positive diagnosis. Magnetic resonance imaging may provide further precision. DECONGESTION OF THE LIVER: As the hepatic lesions are reversible, satisfactory drainage must be achieved as rapidly as possible, either by percutaneous puncture or surgery. The problem is to control the underlying hematology disease to prevent recurrent venous thrombosis, generally the cause of treatment failure. PREVENTIVE ANTICOAGULATION: Effective anticoagulation using low-molecular-weight heparin, which appears to be more adapted than standard heparin, must be achieved prior to any decongestion procedure. Long-term management requires anti-vitamin K therapy if the risk of thrombosis persists.

Acute Disease↗
PubMed1999

[Orthotopic liver transplantation from a living adult donor to an adult using the right hepatic lobe].

STUDY AIM: In children, living donor liver transplantation has been shown to be efficient in treating end-stage liver diseases when the left lateral segment is harvested. In adults, more liver mass is needed to provide adequate hepatic function. The aim of this study is to report 2 successful cases of living donor liver transplantation using a right hepatic lobe from adult. PATIENTS AND METHODS: In 2 sons, the right hepatic lobe was harvested without the middle hepatic vein for transplantation in their fathers who were suffering from end-stage liver cirrhosis. Hepatectomy was done without vascular inflow occlusion after dissection of vascular and biliary structures, itself strictly restricted to the right side. In recipients, the graft was implanted orthotopically with preservation of the native inferior vena cava and after temporary porto-caval shunt. RESULTS: The duration of donors procedures was 7 h and 11 h 45 min; intra-operative transfusions comprised of 700 mL from cell-saver in the first case, and 1300 mL plus 1 autologous red blood cell unit in the second case. Graft weights were 770 g and 1100 g. None of the donors experienced liver failure and both were able to leave the hospital 9 days after the operation. In recipients, initial graft function was excellent in the first case and correct in the second case, despite the necessity to redo intra-operatively the hepatic vein anastomosis secondary to a twisting. Patients were discharged 20 and 40 days respectively following transplantation. CONCLUSION: Adult living donor liver transplantation using a right hepatic lobe is efficient and safe. This option could contribute to reducing the mortality of patients on the waiting list.

Adolescent↗
PubMed1999

Peripheral cholangiocarcinoma: presentation, diagnosis, pathology and management.

AIMS: To report the clinical presentation, diagnosis and results of aggressive surgical management in patients with intrahepatic cholangiocarcinoma. METHODS: From February 1988 to June 1998, 21 patients underwent laparotomy with a 90% resectability rate (19 resections). The 19 liver resections included right trisegmentectomy in six patients, right lobectomy in five, wedge resection in four, left lobectomy in two, left trisegmentectomy in one and a lateral segmentectomy in one. Resection of the biliary confluence with reconstruction by a Roux en Y hepaticojejunostomy was performed in three patients. RESULTS: Mild abdominal pain, weight loss and gastrointestinal disturbances were the most frequent clinical signs. Jaundice was present in only four patients. Pre-operative radiological investigations (abdominal ultrasound, computed tomography, arteriography) correlated with pathological findings in only 60% of cases. Pre-operative histological findings (fine-needle cytology, liver biopsy), available for 19 patients, did not always provide an accurate diagnosis. The mortality and morbidity rates were 5 and 47%, respectively. The median survival of resected patients was 18 months. Overall patient and tumour-free survival rates were 83 and 31% at 1 year, 33 and 16.5% at 2 years and 16.5 and 16.5% at 3 years in the resected group. Lymph-node spread, vascular invasion, positive margins and bilobar distribution were associated with a high recurrence rate and poor prognosis. CONCLUSION: Despite the advanced stage of these tumours at presentation, patient survival can be improved by aggressive surgical resection. As intrahepatic cholangiocarcinoma usually develops in a non-cirrhotic liver, major hepatic resections to obtain disease-free margins can be performed with low mortality.

Adult↗
PubMed1999

Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association.

OBJECTIVE: To review the features of patients with benign and malignant cystadenomas of the pancreas, focusing on preoperative diagnostic accuracy and long-term outcome, especially for nonoperated serous cystadenomas and resected cystadenocarcinomas. SUMMARY BACKGROUND DATA: Serous cystadenomas (SCAs) are benign tumors. Mucinous cystic neoplasms should be resected because of the risk of malignant progression. A correct preoperative diagnosis of tumor type is based on morphologic criteria. Despite the high quality of recent imaging procedures, the diagnosis frequently remains uncertain. Invasive investigations such as endosonography and diagnostic aspiration of cystic fluid may be helpful, but their assessment is limited to small series. The management of typical SCA may require resection or observation. Survival after pancreatic resection seems better for cystadenocarcinomas (MCACs) than for ductal adenocarcinomas of the pancreas. METHODS: Three hundred ninety-eight cases of cystadenomas of the pancreas were collected between 1984 and 1996 in 73 institutions of the French Surgical Association. Clinical presentation, radiologic evaluation, and surgical procedures were analyzed for 144 operated SCAs, 150 mucinous cystadenomas (MCAs), and 78 MCACs. The outcome of 372 operated patients and 26 nonoperated patients with SCA was analyzed. RESULTS: Cystadenomas represented 76% of all primary pancreatic cystic tumors (398/522). An asymptomatic tumor was discovered in 32% of patients with SCA, 26% of those with MCA, and 13% of those with MCAC. The tumor was located in the head or uncinate process of the pancreas in 38% of those with SCA, 27% of those with MCA, and 49% of those with MCAC. A communication between the cyst and pancreatic duct was discovered in 0.6% of those with SCA, 6% of those with MCA, and 10% of those with MCAC. The main investigations were ultrasonography and computed tomography (94% for SCA, MCA, and MCAC), endosonography (34%, 28%, and 22% for SCA, MCA, and MCAC respectively), endoscopic retrograde cholangiopancreatography (16%, 14%, 22%), and cyst fluid analysis (22%, 31%, 35%). An accurate preoperative diagnosis of tumor type was proposed for 20% of those with SCA (144 cases), 30% of those with MCA, and 29% of those with MCAC. An atypical unilocular macrocyst was observed in 10% of SCA cases. The most common misdiagnosis for mucinous cystic tumors was pseudocyst (9% of MCAs, 15% of MCACs). Intraoperative frozen sections (126 cases) allowed a diagnosis according to definitive histologic examination in 50% of those with SCA and MCA and 62% of those with MCAC. For management, 93% of patients underwent surgery. Nonoperated patients (7%) had exclusively typical SCA. A complete cyst excision was performed in 94% of benign cystadenomas, with an operative mortality rate of 2% for SCA and 1.4% for MCA. Resection was possible in 74% of cases of MCAC. Mean follow-up of 26 patients with nonresected SCAs was 38 months, and no patients required surgery. For resected MCACs, the actuarial 5-year survival rate was 63%. CONCLUSIONS: Spiral computed tomography is the examination of choice for a correct prediction of tumor type. Endosonography may be useful to detect the morphologic criteria of small tumors. Diagnostic aspiration of the cyst allows differentiation of the macrocystic form of SCA (10% of cases) and the unilocular type of mucinous cystic neoplasm from a pseudocyst. Surgical resection should be performed for symptomatic SCAs, all mucinous cystic neoplasms, and cystic tumors that are not clearly defined. Conservative management is wholly justified for a well-documented SCA with no symptoms. An extensive resection is warranted for MCAC because the 5-year survival rate may exceed 60%.

Adolescent↗
PubMed1999

Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial.

PURPOSE: The optimal timing of surgery after preoperative radiotherapy in rectal cancer is unknown. The aim of this trial was to evaluate the role of the interval between preoperative radiotherapy and surgery. PATIENTS AND METHODS: Patients with rectal carcinoma accessible to rectal digital examination, staged T2 to T3, NX, M0, were randomized before radiotherapy (39 Gy in 13 fractions) into two groups: in the short interval (SI) group, surgery had to be performed within 2 weeks after completion of radiation therapy, compared with 6 to 8 weeks in the long interval (LI) group. Between 1991 and 1995, 201 patients were enrolled onto the study. RESULTS: A long interval between preoperative radiotherapy and surgery was associated with a significantly better clinical tumor response (53. 1% in the SI group v 71.7% in the LI group, P =.007) and pathologic downstaging (10.3% in the SI group v 26% in the LI group, P =.005). At a median follow-up of 33 months, there were no differences in morbidity, local relapse, and short-term survival between the two groups. Sphincter-preserving surgery was performed in 76% of cases in the LI group versus 68% in the SI group (P = 0.27). CONCLUSION: A long interval between preoperative irradiation and surgery provides increased tumor downstaging with no detrimental effect on toxicity and early clinical results. When sphincter preservation is questionable, a long interval may increase the chance of a successful sphincter-saving surgery.

Adenocarcinoma↗
PubMed1999

[Solid pseudopapillary tumors of the pancreas. Pathology report of 13 cases].

OBJECTIVES: 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. PATIENTS: 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. RESULTS: 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 well-limited lesion in 3 cases and an infiltrative tumor in 2 cases. At the time of diagnosis, multiple liver metastases were present in 1 case. Mean duration of follow-up was 24 months (range: 3-168). At last follow-up, all patients, including the patient with synchronous metastatic disease, were alive, without local recurrence. CONCLUSION: Our study confirms that most cases of solid pseudopapillary tumors of the pancreas present with a suggestive clinical picture, including their occurrence in young women and their good prognosis after surgical resection. However, our results also underline the occurrence of cases presenting with unusual features, including old age, male sex, extra-pancreatic localization and malignant evolution. Histopathological examination is essential for the establishment of the diagnosis but morphological data are of little prognostic value.

Adolescent↗
PubMed1999

[Reoperation for recurrent cholangitis due to a defect in the hepatico-jejunal anastomosis].

We report three cases of postoperative recurrent cholangitis due to a defective hepaticojejunal anastomosis. Causal diseases were alveolar echinococcosis of the liver, alcoholic chronic pancreatitis, liver colorectal metastases. Clinical presentation included major cholestasis and cachexia. Imaging explorations showed that cholangitis was due to an inversion of the Roux-en-Y jejunal loop which had been disposed in a wrong position. Clinical improvement was remarkable after reoperation and replacement of the defective loop in the right position. This exceptional cause of postoperative cholangitis after Roux-en-Y hepaticojejunal anastomosis must be identified and treated by prompt restorative surgery.

Adenocarcinoma↗
PubMed1998

[Medial pancreatectomy with pancreatogastric anastomosis in pancreatic neoplasms].

AIM OF THE STUDY: To report a personal series of ten patients who underwent a medial pancreatectomy with pancreaticogastrostomy for tumor of the pancreas. MATERIAL AND METHODS: 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. RESULTS: 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 dysfunction. CONCLUSION: This series confirms the place of medial pancreatectomy in resection of non-enucleable tumors of the middle part of the pancreas. It also shows that pancreaticogastrostomy is a technical simplification compared to Roux-en Y pancreaticojejunostomy in this particular modality of pancreatectomy.

Adolescent↗
PubMed1998

[Are pancreatic cystadenocarcinomas degenerated mucinous cystadenomas? French Association of Surgery].

OBJECTIVES OF THE STUDY: To define arguments in agreement or disagreement with the generally accepted theory of transformation from benign mucinous cystadenoma (MC) to malignant cystadenocarcinoma (CC) of the pancreas. METHODS: A review of the literature since 1978 was conducted together with a comparative analysis of a multicentre retrospective study of the different mucinous cystic tumours of the pancreas: 150 MC, 79 CC and 55 intraductal papillary mucinous tumours of the pancrease (TIPMP). Multiple epidemiological and clinicopathological data were compared between MC and CC: mean age at diagnosis, sex distribution, association with diabetes or concurrent cancer, tumour location and size, type of pancreatic main duct communication, pancreatic fibrosis and serum CA 19-9 levels. The analysis concerned also histopathological features of resected cystadenocarcinomas (n = 58). RESULTS: Two features suggested malignant transformation of mucinous cystadenomas: older mean age at diagnosis of CC and histological characteristics revealing areas of benign-appearing epithelium associated with areas of invasive carcinoma in 55% of cases. Conversely, two statistically significant discordant features were observed: a higher proportion of men (40% for CC vs 13% for MC) and a more frequent location in the head of the pancreas (49% vs 27%). The other differences were not in contradiction with the malignant transformation of MC: associated diabetes mellitus, increasing serum CA 19-9 levels and chromosomal aberrations were more frequent in CC. TIPMP were predominant in men (67%), and more common in the head of the pancreas (67%). CONCLUSION: The risk of malignant transformation of MC should not be questioned despite sex distribution and location differences between MC and CC. These differences may be due to inaccurate designation of intraductal mucinous carcinomas as communicating CC or of CC as pancreatic mucinous adenocarcinomas.

Aged↗
PubMed1998

[Adrenal metastases of hepatocellular carcinoma. Therapeutic options].

AIM OF THE STUDY: The aim of this study was to evaluate the therapeutic modalities, particularly surgical treatment, for adrenal metastasis of hepatocellular carcinomas. PATIENTS AND METHODS: This series included 13 patients (mean age: 64 years) with hepatocellular carcinoma on cirrhotic liver (n = 8) or healthy liver (n = 5). The adrenal metastasis was synchronous in four cases, metachronous in nine, unilateral in ten cases, and bilateral in three. Resection of the adrenal metastasis was performed in seven patients, combined with the resection of the hepatic carcinoma in three cases or secondarily performed in four. The metastasis was not resected in six patients because of poor liver function or poor patient conditions; two patients were treated with percutaneous ethanol injection, one with radiation and three received only a symptomatic treatment. RESULTS: After adrenalectomy combined with liver resection, two patients died in the postoperative course in relation with pulmonary embolism (n = 1) or acute pancreatitis (n = 1). The mean survival in the five other patients was 38 months after the adrenalectomy and 58.6 months after the liver resection. After percutaneous ethanol injection, one patient survived 47 months and the other one 7 months only. After radiation, the patient survived 18 months. After symptomatic treatment, the mean survival was only 7.3 months. CONCLUSION: The present data suggest that adrenal metastasis, either isolated or associated with a well-controlled intrahepatic recurrence, could be treated surgically when the resection is technically feasible. This aggressive management seems the only chance to offer a long-term survival to selected patients.

Adrenal Gland Neoplasms↗
PubMed1998

Intraductal papillary and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series.

BACKGROUND: Few data are available on the accuracy of preoperative imaging or on long-term outcome after surgery for intraductal papillary and mucinous tumors of the pancreas. The aims of this study were to assess the following: (1) the accuracy of preoperative computed tomography, endoscopic retrograde pancreatography, and endoscopic ultrasonography for determination of tumor invasion and pancreatic extension as compared with surgical findings; (2) the long-term outcome after surgery. METHODS: Forty-seven patients who underwent surgery between 1980 and 1995 for pathologically diagnosed intraductal papillary and mucinous tumors were included in this study. The findings of available computed tomography (n = 25), endoscopic retrograde pancreatography (n = 29), and endoscopic ultrasonography (n = 21) were reviewed by experienced clinicians blinded to pathologic diagnosis to assess tumor invasion and pancreatic extension. Pathologic specimens were reviewed by experienced pathologists. Postoperative follow-up data were analyzed. RESULTS: Histologic features of invasive carcinoma were found in 43% of patients, severe dysplasia in 21%, and mild or moderate dysplasia in 36%. The overall accuracy of computed tomography, endoscopic retrograde pancreatography, and endoscopic ultrasonography in distinguishing between invasive and noninvasive tumors were, respectively, 76%, 79%, and 76%. The overall 3-year disease-free survival rate was 63%, but it was 21% among patients with invasive carcinoma at surgery (p < 0.001). CONCLUSIONS: This study emphasizes the need for early surgical resection in patients with suspected intraductal papillary and mucinous tumors of the pancreas because of the high frequency of invasive carcinoma and the inadequacy of preoperative imaging for assessing malignancy.

Adenocarcinoma, Mucinous↗