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Eric Vibert

Publications and source records attributed to Eric Vibert.

10 recordsLinked to original sources
PubMed2006

[Induction chemotherapy and surgery of colorectal liver metastases].

Surgery is the only curative treatment for patients with colorectal liver metastases with recent reports documenting 5-year survival results of 40-50%. In unresectable patients, the use of more effective regimens of chemotherapy has contributed to improve the results of survival at short term and new onco-surgical strategies have emerged. By allowing resection of previously unresectable liver metastases, these onco-surgical strategies now offer 15-20% of patients a real potential of long-term remission (5-year survival 30-40%). Chemotherapy is also used in the adjuvant setting, to prevent post-operative recurrence. In resectable metastases, it may also be used as neo-adjuvant treatment to control tumor progression before surgery and to select the patients likely to really benefit from liver resection. The objective of this article is to describe this multidisciplinary approach of liver metastases and to report the results of these new strategies.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

[Delayed recurrence of an endobiliary hepatocellular carcinoma without detectable intra-parenchymatous tumor].

Obstructive jaundice is uncommon in patients with hepatocellular carcinoma. It can be due to compression of the common bile duct by the liver tumor or by enlarged lymph node metastases in the porta hepatis. Obstructive jaundice can also be due to direct extension of hepatocellular carcinoma into the bile ducts with or without a detectable primary hepatic tumor. These particular hepatocellular carcinoma have been termed "icteric type hepatoma" by Lin et al. in 1975, who emphasized their poor prognosis. We report a similar case of endobiliary hepatoma without a detectable intraparenchymal hepatic tumor in a seventy year-old man. This case is unusual because of its positive evolution and late recurrence.

Aged↗
PubMed2005

Benign hilar biliary strictures stented with metallic stents can be resected by using an oncologic approach.

BACKGROUND: Biliary metallic stents (MS) are being used increasingly to treat patients with malignant bile duct strictures. In patients with benign strictures, MS are contraindicated because these stents are considered unremovable. The aim of this study was to report the operative treatment of patients with benign biliary strictures at the hepatic confluence stented with MS. METHODS: Five patients with a benign hilar stenosis stented with MS underwent liver resection with biliodigestive anastomoses. The operations were designed to remove all MS by a combined biliary and hepatic resection. RESULTS: After preoperative portal vein embolization in 2 patients and percutaneous biliary drainage in 2 others, all underwent a major hepatectomy with resection of the biliary confluence and a biliodigestive anastomosis. One patient also underwent resection of the portal vein bifurcation that could not be freed from the bile duct wall. Four patients experienced postoperative complications. With a mean follow-up of 37 months (range, 31-47 months), all patients have remained symptom-free. CONCLUSIONS: Operative treatment of benign hilar strictures in patients with MS is possible if they are managed similarly as patients with hilar malignancies. This demanding procedure should be considered an alternative to liver transplantation for benign strictures treated with MS, but the procedure requires expertise in advanced hepatic resections.

Adult↗
PubMed2005

Strategies to treat primary unresectable colorectal liver metastases.

The liver is the most common site of metastases in patients with colorectal cancer (CRC), and hepatic metastases are responsible for fatalities in at least two thirds of patients with colorectal malignancy. However, the only available treatment associated with long-term survival in patients with CRC metastases is liver resection. While recent studies have shown that liver resection achieves a 5-year overall survival from 37% to 58%, only 10% to 20% of patients with colorectal liver metastases are eligible for resection. Pharmacologic developments and conceptual advances in chemotherapy, regional treatment, and aggressive surgical strategies have ultimately changed the current treatment of patients with primary unresectable liver metastases caused by CRC. Patients who were treated by only palliative chemotherapy a few years ago presently have a variety of strategies available to render their disease surgically resectable with the potential for long-term survival. These advances are the result of a strong collaboration between medical oncologists and surgeons. The development of new chemotherapy protocols that offer the potential for curative surgery with optimum timing within the natural history of this metastatic disease is a shared therapeutic challenge.

Colorectal Neoplasms↗
PubMed2005

Groove pancreatitis and pancreatic heterotopia in the minor duodenal papilla.

Groove pancreatitis is a rare form of segmental chronic pancreatitis that involves the anatomic space between the head of the pancreas, the duodenum, and the common bile duct. We report 2 cases of groove pancreatitis with pancreatic heterotopia in the minor papilla. Patients were a 44-year-old woman and a 47-year-old man. Both had a past history of alcohol consumption and presented with abdominal pain, vomiting, and weight loss caused by duodenal stenosis. Abdominal computed tomography revealed thickening of the duodenal wall and enlargement of the pancreatic head in both patients. In 1 patient, ultrasound endoscopy showed a dilated duct in the head of the pancreas. Pancreaticoduodenectomy was performed to rule out pancreatic adenocarcinoma and because of the severity of the symptoms. In both cases, gross and microscopic examinations showed fibrous scar of the groove area. The Santorini duct was dilated and contained protein plugs in both patients, with abscesses in 1 of them. In both cases, there were microscopic foci of heterotopic pancreas with mild fibrosis in the wall of the minor papilla. Groove pancreatitis is often diagnosed in middle-aged alcoholic men presenting with clinical symptoms caused by duodenal stenosis. The pathogenesis of this rare entity could be because of disturbance of the pancreatic secretion through the minor papilla. Pancreatitis in heterotopic pancreas located in the minor papilla and chronic consumption of alcohol seem to be important pathogenic factors.

Adult↗
PubMed2004

Adjuvant interleukin-12 gene therapy for the management of colorectal liver metastases.

In humans, no efficient treatment exists not only against multifocal liver metastases (LM) but also against recurrent microscopic liver metastases within the liver remnant following curative liver resection. Furthermore, in nonmultifocal LM, partial liver resection could be performed, but in more than 50% of the patients, tumor recurrence within liver remnant is observed, partly due to the growth of dormant cancer cells in the setting of postoperative host immune dysfunction. We investigated the therapeutic potential of interleukin-12 (IL-12) immuno-gene therapies in these experimental models under total vascular exclusion (TVE) of the liver. In rats with multiple LM of DHDK12 colon cancer cells, we observed a significant reduction in tumor volume after retroviral-mediated gene transfer of either herpes simplex virus thymidine kinase (HSV1-TK) and ganciclovir (GCV) administration, or IL-12. Combined treatment with HSV1-TK/GCV and IL-12 resulted in improved tumor volume reduction and even survival. In rats with recurrent microscopic DHDK12 LM established after partial liver resection, we observed significantly decreased recurrent tumor volumes and increased survival after retroviral-mediated IL-12 gene transfer. In both settings, immunohistological analysis revealed that IL-12 immuno-gene therapy was accompanied by an infiltration of CD8+ T lymphocytes within the tumors. Altogether, our results suggest that IL-12 adjuvant gene therapy could improve the management of patients with either resectable or unresectable LM.

Animals↗
PubMed2003

Major digestive surgery using a remote-controlled robot: the next revolution.

HYPOTHESIS: A remote-controlled robot can be used to perform computer-enhanced major digestive laparoscopic surgery. DESIGN: Cases series for assessment of the feasibility and safety of this technology in major digestive surgery. SETTING: Tertiary care referral center. PATIENTS: Between September 5, 2001, and December 20, 2001, 5 patients (4 men and 1 woman; mean +/- SD age, 66 +/- 5 years) underwent laparoscopic sigmoidectomy, proctectomy, restoration of continuity after Hartmann operation, Whipple procedure, and right liver lobectomy. In each of the procedures, a remote-controlled robot was used to perform some stages of the surgery. During these stages, the surgeon was seated at a distance from the operating table and performed the surgery using the robot, which offers enhanced intracorporeal tool manipulation and spatial vision. RESULTS: Sigmoidectomy was the only procedure that was completely performed with the robot. For the other procedures, the mean +/- SD duration of robot use was 25% +/- 10% of the operative time. Stages of colorectal surgery, retroportal dissection, 2 anastomoses during a Whipple procedure, hepatic pedicle dissection, and initial hepatotomy were performed using the robot. This technology facilitates laparoscopic anastomoses. The principal drawbacks were the time required for robot mobilization, absence of grip strength feedback, limited availability of adapted surgical tools, and the cost of the system. There was no mortality. Two of the 5 patients experienced complications, a postoperative ileus and unexplained sepsis after the Whipple procedure, both of which were treated medically. CONCLUSIONS: For these procedures, laparoscopic computer-enhanced surgery seems safe and feasible. This introduction of computing to major digestive surgery opens the door to enhanced-reality surgery and new types of surgical education.

Aged↗
PubMed2002

[Portal cavenorma: diagnosis, aetiologies and consequences].

Portal cavernoma is a network of veins whose caliber, initially millimetric or microscopic, is increased and which contain hepatopedal portal blood. It results from occlusion, thrombotic and always chronic, of the extra-hepatic portal system. Diagnosis is mainly done by imaging. Clinical signs of portal cavernoma are usually related to extra-hepatic portal hypertension (hematemesis due to rupture of oeso-gastric varices, splenomegaly, rectal bleeding from ano-rectal varices, growth retardation in children) and sometimes to the cause of portal hypertension (abdominal pain, venous bowel infarction). Occurrence of portal thrombosis is often the conjunction of a local cause and a prothrombotic disorder which must be systematically detected. Biliary consequences of cavernoma are related to compression of common bile duct and are usually asymptomatic. In case of jaundice or cholangitis, portal decompression by portosystemic shunt can be performed to treat both biliary symptoms and portal hypertension.

Common Bile Duct Diseases↗
PubMed2002

[Liver transplantation with cavoportal or renoportal anastomosis: a solution in cases of diffuse portal thrombosis].

OBJECTIVE: Liver transplantation was contraindicated in patients with diffuse thrombosis of the portal vein until the recent use of graft portal vein reperfusion with the caval flow or one of its tributaries. Long term results of these procedures are reported here. PATIENTS AND METHODS: Eight patients with diffuse portal vein thrombosis were transplanted by portal reperfusion via latero-terminal anastomosis between the native caval vein and the graft portal vein (2 patients) or termino-terminal between the native left renal vein and the graft portal vein (6 patients). RESULTS: Three patients died 3, 3 and 6 months following transplantation from intracerebral hemorrhage, cardiac arrest, and chronic rejection respectively. Three patients had complicated portal hypertension. Five patients were alive at home with a median follow-up of 9 months (2 to 37 months) with normal liver and kinase functions. CONCLUSION: Portal reperfusion with the caval vein flow allows transplantation of patients with diffuse poral vein thrombosis. According to our experience and to the analysis of the literature, reno-portal anastomosis is preferable to cavo-portal reconstruction.

Adult↗