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F N Gilly

Publications and source records attributed to F N Gilly.

At least 37 records · Page 2Linked to original sources
PubMed2001

[A case of recto-urethral fistula in Crohn's disease].

The authors report the fourteenth case of rectourethral fistula associated with Crohn's disease, in a 53-year-old man with a 20-year history of ileocolonic Crohn's disease. The patient developed a rectourethral fistula following an episode of complex anoperineal suppuration surgically exposed on several occasions. Repeated surgical exposure and urine drainage were not sufficient to close the fistula and cure the perineal suppuration. After 10 months, the patient was treated by the rectal mucosal transposition flap technique to close the rectal aspect of the fistula, which ensured cure of the patient's fistula and anoperineal lesions. This technique has been used successfully on 4 occasions and appears to be an effective treatment for rectourethral fistula in Crohn's disease with healthy rectal mucosa.

Crohn Disease↗
PubMed2000

Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis.

BACKGROUND: Most patients with peritoneal carcinomatosis of digestive tract origin die within 6 months. Intraperitoneal chemohyperthermia (IPCH) associated with surgery has been reported as a possible new therapeutic approach. METHODS: A prospective Phase II trial was carried out with 83 patients who had digestive tract cancer and peritoneal carcinomatosis to evaluate the tolerance and efficacy of IPCH with mitomycin C (MMC) associated with surgery. Eighty-six IPCH treatments with MMC were given as complementary therapy after surgery (peritoneal perfusate with a 10 mg/L dose of MMC; inflow temperature, 46-49 degrees C; use of a closed circuit; duration, 90 minutes). Primary tumors were mainly gastric (in 42 cases) or colorectal (in 27 cases). RESULTS: Mortality and morbidity occurred in 3 of 83 cases and 8 of 83 cases, respectively. For patients with resectable tumors, the median survival time was 16 months when carcinomatosis was Stage I and II (malignant granulations less than 5 mm in greatest dimension), whereas it was 6 months when carcinomatosis was Stage III and IV (malignant granulations more than 5 mm in greatest dimension). For patients with resectable gastric cancer and Stage I and II carcinomatosis, 1-, 2-, and 3-year actuarial survival rates were 80%, 61%, and 41%, respectively, whereas the rate was 10% at 1 year for patients with bulky disease (Stage III and IV). CONCLUSIONS: IPCH appears to be a promising new approach to treating patients with digestive tract cancers and peritoneal carcinomatosis with small, malignant granulations (Stage I and II).

Adult↗
PubMed2000

Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study.

BACKGROUND: Peritoneal carcinomatosis (PC) is a common evolution of digestive cancer, associated with a poor prognosis. Yet it is poorly documented in the literature. METHODS: Three hundred seventy patients with PC from non-gynecologic malignancies were followed prospectively: the PC was of gastric origin in 125 cases, of colorectal origin in 118 cases, of pancreatic origin in 58 cases, of unknown origin in 43 cases, and of miscellaneous origins in 26 cases. A previously reported PC staging system was used to classify these 370 patients. RESULTS: Mean and median overall survival periods were 6.0 and 3.1 months, respectively. Survival rates were mainly affected by the initial PC stage (9.8 months for Stage I with malignant peritoneal granulations less than 5 mm in greatest dimension, versus 3.7 months for Stage IV with large, malignant peritoneal masses more than 2 cm in greatest dimension). The presence of ascites was associated with poor survival of patients with gastric or pancreatic carcinoma. Differentiation of the primary tumor did not influence the prognoses of patients with PC. CONCLUSIONS: A better knowledge of the natural history of PC is needed, in view of the many Phase I, II, and III trials currently being conducted to evaluate aggressive multimodal therapeutic approaches to treating patients with PC from non-gynecologic malignancies.

Adult↗
PubMed2000

Outcome of ileal pouch after secondary diagnosis of Crohn's disease.

Ileal-pouch anal anastomosis is sometimes performed inappropriately in Crohn's disease patients. The aim of this study was to evaluate long-term results in this subset. In 54 ileal-pouch anal anastomoses performed between 1985 and 1997 for CUD the patient was eventually diagnosed as having Crohn's disease in seven cases. A retrospective review was performed. Definitive diagnosis was established on histopathology, endoscopy, and clinical presentation. The principal outcome factors were pouch failure, reason for failure, and functional results in cases of retained pouch. Patients ranked their quality of life between 1 and 10. We found three failures due to pelvic abscess, anoperineal disease, and anovulvar fistula. The pouch was excised in the latter patient; four patients retained their pouch. Functional results were good in the four (7 year follow-up): 7.25 bowel movements per day, ability to discriminate flatus from feces in three, soiling in one, urgency in one, perianal pad in one, ability to differ bowel movement for 66 min, diet, and antidiarrheal medication all four, pouchitis in one, sexual troubles in one woman, no urinary or obstetric trouble. Quality of life was judged satisfactory by six of the seven patients. Our 13% rate of inadvertent ileal-pouch anal anastomosis is higher than results usually reported. This difference is explained by the diagnostic criteria, whose validity is controversial. Three-stage surgery to decrease inadvertent restorative coloproctectomy is worth considering. Even if results are good when the pouch is functioning, Crohn's disease remains a contraindication to ileal-pouch anal anastomosis because of its high rate of failure and excision.

Adolescent↗
PubMed2000

[Gallbladder cancers discovered fortuitously].

STUDY AIM: The aim of this retrospective study was to report a series of 12 carcinomas of the gallbladder diagnosed on the histological examination of specimens after cholecystectomy. PATIENTS AND METHODS: From 1986 to 1996, 784 cholecystectomies were performed in the same center and 12 unexpected carcinomas of the gallbladder were histologically diagnosed (11 adenocarcinomas and one epidermoid carcinoma; one pT1, five pT2 and six pT3). There were nine women and three men (mean age: 72 years) with symptoms in relation with lithiasis. Complementary treatments were: intraoperative radiation therapy (IRT) plus external beam radiation therapy (ERT) in two cases (one pT1 and one pT2), surgery for a 2 cm deep excision of the liver bed plus lymph node dissection plus IRT and ERT in three cases (three pT3), ERT plus chemotherapy in one case (one pT3), no complementary treatment in six cases (four pT2 and two pT3). RESULTS: One patient died on day 30 from acute respiratory failure. There was no morbidity. One patient died at 7 months from intercurrent disease. The mean survival rate for patients with pT1 and pT2 tumors was 45 months (with two recurrences at 1 year and 3 years) and for patients with pT3 tumors, 6.7 months. CONCLUSION: Unexpected carcinomas of the gallbladder were recognized in 1.5% of specimens after cholecystectomy for lithiasis. In pT1 tumors, a simple cholecystectomy is sufficient. In pT2 and pT3, a liver resection with lymph node dissection is required, eventually associated with radiation therapy. Laparoscopic cholecystectomy is contraindicated in case of pre- or peroperative suspicion of a gallbladder carcinoma because of the risk of port site recurrences.

Adenocarcinoma↗
PubMed2000

[Stomach adenocarcinoma. Evolution of surgical treatment in a series of 350 cases].

STUDY AIM: The aim of this prospective study was to evaluate, in a series of 350 gastric adenocarcinomas, the evolution of their clinical and histological features and the evolution of their surgical management. PATIENTS AND METHODS: From 1970 to 1996, 350 patients with gastric carcinoma (cardiac cancer excluded) were operated on in the same center. Mean age was 68.8 years and the sex ratio 1:4. These patients were divided into three groups which were analysed and compared (group 1 operated on between 1970 and 1988, group 2 between 1979 and 1987, group 3 between 1988 and 1996). RESULTS: Antropyloric cancer was the most common (56% in group 3). Tumor size decreased but there were in group 3 more undifferentiated tumors (54.2%) and more tumors with lymph node involvement (72%). Stage III and IV tumors were still common (70% in group 3) and early gastric cancer incidence very low (9.9%). After 1980, surgical management was more radical, with more total gastrectomies and larger lymph node dissections. Adjuvant intraoperative and postoperative radiotherapy has been associated since 1985. Postoperative mortality rate decreased (13.8% in group 1 vs 6.1% in group 3) (P = 0.04) as did the postoperative morbidity rate (31.8% in group 1 vs 17.5% in group 3). The five-year actuarial survival rate was respectively 18.9% and 39.2% for groups 1 and 2 (P = 0.003); it was respectively 59.8% and 43.6% for all patients treated by adjuvant radiotherapy and for those with lymph node involvement. CONCLUSION: Prognosis of gastric adenocarcinoma is still poor. A more radical surgical treatment did not increase the postoperative morbidity rate, but increased the survival rate. New adjuvant treatments including radiotherapy have to be evaluated in order to improve the prognosis.

Actuarial Analysis↗
PubMed2000

Intra-operative electron radiotherapy as a conservative treatment for infiltrating bladder cancer.

The intent of this feasibility study was to evaluate the use of intra-operative electron radiotherapy (IOERT), after transurethral resection (TUR), combined with external beam radiation with concurrent chemotherapy for the conservative treatment of infiltrating bladder cancer. From November 1988 to June 1998, 27 patients with histologically proven non-metastatic infiltrating bladder cancer were included in this protocol. The treatment consisted of: TUR, external beam irradiation (x18 MV:48 Grays (Gy)/24 fractions/5 weeks), with concurrent chemotherapy (cisplatin 30 mg/day for 3 days-two cycles during irradiation), followed by control cystoscopy and cystotomy with IOERT (e 9 MeV:15 Gy). 14 patients received two cycles of neoadjuvant methotrexate, vinblastine and cisplatin (MVC) and folinic acid chemotherapy. Patients were evaluated for toxicity, local control and survival. The 5-year overall and cystectomy-free survival rates were 53.3% +/-11.1% and 48.1%+/-11.4%, respectively. 4 patients developed infiltrating intravesicular recurrence (3 were treated by salvage cystectomy), and an additional patient developed a superficial recurrence. 2 patients subsequently developed regional recurrence in pelvic nodes and 10 patients were found to have distant metastases. The protocol was found to be feasible and associated with acceptable toxicity. Early and late toxicities consisted of 3 cases of bladder mucosal necrosis or ureteral stenosis which resolved with medical management. These preliminary results indicate that IOERT combined with TUR and neoadjuvant external beam radiation with concurrent chemotherapy is feasible. It could be considered as an alternative therapy for infiltrating carcinoma of the bladder, especially in patients unfit for radical surgery, and is well adapted to treat lesions of the fixed portion of the bladder.

Adult↗
PubMed2000

Intraoperative radiotherapy and external beam radiation therapy in gastric adenocarcinoma with R0-R1 surgical resection.

INTRODUCTION: The aims of this study were to evaluate the results of intraoperative radiotherapy (IORT) and external beam therapy (EBRT) in the treatment of gastric adenocarcinoma. METHODS: From 1986 to 1999, 87 patients who underwent surgical resection for gastric adenocarcinoma combined with IORT were reviewed. A R0 surgical resection was performed in 82 patients and five underwent R1 resection. The stage was: pT1 in 12, pT2 in 19, pT3 in 44 and pT4 in seven. Thirteen patients were pN1 and 43 were pN2, The IORT dose ranged from 12 to 23 Gy. Patients with pT3 and/or pN tumours underwent EBRT with a standard dose of 44-46 Gy. RESULTS: The post-operative mortality and morbidity rates were 2.3 and 6.8%, respectively. The 5-year survival rate for R0 patients was 60%, for R0-pN0 was 90% and for R0-pN+ patients was 55%. The local failure rate in the 19 pN+ patients was 21%. CONCLUSION: IORT and EBRT combined with surgical resection may provide overall survival, improving the local control after gastrectomy.

Adenocarcinoma↗
PubMed1998

Prophylactic pancreaticoduodenectomy for premalignant duodenal polyposis in familial adenomatous polyposis.

The frequency of duodenal adenomas in patients with, familial adenomatous polyposis is high. Duodenal adenoma has malignant potential, and duodenal adenocarcinoma is one of the main causes of death in patients who have had previous proctocolectomy. A conservative approach to the treatment of duodenal adenomas (nonsteroidal anti-inflammatory drugs, endoscopy, polypectomy through duodenotomy) is inefficient and unsafe. When invasive cancer occurs in duodenal adenomas, the result of surgery is poor. We have performed prophylactic pancreaticoduodenal resection (PDR) for nonmalignant severe duodenal polyposis in five patients since 1991. No operative mortality was observed. One patient developed a pancreatic fistula which was successfully managed by medical treatment. The mean follow-up was 35 months. All five patients are still alive and have a good functional outcome. Prophylactic PDR may be indicated in familial adenomatous polyposis when duodenal polyposis is severe. Stages III and IV of Spigelman's classification, periampullary adenoma, age above 40, and family history of duodenal cancer are factors that may lead to the decision to perform prophylactic PDR.

Adenoma↗
PubMed1998

Prevention of lymphorrhea by means of fibrin glue after axillary lymphadenectomy in breast cancer: prospective randomized trial.

A prospective randomized trial was carried out to evaluate the efficacy of fibrin glue in preventing lymphorrhea after axillary lymphadenectomy in breast cancer. One hundred and eight breast cancer patients, operated on by two senior surgeons, were randomized into two groups: group 1 (n = 58) without fibrin glue and group 2 (n = 50) with 2 ml of fibrin glue applied to the axillary dissection area at the end of the lymphadenectomy procedure. Early postoperative morbidity was 2/58 and 0/50 in groups 1 and 2, respectively. Mean daily postoperative drainage was significantly greater in group 1. The mean cumulative drainage quantity 6 days after the operation was 407.8 ml and 214.4 ml in groups 1 and 2, respectively (p = 0.001). The mean postoperative hospital stay was 10.1 days and 8.0 days in groups 1 and 2, respectively (p = 0.006). One delayed seroma was observed in each group. Fibrin glue seems to reduce daily postoperative drainage and hospital stay, but did not affect delayed seroma formation after axillary lymphadenectomy for breast cancer.

Aged↗
PubMed1997

Intraoperative radiation therapy combined with limited lymph node resection in gastric cancer: an alternative to extended dissection?

PURPOSE: To describe the results of a series of 63 Western patients presenting with gastric adenocarcinoma and treated with surgery and intraoperative radiation therapy (IORT) over a 8-year period and to discuss the role of IORT when combined with limited lymph node dissection. METHODS AND MATERIALS: From 1986 to 1993, 63 patients with gastric adenocarcinoma have been operated in the department of radiation oncology of the Hospices Civils de Lyon. The stage was: I in 17, II in 11, IIIA in 9, IIIB in 20, and IV in 6. The lymph node dissection was considered to be limited in 56 patients and extended in 7. The IORT dose ranged from 12 to 23 Gy (median: 15). Thirty patients also underwent a postoperative external beam irradiation with a standard dose of 44-46 Gy. RESULTS: The postoperative mortality rate was 4.8%. The 5-year overall survival in the entire series was 47% and was 82, 55, 78, 20, and 0% in Stages I, II, IIIA, IIIB, and IV, respectively. Loco-regional relapse occurred in 15 of 63 patients and metastases in 15 of 63. CONCLUSION: In Western patients treated by gastrectomy for adenocarcinoma of the stomach, IORT combined with limited lymph node dissection may provide overall survival similar to that observed after gastrectomy with extended lymph node dissection but with less postoperative mortality.

Adenocarcinoma↗
PubMed1997

Intraoperative radiotherapy in resected pancreatic cancer: feasibility and results.

BACKGROUND AND PURPOSE: To evaluate the impact of intraoperative radiotherapy (IORT) combined with postoperative external beam irradiation in patients with pancreatic cancer treated with curative surgical resection. MATERIALS AND METHODS: From January 1986 to April 1995 25 patients (11 male and 14 female, median age 61 years) underwent a curative resection with IORT for pancreatic adenocarcinoma. The tumour was located in the head of the pancreatic gland in 22 patients, in the body in two patients and in the tail in one patient. The pathological stage was pT1 in nine patients, pT2 in nine patients, pT3 in seven patients, pN0 in 14 patients and pN1 in 11 patients. All the patients were pM0. A pancreaticoduodenectomy was performed in 22 patients, a distal pancreatectomy was performed in two patients and a total pancreatectomy was performed in one patient. The resection was considered to be complete in 20 patients. One patient had microscopic residual disease and gross residual disease was present in four patients. IORT using electrons with a median energy of 12 MeV was performed in all the patients with doses ranging from 12 to 25 Gy. Postoperative EBRT was delivered to 20 patients (median dose 44 Gy). Concurrent chemotherapy with 5-fluorouracil was given to seven patients. RESULTS: The overall survival was 56% at 1 year, 20% at 2 years and 10% at 5 years. Nine local failures were observed. Twelve patients developed metastases without local recurrence. Twenty patients died from tumour progression and two patients died from early postoperative complications. Three patients are still alive; two patients in complete response at 17 and 94 months and one patient with hepatic metastases at 13 months. CONCLUSION: IORT after complete resection combined with postoperative external beam irradiation is feasible and well tolerated in patients with pancreatic adenocarcinoma.

Adenocarcinoma↗
PubMed1997

[Intraoperative radiotherapy in 1997].

Intra Operative Radiation Therapy (IORT) has been routinely used for the past 20 years. It is a feasible treatment, with a reasonable cost and an acceptable acute and late toxicity. There is so far no strong randomized trial demonstrating that IORT can improve overall survival. Nevertheless, in many institutions it is recognized as an efficient treatment in selected patients. In case of locally recurrent disease an incomplete gross resection is often the only choice; IORT in such a situation has led to very encouraging results. For locally advanced deep seated primary tumors IORT seems to improve local control. In the near future IORT should be used on a larger and stronger basis. The manufacturing of new mobile linac should allow more surgeons to perform IORT and to conduct clinical trials to confirm the present indications in cancers with high local malignancy.

Combined Modality Therapy↗