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J R Delpero

Publications and source records attributed to J R Delpero.

At least 55 records · Page 3Linked to original sources
PubMed1998

Surgical resection of locally recurrent colorectal adenocarcinoma.

BACKGROUND: Recurrence rates after curative resection of colorectal adenocarcinoma remain steady at 50 per cent. Thirty per cent of the deaths are linked to locoregional recurrence. The aim of this study was to evaluate the results of resection for locoregional recurrence. METHODS: This retrospective review analyzed a series of 120 patients who underwent resection of colonic (56) or rectal (64) locoregional recurrence. Sixty-nine resections were considered as curative. Sixty-one recurrences required extended resection. There were nine synchronous hepatic resections. RESULTS: The hospital mortality rate was 7 per cent and the morbidity rate was 40 per cent. The overall 5-year survival rate was 27 per cent. Survival was significantly higher: (1) after curative resection (44 versus 0 per cent after palliative resection, P < 0.0001); (2) in women (44 versus 11 per cent for men, P = 0.0036); and (3) after resection for intramural recurrence (45 versus 19 per cent for extramural recurrence, P = 0.0024). Multifactorial analysis showed that curability of the resection was the most important prognostic parameter. CONCLUSION: The results in this highly selected group seem to justify an attempt at reresection whenever possible. Long-term results may be improved by using adjuvant treatment.

Adenocarcinoma↗
PubMed1998

Value of endoscopic ultrasonography for assessment of patients presenting elevated tumor marker levels after surgery for colorectal cancers.

BACKGROUND AND STUDY AIMS: This prospective study was undertaken to evaluate the role of endoscopic ultrasound (EUS) in patients presenting with elevated tumor marker levels (CEA, CA 19-9) after surgery for colorectal cancer. PATIENTS AND METHODS: During a 26-month period, colonic EUS was performed in 21 patients who had undergone surgical treatment for colorectal cancers. All patients presented with elevated tumor marker levels at the time of examination but all other diagnostic procedures (US, CT scan of the abdomen and thorax, bone scintigraphy and colonoscopy) did not demonstrate recurrence. Colonic EUS was performed using a linear convex probe (echoendoscopes Pentax: FG 32 UA, 36 U, 38 UX). In cases with normal findings on colonic EUS, upper gastrointestinal tract EUS was also performed. RESULTS: 21 colonic EUS and six upper gastrointestinal tract EUS examinations were performed. Of 21 colonic EUS examinations, 15 showed either local recurrence (n = 9) or peritoneal carcinomatosis (n = 6) and six EUS-guided biopsies were performed. Of these 15 patients, 13 were operated on and results were confirmed in 12 of 13 patients, namely in 8/9 cases with suspected anastomotic recurrence and in all four operated cases with presumed peritoneal carcinomatosis. EUS-guided biopsy had diagnosed three of the four cases before. Upper GI EUS was performed in the six cases with normal colonic EUS; two cases showed mediastinal lymph nodes and one showed celiac lymph nodes. EUS-guided biopsy confirmed the malignancy of these nodes. For the diagnosis of recurrence, sensitivity, specificity and accuracy of lower plus upper gastrointestinal EUS were 94.4%, 66.6% and 90.4% respectively. CONCLUSION: EUS of the colon and--in selected cases--also of the upper gastrointestinal tract is quite useful in this clinical setting. Further studies are needed to evaluate the impact of EUS on outcome in larger patient numbers.

Adult↗
PubMed1998

[Value of surgery in the treatment of advanced cervical cancers].

Surgical resection of advanced nonmetastatic forms of cervical cancers is controversial, but improve local control. The local and regional staging assessment, comprising an examination under general anaesthesia, endocavitary ultrasonography, computed tomography (CT) and/or magnetic resonance imaging (MRI) allows staging, evaluation of the main prognostic factors and selection of the therapeutic strategy. Pelvic and lumboaortic lymph nodes can be investigated by CT, MRI or laparoscopic lymphadenectomy. Surgical resections consist of colpohysterectomy possibly combined with radical lymphadenectomy or pelvic exenteration, followed by pelvic reconstruction using various procedures: low colorectal anastomosis, continent urinary diversion, and vaginal reconstruction with pelvic filling. The mortality and morbidity of pelvic exenteration remain high. It is therefore important to prevent the most frequent complications as effectively as possible. The local control, overall survival and recurrence-free survival can be improved by combining concomitant radiotherapy-chemotherapy and large surgical resection. Some unfavourable local situations can justify palliative pelvic exenteration in highly selected indications designed to improve local control and comfort of survival.

Combined Modality Therapy↗
PubMed1997

Preliminary results of a phase I/II study of post-operative high-dose rate brachytherapy for advanced or recurrent pelvic tumours.

Electron beam intraoperative radiation therapy (EB-IORT) and intraoperative low-dose rate brachytherapy (IOLB) seem able to improve the local control of advanced or recurrent pelvic tumours (ARPT). We report the usefulness, technical considerations and potential advantages of employing post-operative high-dose rate brachytherapy (POHB) as a treatment for ARPT. From February 1995 to February 1997, 14 patients underwent POHB for ARPT. The mean age was 58 years (range: 37-74). Six patients presented with recurrent rectal carcinoma, three with cervix carcinoma (one primary T3; two recurrences), two with bladder carcinoma (one primary T4; one recurrence), one with prostate carcinoma, one with recurrent pre-sacral lymphoma and one with undifferentiated carcinoma. At the time of resection, blind-end HDR catheters were implanted in a single plan in the tumour bed and stabilized by absorbable sutures. Eight days later, POHB delivered 20Gy in 5 fractions or 40Gy in 10 fractions for advanced and recurrent tumours, respectively. To decrease the incidence of late side-effects, a change was made after the tenth patient to deliver 2 Gy per fraction twice a day, with an interval of 6 h between each fraction. With a median follow-up of 8 months (range: 1-22), local control was achieved in all cases. Six patients developed metastatic disease. One patient presented a perineal wound dehiscence requiring surgery 2 months after POHB. POHB is feasible for patients with recurrent or advanced pelvic diseases, and appears more cost-effective than EB-IORT for dosimetric and radiobiological considerations. Compared with IOLB, POHB allows the total radioprotection of the medical staff, and, in the context of cost reduction, a reduction of the overall time of hospitalization.

Adult↗
PubMed1997

Endoscopic ultrasonography for assessment of the response to combined radiation therapy and chemotherapy in patients with esophageal cancer.

BACKGROUND AND STUDY AIMS: Measuring the response of esophageal cancer to combined chemotherapy and radiotherapy is difficult. Initial results using ultrasonography have been contradictory. The purpose of this study was to correlate the endoscopic ultrasonography (EUS) findings after preoperative chemoradiotherapy with the histology of the resected specimens, and to assess the accuracy of EUS in predicting the response to treatment. PATIENTS AND METHODS: From October 1991 to February 1995, 32 patients with esophageal cancer staged as T3 or T4 on EUS were treated by chemoradiotherapy, followed by surgical resection. There were 28 men and four women, with a mean age of 54 years (range 38-70 years). In 25 cases, the diagnosis was squamous-cell carcinoma, and in seven cases it was adenocarcinoma. EUS was carried out using a curved-array ultrasonic transducer (Pentax FG-32 UA). After two courses of chemoradiotherapy, the wall involvement was classified using the following modified post-chemoradiotherapy classification: T0, complete restitution of wall layers; Tw, echo-poor nodules located in the submucosa or muscularis propria, but with wall layers discernible; T2, echo-poor wall thickening without distinguishable layers, but not infiltrating beyond the fifth hyperechoic layer; T3, thickened hypoechoic or heterogeneous wall, no distinguishable layers, infiltrating beyond the fifth hyperechoic layer; T4: a hypoechoic or heterogeneous mass in contact with a mediastinal structure. RESULTS: Using this post-chemoradiotherapy classification, the sensitivity, specificity, and accuracy of EUS in detecting residual tumor (T0 + Tw versus T2, T3, and T4) were 91.3%, 77.7%, and 77.7%, respectively. The accuracy of EUS, endoscopic, and CT criteria in assessing the parietal response was 81.2%, 56.2%, and 59.3%, respectively. CONCLUSION: Complete restoration of the esophageal wall (T0) and Tw stage corresponded to disease-free histology in 78% of cases, and corresponded in all cases either to disease-free esophageal wall or to microscopic tumor residues in the mucosa. No conclusions could be drawn in the other categories (T2-T4), but residual tumor was detected in 87% of cases.

Adenocarcinoma↗
PubMed1997

Results of liver transplantation in the treatment of metastatic neuroendocrine tumors. A 31-case French multicentric report.

OBJECTIVE: The purpose of this study was to assess the value and timing of orthotopic liver transplantation (OLT) in the treatment of metastatic neuroendocrine tumors (NET). SUMMARY BACKGROUND DATA: Liver metastasis from NET seems less invasive than other secondary tumors. This observation suggests that OLT may be indicated when other therapies become ineffective. However, the potential benefit of this highly aggressive procedure is difficult to assess due to the scarcity and heterogeneity of NET. METHODS: A retrospective multicentric study was carried out, including all cases of OLT for NET performed in France between 1989 and 1994. There were 15 cases of metastatic carcinoid tumor and 16 cases of islet cell carcinomas. Hormone-related symptoms were present in 16 cases (55%). Only 5 patients (16%) had no previous surgical or medical therapy before OLT. Median delay from diagnosis of liver metastasis and OLT was 19 months (range, 2 to 120). RESULTS: The primary tumor was removed at the time of OLT in 11 cases, by upper abdominal exenteration in 7 cases and the Whipple resection in 3. Actuarial survival rate after OLT was 59% at 1 year, 47% at 3 years, and 36% at 5 years. Survival rates were significantly higher for metastatic carcinoid tumors (69% at 5 years) than for noncarcinoid apudomas (8% at 4 years), because of higher tumor- and non-tumor-related mortality rates for the latter. CONCLUSION: OLT can achieve control of hormonal symptoms and prolong survival in selected patients with liver metastasis of carcinoid tumors. It does not seem indicated for other NET.

Adult↗
PubMed1997

[Pelvic recurrence of cancers of the uterine cervix. A study of a series of 49 cases].

BACKGROUND: Pelvic recurrence of cervical cancer is a life-threatening event for patients. The main therapeutic challenge is to locally control such relapses. We present our experience of the surgical treatment of pelvic cervical cancer relapses. PATIENTS AND METHODS: From July 1980 to January 1994, 49 patients underwent a surgical procedure for pelvic cervical cancer relapse. Forty four tumor relapses were localized in the pelvis and 5 were associated with distant metastases. Surgery was performed alone in 31 cases and in association with radiotherapy in 18 cases. Median follow-up was 34 months. RESULTS: The treatment was curative in 49% of cases. There was a significant correlation between the initial stage, the site of tumor relapse and surgical curability. Overall actuarial survival was 44% and 24% at 2 and 5 years, respectively. In the curative treatment group, actuarial survival was 71% and 47% at 2 and 5 years, respectively. There was a major surgical complication in 14 cases: 11 reoperations were performed. Thirteen patients are alive of whom 12 with no evidence of disease (median follow-up; 36 months). A local control was achieved in 53% of cases. Age and site of relapse significantly influenced survival. CONCLUSIONS: The results of this study are comparable with other surgical series despite our less favorable patient selection. For patients experiencing pelvic side-wall infiltration, surgical treatment is a worthwhile palliation in selected cases because it is often the only available therapeutic option.

Adult↗
PubMed1997

[Intensive chemotherapy with autologous stem cell transplantation in ovarian cancers: analysis of 67 patients treated at the Paoli-Calmettes Institute and a review of the literature].

Despite important initial chemosensitivity, advanced ovarian cancer has a bad prognosis with a median survival of 20 to 30 months. These results might be better with intensive chemotherapy. We analysed 67 patients treated by intensive chemotherapy with autologous stem cell transplantation for advanced ovarian cancer at Institute Paoli-Calmettes between 1980 and 1994. Population was divided in two groups: salvage group (n = 30) for initial chemotherapy-refractory patients and consolidation group (n = 37) for sensitive patients. Several successive conditioning regimens were used, all based on alkylating agents. Principal toxicities were severe aplasia and mucositis. Four patients died from toxicity related to infection during strong immunosuppression. In salvage group, 9 out of 21 evaluable patients responded (43%), but duration of responses was short (median range of 5 months) and 2-year overall survival rate was 8% after transplantation. In consolidation group, 19 patients are alive and 15 are without disease progression with a median follow-up of 42 months (17, 161) after diagnosis. Five-year disease-free survival rate is 28% (median range of 35 months) and 5-year overall survival rate is 48% (median range of 41 months). Intensification does not seem to be long term beneficial for initial chemotherapy refractory patients, despite objective responses rate better than classical treatment. On the other hand, results seem better than conventional treatments in case of chemosensitive disease and should be confirmed prospectively in larger cohort of patients. Moreover, other research directions are open like intensification supported by hematopoietic growth-factors and peripheral stem cells, definition of best conditioning regimen, use of taxanes, and intensification in first line chemotherapy after initial surgery.

Adult↗
PubMed1997

[Drug-resistant genito-urinary rhabdomyosarcoma in children with primary psoas abscess. Apropos of a case].

We report an unusually uncommon case of genitourinary rhabdomyosarcoma in a child which was chemoresistant and complicated by a primary psoas abscess which presented as a pelvic mass associated with an abscess of the right iliac fossa. Ultrasound and CT investigations suggested the diagnosis of a centropelvic tumor which was confirmed at puncture-aspiration. MRI was most contributive giving a precise description of the local extension. Intensive multi-drug chemotherapy would appear to have improved outcome in patients with poor-prognosis Maurer group III tumors. In exceptional cases when no tumor response is obtained, carcinological surgery with large dissection, possibly with adjuvant radiotherapy, is indicated. Percutaneous drainage of the deep psoas abscess is as effective as classical surgery and spares the abdominal wall, particularly important if a second operation should be needed. Multidisciplinary management is required for the treatment of this highly malignant tumor.

Adolescent↗
PubMed1996

A western surgical experience of peripheral cholangiocarcinoma.

The aim of this retrospective study was to analyse outcome in 31 European patients operated on for peripheral cholangiocarcinoma between 1988 and 1995 (hilar cholangiocarcinoma was excluded). Before 1992, in addition to conventional resection, patients with irresectable tumour and with no extrahepatic metastasis underwent total hepatectomy with liver transplantation. Mild abdominal pain was the most frequent presenting clinical sign (11 of 31 patients) and jaundice was present in only four patients. Preoperative histological findings were available for 20 patients but the diagnosis was correct in only eight of these. Nineteen patients had curative surgery: 17 underwent conventional resection and two had total hepatectomy with liver transplantation. Major hepatectomy was performed in 12 of 17 cases, extended to the caudate lobe in five, to the bile duct confluence in four and to the retrohepatic vena cava in one. Postoperative mortality and morbidity rates were three and seven of 19 patients respectively, median survival was 15 months, and actuarial 1-, 2- and 5-year survival rates were 67, 40 and 32 per cent respectively. Twelve patients had only exploratory laparotomy because of the presence of extrahepatic metastasis or irresectable tumour. The invasive nature of peripheral cholangiocarcinoma can explain the limited number of resectable cases and the particularly unfavourable prognosis. Total hepatectomy does not provide survival benefit. Conventional surgery remains the only effective treatment, even for patients with advanced stage tumours.

Adult↗
PubMed1996

Gastrointestinal hormone mRNA expression in human colonic adenocarcinomas, hepatic metastases and cell lines.

Aims-(1) To investigate the expression of the four main hormones of the digestive tract by performing reverse transcription polymerase chain reaction (RT-PCR) on a series of samples, comprising tumoral and healthy colonic tissues, hepatic metastases and colonic cell line samples; and (2) to study the patterns of labelling obtained with serological and morphological markers.Methods-After extraction and reverse transcription, gastrin, somatostatin, cholecystokinin (CCK) and transforming growth factor alpha (TGFalpha) mRNAs were detected by PCR and nested PCR using specific primers. The corresponding proteins were detected by immunohistochemistry.Results-The cell lines expressed all four mRNAs. Gastrin mRNA was present in most tumoral and metastatic samples, while the somatostatin transcript was detected in all samples and was frequently overexpressed in the normal colon. TGFalpha mRNA was expressed systematically in tumours of the right and transverse colon, but not in those located in the left colon; the expression of CCK mRNA was systematically absent in the left colon.Conclusions-The data presented here shed some light on the transcriptional events involved in the production of the various hormones present in the gastrointestinal tract, in both healthy and tumoral tissues. The various mRNAs expressed in cell lines are therefore not systematically expressed in the human pathology.

Journal Article↗
PubMed1996

[The Miami pouch: a reliable continent urinary diversion after pelvic exenteration].

OBJECTIVES: To describe the technique and present the results obtained with the Miami reservoir, a continent urinary diversion, after pelvic exenteration for advanced gynaecological tumours. METHODS: A Miami reservoir was performed in 12 patients between January 1993 and January 1995. A detubed right colonic reservoir was created using automatic resorbable staples. The ureters were reimplanted into the reservoir using an anti-reflux system and continence was ensured by forming a tube with the terminal loop of ileum and by using a Bauhin valve, which can be reinforced when it is incompetent. Regular postoperative follow-up was conducted (6 to 26 months) with monitoring of laboratory parameters, intravenous urography, opacification of the reservoir, urodynamic assessment of the continent diversion. RESULTS: There were no surgical complications related to the urinary diversion. Urinary continence was obtained in every case and after medical treatment of residual peristaltic contractions of the detubed colonic reservoir in 2 patients. Protection of the upper urinary tract was satisfactory after 2 years of follow-up, without stenosis or reflux of the uretero-colonic anastomoses. The mean capacity of the colonic reservoir was 465.5 +/- 101 ml at 6 months, with filling pressures lower than 20 cm H2O. CONCLUSION: The Miami reservoir is a continent urinary diversion which is relatively easy to perform and reliable in terms of continence and protection of upper tract. However, a longer postoperative follow-up is required. The quality of life of young patients after pelvic exenteration is improved due to this type of contingent diversion which avoids the need for an abdominal urine collector, although it requires intermittent self-catheterization.

Adult↗
PubMed1996

[Pancreatic and duodenal somatostatinoma. Two clinico-pathologic entities].

Somatostatinomas are endocrine tumors with predominant secretion of somatostatin. The majority occur in the pancreas and the duodenum. However, distinctive clinico-pathologic features are reported for both of them. The features of pancreatic somatostatinomas are a larger size, a more frequent clinical expression, a female predominance and a poorer prognosis. Duodenal somatostatinomas are characterized by psammoma bodies at histologic examination. We report here two cases of pancreatic and ampullary somatostatinomas, focusing on the main diagnostic problems and on the characteristics of each tumoral localization.

Aged↗
PubMed1995

In vitro evaluation of donor liver preservation fluids on human hepatocyte function.

Successful liver transplantation depends on adequate preservation of cellular function. We therefore tested the effects of two currently used liver preservation fluids, Euro-Collins (EC) solution and University of Wisconsin (UW) solution, on the viability and some functional activities of hepatocytes isolated from human livers. Cells in primary culture were maintained under hypoxic (95% N2/5% CO2) and hypothermic (4 degrees C) conditions for 24 h, either in EC or UW solution. This treatment did not result in significant hepatocyte damage, as judged by phase contrast microscopy, intracellular LDH release, and the MTT mitochondrial test. However, neutral red uptake indicated that lysosomal functions were slightly affected (35% decrease) when compared to control conditions. At the end of the hypoxia/hypothermia period, hepatocyte monolayers were incubated at 37 degrees C under normoxic conditions for 24 h, in order to simulate the reperfusion of a transplanted liver. Three drugs--midazolam, diazepam, zidovudine--were used as diagnostic substrates to check the metabolic abilities of human hepatocytes replaced in normal conditions. Both phase I (hydroxylation, demethylation) and phase II (glucuronidation) metabolic reactions were affected by the hypoxia/hypothermia shock. Indeed, a 30%-50% decrease in these activities was observed as compared to values obtained in control hepatocytes. No difference could, however, be found at the cellular level regarding the solution used for cold storage. These results suggest that the superiority of UW over EC solution, already reported in clinical practice after transplantation of preserved human livers, was not due to a better preservation of the hepatocytes.

Antimetabolites↗