Biomedical subjects

Jean-Marie Marechal

Publications and source records attributed to Jean-Marie Marechal.

3 recordsLinked to original sources

PubMed2006

A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.

OBJECTIVES: This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (<or=5 cm), solitary, low-stage N0 M0 tumour suspicious for renal cell carcinoma (RCC) and a normal contralateral kidney. METHODS: 541 patients were randomised in a prospective, multicentre, phase 3 trial to undergo NSS (n=268) or RN (n=273) together with a limited lymph node dissection. RESULTS: This publication reports only on the complications reported for both surgical methods. The rate of perioperative blood loss<0.5l was slightly higher after RN (96.0% vs. 87.2%) and the rate of severe haemorrhage was slightly higher after NSS (3.1% vs. 1.2%). Ten patients (4.4%), all of whom were treated with NSS, developed urinary fistulas. Pleural damage (11.5% for NSS vs. 9.3% for RN) and spleen damage (0.4% for NSS and 0.4% for RN) were observed with similar rates in both groups. Postoperative computed tomography scanning abnormalities were seen in 5.8% of NSS and 2.0% of RN patients. Reoperation for complications was necessary in 4.4% of NSS and 2.4% of RN patients. CONCLUSIONS: NSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN. The oncologic results are eagerly awaited to confirm that NSS is an acceptable approach for small asymptomatic RCC.

Aged↗

PubMed2005

[Complications and functional results of Hautmann ileal bladder in a series of 87 patients].

OBJECTIVES: To retrospectively evaluate the complications, urinary reservoir function and quality of life of patients with Hautmann ileal bladder after cystectomy for bladder urothelial carcinoma. METHODS: From 1994 to 2004, 87 patients with a mean age of 61.1 years underwent total cystoprostatectomy (n = 85 men) or radical cystectomy (n = 2 women) with Hautmann replacement enterocystoplasty. The mean follow-up was 40.7 months. Continence, quality of voiding, and quality of life were evaluated by self-administered questionnaires (continence questionnaire, DITROVIE score, I-PSS score). RESULTS: The early complication rate was 30.1%, including 6.9% related to the ileal bladder. The late complication rate was 33.6%, including 20.9% related to the ileal bladder. Four patients died during the perioperative period, 14 patients (17%) died from progression of their cancer and 7 patients (8%) died from an independent cause. One patient was lost to follow-up. Questionnaires were sent to 56 patients and 52 replies were received: 96.2% of patients were continent during the day, 53.8% were continent at night. 4.9% of patients performed self-catheterization for chronic urine retention, 90.4% of patients were satisfied with their replacement bladder and only 5.8% of patients had an altered quality of life. CONCLUSION: Despite a considerable morbidity rate and a significant nocturnal incontinence rate, the orthotopic Hautmann W-shaped ileal bladder does not appear to alter the patients' quality of life.

Adult↗

PubMed2002

[Treatment of renal tumors with radiofrequency: preliminary results].

OBJECTIVE: To study the feasibility and the innocuity of the treatment by radiofrequency of small renal tumours. MATERIAL AND METHODS: From June 2000 to September 2001, 10 renal tumours in 6 patients were treated by radiofrequency. The mean age of the patients was 57 years. The mean tumour diameter was 20 mm. Indications for partial surgery were 3 solitary kidneys, one patient with chronic renal failure, one patient with Von Hippel Lindau disease and one patient in whom several angiomyolipomas were discovered in the right kidney. 4 patients were treated via a lumbar incision and 2 were treated percutaneously (one with ultrasound guidance and the other with computed tomography guidance). Patients were reviewed by imaging (CT and/or MRI) with injection of contrast agent to demonstrate complete devascularization of the tumour. RESULTS: Treatment lasted an average of 180 minutes. The intraoperative complication rate was 16%. The mean hospital stay was 9 days (4 days for the percutaneous route). Nine tumours (5 patients) were devascularized after a single session. One patient (treated via the percutaneous route under ultrasound guidance) showed persistence of tumour tissue (identified by CT). A second session, performed 4 months later, allowed complete devascularization of the tumour. The mean follow-up is 13 months. CONCLUSION: This study demonstrates the feasibility and safety in terms of renal function of radiofrequency treatment of small renal tumours. However further studies are necessary to precisely define the radiological criteria of tumour necrosis and to evaluate the long-term results of this method (outcome of necrotic tumour tissue, metastatic risk, cancer recurrence along the needle track in the case of a percutaneous approach). This treatment must be reserved for selected patients.

Adult↗