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Biomedical subjects

M Rivoire

Publications and source records attributed to M Rivoire.

At least 19 recordsLinked to original sources
PubMed2006

Survival after primary enucleation for choroidal melanoma: changes induced by the introduction of conservative therapies.

BACKGROUND: Most uveal melanomas are currently treated by eye-preserving radiotherapies. However, for melanomas of the largest size or with initial complications, enucleation remains the reference treatment. Enucleation is called primary when it is proposed as the only local treatment option for a melanoma. There is very little literature on the use of primary enucleation after the introduction of conservative treatments. Our main goal was to evaluate the survival of melanoma patients treated by primary enucleation since the introduction of proton-beam therapy in France in 1991. METHODS: All melanoma patients undergoing primary enucleation in our department between 1991 and 2002 were included in this retrospective study. The 5-year melanoma-specific survival rate was calculated using the Kaplan-Meier method. The multivariate prognostic analysis was performed using the Cox proportional hazards model. RESULTS: Forty patients, representing 8% of all patients with choroidal uveal melanoma diagnosed and followed up in our department during an 11-year period, were included in the study. No patient was lost to follow-up. The 5-year melanoma-specific survival rate was 31.45% (SE: 7.8) after primary enucleation. Significant prognosis factors in the multivariate analysis were: tumor thickness > 12 mm (p = 0.03), anterior margin of the tumor involving the iris (p = 0.018), and presence of epithelioid cells (p = 0.02). CONCLUSIONS: The very low survival rate reported reflects the evolution of primary enucleation, which is currently indicated only for melanomas with the worst prognosis. The knowledge of current post-enucleation survival rates represents an essential achievement for both correct assessment of conservative therapies and patient counseling.

Adult↗
PubMed2003

Evaluation of core needle biopsy as a substitute to open biopsy in the diagnosis of soft-tissue masses.

Open biopsy is recommended for a soft-tissue sarcoma (s-t-S) diagnosis. Core needle biopsy (CNB) was recently associated with minimal morbidity, cost and time-consumption, but also potential inaccuracy. Its diagnostic utility was investigated retrospectively in 110 patients with soft-tissue masses (s-t-M) undergoing CNB between September 1994 and September 2000. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values were determined for malignancy (benign/malign), soft-tissue tumour (yes/no), and sarcoma diagnosis (yes/no), comparing CNB and the best standard test available; concordance was evaluated. 103/110 CNB were suitable for analysis. Final diagnosis was 23 benign tumours (19%), 65 s-t-S (59%), 9 lymphomas (8%), 6 fibromatoses (desmoid) (5%) and 7 carcinomas (6%). CNB Sp and PPV were 100%, Se was 95, 99 and 92%, and NPV 85, 95 and 88% for diagnosing malignancy, soft-tissue tumour and sarcoma. CNB Se and NPV were 100% for malignancy, connective tumour and sarcoma in lymphomas, high-grade sarcomas and desmoid tumours. In low grade sarcomas, Se was 94 and 85%, and NPV 84 and 77% for malignancy and sarcoma. Histological grade on CNB seems uneasy, except for grade-III tumours. CNB is accurate, not misleading for s-t-M diagnosis, avoids open biopsy complications, and allows one-surgery or neo-adjuvant chemotherapy planning when combined with appropriate imaging.

Adolescent↗
PubMed2001

Multimodality treatment of patients with liver metastases from germ cell tumors: the role of surgery.

BACKGROUND: The presence of liver metastases represents an independent poor risk prognostic factor for survival in patients with germ cell tumors. METHODS: The clinical files of 37 patients who had undergone liver resection for the treatment of disseminated germ cell tumors were reviewed to define the indications for resection of residual liver metastases after chemotherapy in patients with germ cell tumors. The histologic patterns of primary tumor and residual disease were compared. The prognostic factors for survival were studied by univariate analysis. RESULTS: All but 2 of 37 patients underwent complete resection. One patient died of postoperative complications. Thirteen complications occurred in 10 patients. Twelve patients had active residual tumor, 7 patients had mature teratoma, and 18 patients had only necrosis on histologic examination. Twenty-three of 37 patients (62%) were alive with no evidence of disease after a median follow-up of 66 months (range, 31-134 months). Three prognostic factors were found to be significant in the univariate analysis for unfavorable outcome: the presence of pure embryonal carcinoma in the primary tumor, liver metastases measuring > 30 mm in greatest dimension at the time of surgery, and the presence of viable, active residual disease. CONCLUSIONS: Because it is impossible to determine the histologic pattern of residual liver masses after chemotherapy with current imaging tools and percutaneous biopsy, patient selection for liver surgery may be undertaken according to the size of residual liver masses. Patients with masses that measure < or = 10 mm in greatest dimension should be considered for close follow-up, because they have a high probability of necrosis and are at low risk for malignant disease. Male patients with masses that measure > or = 30 mm in greatest dimension represent a high-risk group of patients who are not likely to benefit from liver surgery. Only male patients with masses that measure 10-29 mm in greatest dimension and all female patients with masses that measure > 10 mm in greatest dimension should be considered for liver resection.

Adolescent↗
PubMed2001

Advanced testis cancer.

Advanced testis tumors are highly curable. The treatment strategy is chemotherapy followed by the surgical exeresis of residual disease. The standard chemotherapy regimen is BEP (bleomycin, etoposide, and cisplatin); the number of cycles of chemotherapy depends upon prognostic factors, based on the primary site, histology, presence of visceral metastases, and serum tumor marker levels. Patients in the good-risk group receive three cycles of chemotherapy, whereas those in the intermediate- and high-risk groups receive four cycles. Exeresis of all residual disease and systematic postchemotherapy retroperitoneal dissection in bulky disease are mandatory. When complete exeresis of necrotic tissue, teratoma, or active germ-cell cancer has been performed, no further postsurgical treatment is warranted. A multidisciplinary approach, rigorous administration of chemotherapy, and skill in surgery of germ-cell tumors are favored in the treatment of these patients in trained centers.

Algorithms↗
PubMed2001

[Cryosurgery of primary and metastatic cancers of the liver].

Cryosurgery is a method of in situ destruction of tissue by a freezing process. Results of hepatic cryosurgery are now available for more than 2100 patients and allow to assess its place in the treatment of hepatic malignancies. Mechanisms of tissue destruction and indications of cryosurgery are detailed. With a peri-operative mortality rate of 1.5%, the safety of hepatic cryosurgery is now admitted. Cryosurgery has its own morbidity: increase of transaminases levels, platelets drop, myoglobinuria and rarely renal failure or cryoshock. In selected patients, hepatic cryosurgery is feasible with a laparoscopic or percutaneous approach. Long term results do not support cryosurgery as an alternative to liver resection. This technique enlarges possibilities of surgical treatment for patients with primary and metastatic liver cancers.

Carcinoma, Hepatocellular↗
PubMed2001

Importance of surgery as salvage treatment after high dose chemotherapy failure in germ cell tumors.

PURPOSE: The survival of patients with germ cell cancer after failed high dose chemotherapy is poor. We retrospectively reviewed the various treatment choices in this situation. MATERIALS AND METHODS: From March 1986 to July 1996, 32 patients had disease progression after high dose cisplatin based chemotherapy plus hematopoietic stem cell support. Patients received high dose chemotherapy in the first line (11) or salvage (21) setting. RESULTS: There was relapse after a complete or partial marker negative response after high dose chemotherapy in 19 cases at a median time to disease progression of 7 months (range 1.5 to 72). Salvage treatment involved chemotherapy alone in 5 cases, chemotherapy plus surgery in 6, surgery plus radiotherapy in 3, surgery alone in 2, combined radiotherapy, chemotherapy and surgery in 1, and no treatment in 1 due to a rapid disease course. The most common chemotherapy regimen was combined vinorelbine, ifosfamide and epirubicin. Eight patients achieved a complete response with the resection of all residual disease. At long-term followup 2 patients have been continuously disease-free for 84 and 109 months, respectively. After high dose chemotherapy 13 patients had evidence of disease, including 4 with a partial marker positive response and 9 with progressive disease. Salvage treatment involved chemotherapy plus surgery in 6 cases, chemotherapy alone in 2, no treatment in 2, and radiotherapy plus chemotherapy, radiotherapy alone and surgery alone in 1 each. One patient with progressive disease and 3 with a partial marker positive response achieved a complete response after salvage surgery, and combined surgery and high dose chemotherapy, respectively. These 4 patients have been continuously free of disease for 105, 95, 92 and 72 months, respectively. CONCLUSIONS: Six of the 32 patients with relapse or progressive disease after high dose chemotherapy have been free of disease in the long term. The most effective treatment was the resection of all residual masses. Chemotherapy had only marginal activity and the efficacy of radiotherapy seems to have been nil.

Adolescent↗
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↗
PubMed1999

Desmoid tumor arising in a cesarean section scar during pregnancy: monitoring and management.

Desmoid tumors (DTs) are frequently associated with either surgical trauma, like scars, or physiologic trauma, like pregnancy. A DT arising in a cesarean scar during pregnancy shows both correlations. A case of DT that grew gradually in a cesarean scar during the first trimester of a subsequent pregnancy is presented. After initial MR imaging, the lesion was biopsied and carefully monitored; immediate surgical removal was considered at any time if indicated by the follow-up results. No increase in the tumor size was observed during the following 6 months of gestation, and the lesion was extirpated with mesh replacement of the abdominal defect at the time of cesarean section.

Adult↗
PubMed1998

Autologous latissimus breast reconstruction: a 3-year clinical experience with 100 patients.

This article presents our technique of autologous breast reconstruction using the latissimus dorsi flap and studies the advantages, disadvantages, and results that can be expected. A consecutive sample of 100 patients was studied. The average length of follow-up was 20 months (range 8 to 44 months), and all of the subjects were reviewed in consultation without loss to follow-up. The supplementary volume of the latissimus dorsi was obtained from five fatty zones: fat on the cutaneous paddle, fat taken from the surface of the muscle, the scapular fat pad, the anterior fatty zone, and the supra-iliac fat pad. This technique must be measured against the transverse rectus abdominis muscle (TRAM) flap, free or pedicled, when the patient needs an autologous breast reconstruction. It can be used when the TRAM flap is contraindicated (this corresponds to 45 percent of patients of our sample) or when the dorsal donor site is preferred (55 percent of cases of our sample). The major complications are rare (1 percent partial necrosis and 1 percent total necrosis of the flap). The minor complications are represented mainly by the dorsal seroma. This is the main drawback of the technique, as it occurs in 79 percent of cases and regularly in obese patients. In view of this frequency, patients should be warned of its likely occurrence. The dorsal donor-site morbidity is relatively low; 4 percent of dorsal sequelae were classed as moderate, and 96 percent were considered low. The scapular sequelae have been classed as low in 97 percent of cases, and temporary scapular sequelae aggravation has been noted in 3 percent. Results of breast reconstruction using this technique are most encouraging. The level of patient satisfaction is high; 87 percent of them were deeply satisfied, 10 percent were satisfied, and only 3 percent were poorly satisfied. This group of poorly satisfied subjects (3 percent) consists of patients who suffered a serious postoperative complication. The aesthetic results have been judged excellent by surgeons in 85 percent of the cases, good in 12 percent of the cases, and poor in 3 percent of the cases; no result has been judged bad. This technique of breast reconstruction by autologous latissimus dorsi brings a major advance in breast reconstruction. The best indications of this technique are when one can bury the cutaneous paddle: cases of skin-sparing mastectomy, cases where the latissimus dorsi flap can be combined with an abdominal advancement flap, and cases of conversion of implant reconstruction to an autologous reconstruction.

Adult↗
PubMed1998

[Posterior thoracic reconstruction with latissimus dorsi flap after partial amputation of the latissimus dorsi muscle for sarcoma of the back. Report of four cases].

Malignant fibrous histiocytomas (MFH) arising from the subcutaneous tissues of the posterior thoracic wall require wide, but usually non-transfixing, resection to ensure adequate resection margins, the only way to reduce the local recurrent rate. Due to its size and position, the Latissimus dorsi muscle usually requires partial amputation. However, its vascular anatomy allows it to be used as a musculocutaneous flap of the residual muscle to fill the defects created. Four clinical cases are reported. This technique reduces the complication rate and simplifies the postoperative course.

Adult↗
PubMed1997

Salvage liver surgery of a chemorefractory ovarian choriocarcinoma.

A 41-year-old woman with pure ovarian choriocarcinoma and widespread liver metastases became refractory to standard cisplatin-based chemotherapy regimens. As metastatic disease was limited to the liver and operable, the patient underwent complete resection of three liver metastases. The serum human chorionic gonadotrophin level promptly returned to normal values. Pathologic studies demonstrated the presence of active residual disease composed of typical syncytiotrophoblastic and cytotrophoblastic cells and large mononucleated intermediate cells. The patient remained disease-free for more than 5 years after treatment. It is concluded that liver salvage surgery may cure patients with chemorefractory ovarian choriocarcinoma with metastases to the liver.

Adult↗
PubMed1997

[Cryosurgery of liver neoplasms].

Cryosurgery is the in situ destruction of tissue using subzero temperatures. Its use for the treatment of some unresectable liver tumors has been clearly established as a therapeutic option. Experimental studies have demonstrated the feasibility of freezing of large liver volumes without any major metabolic and hemorrhagic complications. Modern cryosurgery has received substantial impetus from the development of automated cryosurgical apparatuses using liquid nitrogen. Intraoperative ultrasound has enhanced the process by enabling visualization of tissue freezing and ensuring precise and optimal treatment of the tumor. Clinical reports of cryosurgery for liver primary tumors and metastases have confirmed the safety of the procedure. Major complications include myoglobinuria, coagulopathy and pleural effusions. The benefit of cryosurgery is that it broadens the number of patients that can be brought to surgery and can potentially become disease-free.

Colorectal Neoplasms↗
PubMed1996

Prospective study of microscopic lymph node involvement of the hepatic pedicle during curative hepatectomy for colorectal metastases.

Extensive lymph node dissection of the hepatic pedicle was undertaken in 100 consecutive patients undergoing curative hepatectomy for colorectal liver metastases in whom lymph node involvement of the hepatic pedicle was not macroscopically detectable. Microscopic lymph node involvement was found in 14 patients, in very different lymph node sites, and was related only to the number of metastases, extent of liver involvement and carcinoembryonic antigen level (all P < 0.05).

Adult↗
PubMed1996

[Surgery of soft tissue sarcoma (with the exception of the retroperitoneum)].

The place of surgery in the treatment of soft-tissue sarcoma is defined in the light of a review of the recent litterature. Usual treatment combines conservative surgery and radiotherapy. The essential risk factor of local recurrence is the quality of surgical resection, defined by the definitive resection margins. The addition of radiotherapy after inadequate surgery can improve local control, but cannot ensure that obtained after adequate surgery. Some limited tumours can be treated by surgery alone, but radiotherapy remains essential in more advanced tumours. Under these conditions, local recurrence rates after surgery alone, surgery and systematic radiotherapy and surgery with radiotherapy, as required are 27%, 28% and 30% respectively. The development of a local recurrence appears to affect survival in tumour with a good initial prognosis, early recurrence determining unfavourable outcome. Serious postoperative morbidity is observed in 14% of the cases and is responsible for delayed treatment and functional disorders. The use of muscle flaps to fill the surgical defects can reduce these complications. Evaluation of the functional results must be based on predefined objective criteria.

Amputation, Surgical↗