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P Bachellier

Publications and source records attributed to P Bachellier.

29 records · Page 2Linked to original sources
PubMed1996

Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Française de Chirurgie.

BACKGROUND: Five-year survival rates after resection of liver metastases from colorectal carcinoma are close to 25%. Recurrences occur in two-thirds of the patients after surgery. Selection of patients likely to benefit from surgery remains controversial and subjective. METHODS: Data from 1568 patients with resected liver metastases from colorectal carcinoma were collected. The prognostic value of different factors was studied through uni- and multivariate analyses. A scoring system was developed including the most relevant factors. RESULTS: Two- and 5-year survival rates were 64% and 28%, respectively, and were affected by: age; size of largest metastasis or CEA level; stage of the primary tumor; disease free interval; number of liver nodules; and resection margin. Giving one point to each factor, the population was divided into three risk groups three risk groups with different 2-year survival rates: 0-2 (79%), 3-4 (60%), 5-7 (43%). CONCLUSIONS: A simple prognostic scoring system was proposed to evaluate the chances for cure of patients after resection of liver metastases from colorectal carcinoma. The comparison between expected survival and estimated operative risk can help determine on an objective basis whether surgery is worthwhile. This system needs further prospective validation.

Aged↗
PubMed1996

[Surgical treatment of synchronous hepatic metastases of colorectal cancers. Simultaneous or delayed resection?].

The surgical strategy for resectable synchronous hepatic metastases of colorectal cancer remains controversial. The retrospective analysis of our series of resectable synchronous hepatic metastases focused on the percentage of simultaneous resections, the circumstances, the indications and the results of the one-step procedure compared to the two-step strategy. From January 1, 1982 to December 31, 1995, 129 patients were operated on for resection of hepatic metastases of colorectal cancer. Forty one patients (32%) presented with synchronous hepatic metastases, 20 of whom (49%) underwent simultaneous resection of the primary tumor and the hepatic metastases (simultaneous resection group: SR). For the other 21 patients (51%), the hepatic resection was delayed for a mean interval of 5.2 +/- 4.2 months (delayed resection group: DR). The mean age of the 2 groups was not significantly different (54 years versus 58 years). When the primary tumor was located on the ascending colon, the hepatic excision was performed simultaneously in 9 out of ten cases. The need for blood transfusion and the volume required were not significantly different between the two groups. The length of each surgical operation was comparable between the two groups (331 +/- 76 minutes SR vs 330 +/- 88 minutes DR). Postoperative complications were observed in 20% of patients in the SR group and 10% of patients in the DR group (no significative difference). There was no postoperative mortality in either group. Survival was 83%, 44% and 37% at 1, 2 and 3 years respectively in the SR group and 79%, 59% and 49% in the DR group, with no significant difference between the groups. These results show that simultaneous resection of the primary tumor and the hepatic metastases did not increase either morbidity or mortality in our study, and that it should be proposed especially to patients presenting with a primary tumor of the ascending colon with metastases resectable by means of a minor hepatectomy.

Actuarial Analysis↗
PubMed1994

Survival benefit of repeat liver resections for recurrent colorectal metastases: 143 cases. Association Francaise de Chirurgie.

PURPOSE: Resection is the only chance for cure in patients with colorectal liver metastases (LM). Five-year survival rates are close to 25%. Unfortunately, recurrences occur in most patients. Some recurrent LM are technically resectable. The aim of this study was to determine the risks and benefits of repeat resections for recurrent LM. PATIENTS AND METHODS: Data from 130 patients who received 143 repeat liver resections for recurrent LM were collected. In 116 patients, only the liver was involved, while 14 had both liver and extrahepatic recurrences. RESULTS: In the first group, the operative mortality and morbidity rates were 0.9% and 24.7%, respectively. Two- and 3-year survival rates were 57% and 33%, respectively. Recurrences were observed in 66% of patients. Twelve patients underwent a third hepatectomy for recurrence. The mortality rate was nil, and the mean survival time was 12.5 months. In the group with liver and extrahepatic metastases, the operative mortality and morbidity rates were 0% and 25%. The mean survival time was 16 months. Eleven patients died and 13 had recurrences during the follow-up period. CONCLUSION: Some hepatic recurrences after surgical excision of colorectal metastases can be resected with a low operative risk and with a long-term survival rate similar to that obtained after first resections. This emphasizes the need for a careful follow-up after hepatectomy for colorectal metastases to detect resectable recurrences.

Adult↗
PubMed1989

[Is the ultrasonic dissector an advance? Apropos of 70 hepatectomies].

The aim of this retrospective study was to determinate whether the ultrasonic dissector (U.S.D.) is a major advance over existing methods in hepatic surgery. Between 1983 and 1989, we performed 70 hepatectomies "réglées". Twenty seven patients were operated because of benign lesions and 43 patients because of malignant tumours. Transparenchymal approach using "Kellyclasy" or digitoclasy with control of the hilar vessels was carried out 39 times. U.S.D. was used 31 times. No mortality was observed during operating time or post-operative period. The postoperative morbidity was not attributable to the use of the U.S.D. On the whole, U.S.D. has modified neither the amounts of blood loss nor the duration of hilar clamping. However the use of U.S.D. presents 3 advantages: it allows sometimes to perform hepatectomy without pedicular clamping, it makes easy the transparenchymal approach of the large vascular and biliary structures, and it is useful in hydatic cyst surgery. Although the U.S.D. is not indispensable to carry out hepatectomy, it improves intraparenchymal control of vessels and biliary ducts, making therefore hepatic resection easier.

Constriction↗
PubMedDate not supplied

[Comparative study of results of hepatic transplantation between 2 groups of patients: alcoholic cirrhosis versus non-alcoholic cirrhosis].

Among the patients treated for alcoholic cirrhosis, only a small group could be candidates for liver transplantation (LT). The aim of this multicentric study was to analyse the results of LT in a group of 75 patients with alcoholic cirrhosis (AC) compared with a group of 61 patients with non-alcoholic cirrhosis (NAC). Results were similar in both groups concerning survival rate and quality of life. However the ability to go back to a normal professional life was less in the AC group. The reported recurrence of alcoholic intoxication, which was around 26%, was much lower for patients who interrupted alcohol consumption during at least 3 months before L.T.

Adolescent↗