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Philippe Lasser

Publications and source records attributed to Philippe Lasser.

34 records · Page 2Linked to original sources
PubMed2004

[Salvage surgery for anal canal carcinomas].

The standard treatment of epidermoid carcinoma of the anal canal consists of radiotherapy or chemoradiotherapy. The recommended salvage treatment for local failures relies on abdominoperineal resection and permits a 5-year overall survival rate around 50%. However, the morbidity associated with this surgery is important with regard to delayed perineal wound healing. New techniques for perineal reconstruction offer interesting solutions to limit this morbidity. Musculocutaneous flaps permit to fill the perineal wound left after the resection and in some cases to reconstruct the posterior vaginal wall. Although less popular, the construction of a pseudocontinent perineal colostomy enables some patients to avoid a permanent iliac colostomy. The surgical excision of metastatic inguinal nodes, followed by radiotherapy, is an alternative to radiotherapy alone. Surgery can also be performed after failure of radiotherapy, at the cost of an increased morbidity.

Anus Neoplasms↗
PubMed2003

Intrathecal + PCA morphine improves analgesia during the first 24 hr after major abdominal surgery compared to PCA alone.

PURPOSE: To compare, over a 48-hr follow-up period, the analgesia and side-effects of patient controlled iv analgesia (PCA) with morphine alone vs combined intrathecal and PCA morphine (IT+PCA) in patients undergoing major abdominal surgery. METHODS: Sixty adult patients undergoing abdominal surgery for cancer were randomly allocated to receive preoperative IT (0.3 or 0.4 mg) plus postoperative PCA morphine or postoperative PCA morphine alone. Postoperative analgesia was tested at rest and while coughing on a visual analogue pain scale and morphine consumption was recorded. Patients' satisfaction, arterial oxygen saturation, respiratory rate, episodes of nausea, vomiting and pruritus were also noted. RESULTS: Analgesia at rest and while coughing was significantly better in the IT+PCA morphine group (rest: P = 0.01; coughing: P = 0.005) on the first postoperative day only. IT+PCA morphine constantly provided adequate analgesia during this period. Morphine consumption was lower in the IT+PCA morphine group during this period also (IT+PCA: 9 (17) vs PCA: 40 (26); mg of morphine, mean (SD), P = 0.0001). No difference was found in pain relief and morphine consumption between the groups on the second postoperative day. Nausea and vomiting were more frequent with IT+PCA morphine on the first postoperative day. No respiratory depression occurred in either group. Satisfaction was high in both groups. CONCLUSIONS: IT+PCA morphine improves patient comfort constantly during the first postoperative day after major abdominal surgery. However, after the first postoperative day, IT+PCA morphine provides no additional benefit.

Abdomen↗
PubMed2003

Liver resection (and associated extrahepatic resections) for metastatic well-differentiated endocrine tumors: a 15-year single center prospective study.

BACKGROUND: The timing and benefits of hepatectomy remain controversial for metastatic well-differentiated endocrine neoplasms, which are generally considered slow growth tumors. However, surveillance alone yields only a 22% 5-year survival when metastases occur. The aim of this study was to determine the results of hepatic and extra hepatic resections and to clarify the indications of surgery. METHODS: To define the role of hepatic resection, a database regrouping all patients (n = 47) who underwent hepatectomy with curative intent (R0 status) for well-differentiated endocrine neoplasms in the Gustave-Roussy Institute was constructed in 1984. New prognostic factors such as tumor growth and liver tumor mitotic index were studied. Median follow-up was 62 months. RESULTS: Hepatectomy was associated with extrahepatic tumor resection in 77% of the patients (primary tumor in 51%, lymph nodes in 21%, peritoneal carcinomatosis in 25%, and other in 6%). Resection was curative (R0) only in 53% of the patients, despite removing at least 97% of the tumor in each patient. Mortality was 5%, and morbidity was 45%. Median survival was 91 months, 5-year and 10-year overall survival rates were 71% and 35%, respectively. Liver recurrence rate was 75% at 10 years. No prognostic factor was correlated with overall survival in this population in which at least 97% of the tumor load was resected. The completeness of surgery, the presence of bilateral liver metastases, the number of liver metastases (>10) and a primary tumor from pancreatic origin were all significantly correlated with the disease-free survival. Preoperative tumor growth rate, mitotic index, and Ki67 expression were not predictive of prognosis. No significant prognostic factors could be found by the comparison of the patients who did and did not recur during the 3 years after hepatectomy. CONCLUSION: Hepatectomy for liver metastases from well-differentiated endocrine neoplasms is indicated when all visible intra- and extra hepatic lesions can be resected safely. The number, size, and localization of the tumor sites are less important than performing a complete (or near-complete) resection.

Adult↗
PubMed2003

MR imaging of hepatic metastases caused by neuroendocrine tumors: comparing four techniques.

OBJECTIVE: The aim of our prospective study was to assess the MR imaging characteristics of hepatic metastases of neuroendocrine tumors and to determine the optimal MR sequence for their detection. SUBJECTS AND METHODS: Thirty-seven consecutive patients with liver metastases from neuroendocrine tumors underwent 1.5-T MR imaging of the liver comprising T2-weighted fast spin-echo with respiratory monitoring, breath-hold T2-weighted single-shot fast spin-echo, and T1-weighted gradient-recalled echo sequences before and after the injection of gadoterate dimeglumine. Images were reviewed independently by three observers for the number, location, and pattern of signal and enhancement of metastases. RESULTS: A total of 359 metastases were detected, 279 on T2-weighed fast spin-echo, 231 on T2-weighed single-shot fast spin-echo, 272 on unenhanced T1-weighted, 322 on hepatic arterial phase, and 228 on portal venous phase images. Hepatic arterial phase images revealed the greatest number of metastases in 70% of patients, including 35 metastases seen only on this sequence, and was significantly superior to the unenhanced T1-weighted and portal venous phase sequences (p < 0.01). The lesion-to-liver contrast was significantly greatest with T2-weighed fast spin-echo sequences. The enhancement patterns of metastases were predominantly hypervascular, hypovascular, peripheral with progressive fill-in, and delayed in, respectively, 27, four, four, and two patients. Most metastases with peripheral enhancement and progressive fill-in were heterogeneous on T2-weighted images and were without globular peripheral enhancement. CONCLUSION: Hepatic metastases of neuroendocrine tumors had a typical hypervascular pattern in 73% of patients. Hepatic arterial phase and fast spin-echo T2-weighed sequences are the most sensitive.

Adult↗
PubMed2003

[Pseudomyxoma peritonei treated with complete resection and immediate intraperitoneal chemotherapy].

AIM: Pseudomyxoma peritonei remains a fatal disease. This clinical pathological entity based on the presence of mucin includes different prognostic groups. Complete resection of macroscopic lesions, combined with immediate intraperitoneal chemotherapy to treat remnant infra-millimetric disease, might improve survival. The aim of this prospective study was to evaluate this treatment strategy. METHODS: Thirty-six patients with pseudomyxoma peritonei underwent resection of supra-millimetric lesions then were given either early postoperative intraperitoneal chemotherapy (5 days) (before January 1996) or intraoperative chemohyperthermia treatment (after January 1996). During this same period, only partial resection of the macroscopic lesion was possible in 15 patients; these patients were not given peritoneal chemotherapy. RESULTS: Postoperative mortality was 13.8% (n=5), including 2 deaths not specifically due to the procedure. Morbidity, including severe and non-severe complications was 44%. After a mean follow-up of 48 months, the overall 5-years survival rate was 66%, and disease-free survival rate was 55% (including the postoperative deaths). The main prognostic factor in this series was the pathological grading: 5-years survival was 74% for grade 1 tumors versus 54% for grades 2-3 (P=0.05). CONCLUSION: The main prognostic factor of the pseudomyxoma peritonei, after the completeness of the resection, is the pathological grading. The addition of an intraperitoneal chemohyperthermia improves long-term survival of grades 2-3 tumors and perhaps that of grade 1 (agreement of experts). This treatment is more easily performed, more well-tolerated, and more efficient when performed early.

Adult↗
PubMed2002

Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors.

Our objective was to report the outcome in patients with liver metastasis from endocrine tumors who underwent transarterial chemoembolization (TACE) as first-line non-surgical treatment. From January 1990 to December 2000, 14 patients with progressive unresectable liver metastases from digestive neuroendocrine tumor were treated with TACE (mean of 3.6 sessions) before any non-surgical treatment (somatostatin analogue, chemotherapy or interferon). Liver involvement was less than 50% in 11 patients. Size of the largest lesion ranged from 1.5 to 10 cm. Ten patients presented with carcinoid symptoms. The TACE was performed with Doxorubicin emulsified in Lipiodol and gelatin sponge particles. Symptomatic response upon flushes and/or diarrhea was complete in 7 of 10 cases and partial in 2 of 10 cases. An objective morphologic response was noted in 12 of 14 cases. The 5- and 10-year survival rate from diagnosis was 83 and 56%, respectively. Six patients were alive at the end of the study after 27-100 months from first TACE and 38-142 months from diagnosis. Three of them were successfully palliated for 55, 69, and 100 months with only TACE as treatment. Long-term palliation is possible in unresectable liver metastases from digestive neuroendocrine tumors with a few sessions of TACE as first-line and eventually exclusive treatment.

Adult↗
PubMed2002

[Stomach tumors].

Explore the source record for details and available documents.

Adenocarcinoma↗
PubMed2002

[Locoregional therapy of neuroendocrine tumors].

In digestive neuroendocrine tumours, surgery is the cornerstone of the treatment of the primary tumour. The diameter of the lesion is the main prognostic indicator and consequently impacts the extent of the resection. Types of resection, regarding to tumours sizes and locations, are reported. In metastatic forms, an aggressive policy of multidisciplinary treatments is proposed. Arterial chemoembolization is very efficient in controlling clinical symptoms and liver tumours progression, and allows secondary radical resections in selected cases. Chemoembolization is actually considered as the first line treatment in well-differentiated forms, with rapid progression.

Antineoplastic Agents↗
PubMed2002

Preoperative selective portal vein embolization before hepatectomy for liver metastases: long-term results and impact on survival.

BACKGROUND: Some patients cannot undergo curative surgical procedures for liver metastases because of the risk of severe postoperative hepatic failure, which stems from a too-small future remaining liver (FRL). Preoperative portal vein embolization (PVE) is an effective means of creating hypertrophy of the FRL, thus permitting safe hepatic resection. The aim of this retrospective study was to investigate the long-term results of this technique. METHODS: Sixty-eight patients underwent PVE. Of those, 60 (88%) subsequently underwent hepatic resection. Indication for PVE was an estimated FRL ratio (assessed by volumetric computed tomography) of less than 30%. However, if the patient had undergone multiple courses of chemotherapy, the threshold was 40%. The origin of the primary neoplasm was colorectal in 41 patients (68%); in the remaining 19 (32%), the primary neoplasms originated at other sites. RESULTS: Mean growth of the estimated FRL measured by computed tomography 1 month after PVE was 13%. Major complications after hepatectomy occurred in 27% of the patients, and the operative mortality rate was 3%. For the 60 patients who underwent PVE followed by hepatic resection, the 5-year overall survival rate and the disease-free survival rate were 34% and 24%, respectively. The 5-year overall survival rate and the disease-free survival rate of patients with colorectal metastases only were 37% and 21%, respectively. CONCLUSIONS: The long-term survival rate after PVE followed by resection is comparable with the survival rate obtained after resection without preoperative PVE. The 5-year survival rate of patients undergoing PVE followed by hepatectomy justifies the use of this technique. This technique thus increases the suitability of resection as a treatment choice for patients with liver metastases. PVE should number among the therapeutic options available to every hepatic surgeon.

Adolescent↗
PubMed2002

[The sentinel lymph node in carcinomas of the digestive tract].

Localization of the sentinel lymph node (SLN) in digestive cancers was performed mainly for colorectal primaries and less frequently for oeso-gastric primaries. This technique is feasible in vivo or ex vivo, with a vital dye and/or with a radiolabeled marker. Technically, detection reliability is good, provided a few simple rules are respected. Such intra-operative mapping leads to the localization of unusual lymphatic spread in 5% of the cases and initial resection can be adapted accordingly. "Sophisticated" histological analysis of one SLN, considered negative after a standard pathological examination, leads to three types of additional analyses: scrutiny of multiple serial slices whose prognostic significance is unequivocal when positive, and immunohistochemistry or gene amplification (RT-PCR) to search for circulating cancer cells whose prognostic value is currently uncertain. In the future, the localization and analysis of one SLN could supplant the classic examination of all lymph nodes. If the SLN is proven disease free, only very limited and microinvasive resections would be required to treat some digestive cancers with a curative intent.

Digestive System Neoplasms↗
PubMed2002

[Surgery for rectal cancer: function rather than organ preservation surgery].

Rectal surgery continues to progress during the last ten years. This technical and treatment evolution give the possibility to increase survival, with local recurrence decrease, all associated with more digestive, urinary and sexual function preservation. These progressive and continues modifications make that today the surgeon was a major prognosis factor of success. Whatever the technical solution used, the function preservation that we reported here, was more and more associated with better oncological result, for the patient benefit. These improvements required mixed teams, medical and surgical, implicated in this specific cancer giving the possibility to use all the technical solutions described here.

Anal Canal↗
PubMedDate not supplied

Computed tomographic features of peritoneal carcinomatosis treated by intraperitoneal chemohyperthermia.

PURPOSE: The purpose of this work was to describe the computed tomography (CT) features of peritoneal carcinomatosis after surgery combined with intraperitoneal chemohyperthermia (IPCH). METHOD: Between 1999 and 2001, 51 consecutive patients (33 women and 18 men, with a mean age 45 years) were treated in our institution with IPCH for peritoneal carcinomatosis. Patients that were symptomatic (33 patients) underwent contrast enhanced helical CT of the abdomen and the pelvis during the first 15 postoperative days. The CT scans were reviewed retrospectively by two blinded observers. Computed tomography abnormalities were compared with surgical, biochemical, and clinical findings. RESULTS: None of the CT scans were completely normal. Most postsurgical CT findings, including bowel and peritoneal thickening (14 and 13 cases, respectively), increased intraperitoneal fat density (13 cases), and compartmentalized ascites (8 cases), resulted from an inflammatory mesenteric reaction or inflammation of the small bowel or the peritoneum and did not require specific treatment. Major complications requiring appropriate treatment were intra-abdominal abscesses (5 cases), hemoperitoneum (5 cases), urinary fistula (2 cases), acute pancreatitis (1 case) and abdominal wall abscesses (2 cases). CONCLUSION: Knowledge of early CT findings after therapy with surgery combined with IPCH for peritoneal carcinomatosis is useful for accurate posttreatment management of these patients.

Adenocarcinoma↗
PubMedDate not supplied

Surgical treatment of severe late radiation injury to the bowel: a retrospective analysis of 83 cases.

BACKGROUND/AIMS: The aim of this study was to determine the best surgical approach for the treatment of late radiation injury to the bowel. METHODOLOGY: Clinical and follow-up charts of 83 patients operated in our institution for late radiation injury to the bowel were retrospectively reviewed. The type of operation (resection-anastomosis or bypass) mortality, postoperative complications and reoperation rate were recorded. Seventy-six underwent resection with immediate anastomosis. A bypass or viscerolysis was performed in only 7 patients. RESULTS: Postoperative mortality was 2.4%, morbidity was 23. Twenty-seven patients underwent further surgery; early reoperation (within 1 month) was necessary in 12 (morbidity 41%). A late reoperation has been performed in 15 patients (no mortality, morbidity 53.5%). CONCLUSIONS: From the results of our study it can be concluded that resection with immediate anastomosis for late radiation injury to the bowel is safe and should be the first option for these patients.

Adult↗