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Biomedical subjects

S Houry

Publications and source records attributed to S Houry.

At least 37 records · Page 2Linked to original sources
PubMed1998

Treatment of local recurrence of rectal cancer.

BACKGROUND: Treatment of local recurrence of rectal cancer remains a challenge. Preoperative irradiation and total mesorectal excision halve the risks of local failure, but increase morbidity and even mortality. The results of re-resection of recurrent rectal cancer suggest need to reexamine therapeutic strategies for initial treatment. METHODS: Seventy-one patients operated on for rectal carcinoma without radiotherapy developed local recurrence (29 with metastatic disease). Thirty underwent a curative re-resection (8 had combined resection of metastases). RESULTS: The incidence of asymptomatic recurrence was higher after anterior resection (38%) than after abdominoperineal resection (16%). The actuarial 5-year survival rate was 19%; 28% in asymptomatic patients and 8% in symptomatic (P = 0.04). CONCLUSIONS: Early detection of recurrence of rectal cancer leads to an improved re-resection rate and survival. In patients who did not undergo radiotherapy at the time of the original resection, re-resection can be achieved safely. The place for radiation in the treatment of rectal cancer must be redefined.

Aged↗
PubMed1997

Sphincter-saving resection, or not, for cancer of the midrectum.

BACKGROUND: The purpose of this study was to compare the time to pelvic recurrence and survival after sphincter-saving resection (SSR) or abdominoperineal resection (APR). METHODS: Out of the 119 patients with a cancer of the midrectum, 43 had undergone a SSR and 76 an APR for cure. To eliminate bias of a nonrandomized retrospective comparison, an adjustment for baseline prognostic covariates was used. RESULTS: Pelvic recurrence rates and survival distribution according to the type of resection did not differ significantly, with P values of 0.31 and 0.95, respectively, by the log-rank test. The Cox regression model incorporated nine binary covariates and the treatment group. Given these nine covariates, treatment did not influence either pelvic recurrence (adjusted P value = 0.62, relative risk = 0.78) or overall survival (adjusted P value = 0.89, relative risk = 1.05). CONCLUSION: These results suggest that, in patients with cancer of the midrectum treated by SSR or APR, recurrence and survival rates are similar.

Adenocarcinoma↗
PubMed1997

[Surgically treated esophageal cancers: predictive model of survival].

OBJECTIVES: The aim of this study was to identify prognostic factors in patients with esophageal cancer after curative resection, and to establish a predictive model of their long-term prognosis. PATIENTS--METHODS: Eighty-nine patients operated on for neoplasia of the esophagus, who underwent a curative resection, an who did not die within one month or during the hospital stay, were included in this study. Twenty-one variables were studied by univariate analysis. The variables linked with survival were include in a Cox model. Regression coefficient of independent prognostic factors allowed to compute a score. RESULTS: Life table analysis of the entire population, showed 2 and 5 year survival rates of 48% and 28%, respectively. In univariate analysis, 5 out of 21 factors were statistically linked with survival. In multivariate analysis (Cox model), 4 independent factors were linked with survival: age (P = 0.02), the American Society of Anesthesiologist classification (P = 0.01), parietal invasion (P = 0.03), and lymph node invasion (P = 0.009). The score established with these 4 factors allowed to distinguish 3 sub-groups, discriminated by their long term prognosis. Life table analysis of the 3 sub-groups were at 2 and 5 years 83%, 55%, 20% and 60%, 32%, 0%, respectively. CONCLUSION: This model may be useful for the assessment of prognosis in patients with esophageal cancer after curative surgical treatment.

Adenocarcinoma↗
PubMed1997

[Laparoscopic cholecystectomy. Vascular and biliary complications].

The aim of this study was to analyse the vascular and biliary complications on the first 361 laparoscopic cholecystectomies performed in a university digestive surgery unit. The rate of laparoscopic cholecystectomies increased from 17% in 1991 to 65% in 1995. The conversion rate was 18%. Laparoscopy was almost always converted for cholecystitis. Nine operative complications were observed, 6 hemorrhages, and 3 biliary complications with section of the common bile duct in one case. All these lesions were treated by laparotomy with good results. Six postoperative biliary complications were observed. Symptoms were pain (n = 6), fever (n = 2), jaundice (n = 1), and a choleperitoneum at ultrasound examination (n = 4). In one case a choleperitoneum was drained with an uneventful course. The other patients were reoperated (3 bile leakage of the cystic duct or the gallbladder plate, and 2 partial injuries of the common bile duct) with good results. Complication rates were higher in cholecystitis (P = 0,02) but were similar according to the experience of the surgeon. These results, similar to those of a British independent audit suggest than conversion and complication rates are higher than those reported in most of the multicentre studies. However, in all but one of the patients, the lesions were benign. The only common bile duct section was recognized at laparoscopy and repaired by open operation with a good result.

Adolescent↗
PubMed1996

Tandem high-dose chemotherapy with ifosfamide, carboplatin, and teniposide with autologous bone marrow transplantation for the treatment of poor prognosis common epithelial ovarian carcinoma.

BACKGROUND: A phase I or II trial was conducted to assess the toxicity and the efficacy of a tandem high dose chemotherapy combining ifosfamide, carboplatin, and teniposide in patients with poor prognosis ovarian carcinoma. METHODS: Thirty-seven patients were scheduled to receive tandem high dose therapy combining ifosfamide 7500 to 11250 mg/m2, carboplatin 875 ot 1000 mg/m2 and teniposide 750 to 1000 mg/m2, followed by autologous bone marrow transplantation (ABMT). Eight patients were refractory to the platin-based regimen, 7 were treated in chemosensitive relapse, and 22 in partial or complete response (PR/CR) were treated. Sixty-six cycles were administered. Sixteen patients were evaluated for response. RESULTS: The overall response rate was 56% (CR rate: 12%). Toxic effects consisted of mainly renal toxicity, esophagitis, and enterocolitis. Three patients died of therapy-related complications. Since the time of ABMT, the median overall survival (OS) duration of the whole population was 18 months and the survival rate was 14% at 60 months. For the 22 patients treated after PR or CR, the median OS duration was 24 months and the survival rate was 32% at 60 months. Tandem high dose therapy with ABMT was unable to circumvent resistance to conventional chemotherapy or to prolong the duration of survival for patients treated in chemosensitive relapse. For patients treated after CR or PR, the survival results were similar to that achieved with conventional therapy. CONCLUSIONS: Prospective, randomized studies, including patients only after CR or with minimal residual disease, are urgently required to evaluate the activity of high dose therapy in the treatment of advanced ovarian carcinoma.

Adult↗
PubMed1996

Surgery for left-sided pancreatic cancer.

A total of 590 exocrine pancreatic cancers of the body or tail of the pancreas, operated on between January 1982 and December 1988, were analysed. There were 128 pancreatic resections (group 1), 164 palliative bypasses (group 2) and 293 exploratory laparotomies which included 74 splanchnicectomies (group 3). The mortality rate was lower in group 1 (9 per cent) than in group 2 (19 per cent) (P = 0.012). The mortality rate exceeded 40 per cent in groups 1 and 2 for patients aged more than 70 years with pre-existing organ failure. The morbidity rate was 32 per cent in group 1 and 29 per cent in group 2. Patients with metastases had a median survival of 3.4 months, whatever the operative treatment. In the presence of lymph node involvement there was no significant difference in survival between groups 1 and 2. Patients with no metastases and no lymph node involvement had 1- and 3-year survival rates of 38 and 12 per cent respectively after pancreatic resection. Only patients with a small tumour (< or = 4 cm), no lymph node involvement and no metastases achieved a significantly better survival after resection (P = 0.049). Curative resection should be reserved for a small tumour confined to the pancreas. Fewer than 10 per cent of patients will be suitable for surgery. For the other cases, resection must be considered as a palliative procedure without a significant improvement in survival. It seems justified to limit palliative surgery to candidates for digestive bypass and to use non-surgical palliation for the remainder.

Aged↗
PubMed1996

Phase II trial of 5-fluorouracil, leucovorin and cisplatin for treatment of advanced pancreatic adenocarcinoma.

BACKGROUND: Advanced pancreatic adenocarcinoma is a rapidly fatal disease for which an active chemotherapy regimen is sought. Here we report the outcome of a phase II trial to assess the toxicity and efficacy of a combination of 5-fluorouracil (5-FU), leucovorin and cisplatin (CDDP). METHODS: A regimen combining leucovorin (200 mg/m2/d x 5d), 5-FU (375 mg/m2/d x 5d in a 2-hour infusion) and CDDP (15 mg/m2/d x 5d) was given to 52 patients with histologically-proven, previously untreated, locally advanced (n = 13) and/or metastatic (n = 39) pancreatic adenocarcinoma. RESULTS: Of 48 patients evaluable for response, 10 achieved partial responses, for an overall response rate of 21% (95% CI 9.5%-32.5%), and a palliative effect was observed in 52%. The median survival was 9.5 months (18 months for locally-advanced and 5 months for metastatic disease) with a 1-year survival of 34.6% and a median progression-free survival of 4.5 months. Chemotherapy was well tolerated with grades 3 or 4 nausea/vomiting in 12%, diarrhea in 6%, anaemia in 17%, neutropenia in 12%, and thrombocytopenia in 10%. Eleven patients (21%) had Grade 2 peripheral neuropathy. CONCLUSION: The combination of leucovorin, 5-FU and CDDP seems to be an effective palliative treatment, with moderate toxic effects, in advanced pancreatic adenocarcinoma.

Adenocarcinoma↗
PubMed1996

[Cystic tumors of the pancreas. Cystadenomas and cystadenocarcinomas. Diagnosis and management].

Thirteen cases of cystic tumours of the pancreas were studied: serous cystadenomas (CS) = 4, mucinous cystadenomas (MC) = 4 and cystadenocarcinomas (CC) = 5. There were 9 females and 4 males, mean age 60 years (range 44 to 89 years). Two patients had no clinical manifestations, six (2 MC and 4 CC) had a weight loss (3-10 kg). One patient with CC had jaundice. Tumours of the pancreas were diagnosed with sonographic or CT-scan examinations. Eight were localized in the head of the pancreas, two in the body and three in the tail. The cystic tumour remained unknown after preoperative explorations in three cases. The exact nature of the tumour was identified preoperatively in four cases (SC, MC and two CC). Final diagnosis was obtained after histological examination of the surgical specimen in nine cases, by surgical puncture in one case and due to the presence of liver metastases in one case and ultrasound guided needle biopsy in one other. One patient refused all surgery. Ten patients were operated: four had duodenopancreatectomy (SC and three CC), three had tumour exeresis (SC and two MC), two had caudal splenopancreatectomy (MC and CC) and one had surgical puncture (SC). Clinical surveillance is justified in cases with asymptomatic. SC if certain diagnosis has been obtained. Other cystic tumours of the pancreas should be removed, either because there is doubt as to the exact nature of the tumour; because of symptoms induced by SC or because a MC or CC has been identified. In this latter case, the prognosis appears to be better than for non-metastasis exocrine cancer of the pancreas.

Adult↗
PubMed1996

[Operative mortality in diverticular sigmoiditis].

From 1984 to 1993, 200 patients (mean age 68 years) were hospitalized for complicated diverticulosis of the colon. Hospitalization was motivated in 81 patients for a programmed procedure (40%), by an acute complication requiring emergency surgery in 56 (29%) and by acute complication treated medically in 63 (31%). Among the 81 electively operated patients, one died post-operatively. For the 56 patients operated in an emergency situation, there were 8 post-operative deaths (14%). Six of the 8 deaths occurred in patients over 80 years. The natural history of colonic diverticulosis suggests that it would be logical to operate those patients with two episodes of sigmoiditis of those who have clinical manifestations (47 cases in our series). The other indication for planned surgery are colonic stenosis (17 cases), sequellae of abscesses (16 cases) and fistulae (11 cases). In patients with peritonitis and pelvi-peritonitis (35 cases) for whom exeresis is not a technical risk, it appears to be preferable to colostomy with drainage. Abscesses should be drained under ultrasonic or scan control. Finally, patients with massive haemorrhage should have an emergency angiography to guide the colectomy.

Adult↗
PubMed1996

[Intraoperative radiotherapy in cancers of the pancreas and in recurrent colorectal cancers].

The aim of this study was to evaluate intraoperative radiotherapy in exocrine pancreatic cancer (n = 10) and in recurrent colorectal carcinoma (n = 11). Radiotherapy was delivered with electron beams (energy from 9 MeV to 20 MeV). Doses ranged from 15 Gy to 25 Gy. All patients with pancreatic cancer also received 40 Gy external beam irradiation and 5-Fluorouracil (500 mg/m2) and eight patients with recurrent colorectal carcinoma received postoperative external beam irradiation (20 Gy to 60 Gy). There were no postoperative deaths or complication. In pancreatic cancers, pain relief (7 cases) until death was observed in all cases. After palliative procedures (9 cases), the median survival time was 6 months (ranging from 4 months to 14 months). One patient is alive with a follow-up of 5 years and 6 months following total pancreatectomy. 5 patients with recurrent colorectal carcinoma, died with a median survival time of 13 months (ranging from 2 months to 25 months), and six patients are alive. Two of them have recurrence, and four are free of recurrence with a mean follow-up of 21 months (ranging from 3 months to 54 months). In conclusion, our results for pancreatic cancer agree with the disappointing results reported by other institutions. On the other hand, recurrence of colorectal carcinoma seems to be a good indication for intra-operative radiotherapy even when resection is incomplete.

Actuarial Analysis↗
PubMed1995

A prospective multicenter evaluation of preoperative hemostatic screening tests. The French Associations for Surgical Research.

BACKGROUND: Several retrospective and four prospective reports have questioned the need for routine preoperative hemostatic screening tests (PHST) in general surgery. PATIENTS AND METHODS: The results of four standard tests (prothrombin time, activated partial thromboplastin time, platelet count, and bleeding time) were prospectively compared with patient history and clinical data in a multicenter study of 3,242 consecutive patients. The patients were divided into four groups: group A (n = 1,951) had no clinical or PHST abnormalities; group B (n = 340) had no clinical and one or more PHST abnormalities; group C (n = 779) had one or more clinical and no PHST abnormalities; group D (n = 172) had both clinical and PHST abnormalities. RESULTS: Preoperative modifications of guidelines (postponed operations and ordering of additional hemostatic tests) were significantly more frequent in both groups of patients with PHST abnormalities (groups B and D), but specific treatment to correct hemostatic disorders was prescribed only when clinical abnormalities were also present (group D). Intraoperatively, modifications of anesthetic and surgical vigilance (planning of increased number of blood units, vascular catheter placement, and number of patients requiring transfusion) were significantly more frequent in group D. Postoperatively, all groups had similar incidences of hematoma or bruises, volumes of blood loss per drainage, reoperations to control hemorrhage, and mortality due to bleeding (n = 5). CONCLUSIONS: Our results suggest that PHST should not be performed routinely, but only in patients with abnormal clinical data. Such a policy necessitates a thorough history--including answers to a specific questionnaire like those used in prospective studies--and a rigorous, well-conducted physical examination.

Adolescent↗
PubMed1995

[Sclerosing peritonitis. A series of 10 cases and review of the literature].

OBJECTIVE AND METHODS: The aim of this study was to describe the main features of sclerosing peritonitis, using a retrospective study in 10 patients. RESULTS: The main causes of sclerosing peritonitis were continual ambulatory peritoneal dialysis (n = 3), peritoneal chemotherapy (n = 2) and liver cirrhosis (n = 2). Sclerosing peritonitis was revealed by acute or chronic bowel obstruction (n = 8). Small bowel X-rays and abdominal tomodensitometry showed a small bowel dilatation with a normal mucosa (n = 7), ascites (n = 5) as well as agglutination and fixation of small bowel loops within a cocoon (n = 3). Surgical viscerolysis was performed in 9 patients and allowed prolonged clinical remission in 4; 3 patients died postoperatively (1 had a cirrhosis and 2 were treated with continuous ambulatory peritoneal dialysis), 1 patient had a complicated postoperative course with recurrent enterocutaneous fistulae. CONCLUSION: Sclerosing peritonitis may be suspected in a patient who presents a combination of bowel obstruction, small bowel dilatation without mucosal disease and ascites. Surgical viscerolysis is a dangerous operation associated with high mortality in patients with renal failure or cirrhosis.

Adult↗
PubMed1994

Results of resection for cancer of the exocrine pancreas: a study from the French Association of Surgery.

A multicentre retrospective study was carried out to analyse short- and long-term results of 787 pancreatic resections performed for cancer between 1982 and 1988. The postoperative mortality rate was 10 per cent and the morbidity rate 35 per cent. Age above 70 years and systemic organ failure independently influenced operative mortality. In patients surviving more than 30 days the median survival was 12.3 months and the actuarial survival rate at 5 years 12 per cent. The 5-year survival rate was lower for patients with lymph node involvement than for those without (4 versus 20 per cent, P = 0.001). The operative mortality rate was higher after total pancreatectomy than pancreatoduodenectomy (17 versus 8 per cent, P = 0.015). The median survival time and 5-year survival rate after total pancreatectomy and pancreatoduodenectomy were 11 versus 14 months and 3 versus 15 per cent respectively. Of the clinical and pathological factors studied, location of the tumour in the left pancreas was most strongly related to survival, with no survivors at 4 years. These results suggest that resection should be avoided in patients over 70 years old with systemic organ failure. Pancreatoduodenectomy remains the best procedure for resection, total pancreatectomy being performed only in patients with multifocal carcinoma or those in whom a safe pancreatic anastomosis cannot be constructed.

Aged↗
PubMed1994

Should patients over 80 years old be operated on for colorectal or gastric cancer?

One hundred and three patients aged 80 years or more were operated on for colorectal cancer (n = 80) or gastric cancer (n = 23). The postoperative mortality rate was 8%. Hospital mortality (12%) was not influenced by the factors age or emergency procedure, but by the factors ASA score (P = 0.06), palliative procedure (p = 0.08), and gastric surgery (P = 0.05). The overall 5-year survival rate was 23% after colorectal surgery, and 10% after gastric surgery (P = 0.001). After colorectal surgery, long-term survivals were observed, even in presence of serosal and/or lymph nodes involvement. Thirteen patients were alive more than five years after surgery. In contrast, after gastric surgery, all patients, except those with early carcinoma, died within one year. Indications for operation must be wide in colorectal cancers, and more restrictive in gastric cancers. Long-term survivals were observed after colorectal surgery in the elderly, even in the presence of lymph node involvement. In contrast, after gastric surgery, all patients, except those with early carcinoma, died within one year.

Age Factors↗
PubMed1993

Hepatic flow scintigraphy in evaluation of hepatic metastases in patients with gastrointestinal malignancy.

OBJECTIVE: To assess the value of hepatic flow scintigraphy for occult metastases. DESIGN: Prospective study, 2 years of follow-up. SETTING AND STUDY PARTICIPANTS: One hundred twenty-nine patients undergoing surgery for gastrointestinal cancer. INTERVENTION: Preoperative hepatic flow scintigraphy (3mCi of technetium-99m). MAIN OUTCOME MEASURE: Development of hepatic metastases. RESULTS: Hepatic flow scintigraphy had a sensitivity of 92% and a specificity of 34%. The positive and negative predictive values were 15% and 97%, respectively. CONCLUSIONS: Hepatic flow scintigraphy could therefore be useful in identifying patients who are at low risk of developing metachronous liver metastases and thus avoid unnecessary adjuvant chemotherapy following resection of the primary tumor.

Female↗
PubMed1993

Surgical palliation for unresected cancer of the exocrine pancreas.

Opinions are still divided regarding the optimal palliative procedures in patients with cancer of the pancreas. This retrospective, multicentric study, involving 2493 patients operated on between January 1982 and December 1988 compares the results of various procedures aimed at palliation for pancreatic cancer. Cholecystoenteric bypasses (n = 237) in comparison to choledochoenteric bypasses (n = 1770) were associated with a higher post-operative mortality (20% vs 14%), a lower long-term morbidity (26% vs 35%), and a lower survival rate (means: 3.2 vs 5.2 months). Choledochoduodenostomy (n = 1159) and choledochojejunostomy (n = 611) had similar rates of post-operative mortality (14% vs 13%), morbidity (26% vs 27%), incidence of recurrent jaundice (8% vs 7%), and median survival (5.4 vs 5.0 months). Surgically placed biliary stents (n = 114) were followed by the highest post-operative mortality (27%), morbidity (46%), rate of recurrent jaundice (14%), and the shortest median survival (2.6 months). Post-operative mortality in patients undergoing a choledochoenteric bypass and a gastrojejunostomy (n = 1134) was similar to that observed in patients who had only a biliary bypass (n = 636) (16% and 12%), but among the patients who had a biliary bypass alone, 16% developed a gastric obstruction. For the relief of pancreatic pain, radiotherapy was more effective than other symptomatic treatments (P = 0.02). In conclusion, these results and other previous reports suggest the need (1) in patients with obstructive jaundice to perform a choledochoduodenostomy rather than other biliary bypasses, (2) a routine prophylactic gastrojejunostomy to prevent gastric outlet obstruction, (3) and for the relief of pancreatic pain to perform radiotherapy or splanchnicectomy.

Aged↗