[Recurrences of pelvic cancers. Pelvic reconstruction: when, how, why?].
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Anastomosis, Surgical↗
Biomedical subjects
V Moutardier
Publications and source records attributed to V Moutardier.
Surgical resection of locally recurrent colorectal adenocarcinoma.
BACKGROUND: Recurrence rates after curative resection of colorectal adenocarcinoma remain steady at 50 per cent. Thirty per cent of the deaths are linked to locoregional recurrence. The aim of this study was to evaluate the results of resection for locoregional recurrence. METHODS: This retrospective review analyzed a series of 120 patients who underwent resection of colonic (56) or rectal (64) locoregional recurrence. Sixty-nine resections were considered as curative. Sixty-one recurrences required extended resection. There were nine synchronous hepatic resections. RESULTS: The hospital mortality rate was 7 per cent and the morbidity rate was 40 per cent. The overall 5-year survival rate was 27 per cent. Survival was significantly higher: (1) after curative resection (44 versus 0 per cent after palliative resection, P < 0.0001); (2) in women (44 versus 11 per cent for men, P = 0.0036); and (3) after resection for intramural recurrence (45 versus 19 per cent for extramural recurrence, P = 0.0024). Multifactorial analysis showed that curability of the resection was the most important prognostic parameter. CONCLUSION: The results in this highly selected group seem to justify an attempt at reresection whenever possible. Long-term results may be improved by using adjuvant treatment.
Adenocarcinoma↗
Value of endoscopic ultrasonography for assessment of patients presenting elevated tumor marker levels after surgery for colorectal cancers.
BACKGROUND AND STUDY AIMS: This prospective study was undertaken to evaluate the role of endoscopic ultrasound (EUS) in patients presenting with elevated tumor marker levels (CEA, CA 19-9) after surgery for colorectal cancer. PATIENTS AND METHODS: During a 26-month period, colonic EUS was performed in 21 patients who had undergone surgical treatment for colorectal cancers. All patients presented with elevated tumor marker levels at the time of examination but all other diagnostic procedures (US, CT scan of the abdomen and thorax, bone scintigraphy and colonoscopy) did not demonstrate recurrence. Colonic EUS was performed using a linear convex probe (echoendoscopes Pentax: FG 32 UA, 36 U, 38 UX). In cases with normal findings on colonic EUS, upper gastrointestinal tract EUS was also performed. RESULTS: 21 colonic EUS and six upper gastrointestinal tract EUS examinations were performed. Of 21 colonic EUS examinations, 15 showed either local recurrence (n = 9) or peritoneal carcinomatosis (n = 6) and six EUS-guided biopsies were performed. Of these 15 patients, 13 were operated on and results were confirmed in 12 of 13 patients, namely in 8/9 cases with suspected anastomotic recurrence and in all four operated cases with presumed peritoneal carcinomatosis. EUS-guided biopsy had diagnosed three of the four cases before. Upper GI EUS was performed in the six cases with normal colonic EUS; two cases showed mediastinal lymph nodes and one showed celiac lymph nodes. EUS-guided biopsy confirmed the malignancy of these nodes. For the diagnosis of recurrence, sensitivity, specificity and accuracy of lower plus upper gastrointestinal EUS were 94.4%, 66.6% and 90.4% respectively. CONCLUSION: EUS of the colon and--in selected cases--also of the upper gastrointestinal tract is quite useful in this clinical setting. Further studies are needed to evaluate the impact of EUS on outcome in larger patient numbers.
Adult↗
[Value of surgery in the treatment of advanced cervical cancers].
Surgical resection of advanced nonmetastatic forms of cervical cancers is controversial, but improve local control. The local and regional staging assessment, comprising an examination under general anaesthesia, endocavitary ultrasonography, computed tomography (CT) and/or magnetic resonance imaging (MRI) allows staging, evaluation of the main prognostic factors and selection of the therapeutic strategy. Pelvic and lumboaortic lymph nodes can be investigated by CT, MRI or laparoscopic lymphadenectomy. Surgical resections consist of colpohysterectomy possibly combined with radical lymphadenectomy or pelvic exenteration, followed by pelvic reconstruction using various procedures: low colorectal anastomosis, continent urinary diversion, and vaginal reconstruction with pelvic filling. The mortality and morbidity of pelvic exenteration remain high. It is therefore important to prevent the most frequent complications as effectively as possible. The local control, overall survival and recurrence-free survival can be improved by combining concomitant radiotherapy-chemotherapy and large surgical resection. Some unfavourable local situations can justify palliative pelvic exenteration in highly selected indications designed to improve local control and comfort of survival.
Combined Modality Therapy↗
[Pelvic recurrence of cancers of the uterine cervix. A study of a series of 49 cases].
BACKGROUND: Pelvic recurrence of cervical cancer is a life-threatening event for patients. The main therapeutic challenge is to locally control such relapses. We present our experience of the surgical treatment of pelvic cervical cancer relapses. PATIENTS AND METHODS: From July 1980 to January 1994, 49 patients underwent a surgical procedure for pelvic cervical cancer relapse. Forty four tumor relapses were localized in the pelvis and 5 were associated with distant metastases. Surgery was performed alone in 31 cases and in association with radiotherapy in 18 cases. Median follow-up was 34 months. RESULTS: The treatment was curative in 49% of cases. There was a significant correlation between the initial stage, the site of tumor relapse and surgical curability. Overall actuarial survival was 44% and 24% at 2 and 5 years, respectively. In the curative treatment group, actuarial survival was 71% and 47% at 2 and 5 years, respectively. There was a major surgical complication in 14 cases: 11 reoperations were performed. Thirteen patients are alive of whom 12 with no evidence of disease (median follow-up; 36 months). A local control was achieved in 53% of cases. Age and site of relapse significantly influenced survival. CONCLUSIONS: The results of this study are comparable with other surgical series despite our less favorable patient selection. For patients experiencing pelvic side-wall infiltration, surgical treatment is a worthwhile palliation in selected cases because it is often the only available therapeutic option.
Adult↗
[Drug-resistant genito-urinary rhabdomyosarcoma in children with primary psoas abscess. Apropos of a case].
We report an unusually uncommon case of genitourinary rhabdomyosarcoma in a child which was chemoresistant and complicated by a primary psoas abscess which presented as a pelvic mass associated with an abscess of the right iliac fossa. Ultrasound and CT investigations suggested the diagnosis of a centropelvic tumor which was confirmed at puncture-aspiration. MRI was most contributive giving a precise description of the local extension. Intensive multi-drug chemotherapy would appear to have improved outcome in patients with poor-prognosis Maurer group III tumors. In exceptional cases when no tumor response is obtained, carcinological surgery with large dissection, possibly with adjuvant radiotherapy, is indicated. Percutaneous drainage of the deep psoas abscess is as effective as classical surgery and spares the abdominal wall, particularly important if a second operation should be needed. Multidisciplinary management is required for the treatment of this highly malignant tumor.
Adolescent↗
Wound recurrence after resection of hepatocellular carcinoma.
Cutaneous metastases arising along the exit site of an abdominal drain in one patient and within the operative wound in two others after resection of a hepatocellular carcinoma (HCC) are reported. All patients underwent curative hepatic resection, and cutaneous metastases occurred 9, 12, and 22 months after surgery respectively. Cutaneous metastases were not associated with intrahepatic recurrence and were treated by local excision. Two patients are alive and disease-free 48 and 49 months after hepatic resection, respectively; the third patient died from recurrence 39 months later. These observations suggest that cutaneous malignant seeding may occur, and the authors recommend the observance of special care during liver surgery to prevent occurrence of this complication, including the use of wound protection and avoiding the opening of the specimen by the surgeon. The follow-up of patients who have undergone liver resection for an HCC should include the examination of all operative wounds including the exit site of abdominal drains. These subcutaneous nodules should be resected as an appreciable survival can be expected.
Aged↗
Differences in hypolipidaemic effects of two statins on Hep G2 cells or human hepatocytes in primary culture.
1. The objective of this study was to compare in cultured human hepatocytes or Hep G2 cells, changes in the fate of unesterified low density lipoprotein (LDL)-cholesterol induced by crilvastatin, a new cholesterol lowering drug and a reference statin, simvastatin. 2. The experiments were carried out for 20 h, each well contained 4.2 x 10(5)/cm2 Hep G2 cells or 0.5 x 10(5)/Cm2 human hepatocytes, 130 microM ursodeoxycholate, 0.68 microCi or 1.59 microCi unesterified human [14C]-LDL-cholesterol, crilvastatin or simvastatin at 0 or 50 microM (both cell types) or 300 microM (Hep-G2 cells). Incubation with the two drugs resulted in increased amounts of unesterified [14C]-LDL-cholesterol taken by the two cell types, compared to control. 3. Crilvastatin 50 microM led to significantly higher quantities of [14C]-glyco-tauro-conjugated bile salts, compared to simvastatin. Statins reduced the apo B100 level secreted by the two cell types (simvastatin) or human hepatocytes (crilvastatin). Crilvastatin enhanced both the level of apo A1 secreted by the Hep G2 cells and the level of APF, a high density lipoprotein (HDL) and biliary apoprotein. 4. Crilvastatin not only acts by stimulating LDL-cholesterol uptake by hepatocytes, but also by enhancing the catabolism of LDL-cholesterol in bile salts and probably by stimulating HDL and/or bile component secretion. Such a mechanism was not previously described for HMG CoA reductase inhibitors. Our results on APF show that this apoprotein could be considered also as an indicator of changes in bile and/or HDL compartments. 5. The human hepatocyte model appeared to be a suitable and relevant model in the pharmacological-metabolic experiments carried out in this study. It led to more consistent data than those obtained with Hep G2 cells.
Adult↗
[Carcinomatous degeneration of a choledochal cyst].
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Adenocarcinoma↗
Video-assisted repair of a ruptured right hemidiaphragm.
Video-assisted thoracic surgery is emerging as a viable approach to increasingly complex intrathoracic therapeutic procedures. We present a case of delayed diagnosis of a ruptured right diaphragm caused by a closed trauma in a young woman. The diaphragm was repaired successfully using a video-assisted procedure. Limited postoperative chest pain and muscular impairment allowed early physical therapy that resulted in an excellent outcome. Video-assisted thoracic surgery is suggested as a new treatment option for traumatic diaphragmatic disorders.
Adult↗
[Pancreatic metastasis of a Grawitz tumor].
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Angiography↗
[The so-called "celio-mesenteric button-hole" region, an anatomico-surgical study].
Average biometric values of the abdominal aorta and its collaterals, together with their variations, were studied during 80 multiple organ biopsies and 60 cadaver dissections. Two morphotypes were detected raising technical and tactical problems during multiple organ biopsies, particularly since this region includes the origin of the renal arteries. The left transplexic approach provides enhanced safety during control of arterial ostia.
Celiac Artery↗
A reappraisal of preoperative chemoradiation for localized pancreatic head ductal adenocarcinoma in a 5-year single-institution experience.
Resection of localized pancreatic head ductal adenocarcinoma (LPHDA) has a limited impact on survival. Mechanisms of improvement provided by preoperative chemoradiation therapy (CRT) remain under debate. This study analyzes the outcome of patients treated for LPHDA to delineate the benefits of CRT. Among 87 patients with LPHDA, 17 had a pancreaticoduodenectomy alone (group I). Thirty-nine with initially resectable cancers received CRT with 5-fluorouracil-based chemotherapy (group II). Thirty-one with initially unresectable cancers were similarly treated by CRT (group III). Patients in groups II and III were restaged after completion of CRT. In patients with resectable disease, resection was planned. Patients in groups I and II were statistically comparable in terms of age, sex, and pretherapeutic stage. Median survival and 2-year overall survival in group I were 13.7 months and 31%, respectively. In group II, 23 patients (59%) had a pancreaticoduodenectomy (group IIa) and 16 patients (41%) did not have resection (group IIb). Median survival and 2-year overall survival were as follows: group IIa, 26.6 months and 51%; and group IIb, 6.1 months and 0%, respectively. In group IIa, pathologic examination revealed eight major responses (35%) including two sterilized specimens, and none of the patients had locoregional recurrence. In group III, none of the patients had resection, and median survival was 8 months with one 2-year survivor. Patient selection appears to play a major role with regard to results achieved with preoperative CRT followed by pancreaticoduodenectomy. However, a high histologic response rate and excellent local control can also be achieved.
Aged↗
Surgical resection of locally recurrent cervical cancer: a single institutional 70 patient series.
Pelvic recurrence of cervical cancer is a life-threatening situation and only local control can provide hope for remission. The aim of this study was to evaluate the role of surgery in the treatment of cervical cancer recurrence. This retrospective study analyzed a series of 70 patients who underwent resection of cervix locoregional recurrence. Thirteen patients had palliative salvage surgery for pelvic complications. Twenty-nine resections were considered as curative. Fifty recurrences required pelvic exenterations. The hospital mortality rate was 9% and the morbidity rate was 44%. Overall 5-year actuarial survival rate was 23%. Survival was significantly higher: (a) after curative resection and (b) after centropelvic recurrence resection. Local control was obtained in 48% of the cases and 13 patients are alive with a median follow-up of 75 months. In conclusion, the results of this small and heterogen series seem to justify an attempt to resection for centropelvic recurrences whenever possible. Palliative surgery should be reserved to salvage therapy and highly selected patients.
Adult↗
High incidence of colic anastomotic leakage complicating upper abdominal en bloc evisceration for cancer: a 47-patient series.
BACKGROUND/AIMS: The purpose of this study was to analyze the early outcome of en bloc extended resection for upper abdominal locally advanced cancer. METHODOLOGY: A retrospective medical chart review was performed in 47 consecutive patients who underwent an upper abdominal en bloc resection for cancer involving multiple organs or structures at Paoli-Calmettes Institute and Conception Hospital from October 1988 through April 1997. A third of patients underwent a resection of 4 sus mesocolic organs or more. RESULTS: The postoperative morbidity and mortality rate were respectively, 57% and 19%. Despite a high number of theoretically risky procedures including pancreatic resection and pancreatojejunostomy, total gastrectomy and esophagojejunostomy, total hepatectomy and liver transplantation, the higher percentage of complication was found with colic anastomosis. Five of the 30 patients (17%) who underwent a colic anastomosis developed a colic anastomotic leakage, 4 patients were reoperated and 2 patients died. CONCLUSIONS: Because of this unacceptably high rate of complications, we propose to systematically perform a protective stoma when an upper abdominal evisceration includes a colic anastomosis.
Adenocarcinoma↗
[Hepatic tumoral form of bacterial infections. Diagnostic and therapeutic considerations apropos of 3 cases].
When the clinical picture and complementary tests reveal a tumoural formation in the liver suggesting cancer, it is often difficult to diagnose such formations resulting from bacterial infection without surgical exploration. The diagnosis is particularly difficult since exclusive hepatic formations are extremely rare, the latency period is often long and specific markers are often lacking. We observed 3 such cases with local hepatic tumour-like formations due to tuberculosis, brucellosis and actinomycosis. Pathology examination of a liver biopsy can contribute to the diagnosis and avoid unnecessary exploratory laparotomy allowing successful medical treatment.
Actinomycosis↗