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Vincent Moutardier

Publications and source records attributed to Vincent Moutardier.

At least 19 recordsLinked to original sources
PubMed2007

Short-term outcome after laparoscopic or open restorative mesorectal excision for rectal cancer: a comparative cohort study.

PURPOSE: The laparoscopic approach to rectal cancer is still a controversial procedure. A comparative cohort study was conducted to assess short-term results of laparoscopic restorative mesorectal excision. METHODS: From January 1998 to December 2000, laparotomy was performed on all primary rectal cancer undergoing radical excision. From January 2002 to September 2004, all cases about to undergo radical excision were considered for laparoscopy. Patients with fixed tumor or T4, indications for synchronous hepatectomy, emergencies, and medical contraindications were not included. The study was based on the intention-to-treat principle. RESULTS: Short-term outcome was compared between the laparoscopy group (n=104) and the laparotomy group (n=68). Demographic, general and tumor data, and rates of preoperative irradiation were comparable, as were surgical procedures and perioperative management. Hospital mortality (1 and 2.9 percent, P=0.33) and three-month overall morbidity (43.3 and 48.5 percent, P=0.49) were comparable between laparoscopy and laparotomy groups. Surgical complication rates were comparable (39.3 and 35.5 percent, P=0.58), but a significantly lower medical complication rate was observed in laparoscopy patients (8.7 and 20.6 percent, P=0.025), mainly because this group had fewer respiratory complications. Hospital stay was shorter in laparoscopy patients (10 and 14 days, P<0.001). Oncologic quality criteria were comparable, in terms of number of lymph nodes, lateral and distal margins, and delivery of postoperative chemotherapy. CONCLUSIONS: The laparoscopic approach to restorative mesorectal excision for cancer does not increase postoperative morbidity or reduce oncologic quality. Our results suggest that the short-term outcome is probably improved with this procedure.

Chi-Square Distribution↗
PubMed2006

Perineal small bowel fistula after pelvic exenteration for cancer: technical guidelines for perineal fistula.

BACKGROUND: To determine guidelines for the management of perineal small bowel fistula (PSF) after total or posterior pelvic exenteration. METHODS: During 15 years, 315 curative pelvic exenterations were performed. PSF occurred in 15 patients (3.5%). We retrieved the precise modality of radiotherapy (fields and doses) and management of all patients (type of surgery, number of surgery and mortality). Delay of occurrence was divided in early (within 30 days or before hospital discharge) and delayed. RESULTS: All patients underwent surgery. Mortality rate was 13%. Fourteen patients (93%) had history of radiotherapy. No PSF was noted after anterior pelvic exenteration. Higher frequency of PSF was noted after total pelvic exenteration versus posterior pelvic exenteration (P = 0.04). Early PSF occurred in four patients (27%) with higher frequency of small bowel intraoperative injury. Late PSF occurred in 11 patients (73%) divided in small bowel injury in contact with pelvic staples (n = 4) and disease recurrence (n = 6, local recurrence or carcinomatosis). One patient had delayed PSF by ulceration of small bowel in contact with pelvic drain. CONCLUSION: PSF was a life-threatening complication of pelvic exenteration. Radiotherapy leads to weaken small bowel with difficulty of cicatrisation. During pelvic exenteration: (a) extreme careful dissection and interposition of great omentum could avoid small bowel injury, (b) control of pelvic vessels and closure of rectum remnant should not used staplers. Intraoperative management of PSF used successful simple repair in case of early PSF or segmentary resection indeed enlarged to right colon in case of delayed PSF. Postoperative courses had to use intravenous hyperalimentation and digestive tract discharge.

Female↗
PubMed2006

Acquired resistance to imatinib and secondary KIT exon 13 mutation in gastrointestinal stromal tumour.

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. Most of them have an activating mutation of KIT or PDGFRalpha tyrosine-kinase receptors. Imatinib is a selective tyrosine-kinase inhibitor of ABL, KIT and PDGFR, and provides a clinical benefit in about 85% of patients with advanced GIST. Unfortunately, secondary resistance following initial responses occurs in most of the cases, and molecular mechanisms are poorly understood. We sequenced KIT and PGDFRalpha exons from one patient with GIST before and after the development of imatinib resistance. We identified, in addition to a primary mutation in exon 9, a secondary mutation in KIT exon 13 (first kinase domain) in the resistant sample. We demonstrate for the first time the feasibility of sequencing such samples removed by non-surgical biopsies during imatinib therapy. Such a approach, far less invasive than surgery and combined with sequencing, will likely help in better tailoring the treatment of advanced GISTs and understanding the mechanisms of resistance and response to imatinib.

Antineoplastic Agents↗
PubMed2005

Long-term survival after concomitant chemoradiotherapy prior to surgery in advanced cervical carcinoma.

OBJECTIVE: To report the long-term survival of 35 patients who underwent surgery after concomitant chemoradiation for locally advanced cervical cancers. METHODS: From 1988 to 1992, 20 bulky IB-IIB patients and 15 stage III-IVA patients underwent surgery after concurrent chemotherapy (CDDP and 5-FU) and radiotherapy. 26 had a hysterectomy, 8 had an exenteration, 1 had no tumor resection. 21 had a para-aortic lymphadenectomy. Endpoints were recurrence and distant metastasis rates, overall survival (OS) and disease-free survival (DFS) at 5 and 10 years. Analysis included FIGO stage, type of surgery (palliative or curative), response to chemoradiation or para-aortic lymphatic status. RESULTS: Surgery had been only palliative in 6 cases (17.1%). A pelvic control has been achieved in 31 patients (88.6%). Pelvic recurrences occurred after a median interval of 7 months. Distant metastases occurred in 10 patients (28.6%), after a median interval of 20 months. So far, 16 patients have died (45.7%). The 10-year DFS is 56.7% in the whole series. Only the type of surgery significantly affected the OS. Only the para-aortic lymphatic status significantly affected the DFS. CONCLUSION: Associating chemoradiation with curative surgery, we obtained a 10-year DFS of 66.4% (OS 57.7%). Adjuvant surgery may increase the survival as it reduces the risk of local relapse.

Adult↗
PubMed2005

Hemorrhage after duodenopancreatectomy: impact of neoadjuvant radiochemotherapy and experience with sentinel bleeding.

Postoperative hemorrhage (PH) after duodenopancreatectomy (DP) is frequently lethal. The aim of this study was to delineate guidelines of management. Between August 1994 and July 2003, 172 patients underwent DP for cancer. Altogether, 26 patients were subjected to an institutional protocol (IP) with standard-dose chemoradiation (CRT) and 4 patients to an extrainstitutional protocol (EIP) with high-dose CRT. Sixteen patients (9.3%) were reoperated for PH. Hemorrhage occurred in 23% of irradiated patients (4 EIP, 3 IP) and in 6% of nonirradiated patients [confidence interval (CI) 1.8-6.5]. Pancreatic leak occurred in nine patients with PH (56%). Sentinel bleeding (SB) was noted in eight patients (50%) with a mean delay of 10 days after DP. Overall mortality after hemorrhage was 56%. Morality rates of patients with EIP or IP were, respectively, 100% and 0%. Mortality rates of patients with or without SB were similar. Mortality rates of axial bleeding (hepatic artery, mesenteric vessels) or lateral bleeding (pancreas remnant, splenic vessels) were, respectively, 88% and 25% (CI 1.6-8.6). Completion of pancreatectomy was achieved in 75% without rebleeding. Preoperative high-dose CRT increased the risk of fatal PH. Because SB occurs before massive hemorrhage, prompt reoperation could reduce mortality. Completion of pancreatectomy was essential during reintervention. Axial bleeding supports high mortality. Moving to the left, the pancreatojejunostomy could avoid contact of pancreatic juice with axial vessels in the case of pancreatic leakage. Ligating the gastroduodenal artery during DP had to leave a stump of around 1 cm to facilitate hemorrhage control without ligating the common hepatic artery.

Adenocarcinoma↗
PubMed2005

Salvage abdominoperineal resection after failure of conservative treatment in anal epidermoid cancer.

PURPOSE: Radiotherapy alone or with combined chemotherapy is the first therapeutic option for epidermoid carcinoma of the anal canal. Failure of this conservative treatment may benefit of salvage abdominoperineal resection. This study was designed to analyze postoperative outcome and oncologic results in a single anticancer institution. METHODS: Medical charts of 36 patients (median age, 57.9 years) who underwent salvage abdominoperineal resection after failure of conservative treatment between 1987 and 2002 were reviewed retrospectively. There were 15 patients treated for immediate failure (Group I) and 21 patients for recurrence (Group II). Twenty-two patients have undergone primary use of flap reconstruction of the perineal wound. There were ten rectus abdominis myocutaneous flaps, nine omental flaps, two gracilis muscular flaps, and one combined flap. RESULTS: There was no postoperative mortality. Median follow-up was 67 (range, 15-155) months. Primary closure of the perineum was obtained in 33 patients (92 percent). Secondary wound breakdown occurred in 23 of 33 patients (70 percent). Complications unrelated to the perineal wound occurred in 13 patients. The overall crude five-year survival after salvage abdominoperineal resection was 69.4 percent. The crude five-year survival in Group I and Group II was 60.7 and 71.5 percent respectively (P = 0.28). The crude five-year, disease-free survival in Groups I and II was 31.1 and 48.2 percent respectively (P = 0.10). Twenty-three patients experienced recurrences after salvage abdominoperineal resection (64 percent) with a mean delay of 30 months. CONCLUSIONS: Despite high incidence of perineal morbidity, salvage abdominoperineal resection for epidermoid carcinomas of the anal canal has a high long-term survival rate.

Abdomen↗
PubMed2005

Long-term follow-up of continent urinary diversion after pelvic exenteration for gynecologic malignancies.

OBJECTIVE: The objective of this retrospective study was to analyze the long-term outcome of patients undergoing a continent urinary diversion (UD) at the time of pelvic exenteration (PE). PATIENTS AND METHODS: Between February 1993 and January 2001, 60 PE for gynecologic malignancies and requiring a UD were performed. Patient's preference, type of UD planned, type of UD performed, and late urinary morbidity (after day 90) were analyzed. RESULTS: Eighty-two percent of the entire group (49/60) matched preoperatively criteria to have a continent UD and 41 continent UD were eventually performed (87%). Postoperative mortality in patients with a continent UD was 4.9% (2/41) and wasn't related to urinary complications. After a 20-month median follow-up, 18 patients (46%) with a continent UD developed late complications directly UD-related. These complications were: (a) major in 28% (5/18) requiring re-operation in 3 cases or endoscopic treatment in 2 cases; (b) minor in 72% (13/18) constantly medically treated. Chronic diarrhea was more frequent in patient who had small bowel or left colon resection (P < 0.05) and urine leakage was more frequent in patient with higher BMI (P < 0.05). At last follow-up, no patient had stopped self-catheterizations or asked for undiversion. CONCLUSIONS: In our experience, continent UD at the time of PE despite high acceptability and feasibility rate, appeared to be strongly related to specific late complications, uncommon with ileal conduit. However, these complications remained more frequently minor and could be treated safely and conservatively.

Female↗
PubMed2005

[Oxaliplatin neurotoxicity: a report of three cases with post-operative exacerbation].

Liver metastases of colorectal cancer are rarely rapidly resectable. The efficacy of new chemotherapy regimen, in particular the combination of 5FU and oxaliplatin make further surgical resection possible in the case of an objective response in some patients. Three patients with metastatic colorectal cancer received oxaliplatin-based chemotherapy; only minimal and transient neurosensory toxicity occurred. After a partial response to treatment, surgical resection of metastases was performed. Patients reported major exacerbation of oxaliplatin-induced neurosensory toxicity following surgery (between day 7 and day 15). One patient experienced sensory loss of the extremities with functional impairment (grade 3 on Levi's scale). The symptoms persisted for 812 months after surgery in the three patients. Only seven similar cases have been reported. Toxicity could be associated with the concentration of oxaliplatin in the red blood cells: oxaliplatin binds irreversibly to erythrocytes. This exacerbation could be the consequence of peroperative hemolysis with a redistribution of the pool of intra-erythrocytic oxaliplatin biotransformation products into the plasma. We did not find any relationship with anesthesic or per-operative medications. Studies are necessary to define the precise mechanism and the frequency of this reaction.

Aged↗
PubMed2005

[Locoregional recurrence of cervical and endometrial carcinoma: role of surgical resection].

Locoregional recurrences are frequently larger in case of cervical carcinoma than endometrial carcinoma, classically localized on the upper third of the vagina. Consequently, the place of surgical resection appears to be more important in case of cervical carcinoma recurrence. Furthermore, surgery remains frequently the only curative treatment. However, after a similar local and general staging, surgical resection required is for the most part a pelvic exenteration using procedure of pelvic reconstruction. Postoperative mortality, morbidity and survival results were analyzed. Surgical strategies were proposed after assessment of recurrence type, size and localization and analyze of initial treatment.

Combined Modality Therapy↗
PubMed2004

[Sentinel lymph node negative breast cancer larger than 30 mm: is axillary lymph node dissection constantly necessary?].

Benefits provided by sentinel lymph node biopsy (SLNB) include improvement of pathologic examination and lower rate of sequels. The aim of this study was to assess the accuracy of this procedure in large tumors. From march 1999 and december 2003, 663 patients were operated for a breast cancer and underwent a SLNB. All patients with tumor larger than 30 mm and/or with involved SLNB underwent a complete axillary dissection (AD). One hundred and sixteen patients (17.5%) with a tumor larger than 30 mm underwent an AD. Identification rate of SLNB was 94% (109/116). Among the 43 cases with non metastatic SLNB, the AD was negative in 39 cases (90.7%). In four cases a palpable non sentinel lymph node discovered during the SLNB procedure was found to be involved. In one case the lymphoscintigraphy found only one lymph node with a very low fixation and an AD was performed because of low efficiency of the lymphoscintigraphy procedure. SLNB false negative rate was 1.4 % (1/72) among the 72 cases with lymph node involvement. AD was performed in 66 cases (60.5%) during the same operating time than the SLNB. AD showed a lymph node involvement in 30 cases (30/72, 41.7%): in 5 cases among 24 cases with microscopic disease (20.8%) and in 25 cases among 48 cases with macroscopic disease (52%). This series results suggest than AD could be avoided for negative SLNB tumors up to 50 mm at pathologic examination in patients with clinically-measured tumor smaller than 30 mm.

Adult↗
PubMed2004

Assessment of pathologic response after preoperative chemoradiotherapy and surgery in pancreatic adenocarcinoma.

PURPOSE: The benefits provided by preoperative chemoradiotherapy (CRT) in pancreatic ductular adenocarcinoma (PDA) are still controversial. However, in most reports from referral centers, improvement in local control and survival appears to be provided in selected patients. The aim of this retrospective study was to analyze the radiation-induced pathologic effects of preoperative CRT in patients with resectable PDA and determine the precise long-term outcome of the responding patients. METHODS AND MATERIALS: Between November 1996 and October 2003, 61 patients underwent preoperative CRT for resectable PDA. The tumor location was the pancreatic head in 49 patients and pancreatic body in 12 patients. Of the 61 patients, 21 (34.5%) did not undergo surgery because of disease progression and 40 (65.5%) underwent pancreatic resection, including pancreaticoduodenectomy in 32 (80%) and distal pancreatectomy in 8 (20%). RESULTS: A major pathologic response was noted in 9 patients, including three complete responses, and was found only in patients with tumor of the pancreatic head. The local control rate was similar in patients with and without a major pathologic response. Survival in patients with a major response was significantly greater than in those without a response or with a minor response. CONCLUSION: Major tumor downstaging can be provided by preoperative CRT in patients with resectable cephalic PDA. Survival appears to be significantly improved in selected patients.

Adult↗
PubMed2004

[Colorectal cancer: what should be the management of primary tumour?].

Colon and rectal cancer are in France a challenging problem in public health, reaching the second place in cancer related deaths. Surgery is still the key of curative treatment. Crude survival increased from 33% to 55% during twenty years. Colonoscopy is the referent exam for positive diagnosis. In rectal cancer, endorectal ultrasound and MRI have optimised local staging. The quality of general staging is important since it could change therapeutic strategy. Spiral CT scan is now probably superior to conventional ultrasound in the detection of liver metastases. Laparotomy is still the standard surgical approach. Main prospective studies in the evaluation of laparoscopic approach are still ongoing. Rectal resection for cancer is today a standardised procedure: total mesorectal excision (TME) should be done for rectal tumours below peritoneal reflection; TME decreases both the risk of local recurrence and the frequency of urogenital sequelae. The quality of surgical resection for colorectal cancer should always be checked and particularly, the number of lymph nodes, the longitudinal and lateral margins for rectal cancer, and resection for fixed tumours. Adjuvant chemotherapy with 5 fluorouracil and folinic acid is a standard for UICC stage III patients, but with a clearer benefit for colon tumours. Preoperative irradiation for T3-T4 rectal tumours is an European standard, providing a better local control; irradiation could also improved survival. In the oncoming years, surgeon and hospital specialization will probably be the main factor of progress in the management of colorectal cancer in France.

Antimetabolites, Antineoplastic↗
PubMed2004

[Periampullar gangliocytic paraganglioma resected by surgical ampullectomy: a case report].

We report the case of a 40-Year-old woman with duodenal gangliocytic paraganglioma of the ampulla of Vater. Preoperative diagnosis was periampullar tumor. Final diagnosis of duodenal gangliocytic paragangioma of the ampulla of Vater with negative margins was made by histological and immunohistochemical study of surgical ampullectomy specimen. This case report stresses the yield of immunohostochemical study in the diagnosis of duodenal gangliocytic paraganglioma, a rare entity.

Adult↗
PubMed2003

Radiotherapy and immediate two-stage breast reconstruction with a tissue expander and implant: complications and esthetic results.

PURPOSE: To report complications, failure rate, and esthetic results in patients undergoing immediate breast reconstruction with a tissue expander and implant, with or without adjuvant treatment. METHODS AND MATERIALS: We reviewed the records of the 77 patients who underwent immediate breast reconstruction with an expander/implant between January 1999 and December 2000. Complications were assessed using the Common Toxicity Criteria, version 2, scale. Esthetic results were assessed by the physician using five criteria. RESULTS: Of the 77 patients, 55 had received adjuvant radiotherapy. The median follow-up was 25 months. Complications appeared to correlate with radiotherapy (14% for nonirradiated patients; 51% for irradiated patients; p = 0.006) and adjuvant chemotherapy (54% with chemotherapy [CHT] vs. 25% without CHT; p = 0.02). Breast reconstruction failed in 21% of patients (9% of nonirradiated patients and 24% of irradiated patients; p = 0.1), and chemotherapy was associated with a worse rate of failure (34% with CHT vs. 6% without CHT, p = 0.005). Adjuvant tamoxifen, however, correlated neither with complications (45% with tamoxifen vs. 39% without; p = 0.15) nor with failure (21% with tamoxifen and 23% without, p = 0.79). Esthetic results were acceptable in 60% of cases. CONCLUSION: Immediate breast reconstruction with an expander/implant can be considered even for patients requiring adjuvant treatment. However, the complication and failure rates are three times higher after postexpander radiotherapy.

Adult↗
PubMed2003

Neoadjuvant preoperative chemoradiation in patients with pancreatic cancer.

PURPOSE: To assess the toxicity and efficacy of preoperative chemoradiation in pancreatic cancer. METHODS AND MATERIALS: Between November 1996 and December 2001, 32 patients with biopsy-proven pancreatic adenocarcinoma (28 head; 4 body) were treated by chemoradiation consisting of either split-course therapy (two courses of 15 Gy separated by a 2-week break, n = 10) or standard-fractionation therapy (45 Gy during 5 weeks, n = 22). Concurrent chemotherapy included continuous infusion of 5-fluorouracil and a cisplatin bolus. Pancreatic resection was scheduled for 4-6 weeks after completion of chemoradiation treatment. RESULTS: All 32 patients completed the chemoradiation protocol. Only 2 cases of Grade 3 toxicity (weight loss, vomiting) and one fatal Grade 4 infection occurred. Of the 32 patients, 19 underwent curative resection. Two patients had a complete pathologic response. One patient died 36 months after diagnosis of late treatment-related toxicity (acute superior mesenteric artery thrombosis) with no evidence of disease. The 2-year overall survival rate for the entire group and the resected patients was 37.3% (95% confidence interval 18.2-56.4%) and 59.3% (95% confidence interval 34.1-84.9%), respectively. CONCLUSION: Preoperative chemoradiation with 5-fluorouracil and cisplatin is feasible and promising.

Adenocarcinoma↗
PubMed2003

[Risk of stage underestimation of breast cancer by sentinel lymph node biopsy method].

Sentinel lymph node (SLN) biopsy is fast becoming the standard for testing lymph node involvement in many institutions. However questions remain as to stage underestimation. The aim of this study was to analyse this specific risk in a retrospective study. Between 1975 to 1999, 1,636 patients underwent a breast cancer excision and an axillary lymph node dissection (ALND) for 437 T0, 766 T1 or 433 T2 < or = 30 mm breast cancer without axillary lymph node involvement (NO). We analyse this population because of similar characteristics with SLN biopsy present indication. Node involvement rate was analysed regarding predictive factors of lymph node involvement (LNI): pathologic diameter, grading, peritumoral vascular embols, hormonal receptors, menopause and age. Risk of no adjuvant chemotherapy indication in case of SLN biopsy method using was analysed for pre and post menopaused women. Overall lymph node involvement was 27% (444/1,636): 17% for TO stage (74/437), 26% for T1 stage (202/766), 39% for T2 < or =30 mm stage (168/433). LNI was similar for ductai and lobular invasive breast cancer respectively 27,4% (308/1,125) and 24,3% (52/214). On the other hand LNI rate was sign lower for tubular, medullar and colloids cancers: 15% (20/155). Univariate and multivariate statistical analysis showed LNI significative predictive factors: vascular embols, grade III, age < or = 50 years, tumor diameter > 30 mm. Lymph node involvement rate was defined regarding grading, vascular embols and tumor diameter with increasing rate according to different sub-groups. Among pre-menopaused patients with a false negative rate of SLN of 5%, SLN biopsy without ALND give a specific risk of wrong non-adjuvant chemotherapy indication of 1,4 case/1,000. Among menopaused patients SLN biopsy without ALND give a specific risk of 0,93 cases/1,000. Expected LNI regarding major predictive factors (vascular embols, grading and tumor diameter) allows SLN biopsy risk/benefit evaluation in different sub-groups. SLN biopsy indication could he improved according these data which could be obtain pre-operatively by micro-biopsy.

Breast Neoplasms↗