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Pruitt K, Johnson B, Gahan J, Ma L, Fei B. A High-Speed Hyperspectral Laparoscopic Imaging System. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2023; 12466:1246608. [PMID: 38524190 PMCID: PMC10961180 DOI: 10.1117/12.2653922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Minimally invasive surgery (MIS) has expanded broadly in the field of abdominal and pelvic surgery. Laparoscopic and robotic surgery has improved surgeon ergonomics, instrument precision, operative time, and postoperative recovery across various abdominal procedures. The goal of this study is to establish the feasibility of implementing high-speed hyperspectral imaging into a standard laparoscopic setup and exploring its benefit to common intracorporeal procedures. A hyperspectral laparoscopic imaging system was constructed using a customized hyperspectral camera alongside a standard rigid laparoscope and was validated for both spectral and spatial accuracy. Demosaicing methods were investigated for improved full-resolution visualization. Hyperspectral cameras with different spectral ranges were considered and compared with one another alongside two different light sources to determine the most effective configuration. Finally, different porcine tissues were imaged ex-vivo to test the capabilities of the system and spectral footprints of the various tissues were extracted. The tissue was also imaged in a phantom to simulate the system's use in MIS. The results demonstrated a hyperspectral laparoscopic imaging system that could provide quantitative, diagnostic information while not disrupting normal workflow nor adding excessive weight to the laparoscopic setup. The high-speed hyperspectral laparoscopic imaging system can have immediate applications in image-guided surgery.
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Affiliation(s)
- Kelden Pruitt
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX
- Center for Imaging and Surgical Innovation, University of Texas at Dallas, Richardson, TX
| | - Brett Johnson
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Jeffrey Gahan
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX
| | - Ling Ma
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX
- Center for Imaging and Surgical Innovation, University of Texas at Dallas, Richardson, TX
| | - Baowei Fei
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX
- Center for Imaging and Surgical Innovation, University of Texas at Dallas, Richardson, TX
- University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
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Deng L, Guo S, Li H, You X, Song Y, Su H. CA125, CEA, CA19-9, and Heteroploid Cells in Ascites Fluid May Help Diagnose Peritoneal Carcinomatosis in Patients with Gastrointestinal and Ovarian Malignancies. Cancer Manag Res 2020; 12:10479-10489. [PMID: 33122947 PMCID: PMC7588672 DOI: 10.2147/cmar.s271596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/24/2020] [Indexed: 12/27/2022] Open
Abstract
Background This study explored the value of ascites and serum CA125, CEA, and CA19-9 levels and ascites DNA ploidy analysis for the diagnosis of peritoneal carcinomatosis (PC) in patients with gastrointestinal and ovarian malignancies, which can cause ascites and may disseminate peritoneally. Methods We measured ascites and serum levels of CA125, CEA, CA19-9 and performed an ascites DNA ploidy analysis in 58 patients with PC and 44 patients without PC. Results We found that a high expression level of CA125 in ascites fluid was associated with the occurrence of PC in patients with gastrointestinal and ovarian malignancies (P<0.001), and that high CEA and CA19- 9 levels in ascites fluid were associated with PC in patients with gastrointestinal malignancies (P=0.001, P=0.002). But, these tumor marker expression levels in ascites fluid were not significantly associated with the PC stage (P>0.05). We found similar serum levels of CA125, CEA, and CA19-9 between patients with gastrointestinal and ovarian malignancies and PC and those without PC (P>0.05). We found that the presence of three or more cells with heteroploid in the ascites samples was significantly associated with PC in gastrointestinal and ovarian malignancies (P<0.001). In addition, the best ROC curves and highest AUCs were achieved by combining the CA125 level and heteroploid cell analysis results (AUC for gastrointestinal and ovarian malignancies, 0.815, AUC for gastrointestinal malignancies, 0.873). Moreover, the combined ascites CA125 level and result of heteroploid cell analysis provided the best diagnostic sensitivity and specificity for PC (75.9% and 79.5%, respectively, in gastrointestinal and ovarian malignancies; 85.0% and 86.7%, respectively, in gastrointestinal malignancies). Conclusion Ascites levels of CA125, CEA, CA19-9, and heteroploid cells can be considered valuable markers for the diagnosis of PC in patients with gastrointestinal and ovarian cancer.
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Affiliation(s)
- Lin Deng
- Department of Oncology, Tangdu Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Shikong Guo
- Department of Orthopedics, Tangdu Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Hong Li
- Department of Oncology, Tangdu Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Xianghui You
- Department of Oncology, Tangdu Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Yang Song
- Department of Oncology, Tangdu Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Haichuan Su
- Department of Oncology, Tangdu Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
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Combined liver resection and cytoreductive surgery with HIPEC for metastatic colorectal cancer: Results of a worldwide analysis of 565 patients from the Peritoneal Surface Oncology Group International (PSOGI). Eur J Surg Oncol 2020; 47:89-100. [PMID: 32943276 DOI: 10.1016/j.ejso.2020.07.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 12/26/2022] Open
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The role of single-incision laparoscopic peritoneal exploration in the management of patients with peritoneal metastases. Surg Endosc 2019; 34:2040-2049. [PMID: 31321535 DOI: 10.1007/s00464-019-06984-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The outcome of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) depends on the extent of peritoneal metastases (PM) and the completeness of cytoreduction (CCR). The role of preoperative assessment of PM is to identify potential candidates for CRS/HIPEC and to prevent unwarranted laparotomy for those who are not. Laparoscopy has been utilized for that purpose but with concerns related to technical difficulties and risk of trocar site metastases. Single-incision laparoscopic peritoneal exploration (SILPE) has not yet been evaluated in this setting. METHODS This single-center retrospective study examined patients from January 2011 to December 2015 who underwent SILPE for diagnosis and staging of PM. Preoperative, intraoperative, and postoperative data were collected. For the patients who underwent subsequent laparotomy, a comparison between SILPE and laparotomy findings was made. RESULTS A total of 183 SILPE were performed. Primary sites were mostly colorectal in 72 cases (39.3%) and gastric in 47 (25.7%). Overall, 157 patients (85.8%) had at least one prior abdominal surgery and 48 (26.2%) had 3 or more. SILPE was successfully achieved in 90.2% of the cases. Two (1.2%) intraoperative complications and five (3%) postoperative complications were observed. Eighty-one patients had laparotomy, with a median of 27 days between SILPE and laparotomy (4-162 days). The peritoneal carcinomatosis index PCI was 9.7 ± 7.5 at SILPE, and 13.5 ± 9.6 at laparotomy. The positive predictive value of SILPE to predict CCR was 79.5%. SILPE sensitivity was 75% and specificity 97%. The lowest sensitivity was in regions 9-12 ranging from 44 to 53%. CONCLUSION SILPE can be safely incorporated in the management of patients with PM. It is a safe and feasible staging tool, allowing for preventing unwarranted laparotomy for patients not deemed candidate for CRS/HIPEC. Even though it may underestimate PCI, SILPE accurately predicts the possibility of CCR.
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Colorectal Peritoneal Metastases: A Systematic Review of Current and Emerging Trends in Clinical and Translational Research. Gastroenterol Res Pract 2019; 2019:5180895. [PMID: 31065262 PMCID: PMC6466888 DOI: 10.1155/2019/5180895] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022] Open
Abstract
Colorectal peritoneal metastases (CPM) are associated with abbreviated survival and significantly impaired quality of life. In patients with CPM, radical multimodality treatment consisting of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has demonstrated oncological superiority over systemic chemotherapy alone. In highly selected patients undergoing CRS + HIPEC, overall survival of over 60% has been reported in some series. These are patients in whom the disease burden is limited and where the diagnosis is made at an early stage in the disease course. Early diagnosis and a deeper understanding of the biological mechanisms that regulate CPM are critical to refining patient selection for radical treatment, personalising therapeutic approaches, enhancing prognostication, and ultimately improving long-term survivorship. In the present study, we outline three broad themes which represent critical future research targets in CPM: (1) enhanced radiological strategies for early detection and staging; (2) identification and validation of translational biomarkers for diagnostic, prognostic, and therapeutic deployment; and (3) development of optimized approaches for surgical cytoreduction as well as more precise strategies for intraperitoneal drug selection and delivery. Herein, we provide a contemporary narrative review of the state of the art in these three areas. A systematic review in accordance with PRISMA guidelines was undertaken on all English language studies published between 2007 and 2017. In vitro and animal model studies were deemed eligible for inclusion in the sections pertaining to biomarkers and therapeutic optimisation, as these areas of research currently remain in the early stages of development. Acquired data were then divided into hierarchical thematic categories (imaging modalities, translational biomarkers (diagnostic/prognostic/therapeutic), and delivery techniques) and subcategories. An interactive sunburst figure is provided for intuitive interrogation of the CPM research landscape.
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Dohan A, Hobeika C, Najah H, Pocard M, Rousset P, Eveno C. Preoperative assessment of peritoneal carcinomatosis of colorectal origin. J Visc Surg 2018; 155:293-303. [PMID: 29602696 DOI: 10.1016/j.jviscsurg.2018.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The goal of preoperative assessment of patients with peritoneal carcinomatosis (PC) from colorectal origin is to select candidates for curative surgery by evaluating the possibility of complete resection, and to plan the surgical procedure. Quantitative and qualitative evaluation of lesional localization remains difficult even with current technical progress in imaging. Computed tomography (CT), the reference imaging technique, allows detection of both peritoneal and extra-peritoneal lesions. Sensitivity and specificity for detecting PC are 83% (95%CI: 79-86%) and 86% (95%CI: 82-89%), respectively. Functional imaging, with diffusion-weighted magnetic resonance imaging (MRI) and positron emission tomography PET-CT allows efficient exploration of peritoneal lesions. MRI is operator-dependent, with a long learning curve, and is, at present, essentially used only in expert centers. A standardized protocol provided by the radiologists working with the French National Center for rare peritoneal tumors RENA-RAD (http://www.renape-online.fr/fr/espace-professionnel/rena-rad.html) is however available on line. PET-CT is particularly useful for identifying and defining extra-peritoneal disease. Combining imaging techniques, particular CT with MRI, seems to improve the calculation of the Peritoneal Cancer Index compared to CT alone. Surgical exploration is the reference technique to evaluate PC. Currently, the literature cannot confirm whether laparoscopy performs as well as laparotomy, but laparoscopy is, de facto, the fundamental tool to decrease the number of unnecessary laparotomies in these patients. To optimize the pre-, intra- and postoperative reporting of the extent of PC, the French National Network for management of PC (RENAPE and BIG-RENAPE: http://www.e-promise.org/) has offered on-line a free-of-charge, standardized, multidisciplinary and transversal software.
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Affiliation(s)
- A Dohan
- Department of Body & Interventional Imaging, hôpital Cochin, Inserm UMR 965, université Sorbonne Paris Cité, Paris-Descartes, 27, rue de Faubourg Saint-Jacques, 75014 Paris, France; McGill University Health Center, Department of Radiology, 1650, Cedar Avenue, Rm C5 118, Montreal, QC, Canada.
| | - C Hobeika
- Department of Surgical Oncologic & Digestive Unit, hôpital Lariboisière, Inserm UMR 965, AP-HP, 75475 Paris cedex 10, France
| | - H Najah
- Department of Surgical Oncologic & Digestive Unit, hôpital Lariboisière, Inserm UMR 965, AP-HP, 75475 Paris cedex 10, France
| | - M Pocard
- Department of Surgical Oncologic & Digestive Unit, hôpital Lariboisière, Inserm U965, université Diderot-Paris 7, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - P Rousset
- Department of Radiology, centre hospitalier Lyon-Sud-HCL, Lyon 1 University, EMR 3738, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - C Eveno
- Department of Surgical Oncologic & Digestive Unit, hôpital Lariboisière, Inserm UMR 965, université Sorbonne Paris Cité, Paris Diderot, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
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Passot G, Dumont F, Goéré D, Arvieux C, Rousset P, Regimbeau JM, Elias D, Villeneuve L, Glehen O, Abba J, Abboud K, Carere S, Durand-Fontanier S, Eveno C, Facy O, Gelli M, Gilly FN, Karoui M, Lo Dico R, Ortega-Deballon P, Pocard M, Quenet F, Rat P, Sabbagh C, Sgarbura O, Thibaudeau E, Vaudoyer D, Wernert R. Multicentre study of laparoscopic or open assessment of the peritoneal cancer index (BIG-RENAPE). Br J Surg 2018; 105:663-667. [DOI: 10.1002/bjs.10723] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/01/2017] [Accepted: 09/06/2017] [Indexed: 02/04/2023]
Abstract
Abstract
Background
The peritoneal cancer index (PCI) is a comparative prognostic factor for colorectal peritoneal metastasis (CRPM). The ability of laparoscopy to determine the PCI in consideration of cytoreductive surgery remains undetermined, and this study was designed to compare it with laparotomy.
Methods
A prospective multicentre study was conducted for patients with no known CRPM, but at risk of peritoneal disease. Surgery began with laparoscopic exploration followed by open exploration to determine the PCI. Concordance between laparoscopic and open assessment was evaluated for the diagnosis of CRPM and for the PCI.
Results
Among 50 patients evaluated, CRPM recurrence was found in 29 (58 per cent) and 34 (68 per cent) at laparoscopic and open surgery respectively. Laparoscopy was feasible in 88 per cent (44 of 50) and deemed satisfactory by the surgeon in 52 per cent (26 of 50). Among the 25 evaluable patients with satisfactory laparoscopy, there was concordance of 96 per cent (24 of 25 patients) and 38 per cent (10 of 25) for laparoscopic and open assessment of CRPM and the PCI respectively. Where there were discrepancies, it was laparoscopy that underestimated the PCI.
Conclusion
Laparoscopy may underestimate the extent of CRPM.
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Affiliation(s)
- G Passot
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
| | - F Dumont
- Department of Surgery, Institut de Cancérologie de l'Ouest (René Gauducheau), Site Hospitalier Nord, Saint-Herblain, France
| | - D Goéré
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Villejuif, France
| | - C Arvieux
- Department of Visceral Surgery, Grenoble University Hospital, Hôpital Albert Michallon, Grenoble, France
| | - P Rousset
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
| | - J-M Regimbeau
- Department of Digestive Surgery, Amiens-Picardie University Medical Centre, Amiens, France
| | - D Elias
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Villejuif, France
| | - L Villeneuve
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
| | - O Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France
- Equipe Mixte de Recherche 3738, Lyon 1 University, Lyon, France
| | - J Abba
- Department of Digestive Surgery, Grenoble University Hospital, Grenoble, France
| | - K Abboud
- Department of General Surgery, St Etienne University Hospital, St Etienne, France
| | - S Carere
- Department of Surgical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - S Durand-Fontanier
- Department of Visceral Surgery and Transplantation, Dupuytren University Hospital, Limoges, France
| | - C Eveno
- Surgical Oncological and Digestive Unit, Lariboisiere University Hospital, Paris, France
| | - O Facy
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - M Gelli
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - F-N Gilly
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France
| | - M Karoui
- Department of Digestive Surgery, La Pitié-Salpétriêre University Hospital, Paris, France
| | - R Lo Dico
- Surgical Oncological and Digestive Unit, Lariboisiere University Hospital, Paris, France
| | - P Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - M Pocard
- Surgical Oncological and Digestive Unit, Lariboisiere University Hospital, Paris, France
| | - F Quenet
- Department of Surgical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - P Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - C Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - O Sgarbura
- Department of Surgical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - E Thibaudeau
- Department of Surgery, lnstitut de Cancerologie de l'Ouest (Rene Gauducheau), Saint-Herblain, France
| | - D Vaudoyer
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France
| | - R Wernert
- Department of Surgical Oncology, Institut de Cancerologie de l'Ouest, Paul Papin Cancer Center, Angers, France
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Bouquot M, Dohan A, Gayat E, Barat M, Glehen O, Pocard M, Rousset P, Eveno C. Prediction of Resectability in Pseudomyxoma Peritonei with a New CT Score. Ann Surg Oncol 2017; 25:694-701. [PMID: 29192372 DOI: 10.1245/s10434-017-6275-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Curative treatment of pseudomyxoma peritonei (PMP) is complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). OBJECTIVE The aim of this study was to build and evaluate a preoperative imaging score to predict resectability. PATIENTS AND METHODS Between 2007 and 2014, all PMP patients in two tertiary reference centers who underwent laparotomy with intent to undergo CRS and HIPEC were included in this study retrospectively. Thickness of tumor burden was measured on preoperative multidetector-row computed tomography (MDCT) by two radiologists blinded to surgical results in five predetermined areas. Patients were divided into two cohorts with the same resectability rate (building and validation). The performances of the scores were assessed using receiver operating characteristic (ROC) curve analyses. RESULTS Overall, 126 patients were included, with compete CRS being achieved in 91/126 patients (72.2%). Two cohorts of 63 patients matched by age, sex, burden of disease, resectability rate, and pathological grade were constituted. The MDCT score was the sum of the five measures, and was higher in unresectable disease [median 46.2 mm (range 27.9-74.6) vs. 0.0 mm (range 0.0-14.0), p < 0.001]. Area under the ROC curve was 0.863 (range 0.727-0.968) and 0.801 (range 0.676-0.914) in the building and validation cohorts, respectively. A threshold of 28 mm yielded a sensitivity, specificity, positive predictive and negative predictive value of 94, 81, 81 and 94% in the building cohort, and 80, 68, 59 and 85% in the validation cohort, respectively. Using our score, overall and disease-free survival were increased in the group classified as resectable. CONCLUSION A simple preoperative MDCT score measuring tumor burden in the perihepatic region is able to predict resectability and survival of PMP patients.
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Affiliation(s)
- Morgane Bouquot
- Department of Digestive and Oncological Surgery, Hôpital Lariboisière-AP-HP, Paris, France.,INSERM U 965, Paris, France
| | - Anthony Dohan
- Department of Body and Interventional Imaging, Hôpital Cochin-AP-HP, Université Sorbonne Paris Cité - Paris Descartes, Paris, France.,INSERM U 965, Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care Medicine, Hôpital Lariboisière-AP-HP, Université Sorbonne Paris Cité - Paris Diderot, Paris, France.,INSERM U 965, Paris, France
| | - Maxime Barat
- Department of Body and Interventional Imaging, Hôpital Cochin-AP-HP, Université Sorbonne Paris Cité - Paris Descartes, Paris, France
| | - Olivier Glehen
- Department of Digestive and Oncologic Surgery, Centre Hospitalier Lyon Sud - HCL, Lyon 1 University Pierre-Bénite, Lyon, France
| | - Marc Pocard
- Department of Digestive and Oncological Surgery, Hôpital Lariboisière-AP-HP, Sorbonne Paris Cité - Paris Diderot, Paris, France.,INSERM U 965, Paris, France
| | - Pascal Rousset
- Department of Radiology, Centre Hospitalier Lyon Sud - HCL, Lyon 1 University Pierre-Bénite, Lyon, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, Hôpital Lariboisière-AP-HP, Sorbonne Paris Cité - Paris Diderot, Paris, France. .,INSERM U 965, Paris, France.
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