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Sabbagh C, Beyer-Berjot L, Ouaissi M, Zerbib P, Bridoux V, Manceau G, Karoui M, Panis Y, Buscail E, Venara A, Khaoudy I, Gaillard M, Ortega-Deballon P, Viennet M, Thobie A, Menahem B, Eveno C, Bonnel C, Mabrut JY, Badic B, Godet C, Eid Y, Duchalais E, Lakkis Z, Cotte E, Laforest A, Defourneaux V, Maggiorri L, Rebibo L, Christou N, Talal A, Mege D, Bonnamy C, Germain A, Mauvais F, Tresallet C, Ahmed O, Regimbeau JM, Roudie J, Laurent A, Trilling B, Bertrand M, Massalou D, Romain B, Tranchart H, Giger U, Dejardin O, Pellegrin A, Alves A. Risk factors for severe morbidity and definitive stoma after elective surgery for sigmoid diverticulitis: a multicenter national cohort study. Tech Coloproctol 2024; 28:34. [PMID: 38369674 DOI: 10.1007/s10151-023-02906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/18/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level. METHODS All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD. RESULTS In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m2, and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma. CONCLUSIONS This series provides a real-life picture of elective sigmoidectomy for SDD at a national level. TRIAL REGISTRATION Comité National Information et Liberté (CNIL) (n°920361).
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Affiliation(s)
- C Sabbagh
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France.
| | - L Beyer-Berjot
- Department of Digestive Surgery Assistance Publique Hôpitaux de Marseille, North University Hospital, Marseille, France
| | - M Ouaissi
- Department of Digestive, Oncological, Endocrine, Hepatobiliary and Liver Transplant, Trousseau Hospital, University Hospital of Tours, Tours, France
| | - P Zerbib
- Department of Digestive Surgery and Transplantation, Huriez Hospital, Universite Lille Nord de France, Lille, France
| | - V Bridoux
- Department of Digestive Surgery, University Hospital of Rouen, Rouen, France
| | - G Manceau
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - M Karoui
- Department of Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Y Panis
- Colorectal Surgery Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly, France
| | - E Buscail
- Department of Surgery, CHU Toulouse-Rangueil and Toulouse University, Toulouse, France
| | - A Venara
- Department of Digestive Surgery, University Hospital of Angers, Angers, France
| | - I Khaoudy
- Department of Digestive Surgery, Le Havre Hospital, Le Havre, France
| | - M Gaillard
- Department of Digestive Surgery, Cochin Hospital, Paris, France
| | - P Ortega-Deballon
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - M Viennet
- Department of General Surgery, University Hospital of Bocage, Dijon, France
| | - A Thobie
- Department of Digestive Surgery, Avranches-Granville Hospital, Avranches, France
| | - B Menahem
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
| | - C Eveno
- Department of Digestive Surgery, University Hospital of Lille, Lille, France
| | - C Bonnel
- Department of Digestive Surgery, Nord-Essonne Hospital, Longjumeau, France
| | - J-Y Mabrut
- Department of Digestive Surgery and Transplantation, Croix Rousse University Hospital, Lyon, France
| | - B Badic
- Department of General and Digestive Surgery, University Hospital, Brest, France
| | - C Godet
- Department of Digestive Surgery, Memorial Hospital of Saint-Lô, Saint-Lô, France
| | - Y Eid
- Department of Digestive Surgery, Robert Bisson Hospital, Lisieux, France
| | - E Duchalais
- Department of Oncological, Digestive and Endocrine Surgery, University Hospital of Nantes, Nantes, France
| | - Z Lakkis
- Department of Digestive Surgical Oncology and Liver Transplantation, University Hospital of Besançon, Besançon, France
| | - E Cotte
- Department of Digestive Surgery, Hôpital Lyon Sud, Lyon, France
| | - A Laforest
- Department of Digestive Surgery, Montsouris Institut, Paris, France
| | - V Defourneaux
- Department of Digestive Surgery, CHU Rennes, Rennes, France
| | - L Maggiorri
- Department of Digestive Surgery, Hôpital Saint-Louis, Université Paris VII, APHP, Paris, France
| | - L Rebibo
- Department of Digestive, Oesogastric and Bariatric Surgery, Hôpital Bichat-Claude-Bernard, Paris, France
| | - N Christou
- Department of Digestive Surgery, Limoges Hospital, Limoges, France
| | - A Talal
- Department of Digestive Surgery, Argentan Hospital, Argentan, France
| | - D Mege
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - C Bonnamy
- Department of Digestive Surgery, Bayeux Hospital, Bayeux, France
| | - A Germain
- Department of Digestive Surgery, CHRU Nancy, Nancy, France
| | - F Mauvais
- Department of Digestive Surgery, Beauvais Hospital, Beauvais, France
| | - C Tresallet
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - O Ahmed
- Department of Digestive Surgical Oncology, Avicenne University Hospital, Paris, France
| | - J-M Regimbeau
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - J Roudie
- Department of Digestive Surgery, Martinique Hospital, Fort-de-France, France
| | - A Laurent
- Department of Digestive Surgery, Créteil Hospital, Créteil, France
| | - B Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - M Bertrand
- Department of Digestive Surgery, Universitary Hospital of Nîmes, Nîmes, France
| | - D Massalou
- Department of Digestive Surgery, Hôpital L'Archet, Nice University, Nice, France
| | - B Romain
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - H Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Beclere Hospital, AP-HP, Clamart, France
| | - U Giger
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
| | - O Dejardin
- ANTICIPE, Inserm Unity, UMR 1086, Caen, France
- Department of Clinical Research, University Hospital of Caen, Caen, France
| | - A Pellegrin
- Department of Digestive Surgery Service, Amiens University Hospital, Rond Point du Pr Cabrol, 80054, Amiens Cedex 01, France
| | - A Alves
- Department of Digestive Surgery, University Hospital of Caen, Caen, France
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Auge M, Menahem B, Savey V, Lee Bion A, Alves A. Long-term complications after gastric bypass and sleeve gastrectomy: What information to give to patients and practitioners, and why? J Visc Surg 2022; 159:298-308. [PMID: 35304081 DOI: 10.1016/j.jviscsurg.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bariatric surgery is now recognized as the most effective treatment of morbid obesity, leading to durable weight loss and resolution of associated co-morbidities. Roux-en-Y gastric bypass and sleeve gastrectomy are the two most widely used operations today. However, potentially serious medical, surgical, and/or psychiatric complications can occur that raise questions regarding the benefits of this type of surgery. These complications can lead to surgical re-operations, iterative hospitalizations, severe nutritional deficiencies and psychological disorders. Indeed, death from suicide is said to be three times higher than in non-operated obese patients. These results are of concern, all the more because of the high prevalence of patients lost to follow-up (for various and multifactorial reasons) after bariatric surgery. However, better knowledge of post-surgical sequelae could improve the information provided to patients, the preoperative evaluation of the benefit/risk ratio, and, for patients undergoing surgery, the completeness and quality of follow-up as well as the detection and management of complications. The development of new strategies for postoperative follow-up such as telemedicine but also the mobilization of all the actors along the healthcare pathway can make inroads and warrant further study.
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Affiliation(s)
- M Auge
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - B Menahem
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Unité INSERM UMR1086, Normandie University, UNICAEN, centre François-Baclesse, 14045 Caen cedex, France.
| | - V Savey
- Service de nutrition, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Lee Bion
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Alves
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Unité INSERM UMR1086, Normandie University, UNICAEN, centre François-Baclesse, 14045 Caen cedex, France
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Abstract
Bariatric revisional surgery represents an important new issue for obese patients because of the considerable rate of failure and complications following bariatric surgery. As the frequency of bariatric procedures increases, so too does the incidence of revisional surgery, which has become becoming increasingly important. The surgeon must know the indications and the results of the various revisional procedures in order to best guide the therapeutic decision. The current challenge is to correctly select the patients for revisional surgery and to choose the appropriate procedure in each case. Multidisciplinary management is essential to patient re-assessment and to prepare the patient for a re- intervention. The objective of this update, based on data from all the most recent studies concerning revisional surgery, is to guide the surgeon in the choice of the revisional procedure, depending on patient characteristics, co-morbidities, the previously performed procedure, the type of failure or complication observed, but also on the surgeon's own habits and the center's expertise. The collected results show that revisional surgery is difficult, with higher complication rates and weight-loss results that are often lower than those of first-intent surgery. For these reasons, patient selection must be rigorous and multidisciplinary and the management in expert centers of these difficult situations must be encouraged.
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Affiliation(s)
- A Lee Bion
- Digestive surgery department, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - Y Le Roux
- Digestive surgery department, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - A Alves
- Digestive surgery department, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Unicaen, Inserm, Anticipe, université de Normandie, 14000 Caen, France
| | - B Menahem
- Digestive surgery department, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Unicaen, Inserm, Anticipe, université de Normandie, 14000 Caen, France
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Abstract
Abdominal pelvic radiation therapy can induce acute or chronic lesions in the small bowel wall, called radiation enteritis. Treatment of acute radiation enteritis is essentially symptomatic; symptoms regress when radiation is discontinued. Conversely, late toxicity can occur up to 30 years after discontinuation of radiation therapy, posing diagnostic problems. Approximately one out of five patients treated by radiation therapy will present clinical signs of radiation enteritis, including obstruction, malabsorption, malnutrition and/or other complications. Management should be multidisciplinary, centered mainly on correction of malnutrition. Surgery is indicated in case of complications (i.e., abscess, perforation, fistula) and/or resistance to medical treatment; intestinal resection should be preferred over internal bypass. The main risk in case of iterative resections is the short bowel syndrome and the need for definitive nutritional assistance.
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Affiliation(s)
- L Loge
- Department of digestive surgery, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - C Florescu
- Department of radiotherapy, centre François-Baclesse, avenue du Général-Harris, 14045 Caen cedex, France
| | - A Alves
- Department of digestive surgery, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; ANTICIPE Inserm U 1086, centre François-Baclesse, avenue du Général-Harris, 14045 Caen cedex, France; Health Training and Research Center, 2, rue des Rochambelles, 14032 Caen cedex, France
| | - B Menahem
- Department of digestive surgery, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; ANTICIPE Inserm U 1086, centre François-Baclesse, avenue du Général-Harris, 14045 Caen cedex, France; Health Training and Research Center, 2, rue des Rochambelles, 14032 Caen cedex, France.
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5
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Hobeika C, Fuks D, Cauchy F, Goumard C, Soubrane O, Gayet B, Salamé E, Cherqui D, Vibert E, Scatton O, Nomi T, Oudafal N, Kawai T, Komatsu S, Okumura S, Petrucciani N, Laurent A, Bucur P, Barbier L, Trechot B, Nunèz J, Tedeschi M, Allard MA, Golse N, Ciacio O, Pittau G, Cunha AS, Adam R, Laurent C, Chiche L, Leourier P, Rebibo L, Regimbeau JM, Ferre L, Souche FR, Chauvat J, Fabre JM, Jehaes F, Mohkam K, Lesurtel M, Ducerf C, Mabrut JY, Hor T, Paye F, Balladur P, Suc B, Muscari F, Millet G, El Amrani M, Ratajczak C, Lecolle K, Boleslawski E, Truant S, Pruvot FR, Kianmanesh AR, Codjia T, Schwarz L, Girard E, Abba J, Letoublon C, Chirica M, Carmelo A, VanBrugghe C, Cherkaoui Z, Unterteiner X, Memeo R, Pessaux P, Buc E, Lermite E, Barbieux J, Bougard M, Marchese U, Ewald J, Turini O, Thobie A, Menahem B, Mulliri A, Lubrano J, Zemour J, Fagot H, Passot G, Gregoire E, Hardwigsen J, le Treut YP, Patrice D. Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey. Br J Surg 2020; 107:268-277. [PMID: 31916594 DOI: 10.1002/bjs.11406] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection. RESULTS Among 3150 patients included, LLR was performed in 774 patients with (24·6 per cent) and 2376 (75·4 per cent) without cirrhosis. Severe complication and mortality rates in patients with cirrhosis were 10·6 and 2·6 per cent respectively. Posthepatectomy liver failure (PHLF) developed in 3·6 per cent of patients with cirrhosis and was the major cause of death (11 of 20 patients). After matching, patients with cirrhosis tended to have higher rates of severe complications (odds ratio (OR) 1·74, 95 per cent c.i. 0·92 to 3·41; P = 0·096) and PHLF (OR 7·13, 0·91 to 323·10; P = 0·068) than those without cirrhosis. They also had a higher risk of death (OR 5·13, 1·08 to 48·61; P = 0·039). Rates of cardiorespiratory complications (P = 0·338), bile leakage (P = 0·286) and reoperation (P = 0·352) were similar in the two groups. Patients with cirrhosis had a longer hospital stay than those without (11 versus 8 days; P = 0·018). Centre expertise was an independent protective factor against PHLF in patients with cirrhosis (OR 0·33, 0·14 to 0·76; P = 0·010). CONCLUSION Underlying cirrhosis remains an independent risk factor for impaired outcomes in patients undergoing LLR, even in expert centres.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - D Fuks
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - F Cauchy
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - C Goumard
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | - O Soubrane
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - B Gayet
- Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, University Paris Descartes, Paris, France
| | - E Salamé
- Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Tours University, Tours, France
| | - D Cherqui
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - E Vibert
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Centre Hépato-biliaire de Paul Brousse, Villejuif, France
| | - O Scatton
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Sorbonne Université, Centre de Recherche Scientifique Saint Antoine, Hôpital Pitié Salpétrière, Paris, France
| | | | - T Nomi
- Nara Medical University, Nara, Japan
| | - N Oudafal
- Institut Mutualiste Montsouris, Paris, France
| | - T Kawai
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Komatsu
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | - S Okumura
- Pitié Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
| | | | - A Laurent
- Hôpital Henri Mondor, APHP, Creteil, France
| | - P Bucur
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - L Barbier
- Trousseau Hospital, University Hospital Centre of Tours, Tours, France
| | - B Trechot
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - J Nunèz
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M Tedeschi
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - M-A Allard
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - N Golse
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - O Ciacio
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - G Pittau
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - A Sa Cunha
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - R Adam
- Centre Hépato-biliaire de Paul Brousse, APHP, Villejuif, France
| | - C Laurent
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - L Chiche
- Hospital University Centre of Bordeaux, Bordeaux, France
| | - P Leourier
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Rebibo
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - J-M Regimbeau
- Hospital University Centre of Amiens-Picardie, Amiens, France
| | - L Ferre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F R Souche
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J Chauvat
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - J-M Fabre
- Saint Eloi Hospital, Hospital University Centre of Montpellier, Montpellier, France
| | - F Jehaes
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - K Mohkam
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - M Lesurtel
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - C Ducerf
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - J-Y Mabrut
- Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - T Hor
- St Antoine Hospital, APHP, Paris, France
| | - F Paye
- St Antoine Hospital, APHP, Paris, France
| | - P Balladur
- St Antoine Hospital, APHP, Paris, France
| | - B Suc
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - F Muscari
- Rangueil Hospital, Hospital University Centre of Toulouse, Toulouse, France
| | - G Millet
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - M El Amrani
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - C Ratajczak
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - K Lecolle
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - E Boleslawski
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - S Truant
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - F-R Pruvot
- Claude Huriez Hospital, Hospital University Centre of Lille, Lille, France
| | - A-R Kianmanesh
- Robert Debré Hospital, Hospital University Centre of Reims, Reims, France
| | - T Codjia
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - L Schwarz
- Charles Nicolle Hospital, Hospital University Centre of Rouen, Rouen, France
| | - E Girard
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - J Abba
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - C Letoublon
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | - M Chirica
- Michalon Hospital, Hospital University Centre of Grenoble, Grebnoble, France
| | | | | | - Z Cherkaoui
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - X Unterteiner
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - R Memeo
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - P Pessaux
- Nouvel Hôpital Civil, Hospital University Centre of Strasbourg, Strasbourg, France
| | - E Buc
- Hospital University Centre of Clermont-Ferrand, Clermont-Ferrand, France
| | - E Lermite
- Hospital University Centre of Angers, Angers, France
| | - J Barbieux
- Hospital University Centre of Angers, Angers, France
| | - M Bougard
- Hospital University Centre of Angers, Angers, France
| | - U Marchese
- Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Institut Paoli-Calmettes, Marseille, France
| | - O Turini
- Institut Paoli-Calmettes, Marseille, France
| | - A Thobie
- Hospital University Centre of Caen Normandie, Caen, France
| | - B Menahem
- Hospital University Centre of Caen Normandie, Caen, France
| | - A Mulliri
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Lubrano
- Hospital University Centre of Caen Normandie, Caen, France
| | - J Zemour
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - H Fagot
- Hospital University Centre of Saint-Pierre, Saint Pierre, Department of Réunion, France
| | - G Passot
- Hospital University Centre of Lyon Sud, Lyon, France
| | - E Gregoire
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - J Hardwigsen
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - Y-P le Treut
- La Timone Hospital, Hospital University Centre of Marseille, Marseille, France
| | - D Patrice
- Louis Pasteur Hospital, Colmar, France
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Tabchouri N, Barbier L, Menahem B, Perarnau JM, Muscari F, Fares N, D'Alteroche L, Valette PJ, Dumortier J, Alves A, Lubrano J, Bureau C, Salamé E. Original Study: Transjugular Intrahepatic Portosystemic Shunt as a Bridge to Abdominal Surgery in Cirrhotic Patients. J Gastrointest Surg 2019; 23:2383-2390. [PMID: 30820792 DOI: 10.1007/s11605-018-4053-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/08/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) has been suggested to reduce portal hypertension-associated complications in cirrhotic patients undergoing abdominal surgery. The aim of this study was to compare postoperative outcome in cirrhotic patients with and without specific preoperative TIPS placement, following elective extrahepatic abdominal surgery. METHODS Patients were retrospectively included from 2005 to 2016 in four centers. Patients who underwent preoperative TIPS (n = 66) were compared to cirrhotic control patients without TIPS (n = 68). Postoperative outcome was analyzed using propensity score with inverse probability of treatment weighting analysis. RESULTS Overall, colorectal surgery accounted for 54% of all surgical procedure. TIPS patients had a higher initial Child-Pugh score (6[5-12] vs. 6[5-9], p = 0.043) and received more beta-blockers (65% vs. 22%, p < 0.001). In TIPS group, 56 (85%) patients managed to undergo planned surgery. Preoperative TIPS was associated with less postoperative ascites (hazard ratio = 0.330 [0.140-0.780]). Severe postoperative complications (Clavien-Dindo > 2) and 90-day mortality were similar between TIPS and no-TIPS groups (18% vs. 23%, p = 0.392, and 7.5% vs. 7.8%, p = 0.644, respectively). CONCLUSIONS Preoperative TIPS placement yielded an 85% operability rate with satisfying postoperative outcomes. No significant differences were found between TIPS and no-TIPS groups in terms of severe postoperative complications and mortality, although TIPS patients probably had worse initial portal hypertension.
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Affiliation(s)
- N Tabchouri
- Department of Digestive Surgery, Hepatobiliary Surgery and Liver Transplantation, University Hospital of Tours, CHU Tours, Avenue de la République, F37042, Tours, France.,FHU Support, F37000, Tours, France
| | - L Barbier
- Department of Digestive Surgery, Hepatobiliary Surgery and Liver Transplantation, University Hospital of Tours, CHU Tours, Avenue de la République, F37042, Tours, France.,FHU Support, F37000, Tours, France
| | - B Menahem
- Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France
| | - J-M Perarnau
- Department of Hepatology, University Hospital of Tours, CHU Tours, F37042, Tours, France
| | - F Muscari
- Department of Surgery, Hôpital Rangueil, Toulouse, France
| | - N Fares
- Department of Hepatology and Gastroenterology, Purpan Hospital, University Hospital of Toulouse, Place du Docteur Baylac TSA 40031, 31059, Toulouse Cedex 9, France
| | - L D'Alteroche
- Department of Hepatology, University Hospital of Tours, CHU Tours, F37042, Tours, France
| | - P-J Valette
- Department of Digestive Diseases, Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, Lyon, France
| | - J Dumortier
- Department of Digestive Diseases, Hospices Civils de Lyon, Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, Lyon, France
| | - A Alves
- Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France
| | - J Lubrano
- Department of Digestive Surgery, University Hospital of Caen, Caen Cedex, France
| | - C Bureau
- Department of Hepatology and Gastroenterology, Purpan Hospital, University Hospital of Toulouse, Place du Docteur Baylac TSA 40031, 31059, Toulouse Cedex 9, France
| | - Ephrem Salamé
- Department of Digestive Surgery, Hepatobiliary Surgery and Liver Transplantation, University Hospital of Tours, CHU Tours, Avenue de la République, F37042, Tours, France. .,FHU Support, F37000, Tours, France.
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8
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Eid Y, Menahem B, Bouvier V, Lebreton G, Thobie A, Bazille C, Finochi M, Fohlen A, Galais M, Dupont B, Lubrano J, Dejardin O, Morello R, Alves A. Has adherence to treatment guidelines for mid/low rectal cancer affected the management of patients? A monocentric study of 604 consecutive patients. J Visc Surg 2019; 156:281-290. [DOI: 10.1016/j.jviscsurg.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Affiliation(s)
- A Lee-Bion
- Service de chirurgie viscérale et digestive, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - B Menahem
- Service de chirurgie viscérale et digestive, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; INSERM UMR1086, Normandie University, UNICAEN, CEA, CNRS, CHU Caen, centre François-Baclesse, 3, avenue du Général-Harris, 14045 Caen cedex, France.
| | - Y Le Roux
- Service de chirurgie viscérale et digestive, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - N Contival
- Service de chirurgie viscérale et digestive, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
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10
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Eid Y, Alves A, Lubrano J, Menahem B. Does previous transanal excision for early rectal cancer impair surgical outcomes and pathologic findings of completion total mesorectal excision? Results of a systematic review of the literature. J Visc Surg 2018; 155:445-452. [PMID: 29657063 DOI: 10.1016/j.jviscsurg.2018.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transanal excision (TAE) is increasingly used in the treatment of early rectal cancer because of lower rate of both postoperative complications and postsurgical functional disorders as compared with total mesorectal excision (TME) OBJECTIVE: To compare in a meta-analysis surgical outcomes and pathologic findings between patients who underwent TAE followed by completion proctectomy with TME (TAE group) for early rectal cancer with unfavorable histology or incomplete resection, and those who underwent primary TME (TME group). METHODS The Medline and Cochrane Trials Register databases were searched for studies comparing short-term outcomes between patients who underwent TAE followed by completion TME versus primary TME. Studies published until December 2016 were included. The meta-analysis was performed using Review Manager 5.0 (Cochrane Collaboration, Oxford, UK). RESULTS Meta-analysis showed that completion TME after TAE was significantly associated with increased reintervention rate (OR=4.28; 95% CI, 1.10-16.76; P≤0.04) and incomplete mesorectal excision rate (OR=5.74; 95% CI, 2.24-14.75; P≤0.0003), as compared with primary TME. However there both abdominoperineal amputation and circumferential margin invasion rates were comparable between TAE and TME groups. CONCLUSIONS This meta-analysis suggests that previous TAE impaired significantly surgical outcomes and pathologic findings of completion TME as compared with primary TME. First transanal approach during completion TME might be evaluated in order to decrease technical difficulties.
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Affiliation(s)
- Y Eid
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - A Alves
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Centre François-Baclesse, Normandie université, UNICAEN, CHU de Caen, Inserm UMR1086, 3, avenue du Général-Harris, 14045 Caen cedex, France
| | - J Lubrano
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Centre François-Baclesse, Normandie université, UNICAEN, CHU de Caen, Inserm UMR1086, 3, avenue du Général-Harris, 14045 Caen cedex, France
| | - B Menahem
- Department of digestive surgery, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Centre François-Baclesse, Normandie université, UNICAEN, CHU de Caen, Inserm UMR1086, 3, avenue du Général-Harris, 14045 Caen cedex, France.
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11
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Francoual J, Lebreton G, Bazille C, Galais MP, Dupont B, Alves A, Lubrano J, Morello R, Menahem B. Is pathological complete response after a trimodality therapy, a predictive factor of long-term survival in locally-advanced esophageal cancer? Results of a retrospective monocentric study. J Visc Surg 2018; 155:365-374. [PMID: 29501383 DOI: 10.1016/j.jviscsurg.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate long-term (5- and 10-year) survival and recurrence rates on the basis of the pathological complete response (pCR) in the specimens of patients with esophageal carcinoma, treated with trimodality therapy. METHODS Between 1993 and 2014, all consecutives patients with esophageal locally-advanced non-metastatic squamous cell carcinoma (SCC) or adenocarcinoma (ADC) who received trimodality therapy were reviewed. According to histopathological analysis, patients were divided in two groups with pCR and with pathological residual tumor (pRT). The primary endpoint was overall survival (OS). The secondary endpoints included the disease-free survival (DFS), the recurrence rate, and the predictive factors of overall survival and recurrence. RESULTS One hundred and three patients were included: 49 patients with pCR and 54 patients with pRT. The median OS was significantly longer in pCR group than in pRT group (132±22.3 vs. 25.5±4 months), with both 5- and 10-years OS rates of 75.2% vs. 29.1%, and 51.1% vs. 13.6%, respectively (P<0.001). Also, pRT, major postoperative complications (Dindo-Clavien grade>IIIb) and recurrence were the 3 independent predictive factors for worse OS. CONCLUSIONS Patients with locally-advanced oesophageal carcinoma, who responded to trimodality therapy with a pCR, could be achieved a 10-year survival rate of 51%.
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Affiliation(s)
- J Francoual
- Department of digestive surgery, University Hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - G Lebreton
- Department of digestive surgery, University Hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - C Bazille
- Department of histopathology, University Hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - M P Galais
- Department of oncology and radiotherapy, University Hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - B Dupont
- Department of hepatogastroenterology, University Hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - A Alves
- Department of digestive surgery, University Hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Inserm UMR 1086, UNICAEN, CEA, CNRS, Centre François Baclesse, CHU de Caen, Normandie University, 3, avenue du Général-Harris, 14045 Caen cedex, France
| | - J Lubrano
- Department of digestive surgery, University Hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Inserm UMR 1086, UNICAEN, CEA, CNRS, Centre François Baclesse, CHU de Caen, Normandie University, 3, avenue du Général-Harris, 14045 Caen cedex, France
| | - R Morello
- Department of biostatistical, Centre Georges-Clemenceau, University Hospital of Caen, 14000 Caen cedex, France
| | - B Menahem
- Department of digestive surgery, University Hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Inserm UMR 1086, UNICAEN, CEA, CNRS, Centre François Baclesse, CHU de Caen, Normandie University, 3, avenue du Général-Harris, 14045 Caen cedex, France
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Abstract
Complications in bariatric surgery are varied; they are severe at times but infrequent. They may be surgical or non-surgical, and may occur early or late. The goal of this systematic review is to inform and help the attending physician, the emergency physician and the non-bariatric surgeon who may be called upon to manage surgical complications that arise after adjustable gastric band (AGB), sleeve gastrectomy (SG), or gastric bypass (GBP). Data from evidence-based medicine were extracted from the literature by a review of the Medline database and also of the most recent recommendations of the learned societies implicated. The main complications were classified for each intervention, and a distinction was made between early and late complications. Early complications after AGB include prosthetic slippage or perforation; SG can be complicated early by staple line leak or fistula, and BPG by fistula, stenosis and postoperative hemorrhage. Delayed complications of AGB include intragastric migration of the prosthesis, late prosthetic slippage and infection, while SG can be complicated by gastro-esophageal reflux, and BPG by anastomotic ulcer and internal hernia. The analysis of available data allowed us to develop decisional algorithms for the management of each of these complications.
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Affiliation(s)
- N Contival
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - B Menahem
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - T Gautier
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - Y Le Roux
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - A Alves
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
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Menahem B, Alves A, Morello R, Lubrano J. Should the rectal defect be closed following transanal local excision of rectal tumors? A systematic review and meta-analysis. Tech Coloproctol 2017; 21:929-936. [PMID: 29134387 DOI: 10.1007/s10151-017-1714-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Transanal local excision (TLE) has become the treatment of choice for benign and early-stage selected malignant tumors. However, closure of the rectal wall defect remains a controversial point and the available literature still remains unclear. Our aim was to determine through a systematic review of the literature and a meta-analysis of relevant studies whether or not the wall defect following TLE of rectal tumors should be closed. METHODS Medline and the Cochrane Trials Register were searched for trials published up to December 2016 comparing open versus closed management of the surgical rectal defect after TLE of rectal tumors. Meta-analysis was performed using Review Manager 5.0. RESULTS Four studies were analyzed, yielding 489 patients (317 in the closed group and 182 in the open group). Meta-analysis showed no significant difference between the closed and open groups regarding the overall morbidity rate (OR 1.26; 95% CI 0.32-4.91; p = 0.74), postoperative local infection rate (OR 0.62; 95% CI 0.23-1.62; p = 0.33), postoperative bleeding rate (OR 0.83; 95% CI 0.29-1.77; p = 0.63), and postoperative reintervention rate (OR 2.21; 95% CI 0.52-9.47; p = 0.29). CONCLUSIONS This review and meta-analysis suggest that there is no difference between closure or non-closure of wall defects after TLE.
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Affiliation(s)
- B Menahem
- Department of Digestive Surgery, Caen University Hospital, Avenue de la Côte de Nacre, 14032, Caen Cedex, France.
- UMR, French National Institute for Health and Medical Research U1086 Cancer and Prevention, The François Baclesse Center, Caen, France.
- UFR of Medicine, Caen, France.
| | - A Alves
- Department of Digestive Surgery, Caen University Hospital, Avenue de la Côte de Nacre, 14032, Caen Cedex, France
- UMR, French National Institute for Health and Medical Research U1086 Cancer and Prevention, The François Baclesse Center, Caen, France
- UFR of Medicine, Caen, France
| | - R Morello
- Department of Digestive Surgery, Caen University Hospital, Avenue de la Côte de Nacre, 14032, Caen Cedex, France
- UFR of Medicine, Caen, France
- Department of Clinical Research and Biostatistics, Caen University Hospital, Caen, France
| | - J Lubrano
- Department of Digestive Surgery, Caen University Hospital, Avenue de la Côte de Nacre, 14032, Caen Cedex, France
- UMR, French National Institute for Health and Medical Research U1086 Cancer and Prevention, The François Baclesse Center, Caen, France
- UFR of Medicine, Caen, France
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Abstract
Although we have seen revolutionary changes with multi-disciplinary management of patients with rectal cancer, the evaluation of genito-urinary sequelae remains of great concern. Precise pre-operative evaluation with validated scores allows detection of urinary disorders in 16 to 23% of patients, and sexual disorders in nearly 35% of men and 50% of women. Regardless of the surgical approach, it is fundamental to respect the autonomic innervation during total mesorectal excision in order to prevent these sequelae. Identification of these nerves can be facilitated by intra-operative neuro-stimulation. In spite of these precautions, de novo urinary sequelae are observed in nearly 33% of patients and bladder evacuation disorders in 25% of patients. Advanced age, pre-operative urinary disorders, female gender, and abdomino-perineal resection are independent risk factors for urinary sequelae. Early post-operative urodynamic abnormalities might be predictive of these sequelae and justify early physiotherapy. Likewise, sexual sequelae such as erectile and/or ejaculatory disorders, dyspareunia and lubrication deficits result in de novo cessation of sexual activity in 28% of men and 18% of women. Advanced age, neo-adjuvant radiation therapy, and abdomino-perineal resection are independent risk factors for sexual dysfunction. Pharmacotherapy with sildenafil has proven useful in the treatment of erectile disorders. Genito-urinary and ano-rectal sequelae occur concomitantly in more than one of ten patients, suggesting a potential common pathophysiology.
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Affiliation(s)
- A Abdelli
- Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France
| | - X Tillou
- Service d'urologie et de transplantation rénale, CHU de Caen, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France
| | - A Alves
- Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France
| | - B Menahem
- Service de chirurgie générale et digestive, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France; UFR de médecine de Caen, 14000 Caen, France.
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Affiliation(s)
- A Mulliri
- Unité chirurgie hépatobiliaire et pancréatique, chirurgie générale Pr. A.-Alves, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France.
| | - B Menahem
- Unité chirurgie hépatobiliaire et pancréatique, chirurgie générale Pr. A.-Alves, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France
| | - J Lubrano
- Unité chirurgie hépatobiliaire et pancréatique, chirurgie générale Pr. A.-Alves, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14032 Caen cedex, France
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Said KA, Leroux Y, Menahem B, Doerfler A, Alves A, Tillou X. Effet de la chirurgie bariatrique sur l’incontinence urinaire et fécale chez les sujets obèses. Prog Urol 2016. [DOI: 10.1016/j.purol.2016.07.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chiche L, Menahem B, Bazille C, Bouvier V, Plard L, Saguet V, Alves A, Salame E. Recurrence of hepatocellular carcinoma in noncirrhotic liver after hepatectomy. World J Surg 2014; 37:2410-8. [PMID: 23775516 DOI: 10.1007/s00268-013-2127-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hepatocellular carcinoma in noncirrhotic liver (HCCNC) is rare. This tumor has a particular epidemiology and presentation, and it requires specific treatment, compared with HCC in cirrhotic liver. The aims of this study were to determine the survival and recurrence rates, prognostic factors, and optimum treatment of HCCNC and to propose a follow-up protocol for patients who have undergone surgery for HCCNC. METHODS This study included 131 patients who underwent surgical treatment for HCCNC from January 1992 to December 2010. Survival and recurrence rates were evaluated, and the prognostic factors and characteristics of recurrence were analyzed. Pathologic characteristics of the tumors and the nontumoral liver were examined. RESULTS The mean survival time was 67.9 months. The 5- and 10-year overall survival rates were 72.9 and 36.7 %, respectively. In all, 54 patients (41.2 %) developed recurrence at a median interval of 30.96 months. Of these recurrences, 31.5 % occurred during the first year, and 24.1 % occurred more than 5 years after surgery. Macro- or microvascular invasion and tumor size >5 cm were significantly associated with a poor survival rate. The predictive factors for recurrence were multiple tumors, tumor diameter >5 cm, and satellite nodules. Patients who underwent surgical treatment for recurrence had a significantly longer survival time than those who did not (p < 0.0292). CONCLUSIONS Recurrence is the most common cause of death after hepatectomy for HCC, and patients should undergo careful, long-term follow-up. Early detection and treatment of recurrence with curative intent should improve the prognosis of these patients.
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Affiliation(s)
- Laurence Chiche
- Department of Digestive Surgery, CHU de Bordeaux, Maison du Haut Lévèque, Avenue de Magellan, 33604 Pessac Cedex, France.
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