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Al Taweel B, Tzedakis S, Panaro F. Early cholecystectomy cannot be regarded as a mortality risk factor in moderate and severe acute biliary pancreatitis. Hepatobiliary Surg Nutr 2024; 13:109-111. [PMID: 38322210 PMCID: PMC10839710 DOI: 10.21037/hbsn-23-593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/17/2023] [Indexed: 02/08/2024]
Affiliation(s)
- Bader Al Taweel
- Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier, Montpellier, France
| | | | - Fabrizio Panaro
- Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier, Montpellier, France
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Toubert C, Guiu B, Al Taweel B, Assenat E, Panaro F, Souche FR, Ursic-Bedoya J, Navarro F, Herrero A. Prolonged Survival after Recurrence in HCC Resected Patients Using Repeated Curative Therapies: Never Give Up! Cancers (Basel) 2022; 15:cancers15010232. [PMID: 36612227 PMCID: PMC9818493 DOI: 10.3390/cancers15010232] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/18/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023] Open
Abstract
Surgical resection is the optimal treatment for HCC, despite a high risk of recurrence. Few data are available on patient’s survival after resection. This is a retrospective study of tumor recurrence occurring after hepatectomy for HCC from 2000 to 2016. Univariate and multivariate analyses were performed to identify prognostic factors of survival after recurrence (SAR). Among 387 patients, 226 recurred (58.4%) with a median SAR of 26 months. Curative treatments (liver transplantation, repeat hepatectomy, thermal ablation) were performed for 44.7% of patients. Independent prognostic factors for SAR were micro-vascular invasion on the primary surgical specimen, size of the initial tumor >5 cm, preoperative AFP, albumin and platelet levels, male gender, number, size and localization of tumors at recurrence, time to recurrence, Child−Pugh score and treatment at recurrence. In subgroup analysis, early recurrence (46%) was associated with a decrease in SAR, by contrast with late recurrence. However, the overall survival (OS) of patients with early recurrence and curative treatment did not significantly differ from that of non-recurring patients. For late recurrence, OS did not significantly differ from that of non-recurring patients, regardless of the proposed treatment. Aggressive and repeat treatments are therefore key to improve prognosis of patients with HCC.
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Affiliation(s)
- Cyprien Toubert
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Boris Guiu
- Department of Digestive Imaging, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
- Correspondence:
| | - Bader Al Taweel
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Eric Assenat
- Department of Digestive Oncology, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Fabrizio Panaro
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - François-Regis Souche
- Department of Minimally Invasive and Oncologic Surgery, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Jose Ursic-Bedoya
- Liver Transplantation Unit, Department of Hepatology, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Francis Navarro
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
| | - Astrid Herrero
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, 34295 Montpellier, France
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Cassese G, Castaldi A, Al Taweel B, Le Quintrec M, Thuret R, Navarro F, Panaro F. Incisional hernia repair after kidney transplantation in a tertiary high-volume center: outcomes from a 10-year retrospective cohort study. Int Urol Nephrol 2022; 54:525-531. [PMID: 35112319 DOI: 10.1007/s11255-021-03101-4] [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] [Received: 12/13/2021] [Accepted: 12/26/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIM Incisional hernia (IH) after Kidney Transplantation (KT) is a challenging complication due to both technical reasons and patients' complexity. Data regarding outcomes of hernia repair in KT recipients are uncertain, since the biggest part of previous papers focused on risk factors for incisional hernia occurrence and not on its outcomes. Aim of the study was to focus on risk factors for incisional hernia recurrence after surgical repair in KT recipients. METHODS Data regarding all consecutive patients undergoing kidney transplantations from January 2011 until September 2020 in Montpellier University Hospital were retrospectively collected from a single institutional database. RESULTS After a median follow-up of 48 months (IQR25-75 31-59), data from 1546 consecutive KT were collected. 83 patients underwent 99 incisional hernia surgeries after KT, with 14 patients that had one recurrence (14.4%) and 2 patients that experienced two recurrences (2.4%). Total recurrence rate was 16.8%. At univariate analysis, the only factor associated with an incisional hernia recurrence was having undergone to at least one previous abdominal surgery other than KT (p value 0.002). Overall morbidity was 15% (n = 15), with most of complications classified as mild (59%). No mortality related to incisional hernia repair occurred. CONCLUSION IHs after KT represent an important condition. Its surgical management is challenging due to its anatomical complexity and patient's status. This is the largest sample size in the literature of patients treated for IH after KT and it shows that a previous surgery other than the KT is a risk factor for hernia recurrence after surgical repair, without regarding surgical technique or other comorbidity and therapeutical factors.
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Affiliation(s)
- Gianluca Cassese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Castaldi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.,Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France
| | - Bader Al Taweel
- Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France
| | - Moglie Le Quintrec
- Department of Nephrology and Kidney Transplantation, Montpellier University Hospital, Montpellier, France
| | - Rodolphe Thuret
- Department of Urology and Kidney Transplantation, Montpellier University Hospital, Montpellier, France
| | - Francis Navarro
- Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France
| | - Fabrizio Panaro
- Department of HPB Surgery and Liver Transplantation, Montpellier University Hospital-School of Medicine, 34000, Montpellier, France.
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Richardson GE, Mustafa MA, Gillespie CS, Keshwara SM, Taweel BA, Millward CP, Islim AI, Jenkinson MD. P14.66 Re-operation for recurrent meningioma - are we helping patients? Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Meningioma is the commonest primary brain tumour. Despite surgery, meningiomas can recur. Surgery is usually the first line treatment for recurrent meningioma. The aim was to determine the risk factors associated with clinical outcomes (performance status, morbidity, mortality, recurrence) following re-operation for recurrence of intracranial meningioma.
MATERIAL AND METHODS
Retrospective cohort study (1998–2018). Eligible patients had reoperation for local recurrence of a previously operated meningioma. Collected data included baseline clinical and imaging characteristic. Primary outcome measure was performance status after each reoperation. Secondary outcome measures were medical and surgical morbidity, recurrence-free survival (RFS) and overall survival (OS).
RESULTS
Fifty-eight patients were eligible (37 female, mean age at 1st re-operation 56.1 years (SD=11.6)). Eleven patients (19.6%) had 2 re-operations and 3 patients (5.4%) had 3 re-operations. Median follow up was 128.5 months (IQR=73–194.5). Median time to 1st recurrence and 1st re-operation were 36.5 (IQR=24.3–81.0) and 43.8 months (IQR=20.3–103.4), respectively. Fifteen patients (26.8%) had worse performance status after 1st reoperation, compared to 5.4% (n=3) after the primary operation. Complication rate was 32.1% (n=18) after the primary operation compared to 48.2% (n=27) after 1st reoperation. At primary operation, there were 29 (51.8%) grade 1, 24 (42.9%) grade 2, and 1 (1.8%) grade 3 tumours. Median RFS after first re-operation was 36.5 months (95% CI 29.3–43.9). Median OS was 312 months (95 % CI 257.8–366.2). Increased number of post-operative complications were a risk factor for worsened performance status following reoperation (OR 2.2 [95% CI 1.1–4.6], P=0.029).
CONCLUSION
Re-operation is associated with a worse performance status and increased risk of complications. Re-operating meningiomas for radiological recurrence without symptoms increases patient morbidity. Shared-care management decision should be made with patients when considering operating for radiological recurrence only.
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Affiliation(s)
| | - M A Mustafa
- University of Liverpool, Liverpool, United Kingdom
| | | | - S M Keshwara
- University of Liverpool, Liverpool, United Kingdom
| | - B A Taweel
- University of Liverpool, Liverpool, United Kingdom
| | - C P Millward
- University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A I Islim
- University of Liverpool, Liverpool, United Kingdom
| | - M D Jenkinson
- University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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Gillespie CS, Richardson GE, Mustafa MA, Islim AI, Keshwara SM, Taweel BA, Bakhsh A, Kumar S, Millward CP, Mehta S, Rathi N, Chavredakis E, Brodbelt AR, Mills SJ, Jenkinson MD. P14.02 The Natural History of a Residual Intracranial Meningioma- Volumetric Growth and Predictors of Progression. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Resection of meningioma leaves residual solid tumour in ~25% of patients. Selection for further treatment and follow-up strategy may benefit from knowledge of volumetric growth and associated prognostic factors.
MATERIAL AND METHODS
Growth rates were assessed using a linear mixed effects model, in a retrospective adult cohort that underwent subtotal resection of meningioma (2004–2018). Endpoints were re-treatment, end of follow-up or death. Cox regression analysis was used to identify prognostic factors for progression, defined using the Response Assessment in Neuro-Oncology (RANO) volumetric criteria.
RESULTS
236 patients were included. Mean age at surgery was 56.3 years (SD=13.7) and 73.7% were female. WHO grades were 1 (n=195, 82.6%), 2 (n=40, 16.9%) and 3 (n=1, 0.5%). Adjuvant fractionated radiotherapy (fRT) was administered to 34 patients (14.4%), with no propensity towards higher WHO grade or residual volume. Median pre-operative meningioma and post-operative residual volumes were 34.0cm3 (IQR 16.0–63.0) and 2.0cm3 (IQR 0.8–5.2), respectively. Median follow-up was 64 months (IQR 42–104). Median absolute growth rate (AGR) and relative growth rate (RGR) were 0.1cm3/year and 4.3%/year, respectively. According to RANO criteria, 132 (55.9%) patients progressed, of which 13 (9.8%) developed symptoms. Median progression-free survival was 56 months (95% CI 43.1–69.0). Multivariable analysis identified adjuvant fRT (HR 1.7, [95% CI 1.0–2.8], P=0.046), skull base location (HR 1.5, [95% CI 1.0–2.4], P=0.047) and Ki-67 index (HR 3.7 [95% CI 1.3–10.8], P=0.017) as prognostic factors for volumetric progression. WHO grade was not significant (HR 1.0, [95% CI 0.5–1.7], P=0.905). Forty-nine patients who progressed (37.1%) underwent further treatment: fRT (n=19), re-operation (n=15), Stereotactic radiosurgery (SRS) (n=10) and surgery+adjuvant fRT (n=5). Of those, 8 (16.3%) progressed further (after re-operation [n=6] and SRS [n=2]). Seven were treated with a 2nd re-operation (n=3), fRT (n=3), and SRS (n=1). One patient progressed after a 2nd reoperation and was treated with SRS, after which they remained stable. Median survival was not reached. 5- and 10-year overall survival (OS) was 96% and 86% respectively.
CONCLUSION
Growth rates of a residual meningioma vary with a dichotomy observed in progression rates. Half of patients with a residual meningioma showed radiological progression requiring multiple treatment to control the tumour. The other half demonstrate a more indolent course. Skull base location and higher Ki67 are important prognostic factors for progression and therefore, should be considered to stratify patients for adjuvant radiotherapy.
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Affiliation(s)
- C S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - G E Richardson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - M A Mustafa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - A I Islim
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - S M Keshwara
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - B A Taweel
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - A Bakhsh
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S Kumar
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - C P Millward
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S Mehta
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - N Rathi
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - E Chavredakis
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A R Brodbelt
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S J Mills
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - M D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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Panaro F, Al Taweel B, Leon P, Ghinolfi D, Testa G, Kalisvaart M, Muiesan P, Romagnoli R, Lesurtel M, Cassese G, Truant S, Addeo P, Sainz-Barrica M, Baccarani U, De Simone P, Belafia F, Herrero A, Navarro F. Morbidity and mortality of iatrogenic hemothorax occurring in a cohort of liver transplantation recipients: a multicenter observational study. Updates Surg 2021; 73:1727-1734. [PMID: 34216370 PMCID: PMC8254062 DOI: 10.1007/s13304-021-01098-0] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/19/2021] [Indexed: 12/14/2022]
Abstract
Hemothorax (HT) is a life-threatening condition, mainly iatrogenic and poorly explored in Liver Transplantation (LT) recipients. The aim of this study is to report and analyze for the first time incidence and outcomes of HT in LT recipients, as well as to suggest a management strategy. Data concerning 7130 consecutive adult liver and liver-kidney transplant recipients were retrospectively collected from ten Transplantation Centers' institutional databases, over a 10-year period. Clinical parameters, management strategies and survival data about post-operative HT were analyzed and reported. Thirty patients developed HT during hospitalization (0.42%). Thoracentesis was found to be the most common cause of HT (16 patients). A non-surgical management was performed in 17 patients, while 13 patients underwent surgery. 19 patients developed thoracic complications after HT treatment, with an overall mortality rate of 50%. The median length of stay in Intensive Care Units was 22 days (IQR25-75 5-66.5). Postoperative hemothorax is mainly due to iatrogenic causes in LT recipients. Despite rare, it represents a serious complication with a high mortality rate and a challenging medical and surgical management. Its occurrence should always be prevented.
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Affiliation(s)
- Fabrizio Panaro
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France. .,Division of HBP Surgery and Transplantation, Department of Surgery, St. Eloi Hospital, Montpellier University Hospital-School of Medicine, 80 Avenue Augustin Fliche, 34090, Montpellier, France.
| | - Bader Al Taweel
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
| | - Piera Leon
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
| | - Davide Ghinolfi
- Division of Transplantation, Department of Surgery, Pisa University Hospital, Pisa, Italy
| | - Giuliano Testa
- Liver Transplantation Unit, Department of Surgery, Baylor University Hospital, Dallas, TX, USA
| | | | - Paolo Muiesan
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Renato Romagnoli
- Liver Transplantation Unit, Department of Surgery, Turin University Hospital, Turin, Italy
| | - Mickael Lesurtel
- Division of Liver Transplantation, Department of Surgery, Lyon University Hospital, Lyon, France
| | - Gianluca Cassese
- HPB Surgery Unit, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Stephanie Truant
- Division of Transplantation, Department of Surgery, Lille University Hospital, Lille, France
| | - Pietro Addeo
- Department of Surgery, HPB Surgery and Liver Transplantation, Hôpital de Hautepierre, University Hospital, Strasbourg, France
| | - Mauricio Sainz-Barrica
- Division of Transplantation, Department of Surgery, Leuven University Hospital, Leuven, Belgium
| | - Umberto Baccarani
- Division of Transplantation, Department of Surgery, Udine University Hospital, Udine, Italy
| | - Paolo De Simone
- Division of Transplantation, Department of Surgery, Pisa University Hospital, Pisa, Italy
| | - Fouad Belafia
- Department of ICU, Montpellier University Hospital, 34070, Montpellier, France
| | - Astrid Herrero
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
| | - Francis Navarro
- Division of Digestive Surgery and Transplantation, Department of Surgery, Montpellier University Hospital, 34070, Montpellier, France
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