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van Bodegraven EA, van Ramshorst TME, Bratlie SO, Kokkola A, Sparrelid E, Björnsson B, Kleive D, Burgdorf SK, Dokmak S, Groot Koerkamp B, Cabús SS, Molenaar IQ, Boggi U, Busch OR, Petrič M, Roeyen G, Hackert T, Lips DJ, D'Hondt M, Coolsen MME, Ferrari G, Tingstedt B, Serrablo A, Gaujoux S, Ramera M, Khatkov I, Ausania F, Souche R, Festen S, Berrevoet F, Keck T, Sutcliffe RP, Pando E, de Wilde RF, Aussilhou B, Krohn PS, Edwin B, Sandström P, Gilg S, Seppänen H, Vilhav C, Abu Hilal M, Besselink MG. Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study. Int J Surg 2024:01279778-990000000-01209. [PMID: 38498397 DOI: 10.1097/js9.0000000000001315] [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] [Received: 12/11/2023] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND International guidelines recommend monitoring of the use and outcome of minimally invasive pancreatic surgery (MIPS). However, data from prospective international audits on minimally invasive distal pancreatectomy (MIDP) are lacking. This study examined the use and outcome of robot-assisted (RDP) and laparoscopic (LDP) distal pancreatectomy in the E-MIPS registry. MATERIALS AND METHODS Post-hoc analysis in a prospective audit on MIPS, including consecutive patients undergoing MIDP in 83 centers from 19 European countries (01-01-2019/31-12-2021). Primary outcomes included intraoperative events (grade 1: excessive blood loss, grade 2: conversion/change in operation, grade 3: intraoperative death), major morbidity, and in-hospital/30-day mortality. Multivariable logistic regression analyses identified high-risk groups for intraoperative events. RDP and LDP were compared in the total cohort and in high-risk groups. RESULTS Overall, 1672 patients undergoing MIDP were included; 606 (36.2%) RDP and 1066 (63.8%) LDP. The annual use of RDP increased from 30.5% to 42.6% (P<0.001). RDP was associated with fewer grade 2 intraoperative events compared to LDP (9.6% vs. 16.8%, P<0.001), with longer operating time (238 vs. 201 minutes,P<0.001). No significant differences were observed between RDP and LDP regarding major morbidity (23.4% vs. 25.9%, P=0.264) and in-hospital/30-day mortality (0.3% vs. 0.8%, P=0.344). Three high-risk groups were identified; BMI>25 kg/m2, previous abdominal surgery, and vascular involvement. In each group, RDP was associated with fewer conversions and longer operative times. CONCLUSION This European registry-based study demonstrated favorable outcomes for MIDP, with mortality rates below 1%. LDP remains the predominant approach, whereas the use of RDP is increasing. RDP was associated with less conversions and longer operative time, including in high-risk subgroups. Future randomized trials should confirm these findings and assess cost differences.
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Affiliation(s)
- Eduard A van Bodegraven
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Tess M E van Ramshorst
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, the Netherlands
- Cancer Center Amsterdam, the Netherlands
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Svein O Bratlie
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Arto Kokkola
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Dyre Kleive
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - Stefan K Burgdorf
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Safi Dokmak
- Departement of HPB surgery and liver transplantation, APHP Beaujon Hospital - University of Paris Cité, Clichy, France
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | | | - I Quintus Molenaar
- Department of Surgery, Regional Academic Cancer Centre Utrecht, UMC Utrecht Cancer Centre and St Antonius Hospital Nieuwegein, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ugo Boggi
- Division of General and Transplant surgery, University of Pisa, Pisa, Italy
| | - Olivier R Busch
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, the Netherlands
- Cancer Center Amsterdam, the Netherlands
| | - Miha Petrič
- Department of Abdominal Surgery, Ljubljana University Medical Center, Zaloška cesta 7, 1000, Ljubljana, Slovenia
| | - Geert Roeyen
- Department of HPB, Endocrine and Transplantation Surgery, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium and University of Antwerp, Wilrijk, Belgium
| | - Thilo Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Daan J Lips
- Department of Surgery, Medisch Spectrum Twente, Enschede, Netherland
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Mariëlle M E Coolsen
- Department of Surgery, Maastricht University Medical Center+ , University of Maastricht , Maastricht, the Netherlands
| | - Giovanni Ferrari
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Bobby Tingstedt
- Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Alejandro Serrablo
- HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain
| | - Sebastien Gaujoux
- Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, FRANCE
| | - Marco Ramera
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Igor Khatkov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Fabio Ausania
- Department of HPB and Transplant Surgery, Hospital Clinic, IDIBAPS, University of Barcelona, Spain
| | - Regis Souche
- Department of Surgery, Saint-Éloi Hospital, Montpellier, France
| | | | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Tobias Keck
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elizabeth Pando
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Roeland F de Wilde
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Beatrice Aussilhou
- Departement of HPB surgery and liver transplantation, APHP Beaujon Hospital - University of Paris Cité, Clichy, France
| | - Paul S Krohn
- Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - Per Sandström
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Stefan Gilg
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Seppänen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Caroline Vilhav
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marc G Besselink
- Amsterdam UMC, location University of Amsterdam, Department of Surgery, the Netherlands
- Cancer Center Amsterdam, the Netherlands
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Emmen AM, de Graaf N, Khatkov I, Busch O, Dokmak S, Boggi U, Groot Koerkamp B, Ferrari G, Molenaar I, Saint-Marc O, Ramera M, Lips DJ, Mieog J, Luyer MD, Keck T, D’Hondt M, Souche F, Edwin B, Hackert T, Liem M, Iben-Khayat A, van Santvoort H, Mazzola M, de Wilde RF, Kauffmann E, Aussilhou B, Festen S, Izrailov R, Tyutyunnik P, Besselink M, Abu Hilal M. Implementation and outcome of minimally invasive pancreatoduodenectomy in Europe: a registry-based retrospective study A critical appraisal of the first 3 years of the E-MIPS registry. Int J Surg 2024; 110:01279778-990000000-01012. [PMID: 38265434 PMCID: PMC11019999 DOI: 10.1097/js9.0000000000001121] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND International multicenter audit-based studies focusing on the outcome of minimally invasive pancreatoduodenectomy (MIPD) are lacking. The European registry for Minimally Invasive Pancreatic Surgery (E-MIPS) is the E-AHPBA endorsed registry aimed to monitor and safeguard the introduction of MIPD in Europe. MATERIALS AND METHODS A planned analysis of outcomes among consecutive patients after MIPD from 45 centers in 14 European countries in the E-MIPS registry (2019-2021). Main outcomes of interest were major morbidity (Clavien-Dindo grade ≥3) and 30-day/in-hospital mortality. RESULTS Overall, 1,336 patients after MIPD were included (835 robot-assisted (R-MIPD) and 501 laparoscopic MIPD (L-MIPD)). Overall, 20 centers performed R-MIPD, 15 centers L-MIPD, and 10 centers both. Between 2019 and 2021, the rate of centers performing L-MIPD decreased from 46.9% to 25%, whereas for R-MIPD this increased from 46.9% to 65.6%. Overall, the rate of major morbidity was 41.2%, 30-day/in-hospital mortality 4.5%, conversion rate 9.7%, POPF grade B/C 22.7%, and PPH grade B/C 10.8%. Median length of hospital stay was 12 days [IQR 8-21]. A lower rate of major morbidity, POPF grade B/C, PPH grade BH/C, DGE grade B/C, percutaneous drainage and readmission was found after L-MIPD. The number of centers meeting the Miami Guidelines volume cut-off of ≥20 MIPDs annually increased from 9 (28.1%) in 2019 to 12 (37.5%) in 2021 (P=0.424). Rates of conversion (7.4% vs. 14.8% P<0.001) and reoperation (8.9% vs. 15.1%) P<0.001) were lower in centers which fulfilled the Miami volume cut-off. CONCLUSION During the first 3 years of the pan-European E-MIPS registry, morbidity and mortality rates after MIPD were acceptable. A shift is ongoing from L-MIPD to R-MIPD. Variations in outcomes between the two minimally invasive approaches and the impact of the volume-cut-off should be further evaluated over a longer time period.
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Affiliation(s)
- Anouk M.L.H. Emmen
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia
- Department of Surgery, Amsterdam UMC, University of Amsterdam
- Cancer Center Amsterdam
| | - Nine de Graaf
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia
- Department of Surgery, Amsterdam UMC, University of Amsterdam
- Cancer Center Amsterdam
| | - I.E. Khatkov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - O.R. Busch
- Department of Surgery, Amsterdam UMC, University of Amsterdam
- Cancer Center Amsterdam
| | - S. Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris Cité, Clichy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa
| | | | - Giovanni Ferrari
- Department of Oncological and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - I.Q. Molenaar
- Department of Surgery, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Olivier Saint-Marc
- Service de Chirurgie Digestive, Endocrinienne et Thoracique, Centre Hospitalier Universitaire Orleans, Orleans
| | - Marco Ramera
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia
| | - Daan J. Lips
- Department of Surgery, Medisch Spectrum Twente, Enschede
| | - J.S.D. Mieog
- Department of Surgery, Leiden University Medical Center, Leiden
| | | | - Tobias Keck
- Clinic for Surgery, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Mathieu D’Hondt
- Department of Surgery, AZ Groeninge Hospital, Kortrijk, Belgium
| | - F.R. Souche
- Département de Chirurgie Digestive (A), Mini-invasive et Oncologique, Hôpital Saint-Eloi, Montpellier, France
| | - Bjørn Edwin
- The Intervention Centre and Department of HPB Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - Thilo Hackert
- Department of General, Visceral, and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg
| | - M.S.L. Liem
- Department of Surgery, Medisch Spectrum Twente, Enschede
| | - Abdallah Iben-Khayat
- Service de Chirurgie Digestive, Endocrinienne et Thoracique, Centre Hospitalier Universitaire Orleans, Orleans
| | | | - Michele Mazzola
- Department of Oncological and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - E.F. Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Pisa
| | - Beatrice Aussilhou
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris Cité, Clichy
| | | | - R. Izrailov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - P. Tyutyunnik
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - M.G. Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam
- Cancer Center Amsterdam
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia
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Malgras B, Dokmak S, Aussilhou B, Pocard M, Sauvanet A. Management of postoperative pancreatic fistula after pancreaticoduodenectomy. J Visc Surg 2023; 160:39-51. [PMID: 36702720 DOI: 10.1016/j.jviscsurg.2023.01.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A postoperative pancreatic fistula (POPF) is the main complication after cephalic pancreaticoduodenectomy (CPD). Unlike its prevention, the curative management of POPFs has long been poorly codified. This review seeks best practices for managing POPFs after CPD. The diagnosis of a POPF is based on two signs: (i) an amylase level in drained fluid more than 3 times the upper limit of the blood amylase level; and (ii) an abnormal clinical course. In the standardised definition of the International Study Group of Pancreatic Surgery, a purely biochemical fistula is no longer counted as a POPF and is treated by gradual withdrawal of the drain over at most 3 weeks. POPF risk can be scored using pre- and intraoperative clinical criteria, many of which are related to the quality of the pancreatic parenchyma and are common to several scoring systems. The prognostic value of these scores can be improved as early as Day 1 by amylase assays in blood and drained fluid. Recent literature, including in particular the Dutch randomised trial PORSCH, argues for early systematic detection of a POPF (periodic assays, CT-scan with injection indicated on standardised clinical and biological criteria plus an opinion from a pancreatic surgeon), for rapid minimally invasive treatment of collections (percutaneous drainage, antibiotic therapy indicated on standardised criteria) to forestall severe septic and/or haemorrhagic forms, and for the swift withdrawal of abdominal drains when the risk of a POPF is theoretically low and evolution is favourable. A haemorrhage occurring after Day 1 always requires CT angiography with arterial time and monitoring in intensive care. Minimally invasive treatment of a POPF (radiologically-guided percutaneous drainage or, more rarely, endoscopic drainage, arterial embolisation) should be preferred as first-line treatment. The addition of artificial nutrition (enteral via a nasogastric or nasojejunal tube, or parenteral) is most often useful. If minimally invasive treatment fails, then reintervention is indicated, preserving the remaining pancreas if possible, but the expected mortality is higher.
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Affiliation(s)
- B Malgras
- Digestive and endocrine surgery department, Bégin Army Training Hospital, 69, avenue de Paris, 94160 Saint-Mandé, France; Val de Grâce School, 1, place Alphonse-Lavéran, 75005 Paris, France
| | - S Dokmak
- Hepatobiliary and pancreatic surgery department, Paris-Cité University, Beaujon Hospital, AP-HP, 92110 Clichy, France
| | - B Aussilhou
- Hepatobiliary and pancreatic surgery department, Paris-Cité University, Beaujon Hospital, AP-HP, 92110 Clichy, France
| | - M Pocard
- Department of pancreatic and hepatobiliary digestive surgery and liver transplantation, Pitié Salpêtrière Hospital, 41-83, boulevard de l'Hôpital, 75013 Paris, France; UMR 1275 CAP Paris-Tech, Paris-Cité University, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France
| | - A Sauvanet
- Hepatobiliary and pancreatic surgery department, Paris-Cité University, Beaujon Hospital, AP-HP, 92110 Clichy, France.
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Affiliation(s)
- S Dokmak
- Department of HPB surgery and liver transplantation, Beaujon Hospital, University Paris 7 Denis Diderot, Assistance publique-Hôpitaux de Paris, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
| | - B Aussilhou
- Department of HPB surgery and liver transplantation, Beaujon Hospital, University Paris 7 Denis Diderot, Assistance publique-Hôpitaux de Paris, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - F Samir Ftériche
- Department of HPB surgery and liver transplantation, Beaujon Hospital, University Paris 7 Denis Diderot, Assistance publique-Hôpitaux de Paris, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - O Soubrane
- Department of HPB surgery and liver transplantation, Beaujon Hospital, University Paris 7 Denis Diderot, Assistance publique-Hôpitaux de Paris, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - A Sauvanet
- Department of HPB surgery and liver transplantation, Beaujon Hospital, University Paris 7 Denis Diderot, Assistance publique-Hôpitaux de Paris, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Affiliation(s)
- S Dokmak
- Department of hepato-bilio-pancreatic surgery and liver transplantation, Beaujon hospital, university Paris 7 Denis Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
| | - B Aussilhou
- Department of hepato-bilio-pancreatic surgery and liver transplantation, Beaujon hospital, university Paris 7 Denis Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - F S Ftériche
- Department of hepato-bilio-pancreatic surgery and liver transplantation, Beaujon hospital, university Paris 7 Denis Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - O Soubrane
- Department of hepato-bilio-pancreatic surgery and liver transplantation, Beaujon hospital, university Paris 7 Denis Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - A Sauvanet
- Department of hepato-bilio-pancreatic surgery and liver transplantation, Beaujon hospital, university Paris 7 Denis Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Aussilhou B, Dokmak S, Dondero F, Joly D, Durand F, Soubrane O, Belghiti J. Treatment of polycystic liver disease. Update on the management. J Visc Surg 2018; 155:471-481. [DOI: 10.1016/j.jviscsurg.2018.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Mohkam K, Farges O, Vibert E, Soubrane O, Adam R, Pruvot FR, Regimbeau JM, Adham M, Boleslawski E, Mabrut JY, Ducerf C, Pradat P, Darnis B, Cazauran JB, Lesurtel M, Dokmak S, Aussilhou B, Dondero F, Allard MA, Ciacio O, Pittau G, Cherqui D, Castaing D, Sa Cunha A, Truant S, Hardwigsen J, Le Treut YP, Grégoire E, Scatton O, Brustia R, Sepulveda A, Cosse C, Laurent C, Adam JP, El Bechwaty M, Perinel J. Risk score to predict biliary leakage after elective liver resection. Br J Surg 2017; 105:128-139. [DOI: 10.1002/bjs.10647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 05/29/2017] [Accepted: 06/11/2017] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Biliary leakage remains a major cause of morbidity after liver resection. Previous prognostic studies of posthepatectomy biliary leakage (PHBL) lacked power, population homogeneity, and model validation. The present study aimed to develop a risk score for predicting severe PHBL.
Methods
In this multicentre observational study, patients who underwent liver resection without hepaticojejunostomy in one of nine tertiary centres between 2012 and 2015 were randomly assigned to a development or validation cohort in a 2 : 1 ratio. A model predicting severe PHBL (International Study Group of Liver Surgery grade B/C) was developed and further validated.
Results
A total of 2218 procedures were included. PHBL of any severity and severe PHBL occurred in 141 (6·4 per cent) and 92 (4·1 per cent) patients respectively. In the development cohort (1475 patients), multivariable analysis identified blood loss of at least 500 ml, liver remnant ischaemia time 45 min or more, anatomical resection including segment VIII, transection along the right aspect of the left intersectional plane, and associating liver partition and portal vein ligation for staged hepatectomy as predictors of severe PHBL. A risk score (ranging from 0 to 5) was built using the development cohort (area under the receiver operating characteristic curve (AUROC) 0·79, 95 per cent c.i. 0·74 to 0·85) and tested successfully in the validation cohort (AUROC 0·70, 0·60 to 0·80). A score of at least 3 predicted an increase in severe PHBL (19·4 versus 2·6 per cent in the development cohort, P < 0·001; 15 versus 3·1 per cent in the validation cohort, P < 0·001).
Conclusion
The present risk score reliably predicts severe PHBL. It represents a multi-institutionally validated prognostic tool that can be used to identify a subset of patients at high risk of severe PHBL after elective hepatectomy.
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Affiliation(s)
- K Mohkam
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Ecole Doctorale Interdisciplinaire Sciences Santé 205 – Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon, France
| | - O Farges
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - E Vibert
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France
| | - O Soubrane
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, France
| | - R Adam
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Villejuif, France
| | - F-R Pruvot
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France
| | - J-M Regimbeau
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - M Adham
- Department of Hepatopancreatobiliary Surgery, Hôpital Edouard Herriot, Lyon, France
| | - E Boleslawski
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France
| | - J-Y Mabrut
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Ecole Doctorale Interdisciplinaire Sciences Santé 205 – Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon, France
| | - C Ducerf
- Hôpital de la Croix-Rousse, Lyon, France
| | - P Pradat
- Hôpital de la Croix-Rousse, Lyon, France
| | - B Darnis
- Hôpital de la Croix-Rousse, Lyon, France
| | | | - M Lesurtel
- Hôpital de la Croix-Rousse, Lyon, France
| | | | | | | | | | - O Ciacio
- Hôpital Paul Brousse, Villejuif, France
| | - G Pittau
- Hôpital Paul Brousse, Villejuif, France
| | - D Cherqui
- Hôpital Paul Brousse, Villejuif, France
| | | | | | - S Truant
- Hôpital Claude Huriez, Lille, France
| | | | | | | | - O Scatton
- Hôpital de la Pitié-Salpétrière, Paris, France
| | - R Brustia
- Hôpital de la Pitié-Salpétrière, Paris, France
| | - A Sepulveda
- Hôpital de la Pitié-Salpétrière, Paris, France
| | - C Cosse
- Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - C Laurent
- Hôpital Haut-Lévêque, Bordeaux, France
| | - J-P Adam
- Hôpital Haut-Lévêque, Bordeaux, France
| | | | - J Perinel
- Hôpital Edouard Herriot, Lyon, France
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Dokmak S, Meniconi RL, Aussilhou B. Laparoscopic left hepatectomy with hanging maneuver for hepatocellular carcinoma with thrombectomy of the left portal vein (with video). J Visc Surg 2017; 154:213-215. [PMID: 28161009 DOI: 10.1016/j.jviscsurg.2016.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- S Dokmak
- Department of HPB Surgery and liver transplantation, Beaujon Hospital, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
| | - R L Meniconi
- Department of HPB Surgery and liver transplantation, Beaujon Hospital, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - B Aussilhou
- Department of HPB Surgery and liver transplantation, Beaujon Hospital, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Dokmak S, Aussilhou B, Ftériche FS, de Chaumont A, Malgras B, Belghiti J, Sauvanet A. Laparoscopic pancreaticoduodenectomy: How I do it? (with video). J Visc Surg 2015; 152:393-4. [PMID: 26476676 DOI: 10.1016/j.jviscsurg.2015.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Dokmak
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
| | - B Aussilhou
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - F S Ftériche
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - A de Chaumont
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - B Malgras
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - J Belghiti
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - A Sauvanet
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Hentic O, Cros J, Zappa M, Rebours V, Dokmak S, Aussilhou B, Dreyer C, Levy P, Maire F, Couvelard A, Sauvanet A, Ruszniewski PB, Hammel P. Gemcitabine-oxaliplatin (GemOx) combination followed by chemoradiotherapy (CRT) in borderline pancreatic adenocarcinoma (BPC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Jerome Cros
- Pathology Department, Hopital Beaujon, Clichy, France
| | - Magaly Zappa
- Department of Radiology, Beaujon University Hospital, Clichy, France
| | | | - Safi Dokmak
- HBP Surgery, Hôpital Beaujon, Clichy, France
| | | | - Chantal Dreyer
- Department of Medical Oncology, Beaujon University Hospital, Clichy, France
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Safeukui I, Buffet PA, Perrot S, Sauvanet A, Aussilhou B, Dokmak S, Couvelard A, Hatem DC, Mohandas N, David PH, Mercereau-Puijalon O, Milon G. Surface area loss and increased sphericity account for the splenic entrapment of subpopulations of Plasmodium falciparum ring-infected erythrocytes. PLoS One 2013; 8:e60150. [PMID: 23555907 PMCID: PMC3610737 DOI: 10.1371/journal.pone.0060150] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 02/21/2013] [Indexed: 11/19/2022] Open
Abstract
Ex vivo perfusion of human spleens revealed innate retention of numerous cultured Plasmodium falciparum ring-infected red blood cells (ring-iRBCs). Ring-iRBC retention was confirmed by a microsphiltration device, a microbead-based technology that mimics the mechanical filtering function of the human spleen. However, the cellular alterations underpinning this retention remain unclear. Here, we use ImageStream technology to analyze infected RBCs’ morphology and cell dimensions before and after fractionation with microsphiltration. Compared to fresh normal RBCs, the mean cell membrane surface area loss of trophozoite-iRBCs, ring-iRBCs and uninfected co-cultured RBCs (uRBCs) was 14.2% (range: 8.3–21.9%), 9.6% (7.3–12.2%) and 3.7% (0–8.4), respectively. Microsphilters retained 100%, ∼50% and 4% of trophozoite-iRBCs, ring-iRBCs and uRBCs, respectively. Retained ring-iRBCs display reduced surface area values (estimated mean, range: 17%, 15–18%), similar to the previously shown threshold of surface-deficient RBCs retention in the human spleen (surface area loss: >18%). By contrast, ring-iRBCs that successfully traversed microsphilters had minimal surface area loss and normal sphericity, suggesting that these parameters are determinants of their retention. To confirm this hypothesis, fresh normal RBCs were exposed to lysophosphatidylcholine to induce a controlled loss of surface area. This resulted in a dose-dependent retention in microsphilters, with complete retention occurring for RBCs displaying >14% surface area loss. Taken together, these data demonstrate that surface area loss and resultant increased sphericity drive ring-iRBC retention in microsphilters, and contribute to splenic entrapment of a subpopulation of ring-iRBCs. These findings trigger more interest in malaria research fields, including modeling of infection kinetics, estimation of parasite load, and analysis of risk factors for severe clinical forms. The determination of the threshold of splenic retention of ring-iRBCs has significant implications for diagnosis (spleen functionality) and drug treatment (screening of adjuvant therapy targeting ring-iRBCs).
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Affiliation(s)
- Innocent Safeukui
- Institut Pasteur, Immunologie Moléculaire des Parasites, Département de Parasitologie Mycologie, Paris, France.
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Safeukui I, Buffet PA, Perrot S, Sauvanet A, Aussilhou B, Dokmak S, Couvelard A, Hatem DC, Mohandas N, David PH, Mercereau-Puijalon O, Milon G. Surface area loss and increased sphericity account for the splenic entrapment of subpopulations of Plasmodium falciparum ring-infected erythrocytes. PLoS One 2013. [PMID: 23555907 DOI: 10.1371/joumal.pone.0060150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023] Open
Abstract
Ex vivo perfusion of human spleens revealed innate retention of numerous cultured Plasmodium falciparum ring-infected red blood cells (ring-iRBCs). Ring-iRBC retention was confirmed by a microsphiltration device, a microbead-based technology that mimics the mechanical filtering function of the human spleen. However, the cellular alterations underpinning this retention remain unclear. Here, we use ImageStream technology to analyze infected RBCs' morphology and cell dimensions before and after fractionation with microsphiltration. Compared to fresh normal RBCs, the mean cell membrane surface area loss of trophozoite-iRBCs, ring-iRBCs and uninfected co-cultured RBCs (uRBCs) was 14.2% (range: 8.3-21.9%), 9.6% (7.3-12.2%) and 3.7% (0-8.4), respectively. Microsphilters retained 100%, ∼50% and 4% of trophozoite-iRBCs, ring-iRBCs and uRBCs, respectively. Retained ring-iRBCs display reduced surface area values (estimated mean, range: 17%, 15-18%), similar to the previously shown threshold of surface-deficient RBCs retention in the human spleen (surface area loss: >18%). By contrast, ring-iRBCs that successfully traversed microsphilters had minimal surface area loss and normal sphericity, suggesting that these parameters are determinants of their retention. To confirm this hypothesis, fresh normal RBCs were exposed to lysophosphatidylcholine to induce a controlled loss of surface area. This resulted in a dose-dependent retention in microsphilters, with complete retention occurring for RBCs displaying >14% surface area loss. Taken together, these data demonstrate that surface area loss and resultant increased sphericity drive ring-iRBC retention in microsphilters, and contribute to splenic entrapment of a subpopulation of ring-iRBCs. These findings trigger more interest in malaria research fields, including modeling of infection kinetics, estimation of parasite load, and analysis of risk factors for severe clinical forms. The determination of the threshold of splenic retention of ring-iRBCs has significant implications for diagnosis (spleen functionality) and drug treatment (screening of adjuvant therapy targeting ring-iRBCs).
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Affiliation(s)
- Innocent Safeukui
- Institut Pasteur, Immunologie Moléculaire des Parasites, Département de Parasitologie Mycologie, Paris, France.
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Gauss T, Merckx P, Brasher C, Kavafyan J, Le Bihan E, Aussilhou B, Belghiti J, Mantz J. Deviation from a preoperative surgical and anaesthetic care plan is associated with increased risk of adverse intraoperative events in major abdominal surgery. Langenbecks Arch Surg 2012; 398:277-85. [PMID: 23149461 DOI: 10.1007/s00423-012-1028-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 10/29/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perioperative coordination facilitates team communication and planning. The aim of this study was to determine how often deviation from predicted surgical conditions and a pre-established anaesthetic care plan in major abdominal surgery occurred, and whether this was associated with an increase in adverse clinical events. METHODS In this prospective observational study, weekly preoperative interdisciplinary team meetings were conducted according to a joint care plan checklist in a tertiary care centre in France. Any discordance with preoperative predictions and deviation from the care plan were noted. A link to the incidence of predetermined adverse intraoperative events was investigated. RESULTS Intraoperative adverse clinical events (ACEs) occurred in 15 % of all cases and were associated with postoperative complications [relative risk (RR) = 1.5; 95 % confidence interval (1.1; 2.2)]. Quality of prediction of surgical procedural items was modest, with one in five to six items not correctly predicted. Discordant surgical prediction was associated with an increased incidence of ACE. Deviation from the anaesthetic care plan occurred in around 13 %, which was more frequent when surgical prediction was inaccurate (RR > 3) and independently associated with ACE (odds ratio 6). CONCLUSION Surgery was more difficult than expected in up to one out of five cases. In a similar proportion, disagreement between preoperative care plans and observed clinical management was independently associated with an increased risk of adverse clinical events.
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Affiliation(s)
- T Gauss
- Department of Anaesthesiology and Critical Care, Hôpital Beaujon, 100 Bld Général Leclerc, Clichy, Paris, France.
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Cauchy F, Aussilhou B, Dokmak S, Fuks D, Farges O, Faivre SJ, Belghiti J. Reappraisal of the risks and benefits of major liver resection in patients with initially unresectable colorectal liver metastases. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.3609] [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: 11/20/2022] Open
Abstract
3609 Background: Improvements in both surgical technique and efficacy of chemotherapy have increased the rate of resection for patients with initially unresectable colorectal liver metastases (IU-CRLM). We aimed to evaluate the short and long-term outcomes of major hepatectomy for such patients. Methods: From 2000 to 2011, 257 patients underwent major hepatectomy for CRLM. Seventy-eight (30%) of these patients were considered IU and required portal vein occlusion and/or ≥12 cycles or change in induction chemotherapy regimen to achieve resectability. Results: IU patients had respectively more lesions (5.6 vs.3.6, p=0.001), more frequently bilobar (70% vs.50% p=0.008) and synchronous (83.3% vs.70%, p=0.027) than initially resectable (IR) patients. Post-operative mortality (12.8% vs.1.7%, p=0.001) and major complications (46.2% vs.22.3%, p=0.0001) were higher in IU patients. An associated metabolic syndrome (HR 5.2, CI 1.2-21.9, p=0.025), high grade sinusoidal lesions (HR 2.4, CI 1.1-5.8, p=0.044) and the need for vascular reconstruction (HR 6.3, CI 1.2-34.4, p=0.032) were significant risk factors for major morbidity in IU patients. Significantly fewer IU patients received adjuvant chemotherapy in case of major postoperative complications compared to IR patients (47% vs. 83%, p=0.001). Overall 5-year survival was significantly lower in IU than in IR patients (26% vs.55%, p=0.032) and all IU patients had tumor recurrence within 3 years. The absence of adjuvant chemotherapy and tumor size ≥5 cm were the only factors associated with poor survival in multivariate analysis for IU patients. Conclusions: IU-CRLM patients requiring major liver resection displayed higher morbidity and mortality rates than IR ones, therefore compromising both short and long-term outcomes. Multimodal strategy should be reassessed in the presence of metabolic syndrome, sinusoidal lesions or major vascular involvement.
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Affiliation(s)
| | | | - Safi Dokmak
- HBP Surgery, Hôpital Beaujon, Clichy, France
| | - David Fuks
- HBP Surgery, Hôpital Beaujon, Clichy, France
| | | | - Sandrine J. Faivre
- Department of Medical Oncology, Beaujon University Hospital, Clichy, France
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Aussilhou B, Ragot E, Dokmak S, Faivre SJ, Paradis V, Belghiti J. Regenerative nodular hyperplasia (RNH) induced by oxaliplatin-based chemotherapy for colorectal liver metastases (CRLM): A contraindication for major liver resection? J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.179] [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: 11/20/2022] Open
Abstract
179 Background: Oxaliplatin is recognized to induce vascular lesions in the nontumoral liver parenchyma. Regenerative nodular hyperplasia (RNH), the ultimate state of the vascular lesions, is very rare. In some reported cases, RNH was associated with severe lethal postoperative complications after hepatic resection. This study aimed to compare the postoperative course after major hepatectomy, in patients with colorectal liver metastases treated with oxaliplatin-based chemotherapy, with or without RNH in the resected specimen. Methods: Between 2001 and 2009, among 420 patients who underwent liver resection for CRLM, 17 (4%) patients had RNH lesions (RNH+ group) on the resected specimen after right hepatectomy. These 17 patients were compared to another group of 20 patients with similar clinicopathologic data but without RNH (RNH- group) who underwent right hepatectomy. The mean age of the RNH + and RNH- groups was 57 years (range: 37-71 years) and 60 years (range: 43-73 years), respectively. Preoperatively the patients were treated with a mean number of 7 cycles of oxaliplatin (range: 3-12 cycles). The peroperative blood loss (560 vs. 830 ml) and blood transfusion (18% vs. 20%) were similar in the two groups. Results: The mortality in the RNH+ group and the RNH- group (6% vs. 5%, respectively) were similar (p>0.005). The postoperative morbidity was 53% in the RNH+ group and 35% in RNH– group (p>0.005). The most frequent complications were biliary fistula (3 in the RNH+ group and 2 in the RNH- group) and pulmonary complications (6 in the RNH+ group and 5 in the RNH- group). However, the post operative ascites was significantly encountered in the RNH+ group with 70% of patients compared with 40% in the RNH- group. The number of patients who had a bilirubin level at day 5 superior to 50 was significantly higher in the RNH+ group (35%) compared with 15% in the RNH-group. Conclusions: RNH lesions allow major hepatectomy without increased mortality but with increased postoperative ascites and jaundice justifying preoperative liver biopsy to detect this lesion with subsequent portal embolisation or sparing liver resection in order to avoid major resections. No significant financial relationships to disclose.
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Dokmak S, Cabral C, Couvelard A, Aussilhou B, Belghiti J, Sauvanet A. Pancreatic metastasis from nephroblastoma: an unusual entity. JOP 2009; 10:396-399. [PMID: 19581742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Pancreatic metastasis from renal cell carcinoma is a well-known entity. When metastatic disease is limited to the pancreas, pancreatic resection is the optimal treatment. A nephroblastoma is a frequent childhood cancer but can also occur in adults. A metastatic nephroblastoma mainly affects the lung and the liver. Pancreatic metastases from a nephroblastoma are very rare. CASE REPORT We report an extremely rare case of pancreatic metastases in a 20-year-old man who had a right nephroblastoma resected at 9 years of age and liver metastases treated by right hepatectomy at 18 years of age. Pancreatic metastasis was revealed by acute pancreatitis. Imaging studies revealed one 2 cm nodule in the pancreatic head with upstream dilatation of the Wirsung duct. Imaging studies revealed no other localization except a 1.5 cm liver nodule. Surgical resection was performed without preoperative chemotherapy because the patient was symptomatic and had already received numerous chemotherapy protocols. The patient underwent pancreaticoduodenectomy and limited liver resection with an uneventful postoperative course. Pathological examination confirmed pancreatic and liver metastases from a nephroblastoma composed of blastematous cells mixed with embryonic tubular structures without lymph node metastases. After resection, the patient received adjuvant high dose chemotherapy with autologous hematopoietic stem-cell support. After a 21-month follow-up, the patient was in good general condition but had liver recurrence without intra-pancreatic recurrence. CONCLUSION This is probably the first case of pancreatic metastasis from a nephroblastoma reported in a living patient. A nephroblastoma, like clear cell renal carcinoma, can be considered a possible etiology of pancreatic metastasis from a primary renal tumor.
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Affiliation(s)
- Safi Dokmak
- Department of Hepatobiliary and Pancreatic Surgery, AP-HP, Beaujon Hospital, University Paris VII, Clichy, France
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Herrero A, Pulitano C, Dondero F, Dokmak S, Aussilhou B, Sauvanet A, Farges O, Faivre S, Belghiti J. Use of partial liver resection according to carcinologic procedures as an alternative to liver transplantation for HCC. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15628] [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: 11/20/2022] Open
Abstract
e15628 Background: There are some arguments showing that anatomic resection, anterior approach and preoperative transarterial chemoembolization (TACE) with portal vein embolization (PVE) before major resection improves long term survival after partial liver resection for HCC. This oncologic approach could compete with liver transplantation (LT) which remains poorly accessible in western countries and inaccessible in the greatest part of the world.The aim of this study was to evaluate in patients with good liver function.the result of partial liver resection with an intended carcinologic approach. Methods: Between 1998 and 2007, among 210 patients resected for HCC, we selected a subgroup of 36 patients with single and small HCC (< 6 cm) developed on chronic liver disease (CLD) who underwent anatomic partial resection and anterior approach and TACE and PVE in case of major resection. Results: These 36 patients aged 37 to 76 years included 26 males (72%). Underlying CLD included hepatitis C in 16 (44%); hepatitis B in 8 (22%); alcohol in 9 (25%) and other in 3 ( 8%). The mean size of the tumor was 5.2 cm and 86% (n=31) had major resection. Operative mortality was 2.7% (n=1) and the overall 1-, 3- and 5-year survival rate were 92%,85%,73% while the disease free 1-, 3-, 5-year survival was 80%, 74%, 58%. Tumor recurrence occurred in 16 cases( 44%) after a mean delay of 21 months (ranging from 5 to 58 months). Recurrence was located out of the resected location in 6 cases. Conclusions: Partial liver resection for small tumors in patients with good liver function according to carcinologic procedures allow an excellent overall and disease free survival which can challenge LT. In the case of single HCC <6cm on chronic liver disease, this surgical approach may therefore be considered as a valuable alternative to LT within a curative intent. No significant financial relationships to disclose.
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Aussilhou B, Faivre S, Lepillé D, Le Tourneau C, Vilgrain V, Paradis V, Belghiti J. Preoperative bevacizumab may impair liver hypertrophy of the future remnant liver after a portal vein occlusion in patients undergoing major resections of colorectal liver metastasis. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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