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Laroche S, Lim C, Goumard C, Rayar M, Cherqui D, Chiche L, Barbier L, Salamé E, Mabrut JY, Lesurtel M, Truant S, Boleslawski E, Muscari F, Hobeika C, Chirica M, Buc E, Hardwigsen J, Herrero A, Navarro F, Faitot F, Bachellier P, Regimbeau JM, Laurent A, Fuks D, Soubrane O, Azoulay D, Vibert E, Scatton O. Comparing indications, complexity and outcomes of laparoscopic liver resection between centers with and without a liver transplant program: a French nationwide study. HPB (Oxford) 2024; 26:586-593. [PMID: 38341287 DOI: 10.1016/j.hpb.2024.01.010] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND There are no data to evaluate the difference in populations and impact of centers with liver transplant programs in performing laparoscopic liver resection (LLR). METHODS This was a multicenter study including patients undergoing LLR for benign and malignant tumors at 27 French centers from 1996 to 2018. The main outcomes were postoperative severe morbidity and mortality. RESULTS A total of 3154 patients were included, and 14 centers were classified as transplant centers (N = 2167 patients, 68.7 %). The transplant centers performed more difficult LLRs and more resections for hepatocellular carcinoma (HCC) in patients who more frequently had cirrhosis. A higher rate of performing the Pringle maneuver, a lower rate of blood loss and a higher rate of open conversion (all p < 0.05) were observed in the transplant centers. There was no association between the presence of a liver transplant program and either postoperative severe morbidity (<10 % in each group; p = 0.228) or mortality (1 % in each group; p = 0.915). CONCLUSIONS Most HCCs, difficult LLRs, and cirrhotic patients are treated in transplant centers. We show that all centers can achieve comparable safety and quality of care in LLR independent of the presence of a liver transplant program.
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Affiliation(s)
- Sophie Laroche
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Chetana Lim
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Research Unit, Université de Picardie-Jules Verne, UR UPJV 7518 SSPC, Amiens, France
| | - Claire Goumard
- Sorbonne University, Paris, France; Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France
| | - Michel Rayar
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Claude Huriez Hospital, Rennes, France
| | - Daniel Cherqui
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Laurence Chiche
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Bordeaux University Hospital-Magellan Centre, Bordeaux, France
| | - Louise Barbier
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Bordeaux University Hospital-Magellan Centre, Bordeaux, France
| | - Ephrem Salamé
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Trousseau Hospital, Tours Regional University Hospital, Tours, France
| | - Jean-Yves Mabrut
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, La Croix Rousse Hospital, Lyon, France
| | - Mickael Lesurtel
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Beaujon Hospital, Clichy, France
| | - Stéphanie Truant
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Beaujon Hospital, Clichy, France
| | - Emmanuel Boleslawski
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Claude Huriez Hospital, Lille, France
| | - Fabrice Muscari
- Department of Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Rangueil Hospital, Toulouse, France
| | - Christian Hobeika
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Beaujon Hospital, Clichy, France
| | - Mircea Chirica
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Grenoble Alpes Hospital, Grenoble, France
| | - Emmanuel Buc
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Estaing Hospital, Clermont-Ferrand, France
| | - Jean Hardwigsen
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, La Timone Hospital, Marseille, France
| | - Astrid Herrero
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Saint-Eloi Hospital, Montpellier, France
| | - Francis Navarro
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Saint-Eloi Hospital, Montpellier, France
| | - François Faitot
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, Hautepierre Hospital, Strasbourg, France
| | - Philippe Bachellier
- Department of Hepatopancreato-Biliary Surgery and Liver Transplantation, Hautepierre Hospital, Strasbourg, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France; Research Unit, Université de Picardie-Jules Verne, UR UPJV 7518 SSPC, Amiens, France
| | - Alexis Laurent
- Department of Hepato-Pancreato-Biliary Surgery, APHP Henri Mondor Hospital, Creteil, France
| | - David Fuks
- Department of Hepato-Pancreato-Biliary Surgery, APHP Cochin Hospital, Paris, France
| | - Olivier Soubrane
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris France
| | - Daniel Azoulay
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Eric Vibert
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Paul Brousse Hospital, Villejuif, France
| | - Olivier Scatton
- Sorbonne University, Paris, France; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France.
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Azoulay D, Desterke C, Bhangui P, Serrablo A, De Martin E, Cauchy F, Salloum C, Allard MA, Golse N, Vibert E, Sa Cunha A, Cherqui D, Adam R, Saliba F, Ichai P, Feray C, Scatton O, Lim C. Rescue Liver Transplantation for Posthepatectomy Liver Failure: A Systematic Review and Survey of an International Experience. Transplantation 2024; 108:947-957. [PMID: 37749790 DOI: 10.1097/tp.0000000000004813] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Rescue liver transplantation (LT) is the only life-saving option for posthepatectomy liver failure (PHLF) whenever it is deemed as irreversible and likely to be fatal. The goals were to perform a qualitative systematic review of rescue LT for PHLF and a survey among various international LT experts. METHODS A literature search was performed from 2000 to 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Population, Intervention, Comparison, Outcome framework, and to this, the authors' experience was added. The international online open survey included 6 cases of PHLF extracted from the literature and submitted to 976 LT experts. The primary outcome was whether experts would consider rescue LT for each case. Interrater agreement among experts was calculated using the free-marginal multirater kappa methodology. RESULTS The review included 40 patients. Post-LT mortality occurred in 8 (20%) cases (7/28 with proven cancer and 1/12 with benign disease). In the long term, 6 of 21 (28.6%) survivors with cancer died of recurrence (median = 38 mo) and 15 (71.4%) were alive with no recurrence (median = 111 mo). All 11 survivors with benign disease were alive and well (median = 39 mo). In the international survey among experts in LT, the percentage agreement to consider rescue LT was 28%-98%, higher for benign than for malignant disease ( P = 0.011). Interrater agreement for the primary endpoint was low, expected 5-y survival >50% being the strongest independent predictor to consider LT. CONCLUSIONS Rescue LT for PHLF may achieve good results in selected patients. Considerable inconsistencies of decision-making exist among LT experts when considering LT for PHLF.
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Affiliation(s)
- Daniel Azoulay
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Christophe Desterke
- University of Medicine Paris Saclay, Le Kremlin-Bicêtre, France
- INSERM Unit UMR1310, Villejuif, France
| | - Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Eleonora De Martin
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - François Cauchy
- Department of Hepato-biliary and Pancreatic Surgery and Liver Transplantation, University of Geneva, Geneva, Switzerland
| | - Chady Salloum
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Marc Antoine Allard
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Nicolas Golse
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Eric Vibert
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - René Adam
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Philippe Ichai
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Cyrille Feray
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Olivier Scatton
- Département de Chirurgie et Transplantation Hépatique, Hôpital Universitaire Pitié-Salpêtrière, Sorbonne Université, Paris, France
- Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France
| | - Chetana Lim
- Département de Chirurgie et Transplantation Hépatique, Hôpital Universitaire Pitié-Salpêtrière, Sorbonne Université, Paris, France
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3
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Terasawa M, Imamura H, Allard MA, Pietrasz D, Ciacio O, Pittau G, Salloum C, Sa Cunha A, Cherqui D, Adam R, Azoulay D, Saiura A, Vibert E, Golse N. Intraoperative indocyanine green fluorescence imaging to predict early hepatic arterial complications after liver transplantation. Liver Transpl 2024:01445473-990000000-00340. [PMID: 38466885 DOI: 10.1097/lvt.0000000000000355] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE In liver transplantation (LT) setting, to propose an innovative intraoperative criterion to judge arterial flow abnormality that may lead to early hepatic arterial occlusion, i.e. thrombosis or stenosis, when left untreated and to carry out re-anastomosis. PATIENTS AND METHODS After liver graft implantation, and after ensuring that there is no abnormality on the Doppler ultrasound (qualitative and quantitative assessment), we intraoperatively injected indocyanine green dye (ICG, 0.01 mg/Kg) and we quantified the fluorescence signal at the graft pedicle using ImageJ software. From the obtained images of 89 adult patients transplanted in our center between September 2017 and April 2019, we constructed fluorescence intensity curves of the hepatic arterial signal, and examined their relationship with the occurrence of early hepatic arterial occlusion (thrombosis or stenosis). RESULTS Early hepatic arterial occlusion occurred in seven patients (7.8%), including three thrombosis and four stenosis. Among various parameters of the flow intensity curve analyzed, the ratio of peak to plateau (RPP) fluorescence intensity and the jagged wave pattern at the plateau phase were closely associated with this dreaded event. By combining RPP at 0.275 and a jagged wave, we best predicted the occurrence of early hepatic arterial occlusion and thrombosis, with sensitivity/specificity of 0.86/0.98 and 1.00/0.94, respectively. CONCLUSIONS Through a simple composite parameter, indocyanine green fluorescence imaging system is an additional and promising intraoperative modality for identifying transplant recipients at high risk of developing early hepatic arterial occlusion. This tool could assist the surgeon in the decision to redo the anastomosis despite normal Doppler ultrasonography.
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Affiliation(s)
- Muga Terasawa
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Imamura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Marc Antoine Allard
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du foie ; FHU Hepatinov, 94800, Villejuif, France
| | - Daniel Pietrasz
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du foie ; FHU Hepatinov, 94800, Villejuif, France
| | - Oriana Ciacio
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Gabriella Pittau
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Chady Salloum
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Antonio Sa Cunha
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du foie ; FHU Hepatinov, 94800, Villejuif, France
| | - Daniel Cherqui
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du foie ; FHU Hepatinov, 94800, Villejuif, France
| | - René Adam
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
| | - Daniel Azoulay
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du foie ; FHU Hepatinov, 94800, Villejuif, France
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Eric Vibert
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du foie ; FHU Hepatinov, 94800, Villejuif, France
| | - Nicolas Golse
- Hôpital Paul Brousse, Centre Hépato-Biliaire, AP-HP, Villejuif, France
- Inserm, Université Paris-Saclay, UMRS 1193, Physiopathogénèse et traitement des maladies du foie ; FHU Hepatinov, 94800, Villejuif, France
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4
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Adrales G, Ardito F, Chowbey P, Morales-Conde S, Ferreres AR, Hensman C, Martin D, Matthaei H, Ramshaw B, Roberts JK, Schrem H, Sharma A, Tabiri S, Vibert E, Woods MS. A multi-national, video-based qualitative study to refine training guidelines for assigning an "unsafe" score in laparoscopic cholecystectomy critical view of safety. Surg Endosc 2024; 38:983-991. [PMID: 37973638 DOI: 10.1007/s00464-023-10528-6] [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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The critical view of safety (CVS) was incorporated into a novel 6-item objective procedure-specific assessment for laparoscopic cholecystectomy (LC-CVS OPSA) to enhance focus on safe completion of surgical tasks and advance the American Board of Surgery's entrustable professional activities (EPAs) initiative. To enhance instrument development, a feasibility study was performed to elucidate expert surgeon perspectives regarding "safe" vs. "unsafe" practice. METHODS A multi-national consortium of 11 expert LC surgeons were asked to apply the LC-CVS OPSA to ten LC videos of varying surgical difficulty using a "safe" vs. "unsafe" scale. Raters were asked to provide written rationale for all "unsafe" ratings and invited to provide additional feedback regarding instrument clarity. A qualitative analysis was performed on written responses to extract major themes. RESULTS Of the 660 ratings, 238 were scored as "unsafe" with substantial variation in distribution across tasks and raters. Analysis of the comments revealed three major categories of "unsafe" ratings: (a) inability to achieve the critical view of safety (intended outcome), (b) safe task completion but less than optimal surgical technique, and (c) safe task completion but risk for potential future complication. Analysis of reviewer comments also identified the potential for safe surgical practice even when CVS was not achieved, either due to unusual anatomy or severe pathology preventing safe visualization. Based upon findings, modifications to the instructions to raters for the LC-CVS OPSA were incorporated to enhance instrument reliability. CONCLUSIONS A safety-based LC-CVS OPSA has the potential to significantly improve surgical training by incorporating CVS formally into learner assessment. This study documents the perspectives of expert biliary tract surgeons regarding clear identification and documentation of unsafe surgical practice for LC-CVS and enables the development of training materials to improve instrument reliability. Learnings from the study have been incorporated into rater instructions to enhance instrument reliability.
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Affiliation(s)
- Gina Adrales
- Division of Minimally Invasive Surgery, Minimally Invasive Surgical Training and Innovation Center (MISTIC), Johns Hopkins Hospital, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University, Rome, Italy
| | - Pradeep Chowbey
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
| | - Alberto R Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | - Chrys Hensman
- Monash University Department of Surgery & Lap Surgery, Melbourne, Australia
| | - David Martin
- Division of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, USA
| | - Hanno Matthaei
- Department of Surgery, University Medical Center Bonn, Bonn, Germany
| | - Bruce Ramshaw
- CQInsights PBC, Knoxville, TN, USA
- Caresyntax Corporation, Boston, USA
| | - J Keith Roberts
- Liver Transplant and HPB Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Anil Sharma
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Stephen Tabiri
- Tamale Teaching Hospital, University for Development Studies-School of Medicine and Health Sciences, Tamale, Ghana
| | - Eric Vibert
- Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France
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5
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Garin E, Tselikas L, Guiu B, Chalaye J, Rolland Y, de Baere T, Assenat E, Tacher V, Palard X, Déandreis D, Mariano-Goulart D, Amaddeo G, Boudjema K, Hollebecque A, Meerun MA, Regnault H, Vibert E, Campillo-Gimenez B, Edeline J. Long-Term Overall Survival After Selective Internal Radiation Therapy for Locally Advanced Hepatocellular Carcinomas: Updated Analysis of DOSISPHERE-01 Trial. J Nucl Med 2024; 65:264-269. [PMID: 38212068 PMCID: PMC10858378 DOI: 10.2967/jnumed.123.266211] [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] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/07/2023] [Indexed: 01/13/2024] Open
Abstract
Interim analysis of the DOSISPHERE-01 study demonstrated a strong improvement in response and overall survival (OS) on using 90Y-loaded glass microspheres with personalized dosimetry compared with standard dosimetry in patients with nonoperable locally advanced hepatocellular carcinoma. This report sought to provide a long-term analysis of OS. Methods: In this phase II study (ClinicalTrials.gov identifier NCT02582034), treatment was randomly assigned (1:1) with the goal to deliver either at least 205 Gy (if possible >250-300 Gy) to the index lesion in the personalized dosimetry approach (PDA) or 120 ± 20 Gy to the treated volume in the standard dosimetry approach (SDA). The 3-mo response of the index lesion was the primary endpoint, with OS being one of the secondary endpoints. This report is a post hoc long-term analysis of OS. Results: Overall, 60 hepatocellular carcinoma patients with at least 1 lesion larger than 7 cm and more than 30% of hepatic reserve were randomized (intent-to-treat population: PDA, n = 31; SDA, n = 29), with 56 actually treated (modified intent-to-treat population: n = 28 in each arm). The median follow-up for long-term analysis was 65.8 mo (range, 2.1-73.1 mo). Median OS was 24.8 mo and 10.7 mo (hazard ratio [HR], 0.51; 95% CI, 0.29-0.9; P = 0.02) for PDA and SDA, respectively, in the modified intent-to-treat population. Median OS was 22.9 mo for patients with a tumor dose of at least 205 Gy, versus 10.3 mo for those with a tumor dose of less than 205 Gy (HR, 0.42; 95% CI, 0.22-0.81; P = 0.0095), and was 22.9 mo for patients with a perfused liver dose of 150 Gy or higher, versus 10.3 mo for those with a perfused liver dose of less than 150 Gy (HR, 0.42; 95% CI, 0.23-0.75; P = 0.0033). Lastly, median OS was not reached in patients who were secondarily resected (n = 11, 10 in the PDA group and 1 in the SDA group), versus 10.8 mo in those without secondary resection (n = 45) (HR, 0.17; 95% CI, 0.065-0.43; P = 0.0002). Only resected patients displayed favorable long-term OS rates, meaning an OS of more than 50% at 5 y. Conclusion: After longer follow-up, personalized dosimetry sustained a meaningful improvement in OS, which was dramatically improved for patients who were accurately downstaged toward resection, including most portal vein thrombosis patients.
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Affiliation(s)
- Etienne Garin
- Cancer Institute Eugene Marquis, Rennes, France;
- University of Rennes, INSERM, INRAE, Nutrition Métabolismes et Cancer U1317, Rennes, France
| | | | - Boris Guiu
- Montpellier University Hospital, Montpellier, France
| | - Julia Chalaye
- AP-HP, Hopitaux Universitaires Henri Mondor, Creteil, France
| | - Yan Rolland
- Cancer Institute Eugene Marquis, Rennes, France
- University of Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | | | - Eric Assenat
- Montpellier University Hospital, Montpellier, France
| | - Vania Tacher
- AP-HP, Hopitaux Universitaires Henri Mondor, Creteil, France
| | | | | | | | | | - Karim Boudjema
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, Rennes, France
| | | | | | - Helen Regnault
- AP-HP, Hopitaux Universitaires Henri Mondor, Creteil, France
| | - Eric Vibert
- Centre Hepato-Biliaire, Paul Brousse Hospital, AP-HP, Paris Saclay University, Villejuif, France; and
| | - Boris Campillo-Gimenez
- Cancer Institute Eugene Marquis, Rennes, France
- University of Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - Julien Edeline
- Cancer Institute Eugene Marquis, Rennes, France
- University of Rennes, INSERM, COSS-UMR_S 1242, Rennes, France
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6
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Amory B, Goumard C, Laurent A, Langella S, Cherqui D, Salame E, Barbier L, Soubrane O, Farges O, Hobeika C, Kawai T, Regimbeau JM, Faitot F, Pessaux P, Truant S, Boleslawski E, Herrero A, Mabrut JY, Chiche L, Di Martino M, Rhaiem R, Schwarz L, Resende V, Calderaro J, Augustin J, Caruso S, Sommacale D, Hofmeyr S, Ferrero A, Fuks D, Vibert E, Torzilli G, Scatton O, Brustia R. Combined hepatocellular-cholangiocarcinoma compared to hepatocellular carcinoma and intrahepatic cholangiocarcinoma: Different survival, similar recurrence: Report of a large study on repurposed databases with propensity score matching. Surgery 2024; 175:413-423. [PMID: 37981553 DOI: 10.1016/j.surg.2023.09.040] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Combined hepatocholangiocarcinoma is a rare cancer with a grim prognosis composed of both hepatocellular carcinoma and intrahepatic cholangiocarcinoma morphologic patterns in the same tumor. The aim of this multicenter, international cohort study was to compare the oncologic outcomes after surgery of combined hepatocholangiocarcinoma to hepatocellular carcinoma and intrahepatic cholangiocarcinoma. METHODS Patients treated by surgery for combined hepatocholangiocarcinoma, hepatocellular carcinoma, and intrahepatic cholangiocarcinoma from 2000 to 2021 from multicenter international databases were analyzed retrospectively. Patients with combined hepatocholangiocarcinoma (cases) were compared with 2 control groups of hepatocellular carcinoma or intrahepatic cholangiocarcinoma, sequentially matched using a propensity score based on 8 preoperative characteristics. Overall and disease-free survival were compared, and predictors of mortality and recurrence were analyzed with Cox regression after propensity score matching. RESULTS During the study period, 3,196 patients were included. Propensity score adjustment and 2 sequential matching processes produced a new cohort (n = 244) comprising 3 balanced groups was obtained (combined hepatocholangiocarcinoma = 56, intrahepatic cholangiocarcinoma = 66, and hepatocellular carcinoma = 122). Kaplan-Meier overall survival estimations at 1, 3, and 5 years were 67%, 45%, and 28% for combined hepatocholangiocarcinoma, 92%, 75%, and 55% for hepatocellular carcinoma, and 86%, 53%, and 42% for the intrahepatic cholangiocarcinoma group, respectively (P = .0014). Estimations of disease-free survival at 1, 3, and 5 years were 51%, 25%, and 17% for combined hepatocholangiocarcinoma, 63%, 35%, and 26% for the hepatocellular carcinoma group, and 51%, 31%, and 28% for the intrahepatic cholangiocarcinoma group, respectively (P = .19). Predictors of mortality were combined hepatocholangiocarcinoma subtype, metabolic syndrome, preoperative tumor markers alpha-fetoprotein and carbohydrate antigen 19-9, and satellite nodules, and recurrence was associated with satellite nodules rather than cancer subtype. CONCLUSION Despite data limitations, overall survival among patients with combined hepatocholangiocarcinoma was worse than both groups and closer intrahepatic cholangiocarcinoma, whereas disease-free survival was similar among the 3 groups. Future research on immunophenotypic profiling may hold more promise than traditional nonmodifiable clinical characteristics (as found in this study) in predicting recurrence or response to salvage treatments.
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Affiliation(s)
- Boris Amory
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Paris Est Créteil University, UPEC, France; Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Claire Goumard
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France
| | - Alexis Laurent
- Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France; Paris Est Créteil University, UPEC, France; Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," INSERM U955, Créteil, France; Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Serena Langella
- Department of General and Oncological Surgery, Ospedale Mauriziano, Torino, Italy
| | - Daniel Cherqui
- Center Hepato-Biliaire, AP-HP Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Ephrem Salame
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Tours, University of Tours, France; FHU Support, Tours, France
| | - Louise Barbier
- Department of Digestive Surgery and Liver Transplantation, University Hospital of Tours, University of Tours, France; FHU Support, Tours, France
| | - Olivier Soubrane
- Department of Digestive, Oncological, and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Olivier Farges
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Christian Hobeika
- Department of HPB Surgery and Liver Transplantation, AP-HP Beaujon Hospital, University of Paris, Clichy, France
| | - Takayuki Kawai
- Department of Surgery, Medical Research Institute, Kitano Hospital, Osaka and Graduate School of Medicine, Kyoto University, Japan
| | - Jean-Marc Regimbeau
- SSPC (Simplification of Surgical Patients Care) - Clinical Research Unit, University of Picardie Jules Verne, Amiens, France; Department of Digestive Surgery, Amiens University Medical Center, France
| | - François Faitot
- Service de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Hôpital de Hautepierre, Strasbourg, France
| | - Patrick Pessaux
- Unité Chirurgie HBP, Pôle hépato-digestif Nouvel Hôpital Civil, Strasbourg, France; Institut of Viral and Liver Disease, Inserm U1110, Strasbourg, France
| | - Stéphanie Truant
- Department of Digestive Surgery and Transplantation, University Hospitals, Lille, France
| | - Emmanuel Boleslawski
- Department of Digestive Surgery and Transplantation, University Hospitals, Lille, France
| | - Astrid Herrero
- Department of HBP Surgery and Liver Transplantation, Montpellier University Hospital, University of Montpellier, France
| | - Jean-Yves Mabrut
- Croix Rousse University Hospital, Department of General Surgery and Liver Transplantation, Lyon, France; Cancer Research Center of Lyon, INSERM U1052, France
| | - Laurence Chiche
- Department of Hepato-Bilio-Pancreatic Surgery and Liver Transplantation, Haut Lévêque Hospital, Center Hospitalier Universitaire de Bordeaux, France; Inserm UMR 1312-Team 3 "Liver Cancers and Tumoral Invasion," Bordeaux Institute of Oncology, University of Bordeaux, France
| | - Marcello Di Martino
- HPB Unit, Department of General and Digestive Surgery, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Rami Rhaiem
- Department of Hepatobiliary, Pancreatic, and Digestive Surgery, Robert Debré University Hospital, Reims, France; University Reims Champagne-Ardenne, France
| | - Lilian Schwarz
- Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, Rouen University Hospital, UNIROUEN, UMR 1245 INSERM, Normandie Rouen University, France
| | - Vivian Resende
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Julien Calderaro
- Université Paris Est Créteil, INSERM, IMRB, Créteil, France; Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France; Inserm, U955, Team 18, Créteil, France
| | - Jérémy Augustin
- Université Paris Est Créteil, INSERM, IMRB, Créteil, France; Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France; Inserm, U955, Team 18, Créteil, France
| | - Stefano Caruso
- Université Paris Est Créteil, INSERM, IMRB, Créteil, France; Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France; Inserm, U955, Team 18, Créteil, France
| | - Daniele Sommacale
- Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France; Paris Est Créteil University, UPEC, Créteil, France; Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," INSERM U955, Créteil, France; Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Stefan Hofmeyr
- Division of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Ospedale Mauriziano, Torino, Italy
| | - David Fuks
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Hopital Cochin, Assistance Publique-Hôpitaux de Paris, France; Université Paris Cité, France
| | - Eric Vibert
- Center Hepato-Biliaire, AP-HP Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, Milan, Italy
| | - Olivier Scatton
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France
| | - Raffaele Brustia
- Department of Digestive and Hepato-pancreatic-biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France; Paris Est Créteil University, UPEC, France; Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers," INSERM U955, Créteil, France; Assistance Publique-Hôpitaux de Paris, Créteil, France.
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7
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Adrales G, Ardito F, Chowbey P, Morales-Conde S, Ferreres AR, Hensman C, Martin D, Matthaei H, Ramshaw B, Roberts JK, Schrem H, Sharma A, Tabiri S, Vibert E, Woods MS. Laparoscopic cholecystectomy critical view of safety (LC-CVS): a multi-national validation study of an objective, procedure-specific assessment using video-based assessment (VBA). Surg Endosc 2024; 38:922-930. [PMID: 37891369 DOI: 10.1007/s00464-023-10479-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] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/17/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND A novel 6-item objective, procedure-specific assessment for laparoscopic cholecystectomy incorporating the critical view of safety (LC-CVS OPSA) was developed to support trainee formative and summative assessments. The LC-CVS OPSA included two retraction items (fundus and infundibulum retraction) and four CVS items (hepatocystic triangle visualization, gallbladder-liver separation, cystic artery identification, and cystic duct identification). The scoring rubric for retraction consisted of poor (frequently outside of defined range), adequate (minimally outside of defined range) and excellent (consistently inside defined range) and for CVS items were "poor-unsafe", "adequate-safe", or "excellent-safe". METHODS A multi-national consortium of 12 expert LC surgeons applied the OPSA-LC CVS to 35 unique LC videos and one duplicate video. Primary outcome measure was inter-rater reliability as measured by Gwet's AC2, a weighted measure that adjusts for scales with high probability of random agreement. Analysis of the inter-rater reliability was conducted on a collapsed dichotomous scoring rubric of "poor-unsafe" vs. "adequate/excellent-safe". RESULTS Inter-rater reliability was high for all six items ranging from 0.76 (hepatocystic triangle visualization) to 0.86 (cystic duct identification). Intra-rater reliability for the single duplicate video was substantially higher across the six items ranging from 0.91 to 1.00. CONCLUSIONS The novel 6-item OPSA LC CVS demonstrated high inter-rater reliability when tested with a multi-national consortium of LC expert surgeons. This brief instrument focused on safe surgical practice was designed to support the implementation of entrustable professional activities into busy surgical training programs. Instrument use coupled with video-based assessments creates novel datasets with the potential for artificial intelligence development including computer vision to drive assessment automation.
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Affiliation(s)
- Gina Adrales
- Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21287, USA.
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Catholic University, Rome, Italy
| | - Pradeep Chowbey
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, University Hospital Virgen del Rocío, University of Sevilla, Sevilla, Spain
| | - Alberto R Ferreres
- Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
| | - Chrys Hensman
- Department of Surgery & LapSurgery, Monash University, Melbourne, Australia
| | - David Martin
- Division of Critical Care/Acute Care Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Hanno Matthaei
- Department of Surgery, University Medical Center, Bonn, Germany
| | - Bruce Ramshaw
- CQInsights PBC, Knoxville, TN, USA
- Caresyntax Corporation, Boston, MA, USA
| | - J Keith Roberts
- Liver Transplant and HPB Surgery, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - Harald Schrem
- General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
| | - Anil Sharma
- Institute of Laparoscopic, Endoscopic and Bariatric Surgery, Max Super Specialty Hospital, Saket, New Delhi, India
| | - Stephen Tabiri
- University for Development Studies-School of Medicine and Health Sciences, Tamale Teaching Hospital, Tamales, Ghana
| | - Eric Vibert
- Centre Hépato-Biliaire, Paul Brousse Hospital, AP-HP, Villejuif, France
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8
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Calderaro J, Ghaffari Laleh N, Zeng Q, Maille P, Favre L, Pujals A, Klein C, Bazille C, Heij LR, Uguen A, Luedde T, Di Tommaso L, Beaufrère A, Chatain A, Gastineau D, Nguyen CT, Nguyen-Canh H, Thi KN, Gnemmi V, Graham RP, Charlotte F, Wendum D, Vij M, Allende DS, Aucejo F, Diaz A, Rivière B, Herrero A, Evert K, Calvisi DF, Augustin J, Leow WQ, Leung HHW, Boleslawski E, Rela M, François A, Cha AWH, Forner A, Reig M, Allaire M, Scatton O, Chatelain D, Boulagnon-Rombi C, Sturm N, Menahem B, Frouin E, Tougeron D, Tournigand C, Kempf E, Kim H, Ningarhari M, Michalak-Provost S, Gopal P, Brustia R, Vibert E, Schulze K, Rüther DF, Weidemann SA, Rhaiem R, Pawlotsky JM, Zhang X, Luciani A, Mulé S, Laurent A, Amaddeo G, Regnault H, De Martin E, Sempoux C, Navale P, Westerhoff M, Lo RCL, Bednarsch J, Gouw A, Guettier C, Lequoy M, Harada K, Sripongpun P, Wetwittayaklang P, Loménie N, Tantipisit J, Kaewdech A, Shen J, Paradis V, Caruso S, Kather JN. Deep learning-based phenotyping reclassifies combined hepatocellular-cholangiocarcinoma. Nat Commun 2023; 14:8290. [PMID: 38092727 PMCID: PMC10719304 DOI: 10.1038/s41467-023-43749-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Primary liver cancer arises either from hepatocytic or biliary lineage cells, giving rise to hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICCA). Combined hepatocellular- cholangiocarcinomas (cHCC-CCA) exhibit equivocal or mixed features of both, causing diagnostic uncertainty and difficulty in determining proper management. Here, we perform a comprehensive deep learning-based phenotyping of multiple cohorts of patients. We show that deep learning can reproduce the diagnosis of HCC vs. CCA with a high performance. We analyze a series of 405 cHCC-CCA patients and demonstrate that the model can reclassify the tumors as HCC or ICCA, and that the predictions are consistent with clinical outcomes, genetic alterations and in situ spatial gene expression profiling. This type of approach could improve treatment decisions and ultimately clinical outcome for patients with rare and biphenotypic cancers such as cHCC-CCA.
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Affiliation(s)
- Julien Calderaro
- Université Paris Est Créteil, INSERM, IMRB, F-94010, Créteil, France.
- Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France.
- Inserm, U955, Team 18, Créteil, France.
- European Reference Network (ERN) RARE-LIVER, Créteil, France.
| | - Narmin Ghaffari Laleh
- Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
- Department of Medicine III, University Hospital RWTH Aachen, RWTH Aachen university, Aachen, Germany
| | - Qinghe Zeng
- Centre d'Histologie, d'Imagerie et de Cytométrie (CHIC), Centre de Recherche des Cordeliers, Paris, France
- Laboratoire d'Informatique Paris Descartes (LIPADE), Université Paris Cité, Paris, France
| | - Pascale Maille
- Université Paris Est Créteil, INSERM, IMRB, F-94010, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France
- Inserm, U955, Team 18, Créteil, France
| | - Loetitia Favre
- Université Paris Est Créteil, INSERM, IMRB, F-94010, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France
- Inserm, U955, Team 18, Créteil, France
| | - Anaïs Pujals
- Université Paris Est Créteil, INSERM, IMRB, F-94010, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France
- Inserm, U955, Team 18, Créteil, France
| | - Christophe Klein
- Centre d'Histologie, d'Imagerie et de Cytométrie (CHIC), Centre de Recherche des Cordeliers, Paris, France
- INSERM, Sorbonne Université, Université Paris Cité, Paris, France
| | - Céline Bazille
- Caen University Hospital, Department of Pathology, Caen, France
| | - Lara R Heij
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Arnaud Uguen
- CHRU Brest, Department of Pathology, Brest, 29220, France
- Univ Brest, Inserm, CHU de Brest, LBAI, UMR1227, Brest, France
| | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Luca Di Tommaso
- Department of Pathology, Humanitas University, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Aurélie Beaufrère
- Assistance Publique-Hôpitaux de Paris, Beaujon University Hospital, Department of Pathology, F-92110, Clichy, France
- Université de Paris, Inflammation Research Center, Inserm, U1149, CNRS, ERL8252, F-75018, Paris, France
| | | | | | - Cong Trung Nguyen
- Department of Pathology, E Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Hiep Nguyen-Canh
- Pathology Center, Bachmai Hospital, Hanoi, Vietnam
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Khuyen Nguyen Thi
- Pathology and Molecular biology Center, National Cancer Hospital, Hanoi, Vietnam
| | - Viviane Gnemmi
- University Lille, UMR9020-U1277, Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
- CHU Lille, Institute of Pathology, Lille, France
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Frédéric Charlotte
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Department of Pathology, Paris, France
| | - Dominique Wendum
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, Department of Pathology, Paris, France
| | - Mukul Vij
- Department of Pathology, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Daniela S Allende
- Department of Hepatobiliary Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, L25, Cleveland, OH, 44195, USA
| | - Federico Aucejo
- Department of Gastrointestinal and Hepatobiliary Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alba Diaz
- Barcelona Clinic Liver Cancer (BCLC) Group, Department of Pathology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Benjamin Rivière
- Department of Pathology, Gui-de-Chauliac University Hospital, 80, avenue Augustin-Fliche, 34295, Montpellier, France
| | - Astrid Herrero
- Department of Digestive and Hepatobiliary Surgery, Gui-de-Chauliac University Hospital, 80, avenue Augustin-Fliche, 34295, Montpellier, France
| | - Katja Evert
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Diego Francesco Calvisi
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Jérémy Augustin
- Université Paris Est Créteil, INSERM, IMRB, F-94010, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France
- Inserm, U955, Team 18, Créteil, France
| | - Wei Qiang Leow
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Howard Ho Wai Leung
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Mohamed Rela
- Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Arnaud François
- Rouen University Hospital, Department of Pathology, Rouen, France
| | - Anthony Wing-Hung Cha
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alejandro Forner
- Barcelona Clinic Liver Cancer (BCLC), Liver Unit, Hospital Clinic of Barcelona, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, Spain
| | - Maria Reig
- Barcelona Clinic Liver Cancer (BCLC), Liver Unit, Hospital Clinic of Barcelona, IDIBAPS, CIBEREHD, Universidad de Barcelona, Barcelona, Spain
| | - Manon Allaire
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Department of Hepatology, Paris, France
| | - Olivier Scatton
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Department of Digestive and Hepatobiliary Surgery, Paris, France
| | - Denis Chatelain
- Centre Hospitalier Universitaire d'Amiens, Département de Pathologie, Amiens, France
| | | | - Nathalie Sturm
- Department of Pathology, University Hospital, Grenoble, France
- Translational Innovation in Medicine and Complexity, Centre National de la Recherche Scientifique UMR5525, La Tronche, France
| | - Benjamin Menahem
- Caen University Hospital, Department of Digestive and Hepatobiliary Surgery, Caen, France
| | - Eric Frouin
- Poitiers University Hospital, Department of Pathology, Poitiers, France
- LITEC, Université de Poitiers, Poitiers, France
| | - David Tougeron
- Poitiers University Hospital, Department of Hepatogastroenterology and Oncology, Poitiers, France
| | - Christophe Tournigand
- Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Medical Oncology, Créteil, France
| | - Emmanuelle Kempf
- Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Medical Oncology, Créteil, France
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | | | - Purva Gopal
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Raffaele Brustia
- Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Department of Digestive and Hepatobiliary Surgery, Créteil, France
| | - Eric Vibert
- Assistance Publique-Hôpitaux de Paris, Paul Brousse University Hospital, Department of Digestive and Hepatobiliary Surgery, Paris, France
| | - Kornelius Schulze
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Darius F Rüther
- Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sören A Weidemann
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rami Rhaiem
- Reims University Hospital, Department of Digestive and Hepatobiliary Surgery, Reims, France
| | - Jean-Michel Pawlotsky
- Université Paris Est Créteil, INSERM, IMRB, F-94010, Créteil, France
- Inserm, U955, Team 18, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Paul Brousse University Hospital, Department of Digestive and Hepatobiliary Surgery, Paris, France
| | - Xuchen Zhang
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Alain Luciani
- Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Department of Medical Imaging, Créteil, France
| | - Sébastien Mulé
- Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Department of Medical Imaging, Créteil, France
| | - Alexis Laurent
- Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Department of Digestive and Hepatobiliary Surgery, Créteil, France
| | - Giuliana Amaddeo
- Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Department of Hepatology, Créteil, France
| | - Hélène Regnault
- Assistance Publique-Hôpitaux de Paris, Henri Mondor University Hospital, Department of Hepatology, Créteil, France
| | - Eleonora De Martin
- Assistance Publique-Hôpitaux de Paris, Paul Brousse University Hospital, Department of Hepatology, Paris, France
| | - Christine Sempoux
- Institute of Pathology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Pooja Navale
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - Maria Westerhoff
- Department of Pathology University of Michigan, Ann Arbor, MI, USA
| | - Regina Cheuk-Lam Lo
- Department of Pathology, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
- State Key Laboratory of Liver Research, (The University of Hong Kong), Pok Fu Lam, Hong Kong, China
| | - Jan Bednarsch
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Annette Gouw
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands
| | - Catherine Guettier
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, the Netherlands
- Assistance Publique-Hôpitaux de Paris, Paul Brousse University Hospital, Department of Pathology, Villejuif, France
| | - Marie Lequoy
- Assistance Publique-Hôpitaux de Paris, Saint Antoine University Hospital, Department of Hepatology, Paris, France
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Pimsiri Sripongpun
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | | | - Nicolas Loménie
- Laboratoire d'Informatique Paris Descartes (LIPADE), Université Paris Cité, Paris, France
| | - Jarukit Tantipisit
- Prince of Songkla University, Department of Pathology, Hat Yai, Thailand
| | - Apichat Kaewdech
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Jeanne Shen
- Center for Artificial Intelligence in Medicine and Imaging, Stanford University, 1701 Page Mill Road, Palo Alto, CA, 94304, USA
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Valérie Paradis
- Assistance Publique-Hôpitaux de Paris, Beaujon University Hospital, Department of Pathology, F-92110, Clichy, France
- Université de Paris, Inflammation Research Center, Inserm, U1149, CNRS, ERL8252, F-75018, Paris, France
| | - Stefano Caruso
- Université Paris Est Créteil, INSERM, IMRB, F-94010, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Henri Mondor-Albert Chenevier University Hospital, Department of Pathology, Créteil, France
- Inserm, U955, Team 18, Créteil, France
| | - Jakob Nikolas Kather
- Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
- Medical Oncology, National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany.
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9
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Demir Z, Raynaud M, Aubert O, Debray D, Sebagh M, Duong Van Huyen JP, Del Bello A, Jolivet NC, Paradis V, Durand F, Muratot S, Lozach C, Chardot C, Francoz C, Kamar N, Sarnacki S, Coilly A, Samuel D, Vibert E, Féray C, Lefaucheur C, Loupy A. Identification of liver transplant biopsy phenotypes associated with distinct liver biological markers and allograft survival. Am J Transplant 2023:S1600-6135(23)00907-3. [PMID: 38097016 DOI: 10.1016/j.ajt.2023.12.007] [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: 06/26/2023] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 01/01/2024]
Abstract
The intricate association between histologic lesions and circulating antihuman leucocyte antigen donor-specific antibodies (DSA) in liver transplantation (LT) requires further clarification. We conducted a probabilistic, unsupervised approach in a comprehensively well-annotated LT cohort to identify clinically relevant archetypes. We evaluated 490 pairs of LT biopsies with DSA testing from 325 recipients transplanted between 2010 and 2020 across 3 French centers and an external cohort of 202 biopsies from 128 recipients. Unsupervised archetypal analysis integrated all clinico-immuno-histologic parameters of each biopsy to identify biopsy archetypes. The median time after LT was 1.17 (interquartile range, 0.38-2.38) years. We identified 7 archetypes distinguished by clinico-immuno-histologic parameters: archetype #1: severe T cell-mediated rejection (15.9%); #2: chronic rejection with ductopenia (1.8%); #3: architectural and microvascular damages (3.5%); #4: (sub)normal (55.9%); #5: mild T cell-mediated rejection (4.9%); #6: acute antibody-mediated rejection (6.5%); and #7: chronic rejection with DSA (11.4%). Cell infiltrates vary in the archetype. These archetypes were associated with distinct liver biological markers and allograft outcomes. These findings remained consistent when stratified using the patient's age or indications for LT, with good performance in the external cohort (mean highest probability assignment = 0.58, standard deviation ± 0.17). In conclusion, we have identified clinically meaningful archetypes, providing valuable insights into the intricate DSA-histology association, which may help standardize liver allograft pathology classification.
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Affiliation(s)
- Zeynep Demir
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France
| | - Marc Raynaud
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France
| | - Olivier Aubert
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France; Kidney Transplantation Department, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Dominique Debray
- Pediatric Hepatology and Liver Transplantation Unit, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Mylène Sebagh
- Pathology Department Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Villejuif, France
| | - Jean-Paul Duong Van Huyen
- Pathology Department, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Arnaud Del Bello
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Nicolas Congy Jolivet
- Department of Immunology, Hôpital de Rangueil, CHU de Toulouse, Molecular Immunogenetics Laboratory, EA 3034, IFR150 (INSERM), Toulouse, France
| | - Valérie Paradis
- Pathology Department, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, Clichy, France
| | - François Durand
- Hepatology Department, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, Clichy, France
| | - Sophie Muratot
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France
| | - Cécile Lozach
- Department of Pediatric Radiology, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christophe Chardot
- Department of Pediatric Surgery, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Claire Francoz
- Hepatology Department, Beaujon Hospital, Assistance Publique - Hôpitaux de Paris, Clichy, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Audrey Coilly
- Hepatobiliary Center, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Inserm Paris-Saclay Research Unit 1193, Paris-Saclay University, Villejuif, France
| | - Didier Samuel
- Hepatobiliary Center, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Inserm Paris-Saclay Research Unit 1193, Paris-Saclay University, Villejuif, France
| | - Eric Vibert
- Hepatobiliary Center, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Inserm Paris-Saclay Research Unit 1193, Paris-Saclay University, Villejuif, France
| | - Cyrille Féray
- Hepatobiliary Center, Paul-Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Inserm Paris-Saclay Research Unit 1193, Paris-Saclay University, Villejuif, France
| | - Carmen Lefaucheur
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France; Department of Nephrology and Kidney Transplantation, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, Université de Paris Cité, INSERM, PARCC, Paris, France; Kidney Transplantation Department, Necker enfants malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
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10
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Bredel D, Tihic E, Mouraud S, Danlos FX, Susini S, Aglave M, Alfaro A, Mohamed-Djalim C, Rouanne M, Halse H, Bigorgne A, Tselikas L, Dalle S, Hartl DM, Baudin E, Guettier C, Vibert E, Rosmorduc O, Robert C, Ferlicot S, Parier B, Albiges L, de Montpreville VT, Besse B, Mercier O, Even C, Breuskin I, Classe M, Radulescu C, Lebret T, Pautier P, Gouy S, Scoazec JY, Zitvogel L, Marabelle A, Bonvalet M. Immune checkpoints are predominantly co-expressed by clonally expanded CD4 +FoxP3 + intratumoral T-cells in primary human cancers. J Exp Clin Cancer Res 2023; 42:333. [PMID: 38057799 DOI: 10.1186/s13046-023-02897-6] [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: 07/14/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND In addition to anti-PD(L)1, anti-CTLA-4 and anti-LAG-3, novel immune checkpoint proteins (ICP)-targeted antibodies have recently failed to demonstrate significant efficacy in clinical trials. In these trials, patients were enrolled without screening for drug target expression. Although these novel ICP-targeted antibodies were expected to stimulate anti-tumor CD8 + T-cells, the rationale for their target expression in human tumors relied on pre-clinical IHC stainings and transcriptomic data, which are poorly sensitive and specific techniques for assessing membrane protein expression on immune cell subsets. Our aim was to describe ICP expression on intratumoral T-cells from primary solid tumors to better design upcoming neoadjuvant cancer immunotherapy trials. METHODS We prospectively performed multiparameter flow cytometry and single-cell RNA sequencing (scRNA-Seq) paired with TCR sequencing on freshly resected human primary tumors of various histological types to precisely determine ICP expression levels within T-cell subsets. RESULTS Within a given tumor type, we found high inter-individual variability for tumor infiltrating CD45 + cells and for T-cells subsets. The proportions of CD8+ T-cells (~ 40%), CD4+ FoxP3- T-cells (~ 40%) and CD4+ FoxP3+ T-cells (~ 10%) were consistent across patients and indications. Intriguingly, both stimulatory (CD25, CD28, 4-1BB, ICOS, OX40) and inhibitory (PD-1, CTLA-4, PD-L1, CD39 and TIGIT) checkpoint proteins were predominantly co-expressed by intratumoral CD4+FoxP3+ T-cells. ScRNA-Seq paired with TCR sequencing revealed that T-cells with high clonality and high ICP expressions comprised over 80% of FoxP3+ cells among CD4+ T-cells. Unsupervised clustering of flow cytometry and scRNAseq data identified subsets of CD8+ T-cells and of CD4+ FoxP3- T-cells expressing certain checkpoints, though these expressions were generally lower than in CD4+ FoxP3+ T-cell subsets, both in terms of proportions among total T-cells and ICP expression levels. CONCLUSIONS Tumor histology alone does not reveal the complete picture of the tumor immune contexture. In clinical trials, assumptions regarding target expression should rely on more sensitive and specific techniques than conventional IHC or transcriptomics. Flow cytometry and scRNAseq accurately characterize ICP expression within immune cell subsets. Much like in hematology, flow cytometry can better describe the immune contexture of solid tumors, offering the opportunity to guide patient treatment according to drug target expression rather than tumor histological type.
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Affiliation(s)
- Delphine Bredel
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
| | - Edi Tihic
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - Séverine Mouraud
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - François-Xavier Danlos
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Innovation Thérapeutique Et d'Essais Précoces (DITEP), 94805, Villejuif, France
| | - Sandrine Susini
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - Marine Aglave
- Gustave Roussy, Plateforme de bioinformatique, F-94805, Villejuif, France
| | - Alexia Alfaro
- Gustave Roussy, Université Paris-Saclay, UMS 23/3655, Plateforme Imagerie Et Cytométrie, Villejuif, France
| | - Chifaou Mohamed-Djalim
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
| | - Mathieu Rouanne
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Department of Microbiology and Immunology, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Héloise Halse
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1163, Institut Imagine, Université Paris Descartes, 75015, Paris, France
| | - Amélie Bigorgne
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1163, Institut Imagine, Université Paris Descartes, 75015, Paris, France
| | - Lambros Tselikas
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Stéphane Dalle
- Department of Dermatology, HCL Cancer Institute, Lyon Cancer Research Center, 69495, Lyon, France
| | - Dana M Hartl
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Eric Baudin
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Catherine Guettier
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Service d'Anatomie Pathologique, Hôpital Bicêtre, AP-HP, 94270, Le Kremlin-Bicêtre, France
- UMR-S 1193, Hôpital Paul Brousse Université Paris Saclay, 94800, Villejuif, France
| | - Eric Vibert
- UMR-S 1193, Hôpital Paul Brousse Université Paris Saclay, 94800, Villejuif, France
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, 94800, Villejuif, France
| | - Olivier Rosmorduc
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, 94800, Villejuif, France
| | - Caroline Robert
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U981, Gustave Roussy, 94805, Villejuif, France
| | - Sophie Ferlicot
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Service d'Anatomie Pathologique, Hôpital Bicêtre, AP-HP, 94270, Le Kremlin-Bicêtre, France
- Centre National de Recherche Scientifique (CNRS), Gustave Roussy, Université Paris-Saclay, UMR 9019, 94805, Villejuif, France
| | - Bastien Parier
- Service de Chirurgie Urologique, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Laurence Albiges
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | | | - Benjamin Besse
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Olaf Mercier
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
- Service de Chirurgie Thoracique Et Transplantation Cardio-Pulmonaire, Hôpital Marie-Lannelongue, UMR_S 999 INSERM, Université Paris-Saclay, GHPSJ, 92350, Le Plessis-Robinson, France
| | - Caroline Even
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Ingrid Breuskin
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Marion Classe
- Gustave Roussy, Département de Biopathologie, F-94805, Villejuif, France
| | - Camélia Radulescu
- Département de Pathologie, Hôpital Foch, UVSQ, Université Paris-Saclay, 92150, Suresnes, France
| | - Thierry Lebret
- Département d'Urologie, Hôpital Foch, UVSQ-Université Paris-Saclay, 92150, Suresnes, France
| | - Patricia Pautier
- Gustave Roussy, Département d'Oncologie Médicale, F-94805, Villejuif, France
| | - Sébastien Gouy
- Gustave Roussy, Université Paris Saclay, Département d'Anesthésie, Chirurgie et Imagerie Interventionnelle, F-94805, Villejuif, France
| | - Jean-Yves Scoazec
- Gustave Roussy, Département de Biopathologie, F-94805, Villejuif, France
| | - Laurence Zitvogel
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France
| | - Aurélien Marabelle
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France.
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France.
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France.
- Université Paris-Saclay, Faculté de Médecine, 94270, Le Kremlin-Bicêtre, France.
- Gustave Roussy, Département d'Innovation Thérapeutique Et d'Essais Précoces (DITEP), 94805, Villejuif, France.
| | - Mélodie Bonvalet
- Gustave Roussy, 114 Rue Édouard Vaillant, 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) U1015, Laboratoire de Recherche Translationnelle en Immunothérapie (LRTI), 94805, Villejuif, France
- Institut National de La Santé Et de La Recherche Médicale (INSERM) CIC1428, Centre d'Investigation Clinique BIOTHERIS, 94805, Villejuif, France
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11
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Bekheit M, Grundy L, Salih AK, Bucur P, Vibert E, Ghazanfar M. Post-hepatectomy liver failure: A timeline centered review. Hepatobiliary Pancreat Dis Int 2023; 22:554-569. [PMID: 36973111 DOI: 10.1016/j.hbpd.2023.03.001] [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: 04/11/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Post-hepatectomy liver failure (PHLF) is a leading cause of postoperative mortality after liver surgery. Due to its significant impact, it is imperative to understand the risk stratification and preventative strategies for PHLF. The main objective of this review is to highlight the role of these strategies in a timeline centered way around curative resection. DATA SOURCES This review includes studies on both humans and animals, where they addressed PHLF. A literature search was conducted across the Cochrane Library, Embase, MEDLINE/PubMed, and Web of Knowledge electronic databases for English language studies published between July 1997 and June 2020. Studies presented in other languages were equally considered. The quality of included publications was assessed using Downs and Black's checklist. The results were presented in qualitative summaries owing to the lack of studies qualifying for quantitative analysis. RESULTS This systematic review with 245 studies, provides insight into the current prediction, prevention, diagnosis, and management options for PHLF. This review highlighted that liver volume manipulation is the most frequently studied preventive measure against PHLF in clinical practice, with modest improvement in the treatment strategies over the past decade. CONCLUSIONS Remnant liver volume manipulation is the most consistent preventive measure against PHLF.
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Affiliation(s)
- Mohamed Bekheit
- Department of Surgery, NHS Grampian, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK; Institute of Medical Sciences, Medical School, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK; Hépatica, Integrated Center of HPB Care, Elite Hospital, Agriculture Road, Alexandria, Egypt.
| | - Lisa Grundy
- Department of Surgery, NHS Grampian, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK
| | - Ahmed Ka Salih
- Department of Surgery, NHS Grampian, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK; Institute of Medical Sciences, Medical School, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK
| | - Petru Bucur
- Department of Surgery, University Hospital Tours, Val de la Loire 37000, France
| | - Eric Vibert
- Centre Hépatobiliaire, Paul Brousse Hospital, 12 Paul Valliant Couturier, 94804 Villejuif, France
| | - Mudassar Ghazanfar
- Department of Surgery, NHS Grampian, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK
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12
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Costentin C, Audureau E, Park YN, Langella S, Vibert E, Laurent A, Cauchy F, Scatton O, Chirica M, Rhaiem R, Boleslawski E, di Tommaso L, Ferrero A, Yano H, Akiba J, Donadon M, Nebbia M, Detry O, Honoré P, Di Martino M, Schwarz L, Barbier L, Nault JC, Rhee H, Lim C, Brustia R, Paradis V, Guettier C, Le Bail B, Okumura S, Blanc JF, Calderaro J. ERS: A simple scoring system to predict early recurrence after surgical resection for hepatocellular carcinoma. Liver Int 2023; 43:2538-2547. [PMID: 37577984 DOI: 10.1111/liv.15683] [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: 10/02/2022] [Revised: 06/20/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Surgical resection (SR) is a potentially curative treatment of hepatocellular carcinoma (HCC) hampered by high rates of recurrence. New drugs are tested in the adjuvant setting, but standardised risk stratification tools of HCC recurrence are lacking. OBJECTIVES To develop and validate a simple scoring system to predict 2-year recurrence after SR for HCC. METHODS 2359 treatment-naïve patients who underwent SR for HCC in 17 centres in Europe and Asia between 2004 and 2017 were divided into a development (DS; n = 1558) and validation set (VS; n = 801) by random sampling of participating centres. The Early Recurrence Score (ERS) was generated using variables associated with 2-year recurrence in the DS and validated in the VS. RESULTS Variables associated with 2-year recurrence in the DS were (with associated points) alpha-fetoprotein (<10 ng/mL:0; 10-100: 2; >100: 3), size of largest nodule (≥40 mm: 1), multifocality (yes: 2), satellite nodules (yes: 2), vascular invasion (yes: 1) and surgical margin (positive R1: 2). The sum of points provided a score ranging from 0 to 11, allowing stratification into four levels of 2-year recurrence risk (Wolbers' C-indices 66.8% DS and 68.4% VS), with excellent calibration according to risk categories. Wolber's and Harrell's C-indices apparent values were systematically higher for ERS when compared to Early Recurrence After Surgery for Liver tumour post-operative model to predict time to early recurrence or recurrence-free survival. CONCLUSIONS ERS is a user-friendly staging system identifying four levels of early recurrence risk after SR and a robust tool to design personalised surveillance strategies and adjuvant therapy trials.
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Affiliation(s)
- Charlotte Costentin
- Grenoble Alpes University, Institute for Advanced Biosciences, Research Center UGA/Inserm U 1209/CNRS 5309, Gastroenterology, Hepatology and GI Oncology Department, Digidune, Grenoble Alpes University Hospital, La Tronche, France
| | - Etienne Audureau
- Service de Santé Publique, Assistance Publique Hôpitaux de Paris, Hôpital Henri Mondor, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, Créteil, France
| | - Young Nyun Park
- Department of Pathology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Serena Langella
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Turin, Italy
| | - Eric Vibert
- Centre hépato-biliaire, Assistance Publique Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - Alexis Laurent
- Service de Chirurgie Digestive, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France
| | - François Cauchy
- Service de Chirurgie Hepato-Bilio-Pancréatique et Transplantation Hépatique, Hôpital Beaujon, AP-HP et Université de Paris, Clichy, France
| | - Olivier Scatton
- Service de Chirurgie Digestive, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié Salpétrière, Paris, France
| | - Mircea Chirica
- Service de Chirurgie Digestive, CHU Grenoble-Alpes, Grenoble, France
| | - Rami Rhaiem
- Service de Chirurgie Digestive, CHU de Reims, Reims, France
| | - Emmanuel Boleslawski
- Univ. Lille, INSERM U1189, CHU Lille, Service de Chirurgie Digestive et Transplantations, Lille, France
| | - Luca di Tommaso
- Unit of Pathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Turin, Italy
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Matteo Donadon
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Martina Nebbia
- Department of Surgery, Colon and Rectal Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | - Pierre Honoré
- Department of Abdominal Surgery and Transplantation, Centre Hospitalier Universitaire de Liege, University of Liege, Liege, Belgium
| | - Marcello Di Martino
- Department of Surgery, HPB Unit, University Hospital La Princesa, Madrid, Spain
| | - Lilian Schwarz
- Service de Chirurgie Digestive, CHU de Rouen, Rouen, France
| | - Louise Barbier
- Service de Chirurgie Digestive, CHU de Tours, Tours, France
| | - Jean-Charles Nault
- Liver Unit, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Bobigny, France
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, team « Functional Genomics of Solid Tumors », Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
| | - Hyungjin Rhee
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chetana Lim
- Service de Chirurgie Digestive, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié Salpétrière, Paris, France
| | - Raffaele Brustia
- Service de Chirurgie Digestive, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France
| | - Valérie Paradis
- Service d'Anatomie et de Cytologie Pathologique, Assistance Publique Hôpitaux de Paris, Hôpital Beaujon, Université de Paris, Clichy, France
| | - Catherine Guettier
- Service d'Anatomie et de Cytologie Pathologique, Assistance Publique Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Brigitte Le Bail
- Service de Pathologie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Shinya Okumura
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Jean-Frédéric Blanc
- Service Hépato-Gastroentérologie et Oncologie Digestive, Centre Médico-Chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Julien Calderaro
- Département de Pathologie, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Créteil, France
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Turco C, Hobeika C, Allard MA, Tabchouri N, Brustia R, Nguyen T, Cauchy F, Barbier L, Salamé E, Cherqui D, Vibert E, Soubrane O, Scatton O, Goumard C. Open Versus Laparoscopic Right Hepatectomy for Hepatocellular Carcinoma Following Sequential TACE-PVE: A Multicentric Comparative Study. Ann Surg Oncol 2023; 30:6615-6625. [PMID: 37394670 DOI: 10.1245/s10434-023-13752-5] [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] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/01/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Right hepatectomy (RH) for hepatocellular carcinoma (HCC) is ideally preceded by transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE). Laparoscopic approach improves short-term outcome and textbook outcome (TO), which reflects the "ideal" surgical outcome, after RH. However, laparoscopic RH on an underlying diseased liver and after TACE/PVE remains a challenging procedure. The aim of this study was to compare the outcomes in patients who underwent laparoscopic liver resection (LLR) or open liver resection (OLR) following TACE/PVE. PATIENTS AND METHODS All patients with HCC who underwent RH after TACE/PVE in five French centers were retrospectively included. Outcomes were compared between the LLR group and the OLR group using propensity score matching (PSM). Quality of surgical care was defined by TO. RESULTS Between 2005 and 2019, 117 patients were included (41 in LLR group, 76 in OLR group). Overall morbidity was comparable (51% versus 53%, p = 0.24). In LLR group, TO was completed in 66% versus 37% in OLR group (p = 0.02). LLR and absence of clamping were the only factors associated with TO completion [hazard ratio (HR) 4.27, [1.77-10.28], p = 0.001]. After PSM, 5-year overall survival (OS) and progression-free survival (PFS) were 55% in matched LLR versus 77% in matched OLR, p = 0.35, and 13% in matched LLR versus 17% in matched OLR, p = 0.97. TO completion was independently associated with a better 5-year OS (65.2% versus 42.5%, p = 0.007). CONCLUSION Major LLR after TACE/PVE should be considered as a valuable option in expert centers to increase the chance of TO, the latter being associated with a better 5-year OS.
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Affiliation(s)
- Célia Turco
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, Centre de Recherche Saint Antoine, INSERM UMRS-938, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Christian Hobeika
- Department of Hepato-Biliary, Liver Transplantation, and Pancreatic Surgery, Hospital Beaujon, Clichy, France
| | - Marc-Antoine Allard
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Inserm U 935, Villejuif, France
| | - Nicolas Tabchouri
- Service de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique, CHRU Hôpital Trousseau, Chambray, Tours, France
| | - Raffaele Brustia
- Department of Digestive and Hepato-Pancreatico-Biliary Surgery, Henri Mondor University Hospital, APHP, Créteil, France
| | - Tu Nguyen
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - François Cauchy
- Department of Hepato-Biliary, Liver Transplantation, and Pancreatic Surgery, Hospital Beaujon, Clichy, France
| | - Louise Barbier
- Service de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique, CHRU Hôpital Trousseau, Chambray, Tours, France
| | - Ephrem Salamé
- Service de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique, CHRU Hôpital Trousseau, Chambray, Tours, France
| | - Daniel Cherqui
- Department of Digestive and Hepato-Pancreatico-Biliary Surgery, Henri Mondor University Hospital, APHP, Créteil, France
| | - Eric Vibert
- Department of Digestive and Hepato-Pancreatico-Biliary Surgery, Henri Mondor University Hospital, APHP, Créteil, France
| | - Olivier Soubrane
- Department of Hepato-Biliary, Liver Transplantation, and Pancreatic Surgery, Hospital Beaujon, Clichy, France
| | - Olivier Scatton
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, Centre de Recherche Saint Antoine, INSERM UMRS-938, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Claire Goumard
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France.
- Sorbonne Université, Centre de Recherche Saint Antoine, INSERM UMRS-938, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
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Turco C, Hobeika C, Allard MA, Tabchouri N, Brustia R, Nguyen TT, Cauchy F, Barbier L, Salamé E, Cherqui D, Vibert E, Soubrane O, Scatton O, Goumard C. ASO Visual Abstract: Open Versus Laparoscopic Right Hepatectomy for Hepatocellular Carcinoma Following Sequential TACE-PVE: A Multicentric Comparative Study. Ann Surg Oncol 2023; 30:6626-6627. [PMID: 37436608 DOI: 10.1245/s10434-023-13835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
- Célia Turco
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint Antoine, INSERM UMRS-938, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Christian Hobeika
- Department of Hepato-Biliary, Liver Transplantation, and Pancreatic Surgery, Hospital Beaujon, Clichy, France
| | - Marc-Antoine Allard
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Inserm U 935, Villejuif, France
| | - Nicolas Tabchouri
- Service de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique, CHRU Hôpital Trousseau, Chambray, Tours, France
| | - Raffaele Brustia
- Department of Digestive and Hepato-Pancreatico-Biliary Surgery, Henri Mondor University Hospital, APHP, Créteil, France
| | - Thanh Tu Nguyen
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - François Cauchy
- Department of Hepato-Biliary, Liver Transplantation, and Pancreatic Surgery, Hospital Beaujon, Clichy, France
| | - Louise Barbier
- Service de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique, CHRU Hôpital Trousseau, Chambray, Tours, France
| | - Ephrem Salamé
- Service de Chirurgie Digestive, Oncologique, Endocrinienne et Transplantation Hépatique, CHRU Hôpital Trousseau, Chambray, Tours, France
| | - Daniel Cherqui
- Department of Digestive and Hepato-Pancreatico-Biliary Surgery, Henri Mondor University Hospital, APHP, Créteil, France
| | - Eric Vibert
- Department of Digestive and Hepato-Pancreatico-Biliary Surgery, Henri Mondor University Hospital, APHP, Créteil, France
| | - Olivier Soubrane
- Department of Hepato-Biliary, Liver Transplantation, and Pancreatic Surgery, Hospital Beaujon, Clichy, France
| | - Olivier Scatton
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
- Sorbonne Université, Centre de Recherche Saint Antoine, INSERM UMRS-938, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Claire Goumard
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France.
- Sorbonne Université, Centre de Recherche Saint Antoine, INSERM UMRS-938, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
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Sönmez RE, Besson FL, Ghidaglia J, Lewin M, Gomez L, Salloum C, Pittau G, Ciacio O, Allard MA, Cherqui D, Adam R, Sa Cunha A, Azoulay D, Vibert E, Golse N. Towards refining the utility of dual (18F-FDG / 18F-Choline) PET/CT for the management of hepatocellular carcinoma: a tertiary center study. Q J Nucl Med Mol Imaging 2023; 67:206-214. [PMID: 36345856 DOI: 10.23736/s1824-4785.22.03485-9] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The role of positron emission tomography/computed tomography (PET/CT) in hepatocellular carcinoma (HCC) management is not clearly defined. Our objective was to analyze the utility of dual-PET/CT (18F-FDG + 18F-Choline) imaging findings on the BCLC staging and treatment decision for HCC patients. METHODS Between January 2011 and April 2019, 168 consecutive HCC patients with available baseline dual-PET/CT imaging data were retrospectively analyzed. To identify potential refinement criteria for surgically-treated patients, survival Kaplan-Meier curves of various standard-of-care and dual-PET/CT baseline parameters were estimated. Finally, multivariate cox proportional hazard ratios of the most relevant clinico-biological and/or PET parameters were estimated. RESULTS Dual-PET/CT findings increased the score of BCLC staging in 21 (12.5%) cases. In 24.4% (N.=41) of patients, the treatment strategy was modified by the PET findings. Combining AFP levels at a threshold of 10 ng/mL with 18F-FDG or 18F-Choline N status significantly impacted DFS (P<0.05). In particular, the combined criteria of the N+ status assessed by 18F-Choline with AFP threshold of 10 ng/mL provided a highly predictive composite parameter for estimation of DFS according to multivariate analysis (HR=10.6, P<0.05). CONCLUSIONS The 18F-Choline / AFP composite parameter appears promising, and further prospective studies are mandatory to validate its oncological impact.
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Affiliation(s)
- Recep Erçin Sönmez
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France -
| | - Florent L Besson
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Paris-Saclay University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Paris-Saclay University, CEA, CNRS, Inserm, BioMaps, Orsay, France
- School of Medicine, Paris-Saclay Univrsity, Le Kremlin-Bicêtre, France
| | - Jerome Ghidaglia
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Paris-Saclay University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Maïté Lewin
- Department of Radiology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
| | - Lea Gomez
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Paris-Saclay University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Chady Salloum
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Gabriella Pittau
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Oriana Ciacio
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Marc Antoine Allard
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
- Department of Pathogenesis and Treatment of Liver Diseases, Paris-Saclay University, INSERM, UMR-S 1193, Paris, France
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
- Department of Pathogenesis and Treatment of Liver Diseases, Paris-Saclay University, INSERM, UMR-S 1193, Paris, France
| | - René Adam
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
- Research Group Chronotherapy, Cancers and Transplantation, Paris-Saclay University, Paris, France
| | - Antonio Sa Cunha
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
- Department of Pathogenesis and Treatment of Liver Diseases, Paris-Saclay University, INSERM, UMR-S 1193, Paris, France
| | - Daniel Azoulay
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Eric Vibert
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
- Department of Pathogenesis and Treatment of Liver Diseases, Paris-Saclay University, INSERM, UMR-S 1193, Paris, France
| | - Nicolas Golse
- Department of Hepatobiliary Surgery, Hepato-Biliary Center, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Villejuif, France
- Department of Pathogenesis and Treatment of Liver Diseases, Paris-Saclay University, INSERM, UMR-S 1193, Paris, France
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Beghdadi N, Kitano Y, Golse N, Vibert E, Sa Cunha A, Azoulay D, Cherqui D, Adam R, Allard MA. Features Importance in Acute Kidney Injury After Liver Transplant: Which Predictors Are Relevant? EXP CLIN TRANSPLANT 2023; 21:408-414. [PMID: 37334688 DOI: 10.6002/ect.2023.0049] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
OBJECTIVES Acute kidney injury after liver transplant results from several interconnected factors related to graft, recipient, intraoperative, and postoperative events. The random decision forest model enables an appreciation of each factor's contribution, which may be helpful in setting up a preventive strategy. This study aimed to evaluate the importance of covariates at different times (pretransplant, end of surgery, postoperative day 7) with a random forest permutation algorithm. MATERIALS AND METHODS We used a retrospective singlecenter cohort of patients, without preoperative renal failure, who underwent primary liver transplants from deceased donors (N =1104). Significant covariates for stage 2-3 acute kidney injurywere included in a random forest model, and features importance was evaluated with mean decrease accuracy and Gini index. RESULTS Stage 2-3 acute kidney injury occurred in 200 patients (18.1%) and was associated with lower patient survival, even after exclusion of early graftloss. At univariate analysis, recipient factors (serum creatinine level, Model for End-Stage Liver Disease score, body weight, body mass index), graft variables (weight, macrosteatosis), intraoperative factors (number of red blood cells, duration of surgery, cold ischemia time), and postoperative event (graft dysfunction) were associated with kidney failure. The pretransplant model found that macrosteatosis and graft weight contributed to acute kidney injury. The postoperative model indicated that graft dysfunction and the number of intraoperative packed red blood cells were ranked as the 2 most essential factors in posttransplant renal failure. CONCLUSIONS The application of a random forestfeature identified graft dysfunction, even transient and reversible, and the number of intraoperative packed red blood cells as the 2 most crucial contributors to acute kidney injury,thus indicating that prevention of graft dysfunction and bleeding are key points to limit the risk of renal failure after liver transplant.
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Affiliation(s)
- Nassiba Beghdadi
- From the AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France
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Acidi B, Ghallab M, Cotin S, Vibert E, Golse N. Augmented reality in liver surgery. J Visc Surg 2023; 160:118-126. [PMID: 36792394 DOI: 10.1016/j.jviscsurg.2023.01.008] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION During an operation, augmented reality (AR) enables surgeons to enrich their vision of the operating field by means of digital imagery, particularly as regards tumors and anatomical structures. While in some specialties, this type of technology is routinely ustilized, in liver surgery due to the complexity of modeling organ deformities in real time, its applications remain limited. At present, numerous teams are attempting to find a solution applicable to current practice, the objective being to overcome difficulties of intraoperative navigation in an opaque organ. OBJECTIVE To identify, itemize and analyze series reporting AR techniques tested in liver surgery, the objectives being to establish a state of the art and to provide indications of perspectives for the future. METHODS In compliance with the PRISMA guidelines and availing ourselves of the PubMed, Embase and Cochrane databases, we identified English-language articles published between January 2020 and January 2022 corresponding to the following keywords: augmented reality, hepatic surgery, liver and hepatectomy. RESULTS Initially, 102 titles, studies and summaries were preselected. Twenty-eight corresponding to the inclusion criteria were included, reporting on 183patients operated with the help of AR by laparotomy (n=31) or laparoscopy (n=152). Several techniques of acquisition and visualization were reported. Anatomical precision was the main assessment criterion in 19 articles, with values ranging from 3mm to 14mm, followed by time of acquisition and clinical feasibility. CONCLUSION While several AR technologies are presently being developed, due to insufficient anatomical precision their clinical applications have remained limited. That much said, numerous teams are currently working toward their optimization, and it is highly likely that in the short term, the application of AR in liver surgery will have become more frequent and effective. As for its clinical impact, notably in oncology, it remains to be assessed.
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Affiliation(s)
- B Acidi
- Department of Surgery, AP-HP hôpital Paul-Brousse, Hepato-Biliary Center, 12, avenue Paul-Vaillant Couturier, 94804 Villejuif cedex, France; Augmented Operating Room Innovation Chair (BOPA), France; Inria « Mimesis », Strasbourg, France
| | - M Ghallab
- Department of Surgery, AP-HP hôpital Paul-Brousse, Hepato-Biliary Center, 12, avenue Paul-Vaillant Couturier, 94804 Villejuif cedex, France; Augmented Operating Room Innovation Chair (BOPA), France
| | - S Cotin
- Augmented Operating Room Innovation Chair (BOPA), France; Inria « Mimesis », Strasbourg, France
| | - E Vibert
- Department of Surgery, AP-HP hôpital Paul-Brousse, Hepato-Biliary Center, 12, avenue Paul-Vaillant Couturier, 94804 Villejuif cedex, France; Augmented Operating Room Innovation Chair (BOPA), France; DHU Hepatinov, 94800 Villejuif, France; Inserm, Paris-Saclay University, UMRS 1193, Pathogenesis and treatment of liver diseases; FHU Hepatinov, 94800 Villejuif, France
| | - N Golse
- Department of Surgery, AP-HP hôpital Paul-Brousse, Hepato-Biliary Center, 12, avenue Paul-Vaillant Couturier, 94804 Villejuif cedex, France; Augmented Operating Room Innovation Chair (BOPA), France; Inria « Mimesis », Strasbourg, France; DHU Hepatinov, 94800 Villejuif, France; Inserm, Paris-Saclay University, UMRS 1193, Pathogenesis and treatment of liver diseases; FHU Hepatinov, 94800 Villejuif, France.
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Rajakannu M, Cherqui D, Cunha AS, Castaing D, Adam R, Vibert E. Predictive nomograms for postoperative 90-day morbidity and mortality in patients undergoing liver resection for various hepatobiliary diseases. Surgery 2023; 173:993-1000. [PMID: 36669938 DOI: 10.1016/j.surg.2022.11.009] [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: 05/05/2022] [Revised: 11/10/2022] [Accepted: 11/13/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Postoperative complications affect the long-term survival and quality of life in patients undergoing liver resection. No model has yet been validated to predict 90-day severe morbidity and mortality. METHODS The prospective recruitment of patients undergoing liver resection for various indications was performed. Preoperative clinical and laboratory data, including liver stiffness, indocyanine green retention, and intraoperative parameters, were analyzed to develop predictive nomograms for postoperative severe morbidity and mortality. Calibration plots were used to perform external validation. RESULTS The most common indications in 418 liver resections performed were colorectal metastases (N = 149 [35.6%]), hepatocellular carcinoma (N = 106 [25.4%]), and benign liver tumors (N = 60 [14.3%]). Major liver resections were performed in 164 (39.2%) patients. Severe morbidity and mortality were observed in 87 (20.8%) and 9 (2.2%) of patients, respectively, during the 90-day postoperative period. Post-hepatectomy liver failure was observed in 19 (4.5%) patients, resulting in the death of 4. The independent predictors of 90-day severe morbidity were age (odds ratio:1.02, P = .06), liver stiffness (odds ratio: 1.23, P = .04], number of resected segments (odds ratio: 1.28, P = .004), and operative time (odds ratio: 1.01, P = .01). Independent predictors of 90-day mortality were diabetes mellitus (odds ratio: 6.6, P = .04), tumor size >50 mm (odds ratio:4.8, P = .08), liver stiffness ≥22 kPa (odds ratio:7.0, P = .04), and operative time ≥6 hours (odds ratio: 6.1, P = .05). Nomograms were developed using these independent predictors and validated by testing the Goodness of fit in calibration plots (P = .64 for severe morbidity; P = .8 for mortality). CONCLUSION Proposed nomograms would enable a personalized approach to identifying patients at risk of complications and adapting surgical treatment according to their clinical profile and the center's expertise.
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Affiliation(s)
- Muthukumarassamy Rajakannu
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Denis Castaing
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - René Adam
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Inserm, Unité UMR-S 776, Villejuif, France
| | - Eric Vibert
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France. https://twitter.com/Eric_Vibert
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Sebagh M, Desterke C, Feray C, Hamelin J, Habib M, Samuel D, Rosmorduc O, Vibert E, Golse N. Indocyanine green fluorescence patterns of hepatocellular carcinoma correlate with pathological and molecular features. HPB (Oxford) 2023; 25:198-209. [PMID: 36411232 DOI: 10.1016/j.hpb.2022.10.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intraoperative Indocyanine Green Dye (ICG) routinely used in hepatobiliary surgery identifies different fluorescent patterns of hepatocellular carcinoma (HCC), a highly heterogeneous cancer. We aimed to correlate these patterns with gene mutations and extensive pathological features beyond the well-known tumor differentiation. METHODS Between February 2017 and December 2019, 21 HCC in 16 consecutive patients who underwent intraoperative ICG fluorescence imaging were included. Pathological review was performed by one pathologist blinded to fluorescence features. Random forest machine learning algorithm correlated pathological features of the tumor, peritumoral and non-tumoral liver, and gene mutations from a 28 gene-panel with rim and intra-lesion fluorescence. RESULTS Three HCC had negative intra-lesion and rim-like emission, 7 HCC had homogeneous pattern and 11 heterogeneous patterns in whom 3 with rim-like emission. Rim emission was associated with peritumoral vascular changes, lower differentiation and lower serum AFP level. Homogeneous intra-lesion fluorescence was associated with lower necrosis rate, thinner capsule, absence of peritumoral liver changes, and higher serum AFP level. Heterogeneous HCC without rim harbored lesser TP53 and ARID1A mutations. CONCLUSION Tumoral and peri-tumoral fluorescence classification of HCC yielded a possible intraoperative pathological and molecular characterization. These preliminary observations could lead to intraoperative refinement in surgical strategy.
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Affiliation(s)
- Mylène Sebagh
- AP-HP Hôpital Paul-Brousse, Laboratoire d'Anatomopathologie, Villejuif, F-94800, France; UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France.
| | - Christophe Desterke
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France
| | - Cyrille Feray
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
| | - Jocelyne Hamelin
- AP-HP Hôpital Paul-Brousse, Plateforme de biologie moléculaire, Villejuif, F-94800, France
| | - Myriam Habib
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
| | - Didier Samuel
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
| | - Olivier Rosmorduc
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
| | - Eric Vibert
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
| | - Nicolas Golse
- UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France; AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
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20
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Sala L, Golse N, Joosten A, Vibert E, Vignon-Clementel I. Sensitivity Analysis of a Mathematical Model Simulating the Post-Hepatectomy Hemodynamics Response. Ann Biomed Eng 2023; 51:270-289. [PMID: 36326994 PMCID: PMC9832106 DOI: 10.1007/s10439-022-03098-6] [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: 06/13/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
Recently a lumped-parameter model of the cardiovascular system was proposed to simulate the hemodynamics response to partial hepatectomy and evaluate the risk of portal hypertension (PHT) due to this surgery. Model parameters are tuned based on each patient data. This work focuses on a global sensitivity analysis (SA) study of such model to better understand the main drivers of the clinical outputs of interest. The analysis suggests which parameters should be considered patient-specific and which can be assumed constant without losing in accuracy in the predictions. While performing the SA, model outputs need to be constrained to physiological ranges. An innovative approach exploits the features of the polynomial chaos expansion method to reduce the overall computational cost. The computed results give new insights on how to improve the calibration of some model parameters. Moreover the final parameter distributions enable the creation of a virtual population available for future works. Although this work is focused on partial hepatectomy, the pipeline can be applied to other cardiovascular hemodynamics models to gain insights for patient-specific parameterization and to define a physiologically relevant virtual population.
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Affiliation(s)
- Lorenzo Sala
- Inria Saclay Ile-de-France, 91120 Palaiseau, France
| | - Nicolas Golse
- Université Paris-Saclay, Inserm Physiopathogénèse et traitement des maladie du foie, UMR-S 1193, 94800 Villejuif, France
| | - Alexandre Joosten
- Université Paris-Saclay, Inserm Physiopathogénèse et traitement des maladie du foie, UMR-S 1193, 94800 Villejuif, France
| | - Eric Vibert
- Université Paris-Saclay, Inserm Physiopathogénèse et traitement des maladie du foie, UMR-S 1193, 94800 Villejuif, France
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21
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Hoehme S, Hammad S, Boettger J, Begher-Tibbe B, Bucur P, Vibert E, Gebhardt R, Hengstler JG, Drasdo D. Digital twin demonstrates significance of biomechanical growth control in liver regeneration after partial hepatectomy. iScience 2022; 26:105714. [PMID: 36691615 PMCID: PMC9860368 DOI: 10.1016/j.isci.2022.105714] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/23/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Partial liver removal is an important therapy option for liver cancer. In most patients within a few weeks, the liver is able to fully regenerate. In some patients, however, regeneration fails with often severe consequences. To better understand the control mechanisms of liver regeneration, experiments in mice were performed, guiding the creation of a spatiotemporal 3D model of the regenerating liver. The model represents cells and blood vessels within an entire liver lobe, a macroscopic liver subunit. The model could reproduce the experimental data only if a biomechanical growth control (BGC)-mechanism, inhibiting cell cycle entrance at high compression, was taken into account and predicted that BGC may act as a short-range growth inhibitor minimizing the number of proliferating neighbor cells of a proliferating cell, generating a checkerboard-like proliferation pattern. Model-predicted cell proliferation patterns in pigs and mice were found experimentally. The results underpin the importance of biomechanical aspects in liver growth control.
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Affiliation(s)
- Stefan Hoehme
- Interdisciplinary Centre for Bioinformatics (IZBI), University of Leipzig, Haertelstraße 16-18, 04107 Leipzig, Germany,Institute of Computer Science, University of Leipzig, Haertelstraße 16-18, 04107 Leipzig, Germany,Saxonian Incubator for Clinical Research (SIKT), Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Seddik Hammad
- Section Molecular Hepatology, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Germany,Leibniz Research Centre for Working Environment and Human Factors at the Technical University Dortmund, 44139 Dortmund, Germany,Department of Forensic Medicine and Veterinary Toxicology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Jan Boettger
- Faculty of Medicine, Rudolf-Schoenheimer-Institute of Biochemistry, Leipzig University, 04103 Leipzig, Germany
| | - Brigitte Begher-Tibbe
- Leibniz Research Centre for Working Environment and Human Factors at the Technical University Dortmund, 44139 Dortmund, Germany
| | - Petru Bucur
- Unité INSERM 1193, Centre Hépato-Biliaire, Villejuif, France,Service de Chirurgie Digestive, CHU Trousseau, Tours, France
| | - Eric Vibert
- Unité INSERM 1193, Centre Hépato-Biliaire, Villejuif, France
| | - Rolf Gebhardt
- Faculty of Medicine, Rudolf-Schoenheimer-Institute of Biochemistry, Leipzig University, 04103 Leipzig, Germany
| | - Jan G. Hengstler
- Leibniz Research Centre for Working Environment and Human Factors at the Technical University Dortmund, 44139 Dortmund, Germany
| | - Dirk Drasdo
- Interdisciplinary Centre for Bioinformatics (IZBI), University of Leipzig, Haertelstraße 16-18, 04107 Leipzig, Germany,Leibniz Research Centre for Working Environment and Human Factors at the Technical University Dortmund, 44139 Dortmund, Germany,Inria Paris & Sorbonne Université LJLL, 75012 Paris, France,Correspondence:
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22
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Tortajada P, Doamba R, Cano L, Ghallab M, Allard MA, Ciacio O, Pittau G, Salloum C, Cherqui D, Adam R, Sa Cunha A, Azoulay D, Pascale A, Vibert E, Golse N. Resectable and transplantable hepatocellular carcinoma: Integration of liver stiffness assessment in the decision-making algorithm. Surgery 2022; 172:1704-1711. [PMID: 36241470 DOI: 10.1016/j.surg.2022.08.012] [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: 05/11/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Liver resection is a curative treatment for hepatocellular carcinoma (HCC) and an alternative to liver transplantation (LT). However, post-liver resection recurrence rates remain high. This study aimed to determine whether liver stiffness measurement (LSM) correlated with recurrence and to propose a method for predicting HCC recurrence exclusively using pre-liver resection criteria. METHODS This retrospective monocentric study included patients who had undergone LR liver resection for HCC between 2015 and 2018 and who had (1) preoperative alpha-fetoprotein scores indicating initial transplant viability and (2) available preoperative LSM data. We developed a predictive score for recurrence over time using Cox univariate regression and multivariate analysis with a combination plot before selecting the optimal thresholds (receiver operating characteristic curves + Youden test). RESULTS Sixty-six patients were included. After an average follow-up of 40 months, the recurrence rate was 45% (n = 30). Three-year overall survival was 88%. Four preoperative variables significantly impacted the time to recurrence: age ≥70 years, LSM ≥11 kPa, international normalized ratio (INR) ≥1.2, and maximum HCC diameter ≥3 cm. By assigning 1 point per positive item, patients with a score <2 (n = 22) demonstrated greater mean overall survival (69.7 vs 54.8 months, P = .02) and disease-free survival (52.2 vs 34.7 months, P = .02) than those with a score ≥2. Patients experiencing early recurrence (<1 year) presented a significantly higher preoperative LSM (P = .06). CONCLUSION We identified a simple preoperative score predictive of early hepatocellular carcinoma recurrence after liver resection, highlighting the role of liver stiffness. This score could help physicians select patients and make decisions concerning perioperative medical treatment.
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Affiliation(s)
- Pauline Tortajada
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France.
| | - Rodrigue Doamba
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
| | - Luis Cano
- INSERM, Univ Rennes, INRAE, CHU Pontchaillou, UMR 1241 NUMECAN, Rennes, France
| | - Mohammed Ghallab
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Marc Antoine Allard
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
| | - Oriana Ciacio
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
| | - Gabriella Pittau
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
| | - Chady Salloum
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
| | - Daniel Cherqui
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
| | - René Adam
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; Univ Paris-Sud, UMR-S 776, Villejuif, France
| | - Antonio Sa Cunha
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
| | - Daniel Azoulay
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
| | - Alina Pascale
- Department of Hepatology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France
| | - Eric Vibert
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France. https://twitter.com/Eric_Vibert
| | - Nicolas Golse
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, France; INSERM, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, UMRS 1193, FHU Hepatinov, Villejuif, France
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23
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Labgaa I, Cano L, Mangana O, Joliat GR, Melloul E, Halkic N, Schäfer M, Vibert E, Demartines N, Golse N, Hübner M. An algorithm based on the postoperative decrease of albumin (ΔAlb) to anticipate complications after liver surgery. Perioper Med (Lond) 2022; 11:53. [PMID: 36352456 PMCID: PMC9647979 DOI: 10.1186/s13741-022-00285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Background Perioperative decrease of albumin (ΔAlb) appeared as a promising predictor of complications after digestive surgery, but its role after liver surgery remains unclear. This study aimed to analyze whether and how ΔAlb can be used to predict complications after liver surgery. Methods A bicentric retrospective analysis of patients undergoing liver surgery (2010–2016) was performed, following TRIPOD guidelines. The preoperative and postoperative difference of albumin was calculated on POD 0 and defined as ΔAlb. Patients with any missing variable were excluded. The primary endpoint was overall complications according to the Clavien classification. A multiparametric algorithm based on ΔAlb was generated to optimize prediction performance. Results A total of 110 patients were analyzed. At least one complication occurred in 66 (60%) patients. Patients with and without complication showed a ΔAlb of 15.8 vs. 9.5 g/L (p<0.001). Area under ROC curve (AUC) of ΔAlb was 0.75 (p<0.01.). The ΔAlb-based algorithm showed an AUC of 0.84 (p<0.01), significantly improving performance (p=0.03). Multivariable analysis identified ΔAlb as independent predictor of complications (HR, 1.12; 95% CI, 1.01–1.07; p = 0.002). Conclusions ΔAlb appeared as a promising predictor independently associated with the risk of complication after liver surgery. The study presents a novel decision-tree based on ΔAlb to anticipate complications. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-022-00285-w.
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Conticchio M, Salloum C, Allard MA, Golse N, Pittau G, Ciacio O, Vibert E, Sa Cunha A, Cherqui D, Adam R, Azoulay D. The rex shunt for left portal vein reconstruction during hepatectomy for malignancy using of rex-shunt in adults for oncoliver surgery. Surg Endosc 2022; 36:8249-8254. [PMID: 35441315 DOI: 10.1007/s00464-022-09270-2] [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: 01/08/2022] [Accepted: 04/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Immediate portal reperfusion is mandatory following hepatectomy combined with portal vein (PV) resection. This retrospective study analyzes the feasibility and the outcomes of the Rex shunt (RS) for reconstruction of the left portal vein (LPV) and reperfusion of the remnant left liver or lobe following hepatectomy for cancer combined with resection of the PV in adult patients. METHODS From 2018 to 2021, an RS was used in the above setting to achieve R0 resection or when the standard LPV reconstruction failed or was deemed technically impossible. RESULTS There were 6 male and 5 female patients (median age, 58 years) with perihilar cancer (5 cases) or miscellaneous cancers invading the PV (6 cases). A major hepatectomy was performed in 10/11 patients. The RS was indicated to achieve R0 resection or for technical reasons in 8 and 3 cases, respectively, and was feasible in all consecutive attempts with (10 cases) or without an interposed synthetic graft (1 case). Two fatal complications (PV thrombosis and pulmonary embolism) and three non-severe complications occurred in four patients within 90 days of surgery. Two patients died of tumor recurrence with a patent RS at 13 and 29 months, and 7 were recurrence free with a patent shunt with a follow-up of 1 to 37 months (median, 15 months). CONCLUSION In case of remnant left liver or lobe following hepatectomy combined with resection of the PV, the RS may help to achieve R0 resection and is a valuable option to perform technically satisfying portal reperfusion of the remnant left liver or lobe.
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Affiliation(s)
- Maria Conticchio
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France.,Université Paris-Saclay, Saclay, France
| | - Chady Salloum
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France.,Université Paris-Saclay, Saclay, France
| | - Marc Antoine Allard
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France.,Université Paris-Saclay, Saclay, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 935, Villejuif, France
| | - Nicolas Golse
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France.,Université Paris-Saclay, Saclay, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 935, Villejuif, France
| | - Gabriella Pittau
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France.,Université Paris-Saclay, Saclay, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 935, Villejuif, France
| | - Oriana Ciacio
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France.,Université Paris-Saclay, Saclay, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 935, Villejuif, France
| | - Eric Vibert
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France.,Université Paris-Saclay, Saclay, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 935, Villejuif, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France.,Université Paris-Saclay, Saclay, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 935, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France.,Université Paris-Saclay, Saclay, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 935, Villejuif, France
| | - René Adam
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France.,Université Paris-Saclay, Saclay, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 935, Villejuif, France
| | - Daniel Azoulay
- Centre Hépato-Biliaire, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, 94000, Villejuif, France. .,Université Paris-Saclay, Saclay, France.
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Rajakannu M, Coilly A, Cherqui D, Cunha AS, Castaing D, Adam R, Samuel D, Vibert E. Liver stiffness-based model predicts hepatic venous pressure gradient in patients with liver disease. HPB (Oxford) 2022; 24:1796-1803. [PMID: 35504833 DOI: 10.1016/j.hpb.2021.11.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/31/2021] [Accepted: 11/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim was to develop a model to predict clinically significant portal hypertension, hepatic venous pressure gradient (HVPG) ≥10 mmHg using pre-operative noninvasive makers. METHODS Patients who have been programmed for liver resection/transplantation were enrolled prospectively. Preoperative liver stiffness measurement (LSM), liver function test (LFT), and intraoperative HVPG were assessed. A probability score model to predict HVPG≥10 mmHg called HVPG10 score was developed and validated. RESULTS A total of 161 patients [66% men, median age of 63 years] were recruited for the study. Median LSM, and HVPG were 9.5 kPa, and 5 mmHg respectively. HVPG10 score was developed using independent predictors of HVPG≥10 mmHg in the training set were LSM, total bilirubin, alkaline phosphatase, and international normalized ratio. Area under receiver operating curve of HVPG10 score in the training and validation sets were 0.91 and 0.93 respectively with a cutoff of 15. In the overall cohort, HVPG10 score≥15 had 83% accuracy, 90% sensitivity, 81% specificity and 96% negative predictive value in predicting HVPG≥10 mmHg. CONCLUSION HVPG10 score is an easy-to-use noninvasive continuous scale tool to rule out clinically significant portal hypertension in >95% patients with chronic liver disease.
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Affiliation(s)
- Muthukumarassamy Rajakannu
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Denis Castaing
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - René Adam
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France; Inserm, Unité UMR-S 776, Villejuif, France
| | - Didier Samuel
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Eric Vibert
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France.
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Affiliation(s)
- Annabel K Gravely
- Multi-Organ Transplant and HPB Surgical Oncology, Division of General Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Eric Vibert
- Centre Hépato-Biliaire, Paul Brousse Hospital, Paris Saclay University, AP-HP, Villejuif, France
| | - Gonzalo Sapisochin
- Multi-Organ Transplant and HPB Surgical Oncology, Division of General Surgery, University Health Network, University of Toronto, Toronto, Canada.
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Azoulay D, Desterke C, Bhangui P, Salloum C, Conticchio M, Vibert E, Cherqui D, Adam R, Ichai P, Saliba F, Elmaleh A, Naili S, Lim C, Feray C. Tumors located in the central column of the liver are associated with increased surgical difficulty and postoperative complications following open liver resection for colorectal metastases. HPB (Oxford) 2022; 24:1376-1386. [PMID: 35437222 DOI: 10.1016/j.hpb.2022.03.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/13/2022] [Accepted: 03/10/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND To assess the impact of difficult location (based on preoperative computed tomography) of liver metastases from colorectal cancer (LMCRC) on surgical difficulty, and occurrence of severe postoperative complications (POCs). METHODS A retrospective single-centre study of 911 consecutive patients with LMCRC who underwent hepatectomy by the open approach between 1998 and 2011, before implementation of laparoscopic surgery to obviate approach selection bias. LMCRC with at least one of the following four features on preoperative imaging: tumor invading the hepatocaval confluence or retro-hepatic inferior vena cava, centrally located (Segments 4,5,8) and >10 cm in diameter, abutting the supra-hilar area, or involving the paracaval portion or caudate process of Segment 1; were considered as topographically difficult (top-diff). Independent predictors of surgical difficulty assessed by number of blood units transfused, duration of ischemia, and number of sessions of pedicle clamping during surgery and of severe POCs were identified by multivariate analysis before, and after propensity score matching. RESULTS Top-diff tumor location independently predicted surgical difficulty. Severe POCs were associated with the tumor location [top-diff vs. topographically non difficult (non top-diff)], preoperative portal vein embolization, and variables related to surgical difficulty. CONCLUSION LMCRC in difficult location independently predicts surgical difficulty and severe POCs.
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Affiliation(s)
- Daniel Azoulay
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France; Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France.
| | - Christophe Desterke
- Université Paris-Saclay, Villejuif, France; Inserm UMR-S-MD A9, Hôpital Paul Brousse, Villejuif, France
| | - Prashant Bhangui
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi NCR, India
| | - Chady Salloum
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France
| | - Maria Conticchio
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France
| | - Eric Vibert
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France; Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France; Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France
| | - René Adam
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France; Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France
| | - Philippe Ichai
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France
| | - Annie Elmaleh
- Service de Radiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Villejuif, France
| | - Salima Naili
- Département D'Anesthésie-Réanimation, Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France
| | - Chetana Lim
- Département de Chirurgie Hépato-Biliaire et Transplantation Hépatique, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - Cyrille Feray
- Centre Hépato-Biliaire, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paul Brousse, France; Institut National de La Santé et de La Recherche Médicale (INSERM) Unité 935, And Université Paris-Saclay, Villejuif, France
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Adam R, Accardo C, Houssami S, Sa Cunha A, Levi F, Hammel P, Vibert E, Azoulay D, Cherqui D, Allard MA. Optimal cytoreductive LIVER surgery for unresectable colorectal liver metastases: A prospective observational study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3570] [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
3570 Background: Patients with multiple colorectal liver metastases (CLM) involving all the hepatic segments are currently not eligible for potentially curative liver surgery. Transplantation is a promising alternative but graft shortage and stringent selection criteria limit its accessibility. Owing to the improving efficacy of chemotherapy, the impossibility to resect all the initial metastatic sites could lead to revisit the role of optimal cytoreductive liver surgery (CLS) aiming to treat by resection ± radiofrequency, all the macroscopic residual tumors after a good response to chemotherapy. Although validated for ovarian cancer and peritoneal carcinomatosis, this strategy remains unexplored in CLM. Our objective was to evaluate the outcome of this strategy in patients with definitively unresectable CLM. Methods: Within a prospective monocentric study, we enrolled for debulking surgery, between 2017 and 2021, all consecutive patients with multinodular unresectable CLM involving all segments on initial imaging and consequently ineligible for a curative surgery either after a one or two-stage hepatectomy. These patients should have a strong response to chemotherapy ( > 50 % on RECIST criteria) for at least a 3-month period and no or limited extrahepatic disease, to be included. End-points of the analysis were overall and disease-free survival at 3 years. Results: Among 26 patients considered for this strategy, optimal CLS could be achieved in 21 patients after a median interval of 10 months from CLM diagnosis. The median number of lesions was 11 (7 - 26) on initial imaging. Four patients (19%) had synchronous lung metastases. Liver-first strategy was undertaken in 19 patients (90%). Postoperative complications (Grade ≥ III) occured in 5 patients (24%). One patient died within 90-day after operation from intra-abdominal hemorrage while on anticoagulation therapy. After a median follow-up of 25 months from hepatectomy, the 3-year OS rates was 85%. Median survival was not reached at the time of the analysis. Of the 4 (19%) patients with complete pathological response on the liver specimen, 3 developed recurrence. A total of 17 patients (81%) developed recurrence after a median time of 10,5 months from hepatectomy. Among them, repeat hepatectomy could be undertaken in four patients. The survival time to surgical failure (recurrence untreatable with curative intent) was 32% and 16% at 2 and 3 years. At last follow-up, seven patients (33%) are alive and recurrence-free. Conclusions: The promising results of this prospective series suggest that CLS may be worthy in patients with diffuse CLM non curatively treatable by surgery but responding well to chemotherapy. This strategy should however be reserved to hyperselected patients, super responders, eligible for an optimal resection of all the macroscopic residual tumors, and confimed by other expert centers, to be definitively validated.
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Affiliation(s)
- Rene Adam
- AP-HP, Hôpital Paul Brousse, Univ Paris-Saclay, Villejuif, France
| | | | | | - Antonio Sa Cunha
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Francis Levi
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, United Kingdom
| | - Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | - Eric Vibert
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Daniel Azoulay
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
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Marques F, Ghallab M, Vibert E, Boleslawski E, Soubrane O, Adam R, Farges O, Mabrut JY, Régimbeau JM, Cherqui D, Allard MA, Sa Cunha A, Samuel D, Pruvot FR, Golse N. Prognostic impact of surgical margins for hepatocellular carcinoma according to preoperative alpha-fetoprotein level. HPB (Oxford) 2022; 24:848-856. [PMID: 34785122 DOI: 10.1016/j.hpb.2021.10.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/17/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND HCC are known to have satellite nodules and microvascular invasions requiring sufficient margins. An alpha-fetoprotein (AFP) level >100 ng/mL is associated with worse pathological features in HCC. In practice, large resection margins, particularly >1 cm, are infrequently retrieved on the specimens. METHODS 397 patients from 5 centres were included from 2012 to 2017. The primary endpoint was time-to-recurrence in relation to AFP level (> or <100 ng/ml) as well as surgical margins (> or <1 cm). The secondary endpoint was overall survival (OS). RESULTS The median follow-up was 25 months. In Low AFP group, median time to recurrence (TTR) for patients with margins <1 cm was 36 months and for patients with margins ≥1 cm was 34 months (p = 0.756), and overall survival (OS) was not significantly different according to margins (p = 0.079). In High-AFP group, patients with margins <1 cm had a higher recurrence rate than patients with margins ≥1 cm (p = 0.016): median TTR for patients with margins <1 cm was 8 months whereas it was not reached for patients with margins ≥1 cm. Patients with margins <1 cm had a significantly worse OS compared to the patients with margins ≥1 cm (p = 0.043). CONCLUSION Preoperative AFP level may help determine margins to effectively treat high AFP tumours. For low-AFP tumours, margins didn't have an impact on TTR or OS.
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Affiliation(s)
- Frédéric Marques
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France
| | - Mohammed Ghallab
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Eric Vibert
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France
| | - Emmanuel Boleslawski
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France
| | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Université Paris Clichy, INSERM, Unit 776, Villejuif F-94800, France
| | - René Adam
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Univ Paris-Sud, UMR-S 776, Villejuif, 94800, France
| | - Olivier Farges
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique Hôpitaux de Paris, Université Paris Clichy, INSERM, Unit 776, Villejuif F-94800, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Lyon, France
| | - Jean-Marc Régimbeau
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Amiens, France
| | - Daniel Cherqui
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France
| | - Marc-Antoine Allard
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France
| | - Antonio Sa Cunha
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France
| | - Didier Samuel
- Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France; Department of Hepatology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France
| | - François-René Pruvot
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Claude Huriez, Lille, France
| | - Nicolas Golse
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, UMRS 1193, Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies Du Foie, FHU Hepatinov, 94800, Villejuif, France.
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Lewin M, Laurent-Bellue A, Desterke C, Radu A, Feghali JA, Farah J, Agostini H, Nault JC, Vibert E, Guettier C. Evaluation of perfusion CT and dual-energy CT for predicting microvascular invasion of hepatocellular carcinoma. Abdom Radiol (NY) 2022; 47:2115-2127. [PMID: 35419748 DOI: 10.1007/s00261-022-03511-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE Evaluation of perfusion CT and dual-energy CT (DECT) quantitative parameters for predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC) prior to surgery. METHODS This prospective single-center study included fifty-six patients (44 men; median age 67; range 31-84) who provided written informed consent. Inclusion criteria were (1) treatment-naïve patients with a diagnosis of HCC, (2) an indication for hepatic resection, and (3) available arterial DECT phase and perfusion CT (GE revolution HD-GSI). Iodine concentrations (IC), arterial density (AD), and 9 quantitative perfusion parameters for HCC were correlated to pathological results. Radiological parameters based principal component analysis (PCA), corroborated by unsupervised heatmap classification, was meant to deliver a model for predicting MVI in HCC. Survival analysis was performed using univariable log-rank test and multivariable Cox model, both censored at time of relapse. RESULTS 58 HCC lesions were analyzed (median size 42.3 mm; range of 20-140). PCA showed that the radiological model was predictive of tumor grade (p = 0.01), intratumoral MVI (p = 0.004), peritumoral MVI (p = 0.04), MTM (macrotrabecular-massive) subtype (p = 0.02), and capsular invasion (p = 0.02) in HCC. Heatmap classification of HCC showed tumor heterogeneity, stratified into three main clusters according to the risk of relapse. Survival analysis confirmed that permeability surface-area product (PS) was the only significant independent parameter, among all quantitative tumoral CT parameters, for predicting a risk of relapse (Cox p value = 0.004). CONCLUSION A perfusion CT and DECT-based quantitative imaging profile can provide a diagnosis of histological MVI in HCC. PS is an independent parameter for relapse. CLINICAL TRIALS ClinicalTrials.gov: NCT03754192.
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Affiliation(s)
- Maïté Lewin
- Service de Radiologie, AP-HP-Université Paris Saclay Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94800, Villejuif, France.
- Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France.
| | - Astrid Laurent-Bellue
- Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France
- Service d'Anatomopathologie, AP-HP-Université Paris Saclay Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
| | - Christophe Desterke
- Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France
- Service de Bio-informatique, INSERM UA9, Hôpital Paul Brousse, 94800, Villejuif, France
| | - Adina Radu
- Service de Radiologie, AP-HP-Université Paris Saclay Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Joëlle Ann Feghali
- Service de Radiologie, AP-HP-Université Paris Saclay Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Jad Farah
- Service de Radiologie, AP-HP-Université Paris Saclay Hôpital Paul Brousse, 12-14 avenue Paul Vaillant Couturier, 94800, Villejuif, France
| | - Hélène Agostini
- Service d'Epidémiologie et de Santé Publique, AP-HP-Université Paris Saclay Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
| | - Jean-Charles Nault
- Service d'Hépatologie, AP-HP, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Hôpital Avicenne, 93000, Bobigny, France
- Functional Genomics of Solid Tumors Laboratory, Centre de Recherche Des Cordeliers, Sorbonne Université, Inserm, USPC, Université Paris Descartes, Université Paris Diderot, Université Paris 13, 75006, Paris, France
- Université Paris 13, Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, 93000, Bobigny, France
| | - Eric Vibert
- Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France
- AP-HP-Université Paris Saclay, Hôpital Paul Brousse, 94800, Villejuif, France
- Centre Hépato-Biliaire, INSERM U1193 Hôpital Paul Brousse, 94800, Villejuif, France
| | - Catherine Guettier
- Faculté de Médecine, Université Paris Saclay, 94270, Le Kremlin-Bicêtre, France
- Service d'Anatomopathologie, AP-HP-Université Paris Saclay Hôpital Bicêtre, 94270, Le Kremlin-Bicêtre, France
- Centre Hépato-Biliaire, INSERM U1193 Hôpital Paul Brousse, 94800, Villejuif, France
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Adam R, Badrudin D, Allard MA, Golse N, Ulusakarya A, Cherqui D, Sa Cunha A, Vibert E, Azoulay D, Ciacio O, Pittau G, Lucchese A, Hammel P, Lewin M, Giacchetti S. Is cure possible for breast cancer metastatic to the liver? J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1099] [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
1099 Background: Metastatic breast cancer (MBC) is a lethal disease and is generally only amenable to systemic treatment. Although increasingly recommended on selected patients, local treatments, and particularly surgery, are seldom used in the therapeutic armamentarium for MBC and their long-term survival benefit is unknown. We hypothesized that combining surgery to systemic treatment for selected patients with breast cancer liver metastases could lead to long-term survival or even an option of cure. Methods: A retrospective study of prospectively gathered data from a surgical series of liver resections for MBC was conducted. Patients with no or limited and stable extra-hepatic disease were offered surgery after multidisciplinary discussion, if the liver metastases were responding to systemic treatment and were amenable to complete macroscopic resection. Five- and ten-year actual survivors were identified and their characteristics were explored. Results: From 1984 to 2020, 207 female patients underwent liver resections for MBC in our institution. There was no postoperative mortality. Postoperative complication rate was 23.3% and liver-specific complication rate was 19.0%. There was a total of 48 repeat hepatectomies. Median disease-free interval between initial breast cancer and liver metastasis was 36 ± 90.1 months. There was a median of 2 ± 1.8 liver metastases at diagnosis with a median size of 33.0 ± 18.3 mm and 73.1% of patients had radiological response before resection. Five- and ten-year overall survivals (OS) as well as 5- and 10-year disease-free survivals (DFS) were 39.6% and 12.7% as well as 14.2% and 6.4%, respectively. Median OS was 44.0 ± 47.2 months in the whole series. Focusing on the 5- and 10-year survivors, median OS were 89.5 ± 44.7 months and 144.0 ±42.6 months, respectively. In the 10-year survivors’ group, median DFS was 98 ±62.3 months. Observed survivals in this study underestimate true actual survivals owing to censoring of patients lost to follow-up. Conclusions: Long-term survival (≥ 5 years) as well as a curative perspective (≥ 10 years survival) are achievable for selected patients with breast cancer liver metastases by combining surgery to systemic treatment. Considering the recent improvements in the results of systemic treatments, introducing surgical resection in the treatment sequences of MBC could play an even more beneficial role.
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Affiliation(s)
- Rene Adam
- AP-HP Hôpital Paul Brousse, Université Paris-Saclay, Villejuif, France
| | | | | | | | - Ayhan Ulusakarya
- Digestive and Medical Oncology Unit, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique-Hopitaux de Paris, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Eric Vibert
- Cancer Institute Paul Brousse, Villejuif, France
| | - Daniel Azoulay
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Oriana Ciacio
- Centre Hépato-Biliaire, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Gabriella Pittau
- Centre Hépato-biliaire, AP-HP, Paul Brousse Hospital, Villejuif, France
| | | | - Pascal Hammel
- Hôpital Beaujon (AP-HP), Clichy, and University Paris VII, Paris, France
| | - Maite Lewin
- AP-HP Hopital Paul Brousse, Service de Radiologie, Villejuif, France
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Seehofer D, Petrowsky H, Schneeberger S, Vibert E, Ricke J, Sapisochin G, Nault JC, Berg T. Patient Selection for Downstaging of Hepatocellular Carcinoma Prior to Liver Transplantation—Adjusting the Odds? Transpl Int 2022; 35:10333. [PMID: 35529597 PMCID: PMC9069348 DOI: 10.3389/ti.2022.10333] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/03/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
Background and Aims: Morphometric features such as the Milan criteria serve as standard criteria for liver transplantation (LT) in patients with hepatocellular carcinoma (HCC). Since it has been recognized that these criteria are too restrictive and do not adequately display the tumor biology, additional selection parameters are emerging. Methods: Concise review of the current literature on patient selection for downstaging and LT for HCC outside the Milan criteria. Results: The major task in patients outside the Milan criteria is the need for higher granularity with patient selection, since the benefit through LT is not uniform. The recent literature clearly shows that beneath tumor size and number, additional selection parameters are useful in the process of patient selection for and during downstaging. For initial patient selection, the alpha fetoprotein (AFP) level adds additional information to the size and number of HCC nodules concerning the chance of successful downstaging and LT. This effect is quantifiable using newer selection tools like the WE (West-Eastern) downstaging criteria or the Metroticket 2.0 criteria. Also an initial PET-scan and/or tumor biopsy can be helpful, especially in the high risk group of patients outside the University of California San Francisco (UCSF) criteria. After this entry selection, the clinical course during downstaging procedures concerning the tumor and the AFP response is of paramount importance and serves as an additional final selection tool. Conclusion: Selection criteria for liver transplantation in HCC patients are becoming more and more sophisticated, but are still imperfect. The implementation of molecular knowledge will hopefully support a more specific risk prediction for HCC patients in the future, but do not provide a profound basis for clinical decision-making at present.
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Affiliation(s)
- Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital, Leipzig, Germany
- *Correspondence: Daniel Seehofer,
| | - Henrik Petrowsky
- Swiss HPB and Transplantation Center, Department of Surgery and Transplantation, University Hospital Zürich, Zurich, Switzerland
| | - Stefan Schneeberger
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Eric Vibert
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France
| | - Jens Ricke
- Department of Radiology, LMU Munich, Munich, Germany
| | - Gonzalo Sapisochin
- Ajmera Transplant Program and HPB Surgical Oncology, Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Jean-Charles Nault
- Service d’Hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Université Paris Nord, Paris, France
- INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
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Kitano Y, Pietrasz D, Fernandez-Sevilla E, Golse N, Vibert E, Sa Cunha A, Azoulay D, Cherqui D, Baba H, Adam R, Allard MA. Subjective Difficulty Scale in Liver Transplantation: A Prospective Observational Study. Transpl Int 2022; 35:10308. [PMID: 35387395 PMCID: PMC8977402 DOI: 10.3389/ti.2022.10308] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
The predictive value of a subjective difficulty scale (DS) after surgical procedures is unknown. The objective of this study was to evaluate the prognostic value of a DS after liver transplantation (LT) and to identify predictors of difficulty. Surgeons prospectively evaluated the difficulty of 441 consecutive liver transplantations from donation after brain death at the end of the surgery by using a DS from 0 to 10 (“the easiest to the hardest you can imagine”). DS was associated with severe morbidity. The risk of graft loss at 1 year remained unchanged from 0 to 6 but increased beyond 6. Graft survival and patient survival of group with DS 7–10 was significantly impaired compared to groups with DS: 0–3 or DS: 4–6 but were significantly impaired for the group with DS: 7–10. Independent predictors of difficult LT (DS ≥ 7) were annular segment 1, transjugular intrahepatic portosystemic shunt, retransplantation beyond 30 days, portal vein thrombosis, and ascites. Of them, ascites was a borderline non-significant covariate (p = .04). Vascular complications occurred more often after difficult LT (20.5% vs. 5.9%), whereas there was no difference in the other types of complications. DS can be used to tailor monitoring and anticipate early complications. External validation is needed.
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Affiliation(s)
- Yuki Kitano
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Daniel Pietrasz
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France
| | - Elena Fernandez-Sevilla
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France
| | - Nicolas Golse
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - Eric Vibert
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - Antonio Sa Cunha
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris, Saclay, France
| | - Daniel Azoulay
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France
| | - Daniel Cherqui
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris, Saclay, France
| | - Marc-Antoine Allard
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Sud, Inserm U 935, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris, Saclay, France
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34
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Dip F, Boni L, Bouvet M, Carus T, Diana M, Falco J, Gurtner GC, Ishizawa T, Kokudo N, Lo Menzo E, Low PS, Masia J, Muehrcke D, Papay FA, Pulitano C, Schneider-Koraith S, Sherwinter D, Spinoglio G, Stassen L, Urano Y, Vahrmeijer A, Vibert E, Warram J, Wexner SD, White K, Rosenthal RJ. Consensus Conference Statement on the General Use of Near-infrared Fluorescence Imaging and Indocyanine Green Guided Surgery: Results of a Modified Delphi Study. Ann Surg 2022; 275:685-691. [PMID: 33214476 PMCID: PMC8906245 DOI: 10.1097/sla.0000000000004412] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In recent decades, the use of near-infrared light and fluorescence-guidance during open and laparoscopic surgery has exponentially expanded across various clinical settings. However, tremendous variability exists in how it is performed. OBJECTIVE In this first published survey of international experts on fluorescence-guided surgery, we sought to identify areas of consensus and nonconsensus across 4 areas of practice: fundamentals; patient selection/preparation; technical aspects; and effectiveness and safety. METHODS A Delphi survey was conducted among 19 international experts in fluorescence-guided surgery attending a 1-day consensus meeting in Frankfurt, Germany on September 8th, 2019. Using mobile phones, experts were asked to anonymously vote over 2 rounds of voting, with 70% and 80% set as a priori thresholds for consensus and vote robustness, respectively. RESULTS Experts from 5 continents reached consensus on 41 of 44 statements, including strong consensus that near-infrared fluorescence-guided surgery is both effective and safe across a broad variety of clinical settings, including the localization of critical anatomical structures like vessels, detection of tumors and sentinel nodes, assessment of tissue perfusion and anastomotic leaks, delineation of segmented organs, and localization of parathyroid glands. Although the minimum and maximum safe effective dose of ICG were felt to be 1 to 2 mg and >10 mg, respectively, there was strong consensus that determining the optimum dose, concentration, route and timing of ICG administration should be an ongoing research focus. CONCLUSIONS Although fluorescence imaging was almost unanimously perceived to be both effective and safe across a broad range of clinical settings, considerable further research remains necessary to optimize its use.
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Affiliation(s)
- Fernando Dip
- Hospital de Clinicas Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina
- Cleveland Clinic Florida, Weston, FL
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS - Ca' Granda - Ospedale Maggiore Policlinico University of Milan, Milan, Italy
| | | | | | - Michele Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France
| | - Jorge Falco
- University Hospital Das Clinicas, Buenos Aires, Argentina
| | | | | | - Norihiro Kokudo
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | | | - Francis A Papay
- Cleveland Clinic, Lerner College of Medicine at Case Western Reserve University, Cleveland, OH
| | | | | | | | - Giuseppe Spinoglio
- FPO Candolo Institute for Cancer Research and Treatment I.R.C.C.S, Turin, Italy
| | - Laurents Stassen
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Eric Vibert
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France
| | - Jason Warram
- University of Alabama at Birmingham, Birmingham, AL
| | | | - Kevin White
- ScienceRight Research Consulting London, Ontario, Canada
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Maillot B, Bouzille G, Mabrut JY, Girard E, Laurent A, Navarro F, Chebaro A, Chiche L, Faitot F, Sulpice L, Vibert E, Boudjema K. The Role of Cavoportal and Renoportal Hemitransposition in Liver Transplantation. Ann Transplant 2022; 27:e935892. [PMID: 35256580 PMCID: PMC8917783 DOI: 10.12659/aot.935892] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Betty Maillot
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, Pontchaillou Hospital, University of Rennes 1, Rennes, France
| | - Guillaume Bouzille
- Department of Medical Information and Medical Records, CHU Rennes, Pontchaillou Hospital, University of Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, University of Claude Bernard Lyon 1, Hospices Civils de Lyon. National Institute for Health and Medical Research (INSERM) Unit 1052/CNRS-5286, Lyon, France
| | - Edouard Girard
- Department of Digestive Surgery and Emergency, CHU Grenoble Alpes, La Tronche Hospital, University of Grenoble Alpes, Grenoble, France
| | - Alexis Laurent
- Department of Digestive and Hepatobiliopancreatic Surgery, AP-HP, Henri Mondor Hospital, University of Paris-Est Créteil, Inserm, UMR-955, Paris, France
| | - Francis Navarro
- Department of Hepatobiliary Digestive Surgery and Hepatic and Pancreatic Transplantation, CHU Montpellier, Saint Eloi Hospital, University of Medicine Montpellier-Nîmes, Montpellier, France
| | - Alexandre Chebaro
- Department of Digestive Surgery and Transplantation, CHU Lille, Huriez Hospital, University of Medicine Henri Warembourg, Lille, France
| | - Laurence Chiche
- Department of Hepatobiliary and Hepatic Transplantation, CHU Bordeaux, Haut-Lévêque Hospital, University of Bordeaux, Bordeaux, France
| | - Francois Faitot
- Department of General, Hepatic, Endocrine and Transplantation Surgery, CHU Strasbourg, Hautepierre Hospital, University of Strasbourg, Strasbourg, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, Pontchaillou Hospital, University of Rennes 1, Rennes, France
| | - Eric Vibert
- Hepato-Biliary Center, AP-HP, Paul Brousse Hospital, University of Paris-Saclay, Paris, France
| | - Karim Boudjema
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, Pontchaillou Hospital, University of Rennes 1, Rennes, France
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36
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Azoulay D, Feray C, Lim C, Salloum C, Conticchio M, Cherqui D, Sa Cunha A, Adam R, Vibert E, Samuel D, Allard MA, Golse N. A systematic review of auxiliary liver transplantation of small for size grafts in patients with chronic liver disease. JHEP Rep 2022; 4:100447. [PMID: 35310820 PMCID: PMC8927838 DOI: 10.1016/j.jhepr.2022.100447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 12/14/2022] Open
Abstract
Background & Aims The shortage of liver grafts continues to worsen. Because the expanded use of small-for-size grafts (SFSGs) would substantially alleviate this shortage, we aimed to analyse the available knowledge on auxiliary liver transplantation (ALT) with SFSGs in patients with chronic liver disease (CLD) to identify opportunities to develop ALT with SFSGs in patients with CLD. Methods This is a systematic review on ALT using SFSGs in patients with CLD. The review was completed by updates obtained from the authors of the retained reports. Results Heterotopic ALT was performed in 26 cases between 1980 and 2017, none for SFGS stricto sensu, and auxiliary partial orthotopic liver transplantation (APOLT) in 27 cases (from 1999 to 2021), all for SFSG. In APOLT cases, partial native liver resection was performed in most of cases, whereas the second-stage remnant native liver hepatectomy was performed in 9 cases only. The median graft-to-body weight ratio was 0.55, requiring perioperative or intraoperative portal modulation in 16 cases. At least 1 complication occurred in 24 patients following the transplant procedure (morbidity rate, 89%). Four patients (4/27, 15%) died after the APOLT procedure. At the long term, 19 (70%) patients were alive and well at 13 months to 24 years (median, 4.5 years) including 18 with the APOLT graft in place and 1 following retransplantation. Conclusions Despite high postoperative morbidity, and highly reported technical variability, the APOLT technique is a promising technique to use SFSGs in patients with CLD, achieving satisfactory long-term results. The results need to be confirmed on a larger scale, and a standardised technique could lead to even better results. Lay summary At the cost of a high postoperative morbidity, the long-term results of APOLT for small-for-size grafts are good. Standardisation of the procedure and of portal modulation remain needed. Using a small-for-size graft is a risk factor of small-for-size syndrome. Auxiliary liver transplantation can be orthotopic or heterotopic. In auxiliary transplantation, the remnant native liver prevents small-for-size syndrome. Transplantation with a small-for-size graft requires individually tailored portal modulation. Auxiliary liver transplantation might substantially increase the number of available grafts.
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37
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Garin E, Pinaquy JB, Bailly C, Sengel C, Mariano-Goulart D, Edeline J, Blanc JF, Bouvier A, Tordo J, Rode A, Becker S, Sefrioui D, de Baere T, Somma C, Mastier C, Goupil J, Chevallier P, Regnault H, Vibert E, Manfredi S, Vicaut E, Patel B, Boucher E, Guiu B. Evaluating the Effectiveness of Yttrium-90 Glass Microspheres in the Treatment of Hepatocellular Carcinoma, Intrahepatic Cholangiocarcinoma, and Metastatic Colorectal Cancer in Practice: Protocol for the Prospective PROACTIF Phase IV Registry Study in France. Cardiovasc Intervent Radiol 2021; 45:1-11. [PMID: 34796373 DOI: 10.1007/s00270-021-03002-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/11/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
PRIMARY OBJECTIVE Recently, selective internal radiation therapy using yttrium-90 (Y90) glass microspheres (TheraSphere™) was approved for reimbursement by health authorities in France. The PROACTIF study aims to gather data on effectiveness, patient quality of life, and safety with use of Y90 glass microspheres in real-world clinical settings in France. INCLUSION CRITERIA Patient with a diagnosis of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCC), and/or metastatic colorectal cancer (mCRC) who was treated with a dose of Y90 glass microspheres that has been reimbursed in France and who do not oppose use of their personal medical data. EXCLUSION CRITERIA If data collection is opposed, treatment is reimbursed but not administered, or treatment is administered but not reimbursed. OUTCOME MEASURES Primary outcome measures include overall survival from time of Y90 glass microsphere treatment and quality of life, as assessed using the Functional Assessment of Cancer Therapy- Hepatobiliary questionnaire. ESTIMATED NUMBER OF PATIENTS TO BE INCLUDED This is an open study and there is no set number of patients; 115 have already been enrolled. PLANNED SUBGROUP ANALYSES Analyses will be stratified by disease state (HCC, iCC, or mCRC). Subgroups to be analyzed include age group, unilobar/bilobar disease at baseline, Eastern Cooperative Oncology Group (ECOG) status at baseline, liver tumor burden at baseline, target lesion size, and standard versus multi-compartment personalized dosimetry treatment. PLANNED RECRUITMENT AND OBSERVATION PERIOD Recruitment includes patients who are prescribed and treated with a commercial vial of Y90 glass microspheres between 01 January 2019 and 31 December 2024. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04069468.
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Affiliation(s)
- Etienne Garin
- Nuclear Medicine Unit, Centre Eugene Marquis, Rennes, France
| | | | - Clement Bailly
- Nuclear Medicine Unit, University Hospital, Nantes, France
| | - Christian Sengel
- Radiology and Medical Imaging, CHU Hospital Michallon, Grenoble, France
| | | | | | - Jean-Frederic Blanc
- Hepatology, Gastroenterology, and Digestive Oncology, CHU Bordeaux, Bordeaux, France
| | - Antoine Bouvier
- Department of Radiology, University Hospital, Angers, France
| | - Jeremie Tordo
- Department of Nuclear Medicine, CHU Lyon Sud, Lyon, France
| | - Agnes Rode
- Department of Medical Imaging, CHU Lyon, Lyon, France
| | - Stéphanie Becker
- Departments of Medical Imaging and Nuclear Medicine, Centre Henri Bequerel, Rouen, France
| | - David Sefrioui
- Department of Hepatogastroenterology, Rouen University Hospital, Rouen, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave Roussy Cancer Center, Villejuif, France
| | - Claude Somma
- Department of Nuclear Medicine, CHU La Timone, Marseille, France
| | - Charles Mastier
- Department of Radiology, CRLCC Centre Léon Bérard, Lyon, France
| | - Jean Goupil
- Department of Radiology and Medical Imaging, CHU Nimes, Nimes, France
| | | | - Helene Regnault
- Department of Hepatology, Henri Mondor Hospital, Creteil, France
| | - Eric Vibert
- Department of Hepatology and Surgery, Paul Brousse Hospital, Villejuif, France
| | - Sylvain Manfredi
- Department of Digestive Oncology, University Hospital, Dijon, France
| | - Eric Vicaut
- Clinical Trial Unit, AP-HP Groupe Hospitalier Lariboisière - Fernand-Widal, Paris, France
| | - Binal Patel
- Biostatistics, Boston Scientific Corporation, Marlborough, MA, USA
| | - Eveline Boucher
- Interventional Oncology, Boston Scientific Corporation, Marlborough, MA, USA
| | - Boris Guiu
- Department of Radiology, St. Eloi University Hospital - Montpellier School of Medicine, 80 avenue Augustin Fliche, 34295, Montpellier, France.
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El-Domiaty N, Saliba F, Karam V, Sobesky R, Ibrahim W, Vibert E, Pittau G, Amer K, Saeed MA, Shawky JA, Cherqui D, Adam R, Samuel D. Impact of body mass index on hepatocellular carcinoma recurrence after liver transplantation through long-term follow-up. Hepatobiliary Surg Nutr 2021; 10:598-609. [PMID: 34760964 DOI: 10.21037/hbsn.2020.04.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/24/2020] [Accepted: 03/26/2020] [Indexed: 12/12/2022]
Abstract
Background Obesity is associated with increased oncological risk and outcomes but the evidence surrounding the effect of body mass index (BMI) on increased risk of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) is still questionable. The purpose of this retrospective study of a large cohort of adult patients transplanted for HCC was to investigate the effect of BMI on the incidence of HCC recurrence and outcome. Methods Data from 427 adult recipients transplanted for HCC between 2000 and 2017 were collected. Patients were classified at time of LT according to the World Health Organization BMI classification into 3 groups; group 1: BMI <25 (n=166), group 2: BMI 25-29.9 (n=150) and group 3: BMI ≥30 (n=111). Results There were no significant changes of mean BMI overtime 26.8±5.0 kg/m2 at time of LT and 28.8±23.1 at 5 years. The recurrence rates of HCC after LT in the three groups were 19%, 16% and 17% respectively. The 5, 10 and 15-year recurrence free survival (RFS) rates were respectively 68.6%, 47.3% and 40.8% in group 1, 73.3%, 66.2% and 49.5% in group 2 and 68.8%, 57.5% and 47.7% in group 3 (log rank P=0.47). Conclusions Recipient BMI at time of transplant and during follow-up didn't impact the incidence of HCC recurrence nor long-term patient survival, irrespective to the status of the patients and their tumor characteristic at time of LT. The present study clearly confirms that obesity should not be considered, when selecting patients with HCC to LT, as a predictive factor of recurrence.
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Affiliation(s)
- Nada El-Domiaty
- AP-HP Hôpital Paul Brousse, Hepato-Biliary Centre, INSERM UMR 1193, Université Paris Saclay, Villejuif, France.,Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Hepato-Biliary Centre, INSERM UMR 1193, Université Paris Saclay, Villejuif, France
| | - Vincent Karam
- AP-HP Hôpital Paul Brousse, Hepato-Biliary Centre, INSERM UMR 1193, Université Paris Saclay, Villejuif, France
| | - Rodolphe Sobesky
- AP-HP Hôpital Paul Brousse, Hepato-Biliary Centre, INSERM UMR 1193, Université Paris Saclay, Villejuif, France
| | - Wafaa Ibrahim
- Statistics Department, Faculty of Economics and Political Science, Cairo University, Cairo, Egypt
| | - Eric Vibert
- AP-HP Hôpital Paul Brousse, Hepato-Biliary Centre, INSERM UMR 1193, Université Paris Saclay, Villejuif, France
| | - Gabriella Pittau
- AP-HP Hôpital Paul Brousse, Hepato-Biliary Centre, INSERM UMR 1193, Université Paris Saclay, Villejuif, France
| | - Khaled Amer
- Hepato-Biliary and Liver Transplant Department, International Medical Center, Cairo, Egypt
| | - Maysaa A Saeed
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Jihan A Shawky
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Daniel Cherqui
- AP-HP Hôpital Paul Brousse, Hepato-Biliary Centre, INSERM UMR 1193, Université Paris Saclay, Villejuif, France
| | - René Adam
- AP-HP Hôpital Paul Brousse, Hepato-Biliary Centre, INSERM UMR 1193, Université Paris Saclay, Villejuif, France
| | - Didier Samuel
- AP-HP Hôpital Paul Brousse, Hepato-Biliary Centre, INSERM UMR 1193, Université Paris Saclay, Villejuif, France
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39
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Féray C, Taupin JL, Sebagh M, Allain V, Demir Z, Allard MA, Desterke C, Coilly A, Saliba F, Vibert E, Azoulay D, Guettier C, Chatton A, Debray D, Caillat-Zucman S, Samuel D. Donor HLA Class 1 Evolutionary Divergence Is a Major Predictor of Liver Allograft Rejection : A Retrospective Cohort Study. Ann Intern Med 2021; 174:1385-1394. [PMID: 34424731 DOI: 10.7326/m20-7957] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The HLA evolutionary divergence (HED), a continuous metric quantifying the peptidic differences between 2 homologous HLA alleles, reflects the breadth of the immunopeptidome presented to T lymphocytes. OBJECTIVE To assess the potential effect of donor or recipient HED on liver transplant rejection. DESIGN Retrospective cohort study. SETTING Liver transplant units. PATIENTS 1154 adults and 113 children who had a liver transplant between 2004 and 2018. MEASUREMENTS Liver biopsies were done 1, 2, 5, and 10 years after the transplant and in case of liver dysfunction. Donor-specific anti-HLA antibodies (DSAs) were measured in children at the time of biopsy. The HED was calculated using the physicochemical Grantham distance for class I (HLA-A or HLA-B) and class II (HLA-DRB1 or HLA-DQB1) alleles. The influence of HED on the incidence of liver lesions was analyzed through the inverse probability weighting approach based on covariate balancing, generalized propensity scores. RESULTS In adults, class I HED of the donor was associated with acute rejection (hazard ratio [HR], 1.09 [95% CI, 1.03 to 1.16]), chronic rejection (HR, 1.20 [CI, 1.10 to 1.31]), and ductopenia of 50% or more (HR, 1.33 [CI, 1.09 to 1.62]) but not with other histologic lesions. In children, class I HED of the donor was also associated with acute rejection (HR, 1.16 [CI, 1.03 to 1.30]) independent of the presence of DSAs. There was no effect of either donor class II HED or recipient class I or class II HED on the incidence of liver lesions in adults and children. LIMITATION The DSAs were measured only in children. CONCLUSION Class I HED of the donor predicts acute or chronic rejection of liver transplant. This novel and accessible prognostic marker could orientate donor selection and guide immunosuppression. PRIMARY FUNDING SOURCE Institut National de la Santé et de la Recherche Médicale.
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Affiliation(s)
- Cyrille Féray
- Centre Hépato-Biliaire, Hôpital Paul-Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, unité Institut National de la Santé et de la Recherche Médicale 1193, Villejuif, France (C.F., M.A., C.D., A.C., F.S., E.V., D.A., D.S.)
| | - Jean-Luc Taupin
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, and unité Institut National de la Santé et de la Recherche Médicale 976, Université de Paris, Paris, France (J.T., S.C.)
| | - Mylène Sebagh
- Laboratoire d'Anatomopathologie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul-Brousse, Université Paris-Saclay, unité Institut National de la Santé et de la Recherche Médicale, Physiopathogénèse et traitement des maladies du Foie, and FHU Hepatinov, Villejuif, France (M.S., C.G.)
| | - Vincent Allain
- Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, Laboratoire d'Immunologie et Histocompatibilité, and Institut National de la Santé et de la Recherche Médicale, Paris, France (V.A.)
| | - Zeynep Demir
- Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, and Unité d'Hépatologie pédiatrique, Paris, France (Z.D., D.D.)
| | - Marc-Antoine Allard
- Centre Hépato-Biliaire, Hôpital Paul-Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, unité Institut National de la Santé et de la Recherche Médicale 1193, Villejuif, France (C.F., M.A., C.D., A.C., F.S., E.V., D.A., D.S.)
| | - Christophe Desterke
- Centre Hépato-Biliaire, Hôpital Paul-Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, unité Institut National de la Santé et de la Recherche Médicale 1193, Villejuif, France (C.F., M.A., C.D., A.C., F.S., E.V., D.A., D.S.)
| | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul-Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, unité Institut National de la Santé et de la Recherche Médicale 1193, Villejuif, France (C.F., M.A., C.D., A.C., F.S., E.V., D.A., D.S.)
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Hôpital Paul-Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, unité Institut National de la Santé et de la Recherche Médicale 1193, Villejuif, France (C.F., M.A., C.D., A.C., F.S., E.V., D.A., D.S.)
| | - Eric Vibert
- Centre Hépato-Biliaire, Hôpital Paul-Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, unité Institut National de la Santé et de la Recherche Médicale 1193, Villejuif, France (C.F., M.A., C.D., A.C., F.S., E.V., D.A., D.S.)
| | - Daniel Azoulay
- Centre Hépato-Biliaire, Hôpital Paul-Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, unité Institut National de la Santé et de la Recherche Médicale 1193, Villejuif, France (C.F., M.A., C.D., A.C., F.S., E.V., D.A., D.S.)
| | - Catherine Guettier
- Laboratoire d'Anatomopathologie, Assistance Publique-Hôpitaux de Paris, Hôpital Paul-Brousse, Université Paris-Saclay, unité Institut National de la Santé et de la Recherche Médicale, Physiopathogénèse et traitement des maladies du Foie, and FHU Hepatinov, Villejuif, France (M.S., C.G.)
| | - Arthur Chatton
- Institut National de la Santé et de la Recherche Médicale UMR 1246-SPHERE, Nantes University, Tours University, Nantes, and IDBC, Pacé, France (A.C.)
| | - Dominique Debray
- Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université de Paris, and Unité d'Hépatologie pédiatrique, Paris, France (Z.D., D.D.)
| | - Sophie Caillat-Zucman
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université de Paris, and unité Institut National de la Santé et de la Recherche Médicale 976, Université de Paris, Paris, France (J.T., S.C.)
| | - Didier Samuel
- Centre Hépato-Biliaire, Hôpital Paul-Brousse, Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, unité Institut National de la Santé et de la Recherche Médicale 1193, Villejuif, France (C.F., M.A., C.D., A.C., F.S., E.V., D.A., D.S.)
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Ishizawa T, McCulloch P, Muehrcke D, Carus T, Wiesel O, Dapri G, Schneider-Koriath S, Wexner SD, Abu-Gazala M, Boni L, Cassinotti E, Sabbagh C, Cahill R, Ris F, Carvello M, Spinelli A, Vibert E, Terasawa M, Takao M, Hasegawa K, Schols RM, Pruimboom T, Murai Y, Matano F, Bouvet M, Diana M, Kokudo N, Dip F, White K, Rosenthal RJ. Assessing the development status of intraoperative fluorescence imaging for perfusion assessments, using the IDEAL framework. BMJ Surg Interv Health Technologies 2021; 3:e000088. [PMID: 35047805 PMCID: PMC8749280 DOI: 10.1136/bmjsit-2021-000088] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives Intraoperative fluorescence imaging is currently used in a variety of surgical fields for four main purposes: assessing tissue perfusion; identifying/localizing cancer; mapping lymphatic systems; and visualizing anatomy. To establish evidence-based guidance for research and practice, understanding the state of research on fluorescence imaging in different surgical fields is needed. We evaluated the evidence on fluorescence imaging for perfusion assessments using the Idea, Development, Exploration, Assessment, Long Term Study (IDEAL) framework, which was designed for describing the stages of innovation in surgery and other interventional procedures. Design Narrative literature review with analysis of IDEAL stage of each field of study. Setting All publications on intraoperative fluorescence imaging for perfusion assessments reported in PubMed through 2019 were identified for six surgical procedures: coronary artery bypass grafting (CABG), upper gastrointestinal (GI) surgery, colorectal surgery, solid organ transplantation, reconstructive surgery, and cerebral aneurysm surgery. Main outcome measures The IDEAL stage of research evidence was determined for each specialty field using a previously described approach. Results 196 articles (15 003 cases) were selected for analysis. Current status of research evidence was determined to be IDEAL Stage 2a for upper GI and transplantation surgery, IDEAL 2b for CABG, colorectal and cerebral aneurysm surgery, and IDEAL Stage 3 for reconstructive surgery. Using the technique resulted in a high (up to 50%) rate of revisions among surgical procedures, but its efficacy improving postoperative outcomes has not yet been demonstrated by randomized controlled trials in any discipline. Only one possible adverse reaction to intravenous indocyanine green was reported. Conclusions Using fluorescence imaging intraoperatively to assess perfusion is feasible and appears useful for surgical decision making across a range of disciplines. Identifying the IDEAL stage of current research knowledge aids in planning further studies to establish the potential for patient benefit.
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Affiliation(s)
- Takeaki Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Peter McCulloch
- IDEAL Collaboration, Nuffield Department of Surgical Science, University of Oxford, John Radcliffe Hospital, Oxford, Oxfordshire, UK
| | | | | | - Ory Wiesel
- Maimonides Medical Center, Brooklyn, New York, USA
- Rabin Medical Center, Petah Tikva, Israel
| | - Giovanni Dapri
- Saint-Pierre University Hospital, Bruxelles, Bruxelles, Belgium
| | | | | | - Mahmoud Abu-Gazala
- General Surgery Department, Hadassah Medical Center Hebrew University Biotechnology Park, Jerusalem, Jerusalem, Israel
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, Hauts-de-France, France
- Simplication of Surgical Pateint Care Research Unit, University of Picardie Jules Verne, Amiens, France
| | - Ronan Cahill
- UCD Centre for Precision Surgery, University College Dublin, Dublin, Ireland
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Frederic Ris
- Service of Visceral Surgery, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
| | - Eric Vibert
- Centre Hépato-Biliaire, Hopital Universitaire Paul Brousse, Villejuif, France
| | - Muga Terasawa
- Centre Hépato-Biliaire, Hopital Universitaire Paul Brousse, Villejuif, France
| | - Mikiya Takao
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Rutger M Schols
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands
| | - Tim Pruimboom
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre+, Maastricht, Limburg, Netherlands
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Fumihiro Matano
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Michael Bouvet
- University of California San Diego, La Jolla, California, USA
| | - Michele Diana
- IHU Strasbourg, Institute of Image-Guided Surgery and IRCAD, Research Institute against Cancer of the Digestive System, Strasbourg, France
| | - Norihiro Kokudo
- National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Fernando Dip
- Cleveland Clinic Florida, Weston, Florida, USA
- Hospital de Clinicas Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina
| | - Kevin White
- Science Right Research Consulting London, Ontario, Canada
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Benkabbou A, Souadka A, Hachim H, Awab A, Alilou M, Serji B, El Malki HO, Mohsine R, Ifrine L, Vibert E, Belkouchi A. Risk factors for major complications after liver resection: A large liver resection study from Morocco and audit of a non-Eastern/non-Western experience. Arab J Gastroenterol 2021; 22:229-235. [PMID: 34538587 DOI: 10.1016/j.ajg.2021.05.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND STUDY AIMS In developing countries, endemic indications, blood shortages, and the scarcity of liver surgeons and intensive care providers can affect liver resection (LR) outcomes, but these have been rarely addressed in the literature. Therefore, in this study we determined risk factors for major complications after LR in a North African general surgery and teaching department. PATIENTS AND METHODS From January 2010 to December 2015, 213 consecutive LRs were performed on 203 patients. All patients underwent a postoperative follow-up of >90 days. Postoperative complications were assessed according to the Clavien-Dindo (CD) classification of surgical complications. A score of CD ≥III is considered as major postoperative complications. In this study, we analyzed the variables assumed to affect these complications. RESULTS The overall 90-day complication rate was 35.7% (n = 76), including a CD ≥III of 14% (n = 30) and a mortality rate of 6.1% (n = 14). According to the multivariate analysis, a preoperative performance status (PS) of ≥2 (P = 0.011; odds ratios [OR], 6.8; 95% confidence intervals [CI], 1.55-29.8), an estimated intraoperative blood loss of >500 ml (P = 0.002; OR, 3.71; 95% CI, 1.23-11.20), and bilioenteric anastomosis (P < 0.004; OR, 7.76; 95% CI, 1.5-3.89) were independent risk factors for major complications after LR. CONCLUSION We recommend that, in the setting of a non-Eastern/non-Western general surgery and teaching department, patients with a PS of ≥2 should undergo a specific selection and preoperative optimization protocol; intermittent clamping indications should be extended; and special attention should paid to patients undergoing LR associated with biliary reconstruction, such as for perihilar cholangiocarcinoma.
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Affiliation(s)
- A Benkabbou
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco; Faculty of Medicine, Mohammed V University, and Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco.
| | - A Souadka
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco; Faculty of Medicine, Mohammed V University, and Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco.
| | - H Hachim
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - A Awab
- Faculty of Medicine, Mohammed V University, and Anesthesiology and Intensive Care Department, Ibn Sina Hospital, Rabat, Morocco
| | - M Alilou
- Faculty of Medicine, Mohammed V University, and Anesthesiology and Intensive Care Department, Ibn Sina Hospital, Rabat, Morocco
| | - B Serji
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - H O El Malki
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - R Mohsine
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco; Faculty of Medicine, Mohammed V University, and Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco
| | - L Ifrine
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - E Vibert
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - A Belkouchi
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
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Brustia R, Laurent A, Goumard C, Langella S, Cherqui D, Kawai T, Soubrane O, Cauchy F, Farges O, Menahem B, Hobeika C, Rhaiem R, Sommacale D, Okumura S, Hofmeyr S, Ferrero A, Pruvot FR, Regimbeau JM, Fuks D, Vibert E, Scatton O. Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching. Surgery 2021; 171:1290-1302. [PMID: 34535270 DOI: 10.1016/j.surg.2021.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients where surgical resection is possible, outcome is influenced by perioperative morbidity and lymph node status. Laparoscopic liver resection is associated with improved clinical and oncological outcomes in primary and metastatic liver cancer compared with open liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient. The primary aim of this study was to compare overall survival for a large series of patients treated for intrahepatic cholangiocarcinoma by open or laparoscopic approach. Secondary objectives were to compare disease-free survival, predictors of death, and recurrence. METHODS Patients treated with laparoscopic or open liver resection for intrahepatic cholangiocarcinoma from 2000 to 2018 from 3 large international databases were analyzed retrospectively. Each patient in the laparoscopic resection group (case) was matched with 1 open resection control (1:1 ratio), through a propensity score calculated on clinically relevant preoperative covariates. Overall and disease-free survival were compared between the matched groups. Predictors of mortality and recurrence were analyzed with Cox regression, and the Textbook Outcomes were described. RESULTS During the study period, 855 patients met the inclusion criteria (open liver resection = 709, 82.9%; laparoscopic liver resection = 146, 17.1%). Two groups of 89 patients each were analyzed after propensity score matching, with no significant difference regarding pre- and postoperative variables. Overall survival at 1, 3, and 5 years was 92%, 75%, and 63% in the laparoscopic liver resection group versus 92%, 58%, and 49% in the open liver resection group (P = .0043). Adjusted Cox regression revealed severe postoperative complications (hazard ratio: 10.5, 95% confidence interval [1.01-109] P = .049) and steatosis (hazard ratio: 13.8, 95% confidence interval [1.23-154] P = .033) as predictors of death, and transfusion (hazard ratio: 19.2, 95% confidence interval [4.04-91.4] P < .001) and severe postoperative complications (hazard ratio: 4.07, 95% confidence interval [1.15-14.4] P = .030) as predictors of recurrence. CONCLUSION The survival advantage of laparoscopic liver resection over open liver resection for intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data.
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Affiliation(s)
- Raffaele Brustia
- Department of Digestive and Hepato-Pancreatic-Biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France. https://twitter.com/raffaele.brustia
| | - Alexis Laurent
- Univ Paris Est Creteil, Faculté de Santé, Créteil, France and Department of Digestive and Hepato-Pancreatic-Biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Claire Goumard
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France
| | - Serena Langella
- Department of General and Oncological Surgery, Ospedale Mauriziano, Torino, Italy
| | - Daniel Cherqui
- Centre Hepato-Biliaire, AP-HP Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Takayuki Kawai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Olivier Soubrane
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Francois Cauchy
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Olivier Farges
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, France
| | - Christian Hobeika
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France
| | - Rami Rhaiem
- Department of Hepatobiliary, Pancreatic, and Digestive Surgery, Robert Debré University Hospital, Reims, France University Reims Champagne-Ardenne, France
| | - Daniele Sommacale
- Univ Paris Est Creteil, Faculté de Santé, Créteil, France and Department of Digestive and Hepato-Pancreatic-Biliary Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Shinya Okumura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Stefan Hofmeyr
- Division of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Ospedale Mauriziano, Torino, Italy
| | - François-René Pruvot
- Department of Digestive Surgery and Transplantation, Univ Lille, CHRU Lille, Lille, France
| | - Jean-Marc Regimbeau
- SSPC (Simplification of Surgical Patients Care), Clinical Research Unit, University of Picardie Jules Verne, Amiens, France and Department of Digestive Surgery, Amiens University Medical Center, Amiens, France
| | - David Fuks
- Department of Digestive, Oncologic, and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Eric Vibert
- Centre Hepato-Biliaire, AP-HP Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Olivier Scatton
- Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital Pitié Salpêtrière, CRSA, Sorbonne Université, Paris, France.
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Hobeika C, Cauchy F, Fuks D, Barbier L, Fabre JM, Boleslawski E, Regimbeau JM, Farges O, Pruvot FR, Pessaux P, Salamé E, Soubrane O, Vibert E, Scatton O. Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis. Br J Surg 2021; 108:419-426. [PMID: 33793726 DOI: 10.1093/bjs/znaa110] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/28/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND). METHODS Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching. RESULTS In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012). CONCLUSION The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.
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Affiliation(s)
- C Hobeika
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France.,Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
| | - F Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - D Fuks
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Université Paris V, Paris, France
| | - L Barbier
- Department of Digestive, Endocrine, Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Trousseau, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - J M Fabre
- Department of Digestive, Hepatopancreatobiliary Surgery and Liver Transplantation, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - E Boleslawski
- Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Université Nord de France, Lille, France
| | - J M Regimbeau
- Department of Digestive Surgery, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - O Farges
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - F R Pruvot
- Department of Digestive Surgery and Liver Transplantation, Hôpital Huriez, Centre Hospitalier Universitaire de Lille, Université Nord de France, Lille, France
| | - P Pessaux
- Department of Digestive Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - E Salamé
- Department of Digestive, Endocrine, Hepatopancreatobiliary Surgery and Liver Transplantation, Hôpital Trousseau, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - O Soubrane
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Université de Paris, Paris, France
| | - E Vibert
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Paul Brousse, Assistance Publique-Hopitaux de Paris and Université Paris XI, Paris, France
| | - O Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hopitaux de Paris and Sorbonne University, Paris, France
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Capelli R, Kitano Y, Linhares M, da Silva D, Golse N, Karam V, Sa Cunha A, Vibert E, Azoulay D, Cherqui D, Adam R, Allard MA. The prognostic significance of serum aspartate transaminase and gamma-glutamyl transferase in liver deceased donors. Transpl Int 2021; 34:2247-2256. [PMID: 34288136 DOI: 10.1111/tri.13978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/28/2022]
Abstract
The impact of aspartate transaminases (AST) and gamma-glutamyl transferase (GGT) in serum of deceased donors on outcomes after liver transplantation (LT) is unclear. This study aimed to explore the relationship between donor highest AST value or first donor GGT value and graft survival. All consecutive patients who underwent a primary LT in a single center with available donor AST (N=1253) and GGT value (N=1152) were included. There was no significant association between donor AST and 90-day graft survival. We found a moderate association between GGT and 90-day graft survival. We found a significant interaction with a donor history of alcohol abuse (HAA). The risk of graft loss was associated with AST and GGT in donors with an HAA but remains unchanged in donors without HAA. There was no difference in graft survival according to donor AST or GGT with a cutoff ≥ 95th percentile (475 UI/L for AST and 170 UI/L for GGT). However, graft survival was significantly decreased when donors combined GGT ≥ 170 UI/L and HAA (61% at one year). Hepatic grafts from donors with high AST or high GGT but without alcohol history and no additional risk factors can be transplanted in low-risk recipient.
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Affiliation(s)
- Rafaela Capelli
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Universidade Federal de São Paulo, São Paulo, Brazil
| | - Yuki Kitano
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Doris da Silva
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France
| | - Nicolas Golse
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - Vincent Karam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France
| | - Antonio Sa Cunha
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris Saclay, France
| | - Eric Vibert
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - Daniel Azoulay
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France
| | - Daniel Cherqui
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris Saclay, France
| | - Marc-Antoine Allard
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris Saclay, France
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45
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Golse N, Vibert E, Vignon-Clementel IE. Reply to: "A step forward to predict the risk of post-hepatectomy portal hypertension". J Hepatol 2021; 75:250-251. [PMID: 33865908 DOI: 10.1016/j.jhep.2021.04.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Nicolas Golse
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, France; INRIA, Centre de Recherche de Paris, 2 rue Simone Iff, Paris 75012, France.
| | - Eric Vibert
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, France
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46
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Nitta H, Younès A, El-Domiaty N, Karam V, Sobesky R, Vibert E, Coilly A, Maria Antonini T, De Martin E, Cherqui D, Baba H, Rosmorduc O, Adam R, Samuel D, Saliba F. High trough levels of everolimus combined to sorafenib improve patients survival after hepatocellular carcinoma recurrence in liver transplant recipients. Transpl Int 2021; 34:1293-1305. [PMID: 33932239 DOI: 10.1111/tri.13897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 12/21/2022]
Abstract
Recurrence of hepatocellular carcinoma (HCC) following liver transplantation (LT) occurs in 10%-20% of patients transplanted for HCC. The treatment of HCC recurrence after LT remains a challenge. Consecutive patients who underwent LT for HCC between 2005 and 2015 at our center were recruited. Characteristics of patients with recurrence, modalities of treatment and outcome were collected retrospectively. Patient survival was analyzed according to HCC recurrence therapeutic strategy. Among 306 transplanted patients, 43 patients (14.1%) developed recurrence with a median survival time after recurrence of 10.9 months (95%CI: 6.6-18.6). Survival of patients treated with Sorafenib (SOR) and everolimus (EVL) (n = 19) was significantly better than that of the group treated with other strategies (n = 24) (P = 0.001). Multivariable analysis demonstrated that SOR plus EVL therapy and absence of dissemination at diagnosis of recurrence were independent predictive factors of prolonged survival after recurrence. Among the patients who treated with EVL, survival of patients with controlled EVL blood trough levels ≥5 ng/ml was significantly better compared to those with EVL trough levels <5 ng/ml (P = 0.021). Combination therapy of sorafenib and everolimus was an independent predictor for better survival after HCC recurrence. Patients with controlled everolimus trough level ≥5 ng/ml might get the best survival benefit.
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Affiliation(s)
- Hidetoshi Nitta
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Aline Younès
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Nada El-Domiaty
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France.,Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Vincent Karam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Rodolphe Sobesky
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Eric Vibert
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Audrey Coilly
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Teresa Maria Antonini
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Eleonora De Martin
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Daniel Cherqui
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Olivier Rosmorduc
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Didier Samuel
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
| | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Inserm UMR-S 1193, Université Paris- Saclay, Villejuif, France
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47
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Khonsari RH, Bernaux M, Vie JJ, Diallo A, Paris N, Luong LB, Assouad J, Paugam C, Simon T, Vicaut E, Nizard R, Vibert E. Risks of early mortality and pulmonary complications following surgery in patients with COVID-19. Br J Surg 2021; 108:e158-e159. [PMID: 33793755 PMCID: PMC7929121 DOI: 10.1093/bjs/znab007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/01/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R H Khonsari
- Service de Chirurgie Maxillo-faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - M Bernaux
- Direction de la Stratégie et de la Transformation, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J-J Vie
- Université de Lille, Inria, CNRS, UMR 9189 - CRIStAL, Lille, France
| | - A Diallo
- Unité de Recherche Clinique (URC) Saint-Louis Lariboisière Fernand-Widal, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - N Paris
- Direction des Systèmes d'Information, Web INnovations Données (WIND), Assistance Publique - Hôpitaux de Paris, Paris, France
| | - L B Luong
- CIC Cochin Pasteur, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - J Assouad
- Service de Chirurgie Thoracique et Vasculaire, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris; Sorbonne Université, Paris, France
| | - C Paugam
- Direction Générale, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - T Simon
- Service de Pharmacologie Clinique, Plateforme de Recherche Clinique de l'Est Parisien (URCEST-CRB-CRCEST), AP-HP.SU, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - E Vicaut
- Unité de Recherche Clinique (URC) Saint-Louis Lariboisière Fernand-Widal, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - R Nizard
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, Université de Paris, Paris, France
| | - E Vibert
- Centre Hépato-biliaire, Hôpital Paul-Brousse, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
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48
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El-Domiaty N, Saliba F, Sebagh M, Salloum C, Vibert E, Azoulay D, Hamelin J, Cherqui D, Adam R, Samuel D. De novo hepatocellular carcinoma in a non-cirrhotic allograft 27 years after liver transplantation: A case report. Am J Transplant 2021; 21:1953-1958. [PMID: 33382179 DOI: 10.1111/ajt.16476] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 01/25/2023]
Abstract
Hepatocellular carcinoma recurrence after liver transplantation is a well-known complication but the development of de novo hepatocellular carcinoma in non-cirrhotic allograft with no previous history of hepatic malignancy either in the donor or the recipient is extremely rare. A 33-year-old man underwent deceased donor liver transplantation due to HBV-HDV cirrhosis in 1991. The donor was healthy, with negative viral serology. Pretransplant assessment and explant liver pathology revealed no tumor. He developed an 8 cm mediastinal thymus cancer in 2014, a chronic myeloid leukemia in 2015 and a 16 mm renal cell carcinoma in 2017. After 27 years, in 2018, his routine follow-up sonography showed incidentally a 37 mm hepatic nodule in segment VII which revealed after percutaneous liver guided biopsy a hepatocellular carcinoma. As no extra hepatic metastasis was noted, segmentectomy was done. The pathological report confirmed a moderately differentiated hepatocellular carcinoma nodule of 50 mm diameter with absence of microvascular invasion and the non-tumoral liver showed histological features of NASH (SAF score: S1A2F3, NAS score: A3F3 and LAFSc:5) with absence of HBsAg and HBcAg. This case emphasizes the importance of long-term close surveillance by imaging of the graft even in the absence of viral recurrence and graft cirrhosis.
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Affiliation(s)
- Nada El-Domiaty
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France.,Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Faouzi Saliba
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France
| | - Mylène Sebagh
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France
| | - Chady Salloum
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France
| | - Eric Vibert
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France
| | - Daniel Azoulay
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France
| | - Jocelyne Hamelin
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France
| | - René Adam
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France
| | - Didier Samuel
- Centre Hépato-Biliaire, AP-HP Hôpital Paul Brousse, Inserm UMR-S 1193, Université Paris-Saclay, Villejuif, France
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49
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Laroche S, Maulat C, Kitano Y, Golse N, Azoulay D, Sa Cunha A, Vibert E, Adam R, Cherqui D, Allard MA. Initial piggyback technique facilitates late liver retransplantation - a retrospective monocentric study. Transpl Int 2021; 34:835-843. [PMID: 33650170 DOI: 10.1111/tri.13857] [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: 11/17/2020] [Revised: 01/04/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Abstract
Optimal management of inferior vena cava (IVC) is crucial to ensure safety in late liver retransplantation (ReLT). The aim of this study was to evaluate different surgical strategies with regard to IVC in late ReLT. All consecutive late ReLT (≥90 days from the previous transplant) from 2013 to 2018 in a single center was reviewed (n = 66). Of them, 46 (69.7%) were performed without venovenous bypass (VVB) including 29 with caval preservation (CP) and 17 with caval replacement (CR). The remaining 20 cases (30.3%) required the use of VVB. Among ReLT without VVB, CP was associated with a lower number of packed red blood cells (median 4 vs. 7; P = 0.016) and a lower incidence of post-transplant acute kidney injury (6.9% vs. 47.1%; P = 0.003). The feasibility of CP was 95% (14/15) in patients with previous 3-vein piggyback caval anastomosis versus 48.3% (15/31) after other techniques (P = 0.003). Indirect signs of portal hypertension (PHT) before retransplantation were predictive of VVB requirement. Early and long-term outcomes were similar across the three groups (CP without VVB, CR without VVB, and VVB). Preserving the IVC in late ReLT is associated with better postoperative renal function and is facilitated by a previous 3-vein piggyback. Routine CR is not justified in late ReLT.
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Affiliation(s)
- Sophie Laroche
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France
| | - Charlotte Maulat
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France
| | - Yuki Kitano
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Nicolas Golse
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - Daniel Azoulay
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France
| | - Antonio Sa Cunha
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris Saclay, Villejuif, France
| | - Eric Vibert
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - René Adam
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris Saclay, Villejuif, France
| | - Daniel Cherqui
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Unité INSERM 1193, Villejuif, France
| | - Marc Antoine Allard
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris Saclay, Villejuif, France.,Équipe Chronothérapie, Cancers et Transplantation, Université Paris Saclay, Villejuif, France
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50
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Mazzotta AD, Pascale A, Cano L, Rosmorduc O, Allard MA, Sa Cunha A, Adam R, Cherqui D, Vibert E, Golse N. Number of hepatocellular carcinoma nodules in patients listed for liver transplantation within alpha-fetoprotein score: a new prognostic risk factor. Transpl Int 2021; 34:954-963. [PMID: 33660346 DOI: 10.1111/tri.13858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/19/2021] [Revised: 02/05/2021] [Accepted: 02/26/2021] [Indexed: 01/27/2023]
Abstract
In France, the listing for liver transplantation (LT) for hepatocellular carcinoma (HCC) requires an AFP score ≤2. This study evaluates whether the number of nodules assessed immediately before LT has a prognostic value among patients already listed within AFP score. Among 143 recipients transplanted with an AFP score ≤2 between 2013 and 2017 in our center, the number of nodules was considered at listing on the waiting list and at last imaging before LT. We compared the overall survival (OS) and disease-free survival (DFS) post-LT of patients with ≤3 and >3 nodules (current classification), and aimed to propose a new criteria to exclude patients on list at high risk of recurrence. The 3-year OS of patients with ≤3 HCC vs. >3 HCC at listing was of 90.3% vs. 67.3%, respectively (P = 0.04). At last imaging, eight listed patients presented ≥5 HCC nodules and had a significantly lower OS than <5 nodules patients (5-year OS: 24.4% vs. 78.1%; P = 0.01). Although the current AFP score offers satisfactory outcomes, we highlight the poorer outcomes when ≥5 nodules persist or appear after listing. A modification of the AFP score is mandatory to consider exclusion of high-risk patients already listed for LT program.
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Affiliation(s)
- Alessandro D Mazzotta
- Department of HepatoBiliary Surgery, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Paul-Brousse Hospital, Villejuif, France
| | - Alina Pascale
- Department of Hepatology, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Paul-Brousse Hospital, Villejuif, France
| | - Luis Cano
- INSERM, INRAE, CHU Pontchaillou, UMR 1241 NUMECAN, Univ. Rennes, Rennes, France
| | - Olivier Rosmorduc
- Department of Hepatology, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Paul-Brousse Hospital, Villejuif, France
| | - Marc-Antoine Allard
- Department of HepatoBiliary Surgery, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Paul-Brousse Hospital, Villejuif, France.,Equipe de Recherche "Chronothérapie, Cancers et Transplantation", INSERM, Université Paris-Saclay, Paris, France
| | - Antonio Sa Cunha
- Department of HepatoBiliary Surgery, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Paul-Brousse Hospital, Villejuif, France.,Equipe de Recherche "Chronothérapie, Cancers et Transplantation", INSERM, Université Paris-Saclay, Paris, France
| | - René Adam
- Department of HepatoBiliary Surgery, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Paul-Brousse Hospital, Villejuif, France.,Equipe de Recherche "Chronothérapie, Cancers et Transplantation", INSERM, Université Paris-Saclay, Paris, France
| | - Daniel Cherqui
- Department of HepatoBiliary Surgery, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Paul-Brousse Hospital, Villejuif, France.,INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, Université Paris-Saclay, Paris, France
| | - Eric Vibert
- Department of HepatoBiliary Surgery, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Paul-Brousse Hospital, Villejuif, France.,INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, Université Paris-Saclay, Paris, France
| | - Nicolas Golse
- Department of HepatoBiliary Surgery, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Paul-Brousse Hospital, Villejuif, France.,INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193, Université Paris-Saclay, Paris, France
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