1
|
Mourrégot A, Leclerc G, Lemanski C, Gutowski M, Carrère S, Saint-Aubert B, Colombo PE, Rouanet P. La chirurgie ambulatoire adaptée à la vie d’aujourd’hui, aux évolutions chirurgicales et anesthésiques. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
2
|
Bertrand J, Saint-Aubert B, Joly E, Philippe C, Quenet F, Carrere S, Rouanet P, Domergue J. [Impact of surgery in the management of pancreatic metastases of renal cell cancer]. Prog Urol 2014; 24:307-12. [PMID: 24674337 DOI: 10.1016/j.purol.2013.09.028] [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: 03/08/2013] [Revised: 09/24/2013] [Accepted: 09/24/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Incidence of renal cell carcinoma (RCC) is increasing over the 25 last years. Pancreatic metastases of RCC are rare. The aim of this work was to study overall survival of patients operated for pancreatic metastases of RCC in Montpellier cancer institute. PATIENTS AND METHODS Between 2000 and 2012, a retrospective monocentric study was performed at Montpellier cancer institute. We evaluated the outcomes of curative pancreatic metastases from renal primary and the impact of targeted therapies. RESULTS Thirty-eight patients were treated in our center for pancreatic metastases of RCC. Twelve patients had a curative surgery of metachronous pancreatic metastases. Four patients were without recurrence after pancreatic resection (33.3%). None had adjuvant therapy. Six patients were treated by targeted therapies, because of metastatic progression. Five of 6 died, the sixth evolved with targeted therapies by thyrosine kinase inhibitor. Average deadline between appearance of metastases and death was 89.9 months for operated patients. Average deadline between appearance of c metastases and death was 33.1 months for the others (P=0.004). CONCLUSION Surgical treatment of pancreatic metastases should increase life expectancy of patients. Others studies are necessary to prove the impact of targeted therapies in metastatics patients in this indication. LEVEL OF EVIDENCE 5.
Collapse
Affiliation(s)
- J Bertrand
- Institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier cedex 5, France.
| | - B Saint-Aubert
- Institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier cedex 5, France
| | - E Joly
- Institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier cedex 5, France
| | - C Philippe
- Institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier cedex 5, France
| | - F Quenet
- Institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier cedex 5, France
| | - S Carrere
- Institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier cedex 5, France
| | - P Rouanet
- Institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier cedex 5, France
| | - J Domergue
- Institut du cancer de Montpellier (ICM), 208, avenue des Apothicaires, 34298 Montpellier cedex 5, France
| |
Collapse
|
3
|
Bertrand M, Rouanet P, Mourregot A, Azar C, Carrere S, Gutowski M, Quenet F, Saint-Aubert B, Colombo P. 337. TransAnal Endoscopic Proctectomy (TAEP) – An innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
4
|
Quenet F, Alric P, Iborra F, Roca L, D'Annoville T, Colombo P, Joyeux F, Saint-Aubert B, Marty-Ane C, Rouanet P. Carcinologic resection of abdominal tumors involving retroperitoneal vessels: Results of a synergical multidisciplinary approach between oncologic and vascular surgical teams. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e20521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
5
|
Colombo P, Bertrand M, Gutowski M, Mourregot A, Fabbro M, Saint-Aubert B, Quenet F, Gourgou S, Kerr C, Rouanet P. Total laparoscopic radical hysterectomy for locally advanced cervical carcinoma (stages IIB, IIA and bulky stages IB) after concurrent chemoradiation therapy: Surgical morbidity and oncological results. Gynecol Oncol 2009; 114:404-9. [DOI: 10.1016/j.ygyno.2009.05.043] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Revised: 05/26/2009] [Accepted: 05/30/2009] [Indexed: 10/20/2022]
|
6
|
Colombo PE, Bertrand MM, Mourregot A, Gutowski M, Quenet F, Saint-Aubert B, Rouanet P. [Spontaneous recovery from extensive hepatic ischemia following an extended pancreaticoduodenectomy]. J Chir (Paris) 2008; 145:404-406. [PMID: 18955936 DOI: 10.1016/s0021-7697(08)74337-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
7
|
Quenet F, Claus C, Roca L, Gauthey A, Essissen M, Ychou M, Rouanet P, Saint-Aubert B. Complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from digestive tract cancer—New management with oxaliplatin plus irinotecan: A feasibility study in 37 patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
8
|
Colombo PE, Mourregot A, Fabbro M, Gutowski M, Saint-Aubert B, Quenet F, Gourgou S, Rouanet P. Aggressive surgical strategies in advanced ovarian cancer: a monocentric study of 203 stage IIIC and IV patients. Eur J Surg Oncol 2008; 35:135-43. [PMID: 18289825 DOI: 10.1016/j.ejso.2008.01.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 01/08/2008] [Indexed: 01/13/2023] Open
Abstract
AIMS The standard treatment for advanced ovarian cancer consists of cytoreductive surgery associated with a platinum/paclitaxel-based chemotherapy. Nevertheless, there is still the question as to the extent and timing of the surgical debulking. The aim of this study was to evaluate the place of surgery in the therapeutic sequence. PATIENTS AND METHODS We reviewed data from all consecutive patients with stage IIIC and IV epithelial ovarian cancer, operated on at our institution between 1990 and 2005. Patients were divided into 2 groups, according to the position of surgery in the therapeutic sequence. Patients in group 1 received initial debulking surgery. Group 2 consisted of patients having received their first debulking after initial chemotherapy. RESULTS Two hundred and three patients were identified and frequently underwent aggressive surgery, in particular, digestive surgery with bowel resections. Perioperative mortality and morbidity rates were low (2% and 14%, respectively) and there was no difference between the groups. Overall survival in group 1 for patients with complete cytoreduction (residual disease (RD)=0), optimal surgery (RD<1cm) or sub-optimal surgery (RD>1cm) was 50%, 30% and 14%, respectively. In group 2, overall survival following complete surgery was 30%, and no long-term survival was observed when surgery was not complete at the time of interval surgery. Survival was worse for patients who had received more than 4 cycles of neoadjuvant chemotherapy. CONCLUSION This study confirms the importance of surgery in the prognosis of advanced ovarian cancer. Only the patient subgroup that underwent complete initial or interval surgery was associated with a prolonged remission. Optimal surgery with a controlled morbidity can be achieved in many cases, even if bowel resection is needed, at the time of primary debulking. In the interval cytoreductive surgery subgroup, the response to initial chemotherapy and surgery was found to be essential for prognosis.
Collapse
Affiliation(s)
- P-E Colombo
- Department of Surgical Oncology, CRLC Val d'Aurelle, Montpellier Cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Boige V, Pignon J, Saint-Aubert B, Lasser P, Conroy T, Bouché O, Segol P, Bedenne L, Rougier P, Ychou M. Final results of a randomized trial comparing preoperative 5-fluorouracil (F)/cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD 9703 trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4510] [Citation(s) in RCA: 160] [Impact Index Per Article: 9.4] [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
4510 Background: The combination of 5FU in continuous infusion and cisplatin (FP) is one of the most active regimen in advanced ASLE. The trial was designed to evaluate the impact on survival of 2–3 cycles of preoperative FP in resectable ASLE. Methods: Patients (pts) with resectable adenocarcinoma of the stomach (S) without cardia involvement, cardia (C) or lower esophagus (LE), age ≤ 75 yrs, WHO performance status (PS) < 2 were eligible. Pts were centrally randomized between surgery alone (arm 1) and preoperative FP (arm 2). Chemotherapy (CT) included 2–3 cycles of P (100 mg/m2) and F (800 mg/m2 d1-d5 continuous infusion) every 28 days. Post- operative FP was recommended in arm 2 in case of response to FP preoperative or stable disease with pN+. The main endpoint was overall survival. Comparison of disease-free survival (DFS) used 6-month landmark method and two-sided logrank test. Results: Between 1995 and 2003, 224 pts (arm 1 = 111 pts, arm 2 = 113 pts) were randomized from 28 centers. Initial pts characteristics were equally balanced for age (mean, 61 yrs), gender (83 % male), PS (75 % WHO 0), tumor site (S = 25 %,C = 64 %, LE = 11 %). Median follow-up was 5.7 years. In arm 2, FP was given before surgery in 109 pts (98 pts > 2 cycles) and after surgery in 54 pts. R0 resection rate was 73 % in arm 1 versus 84 % in arm 2 (p=0.04). Preoperative CT improved DFS (p=0.003): hazard ratio (HR) 0.65 (95%CI 0.48–0.89), with 3 and 5-year DFS of 25% (18–34%) and 21% (14–30%) in arm 1 vs. 40% (31–49%) and 34% (26–44%) in arm 2, respectively. HR of death was 0.69 (0.50–0.95, p=0.02) with 3 and 5- year overall survival (OS) of 35% (27–44%) and 24% (17–33%) vs. 48% (39–57%) and 38% (29–47%), respectively. Similar results on OS were observed using Cox model stratified on center and adjusted on gender, age, performance status, and tumor localization. No significant variation of chemotherapy effect with tumor localization was observed. Conclusions: Preoperative chemotherapy using 5- fluorouracil/cisplatin improves disease-free and overall survival in patients with resectable adenocarcinoma of stomach and lower esophagus. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- V. Boige
- Gustave Roussy Institute, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; Centre Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Centre Hospitalier Universitaire, Dijon, France; CHU Ambroise Pare, Boulogne, France
| | - J. Pignon
- Gustave Roussy Institute, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; Centre Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Centre Hospitalier Universitaire, Dijon, France; CHU Ambroise Pare, Boulogne, France
| | - B. Saint-Aubert
- Gustave Roussy Institute, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; Centre Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Centre Hospitalier Universitaire, Dijon, France; CHU Ambroise Pare, Boulogne, France
| | - P. Lasser
- Gustave Roussy Institute, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; Centre Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Centre Hospitalier Universitaire, Dijon, France; CHU Ambroise Pare, Boulogne, France
| | - T. Conroy
- Gustave Roussy Institute, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; Centre Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Centre Hospitalier Universitaire, Dijon, France; CHU Ambroise Pare, Boulogne, France
| | - O. Bouché
- Gustave Roussy Institute, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; Centre Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Centre Hospitalier Universitaire, Dijon, France; CHU Ambroise Pare, Boulogne, France
| | - P. Segol
- Gustave Roussy Institute, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; Centre Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Centre Hospitalier Universitaire, Dijon, France; CHU Ambroise Pare, Boulogne, France
| | - L. Bedenne
- Gustave Roussy Institute, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; Centre Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Centre Hospitalier Universitaire, Dijon, France; CHU Ambroise Pare, Boulogne, France
| | - P. Rougier
- Gustave Roussy Institute, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; Centre Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Centre Hospitalier Universitaire, Dijon, France; CHU Ambroise Pare, Boulogne, France
| | - M. Ychou
- Gustave Roussy Institute, Villejuif, France; Centre Val d’Aurelle, Montpellier, France; Centre Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Centre Hospitalier Universitaire, Dijon, France; CHU Ambroise Pare, Boulogne, France
| |
Collapse
|
10
|
Ychou M, Pignon JP, Lasser P, Conroy T, Bouché O, Boige V, Segol P, Bedenne L, Saint-Aubert B, Rougier P. Phase III preliminary results of preoperative fluorouracil (F) and cisplatin (P) versus surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC 94012-FFCD 9703 trial. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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
4026 Background: The combination of 5FU in continuous infusion and cisplatin (FP) is one of the more active regimen in advanced ASLE. The trial was designed to evaluate the impact on survival of 2–3 cycles of preoperative FP in resectable ASLE. Methods: Patients (pts) with resectable adenocarcima of the stomach (S) without cardia involvement, cardia (C) or lower esophagus (LE), age ≤ 75 yrs, WHO performance status (PS) < 2 were eligible. Pts were centrally randomized between surgery alone (arm 1) and preoperative FP (arm 2). Chemotherapy (CT) included 2–3, cycles of P (100 mg/m2) and F (800 mg/m2 d1-d5 continuous infusion) every 28 days. Post-operative FP was recommended in arm 2 in case of response to FP preoperative or stable disease with pN+. The main endpoint was overall survival. Sample size was 250 (20 % vs 35 % 5-year rates, two-sided logrank test, α = 5 %, β = 20 %). Results: Between 1995 and 2003, 224 pts (arm 1 = 111 pts, arm 2 = 113 pts) were randomized from 28 centers with early stopping because of low accrual. Initial pts characteristics were equally balanced for age (61 yrs), gender (83 % male), PS (75 % WHO 0), tumor site (S = 25 %,C = 64 %, LE = 11 %). In arm 2, FP was given before surgery in 109 pts (98 pts > 2 cycles) and after surgery in 54 pts. Preoperative FP toxicity : 41 pts with at least one grade 3–4 toxicity (polynuclear, 22 pts, vomiting 10 pts), 9 treatment interruption, 1 toxic death. The number of patients with no surgery / no tumor resection / macroscopic incomplete resection (R2)/ microscopic incomplete resection (R1) by arm were 1/10/12/6 in arm 1 and 4/7/2/4 in arm 2. The number of postoperative deaths were 5 in each arm. Complete resection (R0) rate were 73 % in arm 1 versus 84 % in arm 2 (p=0.04). Among eligible RO, R1 patients (85 & 98 pts in arm 1 & 2): the numbers of pts with T0–2/N0/M+ were 27/17/6 and 41/32/1 en arm 1 & 2, the corresponding p-value were 0.16, 0.05 and 0.05 respectively; 3 pts with complete response in arm 2. For DFS, 160 events are observed so far with a median follow-up of 5 years. Conclusions: Preoperative chemotherapy was well tolerated and led to an increase in R0 resection rate, and a decrease in N+/M+ tumors. Disease-free survival will be presented at the meeting. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- M. Ychou
- CRLC Val d’Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; CLCC Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Hôpital du Bocage, Dijon, France; Hôpital Ambroise Paré, Boulogne, France
| | - J. P. Pignon
- CRLC Val d’Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; CLCC Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Hôpital du Bocage, Dijon, France; Hôpital Ambroise Paré, Boulogne, France
| | - P. Lasser
- CRLC Val d’Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; CLCC Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Hôpital du Bocage, Dijon, France; Hôpital Ambroise Paré, Boulogne, France
| | - T. Conroy
- CRLC Val d’Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; CLCC Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Hôpital du Bocage, Dijon, France; Hôpital Ambroise Paré, Boulogne, France
| | - O. Bouché
- CRLC Val d’Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; CLCC Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Hôpital du Bocage, Dijon, France; Hôpital Ambroise Paré, Boulogne, France
| | - V. Boige
- CRLC Val d’Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; CLCC Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Hôpital du Bocage, Dijon, France; Hôpital Ambroise Paré, Boulogne, France
| | - P. Segol
- CRLC Val d’Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; CLCC Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Hôpital du Bocage, Dijon, France; Hôpital Ambroise Paré, Boulogne, France
| | - L. Bedenne
- CRLC Val d’Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; CLCC Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Hôpital du Bocage, Dijon, France; Hôpital Ambroise Paré, Boulogne, France
| | - B. Saint-Aubert
- CRLC Val d’Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; CLCC Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Hôpital du Bocage, Dijon, France; Hôpital Ambroise Paré, Boulogne, France
| | - P. Rougier
- CRLC Val d’Aurelle, Montpellier, France; Institut Gustave Roussy, Villejuif, France; CLCC Alexis Vautrin, Nancy, France; CHU Robert Debré, Reims, France; CHU Côte de Nacre, Caen, France; Hôpital du Bocage, Dijon, France; Hôpital Ambroise Paré, Boulogne, France
| |
Collapse
|
11
|
Plaisant N, Quenet F, Fabbro M, Gourgou S, Gutowski M, Saint-Aubert B, Rouanet P. [Secondary debulking surgery and intraperitoneal chemotherapy in advanced or recurrent epithelial ovarian cancer]. ACTA ACUST UNITED AC 2004; 32:391-7. [PMID: 15177208 DOI: 10.1016/j.gyobfe.2004.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2003] [Accepted: 03/08/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the indications and the results of secondary cytoreduction surgery with intraperitoneal (i.p.) paclitaxel chemotherapy in advanced or recurrent epithelial ovarian cancer. PATIENTS AND METHODS In a retrospective study, records were reviewed for 13 patients who received i.p. paclitaxel therapy (175 mg/m2) during secondary cytoreductive surgery or surgery for recurrent disease. All these patients were initially treated with optimal debulking surgery (macroscopic persistent residual disease) and systemic chemotherapy. RESULTS Nine patients were operated for secondary cytoreductive surgery (group I) and four patients operated for recurrent disease (group II). Postoperative residual disease was absent or microscopic in 69% (n = 9). Median hospital stay was 16 days. Hematologic toxicity grade III-IV was reported by 12 patients (92%). Operative mortality was 7.7% (n = 1). Median follow-up was 22.7 months. The median overall survival was 25.5 months. The median disease-free survival was 8.5 months. The median disease-free survival for group I and II were respectively 11.7 months and 4.2 months (P = 0.3). Progression of disease after completion of treatment was documented in 62% (n = 8): six patients for group I and two patients for group II. DISCUSSION AND CONCLUSION Secondary cytoreduction surgery associated with intraperitoneal chemotherapy is feasible after adjuvant systemic chemotherapy for patients with recurrent or suboptimally resected ovarian cancer. Results on loco-regional control for recurrent disease are poor. Intraperitoneal chemotherapy should be discussed during a two-step surgical strategy, as secondary cytoreductive surgery.
Collapse
Affiliation(s)
- N Plaisant
- Département de chirurgie oncologique, CRLC Val-d'Aurelle, 208, rue des Apothicaires, parc Euromédecine, 34298 Montpellier 5, France
| | | | | | | | | | | | | |
Collapse
|
12
|
Gutowski M, Carcenac M, Pourquier D, Larroque C, Saint-Aubert B, Rouanet P, Pèlegrin A. Intraoperative immunophotodetection for radical resection of cancers: evaluation in an experimental model. Clin Cancer Res 2001; 7:1142-8. [PMID: 11350877] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The aim of our study was to assess the technique of immunophotodetection (IPD) in intraoperative situations in an experimental model and to determine its capacity to detect very small tumor masses. IPD is a recent technology involving fluorescent dye-labeled monoclonal antibodies (MAbs) directed against tumor-associated antigens. Up to now, no intraoperative device for IPD has been developed, and limits of detection of the technique are unknown. MAb-dye conjugates were prepared using the anti-carcinoembryonic antigen MAb 35A7 labeled with indocyanine and (125)I. Time-dependent (6, 12, 24, 48, and 96 h post i.v. injection) and dose-dependent (10, 40, and 100 microg of conjugate) biodistribution studies were performed in nude mice bearing an LS174T peritoneal carcinomatosis demonstrating high tumor uptake (up to 21% of the injected dose/g of tumor 48 h postinjection). Intraoperative IPD was studied, using a newly developed device, in 16 mice 48 h after i.v. injection of 40 microg of the (125)I-MAb 35A7-indocyanine conjugate. The fluorescent status of 333 biopsies was compared with their histological analysis. Sensitivity was 90.7%, specificity was 97.2%, the positive predictive value was 94.7%, and the negative predictive value was 94.9%. Detection of very small nodules (<1 mg in weight or <1 mm in diameter) was possible. However, we observed a decrease in sensitivity as a function of tumor mass: 100% for nodules >10 mg versus 78% for nodules < or =1 mg. These experiments demonstrate that intraoperative IPD is easy to use and associated with high sensitivity and specificity, even for low tumor masses. On the basis of these encouraging results, intraoperative IPD should be assessed in a clinical study.
Collapse
Affiliation(s)
- M Gutowski
- Department of Oncologic and Reconstructive Surgery, JE2176 Université Montpellier I, France
| | | | | | | | | | | | | |
Collapse
|
13
|
Senesse P, Khemissa F, Lemanski C, Masson B, Quenet F, Saint-Aubert B, Simony J, Ychou M, Dubois JB, Rouanet P. [Contribution of endorectal ultrasonography in preoperative evaluation for very low rectal cancer]. Gastroenterol Clin Biol 2001; 25:24-8. [PMID: 11275615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
UNLABELLED Abdominoperineal resection is the standard treatment of very low rectal carcinoma. Pretherapeutic evaluation of locoregional extension relies mainly on digital rectal examination. The interest of endorectal ultrasonography to assess lateral and inferior margins is still to be determined. AIM OF THE STUDY To assess the ability of endorectal ultrasonography to evaluate the possibility of conservative anal sphincter surgery. PATIENTS AND METHODS Between April 1996 and June 1998, 34 patients (20 men, 14 women, mean age: 61 years, range: 43-80) have been treated for rectal adenocarcinoma. Endorectal ultrasonography was made with a linear probe (EUP-U33). Before treatment, the mean distance between the lower pole of the tumor and the anal verge was 3.9 cm (range: 2-5), and between the lower pole and the puborectalis sling 2.3 mm (range: 0-7). A uTN classification was made. Preoperative treatment was radiotherapy (40 Gy in 4 patients, 60 Gy in 24 patients), or radiochemotherapy (6 patients). Pre- and post-radiotherapy endorectal ultrasonography results were compared to the patholocical analysis of operative specimen. RESULTS Wall infiltration was correctly evaluated in 57% of patients after radiotherapy. In 26/34 cases, a safe plane existed before and after radiotherapy, and correlation of endorectal ultrasonography with histology was 96%. For patients without safe plane, correlation with histology was 75%. CONCLUSION For very low rectal tumors, with an aggressive sphincter conservation approach, endorectal ultrasonography allows to assess sphincter invasion with 96% fiability when safe plane exists.
Collapse
|
14
|
Affiliation(s)
- J B Dubois
- Department of Radiotherapy, CRLC Val d'Aurelle, Montpellier, France
| | | | | | | | | | | |
Collapse
|
15
|
Blanc P, Desprez D, Fabre JM, Pageaux G, Daures JP, Larrey D, Saint-Aubert B, Michel H, Maurel P. Contribution of primary cultures of adult human hepatocytes to the pathophysiology of hepatocellular carcinoma. J Hepatol 1996; 25:663-9. [PMID: 8938543 DOI: 10.1016/s0168-8278(96)80236-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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] [Indexed: 02/03/2023]
Abstract
BACKGROUND/AIMS The mechanisms of hepatocarcinogenesis are still poorly understood. The development of hepatocellular carcinoma has recently been shown to be associated with increased DNA synthesis in cirrhosis. The aim of this work was to determine whether the high rate of hepatocyte regeneration observed in cirrhotic liver with hepatocellular carcinoma is associated with the presence of a growth factor that could be detectable in the serum. METHODS Adult human hepatocytes in primary culture, allowing the evaluation of the release of circulating hepatotrophic factors, were used. These cultures were treated for 48 h with serum from patients with cirrhosis with and without hepatocellular carcinoma, from patients with liver metastasis, and from healthy subjects. The rate of DNA synthesis in these cultures was assessed by measuring the amount of [3H]-thymidine incorporation into genomic DNA. RESULTS On average, the synthesis of DNA was increased 2.5-, 2.2-, 2.1-, and 2.3-fold, respectively, in response to serum from patients with cirrhosis with hepatocellular carcinoma, from patients with cirrhosis without hepatocellular carcinoma, from patients with liver metastasis, and from healthy subjects. CONCLUSIONS We conclude that the hepatotrophic activity of the serum is not significantly different in patients with cirrhosis with or without hepatocellular carcinoma. These results suggest that the increased DNA synthesis in hepatocytes of cirrhotic liver with hepatocellular carcinoma might be due to proliferative factor(s) acting by paracrine or autocrine pathways.
Collapse
Affiliation(s)
- P Blanc
- INSERM, Unité 128, CNRS, Montpellier, France
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Ychou M, Astre C, Rouanet P, Fabre JM, Saint-Aubert B, Domergue J, Ribard D, Ciurana AJ, Janbon C, Pujol H. A phase II study of 5-fluorouracil, leucovorin and cisplatin (FLP) for metastatic gastric cancer. Eur J Cancer 1996; 32A:1933-7. [PMID: 8943677 DOI: 10.1016/0959-8049(96)00147-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [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: 02/03/2023]
Abstract
The modulation of 5-fluorouracil (5-FU) with folinic acid (leucovorin, LV) is more efficacious than 5-FU alone in the treatment of metastatic colorectal cancer, and the combination of 5-FU with cisplatin is currently one of the most active regimens in advanced gastric cancer. A phase II study was therefore conducted to test the efficacy and toxicity of the combination of 5-FU, LV and cisplatin (FLP) in metastatic gastric cancer. 28 patients entered the study. Metastatic sites were observed in the liver (in 21 patients), the peritoneum (in 8), the lymph nodes (in 7) or the bones (in 1) and a local recurrence was noted in 4 cases. The performance status (using World Health Organisation criteria) was 0 for 13 patients and 1 or 2 for the others. Cycles of treatment were administered every 28 days and consisted of LV 200 mg/m2/day for 5 days followed by 5-FU 400 mg/m2/day for 5 days with cisplatin 100 mg/m2 on day 2. The response rate for the 27 evaluable patients was 51.8% (95% confidence interval (CI), 33-70.6%). There were four complete responses (14.8%) and 10 partial responses (37%). Median survival was 11 months and 4 patients were alive at 2 years. Both response rate and survival were better for patients with a good performance status. The overall toxicity was very low, except for 1 patient who died of dehydration and cardiac failure. In conclusion, the FLP protocol was effective and well tolerated in patients with metastatic gastric cancer.
Collapse
Affiliation(s)
- M Ychou
- C.R.L.C., Val d'Aurelle-Paul Lamarque, Montpellier, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Ychou M, Faurous P, Pèlegrin A, Saint-Aubert B, Rouanet P, Saccavini J, Guerreau D, Mach J, Dubois J, Artus J. 755 Radioimmunotherapy of metastatic colon cancer: Phase I study with anti-CEA F(AB)′2 fragments labeled with escalating dose OD iodine 131. Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96004-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
18
|
Abstract
We treated 31 soft tissue sarcoma bearing patients with intraoperative radiation therapy (IORT) with ages ranging from 26 to 71: first curative intent treatment, 16 patients; and recurrent tumors, 15 patients. The tumor site was the pelvis and the retroperitoneal spaces in 13 patients and the limbs or the trunk in 18 patients. The histological type was: malignant histiocytofibroma, 14 patients; liposarcomas, 10 patients; malignant schwanoma, 1 patient; leiomyosarcoma, 2 patients; hemangiopericytoma, 1 patient; embryonic rhabdomyosarcoma, 2 patients; and synovialosarcoma, 1 patient. All the patients were diagnosed without any distant metastatic evolution at the moment of the treatment. All the patients except one underwent a complete surgical excision without any gross residual disease and received an intraoperative radiation single dose of 10 Gy in one case, 12.5 Gy in one case, 13 Gy in one case, 15 Gy in 17 cases, 18 Gy in three cases, 20 Gy in seven cases and 25 Gy in one case. Thereafter the treatment was completed by a postoperative X-ray dose of 45-50 Gy in 4.5-5 weeks for 16 patients. Local control (LC) was obtained in 27 out of 31 patients (87%), with a minimal follow-up duration of 2 years. Eleven out of 31 patients died: seven with local control (one from an intercurrent disease, six from distant metastasis) and four with local failure inside the IORT fields. Twenty patients are alive with no evolutive disease in 19 cases and with a distant metastasis in one case.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- J B Dubois
- Department of Radiotherapy, C.R.L.C. Val d'Aurelle, Paul Lamarque, Montpellier, France
| | | | | | | | | | | | | |
Collapse
|
19
|
|
20
|
Briand D, Rouanet P, Kyriakopoulou T, Spiliotis J, Astre C, Saint-Aubert B, Joyeux H. Repeated hepatic resections for liver metastases from colon carcinoma. Montpellier Cancer Institute experience. Eur J Surg Oncol 1994; 20:219-24. [PMID: 8181596] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The main cause of death after hepatic resection for colorectal liver metastases is tumor recurrence. An improvement in survival may be achieved by resection of recurrent hepatic metastases as previously reported. In this paper we report our experience with 13 repeated liver resections in 11 patients. The post-operative mortality was 8% and the morbidity was 23% with two biliary tract fistulas and one recurrent pleural effusion. The median survival time from the first hepatic resection was 23 months, but differed according to the length of the disease-free interval (more than 1 year and less than 1 year: 49 and 17 months, respectively (P < 0.05). Our results suggest that repeated hepatic resection is technically a safe procedure and may be beneficial to selected patients. All candidates should be carefully evaluated pre-operatively for extrahepatic disease.
Collapse
Affiliation(s)
- D Briand
- Department of Surgical Oncology and Nutrition, Montpellier Cancer Institute, University of Montpellier, France
| | | | | | | | | | | | | |
Collapse
|
21
|
Joyeux H, Matias J, Gouttebel MC, Vedrenne JB, Guillaume A, Martella L, Saint-Aubert B. [Therapeutic strategy in 46 cases of radiation injury of the intestine]. Chirurgie 1994; 120:129-133. [PMID: 8746016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Our expérience in the treatment of 46 cases with radiation enteritis (RE) permitted to summarize 5 key points in the Surgical Strategy: laparotomy incision, enterolysis technique, small bowel and colon preservation, anastomosis technic and parenteral nutritional support. Surgery is imposed most of the time in digestive and nutritional Insufficiencies due to radiation enteritis. 46 patients aged to 33-81 years (mean age = 59) were included for possible surgery. The first clinical digestive symptoms were occlusion (n = 39) and/or digestive fistula (n = 7) and/or perforation (n = 3). These abnormalities were often associated with severe malnutrition (weight loss > or = 20% of usual weight) inducing surgery preparation with pre-operative parenteral nutrition (8 to 350 days). 3 patients were not operated because of general problems and lived 1 to 7 months after the beginning of parenteral nutrition. For operated patients (n = 43), 12 underwent 2 operations (resection and/or enteral liberation) and one patient underwent 4 surgical interventions because of digestive fistula. In 35 cases, small bowel resection was performed leaving 135.4 +/- 62.6 cm of intestine (0 to 225 cm of jejunum and/or ileum) and in 13 cases, complete enterolysis was achieved. All the patients received a post-operative parenteral nutrition during 1 to 23 months (median = 6.2 +/- 5.3 months). 31 patients received home parenteral nutrition during the pre and/or post-operative phase for a median duration of 6.3 +/- 3.2 months (range: 1-23 months). 4 patients died during the immediate post-operative phase and among them, 3 died after the second surgery. 12 deaths were observed due to the primary cancer and 6 due to the evolution of radiation lesions. Median survival of patients without cancer evolution reach 180 months with a 5-year survival rate of 94% (Kaplan-Meier method). In patients with radiation enteritis, the pre and post-operative nutritional support associated with radical surgery allows to obtain prolonged survival in non cancer patients.
Collapse
|
22
|
Joyeux H, Gouttebel MC, Briand D, Saint-Aubert B, Matias J. [Short bowel syndromes in adults. Prognostic factors. Evaluation and treatment. Retrospective study. Apropos of 80 cases]. Chirurgie 1994; 120:187-193. [PMID: 7743831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Since 1981, a consensus is appeared in order to define and to precise the natural evolution of short bowel with a maximal remaining small bowel of 150 cm. The phenomenon of intestinal adaptation which are better known in animals than in humans, are on the dependence of luminal, hormonal and humoral factors (epidermal growth factor, polyamines). The knowledge of prognostical factors and the anatomical and functional evaluation of remaining small bowel allow to "measure" the improvement of digestive absorption and to decide the duration of nutritional support. An experience in 80 cases of short bowel syndrome is reported. A significant correlation exists between the duration of parenteral nutrition support and the length of the remaining gut (p < 0.001) and multifactorial analysis differentiates 3 groups of short bowel characterized by their length and parenteral support duration.
Collapse
Affiliation(s)
- H Joyeux
- Institut Curie, Chirurgie viscérale, Paris
| | | | | | | | | |
Collapse
|
23
|
Fabre G, Julian B, Saint-Aubert B, Joyeux H, Berger Y. Evidence for CYP3A-mediated N-deethylation of amiodarone in human liver microsomal fractions. Drug Metab Dispos 1993; 21:978-85. [PMID: 7905403] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Metabolism of amiodarone to its N-deethylated derivative was investigated on a bank of human hepatic microsomal fractions, two of them lacking the CYP2D6 isozyme. Michaelis-Menten constants for amiodarone N-deethylation were 0.33 +/- 0.11 microM and 2.38 +/- 0.74 nmol/min/mg for KM and Vmax. The specific involvement of CYP3A gene subfamily in amiodarone N-deethylation was provided by the following observations: 1) metabolism of amiodarone is inhibited in a concentration-dependent manner by ketoconazole, a specific CYP3A inhibitor, and by nifedipine, a specific substrate for CYP3A gene subfamily, with IC50 of 0.3 and 25 microM, respectively; 2) nifedipine competitively inhibits amiodarone metabolism with a Ki of 38 microM; 3) amiodarone N-deethylation is increased following incubation with hepatic microsomal fractions prepared from CYP3A-inducers such as rifampycin and triacetyloleandomycin, but also following the in vitro disruption of the "cytochrome P-450-Fe-(II)-triacetyloleandomycin nitroso derivative" complex; 4) antibodies raised against either rabbit or baboon monkey CYP3A gene subfamily inhibit amiodarone N-deethylation; and 5) microsomal fractions that specifically express CYP3A4 biotransform amiodarone to its N-deethylated derivative. These studies indicate that CYP3A isozyme(s) mainly metabolize amiodarone to its N-deethylated derivative in human hepatic microsomal fractions.
Collapse
Affiliation(s)
- G Fabre
- Sanofi Recherche, Metabolism and Pharmacokinetics Department, Montpellier, France
| | | | | | | | | |
Collapse
|
24
|
Spiliotis J, Briand D, Gouttebel MC, Astre C, Louer B, Saint-Aubert B, Kalfarentzos F, Androulakis J, Joyeux H. Treatment of fistulas of the gastrointestinal tract with total parenteral nutrition and octreotide in patients with carcinoma. Surg Gynecol Obstet 1993; 176:575-580. [PMID: 8322132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The development of a fistula is a serious postoperative complication. Conservative medical treatment with total parenteral nutrition, skin care and intensive infection control usually succeeds in closing fistulas (60 to 75 percent), but the treatment is of long duration (two to three months), high cost and high morbidity related to prolonged hospitalization. We have used octreotide, a long half-life stomatostatin analog, in 40 patients from two European university centers with postoperative enterocutaneous fistulas. Twenty-two patients had low fistula output and 28 patients had high fistula output. Spontaneous closure was achieved in 77.5 percent of the patients after a mean of 13.6 days. One patient died. Glucose intolerance, which has been reported with stomatostatin treatment of fistulas, was not observed. Previous chemotherapy or radiotherapy or low albumin level (23 grams per deciliter) negatively influenced fistula closure. As an adjunct treatment to primary care (total parenteral nutrition, skin care and infection control), octreotide is efficient in reducing fistula output and accelerating spontaneous fistulas closure.
Collapse
Affiliation(s)
- J Spiliotis
- Department of Surgical Oncology and Nutrition, University of Montpellier, France
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Dubois JB, Rouanet P, Saint-Aubert B, Solassol C, Pujol H. [Pre-operative radiotherapy and sphincter conservation in cancer of the rectum]. Ann Gastroenterol Hepatol (Paris) 1993; 29:127-9. [PMID: 8517627] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J B Dubois
- Département de radiothérapie, CRLC Val d'Aurelle, Montpellier, France
| | | | | | | | | |
Collapse
|
26
|
Ychou M, Fedkovic Y, Saint-Aubert B, Rouanet P, Astre C, Pujol H. A phase II study with 5-FU, leucovorin and cisplatin in metastatic gastric cancer. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91195-q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
27
|
Gérard JP, Calvo F, Braillon G, Dubois JB, Guillemin C, Roussel A, Saint-Aubert B, Sentenac I. [Intraoperative radiotherapy in oncology]. Pathol Biol (Paris) 1992; 39:881-2. [PMID: 1538919] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J P Gérard
- Service Radiothérapie, Hôpital Lyon-Sud, Pierre-Bénite, France
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Saint-Aubert B, Cooper J, Astre C, Spiliotis J, Joyeux H. Evaluation of the induction of polycyclic aromatic hydrocarbons (PAH) by cooking on two geometrically different types of barbecue. J Food Compost Anal 1992. [DOI: 10.1016/0889-1575(92)90045-l] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Gouttebel MC, Astre C, Briand D, Saint-Aubert B, Girardot PM, Joyeux H. Influence of N-acetylglutamine or glutamine infusion on plasma amino acid concentrations during the early phase of small-bowel adaptation in the dog. JPEN J Parenter Enteral Nutr 1992; 16:117-21. [PMID: 1556804 DOI: 10.1177/0148607192016002117] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [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: 12/27/2022]
Abstract
Glutamine is a nonessential neutral amino acid that is widely consumed by the intestinal tract in catabolic states. We have followed up the plasma amino acid profile after extensive small-bowel resection in dogs receiving total parenteral nutrition (TPN) with or without glutamine (GLN) or N-acetylglutamine (aGLN) supplementation. Animals were divided into four groups according to the type of surgery (enterectomy or transection) and nutrition (TPN, TPN with aGLN, or TPN with GLN). Plasma GLN levels decreased in group I (enterectomy and TPN) on day 2 (p = .03) and significantly increased on postoperative days in groups III (enterectomy and TPN with aGLN) and IV (enterectomy and TPN with GLN). A significant increase of plasma GLN was observed in groups III and IV compared with group I on days 6 and 8 (p = .03 and p = .01). Plasma alanine decreased in groups with bowel resection, whereas no change was observed in the control group (transection) and the decrease of plasma alanine was significantly less pronounced in groups III and IV compared with group I. The increase of crypt depth and villous height was more pronounced in groups III and IV. These results suggest that GLN is a required substrate for mucosal growth and function, which could improve the intestinal adaptation encountered after enterectomy.
Collapse
Affiliation(s)
- M C Gouttebel
- Laboratory of Nutrition and Experimental Oncology, Cancer Institute, Monpellier, France
| | | | | | | | | | | |
Collapse
|
30
|
Astre C, Gouttebel MC, Saint-Aubert B, Girardot PM, Briand D, Joyeux H. Plasma and jejunal glutamine levels after extensive small bowel resection in dogs. Clin Nutr 1992; 11:30-4. [PMID: 16839966 DOI: 10.1016/0261-5614(92)90060-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/1991] [Accepted: 10/23/1991] [Indexed: 11/25/2022]
Abstract
Recent studies have demonstrated that glutamine may be required for mucosal growth and that it is widely utilised by the intestinal tract after surgery. This study has evaluated the effect of massive small bowel resection on plasma and jejunal glutamine and related amino-acids level evolution after surgery. Transection was performed in 6 dogs (control group) and enterectomy in 10 dogs leaving 25cm of jejunum, associated with colectomy (group 1). Plasma glutamine levels decreased on D2 (p = 0.03) in the resected group while a significant decrease of plasma alanine levels was observed on D2 (p = 0.002), D4, D6 and D8 (p < 0.001). Intestinal mucosa glutamic acid content was increased on D8 in this group (p < 0.001). No changes were observed in the control group. These results suggest that glutamine is a required substrate after massive small bowel resection which could improve the intestinal adaptation encountered after enterectomy.
Collapse
Affiliation(s)
- C Astre
- Laboratory of Nutrition and Experimental Oncology, Cancer Institute, 34094, Montpellier, Cedex 5, France
| | | | | | | | | | | |
Collapse
|
31
|
Spiliotis J, Saint-Aubert B, Joyeux H. [Possible role of sexual and gastrointestinal hormones on cancer of the digestive system]. Bull Cancer 1991; 78:1007-11. [PMID: 1369546] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
This is a review of the most interesting studies on the possible role of sex and gut hormones in gastrointestinal (GI) carcinomas. Many experimental and some human studies suggest that sex and gut peptides may have a growth effect on normal or neoplastic gut cells. It may be possible in the future to develop strategies for patients with GI cancers that will be based upon hormonal manipulation in a manner similar to current strategies that are at present employed in the treatment of patients with breast cancer.
Collapse
Affiliation(s)
- J Spiliotis
- Département de chirurgie et nutrition, centre Paul-Lamarque, Montpellier, France
| | | | | |
Collapse
|
32
|
Centeno Neto AA, Veyrac M, Briand D, Spiliotis J, Saint-Aubert B, Joyeux H. Autotransplantation of the pylorus sphincter at the terminal abdominal colostomy. Experimental study in dogs. Dis Colon Rectum 1991; 34:874-9. [PMID: 1914720 DOI: 10.1007/bf02049700] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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] [Indexed: 02/08/2023]
Abstract
A method for constructing a continent colostomy has been tried in dogs. The pylorus sphincter with blood supply by the left gastroepiploic vessels was transposed around or anastomosed to the terminal abdominal colostomy in five dogs. One dog had a colostomy without pylorus transplantation. Evaluation was by clinical (consistency and weight of fecal material and number of defecations per day), radiologic, and manometry studies. There was no difference in the clinical data. In all the dogs, the radiologic study demonstrated emptying of the contrast medium to the peristomal skin. By manometry one high-pressure zone was demonstrated, and, in all dogs with a transposed or anastomosed pyloric segment, the average resting pressure was superior to that of the control dog. However, the transposed pylorus sphincter alone was not sufficient to control continence.
Collapse
Affiliation(s)
- A A Centeno Neto
- Laboratoire de Nutrition et Cancerologie Experimentale, Institut du Cancer, Montpellier, France
| | | | | | | | | | | |
Collapse
|
33
|
Pichard L, Fabre JM, Domergue J, Fabre G, Saint-Aubert B, Mourad G, Maurel P. Molecular mechanism of cyclosporine A drug interactions: inducers and inhibitors of cytochrome P450 screening in primary cultures of human hepatocytes. Transplant Proc 1991; 23:978-9. [PMID: 1989351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
34
|
Gouttebel MC, Astre C, Girardot PM, Saint-Aubert B, Joyeux H. Clinical, biological, and histological follow-up during intestinal adaptation after small-bowel resection in the dog. Eur Surg Res 1991; 23:333-40. [PMID: 1802737 DOI: 10.1159/000129173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 12/28/2022]
Abstract
Massive resections of the intestine including the ileocecal valve are associated with a high mortality. This model of short bowel in the dog consists of an extensive small-bowel resection (remaining jejunum 25 cm) associated with colectomy. Small-bowel adaptation is evidenced by increases of crypt depth (p = 0.02) and villus height (p = 0.001) in animals fed per os. Plasma glutamine levels decrease after surgery, while there is a significant decrease of plasma alanine levels (p less than 0.001). This model should allow to pursue investigations on the importance of glutamine as an essential fuel for intestinal mucosa regeneration.
Collapse
Affiliation(s)
- M C Gouttebel
- Laboratory of Nutrition and Experimental Oncology, Cancer Institute, Montpellier, France
| | | | | | | | | |
Collapse
|
35
|
Sami H, Saint-Aubert B, Szawlowski AW, Astre C, Joyeux H. Home enteral nutrition system: one patient, one daily ration of an "all-in-one" sterile and modular formula in a single container. JPEN J Parenter Enteral Nutr 1990; 14:173-6. [PMID: 2112626 DOI: 10.1177/0148607190014002173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 12/30/2022]
Abstract
A home enteral nutrition (HEN) system was introduced to deliver a day's ration of an "all-in-one" sterile and modular formula from a large container. The nutrient formula consisted of carbohydrate, protein, and lipid modules sterilized separately, in an autoclave at 120 degrees C, then mixed and supplemented with minerals and trace elements. Vitamins were given the patients through a feeding tube before connecting the nutrient container. The system was used to feed 12 malnourished patients (10 men and two women) with cancer (carcinoma of esophagus or tongue) or without cancer (esophageal perforation). All patients had normal gastrointestinal function but could not take in more than 500 kcal/day orally, because of their primary disease or the treatment for it (surgery in four patients; and radiotherapy, associated in some cases with chemotherapy, in eight). HEN duration ranged from 30 to 435 days at a daily cost of approximately US $15 to $20. Statistical analysis (Student's t-test for paired data) showed significant body weight gain (p less than 0.05) and significant increases in serum levels of albumin, transthyretin (p less than 0.05, respectively), and transferrin (p less than 0.01). Increases of serum total protein level were not statistically significant (p less than 0.09). The nutrient formula was well tolerated and there were no HEN-related rehospitalizations. Seventy-five % (nine of the patients) considered that HEN had improved their quality of life. The daily savings per patient, compared to the cost of treatment in a hospital, was about $260/day.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- H Sami
- Department of Surgery and Nutrition, Cancer Institute, University of Montpellier, France
| | | | | | | | | |
Collapse
|
36
|
Sami H, Saint-Aubert B, Astre C, Gouttebel MC, Joyeux H. Enteral nutrition in cancer patients: a new approach. Nutrition 1990; 6:175-6. [PMID: 2134534] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- H Sami
- Department of Surgery and Nutrition, University of Montpellier, France
| | | | | | | | | |
Collapse
|
37
|
Saint-Aubert B, Szawlowski AW, Domergue J, Briand D, Joyeux H. The thumb and index finger as principal surgical instruments to secure the inferior vena cava between the liver and the diaphragm in routine operations of the liver. Surg Gynecol Obstet 1990; 170:169-70. [PMID: 2300871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Presented herein is a simple and safe technique to secure the IVC in its segments above the liver and below the diaphragm through a simple incision in the abdomen. After complete division of the hepatic ligaments, the index finger is passed through the upper recessus of the lesser sac, behind the vein, and just above the caudate lobe, meeting the right thumb on the right side of the vein. A tissue string is then passed, and the IVC is secured. The experience of the authors with more than 100 consecutive hepatectomies has shown this technique to be a reliable approach to secure the IVC during routine hepatic operations.
Collapse
Affiliation(s)
- B Saint-Aubert
- Department of Surgery and Nutrition, Cancer Institute, University of Montpellier
| | | | | | | | | |
Collapse
|
38
|
Domergue J, Saint-Aubert B, Rouanet P, Joyeux HM, Solassol C, Pujol H. A new technique of total three-stage esophagectomy for carcinoma with a combined right cervical and thoracic approach. Surg Gynecol Obstet 1989; 169:555-7. [PMID: 2814774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Total esophagectomy with a combined right cervicothoracic approach can be considered to be an extension of the classic right abdominothoracic method. The inclusion of a wide operating field composed of the neck and thorax, as well as the upper right limb, makes the method applicable to both provisional and obligatory operations. The nonobligatory cervical phase constitutes a useful safety approach when frozen section biopsy of the residual esophagus yields positive specimens, if a conventional Lewis-Santy right abdominothoracic procedure has been chosen.
Collapse
Affiliation(s)
- J Domergue
- Department of Surgery, Montpellier Cancer Institute, France
| | | | | | | | | | | |
Collapse
|
39
|
Faurous P, Saint-Aubert B, Szawlowski A, Collet H, Gouttebel MC, Astre C, Joyeux H, Suquet P. Estimation of hepatic volume by SPECT during liver regeneration: an experimental study in an animal model. Int J Rad Appl Instrum B 1989; 16:375-9. [PMID: 2789206 DOI: 10.1016/0883-2897(89)90103-7] [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: 01/02/2023]
Abstract
To calculate hepatic volume in the dog by single photon emission computerized tomography (SPECT), we determined the limits of the organ by choosing an isocontour on each section. This choice entailed prior calculation of an overestimated pseudovolume. The accuracy of the measurement in the animal then approached that of measurements in vitro. We used the method to monitor hepatic regeneration in the dog after 65% hepatectomy and detected oedema and postoperative trauma, and over a longer timespan, stagnation of regeneration and a secondary drop in hepatic volume.
Collapse
Affiliation(s)
- P Faurous
- Department of Nuclear Medicine, University of Montpellier, France
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Domergue J, Ismail M, Astre C, Saint-Aubert B, Joyeux H, Solassol C, Pujol H. Colorectal carcinoma in patients younger than 40 years of age. Montpellier Cancer Institute experience with 78 patients. Cancer 1988; 61:835-40. [PMID: 3338041 DOI: 10.1002/1097-0142(19880215)61:4<835::aid-cncr2820610432>3.0.co;2-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.4] [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: 01/05/2023]
Abstract
During an 18-year period, 2600 patients were treated for colorectal carcinoma in the Montpellier Cancer Institute. Of the 93 patients younger than 40 years of age (3.6%), 78 records were retrospectively studied. The overall 5-year survival rate was 30%. Their survival was not significantly affected by the site of the primary tumor, the degree of tumor differentiation, or sex. The only significant parameter was Dukes' staging at presentation (P less than 0.0001). An analysis of sites of recurrence revealed the frequency of liver metastasis, ovarian metastasis in women, and local recurrence of rectal cancer. Although the high failure rate in these areas clearly justifies aggressive combined therapy, the high frequency of inaugural Stage D patients (27%) and their short mean survival time (5 months), underline the crucial importance of early detection. However, it is unfortunate that colorectal cancer screening in young patients is difficult because of the low rates of precancerous states (4%).
Collapse
Affiliation(s)
- J Domergue
- Department of Surgery, University of Montpellier, France
| | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
Ambulatory total parenteral nutrition (TPN) at home was used in 85 patients within a 6-yr period. Indications include severe malabsorption, fistulas, anorexia nervosa, and malignancies. The median duration of home TPN (HPN) was 67 days (range: 30-4,155 days). HPN duration for patients with benign diseases was longer [357.12 days (range: 30-4,155 days)] than for cancer patients [93.54 days (range: 30-421 days)]. Under HPN, patients gained a good nutritional status with an increase of total protein (p less than 0.001) and serum albumin levels (p less than 0.001). Weight gain was also significant (p less than 0.001). The rehospitalization rate was low (7.8%), but it was higher when HPN lasted for more than 3 months (10.87% +/- 1.58%) compared with short-term HPN (5.69% +/- 1.25%). Metabolic complications were unusual, and rehospitalization was related to the oncological treatment and/or infectious complications. Therefore, ambulatory HPN is a nutritional support that can significantly improve the life of patients with alimentary failure. Moreover, HPN allows significant cost savings compared to the alternative of prolonged hospitalization.
Collapse
Affiliation(s)
- M C Gouttebel
- Department of Surgery and Nutrition, Cancer Institute, Montpellier, France
| | | | | | | | | |
Collapse
|
42
|
Joyeux H, Saint-Aubert B, Gouttebel MC, Zhang GH, Domergue J, Dubois JB, Cupissol D. [Treatment of epithelial cancer of the ovary. In favor of primary radical and regional surgery before chemotherapy and radiotherapy]. Presse Med 1987; 16:1325-8. [PMID: 2956592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The treatment of epithelial carcinoma of the ovary (90% of malignant ovarian tumours) has largely benefited from chemotherapy, notably since the advent of cisplatinum. Radiotherapy may be an important adjuvant treatment to sterilize the pelvis. Both chemo- and radiotherapy are effective mainly on small residual diseases, hence the importance of initial surgery with maximal cell reduction, notably in carcinomas classified as stage III according to the International Gynaecology and Obstetrics Federation system. Regional surgery of the ovary must be pelvic and abdominal: from Douglas' pouch to the diaphragmatic domes. This therapeutic approach requires the resolution of two problems: intensive care and post-operative feeding. It has 2 major advantages: it avoids second-look operations or reduces their number, and it increases the survival rate at 5 years.
Collapse
|
43
|
Gouttebel MC, Saint-Aubert B, Joyeux H. [Parenteral feeding at home. 100 cases]. Presse Med 1987; 16:1265-8. [PMID: 2955385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Between 1979 and 1986, 100 patients underwent parenteral nutrition at home on account of malnutrition consecutive to digestive insufficiency or heavy anti-cancer chemotherapy. Parenteral feeding was performed through a buried catheter for a mean period of 74 days (range 30 to 430 days). The patients' nutritional status was improved, with a significant increase in weight, total plasma proteins and serum albumin (P less than 0.001). The principal complication observed was infection, and few patients (10.61%) were rehospitalized. Home parenteral nutrition may be regarded as "the artificial bowel" for chronic malnutrition patients. It increases the duration and quality of life without prolonging the time spent in hospital, and it reduces health expenses by 50 to 70%.
Collapse
|
44
|
Joyeux H, Saint-Aubert B, Dubois JB, Bories P, Solassol C. [Exocrine pancreas cancer. In favor of an early diagnosis and surgical treatment]. Presse Med 1987; 16:943-4. [PMID: 2954142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
|
45
|
Jonquet O, Gouttebel M, Saint-Aubert B. Le risque infectieux lors de la nutrition parenterale a domicile. Med Mal Infect 1987. [DOI: 10.1016/s0399-077x(87)80297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
46
|
Abstract
The model of extended repeated partial hepatectomy without vascular shunt in dogs is presented. It consisted of 65% initial hepatectomy and after liver regeneration (6-10 weeks) repeated hepatectomy. Finally, only the papillary process of the caudate lobe (PPC), which constitutes 5% of the initial hepatic mass, was left intact. The most important finding was an ability of PPC to reconstitute the liver mass which enabled survival without the vascular shunt. After repeated hepatectomy the need for artificial hepatic assistance (parenteral nutritional support with frozen plasma) was imperative to offset the effects of acute hepatic failure and to support PPC regeneration.
Collapse
Affiliation(s)
- A W Szawlowski
- Laboratory of Nutrition and Experimental Oncology, University of Montpellier, France
| | | | | | | | | |
Collapse
|
47
|
Szawlowski AW, Faurous P, Saint-Aubert B, Gouttebel MC, Astre C, Collet H, Joyeux H. Single photon emission computerized tomography (SPECT) for monitoring regeneration of the human liver after partial hepatectomy for secondary tumours. Eur J Surg Oncol 1986; 12:389-92. [PMID: 3491005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In 18 patients, the liver volume during regeneration after partial hepatectomy for secondary tumours was estimated by single photon emission computerized tomography (SPECT). Hepatic weight index (HWI) was subsequently calculated to follow evolution of the regeneration as a function of postoperative complications over a 30-day period. In patients with postoperative complications the HWI curves initially rose progressively and either reached a plateau or declined thereafter. The same pattern of HWI evolution was observed in patients with tumour recurrence, which was diagnosed later. On the other hand, in patients without postoperative complications the HWI curves rose continuously. These findings showed that a regenerative response was not the same in patients with or without postoperative complications; whereas in patients with tumour recurrence it could additionally provide prognostic information.
Collapse
|
48
|
Abstract
Seventeen patients who had undergone extensive small bowel resection were studied for calcium absorption (FACa) and plasma vitamin D metabolites. FACa was measured by a double radio-tracer technique and expressed as percentage of total oral dose. FACa was decreased compared with controls (34%, range: 3-46 v 65%, range: 57-73, P less than 0.01). A positive correlation (r = 0.49, P = 0.05) was found between FACa and the remaining length of small bowel (SBL). As wide variations in both SBL and duration after surgery were observed among the seventeen investigated patients, we were led to individualize less heterogeneous subgroups of patients. Better correlations were found when the patients were divided into two subgroups according to whether the time interval between the resection and the investigation was shorter (r = 0.75, n = 11, P less than 0.02) or longer (r = 0.89, n = 6, P = 0.05) than 2 years. In thirteen patients who had a SBL shorter than 100 cm, a positive correlation was observed between FACa and the time interval after surgery (months): r = 0.65, P less than 0.05. Plasma 1,25 (OH)2D was markedly reduced in the whole group (31 pmol l-1, range: 8-108) compared with controls (103 pmol-1, range: 59-134, P less than 0.01). The present study shows that in extensively small bowel resected patients, calcium absorption is reduced, the alteration being dependent both on the length of the remnant small bowel and on the time after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
|
49
|
Abstract
Thirty-nine patients with short bowel syndrome after extensive small bowel resection, with or without associated partial or total colectomy, received continuous total parenteral nutrition followed by discontinuous parenteral nutrition. Home parenteral nutrition was introduced in 16 of these patients; in eight it was permanent. The assessment of nutritional status included body weight; standard urinary and blood studies; albumin, prealbumin, and transferrin serum levels; and both urinary and fecal nitrogen. A statistically significant correlation (P less than 0.001) was observed between the length of the remaining small bowel and the necessary duration of nutritional support. Multivariate analysis allowed us to classify patients into three groups as a function of remaining gut length and the duration of required nutritional support. This study should help to define the best nutritional support protocol for patients with various short bowel syndromes in order to ensure the best possible intestinal adaptation and to improve their quality of life.
Collapse
|
50
|
Abstract
Between January 1975 and December 1983 in the Cancer Institute, Montpellier, France, regional surgery (RS) was performed on 18 Stage III and 3 Stage IV patients (International Federation of Gynecology and Obstetrics [FIGO]) with histologically proven cystadenocarcinoma of the ovary. All patients were placed into one of three nonrandomized groups: Group A (9 patients), RS at first-look surgery; Group B (7 patients), RS at second-look surgery; and Group C (5 patients), RS at third-look surgery. Group A was given adjuvant chemotherapy, whereas Group B and C patients underwent nonregional surgery at first- or second-look operation, and received chemotherapy supplemented in some Group C cases by radiotherapy before RS. The adjuvant chemotherapy consisted of: cyclophosphamide plus Alkeran (mephalan) plus 5-fluorouracil (the first 7 patients) and Adriamycin (doxorubicin) plus cisplatin plus hexamethylmelamine (14 additional patients). RS consisted of basic procedures--abdominal hysterectomy; bilateral salpingo-oophorectomy; omentectomy--and specific procedures--abdominal and pelvic peritonectomy; either total or partial colectomy; jejunoilectomy, leaving at least 150 cm of the jejunum; and retroperitoneal lymph node dissection aimed at maximal cytoreduction of tumor mass. There was no operative mortality. The overall postoperative morbidity was 33.3% (seven patients) due to wound sepsis. The survival from the beginning of treatment (absolute survival [AS]) and survival after RS (RSS) were compared. In Group A (AS = RSS) the probability of survival at 112 months (6/9 patients are still alive) was 0.52. In Groups B and C the median survival times (AS and RSS) were 37 and 17 months and 18 and 1 month, respectively. The difference in AS among the three groups of patients was not statistically significant (log-rank test), whereas the RSS was statistically significant between Group A versus Groups B, C, and Groups B and C combined (P less than 0.05).
Collapse
|