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Detroz B, Laurent S, Honoré P, Blaffart F, Limet R, Meurisse M. Rationale for Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in the Treatment or Prevention of Peritoneal Carcinomatosis. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2004.11679577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B. Detroz
- Department of Abdominal Surgery, Department of Cardio-vascular Surgery (*) CHU of Liège, Belgium
| | - S. Laurent
- Department of Abdominal Surgery, Department of Cardio-vascular Surgery (*) CHU of Liège, Belgium
| | - P. Honoré
- Department of Abdominal Surgery, Department of Cardio-vascular Surgery (*) CHU of Liège, Belgium
| | - F. Blaffart
- Department of Abdominal Surgery, Department of Cardio-vascular Surgery (*) CHU of Liège, Belgium
| | - R. Limet
- Department of Abdominal Surgery, Department of Cardio-vascular Surgery (*) CHU of Liège, Belgium
| | - M. Meurisse
- Department of Abdominal Surgery, Department of Cardio-vascular Surgery (*) CHU of Liège, Belgium
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Detry O, De Roover A, Coimbra C, Detroz B, Delwaide J, Kaba A, Polus M, Lamproye A, Joris J, Belaïche J, Meurisse M, Honoré P. [Recent advances in liver surgery and transplantation]. Rev Med Liege 2007; 62:310-6. [PMID: 17725200] [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: 05/16/2023]
Abstract
Over the last 20 years, significant improvements in hepatic surgery and transplantation have allowed better results. Better patients selection, new preoperative modalities aiming at modifying the volume of the liver or the tumour, new surgical techniques, and better postoperative management are the keys to improved outcome. These progresses are reviewed in this article. In hepatic surgery, the latest surgical improvements are the possibility of laparoscopic hepatic resection and of radiofrequency ablation. Modern neoadjuvant chemotherapy may in some cases allow a reduction of large liver colorectal metastases and render them resectable. Improved radiological techniques allow better planning of the surgical resections, reduction of the risks by calculation of the residual liver mass, and induction of liver hypertrophy by preoperative portal embolisation. In liver transplantation, the most significant changes were the use of living related liver donors and of non-heart beating donors to overcome the cadaveric organ donor shortage.
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Affiliation(s)
- O Detry
- Service de Chirurgie Abdominale, Transplantation et des Glandes Endocrines, CHU Sart Tilman, Liège, Belgique.
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De Roover A, Detroz B, Detry O, Coimbra C, Polus M, Belaiche J, Meurisse M, Honoré P. Adjuvant hyperthermic intraperitoneal peroperative chemotherapy (HIPEC) associated with curative surgery for locally advanced gastric carcinoma. An initial experience. Acta Chir Belg 2006; 106:297-301. [PMID: 16910002 DOI: 10.1080/00015458.2006.11679896] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 10/21/2022]
Abstract
AIM OF THE STUDY After macroscopic radical (R0) surgery for advanced gastric carcinoma, 40 to 50% of the tumors recur in the abdomen as locoregional or peritoneal disease. We initiated a protocol in which patients with suspicion of macroscopic serosal, lymphatic or peritoneal invasion, treated with R0 resection, underwent adjuvant HIPEC. METHODS Between June 1998 and January 2003, 16 patients with locally advanced adenocarcinoma of the stomach were included in the study. Surgery consisted of a total gastrectomy with a D2 lymphadenectomy. Splenectomy (n = 1), splenopancreatectomy (n = 4), transverse colectomy (n = 3), left hepatectomy (n = 1), localized peritonectomy (n = 3) were associated to obtain a R0 resection. HIPEC protocol consisted of heated (42.5 degrees C) intraperitoneal mitomycin C (15 mg/m2) for a planned duration of 90 minutes. RESULTS HIPEC median duration was limited to 73(20-90) min because of central hyperthermia recognition in half of the cases. One patient died in the postoperative period of sepsis secondary to a duodenal fistula. Postoperative morbidity included pancreatic fistula (n = 2), pulmonary oedema (n = 1), pulmonary embolus (n = 1) and transient renal failure (n = 1). UICC staging was IB (n = 2), II (n = 2), IIIA (n = 5), IIIB (n = 1), IV (n = 6). Nine of the 16 patients are alive without recurrence with a median follow-up of 52 months. Four patients developed a recurrence, intraperitoneal (n = 2), systemic (n = 1), or combined (n = 1). Two patients were lost to follow-up. CONCLUSIONS Aggressive surgical therapy and HIPEC might represent the standard of care in a selected population with locoregional disease and for whom a R0 resection can be achieved. This protocol was associated in this study with a 75% 5-year survival with a low peritoneal recurrence rate and an acceptable morbidity.
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Affiliation(s)
- A De Roover
- Department of Abdominal Surgery, Centre Hospitalier Universitaire de Liège, Domaine du Sart Tilman, 4000 Liège, Belgium
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Rouers A, Laurent S, Detroz B, Meurisse M. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis: higher complication rate for oxaliplatin compared to Mitomycin C. Acta Chir Belg 2006; 106:302-6. [PMID: 16910003 DOI: 10.1080/00015458.2006.11679897] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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
BACKGROUND Peritoneal carcinomatosis (PC) from colo-rectal cancer carries a very poor prognosis with a mean and median overall survival times of 6.9 and 5.2 months. It has been proved that a locoregional therapeutic approach of this disease with cytoreduction followed by hyperthermic intraperitoneal chemotherapy (HIPEC) improved survival of these patients. However, this combined treatment presents a high complication rate. METHODS 21 patients with PC of colorectal origin underwent complete cytoreduction followed by HIPEC using Mitomycin-C (13 patients) or oxaliplatin (8 patients) and the open coliseum technique. For each case the medical datas were retrospectively analysed to determine feasibility, morbidity, mortality, survival time and prognostic factors. RESULTS All patients presented a Sugarbaker's Peritoneal Cancer index inferior to 15. The mean operating time was 453 minutes. After a median follow-up of 24.9 months, actuarial disease-free survival was 36.6% at 5 years. The median survival time was 34 months. The morbidity rate was 33.3% with a significant higher complication rate in the oxaliplatin group (5/8) than in the Mytomycin-C (MMC) group (2/13). One patient (4.7%) died two months after treatment with MMC (endocarditis). CONCLUSIONS This series confirm positive impact of cytoreduction and HIPEC on PC. We obtained a moderated complications rate thanks to a high degree of selection of the patient. Oxaliplatin scheme is responsible of a higher morbidity than in MMC group. Phase III trial comparing these two drugs is needed.
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Affiliation(s)
- A Rouers
- Dpt of Abdominal Surgery, CHU Sart Tilman B35, B4000 Liège, Belgium.
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Laurent S, Reenaers C, Detroz B, Detry O, Delvenne P, Belaiche J, Meurisse M. A patient who survived total colonic ulcerative colitis surinfected by cytomegalovirus complicated by toxic megacolon and disseminated intravascular coagulation. Acta Gastroenterol Belg 2005; 68:276-9. [PMID: 16013652] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The authors report the case of a patient aged 60-year-old who survived ulcerative colitis complicated by toxic megacolon and disseminated intravascular coagulation. This patient was not known for this ulcerative colitis and was first hospitalised for a suspicion of diverticulitis. The admission symptoms were fever, abdominal pain and bloody diarrhoea. The evolution was defavorable under antibiotics and sulfasalazine. The patient was readmitted 5 days after he left hospital, and the diagnosis of UC was based on colon biopsy made during the first hospitalisation. A treatment with methylprednisolone was started and the patient worsened day by day with apparition of toxic megacolon and disseminated intravascular coagulation. Subtotal colectomy was performed for degradation of general status and coagulation factors. Pathological findings confirmed ulcerative colitis with toxic megacolon. Cytomegalovirus inclusions were demonstrated on the colonic specimen and confirmed by PCR. In this report the authors discuss the etiology of toxic megacolon and disseminated intravascular coagulation in ulcerative colitis surinfected by cytomegalovirus. Mortality of these pathologies is high necessitating rapid diagnosis of cytomegalovirus infection by sigmoid biopsy. Management requires immunosupression interruption and ganciclovir therapy, or surgery in unsuccessful medical treatment.
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Affiliation(s)
- S Laurent
- Dept of Abdominal Surgery, CHU Sart Tilman B35, B-4000 Liège, Belgium.
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6
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Abstract
PURPOSE Nowadays laparoscopic colorectal surgery has demonstrated its advantages, including reduced postoperative pain, decreased duration of ileus, and shorter hospital stay. Few studies report results of laparoscopic surgery in complicated diverticulitis. This study was designed to analyze the results of laparoscopic sigmoidectomy in patients with fistulized sigmoiditis. METHODS The authors retrospectively reviewed 16 patients who had laparoscopic sigmoidectomy for fistulized diverticulitis between 1992 and 2003 in a series of 247 laparoscopic colectomies. Eleven patients presented with colovesical, four with colovaginal, and one with colocutaneous fistulas; all were caused by sigmoiditis. The procedure always consisted of celioscopic sigmoidectomy with stapled transanal suture and, when indicated, closure of the cystic or vaginal fistula orifice. RESULTS Mean age was 60 (range, 39-78) years. Mean number of episodes of diverticulitis before operation was three (range, 1-5). Mean time between the last episode and operation was 46 (range, 2-250) weeks. In our first three years of experience, three cases (18.7 percent) were converted to laparotomy. Reasons for conversion were the necessity for intestinal resection, splenectomy, and a wound of the anterior rectum. The mean operative time was 172 (range, 100-280) minutes. Mean hospital stay was 5.7 (range, 3-12) days. There was no mortality. Postoperative morbidity (2 patients, 12.5 percent) consisted of one pulmonary infection and one splenectomy. Long-term follow-up revealed no recurrence of diverticulitis and one incisional hernia. CONCLUSIONS In experienced hands, laparoscopic sigmoidectomy may be a safe and effective procedure for fistulized sigmoiditis.
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Affiliation(s)
- S R Laurent
- Department of Abdominal Surgery, CHU Sart Tilman B35, Liège, Belgium
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Laurent S, Barbeaux A, Detroz B, Detry O, Louis E, Belaiche J, Meurisse M. Development of adenocarcinoma in chronic fistula in Crohn's disease. Acta Gastroenterol Belg 2005; 68:98-100. [PMID: 15832595] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The authors report the case of a 55 yr-old woman suffering from Crohn's disease since 31 years with stricture and fistulas developed in the ileocolic junction and anorectal portion. Long-standing anorectal fistulas and stricture led to adenocarcinoma and finally fistulisation in the vagina. Diagnosis was made by perineal examination with biopsies under general anaesthesia. Treatment was first posterior pelvectomy with resection of the anterior wall of vagina. Secondarily, radiochemotherapy was administrated. The authors discuss the incidence and risk factors of carcinoma in Crohn's disease with chronic fistulas.
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Affiliation(s)
- S Laurent
- Dpt of Abdominal Surgery, CHU Sart Tilman B35, B-4000 Liège, Belgium.
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8
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Detroz B, Laurent S, Honoré P, Blaffart F, Limet R, Meurisse M. Rationale for hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment or prevention of peritoneal carcinomatosis. Acta Chir Belg 2004; 104:377-83. [PMID: 15469146] [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: 04/30/2023]
Abstract
Up to now, the prognosis of peritoneal carcinomatosis from GI tract cancers remains very poor. Intraperitoneal hyperthermic chemotherapy has been proposed in the prevention or treatment of peritoneal carcinomatosis. The rationale for this locoregional approach comes from a better knowledge of the physiopathology of the disease. Intraperitoneal chemotherapy achieves high local drug concentration with limited systemic toxicity. It should be performed during or immediately after surgery to be effective towards microscopic residual tumor cells. A synergistic cytotoxic effect has been demonstrated when heat is combined with antineoplastic drugs. Intraperitoneal hyperthermic chemotherapy might not be regarded as the panacée but as a promising step in the management of peritoneal carcinomatosis. Some randomized studies of gastric cancer with macroscopic serosal invasion have suggested the efficacy of hyperthermic intraperitoneal chemotherapy for the prevention of peritoneal carcinomatosis. In patients with peritoneal carcinomatosis, some studies suggest, in selected cases, the positive effect of hyperthermic intraperitoneal chemotherapy on survival, when combined with cytoreductive surgery.
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Affiliation(s)
- B Detroz
- Department of Abdominal Surgery, CHU of Liège, Belgium.
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Honoré P, De Roover A, Detry O, Detroz B, Meurisse M. [Boerhaave's syndrome]. Rev Med Liege 2004; 59:203-4. [PMID: 15182029] [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: 04/29/2023]
Abstract
Spontaneous rupture of the oesophagus, so called Boerhaave's syndrome, still remains a surgical emergency. Early diagnosis governs the appropriate repair and the vial prognosis.
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Affiliation(s)
- P Honoré
- Service de Chirurgie abdominale, Sénologique, Endocrine et de Transplantation, CHU Liège
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Polus M, Piront P, Jerusalem G, Sautois B, Louis E, Detroz B, Laurent S, Belaiche J, Fillet G. [Primary and secondary prevention of colorectal cancer]. Rev Med Liege 2003; 58:247-53. [PMID: 12868329] [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: 03/03/2023]
Abstract
Colorectal cancer is really a public health problem. The authors review the literature about the environmental factors leading to colorectal cancer. Chemoprevention of colorectal cancer is also discussed, particularly by aspirin and non steroidal anti-inflammatory drugs. Development of specific cyclooxygenase-2 inhibitors constitutes a promising research's field. Secondary prevention by coloscopy and polypectomy must lead to a lower rate of colorectal cancer disease and improvement of mortality.
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Affiliation(s)
- M Polus
- Service d'Oncologie médicale, CHU Liège.
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Detry O, De Roover A, Detroz B, Honoré P. The role of intraoperative cholangiography in detecting and preventing bile duct injury during laparoscopic cholecystectomy. Acta Chir Belg 2003; 103:161-2. [PMID: 12768858 DOI: 10.1080/00015458.2003.11679401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- O Detry
- Dpt of Abdominal Surgery, CHU Sart Tilman B35, B-4000 Liège, Belgium.
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12
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Polus M, Honoré P, De Roover A, Detry O, Detroz B, Jérusalem G, Sautois B, Fillet G. [Hepatic metastases of colorectal cancer: current therapies]. Rev Med Liege 2002; 57:771-8. [PMID: 12632834] [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: 03/01/2023]
Abstract
Important progress has been made in the treatment of liver metastases of advanced colorectal cancer. Surgery with curative intent, when possible, shows evidence of prolonged survival. Response rate and overall survival can be improved with modern polychemotherapy. Cytotoxic drug combinations and sequential treatments sometimes make surgery possible for initially non resectable lesions. Impact of loco-regional treatment such as hepatic arterial infusion chemotherapy must be defined in randomised trials. Radiofrequency ablation is also currently evaluated in clinical trials. In this review the benefit of each treatment is discussed.
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Affiliation(s)
- M Polus
- Service d'Oncologie médicale, CHU, Sart Tilman
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13
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Laurent S, Detry O, Detroz B, DeRoover A, Joris J, Honoré P, Louis E, Belaïche J, Jacquet N. Strictureplasty in Crohn's disease: short- and long-term follow-up. Acta Chir Belg 2002; 102:253-5. [PMID: 12244904 DOI: 10.1080/00015458.2002.11679307] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Strictureplasty for obstructive Crohn's disease is still controversial because lesions are left in place and the suture is performed on a diseased bowel. Many surgeons prefer to perform bowel resection, hoping for fewer complications and a lower recurrence rate. In this paper, the authors reports their strictureplasty experience. They performed a systematic retrospective review of the patients suffering from Crohn's disease who underwent strictureplasties during a 10-year period in the abdominal surgery department of the University Hospital of Liège Sart Tilman, and studied the short- and long-term clinical results of 68 strictureplasties performed in 18 patients. Median follow-up was 63 months (range 12 to 144). Mortality was 0% and septic morbidity was 11% (one wound abscess and one leakage). Among the 16 patients available for the latest follow-up, symptomatic stenotic recurrence had to be medically treated in hospital for 4 patients (25%) with a recurrence delay range of 19 to 49 months. Stenosis recurrence needed re-intervention in one patient 48 months after surgery: stenosis occurred at a distance from the corrected site. These results confirmed that strictureplasty is a safe and efficient procedure in selected patients undergoing surgery for obstructive Crohn's disease.
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Affiliation(s)
- S Laurent
- Dpt of Abdominal Surgery, CHU Sart Tilman B-35, Liège, Belgium
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Andrianne R, Detroz B, Delbecque K, Leduc F, Szapiro D, Boniver J, de Leval L. [Anatomic-clinical confrontation. Large pelvic mass in a young man]. Rev Med Liege 2002; 57:148-54. [PMID: 12014262] [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: 02/25/2023]
Abstract
The authors report the case of a gastro-intestinal stromal tumor (GIST) with unusual clinico-pathological features, presenting as a large cystic rectal mass in a young man. The differential diagnosis of pelvic masses is discussed. In light of this case, the recent literature related to the pathogenesis, diagnosis and treatment of GIST is reviewed.
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Affiliation(s)
- R Andrianne
- Département d'Anatomie Pathologique, CHU Sart Tilman
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Abstract
Retransplantation is common after liver transplantation (LT). However, in the present era of organ shortages, every attempt to save the liver graft should be performed before considering retransplantation. We report our experience with right hepatic lobectomy (RHL) for liver graft salvage. In a retrospective series of 180 adult LTs, 4 patients underwent RHL (Couinaud's segments V, VI, VII, VIII) in the post-LT period. In all cases, the procedure was performed without Pringle's maneuver or mobilization of the left liver lobe to preserve its vascularization. Three liver graft recipients developed intrahepatic biliary strictures, mainly localized to the right lobe of the graft, and RHL was performed 14, 75, and 78 months after LT. These patients were alive at last follow-up without further episodes of cholangitis or retransplantation (mean follow-up, 38 months). The fourth patient developed early post-LT right liver necrosis with a functioning hepatic artery and underwent right lobectomy 48 hours after LT. He later developed cholangitis secondary to late hepatic artery thrombosis, requiring retransplantation after 18 months. We conclude that RHL can be considered a graft-saving option in selected liver transplant recipients with localized biliary strictures, with excellent patient and graft survival.
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Affiliation(s)
- P Honoré
- Department of Liver Surgery and Transplantation, University of Liège, University Hospital Sart Tilman, B-4000 Liège, Belgium
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Urbain D, Detroz B, Gelin M, Gigot JF, Gillard V, Moortele K, Van Hootegem P. Approach of suspected common bile duct stones--current recommendations from the Belgian Working Group. Acta Gastroenterol Belg 2000; 63:290. [PMID: 11189991] [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: 02/19/2023]
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Gast P, Bours V, Detroz B, Colette MY, Booz V. [Guidelines concerning the treatment of rectal cancer]. Rev Med Liege 2000; 55:350-5. [PMID: 10941296] [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: 02/17/2023]
Abstract
Curative resection of primary tumor and metastases is the only way to obtain a prolonged survival. Several additional treatments are under evaluation; some are already routinely proposed, in order to reduce the tumor size and to allow surgery, to reduce the recurrence rate, and to give a better survival in case of unresectable metastases. Even in case of unresectable metastases, resection of the primary tumor should be envisaged, as quality of life with an evolving rectal tumor is very poor.
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Affiliation(s)
- P Gast
- Service de Gastroentérologie, Université de Liège
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18
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Hustinx R, Paulus P, Daenen F, Detroz B, Honoré P, Jacquet N, Rigo P. [Role of positron emission tomography is the evaluation of digestive tract tumors]. Rev Med Liege 1999; 54:925-30. [PMID: 10686798] [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: 02/15/2023]
Abstract
Imaging and endoscopic techniques have taken an increasing part in the management of gastroenterological disorders. Among these techniques, FDG-PET imaging has emerged as a powerful tool in the management of several cancer diseases, including tumors of the digestive tract. In particular, the role of PET for diagnosing and staging recurrent colorectal cancers, and for differentiating mass forming pancreatitis from carcinoma is now well established. In this review, we will briefly discuss the place of PET imaging in the work-up of the tumors of the digestive tract.
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Affiliation(s)
- R Hustinx
- Service de Médecine nucléaire, Université de Liège
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19
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Hustinx R, Paulus P, Daenen F, Detroz B, Honoré P, Jacquet N, Rigo P. [Clinical value of positron emission tomography in the detection and staging of recurrent colorectal cancer]. Gastroenterol Clin Biol 1999; 23:323-9. [PMID: 10384334] [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: 02/13/2023]
Abstract
BACKGROUND Positron emission tomography (PET) has been shown useful for the staging of patients with various carcinomas. METHODS We have applied this technique to 54 cases of colorectal carcinoma and compared it to conventional imaging techniques. RESULTS PET had moderately higher sensitivity and specificity than conventional techniques to detect individual lesion sites (75% vs 70.8% and 63% vs 21% respectively). It detected the same number of patients with recurrences (35/39) but overestimated disease less frequently (5 cases vs 12). PET favorably influenced therapeutic management in 17 patients, indicating different or additional surgery in 9 while avoiding surgery with curative intent or unnecessary surgery in 8. In 5 cases, erroneous information provided by PET could be corrected by conventional imaging techniques. CONCLUSION We conclude that PET appears to provide complementary information useful for staging patients with colorectal carcinomas. It can significantly modify patients management. These data should be confirmed by a prospective study.
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Affiliation(s)
- R Hustinx
- Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Liège, Belgique
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Lechanteur C, Princen F, Lo Bue S, Detroz B, Fillet G, Gielen J, Bours V, Merville MP. HSV-1 thymidine kinase gene therapy for peritoneal carcinomatosis. Adv Exp Med Biol 1999; 451:115-9. [PMID: 10026859 DOI: 10.1007/978-1-4615-5357-1_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- C Lechanteur
- Laboratory of Medical Oncology and Medical Chemistry, University of Liège, Belgium
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Princen F, Lechanteur C, Lopez M, Rocoux G, Detroz B, Gielen J, Fillet G, Merville MP, Bours V. Repeated cycles of retrovirus-mediated HSVtk gene transfer plus ganciclovir increase survival of rats with peritoneal carcinomatosis. Gene Ther 1998; 5:1054-60. [PMID: 10326028 DOI: 10.1038/sj.gt.3300710] [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: 11/08/2022]
Abstract
Peritoneal carcinomatosis is a common clinical situation that requires novel therapeutic approaches. We investigated the efficiency of an HSVtk gene therapy for the treatment of peritoneal carcinomatosis induced in syngeneic rats by DHD/K12 colon carcinoma cells. In this setting, the efficiency of two different retrovirus producing cell lines (GP+AmEnv12 and FLYA13) was compared. Rats treated with a single injection of retrovirus producing cells followed by a 5-day course of ganciclovir treatment showed an increased survival as compared with control animals. Animals treated with three injections of producing cells, each followed by a 4-5-day course of ganciclovir treatment, showed an increased survival as compared with control rats and with those treated with a single cycle of retrovirus producing cells plus ganciclovir. However, only a few animals remained tumor-free after day 180. There was no difference between the two producing cell lines in any of the experiments. RT-PCR demonstrated a faint expression of the tk transgene in the liver, spleen, epiploon, bowels and the lung of the animals injected with the HSVtk producing cells, reflecting most likely the transduction of only a limited number of cells.
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Affiliation(s)
- F Princen
- Laboratory of Medical Chemistry and Medical Oncology, University of Liège, Belgium
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Detroz B, Honoré P, Denoiseux C, Jacquet N. Biology, physiology and physiopathology of clamping during liver surgery. Hepatogastroenterology 1998; 45:357-63. [PMID: 9638406] [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: 02/07/2023]
Abstract
Liver surgery is currently performed with minimal morbidity and mortality, mostly thanks to reduced intraoperative blood loss, achievable by various types of liver clamping. A better knowledge of the physiological and physiopathological changes caused by liver clamping is however still necessary. The "natural" evolution of biochemical and liver function tests after liver surgery have been described. This paper describes the hemodynamic changes observed with different types of clamping and discusses several ways in which liver clamping techniques might be improved.
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Affiliation(s)
- B Detroz
- Department of Abdominal Surgery, CHU Sart-Tilman B35, Liège, Belgium.
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23
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Detroz B, Jacquet N. [Intraperitoneal chemotherapy in colorectal cancer: from the laboratory to the clinic]. Rev Med Liege 1998; 53:85-7. [PMID: 9564226] [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: 02/07/2023]
Abstract
Some patients operated of a colo-rectal cancer can be selected to receive a post-operative adjuvant chemotherapy to decrease the risk of recurrence. The authors report the results of experimental works on intraperitoneal chemotherapy (IPC). At the laboratory, they showed that this option significantly reduced the risk of recurrences in the most frequent sites of colo-rectal cancer recurrences: liver, lymph nodes, peritoneum and the surgical site. Moreover, the survival of the treated animals was significantly prolonged compared to the controls. In human, they proved the feasibility of a intraperitoneal chemotherapy managed into the immediate post-operative period. Low morbidity, null mortality and the interesting preliminary carcinological results suggest the interest of such an option which could be confirmed by a randomized multi-centric study currently in preparation.
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Affiliation(s)
- B Detroz
- Université de Liége, Service de Chirurgie abdominale
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24
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Lechanteur C, Princen F, Lo Bue S, Detroz B, Fillet G, Gielen J, Bours V, Merville MP. HSV-1 thymidine kinase gene therapy for colorectal adenocarcinoma-derived peritoneal carcinomatosis. Gene Ther 1997; 4:1189-94. [PMID: 9425442 DOI: 10.1038/sj.gt.3300520] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 02/05/2023]
Abstract
Peritoneal carcinomatosis is a common clinical situation which, in most cases, cannot be eradicated by surgery or chemotherapy. The feasibility of an HSV-TK-based suicide gene therapy for peritoneal carcinomatosis induced by DHD/K12 colon carcinoma cells was investigated. DHD/K12 cells stably expressing the tk gene were killed in vitro in the presence of low concentrations of ganciclovir, they exhibited a 'bystander effect' when mixed with TK-negative cells. BD-IX rats injected intraperitoneally, either directly or after surgical peritoneal irritations, with DHD/K12 cells developed peritoneal carcinomatosis within 2 weeks. Ganciclovir treatment of animals injected with DHD/K12-TK cells allowed a significant reduction of the tumor volume as well as a prolonged survival. Of these animals 35-40% showed a long-term disease-free survival after ganciclovir therapy. Residual or relapsing tumors could be explained by a low expression of the transgene as demonstrated by RT-PCR.
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Affiliation(s)
- C Lechanteur
- Laboratory of Medical Oncology and Medical Chemistry, University of Liège, Belgium
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25
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Jerusalem G, Detroz B, Herman P. [Therapeutic approach to epithelial cancer of the ovary at CHU Sart Tilman. Conclusions of the interdisciplinary meeting of 22 March 1995. Consensus Group]. Rev Med Liege 1995; 50:469-71. [PMID: 8532992] [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)
- G Jerusalem
- Service d'Oncologie médicale, Université de Liège
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26
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Abstract
BACKGROUND To assess the safety of simultaneous, "one-stage," hepatectomy and intestinal anastomosis, we retrospectively studied 53 patients who underwent such a procedure, with 76 digestive tract sutures. They represented 80% of all the cases eligible for one-stage procedures among 332 liver resections for malignant tumors. METHODS The medical records of the patients were retrospectively analyzed to assess details of the surgical procedures, postoperative mortality and morbidity, and postoperative liver function, with special attention being paid to the prothrombin time and the bilirubin value on days 1, 2, 3, and 7. RESULTS No postoperative mortality occurred and the postoperative morbidity rate was 19%. Only 2 cases of digestive tract anastomotic leakage occurred, which led to reoperation. Hepatectomy-related complications were noted in 5 patients (3 biliary fistulas, 1 hemorrhage and 1 transient liver failure), and pulmonary infections occurred 3 times. The technical difficulties of the one-stage procedure are discussed, focusing on the choice of the incision, the risk of sepsis for the liver if there is an intestinal aperture, possible repercussions of liver impairment and hepatic pedicle clamping on bowel suture healing, and the risk of digestive fistula according to the location of the bowel suture. CONCLUSION It appears that this one-stage procedure is safe if the bowel is systematically cleaned before the operation, if an appropriate Rio-Branco incision is used, and if the risk of postoperative liver failure is low. It seems preferable to use intermittent hepatic pedicle clamping rather than continuous clamping (when feasible), and to temporarily protect a low rectal anastomosis with a colostomy.
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Affiliation(s)
- D Elias
- Department of Digestive and Hepatobiliary Oncologic Surgery, Institut Gustave Roussy, Villejuif, France
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27
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Elias D, Detroz B, Debaene B, Damia E, Leclercq B, Rougier P, Lasser P. Treatment of peritoneal carcinomatosis by intraperitoneal chemo-hyperthermia: reliable and unreliable concepts. Hepatogastroenterology 1994; 41:207-13. [PMID: 7959539] [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: 01/28/2023]
Abstract
Intraoperative peritoneal chemo-hyperthermia (IPCH) is a promising treatment of peritoneal carcinomatosis arising from digestive tumors. After presenting the rationale for the use of IPCH, this review reports the results published to date by different groups. Unfortunately, data with respect to technical aspects, indications and results are unclear, inhomogeneous and questionable. The discussion presents reliable and unreliable points, mainly concerning the technical aspects of IPCH: what is the maximal desirable tumor thickness before initiating treatment? What is the ideal temperature? Is central hyperthermia beneficial? What is the ideal duration? What is the most effective antimitotic drug? A new classification of peritoneal seeding before cytoreductive surgery and before the initiation of IPCH, is proposed, and a suggestion concerning the reporting of drug concentrations made. Numerous prospective studies need to be conducted to test different technical modalities and to evaluate the results of IPCH.
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Affiliation(s)
- D Elias
- Department of Oncologic Digestive Surgery, Institute Gustave Roussy, Cancer Center Hospital, Villejuif, France
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28
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Detroz B, Elias D, Damia E, Debaene B, Rougier P, Lasser P. [Intraperitoneal hyperthermic chemotherapy (IPHC), a promising treatment of peritoneal carcinomatosis]. Bull Cancer 1994; 81:182-93. [PMID: 7894126] [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]
Abstract
Intraperitoneal hyperthermic chemotherapy (IPHC) appears to be a promising treatment of peritoneal carcinomatosis. This paper reports the physio-pathological background of IPHC and the various studies which have been published in the literature. It points out the heterogeneity of these series and discuss the most critical points as surgical indications, choice of the antineoplastic drugs, their doses, temperatures of the IPHC, extend of the cytoreductive surgery, morbidity and mortality. Finally, several options are proposed for those points which are not yet standardized.
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Affiliation(s)
- B Detroz
- Service de chirurgie digestive carcinologique, institut Gustave-Roussy, Villejuif, France
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29
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Meurisse M, Detroz B, Hamoir E, Parizel P. Prediction of malignancy in solitary thyroid nodules: value of preoperative explorations. Acta Chir Belg 1994; 94:25-9. [PMID: 8184647] [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]
Abstract
The thyroid nodule is a topic in clinical medicine which remains controversial because any thyroid disease can virtually turn up a thyroid nodule. The reliability of the diagnostic techniques for making the distinction between a benign and a malignant lesion varies. The various techniques for the assessment of a solitary nonfunctional thyroid nodule are described and their comparative values in establishing the nature of the nodule, identifying patients with low likelihood of malignancy--making it possible to defer surgery or to avoid it altogether--are analyzed. According to the results and for several reasons, controversy over the best approach of solitary cold nodule management can remain. We propose an alternative approach and provide a personal guideline for the use of these tests.
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Affiliation(s)
- M Meurisse
- Centre Hospitalier Universitaire de Liège, Belgium
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30
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Affiliation(s)
- B Detroz
- Centre Hospitalier Universitaire de Liege, Service de Chirurgia Abdominale et Generale, Domaine Universitaire du Sart Tilman, Belgium
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31
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Detry O, Detroz B, D'Silva M, Pirenne J, Defraigne JO, Meurisse M, Honoré P, Boniver J, Limet R, Jacquet N. [Transplantation of unsuspected malignant tumors with organ transplants]. Rev Med Liege 1994; 49:23-31. [PMID: 8128119] [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: 01/28/2023]
Affiliation(s)
- O Detry
- Service de Chirurgie générale et digestive, Université de Liège
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32
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Meurisse M, Detroz B, Messens D, D'Silva M, Zakaria Z, Joris J, Mary-Rabine L, Hennen G. The treatment of amiodarone-induced hyperthyroidism. Is there a place for surgery? Acta Chir Belg 1994; 94:36-41. [PMID: 8184650] [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]
Abstract
In many instances amiodarone-induced hyperthyroidism has been reported as mild, thyroid functions returning to normal after discontinuation of the drug. Nevertheless, life-threatening amiodarone-induced thyrotoxicosis has also been described. Conventional treatments such as with antithyroid drugs (Thionamide) and corticosteroids are essentially ineffective or fail to stop the dramatic course of the thyroid crisis. This limited efficacy of medical therapy, particularly in patients with previously--neglected or unknown--thyroid disease, prompted us to intervene surgically. We report a series of six patients who underwent total or nearly total thyroidectomy as first line therapy for four of them. Surgery resulted in rapid resolution of thyrotoxicosis with an uneventful postoperative course. This approach has the advantage of immediate and safe efficacy, low risk of relapse and finally, appears to be the only antithyroid treatment that permits continued therapy with amiodarone.
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Affiliation(s)
- M Meurisse
- Laboratory of Endocrinology, Centre Hospitalier Universitaire de Liège, Belgium
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33
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34
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Elias D, Lasser PH, Desruennes E, Mankarios H, Detroz B. [Surgical approaches to segment I for malignant tumors (20 cases)]. J Chir (Paris) 1993; 130:335-342. [PMID: 8253880] [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
Seven complete and 13 partial resections of segment I (caudate lobe) were performed for malignant tumors. In all except one instance, removal of segment I was combined with other types of hepatic resection for technical or carcinologic reasons. Six were iterative hepatic resections for recurrent hepatic metastases. In two, the future remaining left lobe was hypertrophied by right portal venous embolization preoperatively. Hepatectomies were performed with intermittent portal triad clamping (mean total duration of 63 minutes, range of 20 to 120 minutes) and after preparation for total vascular exclusion. Associated partial resection of the inferior vena cava was necessary in three instances. Mean duration of operation was 285 minutes (range of 60 to 540 minutes) and mean blood loss was 1,749 milliliters (range of 200 to 5,200 milliliters). There was no postoperative mortality and the morbidity rate was low. Surprisingly, we discovered retrospectively that free margins were small (less than 5 millimeters) in 83 percent of the patients. Regardless of limited free margins and six iterative hepatectomies, eight patients were free of disease with a mean follow-up examination period of 19.2 months. Technical problems were different for each patient and a patient by patient adaptation was necessary. Left, right and central approaches were used accordingly. If resection of segment I associated with a right of left hepatectomy can currently considered as a standard hepatic resection, isolated complete resection of segment I remains a real technical challenge.
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Affiliation(s)
- D Elias
- Département de Chirurgie Digestive Carcinologique, Institut Gustave Roussy, Villejuif
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35
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Meurisse M, Detroz B, Hamoir E. [Surgical approach to multiple endocrine neoplasms]. Rev Med Liege 1993; 48:352-358. [PMID: 8102001] [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: 05/22/2023]
Affiliation(s)
- M Meurisse
- Service de Chirurgie abdominale, Université de Liège
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36
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Abstract
The case reports of three patients who received cancer-bearing organs at this institution are presented. A fourth recipient, who was to be transplanted with a cancerous kidney, was spared this disastrous complication. The relevant data regarding the donors is also alluded to, with special reference to the type and site of the primary malignancy. Following these case reports, the implications of these issues, their possible prevention, and further management are discussed.
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Affiliation(s)
- O Detry
- Department of Surgery, Centre Hôspitalier Universitaire, University of Liège, Belgium
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37
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Detry O, Detroz B, D'Silva M, Pirenne J, Defraigne JO, Meurisse M, Honoré P, Michel P, Boniver J, Limet R. Misdiagnosed malignancy in transplanted organs. Transpl Int 1993; 6:50-4. [PMID: 8452633 DOI: 10.1007/bf00336641] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 01/30/2023]
Abstract
The case reports of three patients who received cancer-bearing organs at this institution are presented. A fourth recipient, who was to be transplanted with a cancerous kidney, was spared this disastrous complication. The relevant data regarding the donors is also alluded to, with special reference to the type and site of the primary malignancy. Following these case reports, the implications of these issues, their possible prevention, and further management are discussed.
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Affiliation(s)
- O Detry
- Department of Surgery, Centre Hôspitalier Universitaire, University of Liège, Belgium
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38
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Detroz B, Honore P, Monami B, Meurisse M, Canivet JL, Legrand M, Damas P, Jacquet N. Combined treatment of liver failure and hepatorenal syndrome with orthotopic liver transplantation. Acta Gastroenterol Belg 1992; 55:350-7. [PMID: 1462747] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hepatorenal syndrome (HRS) is a severe complication of liver failure with high mortality. The pathogenesis of this reversible functional renal failure is not yet clearly understood. Diagnosis is based upon the association of clinical and biological criteria. A patient was admitted to our institution for severe liver failure secondary to an exacerbation of cirrhosis, where he developed a fulminant hepatorenal syndrome. Both, the renal and hepatic failure were successfully treated by orthotopic liver transplantation. Special attention was paid to the immunosuppressive treatment with Cyclosporine whose use, we believe, should be delayed until function has partially recovered.
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Affiliation(s)
- B Detroz
- Department of Abdominal Surgery, Transplantation and Anaesthesiology, CHU-Liège, Belgium
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39
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D'Silva M, Pirenne J, Bonnet P, Detroz B, Honoré P, Meurisse M, Jacquet N. "Arterialization", "revascularization", "rearterialization"--what's in a name? Transpl Int 1992; 5:121-2. [PMID: 1627240] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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40
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Honoré P, D'Silva M, Meurisse M, Pirenne J, Bonnet P, Detroz B, Jacquet N. [Ex-situ hepatic resection]. Rev Med Liege 1991; 46:602-6. [PMID: 1754779] [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: 12/28/2022]
Affiliation(s)
- P Honoré
- CHU, Service de Chirurgie, abdominale et générale, Université de Liège
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41
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D'Silva M, Pirenne J, Bonnet P, Detroz B, Meurisse M, Honoré P, Lee S, Jacquet N. A technique for multiorgan harvesting in rats--an educational tool in transplantation. Transplant Proc 1991; 23:2692. [PMID: 1926540] [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: 12/29/2022]
Affiliation(s)
- M D'Silva
- Department of Abdominal and Transplantation Surgery, University of Liege, Belgium
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42
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Detroz B, Detry O, D'Silva M, Pirenne J, Defraigne JO, Meurisse M, Honore P, Jacquet N. Organ transplantation with undetected donor neoplasm. Transplant Proc 1991; 23:2657. [PMID: 1926521] [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: 12/29/2022]
Affiliation(s)
- B Detroz
- Department of Abdominal Surgery and Transplantation, Liege, Belgium
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43
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Detroz B, Honoré P, Monami B, Dewandre JM, Defraigne JO, Pirotte J, Beaujean MA, Meurisse M, Jacquet N. [Hepatorenal syndrome]. Rev Med Liege 1991; 46:188-95. [PMID: 2052812] [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: 12/30/2022]
Affiliation(s)
- B Detroz
- Service de Chirurgie digestive et Transplantation, Université de Liège
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44
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Meurisse M, Dewandre JM, Pirenne J, D'Silva M, Detroz B, Joris J, Honore P, Jacquet N. [Surgical aspects of the treatment of adrenal gland diseases]. Acta Chir Belg 1991; 91:107-11. [PMID: 2068884] [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: 12/30/2022]
Abstract
With the greatly enhanced accuracy of current endocrinologic diagnosis assisted by precise diagnostic imaging, together with greatly enhanced preparation of patients with endocrinopathy for safer anesthetic and surgical procedure (e.g. adrenal cortical cancers, cortisol and aldosterone producing adenomas and pheochromocytomas), operative procedures can be planned and conducted more precisely. For the surgeon, the strategy for treatment of functional and neoplastic disorders of the adrenal glands has essentially to consider the anatomy of the suprarenal glands, the deleterious effects of hormone excess before and during operation, the presumed nature of incidentally discovered adrenal mass and the size of the tumor.
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Affiliation(s)
- M Meurisse
- Service de Chirurgie abdominale, générale Centre Hospitalier, Universitaire du Sart-Tilman, Liège
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45
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Meurisse M, Dewandre JM, Detroz B, Duverger A, Defêchereux T, Dallemagne B, Weerts J, Legrand M, Joris J, Honoré P. [Surgery of the endocrine glands: myth or reality? Status of 2 years of activity]. Rev Med Liege 1990; 45:286-95. [PMID: 2195617] [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: 12/30/2022]
Affiliation(s)
- M Meurisse
- Université de Liège, CHU, Service de Chirurgie abdominale, générale et endocrinienne
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46
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Defraigne JO, Canivet JL, Bonnet P, Pirenne J, Detroz B, Delbouille MH, Larbuisson R, Honoré P, Meurisse M. [Multi-organ procurement: an essential link in the chain of interdependence]. Rev Med Liege 1989; 44:138-48. [PMID: 2704904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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47
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Defraigne JO, Detroz B, Dubois J. [Lymphangiosarcoma following mastectomy: review of the literature apropos of 2 recent cases of Stewart-Treves syndrome]. Acta Chir Belg 1989; 89:29-33. [PMID: 2655358] [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: 01/02/2023]
Abstract
Two cases of lymphangiosarcomas which arose 4 and 14 years after a mastectomy are reported (Stewart-Treves syndrome). One of the patients was treated by shoulder disarticulation and the other by chemotherapy (using Melphalan, Cyclophosphamide and 5-fluorouracil). Disseminated metastases and deaths occurred 6 and 18 months after the onset of the lesion. Stewart-Treves syndrome occurs in approximately 0.07 to 0.45% of mastectomy. Prognosis is worse: survival at five year is fewer than 10%. Early diagnosis is mandatory. Surgical resection of the lesions and adjunctive chemotherapy seem the best treatment.
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Affiliation(s)
- J O Defraigne
- Service de chirurgie cardio-vasculaire et digestive, Centre Hospitalier Universitaire de Liège, Sart-Tilman
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48
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Beguin Y, Boniver J, Bury J, Defraigne JO, Detroz B, Fillet G, Lejeune G. Plasmacytoma of the thyroid: a case report, a study with use of the immunoperoxidase technique, and a review of the literature. Surgery 1987; 101:496-500. [PMID: 3551167] [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]
Abstract
A case of solitary plasmacytoma of the thyroid is reported. A monoclonal component (IgG lambda) was identified in the serum of the patient and disappeared after total thyroidectomy and radiotherapy. The use of the immunoperoxidase technique on thyroid, bone marrow, and lymph node specimens allowed us to demonstrate the production of IgG lambda by the tumor, and to rule out the possibility of multiple myeloma. Previously reported cases are reviewed (15 cases). The diagnostic criteria, the association with thyroiditis, and the treatment of this rare disorder are discussed.
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