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Cordier Q, Le Thien MA, Polazzi S, Chollet F, Carty MJ, Lifante JC, Duclos A. A time-adjusted control chart for monitoring surgical outcome variations. PLoS One 2024; 19:e0303543. [PMID: 38748637 PMCID: PMC11095702 DOI: 10.1371/journal.pone.0303543] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Statistical Process Control (SPC) tools providing feedback to surgical teams can improve patient outcomes over time. However, the quality of routinely available hospital data used to build these tools does not permit full capture of the influence of patient case-mix. We aimed to demonstrate the value of considering time-related variables in addition to patient case-mix for detection of special cause variations when monitoring surgical outcomes with control charts. METHODS A retrospective analysis from the French nationwide hospital database of 151,588 patients aged 18 and older admitted for colorectal surgery between January 1st, 2014, and December 31st, 2018. GEE multilevel logistic regression models were fitted from the training dataset to predict surgical outcomes (in-patient mortality, intensive care stay and reoperation within 30-day of procedure) and applied on the testing dataset to build control charts. Surgical outcomes were adjusted on patient case-mix only for the classical chart, and additionally on secular (yearly) and seasonal (quarterly) trends for the enhanced control chart. The detection of special cause variations was compared between those charts using the Cohen's Kappa agreement statistic, as well as sensitivity and positive predictive value with the enhanced chart as the reference. RESULTS Within the 5-years monitoring period, 18.9% (28/148) of hospitals detected at least one special cause variation using the classical chart and 19.6% (29/148) using the enhanced chart. 59 special cause variations were detected overall, among which 19 (32.2%) discordances were observed between classical and enhanced charts. The observed Kappa agreement between those charts was 0.89 (95% Confidence Interval [95% CI], 0.78 to 1.00) for detecting mortality variations, 0.83 (95% CI, 0.70 to 0.96) for intensive care stay and 0.67 (95% CI, 0.46 to 0.87) for reoperation. Depending on surgical outcomes, the sensitivity of classical versus enhanced charts in detecting special causes variations ranged from 0.75 to 0.89 and the positive predictive value from 0.60 to 0.89. CONCLUSION Seasonal and secular trends can be controlled as potential confounders to improve signal detection in surgical outcomes monitoring over time.
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Affiliation(s)
- Quentin Cordier
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - My-Anh Le Thien
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Stéphanie Polazzi
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | | | - Matthew J. Carty
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jean-Christophe Lifante
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - Antoine Duclos
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Skinner S, Pascal L, Polazzi S, Chollet F, Lifante JC, Duclos A. Economic analysis of surgical outcome monitoring using control charts: the SHEWHART cluster randomised trial. BMJ Qual Saf 2024; 33:284-292. [PMID: 37553238 DOI: 10.1136/bmjqs-2022-015390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/27/2023] [Indexed: 08/10/2023]
Abstract
IMPORTANCE Surgical complications represent a considerable proportion of hospital expenses. Therefore, interventions that improve surgical outcomes could reduce healthcare costs. OBJECTIVE Evaluate the effects of implementing surgical outcome monitoring using control charts to reduce hospital bed-days within 30 days following surgery, and hospital costs reimbursed for this care by the insurer. DESIGN National, parallel, cluster-randomised SHEWHART trial using a difference-in-difference approach. SETTING 40 surgical departments from distinct hospitals across France. PARTICIPANTS 155 362 patients over the age of 18 years, who underwent hernia repair, cholecystectomy, appendectomy, bariatric, colorectal, hepatopancreatic or oesophageal and gastric surgery were included in analyses. INTERVENTION After the baseline assessment period (2014-2015), hospitals were randomly allocated to the intervention or control groups. In 2017-2018, the 20 hospitals assigned to the intervention were provided quarterly with control charts for monitoring their surgical outcomes (inpatient death, intensive care stay, reoperation and severe complications). At each site, pairs, consisting of one surgeon and a collaborator (surgeon, anaesthesiologist or nurse), were trained to conduct control chart team meetings, display posters in operating rooms, maintain logbooks and design improvement plans. MAIN OUTCOMES Number of hospital bed-days per patient within 30 days following surgery, including the index stay and any acute care readmissions related to the occurrence of major adverse events, and hospital costs reimbursed for this care per patient by the insurer. RESULTS Postintervention, hospital bed-days per patient within 30 days following surgery decreased at an adjusted ratio of rate ratio (RRR) of 0.97 (95% CI 0.95 to 0.98; p<0.001), corresponding to a 3.3% reduction (95% CI 2.1% to 4.6%) for intervention hospitals versus control hospitals. Hospital costs reimbursed for this care per patient by the insurer significantly decreased at an adjusted ratio of cost ratio (RCR) of 0.99 (95% CI 0.98 to 1.00; p=0.01), corresponding to a 1.3% decrease (95% CI 0.0% to 2.6%). The consumption of a total of 8910 hospital bed-days (95% CI 5611 to 12 634 bed-days) and €2 615 524 (95% CI €32 366 to €5 405 528) was avoided in the intervention hospitals postintervention. CONCLUSIONS Using control charts paired with indicator feedback to surgical teams was associated with significant reductions in hospital bed-days within 30 days following surgery, and hospital costs reimbursed for this care by the insurer. TRIAL REGISTRATION NUMBER NCT02569450.
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Affiliation(s)
- Sarah Skinner
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Léa Pascal
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Stéphanie Polazzi
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
| | | | - Jean-Christophe Lifante
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Department of Endocrine Surgery, Hospices Civils de Lyon, Lyon, France
| | - Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School, Boston, MA, USA
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Santucci N, Ksiazek E, Pattou F, Baud G, Mirallié E, Frey S, Trésallet C, Sébag F, Guérin C, Mathonnet M, Christou N, Donatini G, Brunaud L, Gaujoux S, Ménégaux F, Najah H, Binquet C, Goudet P, Lifante JC. Recurrence After Surgery for Primary Hyperparathyroidism in 517 Patients With Multiple Endocrine Neoplasia Type 1: An Association Francophone de Chirurgie Endocrinienne and Groupe d'étude des Tumeurs Endocrines study. Ann Surg 2024; 279:340-345. [PMID: 37389888 DOI: 10.1097/sla.0000000000005980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To assess recurrence according to the type of surgery for primary hyperparathyroidism (pHPT) in multiple endocrine neoplasia type 1 ( MEN1 ) patients and to identify the risk factors for recurrence after the initial surgery. BACKGROUND In MEN1 patients, pHPT is multiglandular, and the optimal extent of initial parathyroid resection influences the risk of recurrence. METHODS MEN1 patients who underwent initial surgery for pHPT between 1990 and 2019 were included. Persistence and recurrence rates after less than subtotal parathyroidectomy (LTSP) and subtotal parathyroidectomy (STP) were analyzed. Patients with total parathyroidectomy with reimplantation were excluded. RESULTS Five hundred seventeen patients underwent their first surgery for pHPT: 178 had LTSP (34.4%) and 339 STP (65.6%). The recurrence rate was significantly higher after LTSP (68.5%) than STP (45%) ( P < 0.001). The median time to recurrence after pHPT surgery was significantly shorter after LTSP than after STP: 4.25 (1.2-7.1) versus 7.2 (3.9-10.1) years ( P < 0.001). A mutation in exon 10 was an independent risk factor of recurrence after STP (odds ratio = 2.19; 95% CI: 1.31; 3.69; P = 0.003). The 5 and 10-year recurrent pHPT probabilities were significantly higher in patients after LTSP with a mutation in exon 10 (37% and 79% vs 30% and 61%; P = 0.016). CONCLUSIONS Persistence, recurrence of pHPT, and reoperation rate are significantly lower after STP than LTSP in MEN1 patients. Genotype seems to be associated with the recurrence of pHPT. A mutation in exon 10 is an independent risk factor for recurrence after STP, and LTSP may not be recommended when exon 10 is mutated.
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Affiliation(s)
- Nicolas Santucci
- Department of Digestive and Endocrine Surgery, Dijon University Hospital
- INSERM, University de Bourgogne-Franche-Comté, UMR1231, EPICAD Team "Lipids, Nutrition, Cancer"
| | | | - François Pattou
- Department of General and Endocrine Surgery, University Hospital, Lille, INSERM U1190, Lille
| | - Gregory Baud
- Department of General and Endocrine Surgery, University Hospital, Lille, INSERM U1190, Lille
| | - Eric Mirallié
- Department of Oncological, Digestive and Endocrine Surgery (CCDE) Hôtel Dieu, CIC-IMAD, Nantes
| | - Samuel Frey
- Department of Oncological, Digestive and Endocrine Surgery (CCDE) Hôtel Dieu, CIC-IMAD, Nantes
| | - Christophe Trésallet
- Department of Digestive and Endocrine Surgery, Avicenne University Hospital, AP-HP Sorbonne Paris Nord University, Bobigny
| | - Frédéric Sébag
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, APHM, Aix Marseille University, Marseille
| | - Carole Guérin
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, APHM, Aix Marseille University, Marseille
| | - Muriel Mathonnet
- Department of Surgery, Dupuytren University Hospital of Limoges, Limoges
| | - Niki Christou
- Department of Surgery, Dupuytren University Hospital of Limoges, Limoges
| | - Gianluca Donatini
- Department of General and Endocrine Surgery, University Hospital of Poitiers, Poitiers
| | - Laurent Brunaud
- Department of Gastrointestinal, Metabolic, and Cancer Surgery (CVMC), University Hospital of Nancy (CHRU Nancy), INSERM NGERE U1256, University of Lorraine, Rue du Morvan
| | - Sébastien Gaujoux
- Department of Endocrine and Pancreatic Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris
| | - Fabrice Ménégaux
- Department of Endocrine and Pancreatic Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris
| | - Haythem Najah
- Department of Hepatobiliary Surgery, Bordeaux University Hospital, Bordeaux
| | - Christine Binquet
- INSERM, University de Bourgogne-Franche-Comté, UMR1231, EPICAD Team "Lipids, Nutrition, Cancer"
- INSERM, CIC1432, Clinical Epidemiology, Dijon
| | - Pierre Goudet
- Department of Digestive and Endocrine Surgery, Dijon University Hospital
| | - Jean-Christophe Lifante
- Department of Digestive and Endocrine Surgery, University Hospital of Lyon Sud and EA 7425 HESPER, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
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Goudet P, Cadiot G, Barlier A, Baudin E, Borson-Chazot F, Brunaud L, Caiazzo R, Cardot-Bauters C, Castinetti F, Chanson P, Cuny T, Dansin E, Gaujoux S, Giraud S, Groussin L, Le Bras M, Lifante JC, Mathonnet M, de Mestier L, Mirallié E, Pattou F, Romanet P, Sebag F, Tresallet C, Vezzosi D, Walter T, Tabarin A. French guidelines from the GTE, AFCE and ENDOCAN-RENATEN (Groupe d'étude des Tumeurs Endocrines/Association Francophone de Chirurgie Endocrinienne/Reseau national de prise en charge des tumeurs endocrines) for the screening, diagnosis and management of Multiple Endocrine Neoplasia Type 1. Ann Endocrinol (Paris) 2024; 85:2-19. [PMID: 37739121 DOI: 10.1016/j.ando.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Affiliation(s)
- Pierre Goudet
- Department of Digestive and Endocrine Surgery, Dijon University Hospital, Dijon, France; INSERM, U1231, EPICAD Team UMR "Lipids, Nutrition, Cancer", Dijon, France; INSERM, CIC1432, Clinical epidemiology Dijon, Dijon, France.
| | - Guillaume Cadiot
- Department of Hepato-Gastro-Enterology and Digestive Oncology, Robert Debré Hospital, Reims, France.
| | - Anne Barlier
- Aix Marseille Univ, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille, France.
| | - Eric Baudin
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Cancer Campus, Villejuif, France.
| | - Françoise Borson-Chazot
- Federation of Endocrinology, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon1 University and INSERM U1290, Lyon, France.
| | - Laurent Brunaud
- Department of Gastrointestinal, Visceral, Metabolic, and Cancer Surgery (CVMC), University Hospital of Nancy (CHRU Nancy), University of Lorraine, 54511 Vandoeuvre-les-Nancy, France; INSERM U1256 NGERE, Lorraine University, 11, allée du Morvan, 54511 Vandoeuvre-les-Nancy, France.
| | - Robert Caiazzo
- General and Endocrine Surgery Department, University Hospital Center of Lille, Lille, France.
| | | | - Frédéric Castinetti
- Aix Marseille University, Marseille Medical Genetics, INSERM U1251 and Assistance Publique Hopitaux de Marseille, La Conception Hospital, Department of Endocrinology, Marseille, France.
| | - Philippe Chanson
- University Paris-Saclay, INSERM, Endocrine Physiology and Pathophysiology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, Service of Endocrinology and Reproductive Diseases, National Reference Center for Rare Pituitary Diseases, 94275 Le Kremlin-Bicêtre, France.
| | - Thomas Cuny
- APHM, Marseille Medical Genetics, INSERM U1251, Conception Hospital, Endocrinology Department, Aix Marseille University, Marseille, France.
| | - Eric Dansin
- Department of Medical Oncology, Oscar Lambret Center, 59000 Lille, France.
| | - Sébastien Gaujoux
- Department of Endocrine and Pancreatic Surgery, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
| | - Sophie Giraud
- Cancer Genetics Unit, Institut Bergonié, Bordeaux, France.
| | - Lionel Groussin
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, 75014 Paris, France.
| | - Maëlle Le Bras
- Department of Endocrinology, Nantes University Hospital, Nantes, France.
| | - Jean-Christophe Lifante
- Department of Digestive and Endocrine Surgery, University Hospital of Lyon Sud, Lyon, France; EA 7425 HESPER, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.
| | - Muriel Mathonnet
- Department of Surgery, Dupuytren University Hospital of Limoges, Limoges, France.
| | - Louis de Mestier
- Paris-Cité University, Department of Pancreatology and Digestive Oncology, Beaujon Hospital (AP-HP-Nord), Clichy, France.
| | - Eric Mirallié
- Department of Oncological, Digestive and Endocrine Surgery (CCDE) Hôtel Dieu, CIC-IMAD, Nantes, France.
| | - François Pattou
- Department of General and Endocrine Surgery, University Hospital. Lille, INSERM U1190, Lille, France.
| | - Pauline Romanet
- Aix Marseille University, APHM, INSERM, MMG, Laboratory of Molecular Biology, La Conception Hospital, Marseille, France.
| | - Frédéric Sebag
- Department of General Endocrine and Metabolic Surgery, Conception University Hospital, APHM, Aix Marseille University, Marseille, France.
| | - Christophe Tresallet
- Department of Digestive, Bariatric and Endocrine Surgery, Avicenne University Hospital, Sorbonne Paris Nord Universty, Assistance Pubique des Hôpitaux de Paris (APHP), Paris, France.
| | - Delphine Vezzosi
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, 24 chemin de Pouvourville, TSA 30030, 31059 Toulouse Cedex, France.
| | - Thomas Walter
- Medical Oncology Department, Edouard-Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Antoine Tabarin
- Endocrinology Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France.
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Vignaud T, Baud G, Nominé-Criqui C, Donatini G, Santucci N, Hamy A, Lifante JC, Maillard L, Mathonnet M, Chereau N, Pattou F, Caiazzo R, Tresallet C, Kuczma P, Ménégaux F, Drui D, Gaujoux S, Brunaud L, Mirallié E. Surgery for Primary Aldosteronism in France From 2010 to 2020 - Results from the French-Speaking Association of Endocrine Surgery (AFCE): Eurocrine Study Group. Ann Surg 2023; 278:717-724. [PMID: 37477017 PMCID: PMC10549884 DOI: 10.1097/sla.0000000000006026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Describe the diagnostic workup and postoperative results for patients treated by adrenalectomy for primary aldosteronism in France from 2010 to 2020. BACKGROUND Primary aldosteronism (PA) is the underlying cause of hypertension in 6% to 18% of patients. French and international guidelines recommend CT-scan and adrenal vein sampling as part of diagnostic workup to distinguish unilateral PA amenable to surgical treatment from bilateral PA that will require lifelong antialdosterone treatment.Adrenalectomy for unilateral primary aldosteronism has been associated with complete resolution of hypertension (no antihypertensive drugs and normal ambulatory blood pressure) in about one-third of patients and complete biological success in 94% of patients.These results are mainly based on retrospective studies with short follow-up and aggregated patients from various international high-volume centers. METHODS Here we report results from the French-Speaking Association of Endocrine Surgery (AFCE) using the Eurocrine® Database. RESULTS Over 11 years, 385 patients from 10 medical centers were eligible for analysis, accounting for >40% of adrenalectomies performed in France for primary aldosteronism over the period.Preoperative workup was consistent with guidelines for 40% of patients. Complete clinical success (CCS) at the last follow-up was achieved in 32% of patients, and complete biological success was not sufficiently assessed.For patients with 2 follow-up visits, clinical results were not persistent at 1 year for one-fifth of patients.Factors associated with CCS on multivariate analysis were body mass index, duration of hypertension, and number of antihypertensive drugs. CONCLUSIONS These results call for an improvement in thorough preoperative workup and long-term follow-up of patients (clinical and biological) to early manage hypertension and/or PA relapse.
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Affiliation(s)
- Timothée Vignaud
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l’Appareil Digestif, Nantes, France
| | - Grégory Baud
- Service de Chirurgie Générale et Endocrinienne, CHU de Lille, Lille, France
| | - Claire Nominé-Criqui
- Department of Gastrointestinal, Visceral, Metabolic, and Cancer Surgery (CVMC) Multidisciplinary unit of metabolic, endocrine and thyroid surgery INSERM NGERE U1256, Université de Lorraine Hopital Brabois adultes (7éme étage), CHRU NANCY 54511 Vandoeuvre-les-Nancy, France
| | - Gianluca Donatini
- Department of Endocrine Surgery, CHU Poitiers, University of Poitiers- INSERM Unit 1082-IRMETIST
| | - Nicolas Santucci
- Department of Digestive and Endocrine Surgery, Dijon University Hospital, Dijon, France
| | - Antoine Hamy
- Chirurgie Viscérale et Endocrinienne, CHU Angers, Angers, France
| | | | - Laure Maillard
- Service de chirurgie endocrinienne, Hospices Civils de Lyon, Lyon, France
| | | | | | - François Pattou
- Service de Chirurgie Générale et Endocrinienne, CHU de Lille, Lille, France
| | - Robert Caiazzo
- Service de Chirurgie Générale et Endocrinienne, CHU de Lille, Lille, France
| | - Christophe Tresallet
- Service de Chirurgie Digestive, Bariatrique et Endocrinienne, HU Paris Seine-Saint-Denis, AP-HP, Hôpital Avicenne, Bobigny, France
| | - Paulina Kuczma
- Service de Chirurgie Digestive, Bariatrique et Endocrinienne, HU Paris Seine-Saint-Denis, AP-HP, Hôpital Avicenne, Bobigny, France
| | | | - Delphine Drui
- Service endocrinologie diabétologie nutrition, l’institut du thorax - CHU de Nantes - Nantes - France
| | | | - Laurent Brunaud
- Department of Gastrointestinal, Visceral, Metabolic, and Cancer Surgery (CVMC) Multidisciplinary unit of metabolic, endocrine and thyroid surgery INSERM NGERE U1256, Université de Lorraine Hopital Brabois adultes (7éme étage), CHRU NANCY 54511 Vandoeuvre-les-Nancy, France
| | - Eric Mirallié
- Nantes Université, CHU Nantes, Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l’Appareil Digestif, Nantes, France
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Alsugair Z, Calcagno F, Lifante JC, Descotes F, Meurgey A, Decaussin-Petrucci M. Primary thyroid rhabdomyosarcoma in an adult: A challenging case with histomolecular diagnosis and literature review. Int J Surg Case Rep 2023; 107:108305. [PMID: 37187114 DOI: 10.1016/j.ijscr.2023.108305] [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: 03/23/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary thyroid sarcomas are very rare tumours, accounting for less than 1 % of all thyroid malignancies. We present the fifth case in the literature of primary thyroid rhabdomyosarcoma and the third in adults with, for the first time, an extensive molecular analysis. CASE PRESENTATION A 61-year-old woman presented with a rapidly progressive neck mass with extensive local invasion of the tumour. CLINICAL DISCUSSION Histologically, the neoplasm was composed of sheets of pleomorphic or spindle-shaped cells with eosinophilic cytoplasm and few large and very pleomorphic cells admixed with the spindle cell proliferation, without any thyroid epithelial component. Immunohistochemically, the tumour cells were positive for muscular markers and negative for epithelial and thyroid differentiation markers. Molecular tests revealed the presence of NF1, PTEN and TERT pathogenic mutations. Classifying undifferentiated neoplasm with muscular differentiation into the thyroid is challenging as many more common differential diagnoses could be favoured including anaplastic thyroid carcinoma with rhabdoid phenotype, leiomyosarcoma, and other rare sarcomas. CONCLUSION Primary thyroid rhabdomyosarcoma is extremely rare and can be diagnostically challenging. We emphasize the histological, immunohistochemical and molecular criteria in order to make an accurate diagnosis.
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Affiliation(s)
- Ziyad Alsugair
- Department of Pathology, Lyon Sud Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Fabien Calcagno
- Department of Oncology, University Hospital of Besançon, Besançon, France
| | - Jean-Christophe Lifante
- Digestive and Endocrine Surgery, Lyon Sud Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - Francoise Descotes
- Biochemistry and Molecular Biology Department, Lyon Sud hospital, Claude Bernard Lyon 1 University, Lyon, France
| | | | - Myriam Decaussin-Petrucci
- Department of Pathology, Lyon Sud Hospital, Claude Bernard Lyon 1 University, Lyon, France; Université Lyon-1, EA 3738 CICLY, Oullins, France.
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Pasquer A, Pascal L, Polazzi S, Skinner S, Poncet G, Lifante JC, Duclos A. Association of Hospital Bed Turnover With Patient Outcomes in Digestive Surgery. Ann Surg Open 2022; 3:e229. [PMID: 37600282 PMCID: PMC10406035 DOI: 10.1097/as9.0000000000000229] [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: 05/24/2022] [Accepted: 11/10/2022] [Indexed: 03/05/2023] Open
Abstract
To determine the influence of hospital bed turnover rate (BTR) on the occurrence of complications following minor or major digestive surgery. Background Performance improvement in surgery aims at increasing productivity while preventing complications. It is unknown whether this relationship can be influenced by the complexity of surgery. Methods A nationwide retrospective cohort study was conducted, based on generalized estimating equation modeling to determine the effect of hospital BTR on surgical outcomes, adjusting for patient mix and clustering within 631 public and private French hospitals. All patients who underwent minor or major digestive surgery between January 1, 2013 and December 31, 2018 were included. Hospital BTR was defined as the annual number of stays per bed for digestive surgery and categorized into tertiles. The primary endpoint was a composite measurement of events occurring within 30 days after surgery: inpatient death, extended intensive care unit (ICU) admission, and reoperation. Results Rate of adverse events was 2.51% in low BTR hospitals versus 2.25% in high BTR hospitals for minor surgery, and 16.79% versus 16.83% for major surgery. Patients who underwent minor surgery in high BTR hospitals experienced lower complications (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.81-0.97; P = 0.009), mortality (OR, 0.87; 95% CI, 0.78-0.98, P = 0.02), ICU admission (OR, 0.83; 95% CI, 0.70-0.99; P = 0.03), and reoperation (OR, 0.91; 95% CI, 0.85-0.97; P = 0.002) compared to those in low BTR hospitals. Such differences were not consistently observed among patients admitted for major surgery. Conclusions High turnover of patients in beds is beneficial for minor procedures, but questionable for major surgeries.
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Affiliation(s)
- Arnaud Pasquer
- From the Research on Healthcare Performance RESHAPE, Inserm U1290, Université Claude Bernard Lyon 1, Lyon, France
- Department of Digestive and Colorectal Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, France
| | - Léa Pascal
- From the Research on Healthcare Performance RESHAPE, Inserm U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, France
| | - Stephanie Polazzi
- From the Research on Healthcare Performance RESHAPE, Inserm U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, France
| | - Sarah Skinner
- From the Research on Healthcare Performance RESHAPE, Inserm U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, France
| | - Gilles Poncet
- Department of Digestive and Colorectal Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, France
| | - Jean-Christophe Lifante
- From the Research on Healthcare Performance RESHAPE, Inserm U1290, Université Claude Bernard Lyon 1, Lyon, France
- Department of Endocrine Surgery, Lyon Sud Hospital, Hospices Civils de Lyon, France
| | - Antoine Duclos
- From the Research on Healthcare Performance RESHAPE, Inserm U1290, Université Claude Bernard Lyon 1, Lyon, France
- Health Data Department, Hospices Civils de Lyon, France
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8
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Menegaux F, Baud G, Chereau N, Christou N, Deguelte S, Frey S, Guérin C, Marciniak C, Paladino NC, Brunaud L, Caiazzo R, Donatini G, Gaujoux S, Goudet P, Hartl D, Lifante JC, Mathonnet M, Mirallié E, Najah H, Sebag F, Trésallet C, Pattou F. SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Surgical treatment. Ann Endocrinol (Paris) 2022; 83:415-422. [PMID: 36309207 DOI: 10.1016/j.ando.2022.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid, with benign non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians and surgeons, but also involves other specialists. Therefore, this consensus statement was established jointly by 3 societies: the French Society of Endocrinology (SFE), French-speaking Association of Endocrine Surgery (AFCE) and French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This section deals with the surgical management of thyroid nodules.
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Affiliation(s)
- Fabrice Menegaux
- Service de Chirurgie Générale, Viscérale et Endocrinienne, GH Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France.
| | - Gregory Baud
- Service de Chirurgie Générale et Endocrinienne, CHRU de Lille, Université de Lille, Lille, France
| | - Nathalie Chereau
- Service de Chirurgie Générale, Viscérale et Endocrinienne, GH Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Niki Christou
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Limoges, France
| | - Sophie Deguelte
- Service de Chirurgie Digestive et Endocrinienne, Hôpital Robert-Debré, Université de Champagne Ardennes, Reims, France
| | - Samuel Frey
- Service de Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, Université de Nantes, Nantes, France
| | - Carole Guérin
- Service de chirurgie Générale, Endocrinienne et Métabolique, CHU La Conception, AP-HM, Aix Marseille Université, Marseille, France
| | - Camille Marciniak
- Service de Chirurgie Générale et Endocrinienne, CHRU de Lille, Université de Lille, Lille, France
| | - Nunzia Cinzia Paladino
- Service de chirurgie Générale, Endocrinienne et Métabolique, CHU La Conception, AP-HM, Aix Marseille Université, Marseille, France
| | - Laurent Brunaud
- Département de Chirurgie Viscérale, Métabolique et Cancérologique, Université de Lorraine, CHRU Nancy, Hôpital Brabois Adultes, Vandœuvre les Nancy, France
| | - Robert Caiazzo
- Service de Chirurgie Générale et Endocrinienne, CHRU de Lille, Université de Lille, Lille, France
| | - Gianluca Donatini
- Service de Chirurgie Viscérale et Endocrinienne, CHU-Poitiers, Poitiers Université, Poitiers, France
| | - Sebastien Gaujoux
- Service de Chirurgie Générale, Viscérale et Endocrinienne, GH Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Pierre Goudet
- Département de Chirurgie Générale et Endocrinienne, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Dana Hartl
- Département d'Anesthésie, de Chirurgie et de Radiologie Interventionnelle, Unité de Chirurgie Thyroïdienne, Institut Gustave Roussy, Villejuif, France
| | - Jean-Christophe Lifante
- Service de Chirurgie Endocrinienne, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Muriel Mathonnet
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Limoges, France
| | - Eric Mirallié
- Service de Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, Université de Nantes, Nantes, France
| | - Haythem Najah
- Service de Chirurgie Digestive et Endocrinienne, Hôpital Haut Lévêque, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Frederic Sebag
- Service de chirurgie Générale, Endocrinienne et Métabolique, CHU La Conception, AP-HM, Aix Marseille Université, Marseille, France
| | - Christophe Trésallet
- Service de Chirurgie Digestive, Bariatrique et Endocrinienne, HU Paris Seine-Saint-Denis, AP-HP, Hôpital Avicenne, Bobigny, France
| | - Francois Pattou
- Service de Chirurgie Générale et Endocrinienne, CHRU de Lille, Université de Lille, Lille, France
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Sens F, Viprey M, Piriou V, Peix JL, Herquelot E, Occelli P, Bourdy S, Gawande AA, Carty Mj MJ, Michel P, Lifante JC, Colin C, Duclos A. Safety Attitude of Operating Room Personnel Associated With Accurate Completion of a Surgical Checklist: A Cross-sectional Observational Study. J Patient Saf 2022; 18:449-456. [PMID: 35948294 DOI: 10.1097/pts.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE How the checklist is executed in routine practice may reflect the teamwork and safety climate in the operating room (OR). This cross-sectional study aimed to identify whether the presence of a fully completed checklist in medical records was associated with teams' safety attitudes. METHODS Data from 29 French hospitals, including 5677 operated patients and 834 OR professionals, were prospectively collected. The degree of checklist compliance was categorized for each patient in 1 of 4 ways: full, incomplete, inaccurate, and no checklist completed. The members of OR teams were invited to complete a questionnaire including teamwork climate measurement (Safety Attitudes Questionnaire) and their opinion regarding checklist use, checklist audibly reading, and communication change with checklist. Multilevel modeling was performed to investigate the effect of variables related to hospitals and professionals on checklist compliance, after adjustment for patient characteristics. RESULTS A checklist was present for 83% of patients, but only 35% demonstrated full completion. Compared with no checklist, full completion was associated with higher safety attitude (high teamwork climate [adjusted odds ratio for full completion, 4.14; 95% confidence interval, 1.75-9.76]; communication change [1.31, 1.04-1.66]; checklist aloud reading [1.16, 1.02-1.32]) and was reinforced by the designation of a checklist coordinator (2.43, 1.06-5.55). Incomplete completion was also associated with enhanced safety attitude contrary to inaccurate completion. CONCLUSIONS Compliance with checklists is associated with safer OR team practice and can be considered as an indicator of the extent of safety in OR practice.
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10
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Demarchi MS, Lifante JC, Triponez F. Indocyanine Green Angiography Use in Subtotal Parathyroidectomy for Renal Hyperparathyroidism. VideoEndocrinology 2022. [DOI: 10.1089/ve.2021.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Department of General, Digestive, and Endocrine Surgery, Lyon Sud Hospital Center, Pierre Benite, France
| | - Jean-Christophe Lifante
- Department of General, Digestive, and Endocrine Surgery, Lyon Sud Hospital Center, Pierre Benite, France
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
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11
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Li M, Delafosse P, Meheus F, Borson-Chazot F, Lifante JC, Simon R, Groclaude P, Combes JD, Dal Maso L, Polazzi S, Duclos A, Colonna M, Vaccarella S. Temporal and geographical variations of thyroid cancer incidence and mortality in France during 1986-2015: The impact of overdiagnosis. Cancer Epidemiol 2021; 75:102051. [PMID: 34743057 DOI: 10.1016/j.canep.2021.102051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND France is among the countries showing fastest growth of thyroid cancer (TC) incidence and highest incidence rates in Europe. This study aimed to clarify the temporal and geographical variations of TC in France and to quantify the impact of overdiagnosis. METHODS We obtained TC incidence data in 1986-2015, and mortality data in 1976-2015, for eight French departments covering 8% of the national population, and calculated the age-standardised rates (ASR). We estimated the average annual percent changes (AAPC) of TC incidence, overall and by department and histological subtype. Numbers and proportions of TC cases attributable to overdiagnosis were estimated by department and period, based on the comparison between the shape of the age-specific curves with that observed prior to changes in diagnostic practice. RESULTS During 1986-2015, there were 13,557 TC cases aged 15-84 years. Large variations of TC incidence were observed across departments, with the highest ASR and the fastest increase in Isère. Papillary subtype accounted for 82.8% of the cases, and presented an AAPC of 7.0% and 7.6% in women and men, respectively. Anaplastic TC incidence decreased annually 3.0% in women and 0.8% in men. Mortality rates declined consistently for all departments. The absolute number (and proportion) of TC cases attributable to overdiagnosis grew from 1074 (66%) in 1986-1995 to 3830 (72%) in 2006-2015 in women, and varied substantially across departments. CONCLUSIONS Overdiagnosis plays an important role in the temporal and regional variations of TC incidence in France. Monitoring the time trends and regulating the regional healthcare practice are needed to reduce its impact.
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Affiliation(s)
- Mengmeng Li
- Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; International Agency for Research on Cancer, Lyon, France
| | | | - Filip Meheus
- International Agency for Research on Cancer, Lyon, France
| | - Françoise Borson-Chazot
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; Fédération d'Endocrinologie, Groupement Hospitalier Est and Registre des Cancers Thyroïdiens du Rhône, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Lifante
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; Service de Chirurgie Endocrinienne, Groupement Hospitalier Sud and Registre des Cancers Thyroïdiens du Rhône, Hospices Civils de Lyon, Lyon, France
| | - Raphael Simon
- International Agency for Research on Cancer, Lyon, France
| | - Pascale Groclaude
- Claudius Regaud Institute, IUCT-Oncopole, Tarn Cancer Registry, Toulouse, France
| | | | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), Istituto di Ricovero e Cura a Carattere Scientifico, Aviano, Italy
| | - Stéphanie Polazzi
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; Health data department, Lyon University Hospital, Lyon, France
| | - Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; Health data department, Lyon University Hospital, Lyon, France
| | - Marc Colonna
- Registre du cancer de l'Isère, Grenoble, France.
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12
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Fanget F, Demarchi MS, Maillard L, El Boukili I, Gerard M, Decaussin M, Borson-Chazot F, Lifante JC. Hypoparathyroidism: Consequences, economic impact, and perspectives. A case series and systematic review. Ann Endocrinol (Paris) 2021; 82:572-581. [PMID: 34400129 DOI: 10.1016/j.ando.2021.07.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/23/2021] [Accepted: 07/12/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Postoperative hypoparathyroidism (PH) is the most common complication after total thyroidectomy. Incidence varies from 2% to 83%, depending on the definition. OBJECTIVE We performed a systematic review of the literature to determine the medico-economic effects of PH and update understanding of long-term consequences, morbidity, and quality of life related to hypoparathyroidism. METHODS We considered relevant articles published between 2000 and 2020 concerning long-term consequences of PH and quality of life. All studies concerning the medico-economic assessment of PH were included. We compared data from 2018 to results in the literature. RESULTS A proportion of 64/403 (16.8%) patients presented with transient PH during 2018, and 7/403 (1.7%) had permanent PH. Seven patients needed supplementation with alfacalcidol at 6-month follow-up. Factors predicting the need for alfacalcidol were age <45, thyroidectomy for goiter, and lymph node dissection. Additional therapy costs related to PH were €9781.10, and additional hospital costs were €230,400. We qualitatively synthesized 41 studies. Most were retrospective studies and only a few reported costs. No series assessed direct or indirect costs of postoperative PH. CONCLUSION To our knowledge, no previous studies reported the medico-economic impact of PH. Decreasing PH associated with fluorescence usage should be considered, particularly concerning cost-effectiveness.
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Affiliation(s)
- Florian Fanget
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - Marco Stefano Demarchi
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France; Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4, rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland
| | - Laure Maillard
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - Ilies El Boukili
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - Maxime Gerard
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France
| | - M Decaussin
- Department of Pathology, Hospices Civils de Lyon, Lyon, France
| | - Francoise Borson-Chazot
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France; Department of Pathology, Hospices Civils de Lyon, Lyon, France; Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude-Bernard Lyon 1, Lyon, France; Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4, rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland
| | - Jean-Christophe Lifante
- Department of General, Digestive and Endocrine Surgery, Lyon Sud Hospital Center, Pierre-Bénite, France; Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude-Bernard Lyon 1, Lyon, France.
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13
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Demarchi MS, Seeliger B, Lifante JC, Alesina PF, Triponez F. Fluorescence Image-Guided Surgery for Thyroid Cancer: Utility for Preventing Hypoparathyroidism. Cancers (Basel) 2021; 13:cancers13153792. [PMID: 34359693 PMCID: PMC8345196 DOI: 10.3390/cancers13153792] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/08/2021] [Accepted: 07/23/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Hypoparathyroidism is one of the most frequent complications of thyroid surgery, especially when associated with lymph node dissection in cases of thyroid cancer. Fluorescence-guided surgery is an emerging tool that appears to help reduce the rate of this complication. The present review aims to highlight the utility of fluorescence imaging in preserving parathyroid glands during thyroid cancer surgery. Methods: We performed a systematic review of the literature according to PRISMA guidelines to identify published studies on fluorescence-guided thyroid surgery with a particular focus on thyroid cancer. Articles were selected and analyzed per indication and type of surgery, autofluorescence or exogenous dye usage, and outcomes. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the methodological quality of the included articles. Results: Twenty-five studies met the inclusion criteria, with three studies exclusively assessing patients with thyroid cancer. The remaining studies assessed mixed cohorts with thyroid cancer and other thyroid or parathyroid diseases. The majority of the papers support the potential benefit of fluorescence imaging in preserving parathyroid glands in thyroid surgery. Conclusions: Fluorescence-guided surgery is useful in the prevention of post-thyroidectomy hypoparathyroidism via enhanced early identification, visualization, and preservation of the parathyroid glands. These aspects are notably beneficial in cases of associated lymphadenectomy for thyroid cancer.
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Affiliation(s)
- Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland;
- Department of Endocrine Surgery, Lyon Sud University Hospitals, 69310 Pierre Benite, France;
| | - Barbara Seeliger
- IHU—Strasbourg, Institute of Image-Guided Surgery, 67091 Strasbourg CEDEX, France;
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg CEDEX, France
- Department of General, Digestive, and Endocrine Surgery, Strasbourg University Hospitals, 67091 Strasbourg CEDEX, France
- Department of Surgery and Center of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, 45136 Essen, Germany;
| | - Jean-Christophe Lifante
- Department of Endocrine Surgery, Lyon Sud University Hospitals, 69310 Pierre Benite, France;
- Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, 69622 Lyon, France
| | - Pier Francesco Alesina
- Department of Surgery and Center of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, 45136 Essen, Germany;
- Department of Surgery, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland;
- Correspondence: ; Tel.: +41-(0)22-372-78-62
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14
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Neyrand S, Fontaine J, Tordo J, Lifante JC, Decaussin-Petrucci M. [Adenomatoid tumor of the adrenal gland: Clinicopathologic characteristics and differential diagnosis on two tumors of exceptional adrenal location]. Ann Pathol 2021; 41:410-416. [PMID: 34119370 DOI: 10.1016/j.annpat.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/04/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
Adenomatoid tumors are benign tumors from mesothelial origin, usually occurring in the genital tract. Extragenital locations, especially in the adrenal gland are extremely rare. Here we are reporting two cases of a 28-year-old and 50-year-old men with an adenomatoid tumor of the right adrenal gland. Usual morphological aspects join scattered and microcystic pattern with epithelioid or signet-ring cells. According to the morphological features, main differential diagnoses are adenocarcinoma metastasis, vascular tumors or mesotheliomas. Immunohistochemistry provides precious help to confirm the mesothelial origin thanks to positivity of epithelial markers (CK7, AE1-AE3, CK5/6) coupled to mesothelial markers (D2-40, Calretinin, WT1). On the other hand, there is no loss of BAP1 by immunohistochemistry and usually a surexpression of P16. Adrenal gland adenomatoid tumor is a benign tumor, which can be promoted by iatrogenous or constitutive immunodepression.
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Affiliation(s)
- Sophie Neyrand
- Service d'anatomie et cytologie pathologiques, hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
| | - Juliette Fontaine
- Service d'anatomie et cytologie pathologiques, hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Jeremie Tordo
- Nuclear Medicine Department, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Jean-Christophe Lifante
- Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Myriam Decaussin-Petrucci
- Service d'anatomie et cytologie pathologiques, hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Service de chirurgie digestive et endocrinienne, hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Cancer Research Center of Lyon, INSERM1052 CNRS5286, Lyon 1 University, France
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15
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Gerard M, Hamy A, Lifante JC, Pattou F, Christou N, Blanchard C, Mirallié E. Comparison of Morbidity After Total Thyroidectomy Among Adult Patients With and Without Preoperative Hyperthyroidism. JAMA Otolaryngol Head Neck Surg 2021; 147:573-575. [PMID: 33734304 DOI: 10.1001/jamaoto.2021.0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Maxime Gerard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Hôtel Dieu, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Antoine Hamy
- Centre Hospitalier Universitaire Angers, Chirurgie Viscérale et Endocrinienne, Angers, France
| | - Jean-Christophe Lifante
- Chirurgie Générale, Endocrinienne, Digestive et Thoracique, Centre Hospitalier Lyon-Sud, Pierre Bénite, Lyon, France
| | - François Pattou
- Centre Hospitalier Universitaire Lille, Université de Lille, Chirurgie Générale et Endocrinienne, Lille, France
| | - Niki Christou
- Chirurgie Digestive, Générale et Endocrinienne, Centre Hospitalier Universitaire de Limoges-Hôpital Dupuytren, Limoges, France
| | - Claire Blanchard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Hôtel Dieu, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Eric Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne, Hôtel Dieu, Centre Hospitalier Universitaire Nantes, Nantes, France
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16
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Fanget F, Demarchi MS, Maillard L, Lintis A, Decaussin M, Lifante JC. Medullary thyroid cancer outcomes in patients with undetectable versus normalized postoperative calcitonin levels. Br J Surg 2021; 108:1064-1071. [PMID: 33899100 DOI: 10.1093/bjs/znab106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/27/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Calcitonin (Ct) is a sensitive diagnostic biomarker and one of the most important prognostic factors in medullary thyroid cancer (MTC). This study aimed to evaluate progression-free survival and recurrence rates of MTC associated with undetectable compared with normalized serum Ct levels after surgery. METHODS This retrospective observational study included patients operated for MTC at the Digestive and Endocrine Surgery Department of Lyon Sud Hospital Centre between 2000 and 2019. Clinical and pathological factors were correlated with postoperative Ct concentrations. Undetectable and normalized Ct concentrations were defined as below 2 pg/ml and 2-10 pg/ml respectively. RESULTS Overall, 176 patients were treated for MTC, and 127 were considered biochemically cured after surgery. Of these, 24 and 103 had normalized and undetectable Ct concentrations respectively. Patients with Ct level normalization had a 25 per cent risk of disease recurrence, compared with 3 per cent in patients with undetectable Ct levels after surgery. The presence of metastasis in two or more compartments was predictive of failure to achieve undetectable Ct concentrations after surgery and an increased risk of recurrence. CONCLUSION Among patients with biochemically cured MTC, those with undetectable or normalized Ct concentrations after surgery had different risks of recurrence. Simply assessing postoperative Ct normalization can be falsely reassuring, and long-term follow-up is needed.
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Affiliation(s)
- F Fanget
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France
| | - M S Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - L Maillard
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France
| | - A Lintis
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France
| | - M Decaussin
- Department of Pathology, Hospices Civils de Lyon, Lyon, France
| | - J C Lifante
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France.,Health Services and Performance Research Laboratory (EA 7425 HESPER), Université Claude Bernard, Lyon, France
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17
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Menegaux F, Lifante JC. Controversy: For or against thyroid lobectomy in>1cm differentiated thyroid cancer? Ann Endocrinol (Paris) 2021; 82:78-82. [PMID: 33757822 DOI: 10.1016/j.ando.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this controversy article, the respective advantages of lobectomy vs. total thyroidectomy in differentiated thyroid cancers are argued. The authors conclude that lobectomy has the same oncological prognosis as thyroidectomy in terms of specific survival or recurrence, in case of low risk of recurrence (T1-2N0). However, as a precaution, and taking into account current data, thyroidectomy is recommended in N0 thyroid papillary cancers with aggressive subtype, with even minimal infiltration of perithyroid tissue and/or vascular invasion, and in N1 cancers with more than 5 lymphadenopathies or lymphadenopathies with a major axis greater than or equal to 0.2cm. Other forms of papillary cancer should be treated with lobectomy, as risk of morbidity is low and hospital stay is short. Lobectomy allows reliable monitoring, especially by ultrasound. On the other hand, total thyroidectomy, despite a higher rate of surgical complications due to the risk of recurrent paralysis and permanent hypoparathyroidism, is nevertheless preferable to lobectomy. Indeed lobectomy is not always avoiding hormone replacement therapy, for more precise monitoring by thyroglobulin assay, which is an uninterpretable tool after lobectomy but allows early diagnosis of local or metastatic recurrence with reducing mortality. Thus, in situations where the diagnostic criteria for high-risk cancer are not rigorously determined or taken into account, thyroidectomy is recommended. In addition, it will remain preferable as long as the recommendations for administration of radioactive iodine do not change in favor of use reserved for high-risk cancers as in US guidelines.
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Affiliation(s)
- Fabrice Menegaux
- GRC n(o) 16 tumeurs thyroïdiennes, department of general, digestive and endocrine surgery, Sorbonne University, hôpital de la Pitié, AP-HP, 83, boulevard de l'hôpital, 75013 Paris, France.
| | - Jean-Christophe Lifante
- Department of endocrine surgery, Hôpital Lyon Sud, 165, rue du grand Revoyet, 69495 Pierre-Bénite, France; Inserm U1290, Research on Healthcare Performance Lab (RESHAPE), Université Claude-Bernard Lyon 1, domaine Rockefeller, 8, avenue Rockefeller, 69003 Lyon, France.
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Salgues B, Guerin C, Amodru V, Pattou F, Brunaud L, Lifante JC, Mirallié E, Sahakian N, Castinetti F, Loundou A, Baumstarck K, Sebag F, Taïeb D. Risk stratification of adrenal masses by [ 18 F]FDG PET/CT: Changing tactics. Clin Endocrinol (Oxf) 2021; 94:133-140. [PMID: 32978795 DOI: 10.1111/cen.14338] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
CONTEXT [18 F]FDG PET/CT improves adrenal tumour characterization. However, there is still no consensus regarding the optimal imaging biomarkers of malignancy. OBJECTIVES To assess the performance of Tumour standardized uptake value (SUV)max :Liver SUVmax for malignancy-risk and to build and evaluate a prediction model. DESIGN/METHODS The cohort consisted of consecutive patients with adrenal masses evaluated by [18 F]FDG PET/CT. The gold standard for malignancy was based on histology or a multidisciplinary consensus in nonoperated cases. The performance of the previously reported cut-off for Tumour SUVmax :Liver SUVmax (>1.5) was evaluated in this independent cohort. Additionally, a predictive model of malignancy was built from the training cohort (previous study) and evaluated in the validation cohort (current study). RESULTS Sixty-four patients were evaluated; 28% of them had a Cushing's syndrome. Fifty-four adrenal masses were classified as benign and 10 as malignant (including 7 adrenocortical carcinomas). Compared to benign masses, malignant lesions were larger in size, had higher unenhanced densities and higher [18 F]FDG uptake. CT-derived anthropometric parameters did not differ between benign and malignant masses. A tumour SUVmax :Liver SUVmax > 1.5 showed a good diagnostic performance: Se = 90.0%/Sp = 92.6%/PPV = 69.2%/NPV = 98.0% and accuracy = 92.2%. A predictive model based on tumour size and tumour-to-liver uptake SUVmax ratio for malignancy-risk was validated and provides a complementary approach to the ratio. CONCLUSIONS Tumour SUVmax :Liver SUVmax uptake ratio is a useful biomarker for diagnosis of adrenal masses. Another tactic would be to calculate with the model an individual risk of malignancy and integrate this information into a shared decision-making process.
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Affiliation(s)
- Betty Salgues
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, Marseille, France
| | - Carole Guerin
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Conception, APHM, Aix Marseille Univ, Marseille, France
| | - Vincent Amodru
- Service d'Enodrinologie, Centre hospitalier Conception, APHM, Aix Marseille Univ, Marseille, France
| | - François Pattou
- Service de Chirurgie Endocrinienne, Centre Hospitalier Régional Universitaire de Lille, Lille, France
- Université Lille nord de France, INSERM, Lille, France
| | - Laurent Brunaud
- Université de Lorraine, Service de Chirurgie et unité multidisciplinaire de Chirurgie Endocrinienne, Métabolique et Thyroïdienne, Centre hospitalo-universitaire Nancy Brabois, Nancy, France
| | | | - Eric Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne, CHU Nantes, Nantes, France
| | - Nicolas Sahakian
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, Marseille, France
| | - Frédéric Castinetti
- Service d'Enodrinologie, Centre hospitalier Conception, APHM, Aix Marseille Univ, Marseille, France
| | - Anderson Loundou
- Service de Santé Publique, Faculté de Médecine de la Timone, Aix Marseille Univ, Marseille, France
| | - Karine Baumstarck
- Service de Santé Publique, Faculté de Médecine de la Timone, Aix Marseille Univ, Marseille, France
| | - Fréderic Sebag
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Conception, APHM, Aix Marseille Univ, Marseille, France
| | - David Taïeb
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, Marseille, France
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Duclos A, Chollet F, Pascal L, Ormando H, Carty MJ, Polazzi S, Lifante JC. Effect of monitoring surgical outcomes using control charts to reduce major adverse events in patients: cluster randomised trial. BMJ 2020; 371:m3840. [PMID: 33148601 PMCID: PMC7610189 DOI: 10.1136/bmj.m3840] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the effect of introducing prospective monitoring of outcomes using control charts and regular feedback on indicators to surgical teams on major adverse events in patients. DESIGN National, parallel, cluster randomised trial embedding a difference-in-differences analysis. SETTING 40 surgical departments of hospitals across France. PARTICIPANTS 155 362 adults who underwent digestive tract surgery. 20 of the surgical departments were randomised to prospective monitoring of outcomes using control charts with regular feedback on indicators (intervention group) and 20 to usual care only (control group). INTERVENTIONS Prospective monitoring of outcomes using control charts, provided in sets quarterly, with regular feedback on indicators (intervention hospitals). To facilitate implementation of the programme, study champion partnerships were established at each site, comprising a surgeon and another member of the surgical team (surgeon, anaesthetist, or nurse), and were trained to conduct team meetings, display posters in operating rooms, maintain a logbook, and devise an improvement plan. MAIN OUTCOME MEASURES The primary outcome was a composite of major adverse events (inpatient death, intensive care stay, reoperation, and severe complications) within 30 days after surgery. Changes in surgical outcomes were compared before and after implementation of the programme between intervention and control hospitals, with adjustment for patient mix and clustering. RESULTS 75 047 patients were analysed in the intervention hospitals (37 579 before and 37 468 after programme implementation) versus 80 315 in the control hospitals (41 548 and 38 767). After introduction of the control chart, the absolute risk of a major adverse event was reduced by 0.9% (95% confidence interval 0.4% to 1.4%) in intervention compared with control hospitals, corresponding to 114 patients (70 to 280) who needed to receive the intervention to prevent one major adverse event. A significant decrease in major adverse events (adjusted ratio of odds ratios 0.89, 95% confidence interval 0.83 to 0.96), patient death (0.84, 0.71 to 0.99), and intensive care stay (0.85, 0.76 to 0.94) was found in intervention compared with control hospitals. The same trend was observed for reoperation (0.91, 0.82 to 1.00), whereas severe complications remained unchanged (0.96, 0.87 to 1.07). Among the intervention hospitals, the effect size was proportional to the degree of control chart implementation witnessed. Highly compliant hospitals experienced a more important reduction in major adverse events (0.84, 0.77 to 0.92), patient death (0.78, 0.63 to 0.97), intensive care stay (0.76, 0.67 to 0.87), and reoperation (0.84, 0.74 to 0.96). CONCLUSIONS The implementation of control charts with feedback on indicators to surgical teams was associated with concomitant reductions in major adverse events in patients. Understanding variations in surgical outcomes and how to provide safe surgery is imperative for improvements. TRIAL REGISTRATION ClinicalTrials.gov NCT02569450.
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Affiliation(s)
- Antoine Duclos
- Health Services and Performance Research lab (HeSPeR, EA 7425), Université Claude Bernard Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Léa Pascal
- Health Data Department, Hospices Civils de Lyon, France
| | - Hector Ormando
- Human Resource Department, EM Lyon Business School, France
| | - Matthew J Carty
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stéphanie Polazzi
- Health Services and Performance Research lab (HeSPeR, EA 7425), Université Claude Bernard Lyon 1, France
- Health Data Department, Hospices Civils de Lyon, France
| | - Jean-Christophe Lifante
- Health Services and Performance Research lab (HeSPeR, EA 7425), Université Claude Bernard Lyon 1, France
- Department of Digestive and Endocrine Surgery, Hospices Civils de Lyon, France
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Ravella L, Lopez J, Descotes F, Giai J, Lapras V, Denier ML, Borson-Chazot F, Lifante JC, Decaussin-Petrucci M. Cytological features and nuclear scores: Diagnostic tools in preoperative fine needle aspiration of indeterminate thyroid nodules with RAS or BRAF K601E mutations? Cytopathology 2020; 32:37-44. [PMID: 32803788 DOI: 10.1111/cyt.12904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The cytological diagnosis of follicular-patterned thyroid lesions is challenging, especially since the World Health Organisation classification has recognised non-invasive follicular thyroid neoplasm with papillary-like features. These entities are often classified as indeterminate on cytology. Molecular testing has been proposed to help classify indeterminate nodules. RAS and K601E BRAF mutations are mostly encountered in follicular-patterned lesions, but their diagnostic value is not well established. Nuclear scores have also been proposed to help classify indeterminate lesions. OBJECTIVE To investigate the correlation between cytological features and histology and to assess nuclear scores in a series of indeterminate RAS or BRAF K601E positive thyroid nodules. METHODS The cytological parameters of 69 indeterminate RAS or BRAF K601E-positive thyroid nodules were evaluated. The Strickland and Maletta scores and a new nuclear score were assessed. Diagnosis of malignant, benign or indolent neoplasms was confirmed in each case by histology. Malignant and indolent nodules were considered surgical nodules, and adenomas non-surgical nodule. RESULTS Surgical nodules were associated with the presence of ground glass nuclei (P = .001), grooves (P < .001) or irregular nuclear membranes (P = .01) on cytology. Nuclear scores were more often ≥2 in surgical nodules compared to benign ones (P < .001), with high sensitivity, but a low negative predictive value. CONCLUSIONS Analysis of nuclear features is useful to distinguish non-surgical from surgical nodules in indeterminate FNAs. Although nuclear scores are not ideal rule-out tests for indeterminate RAS or BRAF K601E positive nodules, they seem useful to screen non-molecular tested or non-mutated indeterminate FNAs. This work shows that meticulous analysis of nuclear features on cytological specimens can be useful to distinguish non-surgical nodules (adenoma) from surgical nodules in indeterminate FNAs. Although nuclear scores are not rule-out tests for indeterminate RAS or BRAF K601E positive nodules, they are useful in screening non-molecular tested or non-mutated indeterminate FNAs for surgery.
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Affiliation(s)
- Lucie Ravella
- Centre de Biologie et Pathologie Sud, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Jonathan Lopez
- Biochemistry and Molecular Biology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,Team EMT and Cancer Cell Plasticity, Cancer Research Center of Lyon, Lyon 1 University, Villeurbanne, France
| | - Françoise Descotes
- Biochemistry and Molecular Biology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Joris Giai
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Véronique Lapras
- Radiology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Marie-Laure Denier
- Radiology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Françoise Borson-Chazot
- Endocrinology Department, Groupement Hospitalier Est, Bron, France.,Faculté de Médecine Lyon Est, Universite Claude Bernard Lyon 1, Lyon, France
| | - Jean-Christophe Lifante
- Endocrine Surgery Department, Centre Hospitalier Lyon Sud, France.,Faculté de Médecine Lyon Sud, Universite, Oullins, France
| | - Myriam Decaussin-Petrucci
- Centre de Biologie et Pathologie Sud, Centre Hospitalier Lyon Sud, Pierre Bénite, France.,INSERM1052, CNRS5286, Cancer Research Center of Lyon, Lyon 1 University, Villeurbanne, France
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21
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Christou N, Mathonnet M, Gaujoux S, Cadiot G, Deguelte S, Kraimps JL, Lifante JC, Menegaux F, Mirallié E, Muscari F, Carnaille B, Pattou F, Sauvanet A, Goudet P. One-Year Postoperative Mortality in MEN1 Patients Operated on Gastric and Duodenopancreatic Neuroendocrine Tumors: An AFCE and GTE Cohort Study. World J Surg 2020; 43:2856-2864. [PMID: 31384998 DOI: 10.1007/s00268-019-05107-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE In MEN1 patients with gastric and duodenopancreatic neuroendocrine tumors (GPD-NET), surgery aims to control secretions or to prevent metastatic spread, but after GPD-NET resection, postoperative mortality may be related to the surgery itself or to other associated MEN1 lesions with their own uncontrolled secretions or metastatic behavior. OBJECTIVE To analyze the causes of death within 1 year following a GPD-NET resection in MEN1 patients. DESIGN An observational study collecting data from the Groupe d'étude des Tumeurs Endocrines (GTE) database. The analysis considered the time between surgery and death (early deaths [<1 month after surgery] versus delayed deaths [beyond 1 month after surgery]) and the period (before 1990 vs after 1990). Causes of death were classified as related to GDP surgery, related to surgery for other MEN1 lesions or not related to MEN1 causes. SETTING GTE database which includes 1220 MEN1 patients and 441 GPD-NET resections. PARTICIPANTS Four hundred and forty-one GPD-NET resections. MAIN OUTCOME MEASURES The primary end point was postoperative mortality within 1 year after surgery. RESULTS Twenty-four patients met the inclusion criteria (2%). Median age at death was 50.5 years. Sixteen deaths occurred in the 30-day postoperative period (76%). Among the 8 delayed deaths, 3 occurred as a result of medical complications between 30 and 90 postoperative days. After 1990, mean age at death increased from 48 to 58 years (p = 0.09), deaths related to uncontrolled acid secretion disappeared (p < 0.001) and deaths related to associated MEN1 lesions increased from 8 to 54% (p = 0.16). CONCLUSION Surgery and uncontrolled secretions remain the two main causes of death in MEN1 patients operated for a GPD-NET tumor. Improving the prognosis of these patients requires a strict evaluation of the secretory syndrome and MEN1 aggressiveness before GDP surgery.
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Affiliation(s)
- Niki Christou
- Department of General, Digestive and Endocrine Surgery, Dupuytren University Hospital, Limoges, France
| | - Muriel Mathonnet
- Department of General, Digestive and Endocrine Surgery, Dupuytren University Hospital, Limoges, France. .,Chirurgie Digestive, Générale et Endocrinienne, CHU de Limoges - Hôpital Dupuytren, 87042, Limoges Cedex, France.
| | - Sébastien Gaujoux
- Department of Pancreatic and Endocrine Surgery, Cochin University Hospital, APHP, Paris, France
| | - Guillaume Cadiot
- Department of Hepato-Gastroenterology and Digestive Oncology, Robert-Debré Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Sophie Deguelte
- Department of General and Digestive Surgery, Robert-Debré Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Jean-Louis Kraimps
- Department of Digestive Surgery, Jean-Bernard University Hospital, Poitiers, France
| | - Jean-Christophe Lifante
- Department of General, Digestive and Endocrine Surgery, University Hospital of Lyon Sud, Pierre-Bénite, France.,EA 7425 HESPER, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
| | - Fabrice Menegaux
- Department of General and Endocrine Surgery, Pitié-Salpétrière University Hospital, APHP, Sorbonne University, Paris, France
| | - Eric Mirallié
- Department of Digestive and Endocrine Surgery, Hôtel-Dieu Hospital, CIC-IMAD, Nantes, France
| | - Fabrice Muscari
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - Bruno Carnaille
- Department of General and Endocrine Surgery, Lille University Hospital, University of Lille, Lille, France
| | - François Pattou
- Department of General and Endocrine Surgery, Lille University Hospital, INSERM U1190, University of Lille, Lille, France
| | - Alain Sauvanet
- Department of Hepato-Pancreato-Biliary Surgery, Paris Diderot University, Beaujon Hospital, APHP, Clichy, France
| | - Pierre Goudet
- Department of Digestive and Endocrine Surgery, Dijon University Hospital, Dijon, France.,CIC1432, Clinical Epidemiology Unit, INSERM, Dijon, France.,Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, Dijon-Bourgogne University Hospital, Dijon, France
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Brunaud L, Payet C, Polazzi S, Bihain F, Quilliot D, Lifante JC, Duclos A. Reoperation Incidence and Severity Within 6 Months After Bariatric Surgery: a Propensity-Matched Study from Nationwide Data. Obes Surg 2020; 30:3378-3386. [PMID: 32367174 DOI: 10.1007/s11695-020-04570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Data about incidence and severity of reoperations up to 6 months after bariatric surgery are currently limited. The aim of this cohort study was to evaluate the incidence and severity of reoperations after initial bariatric surgical procedures and to compare this between the 3 most frequent current surgical procedures (sleeve, gastric bypass, gastric banding). STUDY DESIGN Nationwide observational cohort study using data from French Hospital Information System (2013-2015) to evaluate incidence and severity of reoperations within 6 months after bariatric surgery. Hazard ratios (HR) of longitudinal comparison between historical propensity-matched cohorts were estimated from a Fine and Gray's model using competing risk of death. RESULTS Cumulative reoperation rates increased from postoperative day-30 to day-180. Consequently, 31.1 to 90.0% of procedures would have been missed if the reoperation rate was based solely on a 30-day follow-up. Reoperation rate at 6 months was significantly higher after gastric bypass than after sleeve (HR 0.64; IC 95% [0.53-0.77]) and corresponded to moderate-risk reoperations (HR 0.65; IC 95% [0.53-0.78]). Reoperation rate at 6 months was significantly higher after gastric banding than after sleeve (HR 0.08; IC 95% [0.07-0.09]) and corresponded to moderate-risk reoperations (HR 0.08; IC 95% [0.07-0.10]). CONCLUSION Cumulative incidence of reoperations increased from 30 days to 6 months after sleeve, gastric bypass, or gastric banding and corresponded to moderate-risk surgical procedures. Consequently, 30-day reoperation rate should no longer be considered when evaluating complications and surgical performance after bariatric surgery.
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Affiliation(s)
- Laurent Brunaud
- Department of Gastrointestinal, Metabolic, and Surgical Oncology (DCVMC). Multidisciplinary unit of obesity surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, 11 allée du morvan, 54511, Vandoeuvre-les-Nancy, France. .,INSERM U1256, Nutrition, Genetics, Environmental Risks, Faculty of Medicine, University of Lorraine, Nancy, France.
| | - Cecile Payet
- Department of Medical Information Evaluation and Research, Lyon University Hospital, Lyon, France Health Services and Performance Research Lab (EA 7425 HESPER), Lyon 1 Claude Bernard University, Lyon, France
| | - Stephanie Polazzi
- Department of Medical Information Evaluation and Research, Lyon University Hospital, Lyon, France Health Services and Performance Research Lab (EA 7425 HESPER), Lyon 1 Claude Bernard University, Lyon, France
| | - Florence Bihain
- Department of Gastrointestinal, Metabolic, and Surgical Oncology (DCVMC). Multidisciplinary unit of obesity surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, 11 allée du morvan, 54511, Vandoeuvre-les-Nancy, France
| | - Didier Quilliot
- Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France
| | | | - Antoine Duclos
- Department of Medical Information Evaluation and Research, Lyon University Hospital, Lyon, France Health Services and Performance Research Lab (EA 7425 HESPER), Lyon 1 Claude Bernard University, Lyon, France
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Baud G, Brunaud L, Lifante JC, Tresallet C, Sebag F, Bizard JP, Mathonnet M, Menegaux F, Caiazzo R, Mirallié É, Pattou F. [Endocrine surgery during and after the COVID-19 epidemic: Guidelines from AFCE]. ACTA ACUST UNITED AC 2020; 157:S44-S51. [PMID: 32355510 PMCID: PMC7190492 DOI: 10.1016/j.jchirv.2020.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
La pandémie de COVID-19 impose une réorganisation majeure de l’ensemble de notre système de soins. En France, des règles générales ont été diffusées au niveau national et sont déclinées par chaque établissement, public comme privé, sur l’ensemble du territoire. Ces recommandations, rédigées par un groupe d’experts sous l’égide de l’Association francophone de chirurgie endocrinienne (AFCE), ont pour objectif de proposer des principes spécifiques de prise en charge chirurgicale au cours et au décours de l’épidémie de COVID- 19, pour les pathologies chirurgicales de la thyroïde, des parathyroïdes, du pancréas endocrine, et des surrénales.
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Affiliation(s)
- G Baud
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
| | - L Brunaud
- Chirurgie viscérale, métabolique et cancérologique (CVMC), CHRU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - J C Lifante
- Chirurgie digestive, oncologique et endocrinienne, CHU de Lyon, 69310 Pierre-Bénite, France
| | - C Tresallet
- Chirurgie digestive, bariatrique et endocrinienne, AP-HP, Hôpital Avicenne, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - F Sebag
- Chirurgie générale et endocrinienne, AP-HM, La Conception, 13005 Marseille, France
| | - J P Bizard
- Chirurgie endocrinienne et viscérale, hôpital privé Arras-lès-Bonnettes, 62000 Arras, France
| | - M Mathonnet
- Chirurgie digestive et endocrinienne, CHU de Limoges, 87000 Limoges, France
| | - F Menegaux
- Chirurgie générale digestive et endocrinienne, Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - R Caiazzo
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
| | - É Mirallié
- Chirurgie cancérologique, digestive et endocrinienne (CCDE), CHU de Nantes, 44093 Nantes, France
| | - F Pattou
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
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Payet C, Polazzi S, Lifante JC, Cotte E, Grinberg D, Carty MJ, Sanchez S, Rabilloud M, Duclos A. Influence of trends in hospital volume over time on patient outcomes for high-risk surgery. BMC Health Serv Res 2020; 20:274. [PMID: 32238160 PMCID: PMC7114802 DOI: 10.1186/s12913-020-05126-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The "practice makes perfect" concept considers the more frequent a hospital performs a procedure, the better the outcome of the procedure. We aimed to study this concept by investigating whether patient outcomes improve in hospitals with a significantly increased volume of high-risk surgery over time and whether a learning effect existed at the individual hospital level. METHODS We included all patients who underwent one of 10 digestive, cardiovascular and orthopaedic procedures between 2010 and 2014 from the French nationwide hospitals database. For each procedure, we identified three groups of hospitals according to volume trend (increased, decreased, or no change). In-hospital mortality, reoperation, and unplanned hospital readmission within 30 days were compared between groups using Cox regressions, taking into account clustering of patients within hospitals and potential confounders. Individual hospital learning effect was investigated by considering the interaction between hospital groups and procedure year. RESULTS Over 5 years, 759,928 patients from 694 hospitals were analysed. Patients' mortality in hospitals with procedure volume increase or decrease over time did not clearly differ from those in hospitals with unchanged volume across the studied procedures (e.g., Hazard Ratios [95%] of 1.04 [0.93-1.17] and 1.08 [0.97-1.21] respectively for colectomy). Furthermore, patient outcomes did not improve or deteriorate in hospitals with increased or decreased volume of procedures over time (e.g., 1.01 [0.95-1.08] and 0.99 [0.92-1.05] respectively for colectomy). CONCLUSIONS Trend in hospital volume over time did not appear to influence patient outcomes based on real-world data. TRIAL REGISTRATION NCT02788331, June 2, 2016.
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Affiliation(s)
- Cécile Payet
- Health Data Department, Hospices Civils de Lyon, F-69003, Lyon, France. .,Health Services and Performance Research Lab (HESPER EA7425), Université Claude Bernard Lyon 1, F-69008, Lyon, France.
| | - Stéphanie Polazzi
- Health Data Department, Hospices Civils de Lyon, F-69003, Lyon, France.,Health Services and Performance Research Lab (HESPER EA7425), Université Claude Bernard Lyon 1, F-69008, Lyon, France
| | - Jean-Christophe Lifante
- Health Services and Performance Research Lab (HESPER EA7425), Université Claude Bernard Lyon 1, F-69008, Lyon, France.,Service de Chirurgie Digestive et Endocrinienne, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69300, Pierre Bénite, France
| | - Eddy Cotte
- Service de Chirurgie Digestive et Endocrinienne, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, F-69300, Pierre Bénite, France
| | - Daniel Grinberg
- Service de Chirurgie Cardio-thoracique et Transplantation, Hôpital Cardio-thoracique Louis Pradel, Lyon-Bron, Avenue du Doyen Lépine, 69500, Bron, France
| | - Matthew J Carty
- Brigham and Women's Hospital, Harvard Medical School, Center for Surgery and Public Health, Boston, MA, USA
| | - Stéphane Sanchez
- Hôpitaux Champagne Sud, Centre Hospitalier de Troyes, Pôle Information Médicale Évaluation Performance, Troyes, France
| | - Muriel Rabilloud
- Pôle de Santé Publique, Service de Biostatistique, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Antoine Duclos
- Health Data Department, Hospices Civils de Lyon, F-69003, Lyon, France.,Health Services and Performance Research Lab (HESPER EA7425), Université Claude Bernard Lyon 1, F-69008, Lyon, France.,Brigham and Women's Hospital, Harvard Medical School, Center for Surgery and Public Health, Boston, MA, USA
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Gazeu A, Lopez J, Guyetant S, Sobrinho-Simoes M, Lifante JC, Cugnet-Anceau C, Decaussin-Petrucci M. Poorly differentiated thyroid carcinoma with pleomorphic giant cells-a case report. Virchows Arch 2020; 477:597-601. [PMID: 32239274 DOI: 10.1007/s00428-020-02807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/10/2020] [Accepted: 03/25/2020] [Indexed: 11/25/2022]
Abstract
Poorly differentiated thyroid carcinoma (PDTC) refers to a malignant tumour that displays an intermediate prognosis between well-differentiated carcinomas and anaplastic thyroid carcinomas (ATC). In the thyroid, pleomorphic giant cells are observed in ATC or in some non-neoplastic thyroid diseases. We described the case of a 43-year-old woman with a 34-mm nodule in her thyroid right lobe. Microscopic examination revealed an encapsulated tumour with a main solid growth pattern and extensive capsular invasion. Multiple images of angioinvasion were observed. There was neither necrosis nor inflammation. Most of the tumour cells were medium-sized and intermingled with pleomorphic giant tumour cells with bizarre features. The immunoprofile (keratins +, TTF1+, Pax 8+) proved their thyroid origin. By NGS, no molecular alteration was identified. The patient was treated by surgery and radioiodine therapy and she has no recurrence after a follow-up of 24 months. Our case meets all the histological criteria of the Turin proposal for PDTC but with pleomorphic giant cells and is very different from ATC according to clinical, histological and immunohistochemical features. Pleomorphic tumour giant cells in thyroid carcinomas could be present in PDTC and do not always represent dedifferentiation and more aggressive carcinoma, thyroid neoplasm.
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Affiliation(s)
- Alexia Gazeu
- Pathology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jonathan Lopez
- Biochemistry and Molecular Biology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Cancer Research Center of Lyon, Team EMT and Cancer Cell Plasticity, Lyon 1 University, Villeurbanne, France
| | - Serge Guyetant
- Department of Pathology and Tumor Biobank, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Manuel Sobrinho-Simoes
- Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- Medical Faculty, University of Porto, Porto, Portugal
- Department of Pathology, Hospital de S. João, 4200-319, Porto, Portugal
| | - J C Lifante
- Endocrine Surgery department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Christine Cugnet-Anceau
- Department of Endocrinology and Diabetes, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre-Bénite, France
- ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France
| | - Myriam Decaussin-Petrucci
- Pathology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
- Cancer Research Center of Lyon, INSERM1052 CNRS5286, Lyon 1 University, Villeurbanne, France.
- Département de Biopathologie Sud, Hospices civils de Lyon - Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.
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Mirallié E, Borel F, Tresallet C, Hamy A, Mathonnet M, Lifante JC, Brunaud L, Menégaux F, Hardouin JB, Blanchard C, Ansquer C, Mourrain-Langlois E, Delemazure AS, Perrot B, Longhi M, Nominé C, Espitalier F, Drui D, Caillard C, Renaud-Moreau N, Marret O, Mucci S, Christou N. Impact of total thyroidectomy on quality of life at 6 months: the prospective ThyrQoL multicentre trial. Eur J Endocrinol 2020; 182:195-205. [PMID: 31804967 DOI: 10.1530/eje-19-0587] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 12/03/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study is to determine the impact of complications after total thyroidectomy on health-related quality of life (HR-QoL) and to identify significant predictive factors of HR-QoL changes. HR-QoL is usually impaired in patients with thyroid diseases compared to the general population. Thyroidectomy is largely performed in the case of benign thyroid benign and can be associated with long-term complications (vocal cord palsy, hypoparathyroidism). DESIGN The prospective ThyrQoL multicenter trial (NCT02167529) included 800 patients who underwent total thyroidectomy for benign or malignant non-extensive disease in seven French referral hospitals between 2014 and 2016. METHODS HR-QoL was assessed using the MOS 36-item short form health survey (SF-36) self-questionnaire with a 6-month follow-up. RESULTS We observed a significant improvement of HR-QoL 6 months after surgery (P < 0.0001). Postoperative complications were associated with a non-significant impairment of HR-QoL. In multivariable analysis, Graves' disease was associated with a significant improvement of HR-QoL (OR = 2.39 [1.49; 3.84]) and thyroid malignant disease with an impairment of HR-QoL (OR = 1.44 [0.99; 2.08]) after thyroidectomy. CONCLUSION We observed a significant improvement of HR-QoL 6 months after total thyroid surgery for benign thyroid disease.
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Affiliation(s)
- E Mirallié
- Chirurgie Cancérologique, Digestive et Endocrinienne, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, Nantes Cedex 1, France
| | - F Borel
- Chirurgie Cancérologique, Digestive et Endocrinienne, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, Nantes Cedex 1, France
| | - C Tresallet
- Chirurgie Générale, Viscérale et Endocrinienne, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Universités Pierre et Marie Curie (Paris 6), Paris, France
| | - A Hamy
- CHU Angers, Chirurgie Digestive et Endocrinienne, Angers Cedex 09, France
| | - M Mathonnet
- Chirurgie Digestive, Générale et Endocrinienne, CHU de Limoges - Hôpital Dupuytren, Limoges Cedex, France
| | - J C Lifante
- Chirurgie Générale, Endocrinienne, Digestive et Thoracique, Centre Hospitalier Lyon-Sud, Pierre Bénite Cedex, France
| | - L Brunaud
- Service de Chirurgie Digestive, Hépato-Biliaire, et Endocrinienne, CHU Nancy - Hôpital de Brabois, Nancy, France
| | - F Menégaux
- Chirurgie Générale, Viscérale et Endocrinienne, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Universités Pierre et Marie Curie (Paris 6), Paris, France
| | - J B Hardouin
- UMR INSERM 1246-SPHERE, Université de Nantes, Université de Tours-Institut de Recherche en santé 2, Nantes, France
- Plateforme de Méthodologie et de Biostatistique - DRCi - CHU de Nantes, Nantes, France
| | - C Blanchard
- Chirurgie Cancérologique, Digestive et Endocrinienne, Hôtel Dieu, CHU Nantes, Place Alexis Ricordeau, Nantes Cedex 1, France
- Institut du Thorax, INSERM, CNRS, UNIV Nantes, Nantes, France
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Sarkis P, Rabilloud M, Lifante JC, Siamand A, Jouanneau E, Gay E, Chaffanjon P, Chabre O, Raverot G. Bilateral adrenalectomy in Cushing's disease: Altered long-term quality of life compared to other treatment options. Annales d'Endocrinologie 2019; 80:32-37. [DOI: 10.1016/j.ando.2018.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/14/2018] [Accepted: 01/30/2018] [Indexed: 10/28/2022]
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Bournaud C, Descotes F, Decaussin-Petrucci M, Berthiller J, de la Fouchardière C, Giraudet AL, Bertholon-Gregoire M, Robinson P, Lifante JC, Lopez J, Borson-Chazot F. TERT promoter mutations identify a high-risk group in metastasis-free advanced thyroid carcinoma. Eur J Cancer 2019; 108:41-49. [PMID: 30648628 DOI: 10.1016/j.ejca.2018.12.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 08/03/2018] [Revised: 11/18/2018] [Accepted: 12/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND TERT promoter mutations are associated with adverse clinicopathological characteristics in thyroid carcinomas and considered as a major indicator of poor outcomes. Nevertheless, most studies have pooled heterogeneous types of thyroid carcinomas and have been conducted retrospectively. We investigated the association between TERT promoter mutations and recurrence in a prospective series of 173 intermediate- to high-risk patients with thyroid cancer. PATIENTS Patients referred for radioiodine treatment after thyroidectomy for intermediate- to high-risk differentiated thyroid carcinoma were included in a prospective observational study and tested for TERT promoter, BRAF, and RAS mutations of their primary tumours. We analysed the relationship between TERT promoter mutations and outcomes. RESULTS The prevalence of TERT promoter mutations was 20.2% (35/173) in the total population. It was significantly higher in tumours harbouring aggressive histological features (poorly differentiated carcinoma, tall cell variant of papillary cancer or widely invasive follicular cancer) than in non-aggressive tumours: 32.7% (16/49) versus 15.3% (19/124; p = 0.020). TERT promoter mutations were also strongly associated with age ≥45 years (p = 0.005), pT4 stage (p = 0.015), metastatic disease (p = 0.014), and extrathyroidal extension (p = 0.002). TERT promoter mutations were associated with poor outcomes in the total population (p < 0.001) but not in the subgroup of non-metastatic patients (p = 0.051). However, they were associated with a worse outcome in patients both free of metastases and devoid of aggressive histological features. Neither BRAF nor RAS mutations were associated with event-free survival in non-metastatic patients. CONCLUSION Although their prognostic value does not seem to overcome that of histology, TERT promoter mutations may help to better define the prognosis of localized thyroid cancer patients without aggressive histology.
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Affiliation(s)
- Claire Bournaud
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Médecine Nucléaire, Bron Cedex, F-69677, France.
| | - Françoise Descotes
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Biochimie et Biologie Moléculaire, Pierre Bénite, cedex, F-69495, France
| | - Myriam Decaussin-Petrucci
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service D'Anatomie Pathologique, Pierre Bénite, cedex, F-69495, France; Université Lyon 1, Cancer Research Center of Lyon, INSERM1052 CNRS5286, Lyon, F-69008, France
| | - Julien Berthiller
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service D'Epidémiologie Clinique, Pôle Information Médicale Evaluation Recherche, Bron Cedex, F-69677, France
| | | | - Anne-Laure Giraudet
- Centre Léon-Bérard, Dardre LaennecMedical Oncologyuat, 28, Rue Laennec, Lyon, cedex, F-69373, France
| | - Mireille Bertholon-Gregoire
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Médecine Nucléaire, Bron Cedex, F-69677, France
| | - Philip Robinson
- Hospices Civils de Lyon, Direction de La Recherche Clinique et de L'Innovation, Lyon, cedex, F-69437, France
| | - Jean-Christophe Lifante
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, cedex, F-69495, France; Hospices Civils de Lyon, Fédération D'Endocrinologie, Bron Cedex, F-69677, France
| | - Jonathan Lopez
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Biochimie et Biologie Moléculaire, Pierre Bénite, cedex, F-69495, France; Université Lyon 1, Cancer Research Center of Lyon, INSERM1052 CNRS5286, Lyon, F-69008, France
| | - Françoise Borson-Chazot
- Hospices Civils de Lyon, Fédération D'Endocrinologie, Bron Cedex, F-69677, France; Université Lyon 1, HESPER EA 7425, Lyon, F-69008, France
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Brunaud L, Polazzi S, Lifante JC, Pascal L, Nocca D, Duclos A. Health Care Institutions Volume Is Significantly Associated with Postoperative Outcomes in Bariatric Surgery. Obes Surg 2018; 28:923-931. [PMID: 29039053 DOI: 10.1007/s11695-017-2969-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The volume of bariatric surgery has significantly increased over the past decade with concomitant postoperative outcomes improvement. The goal of this nationwide study was to estimate the volume-outcome relationship in bariatric surgery at the hospital level. MATERIALS AND METHODS A cross-sectional analysis of all patients who underwent bariatric surgery procedure in France from January 2011 to December 2014 was designed. Volume-outcome relationship was analyzed using generalized estimating equations. RESULTS We identified 184,332 inpatient stays for bariatric surgical procedures performed in 606 hospitals. Health care institutions performing more than 200 bariatric cases per year were significantly associated with shorter average length of stay (p < 0.001) and less frequent need for intensive or critical care unit (p = 0.003) during the index stay in comparison with lower volume institutions. Reoperations rate increased from 3.1% [95% CI, 2.8-3.3] (n = 5627) at 1 month to 4.9% [4.6-5.2] at 3 months and 8.2% [7.8-8.7] at 6 months. The risk of reoperation after gastric bypass was 1.37 times less frequent in higher volume institutions (≥ 200 inpatient stays per year, p = 0.003), while it was 1.26 times more frequent after gastric banding in higher volume institutions (p = 0.057) and was unaltered regarding sleeve gastrectomy (p = 0.819). CONCLUSION This study showed for the first time in bariatric surgery that reoperation rate after gastric bypass or sleeve significantly increased at 3 and 6 months postoperatively. Health care institutions performing more than 200 bariatric cases per year were significantly associated with improved postoperative outcomes and less frequent need for reoperation.
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Affiliation(s)
- Laurent Brunaud
- CHU Nancy - Hospital Brabois Adultes, Department of Digestive, Hepato-Biliary and Endocrine Surgery, and Multidisciplinary Unit for Obesity Surgery (UMCO), Université de Lorraine, 11 allée du morvan, 54511, Vandoeuvre-les-Nancy, France. .,Unité INSERM U954 « Nutrition - génétique et exposition aux risques environnementaux », Faculté de Médecine, Université de Lorraine, 54511, Vandoeuvre-les-Nancy, France.
| | - Stephanie Polazzi
- Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, Health Services and Performance Research Lab, Université Claude Bernard Lyon 1, 69003, Lyon, France
| | - Jean-Christophe Lifante
- Centre Hospitalier Lyon Sud, Service de Chirurgie Générale et Endocrinienne, Hospices Civils de Lyon, 69300, Pierre Bénite, France
| | - Lea Pascal
- Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, Health Services and Performance Research Lab, Université Claude Bernard Lyon 1, 69003, Lyon, France
| | - David Nocca
- CHRU Montpellier, Département de Chirurgie Digestive, Hôpital St Eloi, Université de Montpellier, 34000, Montpellier, France
| | - Antoine Duclos
- Hospices Civils de Lyon, Pôle Information Médicale Évaluation Recherche, Health Services and Performance Research Lab, Université Claude Bernard Lyon 1, 69003, Lyon, France
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Decaussin-Petrucci M, Descotes F, Lifante JC, Borson-Chazot F, Lopez J. Reply to Dr Ozden et al. Cytopathology 2018; 29:599. [PMID: 30084521 DOI: 10.1111/cyt.12620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/16/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Françoise Descotes
- Service de Biochimie et Biologie moléculaire, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Jean-Christophe Lifante
- Service de Chirurgie endocrinienne, Hospices Civils de Lyon, Pierre-Bénite, France.,Faculté de Médecine Lyon Sud, Universite Claude Bernard Lyon 1, Oullins, France
| | - Françoise Borson-Chazot
- Hospices Civils de Lyon, Fédération d'Endocrinologie Est, Bron, France.,Faculté de Médecine Lyon Est, Universite Claude Bernard Lyon 1, Lyon, France
| | - Jonathan Lopez
- Service de Biochimie et Biologie moléculaire, Hospices Civils de Lyon, Pierre-Bénite, France
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Affiliation(s)
- F Fanget
- Service de chirurgie générale digestive et endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, rue du grand-Revoyet, 69495 Pierre-Bénite, France
| | - R Thievenaz
- Service de chirurgie générale digestive et endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, rue du grand-Revoyet, 69495 Pierre-Bénite, France
| | - J C Lifante
- Service de chirurgie générale digestive et endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, rue du grand-Revoyet, 69495 Pierre-Bénite, France; Université Claude-Bernard-Lyon I, Health Services and Performance Research Lab, 69003 Lyon, France.
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Ravella L, Lopez J, Descotes F, Lifante JC, David C, Decaussin-Petrucci M. [DICER1 mutated, solid/trabecular thyroid papillary carcinoma in an 11-year-old child]. Ann Pathol 2018; 38:316-320. [PMID: 29884466 DOI: 10.1016/j.annpat.2018.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 10/14/2022]
Abstract
We report the case of an 11-year-old patient diagnosed with a solid variant of papillary thyroid carcinoma. Papillary thyroid carcinoma (PTC) is the most common thyroid cancer, representing 80-90% of all newly diagnosed thyroid cancers. Among the many variants described, solid/trabecular variant of papillary thyroid carcinoma is a rare entity and account for 3% of thyroid cancers. It is more common in children and young adults, and it is seen in higher proportion in post radiation papillary thyroid carcinoma cases. Histologically, solid variant papillary carcinoma is characterized by a predominantly solid, trabecular or insular growth pattern, and the presence of cytological features typical of PTC. Its main differential diagnosis is poorly differentiated thyroid carcinoma. It has a less favorable prognosis than the classical papillary type, with a higher risk of distant metastasis, extrathyroidal extension and lympho-vascular invasion. It is associated with a slightly lower long-term survival in adult cases, but not in children. The management of solid variant PTC includes surgery, associated or not with postoperative radioiodine ablation, according to the aggressiveness criteria. Our patient had a DICER1 somatic mutation. Carriers of germline DICER1 mutations are predisposed to a rare cancer syndrome, the DICER1 syndrome, with a higher risk of numerous tumors and infrequently differentiated thyroid carcinomas.
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Affiliation(s)
- Lucie Ravella
- Service d'anatomie et cytologie pathologique, centre hospitalier Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | - Jonathan Lopez
- Service de biochimie et biologie moléculaire, centre hospitalier Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - Françoise Descotes
- Service de biochimie et biologie moléculaire, centre hospitalier Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - Jean-Christophe Lifante
- Service de chirurgie endocrinienne, centre hospitalier Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - Catherine David
- Service d'anatomie et cytologie pathologique, centre hospitalier Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - Myriam Decaussin-Petrucci
- Service d'anatomie et cytologie pathologique, centre hospitalier Lyon Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
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Ilie I, Vouillarmet J, Decaussin-Petrucci M, Jeannin-Mayer S, Lifante JC, Thivolet C, Marchand L. Bilateral vertebral artery dissection revealing Cushing's syndrome. Ann Endocrinol (Paris) 2018; 80:67-69. [PMID: 29555079 DOI: 10.1016/j.ando.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 01/22/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Iuliana Ilie
- Department of endocrinology and diabetes, Lyon-Sud hospital, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - Julien Vouillarmet
- Department of endocrinology and diabetes, Lyon-Sud hospital, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | | | - Sophie Jeannin-Mayer
- Department of neurology, groupement hospitalier Est, hospices civils de Lyon, 69677 Bron, France
| | - Jean-Christophe Lifante
- Department of general and endocrine surgery, Lyon-Sud hospital, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - Charles Thivolet
- Department of endocrinology and diabetes, Lyon-Sud hospital, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - Lucien Marchand
- Department of endocrinology and diabetes, Lyon-Sud hospital, hospices civils de Lyon, 69310 Pierre-Bénite, France.
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de la Fouchardière C, Decaussin-Petrucci M, Berthiller J, Descotes F, Lopez J, Lifante JC, Peix JL, Giraudet AL, Delahaye A, Masson S, Bournaud-Salinas C, Borson Chazot F. Predictive factors of outcome in poorly differentiated thyroid carcinomas. Eur J Cancer 2018; 92:40-47. [DOI: 10.1016/j.ejca.2017.12.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 12/10/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
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Mercier F, Bonal M, Fanget F, Maillard L, Laplace N, Peix JL, Lifante JC. Correction to: Does Surgery Without Lugol's Solution Pretreatment for Graves' Disease Increase Surgical Morbidity? World J Surg 2018; 42:2127. [PMID: 29423741 DOI: 10.1007/s00268-018-4540-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the original article, Mathieu Bonal's last name was spelled incorrectly. It is correct as reflected here. The original article has also been updated.
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Affiliation(s)
- Frederic Mercier
- The Department of Digestive and Endocrine Surgery, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Mathieu Bonal
- The Department of Digestive and Endocrine Surgery, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Florian Fanget
- The Department of Digestive and Endocrine Surgery, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Laure Maillard
- The Department of Digestive and Endocrine Surgery, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Nathalie Laplace
- The Department of Digestive and Endocrine Surgery, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Jean-Louis Peix
- The Department of Digestive and Endocrine Surgery, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - Jean-Christophe Lifante
- The Department of Digestive and Endocrine Surgery, CHU Lyon Sud, Hospices Civils de Lyon, University of Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France. .,EA 7425 HESPER, Health Services and Performance Research, Université Claude Bernard Lyon 1, Domaine Rockefeller- 4eme étage (aile CD), 8 Avenue Rockefeller, 69373, Lyon 8, France.
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Mirallié É, Caillard C, Pattou F, Brunaud L, Hamy A, Dahan M, Prades M, Mathonnet M, Landecy G, Dernis HP, Lifante JC, Sebag F, Jegoux F, Babin E, Bizon A, Espitalier F, Durand-Zaleski I, Volteau C, Blanchard C. Does intraoperative neuromonitoring of recurrent nerves have an impact on the postoperative palsy rate? Results of a prospective multicenter study. Surgery 2017; 163:124-129. [PMID: 29128183 DOI: 10.1016/j.surg.2017.03.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/07/2017] [Accepted: 03/29/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The impact of intraoperative neuromonitoring on recurrent laryngeal nerve palsy remains debated. Our aim was to evaluate the potential protective effect of intraoperative neuromonitoring on recurrent laryngeal nerve during total thyroidectomy. METHODS This was a prospective, multicenter French national study. The use of intraoperative neuromonitoring was left at the surgeons' choice. Postoperative laryngoscopy was performed systematically at day 1 to 2 after operation and at 6 months in case of postoperative recurrent laryngeal nerve palsy. Univariate and multivariate analyses and propensity score (sensitivity analysis) were performed to compare recurrent laryngeal nerve palsy rates between patients operated with or without intraoperative neuromonitoring. RESULTS Among 1,328 patients included (females 79.9%, median age 51.2 years, median body mass index 25.6 kg/m2), 807 (60.8%) underwent intraoperative neuromonitoring. Postoperative abnormal vocal cord mobility was diagnosed in 131 patients (9.92%), including 69 (8.6%) and 62 (12.1%) in the intraoperative neuromonitoring and nonintraoperative neuromonitoring groups, respectively. Intraoperative neuromonitoring was associated with a lesser rate of recurrent laryngeal nerve palsy in univariate analysis (odds ratio = 0.68, 95% confidence interval, 0.47; 0.98, P = .04) but not in multivariate analysis (oddsratio = 0.74, 95% confidence interval, 0.47; 1.17, P = .19), or when using a propensity score (odds ratio = 0.76, 95% confidence interval, 0.53; 1.07, P = .11). There was no difference in the rates of definitive recurrent laryngeal nerve palsy (0.8% and 1.3% in intraoperative neuromonitoring and non-intraoperative neuromonitoring groups respectively, P = .39). The sensitivity, specificity, and positive and negative predictive values of intraoperative neuromonitoring for detecting abnormal postoperative vocal cord mobility were 29%, 98%, 61%, and 94%, respectively. CONCLUSION The use of intraoperative neuromonitoring does not decrease postoperative recurrent laryngeal nerve palsy rate. Due to its high specificity, however, intraoperative neuromonitoring is useful to predict normal vocal cord mobility. From the CHU de Nantes,a Clinique de Chirurgie Digestive et Endocrinienne, Nantes, France; CHU Lille, Université de Lille,b Chirurgie Générale et Endocrinienne, Lille, France; CHU Nancy-Hôpital de Brabois,c Service de Chirurgie Digestive, Hépato-Biliaire, et Endocrinienne, Nancy, France; CHU Angers,d Chirurgie Digestive et Endocrinienne, Angers, France; CHU de Toulouse-Hôpital Larrey,e Chirurgie Thoracique, Pôle Voies Respiratoires, Toulouse; CHU Saint-Etienne-Hôpital Nord,f ORL et Chirurgie Cervico-Faciale et Plastique, Saint-Etienne, France; CHU de Limoges-Hôpital Dupuytren,g Chirurgie Digestive, Générale et Endocrinienne, Limoges, France; CHU de Besançon-Hôpital Jean Minjoz,h Chirurgie Digestive, Besançon, France; Centre Hospitalier du Mans,i Service ORL et Chirurgie Cervico-Faciale, Le Mans, France; Centre Hospitalier Lyon-Sud,j Chirurgie Générale, Endocrinienne, Digestive et Thoracique, Pierre Bénite, France; AP-HM-Hôpital de La Conception,k Chirurgie Générale, Marseille, France; CHU de Rennes-Hôpital Pontchaillou,l Service ORL et Chirurgie Maxillo-Faciale, Rennes, France; CHU de Caen,m ORL et Chirurgie Cervico-Faciale, Caen, France; CHU d'Angers,n ORL et Chirurgie Cervico-Faciale, Angers, France; CHU de Nantes,o Service ORL, Nantes, France; AP HP URCEco île-de-France,p hôpital de l'Hôtel-Dieu, Paris, France; DRCI, département Promotion,q Nantes, France.
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Affiliation(s)
- Éric Mirallié
- CHU de Nantes, Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Nantes, France.
| | - Cécile Caillard
- CHU de Nantes, Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Nantes, France
| | - François Pattou
- CHU Lille, Université de Lille, Chirurgie Générale et Endocrinienne, Lille, France
| | - Laurent Brunaud
- CHU Nancy - Hôpital de Brabois, Service de Chirurgie Digestive, Hépato-Biliaire et Endocrinienne, Nancy, France
| | - Antoine Hamy
- CHU Angers, Chirurgie Digestive et Endocrinienne, Angers, France
| | - Marcel Dahan
- CHU de Toulouse - Hôpital Larrey, Chirurgie Thoracique, Pôle Voies Respiratoires, Toulouse, France
| | - Michel Prades
- CHU Saint-Etienne - Hôpital Nord, ORL et Chirurgie Cervico-Faciale et Plastique, Saint-Etienne, France
| | - Muriel Mathonnet
- CHU de Limoges - Hôpital Dupuytren, Chirurgie Digestive, Générale et Endocrinienne, Limoges, France
| | - Gérard Landecy
- CHU de Besançon - Hôpital Jean Minjoz, Chirurgie Digestive, Besançon, France
| | - Henri-Pierre Dernis
- Centre Hospitalier du Mans, Service ORL et Chirurgie Cervico-Faciale, Le Mans, France
| | - Jean-Christophe Lifante
- Centre Hospitalier Lyon-Sud, Chirurgie Générale, Endocrinienne, Digestive et Thoracique, Pierre Bénite, France
| | - Frederic Sebag
- AP-HM - Hôpital de La Conception, Chirurgie Générale, Marseille, France
| | - Franck Jegoux
- CHU de Rennes - Hôpital Pontchaillou, Service ORL et Chirurgie Maxillo-Faciale, Rennes, France
| | - Emmanuel Babin
- CHU de Caen, ORL et Chirurgie Cervico-Faciale, Caen, France
| | - Alain Bizon
- CHU d'Angers, ORL et Chirurgie Cervico-Faciale, Angers, France
| | | | | | | | - Claire Blanchard
- CHU de Nantes, Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Nantes, France
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Lasolle H, Riche B, Decaussin-Petrucci M, Dantony E, Lapras V, Cornu C, Lachuer J, Peix JL, Lifante JC, Capraru OM, Selmi-Ruby S, Rousset B, Borson-Chazot F, Roy P. Predicting thyroid nodule malignancy at several prevalence values with a combined Bethesda-molecular test. Transl Res 2017; 188:58-66.e1. [PMID: 28797549 DOI: 10.1016/j.trsl.2017.07.005] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/06/2017] [Accepted: 07/18/2017] [Indexed: 01/21/2023]
Abstract
Investigation of thyroid nodules using fine-needle aspiration cytology (FNAC) gives indeterminate results in up to 30% of samples using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). We present a combined Bethesda-molecular predictor of nodule malignancy to improve the accuracy of the preoperative diagnosis of thyroid nodules. To detect a molecular signature of thyroid nodule malignancy, a molecular test was performed on FNACs from 128 thyroid nodules from prospectively included patients, collected in a tertiary center. The test relied on a transcriptomic array of 20 genes selected from a previous study. An optimal set of seven genes was identified using a logistic regression model. Comparison between the combined predictor (TBSRTC + molecular) and TBSRTC alone used the area under the ROC curve (AUC). Performance of the combined predictor was calculated according to various malignancy prevalence values and benefit-to-harm ratios (B/Hr) (favoring sensitivity or specificity). In our population (36% malignancy prevalence) and with a B/Hr of 1, the combined predictor achieved 95% specificity and 76% sensitivity. The AUC was 93.5%; higher than that of TBSRTC (P = 0.004). Among indeterminate nodules (30% malignancy prevalence), sensitivity and specificity were 52.2% and 96.2%, respectively, with a B/Hr of 1, or 95.7% and 64.2% with a B/Hr of 4 (favoring sensitivity), allowing avoidance of 64% of unnecessary surgeries at the cost of only one false-positive result. In conclusion, this predictor could improve the detection of thyroid nodule malignancy, taking into account malignancy prevalence and B/Hr, and reduce the number of unnecessary thyroidectomies.
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Affiliation(s)
- Hélène Lasolle
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.
| | - Benjamin Riche
- Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Myriam Decaussin-Petrucci
- Université Lyon 1, Lyon, France; Service d'anatomie-pathologique, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Emmanuelle Dantony
- Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Véronique Lapras
- Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Catherine Cornu
- Université Lyon 1, Lyon, France; INSERM, CIC1407, Bron, France; Service de Pharmacologie Clinique, Hospices Civils de Lyon, Bron, France
| | - Joël Lachuer
- Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France; ProfileXpert, SFR santé Lyon Est, UMS 3453 CNRS - US7 INSERM, Lyon, France
| | - Jean-Louis Peix
- Université Lyon 1, Lyon, France; Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jean-Christophe Lifante
- Université Lyon 1, Lyon, France; Service de Chirurgie Digestive et Endocrinienne, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Oana-Maria Capraru
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France; University of Medicine and Pharmacy, Tirgu Mures, Romania
| | - Samia Selmi-Ruby
- Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France
| | - Bernard Rousset
- Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France
| | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM, U 1052, Lyon, France
| | - Pascal Roy
- Université Lyon 1, Lyon, France; Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; CNRS UMR5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
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Guerin C, Pattou F, Brunaud L, Lifante JC, Mirallié E, Haissaguerre M, Huglo D, Olivier P, Houzard C, Ansquer C, Hindié E, Loundou A, Archange C, Tabarin A, Sebag F, Baumstarck K, Taïeb D. Performance of 18F-FDG PET/CT in the Characterization of Adrenal Masses in Noncancer Patients: A Prospective Study. J Clin Endocrinol Metab 2017; 102:2465-2472. [PMID: 28431167 DOI: 10.1210/jc.2017-00254] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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] [Received: 01/25/2017] [Accepted: 04/14/2017] [Indexed: 02/04/2023]
Abstract
CONTEXT Few prospective studies have evaluated the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the characterization of adrenal masses. OBJECTIVE To assess the performance of 18F-FDG PET/CT in the malignancy diagnosis of adrenal masses in noncancer patients. DESIGN Prospective multicenter study. MATERIAL AND METHODS The study population consisted of 87 patients (87 adrenal masses) referred to endocrine surgeons: 56 with mass diameter ≥40 mm and 31 with a diameter <40 mm and of indeterminate nature based on unenhanced and washout CT attenuation densities. Fourteen patients had hypercortisolism. Adrenal masses were characterized by 18F-FDG PET/CT. Histology was the gold standard for the diagnosis of malignancy. In the absence of pathological proof (n = 23), the nature of the lesion was based on the 12-month imaging follow-up. RESULTS Fifteen adrenal masses were classified as malignant (including 11 adrenocortical carcinomas) and 72 as benign. Compared with benign lesions, malignant lesions were larger in size (P = 0.003), had higher unenhanced densities (P = 0.002), lower relative washout values (P = 0.007), and higher 18F-FDG uptake parameters (P < 10-3). The optimal threshold value of (Tumor SUVmax:Liver SUVmax) the ratio for malignancy was >1.5 with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 86.7%, 86.1%, 56.5%, 96.9%, and 86.2%, respectively. CONCLUSIONS Our results show that 18F-FDG PET/CT complements adrenal washout CT in the evaluation of adrenal masses and should be recommended in the evaluation of large and/or indeterminate adrenal masses.
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Affiliation(s)
- Carole Guerin
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Conception, APHM, Aix Marseille Univ, 13005 Marseille, France
| | - François Pattou
- Service de Chirurgie Endocrinienne, Centre Hospitalier Régional Universitaire de Lille, 59037 Lille, France; Université Lille Nord de France, INSERM, Lille, France
| | - Laurent Brunaud
- Université de Lorraine, Service de Chirurgie Digestive, Hépatobiliaire et Endocrinienne, Centre Hospitalo-Universitaire Nancy Brabois, 54511 Nancy, France
| | - Jean-Christophe Lifante
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Lyon Sud, Pierre Bénite, 69495 Lyon, France
| | - Eric Mirallié
- Clinique de Chirurgie Digestive et Endocrinienne, Hôtel Dieu, CHU Nantes, 44000 Nantes, France
| | - Magalie Haissaguerre
- Service d'Endocrinologie, Diabétologie et Nutrition, Centre Hospitalo-Universitaire de Bordeaux, Hôpital Haut-Lévêque Pessac, 33600 Pessac, France
| | - Damien Huglo
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de Lille, OncoTHAI, INSERM U 1189, Univ, 59037 Lille, France
| | - Pierre Olivier
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire Nancy Brabois, 54511 Nancy, France
| | - Claire Houzard
- Service de Médecine Nucléaire, Centre Hospitalier Lyon Sud, Pierre-Bénite, 69495 Lyon, France
| | - Catherine Ansquer
- Service de Médecine Nucléaire, Hôtel Dieu, CHU Nantes, 44000 Nantes, France
| | - Elif Hindié
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de Bordeaux, Hôpital Haut-Lévêque Pessac, 33600 Pessac, France
| | - Anderson Loundou
- Service de Santé Publique, Faculté de Médecine de la Timone, Aix Marseille Univ, 13005 Marseille, France
| | - Cendrine Archange
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, 13385 Marseille, France
| | - Antoine Tabarin
- Service d'Endocrinologie, Diabétologie et Nutrition, Centre Hospitalo-Universitaire de Bordeaux, Hôpital Haut-Lévêque Pessac, 33600 Pessac, France
| | - Fréderic Sebag
- Service de Chirurgie Générale et Endocrinienne, Centre Hospitalier Conception, APHM, Aix Marseille Univ, 13005 Marseille, France
| | - Karine Baumstarck
- Service de Santé Publique, Faculté de Médecine de la Timone, Aix Marseille Univ, 13005 Marseille, France
| | - David Taïeb
- Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de la Timone, APHM, Centre Européen de Recherche en Imagerie Médicale, Aix Marseille Univ, 13385 Marseille, France
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de la Fouchardiere C, Oussaid N, Derbel O, Decaussin-Petrucci M, Fondrevelle ME, Wang Q, Bringuier PP, Bournaud-Salinas C, Peix JL, Lifante JC, Giraudet AL, Lopez J, Borson-Chazot F. Does Molecular Genotype Provide Useful Information in the Management of Radioiodine Refractory Thyroid Cancers? Results of a Retrospective Study. Target Oncol 2016; 11:71-82. [PMID: 26285789 DOI: 10.1007/s11523-015-0380-y] [Citation(s) in RCA: 6] [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: 11/25/2022]
Abstract
INTRODUCTION Whether mutation status should be used to guide therapy is an important issue in many cancers. We correlated mutation profile in radioiodine-refractory (RAIR) metastatic thyroid cancers (TCs) with patient outcome and response to tyrosine kinase inhibitors (TKIs), and discussed the results with other published data. MATERIALS AND METHODS Outcome in 82 consecutive patients with metastatic RAIR thyroid carcinoma prospectively tested for BRAF, RAS and PI3KCA mutations was retrospectively analyzed, including 55 patients treated with multikinase inhibitors. RESULTS Papillary thyroid carcinomas (PTCs) were the most frequent histological subtype (54.9 %), followed by poorly differentiated thyroid carcinoma [PDTC] (30.5 %) and follicular thyroid carcinoma [FTC] (14.6 %). A genetic mutation was identified in 23 patients (28 %) and BRAF was the most frequently mutated gene (23 %). Median progression-free survival (PFS) on first-line TKI treatment was 14.6 months (95% CI 9.9-18.4). BRAF mutation positively influenced median PFS, both in the entire TKI-treated cohort (median PFS 34.7 months versus 11.6 months; hazard ratio [HR] 0.29; 95% CI 0.09-0.98; p = 0.03) and in the TKI-treated PTC cohort (n = 22) [log-rank p = 0.086; HR 2.95; 95 % CI 0.81-10.70). However, in TKI-treated patients, PDTC histologic subtype was the only independent prognostic factor for PFS identified in the multivariate analysis (HR 2.36; 95% CI 1.01-5.54; p = 0.048). CONCLUSION Patients with BRAF-mutant PTC had a significantly longer PFS than BRAF wild-type when treated with TKIs. However, due to the small number of BRAF-mutant patients, further investigations are required, especially to understand the potential positive effect of BRAF mutations in RAIR TC patients while having a negative prognostic impact in RAI-sensitive PTC patients.
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Affiliation(s)
| | - Nadia Oussaid
- Department of Biostatistics, Centre Leon Berard, University Lyon I, Lyon, France
| | - Olfa Derbel
- Medical Oncology Department, Centre Leon Berard, University Lyon I, 28 rue Laennec, 69003, Lyon, France
| | | | | | - Qing Wang
- Molecular Biology Platform, Clinical Science Center, Centre Leon Berard, University Lyon I, Lyon, France
| | | | | | - Jean-Louis Peix
- Department of General and Endocrine Surgery, Hospital Lyon-Sud, University Lyon I, Lyon, France
| | - Jean-Christophe Lifante
- Department of General and Endocrine Surgery, Hospital Lyon-Sud, University Lyon I, Lyon, France
| | - Anne-Laure Giraudet
- Department of Nuclear Medicine, Centre Leon Berard, University Lyon I, Lyon, France
| | - Jonathan Lopez
- Department of Biochemistry, Hospital Lyon-Sud, University Lyon I, Lyon, Pierre-Bénite, France
- Inserm UMR-S1052, CNRS UMR5286, Centre Leon Berard, University Lyon I, Lyon, France
| | - Françoise Borson-Chazot
- Endocrinology Department-INSERM, UMR 1052, Hospital Louis Pradel, University Lyon I, Lyon, France
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Chereau N, Giudicelli X, Pattou F, Lifante JC, Triponez F, Mirallié E, Goudet P, Brunaud L, Trésallet C, Tissier F, Leenhardt L, du Montcel ST, Menegaux F. Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma Is Associated With Aggressive Histopathological Features and a Poor Outcome: Results of a Large Multicentric Study. J Clin Endocrinol Metab 2016; 101:4603-4610. [PMID: 27626975 DOI: 10.1210/jc.2016-2341] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 02/13/2023]
Abstract
CONTEXT Diffuse sclerosing variant (DSV) is a rare and aggressive subtype of papillary thyroid carcinoma (PTC). OBJECTIVE The objective of the study was to investigate the clinicopathological features and prognosis of DSV patients and compare these findings with all other PTCs and high-risk PTCs. DESIGN AND SETTING The data of patients who underwent surgery for DSV and PTC between 2003 and 2014 in seven surgical departments specialized in endocrine surgery were reviewed. PATIENTS Fifty-six DSV patients were included (mean age 32.6 ± 12.5 y; 46 [82%] female) and were compared with 2945 non-DSV PTCs and 48 high-risk PTCs. RESULTS Forty-six DSV patients (82%) were pT3, 43 (77%) had an extrathyroidal extension, and 54 (96%) had lymph node metastasis, including 48 patients with involvement in the lateral compartment (86%). During the follow-up period of 4.3 ±2.3 years, 19 patients (34%) had a recurrence, including 18 patients with an ipsilateral lateral compartment recurrence. The only prognostic factor for recurrence in the multivariate analysis was extranodal extension (odds ratio 3.4 [1.1; 10.8]). The 7-year recurrence-free survival (RFS) was 63%. The RFS was significantly worse in patients with DSV than in other PTC patients (hazard risk 8.5 [5.2; 13.9], P < .0001) and were similar to the RFS of high-risk PTCs (hazard risk 1.1 [0.6; 2.2], P = .5). CONCLUSION DSV patients share the same recurrence rate as high-risk PTC patients. Despite aggressive surgical approaches, the recurrence rate within the first 5 years requires a careful ongoing surveillance, similar to the follow-up of high-risk PTC patients.
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Affiliation(s)
- Nathalie Chereau
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Xavier Giudicelli
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Francois Pattou
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Jean-Christophe Lifante
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Frederic Triponez
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Eric Mirallié
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Pierre Goudet
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Laurent Brunaud
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Christophe Trésallet
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Frédérique Tissier
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Laurence Leenhardt
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Sophie Tezenas du Montcel
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
| | - Fabrice Menegaux
- Departments of General and Endocrine Surgery (N.C., X.G., C.T., F.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France; University Hospital of Lille (F.P.), 59037 Lille, France; University Hospital Lyon Sud (J.-C.L.), 69310 Lyon, France; University Hospitals of Geneva (F.Tr.), 1211 Geneva, Switzerland; University Hospital Hôtel-Dieu (E.M.), 44093 Nantes, France; University Hospital of Dijon (P.G.), 21079 Dijon, France; University Hospital of Nancy (L.B.), 54511 Nancy, France; Departments of Pathology (F.Ti.), Endocrinology (L.L.), and Biostatistics, and Unité Mixte de Recherche en Santé 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique (T.d.M.), Hospital Pitié Salpêtrière, Pierre et Marie Curie University, 75013 Paris, France
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Képénékian L, Mognetti T, Lifante JC, Giraudet AL, Houzard C, Pinson S, Borson-Chazot F, Combemale P. Interest of systematic screening of pheochromocytoma in patients with neurofibromatosis type 1. Eur J Endocrinol 2016; 175:335-44. [PMID: 27450695 DOI: 10.1530/eje-16-0233] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/22/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Pheochromocytoma (PHEO) may occur in 0.1-5.7% of patients presenting with a neurofibromatosis type 1 (NF1). Current recommendations are to explore only symptomatic patients. The objective of the study is to evaluate the prevalence and the interest of a systematic PHEO screening in this population. DESIGN A prospective study in a French tertiary center including consecutive NF1 patients older than 18 years. METHODS A systematic screening combining abdominal imaging and urinary fractionated metanephrines was proposed. In case of positivity of one or both exams, (123)I-metaiodobenzylguanidine scintigraphy or [(18)F]-fluoro-dihydroxyphenylalanine PET imaging was performed. The diagnosis of secreting PHEO was retained in case of elevated urinary metanephrines associated with positive scintigraphy and non-secreting PHEO when urinary metanephrines were normal with a positive scintigraphy. RESULTS Between January 2014 and August 2015, 234 patients were included and 156 patients (66.7%) completed both exams. In these 156 patients, 12 PHEOs were diagnosed, representing a prevalence of 7.7%. Of these, six PHEOs were secreting, with only two symptomatic patients. The tumor size of these PHEOs were bigger than that of non-secreting PHEO (25.2 ± 6.6 vs 14 ± 6.9 mm, P = 0.0165). One lesion was bilateral. Mean metanephrine and normetanephrine levels were 3.2 ± 2.6N and 2.8 ± 1N respectively. Three patients underwent surgery. The six patients with non-secreting PHEO were asymptomatic. One of them had bilateral lesion and one underwent surgery. CONCLUSIONS PHEO in NF1, whether or not secreting, are mostly asymptomatic. The current strategy to explore only symptomatic patients leads to an underestimation of prevalence with the risks inherent to the existence of an unrecognized PHEO.
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Affiliation(s)
- Lori Képénékian
- Department of Endocrinology and DiabetologyHospices Civils de Lyon, Groupement Hospitalier Est, Hôpital Louis Pradel, Bron Cedex, France
| | - Thomas Mognetti
- Department of Nuclear MedicineLéon Bérard Comprehensive Cancer Center, Lyon, France
| | - Jean-Christophe Lifante
- Department of GeneralDigestive and Endocrine Surgery, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - Anne-Laure Giraudet
- Department of Nuclear MedicineLéon Bérard Comprehensive Cancer Center, Lyon, France
| | - Claire Houzard
- Nuclear Medicine UnitImaging Department, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Stéphane Pinson
- Molecular Genetics LaboratoryHôpital Edouard Herriot, Bâtiment E, Lyon, France
| | - Françoise Borson-Chazot
- Department of Endocrinology and DiabetologyHospices Civils de Lyon, Groupement Hospitalier Est, Hôpital Louis Pradel, Bron Cedex, France
| | - Patrick Combemale
- Rhône-Alpes Auvergne Competence Center for the treatment of Neurofibromatosis type 1Léon Bérard Comprehensive Cancer Center, Lyon, France
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Payet C, Rabilloud M, Lifante JC, Duclos A. Methodological Quality of Surgical Mortality Studies Using Large Hospital Databases: A Systematic Review. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.434] [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: 11/16/2022]
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Duclos A, Peix JL, Piriou V, Occelli P, Denis A, Bourdy S, Carty MJ, Gawande AA, Debouck F, Vacca C, Lifante JC, Colin C, Aegerter P, Aouifi A, Arickx D, Aubart F, Baudrin D, Berry WR, Beuvry C, Bonnet F, Bouveret L, Cabarrot P, Cames E, Carty MJ, Caton J, Chenitz MC, Clergues F, Colin C, Coudray JM, Damiens M, Dauzac C, Debono B, Debouck F, De Germay B, Deleforterie AC, Denis A, Desrousseaux JF, Didelot MP, Doat B, Domingo-Saidji NY, Duclos A, Durieux P, Fessy M, Hardy P, Cariven P, Fontas N, Ganansia P, Gawande AA, Giraud F, Gostiaux G, Habi S, Haga S, Houlgatte A, Jaffe M, Jourdan J, Kaczmarek N, Lamblin S, Level C, Liaras E, Lifante JC, Lipsitz SR, Majchrzak C, Malavaud B, Serres TM, Martin X, Martinet C, Maupetit B, Michel P, Movondo A, Naamani B, Nacry R, Occelli P, Olousouzian S, Papin P, Paquet JC, Parfaite A, Pattou F, Paugam C, Pavy E, Peix JL, Petit H, Pierre S, Piriou V, Poupon Bourdy S, Pradere B, Quesne M, Radola Y, Raould A, Rongieras F, Rouquette I, Sanders V, Sanz F, Sens F, Surmont S, Sicre C, Tabur D, Targosz P, Thery D, Toppan N, Usandizaga G, Vacca C, Verheyde I, Zadegan F. Cluster randomized trial to evaluate the impact of team training on surgical outcomes. Br J Surg 2016; 103:1804-1814. [DOI: 10.1002/bjs.10295] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/07/2016] [Accepted: 07/15/2016] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The application of safety principles from the aviation industry to the operating room has offered hope in reducing surgical complications. This study aimed to assess the impact on major surgical complications of adding an aviation-based team training programme after checklist implementation.
Methods
A prospective parallel-group cluster trial was undertaken between September 2011 and March 2013. Operating room teams from 31 hospitals were assigned randomly to participate in a team training programme focused on major concepts of crew resource management and checklist utilization. The primary outcome measure was the occurrence of any major adverse event, including death, during the hospital stay within the first 30 days after surgery. Using a difference-in-difference approach, the ratio of the odds ratios (ROR) was estimated to compare changes in surgical outcomes between intervention and control hospitals.
Results
Some 22 779 patients were enrolled, including 5934 before and 16 845 after team training implementation. The risk of major adverse events fell from 8·8 to 5·5 per cent in 16 intervention hospitals (adjusted odds ratio 0·57, 95 per cent c.i. 0·48 to 0·68; P < 0·001) and from 7·9 to 5·4 per cent in 15 control hospitals (odds ratio 0·64, 0·50 to 0·81; P < 0·001), resulting in the absence of difference between arms (ROR 0·90, 95 per cent c.i. 0·67 to 1·21; P = 0·474). Outcome trends revealed significant improvements among ten institutions, equally distributed across intervention and control hospitals.
Conclusion
Surgical outcomes improved substantially, with no difference between trial arms. Successful implementation of an aviation-based team training programme appears to require modification and adaptation of its principles in the context of the the surgical milieu. Registration number: NCT01384474 (http://www.clinicaltrials.gov).
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Affiliation(s)
- A Duclos
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
| | - J L Peix
- Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - V Piriou
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Service d'Anesthésie Réanimation Médicale et Chirurgicale, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - P Occelli
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
| | - A Denis
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - S Bourdy
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - M J Carty
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
| | - A A Gawande
- Center for Surgery and Public Health, Brigham and Women's Hospital – Harvard Medical School, Boston, Massachusetts, USA
- Ariadne Labs and Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - F Debouck
- Air France Consulting, AFM42, Chambourcy, France
| | - C Vacca
- Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes, Lyon, France
| | - J C Lifante
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
- Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, France
| | - C Colin
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
- Health Services and Performance Research Laboratory, Université Claude Bernard Lyon 1, EA, 7425, Lyon, France
| | | | | | | | | | - D Baudrin
- Agence Régional de Santé de Toulouse
| | | | | | - F Bonnet
- Assistance Publique-Hôpitaux de Paris
| | | | | | - E Cames
- Centre Hospitalier Universitaire de Toulouse
| | - M J Carty
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Caton
- Clinique Emile Vialar de Lyon
| | | | | | | | | | | | - C Dauzac
- Assistance Publique-Hôpitaux de Paris
| | - B Debono
- Clinique des Cèdres de Cornebarrieu
| | | | | | | | | | | | | | | | | | | | - P Durieux
- Assistance Publique-Hôpitaux de Paris
| | | | - P Hardy
- Assistance Publique-Hôpitaux de Paris
| | | | - N Fontas
- Centre Hospitalier Universitaire de Toulouse
| | | | - A A Gawande
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - S Habi
- Centre Hospitalier de Vienne
| | - S Haga
- Infirmerie Protestante de Lyon
| | - A Houlgatte
- Hôpital d'Instruction des Armées du Val de Grâce
| | - M Jaffe
- Clinique Ambroise Paré de Toulouse
| | | | | | | | - C Level
- Assistance Publique-Hôpitaux de Paris
| | - E Liaras
- Hôpital Privé de Natécia de Lyon
| | | | - S R Lipsitz
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - B Malavaud
- Centre Hospitalier Régional Universitaire de Toulouse
| | | | | | | | | | | | | | | | | | | | | | - P Papin
- Centre Hospitalier de Villefranche sur Saône
| | | | | | - F Pattou
- Centre Hospitalier Régional Universitaire de Lille
| | - C Paugam
- Assistance Publique-Hôpitaux de Paris
| | - E Pavy
- Hôpital Simone Veil d'Eaubonne
| | | | | | - S Pierre
- Institut Claudius Régaud de Toulouse
| | | | | | - B Pradere
- Centre Hospitalier Régional Universitaire de Lille
| | | | - Y Radola
- Centre Hospitalier Régional Universitaire de Lille
| | - A Raould
- Assistance Publique-Hôpitaux de Paris
| | - F Rongieras
- Hôpital d'Instruction des Armées Desgenettes de Lyon
| | | | - V Sanders
- Centre Hospitalier Régional Universitaire de Lille
| | - F Sanz
- Centre Hospitalier Régional Universitaire de Lille
| | | | | | | | | | | | - D Thery
- Institut Catholique de Lille
| | - N Toppan
- Clinique de l'Union de Saint Jean
| | | | - C Vacca
- Coordination pour l'Evaluation des Pratiques Professionnelles en Santé en Rhône-Alpes de Lyon
| | | | - F Zadegan
- Assistance Publique-Hôpitaux de Paris
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Ravella L, Lifante JC, Decaussin-Petrucci M. [An unusual cause of primary hyperparathyroidism]. Ann Pathol 2016; 36:286-9. [PMID: 27474534 DOI: 10.1016/j.annpat.2016.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/22/2016] [Accepted: 03/28/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Lucie Ravella
- Service d'anatomie pathologique, hôpital Lyon-Sud, hospices civils de Lyon, université Lyon I, 69495 Pierre-Bénite, France
| | - Jean-Christophe Lifante
- Service de chirurgie endocrinienne, hôpital Lyon-Sud, hospices civils de Lyon, université Lyon I, 69495 Pierre-Bénite, France
| | - Myriam Decaussin-Petrucci
- Service d'anatomie pathologique, hôpital Lyon-Sud, hospices civils de Lyon, université Lyon I, 69495 Pierre-Bénite, France.
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Caillet P, Payet C, Polazzi S, Carty MJ, Lifante JC, Duclos A. Increased Mortality for Elective Surgery during Summer Vacation: A Longitudinal Analysis of Nationwide Data. PLoS One 2015; 10:e0137754. [PMID: 26407191 PMCID: PMC4583258 DOI: 10.1371/journal.pone.0137754] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/20/2015] [Indexed: 11/18/2022] Open
Abstract
Surgical safety during vacation periods may be influenced by the interplay of several factors, including workers' leave, hospital activity, climate, and the variety of patient cases. This study aimed to highlight an annually recurring peak of surgical mortality during summer in France and explore its main predictors. We selected all elective of open surgical procedures performed in French hospitals between 2007 and 2012. Surgical mortality variation was analyzed over time in relation to workers leaving on vacation, the volume of procedures performed by hospitals, and temperature changes. We ran a multilevel logistic regression for exploring the determinants of surgical mortality, taking into account the clustering of patients within hospitals and adjusting for patient and hospital characteristics. A total of 609 French hospitals had 8,926,120 discharges related to open elective surgery. During 6 years, we found a recurring mortality peak of 1.15% (95% CI 1.09–1.20) in August compared with 0.81% (0.79–0.82, p<.001) in other months. The incidence of worker vacation was 43.0% (38.9–47.2) in August compared with 7.3% (4.6–10.1, p<.001) in other months. Hospital activity decreased substantially in August (78,126 inpatient stays, 75,298–80,954) in relation to other months (128,142, 125,697–130,586, p<.001). After adjusting for all covariates, we found an "August effect" reflecting a higher risk to patients undergoing operations at this time (OR 1.16, 95% CI 1.12–1.19, p<.001). The main study limitation was the absence of data linkage between surgical staffing and mortality at the hospital level. The observed, recurring mortality peak in August raises questions about how to maintain hospital activity and optimal staffing through better regulation of human activities.
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Affiliation(s)
- Pascal Caillet
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, F-69003, France
- INSERM Research Unit 1033, Lyon, F-69003, France
- Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, Lyon, F-69003, France
- * E-mail:
| | - Cécile Payet
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, F-69003, France
- Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, Lyon, F-69003, France
| | - Stéphanie Polazzi
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, F-69003, France
- Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, Lyon, F-69003, France
| | - Matthew J. Carty
- Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jean-Christophe Lifante
- Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, Lyon, F-69003, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, F-69300, France
| | - Antoine Duclos
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, F-69003, France
- Université Claude Bernard Lyon 1, Health Services and Performance Research Lab, Lyon, F-69003, France
- Center for Surgery and Public Health, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, United States of America
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Peix JL, Duclos A, Lifante JC. [Not Available]. Bull Acad Natl Med 2015; 199:629-638. [PMID: 27509683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Evaluation and research of quality factors in surgery necessitates the consideration of 3 types of indicators: indicators of structures, indicators of processes and indicators of outcomes. We used these 3 types of indicators to assess the quality of thyroid surgery and to evaluate quality indicators. These studies allowed us to demonstrate the importance of a permanent monitoring of the outcomes of the thyroid surgery and the presence of human and organizational factors in the mechanisms of the surgical complications. This type of evaluation and research in quality of health care should be extended to all the surgical subspecialties.
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Lifante JC, Blanchard C, Mirallié E, David A, Peix JL. Role of preoperative basal calcitonin levels in the timing of prophylactic thyroidectomy in patients with germline RET mutations. World J Surg 2014; 38:576-81. [PMID: 24357249 DOI: 10.1007/s00268-013-2413-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The American Thyroid Association (ATA) published recommendations for the timing of prophylactic surgery for medullary thyroid carcinoma based on the specific mutation, patient age, family history, and serum calcitonin levels. The aim of this study was to assess the role of preoperative basal calcitonin (prebCt) levels in predicting the presence of medullary carcinoma of the thyroid in patients with RET mutations. METHODS We conducted a retrospective study in two endocrine surgery departments. Between 1986 and 2012, a total of 32 patients with RET mutations underwent prophylactic thyroidectomy. The patients were stratified into four ATA risk levels: A, B, C, and D. RESULTS All of the patients were biologically cured. Microcarcinoma was observed in the final pathology report for four of the 20 patients with normal prebCt (25 %) and for nine of the 12 patients with elevated prebCt (75 %). In the level A group, four patients with normal prebCt and one patient with elevated prebCt presented with microcarcinoma. In the level C group, one patient with normal prebCt and six of the seven patients with elevated prebCt (86 %) presented with microcarcinoma. CONCLUSIONS PrebCt can predict the presence of microcarcinoma according to surgical pathological analysis. Patients with microcarcinoma can be biochemically and clinically cured using prophylactic thyroidectomy.
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Affiliation(s)
- Jean-Christophe Lifante
- Department of General, Digestive and Endocrine Surgery, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Rue du grand Revoyet, 69495, Pierre Bénite, France,
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Tessonnier L, Ansquer C, Bournaud C, Sebag F, Mirallié E, Lifante JC, Palazzo FF, Morange I, Drui D, de la Foucardère C, Mancini J, Taïeb D. (18)F-FDG uptake at initial staging of the adrenocortical cancers: a diagnostic tool but not of prognostic value. World J Surg 2013; 37:107-12. [PMID: 23001287 DOI: 10.1007/s00268-012-1802-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare cancer for which little level evidence exists to guide management. (18)F-FDG PET ((18)F-fluorodeoxyglucose positron emission tomography) is an increasingly used diagnostic tool in patients with suspicious or indeterminate adrenal tumors. In some other solid tumors, (18)F-FDG PET may offer prognostic information that can guide optimal patient treatment. The aim of the present study was to evaluate whether preoperative (18)F-FDG PET based on SUVs assessments has a prognostic value in ACC patients. METHODS A retrospective analysis was performed in patients who underwent (18)F-FDG PET/CT for the evaluation of ACC. Inclusion criteria were an unequivocal diagnosis of ACC; all data from primary diagnosis available; (18)F-FDG PET/CT performed prior to surgery or other treatment of the primary tumor; a minimum of 6-months follow-up for surviving patients. All (18)F-FDG PET/CT procedures were reinterpreted in a blind fashion. RESULTS Thirty-seven patients (23 without metastasis [M0], 14 with metastasis [M1]) fulfilled the study criteria. Median uptake values were tumor standardized uptake values (SUV)(max) = 11 (range: 3-56) and a tumor/liver SUV(max) ratio = 4.2 (range: 1.3-15). Median follow-up was 20 months. Although classic risk factors (tumoral stage, Weiss score) were associated with poor outcome, there was no correlation between primary tumor FDG uptake with overall survival (OS) and disease free survival (DFS) in M0 patients and with overall survival in M1 patients. (18)F-FDG uptake correlated inconsistently with sinister histological features, such as atypical mitoses or necrosis. CONCLUSIONS At initial staging, primary tumor FDG uptake in ACC patients does not correlate with OS and DFS at 2 years. Patient prognosis and treatment strategy should not be based on uptake values.
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Affiliation(s)
- L Tessonnier
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264 rue Saint-Pierre, 13385 Marseille Cedex 5, France
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Kopsombut G, Shoulson R, Milone L, Korner J, Lifante JC, Sebastian M, Inabnet WB. Partial small bowel resection with sleeve gastrectomy increases adiponectin levels and improves glucose homeostasis in obese rodents with type 2 diabetes. World J Surg 2012; 36:1432-8. [PMID: 22362044 DOI: 10.1007/s00268-012-1483-6] [Citation(s) in RCA: 4] [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] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim of this study was to examine the effect of small bowel resection with and without sleeve gastrectomy on glucose homeostasis in an obese rodent model of type 2 diabetes. METHODS Zucker diabetic fatty rats were randomized into three surgical groups: Sham, small bowel resection, and small bowel resection with sleeve gastrectomy (BRSG). Weight and fasting glucose levels were measured at randomization and monitored after surgery. Oral glucose tolerance testing was performed at baseline and 45 days after surgery to assess glucose homeostasis and peptide changes. RESULTS At baseline, all animals exhibited impaired glucose tolerance and showed no difference in weight or fasting (area under the curve) AUC(glucose). At sacrifice, Sham animals weighed more than BRSG animals (p = 0.047). At day 45, the Sham group experienced a significant increase in AUC(glucose) compared to baseline (p = 0.02), whereas there was no difference in AUC(glucose) in either surgical group at any time point: BR (p = 0.58) and BRSG (p = 0.56). Single-factor ANOVA showed a significant difference in AUC(glucose) of p = 0.004 between groups postoperatively: Sham (50,745 ± 11,170) versus BR (23,865 ± 432.6) (p = 0.01); Sham versus BRSG (28,710 ± 3188.8) (p = 0.02). There was no difference in plasma insulin, GLP-1, or adiponectin levels before surgery, although 45 days following surgery adiponectin levels where higher in the BRSG group (p = 0.004). CONCLUSIONS Partial small bowel resection improved glucose tolerance independent of weight. The combination of small bowel resection and sleeve gastrectomy leads to an increase in adiponectin levels, which may contribute to improved glucose homeostasis.
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Affiliation(s)
- Gift Kopsombut
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Duclos A, Carty MJ, Peix JL, Colin C, Lipsitz SR, Kraimps JL, Menegaux F, Pattou F, Sebag F, Voirin N, Touzet S, Bourdy S, Lifante JC. Development of a charting method to monitor the individual performance of surgeons at the beginning of their career. PLoS One 2012; 7:e41944. [PMID: 22860036 PMCID: PMC3409207 DOI: 10.1371/journal.pone.0041944] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 06/27/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Efforts to provide a valid picture of surgeons' individual performance evolution should frame their outcomes in relation to what is expected depending on their experience. We derived the learning curve of young thyroidectomy surgeons as a baseline to enable the accurate assessment of their individual outcomes and avoid erroneous conclusions that may derive from more traditional approaches. METHODS Operative time and postoperative recurrent laryngeal nerve palsy of 2006 patients who underwent a thyroidectomy performed by 19 young surgeons in five academic hospitals were monitored from April 2008 to December 2009. The database was randomly divided into training and testing datasets. The training data served to determine the expected performance curve of surgeons during their career and factors influencing outcome variation using generalized estimating equations (GEEs). To simulate prospective monitoring of individual surgeon outcomes, the testing data were plotted on funnel plots and cumulative sum charts (CUSUM). Performance charting methods were utilized to present outcomes adjusted both for patient case-mix and surgeon experience. RESULTS Generation of performance curves demonstrated a gradual reduction in operative time from 139 (95% CI, 137 to 141) to 75 (71 to 80) minutes, and from 15.7% (15.1% to 16.3%) to 3.3% (3.0% to 3.6%) regarding the nerve palsy rate. Charts interpretation revealed that a very young surgeon had better outcomes than expected, whereas a more experienced surgeon appeared to be a poor performer given the number of years that he had already spent in practice. CONCLUSIONS Not considering the initial learning curve of surgeons exposes them to biased measurement and to misinterpretation in assessing their individual performance for thyroidectomy. The performance chart represents a valuable tool to monitor the outcome of surgeons with the expectation to provide safe and efficient care to patients.
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Affiliation(s)
- Antoine Duclos
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France.
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