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Sérénon V, Rouanet P, Charleux-Muller D, Eveno C, Poirot K, Trilling B, Benoist S, Manceau G, Panis Y, Alves A, Kartheuser A, Venara A, Pocard M, Sabbagh C, Laforest A, Lakkis Z, Badic B, Chau A, Christou N, Beyer-Berjot L, Dumont F, Germain A, Valverde A, Duchalais E, Ouaissi M, Benhaim L, Collard M, Tuech JJ, Buscail E, Mege D. Iatrogenic ureteral injury during colorectal surgery has a significant impact on patient outcomes: a French multicentric retrospective cohort study. Colorectal Dis 2023. [PMID: 37254657 DOI: 10.1111/codi.16630] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 06/01/2023]
Abstract
AIM The long-term urological sequelae after iatrogenic ureteral injury (IUI) during colorectal surgery are not clearly known. The aims of this work were to report the incidence of IUI and to analyse the long-term consequences of urological late complications and their impact on oncological results of IUI occurring during colorectal surgery through a French multicentric experience (GRECCAR group). METHOD All the patients who presented with IUI during colorectal surgery between 2010 and 2019 were retrospectively included. Patients with ureteral involvement needing en bloc resection, delayed ureteral stricture or noncolorectal surgery were not considered. RESULTS A total of 202 patients (93 men, mean age 63 ± 14 years) were identified in 29 centres, corresponding to 0.32% of colorectal surgeries (n = 63 562). Index colorectal surgery was mainly oncological (n = 130, 64%). IUI was diagnosed postoperatively in 112 patients (55%) after a mean delay of 11 ± 9 days. Intraoperative diagnosis of IUI was significantly associated with shorter length of stay (21 ± 22 days vs. 34 ± 22 days, p < 0.0001), lower rates of postoperative hydronephrosis (2% vs. 10%, p = 0.04), anastomotic complication (7% vs. 22.5%, p = 0.002) and thromboembolic event (0% vs. 6%, p = 0.02) than postoperative diagnosis of IUI. Delayed chemotherapy because of IUI was reported in 27% of patients. At the end of the follow-up [3 ± 2.6 years (1 month-13 years)], 72 patients presented with urological sequalae (36%). Six patients (3%) required a nephrectomy. CONCLUSION IUI during colorectal surgery has few consequences for the patients if recognized early. Long-term urological sequelae can occur in a third of patients. IUI may affect oncological outcomes in colorectal surgery by delaying adjuvant chemotherapy, especially when the ureteral injury is not diagnosed peroperatively.
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Affiliation(s)
- Victor Sérénon
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Aix Marseille University, Marseille, France
| | - Philippe Rouanet
- Department of Digestive Surgery, Cancer Institute of Montpellier, Montpellier, France
| | | | - Clarisse Eveno
- Department of Digestive Surgery, Lille University Hospital, Lille, France
| | - Karine Poirot
- Department of Digestive Surgery, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Bertrand Trilling
- Department of Digestive Surgery, Grenoble University Hospital, Grenoble, France
| | - Stéphane Benoist
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Gilles Manceau
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Georges-Pompidou European Hospital, Paris, France
| | - Yves Panis
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Beaujon Hospital, Clichy, France
| | - Arnaud Alves
- Registre des Cancers Digestifs, Unité INSERM 1086 ANTICIPE, Department of Digestive Surgery, Caen University Hospital, University Caen Normandy, Caen, France
| | - Alex Kartheuser
- Department of Digestive Surgery, University Clinics Saint-Luc, Bruxelles, Belgium
| | - Aurélien Venara
- Department of Digestive Surgery, Angers University Hospital, Angers, France
| | - Marc Pocard
- Department of Digestive Surgery, Hepato-Biliary-pancreatic Gastrointestinal Surgery and Liver Transplantation, Pitié Salpêtrière Hospital, Paris, France
| | - Charles Sabbagh
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Anaïs Laforest
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Zaher Lakkis
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - Bogdan Badic
- Department of Digestive Surgery, Brest University Hospital, Brest, France
| | - Amélie Chau
- Department of Digestive Surgery, Hénin-Beaumont Hospital, Hauts-de-France, France
| | - Niki Christou
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - Laura Beyer-Berjot
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, North Hospital, Marseille, France
| | - Frederic Dumont
- Department of Digestive Surgery, Cancer Institute of West, Saint-Herblain, France
| | - Adeline Germain
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - Alain Valverde
- Department of Digestive Surgery, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Emilie Duchalais
- Department of Digestive Surgery, Nantes University Hospital, Nantes, France
| | - Mehdi Ouaissi
- Department of Digestive Surgery, Tours University Hospital, Tours, France
| | - Leonor Benhaim
- Department of Digestive Surgery, Gustave Roussy Institute, Villejuif, France
| | - Maxime Collard
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Paris, France
| | - Jean-Jacques Tuech
- Department of Digestive Surgery, Rouen University Hospital, Charles Nicolle Hospital, Rouen, France
| | - Etienne Buscail
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - Diane Mege
- Department of Digestive Surgery, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Aix Marseille University, Marseille, France
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Veziant J, Poirot K, Mulliez A, Pereira B, Slim K. Is an enhanced recovery program (ERP) after rectal surgery as feasible as after colonic surgery? A multicentre Francophone study of 870 rectal resections. Langenbecks Arch Surg 2020; 405:1155-1162. [PMID: 33057822 DOI: 10.1007/s00423-020-02001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/23/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Enhanced recovery program (ERP) is well-established in colorectal surgery. Rectal surgery (RS) is known to be associated with high morbidity and prolonged hospital stay, which might explain why ERPs are less applied in this specific group of patients. The aim of this large-scale study was to assess the feasibility of an ERP in RS compared with colonic surgery. METHODS This study was a retrospective analysis of a prospective database including 3740 patients eligible for colorectal resection from February 2014 to January 2017 in 75 European Francophone centres. Patients were divided into two groups (colon group C vs. rectum group R). The main endpoint was compliance with ERP components. A subgroup analysis was performed in patients for whom a defunctioning stoma (DS) was required after RS. RESULTS A total of 3740 patients were included. There were 2870 patients in group C and 870 patients in group R. The overall compliance rate for ERPs was 81.71% in group C and 79.09% in group R. Patients were significantly less mobilized within 24 h in group R. Specific recommendations for RS concerning bowel preparation and abdominal drainage were significantly less implemented. Overall morbidity was significantly higher in group R. Mean length of stay (LOS) was significantly shorter in group C. In the sub-group analysis, a DS was significantly associated with fewer compliance with early mobilization and early feeding, leading to significantly longer LOS (group R). CONCLUSION ERP is safe and effective in RS, despite the well-known higher morbidity and LOS compared with colonic surgery. DS could be a limiting factor in ERP implementation after RS.
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Affiliation(s)
- J Veziant
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France.
| | - K Poirot
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
| | - A Mulliez
- Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), University Hospital, Clermont Ferrand, France
| | - B Pereira
- Biostatistics Unit, Department of Clinical Research and Innovation (DRCI), University Hospital, Clermont Ferrand, France
| | - K Slim
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
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Veziant J, Poirot K, Chevarin C, Cassagnes L, Sauvanet P, Chassaing B, Robin F, Godfraind C, Barnich N, Pezet D, Pereira B, Gagniere J, Bonnet M. Prognostic value of a combination of innovative factors (gut microbiota, sarcopenia, obesity, metabolic syndrome) to predict surgical/oncologic outcomes following surgery for sporadic colorectal cancer: a prospective cohort study protocol (METABIOTE). BMJ Open 2020; 10:e031472. [PMID: 31915159 PMCID: PMC6955509 DOI: 10.1136/bmjopen-2019-031472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) is still associated with poor prognosis, especially in patients with advanced disease. Development of new prognostic tools replacing or supplementing those routinely used is definitely needed, with the aim to optimise and personalise treatment strategies. Gut microbiota composition and body composition profile (obesity, sarcopenia and metabolic syndrome) have recently been reported separately as new relevant prognostic factors for postoperative surgical and oncologic outcomes following CRC surgery. However interactions that exist between these factors have been poorly studied. The purpose of this translational prospective cohort study (METABIOTE) is to investigate potential interactions between gut microbiota, body composition profile and postoperative outcomes and recurrence in patients undergoing surgery for non-metastatic sporadic CRC. METHODS AND ANALYSIS This single-centre project aims to prospectively enrol 300 consecutive patients undergoing surgery for non-metastatic sporadic CRC at the University Hospital of Clermont-Ferrand, France for the identification of specific microbial signatures (from tumour, colonic mucosa and stools samples) associated with particular metabolic profiles that could impact postoperative morbidity and oncologic outcomes, using microbiological, molecular and imaging approaches. The primary outcome is the 5-year overall survival (OS). Other outcomes are 5-year CRC-related OS, 5-year disease-free survival, 30-day postoperative morbidity, 90-day postoperative mortality and length of hospital stay. ETHICS AND DISSEMINATION This study protocol was reviewed and approved by an independent French regional review board (n°2018-A00352-53, 'Comité de Protection des Personnes Ile de France VII' on 4 July 2018, declared to the competent French authority ('Agence Nationale de Sécurité du Médicament et des produits de santé', France), and registered on the Clinical Trials web-based platform (NCT03843905). Oral and written informed consent will be obtained from each included patient. Study results will be reported to the scientific community at conferences and in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT03843905..
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Affiliation(s)
- Julie Veziant
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Karine Poirot
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
| | - Caroline Chevarin
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Lucie Cassagnes
- Department of Radiology, Universitary Hospital, Clermont Ferrand, France
| | - Pierre Sauvanet
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | | | - Frederic Robin
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Catherine Godfraind
- Department of Anatomopathology, Universitary Hospital, Clermont Ferrand, France
| | - Nicolas Barnich
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Bruno Pereira
- Department of Clinical research and Innovation (DRCI), Universitary Hospital, Clermont Ferrand, France
| | - Johan Gagniere
- Department of Digestive and Hepatobiliary Surgery, University Hospital, Clermont-Ferrand, France
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Mathilde Bonnet
- U1071 Inserm, Clermont-Auvergne University, Clermont-Ferrand, France
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Abstract
INTRODUCTION Surgical site infections (SSI) are a public health issue. The purpose of this review is to review the literature on methods of pre-operative skin preparation for the prevention of SSI in abdominal surgery. METHODS In order to obtain the best level of evidence, only meta-analyses and randomized controlled clinical trials were selected from the Cochrane Library and PubMed databases. High-powered non-randomized studies were included when results were not available for the questions asked. The primary endpoint was the rate of SSI within 30 days. RESULTS Analysis of the 20 selected studies suggested that hair removal in the operative field is not recommended except when it interferes with surgery; in this case, hair clipping or chemical depilation is recommended and shaving should be banned. For the pre-operative shower, the choice of a detergent product with or without antiseptic does not seem to matter, and there were no published data on the required number of showers or the interval before surgery. Application of an alcohol-based solution to the operative field for cutaneous disinfection is recommended; the products used seem to be equivalent, and there is no need for pre-operative detergent scrubbing. There is no strong evidence to recommend adhesive plastic drapes for clean or contaminated surgery. CONCLUSION Some recommendations on skin preparation before abdominal surgery to reduce the rate of SSI are based on a high level of evidence. Other recommendations such as the number and duration of pre-operative showers or use of adhesive plastic skin drapes are less well supported.
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Affiliation(s)
- K Poirot
- Service de chirurgie digestive, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - B Le Roy
- Service de chirurgie digestive, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - L Badrikian
- Service d'hygiène hospitalière, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - K Slim
- Service de chirurgie digestive, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France.
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Phutane P, Buc E, Poirot K, Ozgur E, Pezet D, Bartoli A, Le Roy B. Preliminary trial of augmented reality performed on a laparoscopic left hepatectomy. Surg Endosc 2017; 32:514-515. [PMID: 28791423 DOI: 10.1007/s00464-017-5733-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 12/29/2016] [Accepted: 07/14/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Laparoscopic liver surgery is seldom performed, mainly because of the risk of hepatic vein bleeding or incomplete resection of the tumour. This risk may be reduced by means of an augmented reality guidance system (ARGS), which have the potential to aid one in finding the position of intrahepatic tumours and hepatic veins and thus in facilitating the oncological resection and in limiting the risk of operative bleeding. METHODS We report the case of an 81-year-old man who was diagnosed with a hepatocellular carcinoma after an intraabdominal bleeding. The preoperative CT scan did not show metastases. We describe our preferred approach for laparoscopic left hepatectomy with initial control of the left hepatic vein and preliminary results of our novel ARGS achieved postoperatively. In our ARGS, a 3D virtual anatomical model is created from the abdominal CT scan and manually registered to selected laparoscopic images. For this patient, the virtual model was composed of the segmented left liver, right liver, tumour and median hepatic vein. RESULTS The patient's operating time was summed up to 205 min where a blood loss of 300 cc was recorded. The postoperative course was simple. Histopathological analysis revealed the presence of a hepatocellular carcinoma with free margins. Our results of intrahepatic visualization suggest that ARGS can be beneficial in detecting the tumour, transection plane and medial hepatic vein prior to parenchymal transection, where it does not work due to the substantial changes to the liver's shape. CONCLUSIONS As of today, we have performed eight similar left hepatectomies, with good results. Our ARGS has shown promising results and should now be attempted intraoperatively.
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Affiliation(s)
- Priyanka Phutane
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Emmanuel Buc
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France. .,Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France. .,Department of HPB surgery, Clermont-Ferrand University Hospital Estaing, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand Cedex, France.
| | - Karine Poirot
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France.,Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
| | - Erol Ozgur
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
| | - Adrien Bartoli
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France
| | - Bertrand Le Roy
- UMR Auvergne CNRS 6284, Faculty of Medicine from Clermont-Ferrand, 28 Place Henri Dunant, 63000, Clermont-Ferrand, France.,Department of Digestive and Hepatobiliary Surgery, Estaing Hospital, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63003, Clermont-Ferrand, France
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Sugarman SM, Zou Y, Wasan K, Poirot K, Kumi R, Reddy S, Perez-Soler R. Lipid-complexed camptothecin: formulation and initial biodistribution and antitumor activity studies. Cancer Chemother Pharmacol 1996; 37:531-8. [PMID: 8612306 DOI: 10.1007/s002800050425] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Water-soluble derivatives of camptothecin, and active topoisomerase I inhibitor, have shown a broad spectrum of activity against human tumors. Early clinical trials with the water-soluble sodium salt of camptothecin were hindered by significant cystitis, gastroenteritis, and leukopenia. Furthermore, the sodium salt of camptothecin has been shown to have significantly less activity than the water-insoluble lactone form of the compound. We describe a formulation of lipid-complexed CPT (LC-CPT; particle size range 20.8-208.1 nm) that is very easy to prepare and allows for intravenous administration in vivo in clinically relevant lipid-drug ratios (12.5:1 w/w). The lipid formulation had in vitro antitumor activity similar to that of CPT formulated without lipids and displayed similar cytotoxicity against MDR-1-negative and -positive tumor cells. The biodistribution of CPT was profoundly affected by lipid complexation; free CPT achieved the greatest concentration in the pulmonary parenchyma while LC-CPT achieved the highest concentration in the gastrointestinal tract. LC-CPT had significant antitumor activity in vivo against intraperitoneal L1210 and P338 leukemia and appeared to be more potent then free CPT.
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Affiliation(s)
- S M Sugarman
- Department of Gastrointestinal Oncology and Digestive Diseases, University of Texas, M.D. Anderson Cancer Center, Houston TX 77030, USA
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