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Abboretti F, Lambert C, Schäfer M, Pereira B, Le Roy B, Mège D, Piessen G, Gagnière J, Gronnier C, Mantziari S. Neoadjuvant Chemotherapy Does Not Improve Survival in cT2N0M0 Gastric Adenocarcinoma Patients: A Multicenter Propensity Score Analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15418-2. [PMID: 38762640 DOI: 10.1245/s10434-024-15418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/23/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND According to current international guidelines, stage cT2N0M0 gastric adenocarcinoma warrants preoperative chemotherapy followed by surgery. However, upfront surgery is often preferred in clinical practice, depending on patient clinical status and local treatment preferences. OBJECTIVE The aim of the present study was to assess the impact of neoadjuvant chemotherapy in overall survival (OS) and disease-free survival (DFS) of cT2N0M0 patients. METHODS A retrospective analysis was performed among 32 centers, including gastric adenocarcinoma patients operated between January 2007 and December 2017. Patients with cT2N0M0 stage were divided into upfront surgery (S) and neoadjuvant chemotherapy followed by surgery (CS) groups. Inverse probability of treatment weighting (IPTW) was used to compensate for baseline differences between the groups. RESULTS Among the 202 patients diagnosed with cT2N0M0 stage, 68 (33.7%) were in the CS group and 134 (66.3%) were in the S group. CS patients were younger (mean age 62.7 ± 12.8 vs. 69.8 ± 12.1 years for S patients; p < 0.001) and had a better health status (World Health Organization performance status = 0 in 60.3% of CS patients vs. 34.5% of S patients; p = 0.006). During follow-up, recurrence occurred in 27.2% and 19.6% of CS and S patients, respectively, after IPTW (p = 0.32). Five-year OS was similar between CS and S patients (78.9% vs. 68.3%; p = 0.42), as was 5-year DFS (70.4% vs. 68.5%; p = 0.96). Neoadjuvant chemotherapy was associated with neither OS nor DFS in multivariable analysis after IPTW. CONCLUSIONS Patients with cT2N0M0 gastric adenocarcinoma did not present a survival or recurrence benefit if treated with perioperative chemotherapy followed by surgery as opposed to surgery alone.
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Affiliation(s)
- Francesco Abboretti
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Bruno Pereira
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bertrand Le Roy
- Department of Digestive and Oncologic Surgery, Hospital Nord, CHU de Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Diane Mège
- Department of Digestive Surgery, Aix Marseille Univ, APHM, Timone University Hospital, Marseille, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, CHU Lille, Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | - Johan Gagnière
- Department of Digestive Surgery and Liver Transplantation, Estaing University Hospital, Clermont-Ferrand, France
- U1071 Inserm/Clermont-Auvergne University, Clermont-Ferrand, France
| | - Caroline Gronnier
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Pessac, France
- Faculty of Medicine, Bordeaux Ségalen University, Bordeaux, France
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland.
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Ferrero R, Rainer PY, Rumpler M, Russeil J, Zachara M, Pezoldt J, van Mierlo G, Gardeux V, Saelens W, Alpern D, Favre L, Vionnet N, Mantziari S, Zingg T, Pitteloud N, Suter M, Matter M, Schlaudraff KU, Canto C, Deplancke B. A human omentum-specific mesothelial-like stromal population inhibits adipogenesis through IGFBP2 secretion. Cell Metab 2024:S1550-4131(24)00137-2. [PMID: 38729152 DOI: 10.1016/j.cmet.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/22/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024]
Abstract
Adipose tissue plasticity is orchestrated by molecularly and functionally diverse cells within the stromal vascular fraction (SVF). Although several mouse and human adipose SVF cellular subpopulations have by now been identified, we still lack an understanding of the cellular and functional variability of adipose stem and progenitor cell (ASPC) populations across human fat depots. To address this, we performed single-cell and bulk RNA sequencing (RNA-seq) analyses of >30 SVF/Lin- samples across four human adipose depots, revealing two ubiquitous human ASPC (hASPC) subpopulations with distinct proliferative and adipogenic properties but also depot- and BMI-dependent proportions. Furthermore, we identified an omental-specific, high IGFBP2-expressing stromal population that transitions between mesothelial and mesenchymal cell states and inhibits hASPC adipogenesis through IGFBP2 secretion. Our analyses highlight the molecular and cellular uniqueness of different adipose niches, while our discovery of an anti-adipogenic IGFBP2+ omental-specific population provides a new rationale for the biomedically relevant, limited adipogenic capacity of omental hASPCs.
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Affiliation(s)
- Radiana Ferrero
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Pernille Yde Rainer
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Marie Rumpler
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Julie Russeil
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Magda Zachara
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Joern Pezoldt
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Guido van Mierlo
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Vincent Gardeux
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Wouter Saelens
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Daniel Alpern
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Lucie Favre
- Department of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne 1005, Switzerland
| | - Nathalie Vionnet
- Department of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne 1005, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne 1011, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne 1005, Switzerland
| | - Tobias Zingg
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne 1011, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne 1005, Switzerland
| | - Nelly Pitteloud
- Department of Endocrinology, Diabetology and Metabolism, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne 1005, Switzerland
| | - Michel Suter
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne 1011, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne 1005, Switzerland
| | - Maurice Matter
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Lausanne 1011, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne 1005, Switzerland
| | | | - Carles Canto
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland
| | - Bart Deplancke
- Laboratory of Systems Biology and Genetics, Institute of Bioengineering, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland.
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Bomio-Pacciorini L, Gaspar-Figueiredo S, Mantziari S, Godat S, Schäfer M, Teixeira Farinha H. Functional results after hiatal repair and gastropexy without fundoplication in patients with paraoesophageal hernia. Langenbecks Arch Surg 2024; 409:150. [PMID: 38702556 PMCID: PMC11068662 DOI: 10.1007/s00423-024-03340-w] [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: 01/16/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Paraoesophageal hernias (PEH) are associated with a high complication rate and often occur in elderly and fragile patients. Surgical gastropexy without fundoplication is an accepted alternative procedure; however, outcomes and functional results are rarely described. Our study aims to evaluate short-term outcomes and the long-term quality of life after gastropexy as treatment for PEH. METHODS Single center cohort analysis of all consecutive patients who underwent gastropexy for PEH without fundoplication. Postoperative outcomes and functional results were retrospectively collected. Reflux symptoms developed postoperatively were reported using the validated quality of life questionnaire: GERD-Health Related Quality of Life Qestionnaire (GERD-HRQL). RESULTS Thirty patients (median age: 72 years (65-80)) were included, 40% classified as ASA III. Main PEH symptoms were reflux (63%), abdominal/thoracic pain (47%), pyrosis (33%), anorexia (30%), and food blockage (26%). Twenty-six laparoscopies were performed (86%). Major complications (III-IVb) occurred in 9 patients (30%). Seven patients (23%) had PEH recurrence, all re-operated, performing a new gastropexy. Median follow-up was 38 (17-50) months. Twenty-two patients (75%) reported symptoms resolution with median GERD-HRQL scale of 4 (1-6). 72% (n = 21) reported operation satisfaction. GERD-HRQL was comparable between patients who were re-operated for recurrence and others: 5 (2-19) versus 3 (0-6), p = 0.100. CONCLUSION Gastropexy without fundoplication was performed by laparoscopy in most cases with acceptable complications rates. Two-thirds of patients reported symptoms resolution, and long-term quality-of-live associated to reflux symptoms is good. Although the rate of PEH recurrence requiring a new re-intervention remained increased (23%), it does not seem to affect long-term functional results.
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Affiliation(s)
- Laura Bomio-Pacciorini
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sérgio Gaspar-Figueiredo
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sébastien Godat
- Department of Gastroenterology and Hepatology, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Winiker M, Gaspar Figueiredo S, Mantziari S. Obturator hernia as a cause of intestinal obstruction in an elderly female patient - A clinical image. J Visc Surg 2024:S1878-7886(24)00057-2. [PMID: 38637178 DOI: 10.1016/j.jviscsurg.2024.04.005] [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: 04/20/2024]
Affiliation(s)
- Michael Winiker
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Sergio Gaspar Figueiredo
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland; Division of Surgery, Riviera-Chablais Hospital (HRC), Rennaz, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
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Mantziari S, Teixeira Farinha H, Piessen G, Schäfer M. ASO Author Reflections: Neoadjuvant Radiotherapy in Locally Advanced Esophageal Adenocarcinoma; Low-Dose Radiation, Low-Dose Expectations? Ann Surg Oncol 2024; 31:2515-2516. [PMID: 38206505 PMCID: PMC10908600 DOI: 10.1245/s10434-023-14885-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland.
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, CHU Lille, Lille, France
- UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, University of Lille, CNRS, Inserm, CHU Lille, Lille, France
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
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Mantziari S, Farinha HT, Messier M, Winiker M, Allemann P, Ozsahin EM, Demartines N, Piessen G, Schäfer M. Low-Dose Radiation Yields Lower Rates of Pathologic Response in Esophageal Cancer Patients. Ann Surg Oncol 2024; 31:2499-2508. [PMID: 38198002 PMCID: PMC10908612 DOI: 10.1245/s10434-023-14810-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/30/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Although neoadjuvant chemoradiation (nCRT) followed by surgery is standard treatment for locally advanced esophageal or gastroesophageal junction (E/GEJ) cancer, the optimal radiation dose is still under debate. OBJECTIVE The aim of this study was to assess the impact of different preoperative radiation doses (41.4 Gy, 45 Gy or 50.4 Gy) on pathologic response and survival in E/GEJ cancer patients. METHODS All consecutive patients with E/GEJ tumors, treated with curative intent between January 2009 and December 2016 in two referral centers were divided into three groups (41.4 Gy, 45 Gy and 50.4 Gy) according to the dose of preoperative radiotherapy. Pathologic complete response (pCR) rates, postoperative morbidity, overall survival (OS) and disease-free survival (DFS) were compared among the three groups, with separate analyses for adenocarcinoma (AC) and squamous cell carcinoma (SCC). RESULTS From the 326 patients analyzed, 48 were included in the 41.4 Gy group (14.7%), 171 in the 45 Gy group (52.5%) and 107 in the 50.4 Gy group (32.8%). Postoperative complication rates were comparable (p = 0.399). A pCR was observed in 15%, 30%, and 34% of patients in the 41.4 Gy, 45 Gy and 50.4 Gy groups, respectively (p = 0.047). A 50.4 Gy dose was independently associated with pCR (odds ratio 2.78, 95% confidence interval 1.10-7.99) in multivariate analysis. Within AC patients, pCR was observed in 6.2% of patients in the 41.4 Gy group, 29.2% of patients in the 45 Gy group, and 22.7% of patients in the 50.4 Gy group (p = 0.035). No OS or DFS differences were observed. CONCLUSIONS A pCR was less common after a preoperative radiation dose of 41.4 Gy in AC patients. Radiation dose had no impact on postoperative morbidity, long-term survival, and recurrence.
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Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland.
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Marguerite Messier
- Department of Digestive and Oncological Surgery, CHU Lille, Lille, France
| | - Michael Winiker
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Pierre Allemann
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Esat Mahmut Ozsahin
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
- Department of Radiation Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, CHU Lille, Lille, France
- CNRS, Inserm, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, CHU Lille, Univ. Lille, Lille, France
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
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Michel M, Gilet P, Mantziari S, Puder JJ, Legardeur H, Favre L. [Pregnancy and bariatric surgery : from pre-conception to postpartum]. Rev Med Suisse 2024; 20:575-579. [PMID: 38506457 DOI: 10.53738/revmed.2024.20.866.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Bariatric surgery is regularly offered to women of childbearing age. Pregnancy after such surgery should be planned and requires special attention. Some complications associated with obesity during pregnancy are reduced after bariatric surgery, but reduced dietary intake and malabsorption can cause nutritional deficiencies, that need to be carefully screened for and supplemented. Dietary management is recommended, and any unusual abdominal pain should be referred to a bariatric surgeon. We offer a summary of recommendations for appropriate follow-up of these pregnancies.
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Affiliation(s)
- Mélina Michel
- Service d'endocrinologie, diabétologie et métabolisme, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Patricia Gilet
- Service d'endocrinologie, diabétologie et métabolisme, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Styliani Mantziari
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Jardena J Puder
- Service d'obstétrique, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Hélène Legardeur
- Service d'obstétrique, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Lucie Favre
- Service d'endocrinologie, diabétologie et métabolisme, Centre hospitalier universitaire vaudois, 1011 Lausanne
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Mantziari S, Elliott JA, Markar SR, Klevebro F, Goense L, Johar A, Lagergren P, Zaninotto G, van Hillegersberg R, van Berge Henegouwen MI, Schäfer M, Nilsson M, Hanna GB, Reynolds JV. Sex-related differences in oncologic outcomes, operative complications and health-related quality of life after curative-intent oesophageal cancer treatment: multicentre retrospective analysis. BJS Open 2024; 8:zrae026. [PMID: 38568850 PMCID: PMC10989878 DOI: 10.1093/bjsopen/zrae026] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Oesophageal cancer, in particular adenocarcinoma, has a strong male predominance. However, the impact of patient sex on operative and oncologic outcomes and recovery of health-related quality of life is poorly documented, and was the focus of this large multicentre cohort study. METHODS All consecutive patients who underwent oncological oesophagectomy from 2009 to 2015 in the 20 European iNvestigation of SUrveillance after Resection for Esophageal cancer study group centres were assessed. Clinicopathologic variables, therapeutic approach, postoperative complications, survival and health-related quality of life data were compared between male and female patients. Multivariable analyses adjusted for age, sex, tumour histology, treatment protocol and major complications. Specific subgroup analyses comparing adenocarcinoma versus squamous cell cancer for all key outcomes were performed. RESULTS Overall, 3974 patients were analysed, 3083 (77.6%) male and 891 (22.4%) female; adenocarcinoma was predominant in both groups, while squamous cell cancer was observed more commonly in female patients (39.8% versus 15.1%, P < 0.001). Multivariable analysis demonstrated improved outcomes in female patients for overall survival (HRmales 1.24, 95% c.i. 1.07 to 1.44) and disease-free survival (HRmales 1.22, 95% c.i. 1.05 to 1.43), which was caused by the adenocarcinoma subgroup, whereas this difference was not confirmed in squamous cell cancer. Male patients presented higher health-related quality of life functional scores but also a higher risk of financial problems, while female patients had lower overall summary scores and more persistent gastrointestinal symptoms. CONCLUSION This study reveals uniquely that female sex is associated with more favourable long-term survival after curative treatment for oesophageal cancer, especially adenocarcinoma, although long-term overall and gastrointestinal health-related quality of life are poorer in women.
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Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Jessie A Elliott
- Trinity St. James’s Cancer Institute, Trinity College Dublin, and St. James’s Hospital, Dublin, Ireland
| | - Sheraz R Markar
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | | | - Lucas Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Asif Johar
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Lagergren
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | | | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Magnus Nilsson
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
- CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College, London, UK
| | - John V Reynolds
- Trinity St. James’s Cancer Institute, Trinity College Dublin, and St. James’s Hospital, Dublin, Ireland
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Mantziari S, Teixeira Farinha H, Messier M, Winiker M, Allemann P, Ozsahin EM, Demartines N, Piessen G, Schäfer M. ASO Visual Abstract: Low-Dose Radiation Yields Lower Rates of Pathologic Response in Esophageal Cancer Patients. Ann Surg Oncol 2024:10.1245/s10434-024-15032-2. [PMID: 38358609 DOI: 10.1245/s10434-024-15032-2] [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: 02/16/2024]
Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Marguerite Messier
- Department of Digestive and Oncological Surgery, CHU Lille, Lille, France
| | - Michael Winiker
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Pierre Allemann
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Esat Mahmut Ozsahin
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
- Department of Radiation Oncology, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, CHU Lille, Lille, France
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne UNIL, Lausanne, Switzerland.
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10
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Boubaddi M, Teixeira Farinha H, Lambert C, Pereira B, Piessen G, Gualtierotti M, Voron T, Mantziari S, Pezet D, Gronnier C. ASO Visual Abstract: Total Versus Subtotal Gastrectomy for Distal Gastric Poorly Cohesive Carcinoma. Ann Surg Oncol 2024; 31:814-815. [PMID: 37978106 DOI: 10.1245/s10434-023-14571-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Mehdi Boubaddi
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Bordeaux, France
| | - Hugo Teixeira Farinha
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Bordeaux, France
- Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Department of Digestive Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Department of Digestive Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Monica Gualtierotti
- Division of Minimally Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Thibault Voron
- Department of General and Digestive Surgery, Saint-Antoine Hospital, Paris, France
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Denis Pezet
- Bordeaux University Hospital, U1312 Bordeaux Institute of Oncology, INSERM, Bordeaux, France
| | - Caroline Gronnier
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Bordeaux, France.
- Bordeaux University Hospital, U1312 Bordeaux Institute of Oncology, INSERM, Bordeaux, France.
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11
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Chapellier P, Fasquelle F, Saglietti C, Kinj R, Mantziari S, Schäfer M, Haefliger L, Jreige M, Vietti Violi N, Sempoux C, Dromain C. Prospective evaluation of MR-TRG (Tumor Regression Grade) in esophageal cancer after neo-adjuvant therapy: Preliminary results. Eur J Radiol 2024; 171:111263. [PMID: 38159523 DOI: 10.1016/j.ejrad.2023.111263] [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: 09/13/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To develop MRI-based criteria to assess tumor response to neoadjuvant therapies (NAT) of esophageal cancers (EC) and to evaluate its diagnostic performance in predicting the pathological Tumor Regression Grade (pTRG). METHOD From 2018 to 2022, patients with newly diagnosed locally advanced EC underwent MRI examinations for initial staging and restaging after NAT. Magnetic Resonance TRG (MR-TRG), equivalent to the Mandard and Becker classifications, were developed and independently assessed by two radiologists, blinded to pTRG, using T2W and DW-MR Images. All patients underwent surgery and benefited from a blinded pTRG evaluation by two pathologists. The agreement between readers and between MR-TRG and pTRG were assessed with Cohen's Kappa. The correlation of MR-TRG and pTRG was determined using Spearman's correlation. RESULTS 28 patients were included. Interrater agreement was substantial between radiologists, improved when grouping grade 1 and 2 (κ = 0.78 rose to 0,84 for Mandard and 0.68 to 0,78 for Becker score). Agreement between pTRG and MR-TRG was moderate with a percentaged agreement (p) = 87.5 %, kappa (κ) = 0.54 and p = 83.3 %, κ = 0.49 for Mandard and Becker, respectively. Agreement was improved to substantial when grouping grades 1-2 for Mandard and 1a-1b for Becker with p = 89.3 %, κ = 0.65 and p = 85.2 %, κ = 0.65 respectively. Sensitivity and specificity of MR-TRG in predicting pTRG were 88.2 % and 72.7 % for Mandard system (scores 1-2 versus 3-5), and 83.3 % and 80 % for Becker system (scores 1a-1b versus 2-3). CONCLUSION A substantial agreement between MR-TRG and pTRG was achieved when grouping grade 1-2. Hence, MR-TRG could be used as a surrogate of complete and near-complete pTRG.
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Affiliation(s)
- Pauline Chapellier
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - François Fasquelle
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Chiara Saglietti
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rémy Kinj
- Service of radiation oncology, Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laura Haefliger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mario Jreige
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Naïk Vietti Violi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Clarisse Dromain
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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12
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Boubaddi M, Teixeira Farinha H, Lambert C, Pereira B, Piessen G, Gualtierotti M, Voron T, Mantziari S, Pezet D, Gronnier C. Total Versus Subtotal Gastrectomy for Distal Gastric Poorly Cohesive Carcinoma. Ann Surg Oncol 2024; 31:744-752. [PMID: 37971616 DOI: 10.1245/s10434-023-14496-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: 07/13/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Gastric poorly cohesive carcinoma (PCC) in advanced stages has a poor prognosis. Total gastrectomy (TG) remains the common treatment for distal gastric PCC, but subtotal gastrectomy (SG) may improve quality of life without compromising outcomes. Currently, no clear recommendation on the best surgical strategy for distal PCC is available. This study aimed to compare overall survival (OS) and disease-free survival (DFS) at 5 years for patients with antropyloric PCC treated by total versus subtotal gastrectomy. METHODS A large retrospective European multicenter cohort study analyzed 2131 patients treated for gastric cancer between 2007 and 2017 by members of the French Association of Surgery (AFC). The study compared a group of patients who underwent TG with a group who underwent SG for antropyloric PCC. The primary outcomes were 5 year OS and DFS. RESULTS The study enrolled 269 patients: 140 (52.0%) in the TG group and 129 (48.0%) in the SG group. The baseline characteristics and pTNM stage were similar between the two groups. According to Dindo-Claven classification, the patients treated with TG had more postoperative complications than the patients treated with SG (p < 0.001): grades I to IIIa (77.1% vs 59.5%) and grades IIIb to IVb (14.4% vs 9.0%). No difference in 5-year OS was observed between TG (53.8%; 95 % confidence interval [CI], 43.2-63.3%) and SG (53.0%; 95% CI, 41.4-63.3%) (hazard ratio [HR], 0.94; 95% CI, 0.68-1.29). The same was observed for 5-year DFS: TG (46.0%; 95% CI, 35.9-55.5%) versus SG (45.3%; 95% CI, 34.3-55.6%) (HR, 0.97; 95% CI, 0.70-1.34). CONCLUSIONS At 5 years, SG was not associated with worse OS and DFS than TG for distal PCC. Surgical morbidity was higher after TG. Subtotal gastrectomy is a valuable option for distal PCC gastric cancer.
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Affiliation(s)
- Mehdi Boubaddi
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Bordeaux, France
| | - Hugo Teixeira Farinha
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Bordeaux, France
- Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Department of Digestive Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Department of Digestive Surgery, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Monica Gualtierotti
- Division of Minimally Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Thibault Voron
- Department of General and Digestive Surgery, Saint-Antoine Hospital, Paris, France
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital of Lausanne, CHUV, Lausanne, Switzerland
| | - Denis Pezet
- Bordeaux University Hospital, U1312 Bordeaux Institute of Oncology, INSERM, Bordeaux, France
| | - Caroline Gronnier
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, Bordeaux, France.
- Bordeaux University Hospital, U1312 Bordeaux Institute of Oncology, INSERM, Bordeaux, France.
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13
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Elliott JA, Klevebro F, Mantziari S, Markar SR, Goense L, Johar A, Lagergren P, Zaninotto G, van Hillegersberg R, van Berge Henegouwen MI, Schäfer M, Nilsson M, Hanna GB, Reynolds JV. Neoadjuvant Chemoradiotherapy Versus Chemotherapy for the Treatment of Locally Advanced Esophageal Adenocarcinoma in the European Multicenter ENSURE Study. Ann Surg 2023; 278:692-700. [PMID: 37470379 DOI: 10.1097/sla.0000000000006018] [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: 07/21/2023]
Abstract
OBJECTIVE This study aimed to compare clinicopathologic, oncologic, and health-related quality of life (HRQL) outcomes following neoadjuvant chemoradiation (nCRT) and chemotherapy (nCT) in the ENSURE international multicenter study. BACKGROUND nCT and nCRT are the standards of care for locally advanced esophageal cancer (LAEC) treated with curative intent. However, no published randomized controlled trial to date has demonstrated the superiority of either approach. METHODS ENSURE is an international multicenter study of consecutive patients undergoing surgery for LAEC (2009-2015) across 20 high-volume centers (NCT03461341). The primary outcome measure was overall survival (OS), secondary outcomes included histopathologic response, recurrence pattern, oncologic outcome, and HRQL in survivorship. RESULTS A total of 2211 patients were studied (48% nCT, 52% nCRT). pCR was observed in 4.9% and 14.7% ( P <0.001), with R0 in 78.2% and 94.2% ( P <0.001) post nCT and nCRT, respectively. Postoperative morbidity was equivalent, but in-hospital mortality was independently increased [hazard ratio (HR)=2.73, 95% CI: 1.43-5.21, P= 0.002] following nCRT versus nCT. Probability of local recurrence was reduced (odds ratio=0.71, 95% CI: 0.54-0.93, P =0.012), and distant recurrence-free survival time reduced (HR=1.18, 95% CI: 1.02-1.37, P =0.023) after nCRT versus nCT, with no difference in OS among all patients (HR=1.10, 95% CI: 0.98-1.25, P =0.113). On subgroup analysis, patients who underwent R0 resection following nCT as compared with nCRT had improved OS (median: 60.7 months, 95% CI: 49.5-71.8 vs 40.8 months, 95% CI: 42.8-53.4, P <0.001). CONCLUSIONS In this European multicenter study, nCRT compared with nCT was associated with reduced probability of local recurrence but reduced distant recurrence-free survival for patients with LAEC, without differences in OS. These data support tailored patient-specific decision-making in the overall approach to achieving optimum outcomes in LAEC.
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Affiliation(s)
- Jessie A Elliott
- Trinity St. James's Cancer Institute, Trinity College Dublin, and St. James's Hospital, Dublin, Ireland
| | - Fredrik Klevebro
- CLINTEC, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Styliani Mantziari
- Lausanne University Hospital CHUV and University of Lausanne UNIL, Lausanne, Switzerland
| | - Sheraz R Markar
- Surgical Interventional Trials Unit, Nuffield Department of Surgery, University of Oxford, Oxford, UK
- Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Lucas Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Asif Johar
- Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Giovanni Zaninotto
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Markus Schäfer
- Lausanne University Hospital CHUV and University of Lausanne UNIL, Lausanne, Switzerland
| | - Magnus Nilsson
- CLINTEC, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| | - John V Reynolds
- Trinity St. James's Cancer Institute, Trinity College Dublin, and St. James's Hospital, Dublin, Ireland
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14
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Gaspar-Figueiredo S, Allemann P, Borgstein ABJ, Joliat GR, Luzuy-Guarnero V, Brunel C, Sempoux C, Gisbertz SS, Demartines N, van Berge Henegouwen MI, Schäfer M, Mantziari S. Impact of positive microscopic resection margins (R1) after gastrectomy in diffuse-type gastric cancer. J Cancer Res Clin Oncol 2023; 149:11105-11115. [PMID: 37344606 PMCID: PMC10465620 DOI: 10.1007/s00432-023-04981-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/10/2023] [Indexed: 06/23/2023]
Abstract
INTRODUCTION Diffuse-type gastric cancer (DTGC) is associated with poor outcome. Surgical resection margin status (R) is an important prognostic factor, but its exact impact on DTGC patients remains unknown. The aim of this study was to assess the prognostic value of microscopically positive margins (R1) after gastrectomy on survival and tumour recurrence in DTGC patients. METHODS All consecutive DTGC patients from two tertiary centers who underwent curative oncologic gastrectomy from 2005 to 2018 were analyzed. The primary endpoint was overall survival (OS) for R0 versus R1 patients. Secondary endpoints included disease-free survival (DFS), recurrence patterns as well as the overall survival benefit of chemotherapy in this DTGC patient cohort. RESULTS Overall, 108 patients were analysed, 88 with R0 and 20 with R1 resection. Patients with negative lymph nodes and negative margins (pN0R0) had the best OS (median 102 months, 95% CI 1-207), whereas pN + R0 patients had better median OS than pN + R1 patients (36 months 95% CI 13-59, versus 7 months, 95% CI 1-13, p < 0.001). Similar findings were observed for DFS. Perioperative chemotherapy offered a median OS of 46 months (95% CI 24-68) versus 9 months (95% CI 1-25) after upfront surgery (p = 0.022). R1 patients presented more often early recurrence (< 12 postoperative months, 30% vs 8%, p = 0.002), however, no differences were observed in recurrence location. CONCLUSION DTGC patients with microscopically positive margins (R1) presented poorer OS and DFS, and early tumour recurrence in the present series. R0 resection should be obtained whenever possible, even if other adverse biological features are present.
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Affiliation(s)
- Sérgio Gaspar-Figueiredo
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, 1011, Lausanne, Switzerland
| | - Pierre Allemann
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Alexander B J Borgstein
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, 1011, Lausanne, Switzerland
| | - Valentine Luzuy-Guarnero
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Christophe Brunel
- Faculty of Biology and Medicine, University of Lausanne UNIL, 1011, Lausanne, Switzerland
- Department of Pathology, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Christine Sempoux
- Faculty of Biology and Medicine, University of Lausanne UNIL, 1011, Lausanne, Switzerland
- Department of Pathology, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Suzanne Sarah Gisbertz
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, 1011, Lausanne, Switzerland
| | - Mark Ivo van Berge Henegouwen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine, University of Lausanne UNIL, 1011, Lausanne, Switzerland.
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne UNIL, 1011, Lausanne, Switzerland
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15
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Haefliger L, Jreige M, Du Pasquier C, Ledoux JB, Wagner D, Mantziari S, Shäfer M, Vietti Violi N, Dromain C. Esophageal cancer T-staging on MRI: A preliminary study using cine and static MR sequences. Eur J Radiol 2023; 166:111001. [PMID: 37516096 DOI: 10.1016/j.ejrad.2023.111001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES To evaluate the added value of cine MR in addition to static MRI for T-Staging assessment of esophageal cancer (EC). MATERIALS AND METHODS This prospective monocentric study included 54 patients (mean age 66.3 ± 9.4 years, 46 men) with histologically proven EC. They underwent MRI on a 3 T-scanner in addition to the standard workup. Acquisitions included static and cine sequences (steady-state-free-precession and real-time True-FISP during water ingestion). Three radiologists independently assessed T-staging and diagnosis confidence by reviewing (1) static sequences (S-MRI) and (2) adding cine sequences (SC-MRI). Inter-reader agreement was performed. MRI T-staging was correlated to reference standard T-staging (histopathology or consensus on endoscopic ultrasonography and imaging findings) and to clinical outcome by log-rank test. RESULTS Both S-MRI and SC-MRI T-staging showed a significant correlation with reference T-staging (rs = 0.667, P < 0.001). SC-MRI showed a slightly better performance in distinguishing T1-T3 from T4 with a sensitivity, specificity and AUC of 76.5% (95% CI: 50.1-93.2), 83.8% (68-93.8) and 0.801 (0.681-0.921) vs 70.6% (44-89.7), 83% (68-93.8) and 0.772 (0.645-0.899) for S-MRI. Compared to S-MRI, SC-MRI increased inter-reader agreement for T4a and T4b (κ = 0.403 and 0.498) and T-staging confidence. CONCLUSION MRI is accurate for T-staging of EC. The addition of cine sequences allows better differentiation between T1-T3 and T4 tumors with increased diagnostic confidence and inter-reader agreement.
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Affiliation(s)
- Laura Haefliger
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Mario Jreige
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Céline Du Pasquier
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Jean-Baptiste Ledoux
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Dorothea Wagner
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Styliani Mantziari
- Department of Surgery, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Markus Shäfer
- Department of Surgery, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Naïk Vietti Violi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Clarisse Dromain
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
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16
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Teixeira Farinha H, Bouriez D, Grimaud T, Rotariu AM, Collet D, Mantziari S, Gronnier C. Gastro-Intestinal Disorders and Micronutrient Deficiencies following Oncologic Esophagectomy and Gastrectomy. Cancers (Basel) 2023; 15:3554. [PMID: 37509216 PMCID: PMC10376982 DOI: 10.3390/cancers15143554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Primary surgical indications for the esophagus and stomach mainly involve cancer surgeries. In recent years, significant progress has been made in the field of esogastric surgery, driven by advancements in surgical techniques and improvements in perioperative care. The rate of resectability has increased, and surgical strategies have evolved to encompass a broader patient population. However, despite a reduction in postoperative mortality and morbidity, malnutrition remains a significant challenge after surgery, leading to weight loss, muscle mass reduction, and deficiencies in essential nutrients due to digestive complications. Malnutrition worsens quality of life and increases the risk of tumor recurrence, significantly affecting prognosis. Nevertheless, the nutritional consequences following surgery are frequently overlooked, mainly due to a lack of awareness regarding their long-term effects on patients who have undergone digestive surgery, extending beyond six months. Micronutrient deficiencies are frequently observed following both partial and total gastrectomy, as anticipated. Surprisingly, these deficiencies appear to be similarly prevalent in patients who have undergone esophagectomy with iron, vitamins A, B1, B12, D, and E deficiencies commonly observed in up to 78.3% of the patients. Recognizing the distinct consequences associated with each type of intervention underscores the importance of implementing preventive measures, early detection, and prompt management.
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Affiliation(s)
- Hugo Teixeira Farinha
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600 Pessac, France
- Department of Visceral Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Damien Bouriez
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600 Pessac, France
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Thomas Grimaud
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600 Pessac, France
| | - Ana-Maria Rotariu
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600 Pessac, France
| | - Denis Collet
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600 Pessac, France
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Caroline Gronnier
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600 Pessac, France
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
- Faculty of Medicine, Bordeaux Ségalen University, 33000 Bordeaux, France
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17
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Lüscher A, Vionnet N, Amiguet M, Chartoumpekis D, Mantziari S, Frantz J, Favre L. Impact of Preoperative Psychiatric Profile in Bariatric Surgery on Long-term Weight Outcome. Obes Surg 2023; 33:2072-2082. [PMID: 37145292 PMCID: PMC10289928 DOI: 10.1007/s11695-023-06595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Conflicting results have been reported regarding the predictive value of preoperative psychological assessment and weight outcome after bariatric surgery. This might be attributed to different factors affecting early weight loss and long-term weight loss. Herein, we investigated whether preoperative psychiatric profile was associated with preoperative BMI and with both early (1 year) and long-term (5 years) weight loss after Roux-en-Y gastric bypass (RYGB). METHODS Prospective observational cohort study of patients undergoing RYGB between 2013 and 2019. Symptoms related to anxiety, depression, eating disorder, and alcohol use disorders were assessed by employing validated, specific psychometric tests (STAI-S/T, BDI-II, BITE, AUDIT-C) prior to surgery. Pre-operative BMI, early weight loss (1 year), and long-term weight evolution (up to 5 years) were registered. RESULTS Two hundred thirty six patients (81% women) were included in the present study. Linear longitudinal mixed model showed a significant effect of preoperative high anxiety (STAI-S) on long-term weight outcome, after controlling for gender, age and type 2 diabetes. Patient with high preoperative anxiety score regained weight faster than those experiencing low anxiety (each year percent excess BMI loss (%EBMIL) - 4.02%, ± 1.72, p = 0.021). No other pre-operative psychiatric symptoms have been shown to have an impact on long-term weight loss. In addition, no significant association was found between any of the pre-operative psychiatric variables and pre-operative BMI, or early weight loss (%EBMIL) at 1-year post-RYGB. CONCLUSION Herein we identified high anxiety score (STAI-S) as a predictor for long-term weight regain. Thus, long-term psychiatric surveillance of these patients and the development of tailored management tools could serve as a means to prevent weight regain.
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Affiliation(s)
- Anouk Lüscher
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nathalie Vionnet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael Amiguet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Dionysios Chartoumpekis
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Styliani Mantziari
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Service of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Johanna Frantz
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Liaison Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Lucie Favre
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
- Centre Hospitalier Universitaire Vaudois, CHUV, Division of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Rue St Martin 3, CH-1003, Lausanne, Switzerland.
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18
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Mantziari S, Abboretti F, Favre L, Thomopoulos T, Barigou M, Demartines N, Suter M. Protein malnutrition after Roux-en-Y gastric bypass: a challenging case and scoping review of the literature. Surg Obes Relat Dis 2023; 19:746-754. [PMID: 36702647 DOI: 10.1016/j.soard.2022.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/08/2022] [Revised: 12/10/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022]
Abstract
Although protein malnutrition (PM) is often reported after highly malabsorptive procedures, its exact incidence and mechanisms after Roux-en-Y gastric bypass (RYGB) are poorly understood. The aim of this study was to present a challenging clinical case of PM after RYGB and conduct a scoping review of the literature. Among the 18 studies with 3015 RYGB patients included in the review, the median incidence of PM was 1.7% (range, 0%-8.9%), and it was diagnosed 12 to 120 months after RYGB. The most common cause is insufficient oral intake of protein; however, in cases of persistent hypoalbuminemia, a thorough diagnostic workup needs to be performed. Risk factors for PM after RYGB include specific triggering events such as intractable vomiting and dysphagia, and a total alimentary limb length less than 250 to 300 cm.
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Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland
| | - Francesco Abboretti
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland
| | - Lucie Favre
- Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland; Division of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Theodoros Thomopoulos
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mohammed Barigou
- Division of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland
| | - Michel Suter
- Department of Visceral Surgery, Lausanne University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland; Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland.
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Adisa A, Bahrami-Hessari M, Bhangu A, George C, Ghosh D, Glasbey J, Haque P, Ingabire JCA, Kamarajah SK, Kudrna L, Ledda V, Li E, Lillywhite R, Mittal R, Nepogodiev D, Ntirenganya F, Picciochi M, Simões JFF, Booth L, Elliot R, Kennerton AS, Pettigrove KL, Pinney L, Richard H, Tottman R, Wheatstone P, Wolfenden JWD, Smith A, Sayed AE, Goswami AG, Malik A, Mclean AL, Hassan A, Nazimi AJ, Aladna A, Abdelgawad A, Saed A, Abdelmageed A, Ghannam A, Mahmoud A, Alvi A, Ismail A, Adesunkanmi A, Ebrahim A, Al-Mallah A, Alqallaf A, Durrani A, Gabr A, Kirfi AM, Altaf A, Almutairi A, Sabbagh AJ, Ajiya A, Haddud A, Alnsour AAM, Singh A, Mittal A, Semple A, Adeniran A, Negussie A, Oladimeji A, Muhammad AB, Yassin A, Gungor A, Tarsitano A, Soibiharry A, Dyas A, Frankel A, Peckham-Cooper A, Truss A, Issaka A, Ads AM, Aderogba AA, Adeyeye A, Ademuyiwa A, Sleem A, Papa A, Cordova A, Appiah-Kubi A, Meead A, Nacion AJD, Michael A, Forneris AA, Duro A, Gonzalez AR, Altouny A, Ghazal A, Khalifa A, Ozair A, Quzli A, Haddad A, Othman AF, Yahaya AS, Elsherbiny A, Nazer A, Tarek A, Abu-Zaid A, Al-Nusairi A, Azab A, Elagili A, Elkazaz A, Kedwany A, Nuhu AM, Sakr A, Shehta A, Shirazi A, Mohamed AMI, Sherif AE, Awad AK, Abbas AM, Abdelrahman AS, Ammar AS, Azzam AY, Ciftci AB, Dural AC, Sanli AN, Rahy-Martín AC, Tantri AR, Khan A, Al-Touny A, Tariq A, Gmati A, Costas-Chavarri A, Auerkari A, Landaluce-Olavarria A, Puri A, Radhakrishnan A, Ubom AE, Pradhan A, Turna A, Adepiti A, Kuriyama A, Kassam AF, Hassouneh A, El-Hussuna A, Habeebullah A, Ads AM, Mousli A, Biloslavo A, Hoang A, Kirk A, Santini A, Melero AV, Calvache AJN, Baduell A, Chan A, Abrate A, Balduzzi A, Sánchez AC, Navarrete-Peón A, Porcu A, Brolese A, Barranquero AG, Saibene AM, Adam AA, Vagge A, Maquilón AJ, Leon-Andrino A, Sekulić A, Trifunovski A, Mako A, Bedada AG, Broglia A, Coppola A, Giani A, Grandi A, Iacomino A, Moro A, D’amico A, Malagnino A, Tang A, Doyle A, Alfieri A, Haynes A, Wilkins A, Baldwin A, Heriot A, Laird A, Lazarides A, O'connor A, Trulson A, Rokohl AC, Caziuc A, Triantafyllou A, Anesi A, Nikova A, Andrianakis A, Charalabopoulos A, Tsolakidis A, Chirca A, Arnaud AP, Narvaez-Rojas AR, Kavalakat A, Spina A, Recordare A, Annicchiarico A, Conti A, Mohammed AD, Kocataş A, Almhimid A, Arnaout A, Fahmy A, Mangi A, Modabber A, Ulas AB, Mohamedahmed AYY, Frontali A, Moynihan A, Yunus A, Ahmad A, Kent AJ, Khamees A, Ugwu AO, Turan A, Mohammed AAK, Navarro-Barrios A, Yebes A, De Sousa ÁFL, Moreno A, Sethi A, Dawson AC, Othman AAA, Kaur A, Wolde A, Antonelli A, Scifo A, Alhamad A, Davis A, Alderazi A, Harky A, Mohammed-Durosinlorun A, Seguya A, Okhakhu A, Chamakhi A, Sebai A, Souadka A, Asla A, Agrawal A, Persad A, Gupta A, Elgazar A, Kulkarni A, Coates A, Bellés AC, Hadzibegovic AD, Jotic A, Kowark A, Martins A, Pineda AM, Peral A, Gollarte AS, Senent-Boza A, Camarena AIA, Castaño-Leon AM, Bravo AMM, Moro AMG, Musina AM, Tapia-Herrero AM, Kothari A, Gupta A, Raja A, Aljaiuossi A, Taha A, Majbar AM, Prodromidou A, Kanatas A, Gupte A, Zakaria AD, Balla A, Barberis A, Bondurri A, Bottari A, Costantino A, Figus A, Lauretta A, Mingoli A, Romanzi A, Sagnotta A, Scacchi A, Picchetto A, Valadez AEC, Luzzi AP, Älgå A, Fontalis A, Hecker A, Demetriades AK, Serban AM, Văcărașu AB, Cokan A, Isaza-Restrepo A, Beamish A, Schache A, Stevenson A, Yiu A, Cockbain AJ, Litvin A, Abad-Motos A, Becerra A, Ramos ÁC, Chiaradia A, Dell A, Romano A, Pascale A, Marra AA, Dimas A, Kolias A, Cerovac A, Koneru A, Tidjane A, Agbeko AE, Bajaj A, Gosain A, Allan A, Carreras-Castañer A, D'amore A, Dare A, Maffioli A, Palepa A, Paspala A, Konney A, Gatta AND, Ezanno AC, Yiallourou A, Kinnair A, Rayner A, Scafa AK, Bowan AB, Veglia A, Russo A, Maniaci A, Castaldi A, Gil-Moreno A, Maffuz-Aziz A, Meola A, Nenna A, Ferrer AP, Bonilla AR, Ramos-De La Medina A, Infante AR, Santoro A, Laganà AS, Bateman A, Michael ALR, Abozid A, Seidu AS, Lowery A, Tantraworasin A, Rasheed A, Picciariello A, Isik A, Saif A, Anjum A, Ioannidis A, Abeldaño A, Hussain A, Nathan A, Bedzhanyan A, Perfecto A, De Virgilio A, Galvan A, Sablotzki A, Böttcher A, Pellacani A, Gatti A, Ibrahimli A, Menon A, Sahni A, Mwenda AS, Choudhry A, Jayawardane A, Gupta A, Ramasamy A, Mitul AR, Bawa A, Nugur A, Rammohan A, Sachdeva A, Mehraj A, Yildirim A, Alqaseer A, Radwan A, Sallam A, Syllaios A, Tampakis A, Alwael A, Samara A, Eroglu A, Rahman A, Ulkucu A, Zaránd A, Dulskas A, Tawiah A, Zani A, Vas A, Lukosiute-Urboniene A, Adamu A, Aujayeb A, Malik AA, İplikçi A, Mahmud A, Cil AP, Makanjuola A, Akwaisah A, Galandarova A, Saracoglu A, Regan A, Barlas AM, Alhassan BAB, Mostafa B, Hamida BB, Torun BC, Abdullah B, Balagobi B, Banky B, Singh B, Alegbeleye B, Yigit B, Hajjaj BN, Burgos-Blasco B, Seeliger B, Alayande B, Alhazmi B, Enodien B, Torre B, Pérez BG, Tamayo BV, De Andrés-Asenjo B, Quintana-Villamandos B, Girgin B, Barmayehvar B, Beisenov B, Creavin B, Dunne B, Marson B, Waterson B, Martin B, Zucker B, Wong BNX, Ozmen BB, Hammond B, Mbwele B, Núñez B, Dhondt B, Gafsi B, Mcleish B, Lieske B, Tailor B, La Pira B, Picardi B, Zampogna B, Casagranda B, Festa BM, Panda B, Kirmani B, Sulaiman B, Gurung B, Zacharia B, Bette B, Ayana B, Nikolovska B, Vilaró BC, De Vega Sánchez B, Hameed BZ, Diaconescu B, Kovacevic B, Bumber B, Sakakushev B, Tadic B, Malek B, Alrayes B, Thomas B, Gális B, Gallagher B, Knowles B, Cunningham B, Daley B, Mishra B, Ashford B, Pirozzi BM, Berselli B, Martinez-Leo B, Sensi B, Nardo B, Celik B, Giray B, Abud B, Almiqlash B, Pramesh CS, Taskiran C, De Campos Prado CA, Cipolla C, Kumar C, English C, Riccetti C, Vanni C, Brasset C, Downey C, Duffy C, Chwat C, Cutmore C, Sars C, Ratto C, Pacilio CA, De La Infiesta García C, Moreno CG, Magalhães C, Prada C, Zapata CS, Senni C, Flumignan CDQ, Martinez-Perez C, Duarte CL, Garcia CSR, Anderson C, Hing C, Cullinane C, Cina C, Zabkiewicz C, Sohrabi C, Guldogan CE, Ciubotaru C, Desai C, Raut C, Demetriou C, Handford C, Okpani C, Paranjape C, Koh C, Khatri C, Parmar C, Mok CW, Caricato C, Marafante C, Echieh CP, Tan CY, Ong CS, Conso C, Jardinez C, Konrads C, Warner C, Makwe CC, Henein C, Fleming C, Roland CL, Maurus C, Nitschke C, Mittermair C, Mallmann C, Andro C, Harmston C, Kuppler C, Lotz C, Nahm C, Rowe C, Ryalino C, Wallis C, Millward CP, Anthoulakis C, Apostolou C, Chouliaras C, Kalfountzos C, Kaselas C, Vosinakis C, Okereke C, Chean CS, Barlow C, Tatar C, Clancy C, Forde C, Sharpin C, Mccarthy C, Nestor C, Warden C, Ávila CC, Massaguer C, Fang CEH, Martins CP, Guerci C, Mauriello C, Holzmeister C, Miller C, Weber C, Wiesinger CG, Kenington C, Noel C, Sue-Chue-Lam C, Adumah C, Neary C, Sen C, Fitzgerald C, Ezeme C, Nastos C, Mesina C, Bombardini C, Torregrosa C, Valdespino CP, Don CP, Wickramasinghe D, Milanesi D, Armijos D, Asiimwe D, Beswick D, Clerc D, Cox D, Doherty D, Martínez DF, Lechuga DG, Gero D, Gil-Sala D, Lindegger D, Reim D, Shaerf D, Shmukler D, Branzan D, Filipescu D, Rega D, Bernardi D, Bissacco D, Fusario D, Morezzi D, Sabella D, Zimak DM, Vinci D, Sale D, Khan DZ, Thereska D, Andreotti D, Tartaglia D, Abdulai DR, Mukherjee D, Verdi D, Idowu D, John D, Johnson D, Moro-Valdezate D, Naumann D, Omar D, Proud D, Roberts D, Guzmán DS, Watson D, Bergkvist DJ, Lumenta DB, Ferrari D, Rizzo D, Degarege D, Castillo DFC, Douglas D, Wright D, Nanjiani D, Bratus D, Altun D, Sievers D, Vaysburg D, Katechia D, Ghosh D, Azize DA, Rodrigues D, Pachajoa DAP, Hayne D, Mutter D, Raimondo D, Eskinazi D, Sasia D, Corallino D, Muduly D, Grewal D, Hadzhiev D, Peristeri D, Pournaras D, Raptis DA, Angelou D, Haidopoulos D, Magouliotis D, Moris D, Schizas D, Symeonidis D, Tsironis D, Korkolis D, Tatsis D, Thekkinkattil D, Bulian DR, Pandey D, Vatansever D, Parker D, Wiedemann D, Borselle D, Pedini D, Schweitzer D, Venskutonis D, Otokwala J, Adamu KM, Pk P, Garod M, Ellafi AAD, Zivkovic D, Jelovac D, Wijeysundera D, Mcpherson D, Ryan É, Ugwu E, Baidoo EI, Shaddad E, Memişoğlu E, Naranjo EPL, Brodkin E, Segalini E, 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Kalın M, Kurawa M, Dincer MB, Tolani MA, Soytas M, Yakubu M, Usman MI, Aremu M, Paranyak M, Talat N, Kausar N, Dudi-Venkata N, Bazzi N, Hasan NB, Van Wyk NN, Shaban N, Almgla N, Kandevani NY, Alzerwi N, Alvarez N, Motas N, Rincón NAR, Blencowe N, Simon N, Aghtarafi N, Ghuman NK, Sharma N, Wijekoon N, Kumar N, Hassan N, Onyemaechi N, Prijović N, Özçay N, Goel N, Segaren N, Sharma N, Kalyva N, Palacios NM, Alonso NFP, Onyeagwara N, Petrucciani N, Daddi N, Lightfoot N, Power N, Segaren N, Starr N, Dreger NM, Cillara N, Colucci N, Eardley N, Tartaglia N, Zanini N, Bacalbasa N, Campuzano N, Mouawad N, Federico NSP, Tamini N, Mariani NM, Beasley N, Adu-Aryee NA, Burlov N, Dimitrokallis N, Gouvas N, Machairas N, Memos N, Thomakos N, Tsakiridis N, Schizas N, Börner N, Theochari N, Al-Saadi N, Glass N, Horesh N, R NE, Gahlot N, Ismail N, Aljirdabi N, Maria NUH, Trabulsi N, Akeel N, Borges N, Moda N, Redondo NV, Nyarko OO, Ginghina O, Enciu O, Okere O, Ekwunife OH, Quadri O, Ogundoyin O, Tucker 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P, Choong P, Elbe P, Hutchinson P, Labib P, Paal P, Pockney P, Reemst P, Szatmary P, Vaughan-Shaw PG, Alexander P, Pucher P, Stather P, Foessleitner P, Winnand P, Zehnder P, Kruse P, Matos PAW, Lapolla P, Cicerchia PM, Solli P, Di Lascio P, Zarif P, Champagne PO, Anoldo P, Bertoglio P, Fransvea P, Familiari P, Lombardi PM, Stogowski PT, Bruzzaniti P, Tripathi P, D'sa P, Salunke P, Shah PA, Punjabi PPP, Christodoulou P, Hamdan Q, Tawalbeh R, Gadelkareem R, Awad R, Callcut R, Clegg R, Choron R, Payne R, Gefen R, Costea R, Drasovean R, Mirica RM, Ravindra R, Fajardo RT, Nunes RL, Aspide R, Lombardi R, Vidya R, Elboraei R, Saaid R, Ghodke R, Gupta R, Sharma RD, Lunevicius R, Kalayarasan R, Mohan R, Singh R, Sivaprakasam R, Seenivasagam RK, Rajendram R, Radulescu RB, Goicea R, Seshadri RA, Sarı R, Nataraja R, Aslam R, Abdelemam R, Shrestha R, Bharathan R, Pellini R, Guevara R, Agarwal R, Vissapragada R, Alharmi RA, Sayyed R, Browning R, Critchley R, Mallick R, Alarabi R, Beron RI, Függer R, 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Mittal S, Hirji S, Tebha S, Emile S, Dbouk S, Bandyopadhyay SK, Muhammad S, Olori S, Asirifi SA, Hailu S, Ling S, Newman S, Ross S, Wanjara S, Kumar S, Seneviratne S, Tamburello S, Suarez SB, Ingallinella S, Irshaidat S, Konswa S, Mambrilla S, Nasser S, Parini S, Pitoni S, Ornaghi S, Rodrigues SC, Abdelmohsen S, Aitken S, Tian S, Badiani S, Ahmad S, Swed S, Muthu S, Lakpriya S, Alzahrani S, Mikalauskas S, Lasrado S, Satoskar S, Bawa S, Altiner S, Garcia S, Stevens S, Demir S, Ken-Amoah S, Tranca S, Ziemann S, Awad S, Atici SD, Subramaniam S, Erel S, Jiang S, Efetov S, Efremov S, Katorkin S, Valladares SC, Contreras SM, Meriç S, Zenger S, Safi S, Leventoğlu S, Elsalhawy S, Shaikh S, Sheik S, Islam S, Shamim S, Waqar SH, Ahmad S, Farid S, Seraj SS, Sundarraju S, Karandikar S, Sambhwani S, Chopra S, Chowdhury S, Laura S, Ahmed S, Wason S, Tan SJH, Fraser S, Williams S, Ghozy S, Abdelmawgoud S, Shehata S, Sharma S, Ahmed S, Al-Touny SA, Ramzanali S, Nah SA, Jansen S, Rajan S, Dindyal S, 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Balogh ZJ. Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries. Br J Surg 2023; 110:804-817. [PMID: 37079880 PMCID: PMC10364528 DOI: 10.1093/bjs/znad092] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. METHODS This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. RESULTS In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. CONCLUSION This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
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Frantz J, Mantziari S, Favre L. [Stigmatization of people with obesity: understanding and confronting societal prejudice]. Rev Med Suisse 2023; 19:546-551. [PMID: 36950783 DOI: 10.53738/revmed.2023.19.819.546] [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: 03/24/2023]
Abstract
Obesity (BMI ≥ 30 kg/m2) has been officially classified as a disease by the WHO since 2008, yet individuals affected by obesity often face blame and negative stereotypes from society and healthcare providers. This stigmatization can lead to negative impacts on both mental and physical health. This phenomenon can also lead the stigmatized person to internalize the prejudice, considering their fate as deserved. This article aims to provide healthcare professionals with the tools to better understand and care for patients with obesity.
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Affiliation(s)
- Johanna Frantz
- Service d'endocrinologie, diabétologie et métabolisme, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
- Service de psychiatrie de liaison, Département de psychiatrie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Styliani Mantziari
- Service de chirurgie viscérale, Département de chirurgie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Lucie Favre
- Service d'endocrinologie, diabétologie et métabolisme, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
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Favre L, Frantz J, Mantziari S. [Interdisciplinary Center for Obesity: a single-entry point for personalized care]. Rev Med Suisse 2023; 19:567-571. [PMID: 36950787 DOI: 10.53738/revmed.2023.19.819.567] [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: 03/24/2023]
Abstract
Obesity is a chronic disease that seriously affects physical and psychological health. However, its management is insufficiently coordinated. The lack of defined therapeutic strategies is particularly evident since the arrival of new drug treatments. Coordination between the professionals involved- obesity specialists, general practitioners and other caregivers - and the involvement of the patient are all issues at the heart of an evaluation necessary for the construction of a personalized care project. Interdisciplinary centers must guarantee access to information and offer the full range of therapies currently available. An early psychological evaluation allows for the orientation of care, taking into account the vulnerability and resources of patients.
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Affiliation(s)
- Lucie Favre
- Service d'endocrinologie, diabétologie et métabolisme, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Johanna Frantz
- Service d'endocrinologie, diabétologie et métabolisme, Département de médecine, Centre hospitalier universitaire vaudois, 1011 Lausanne
- Service de physiatrie de liaison, Département de psychiatrie, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Styliani Mantziari
- Service de chirurgie viscérale, Département de chirurgie, Centre hospitalier universitaire vaudois, 1011 Lausanne
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Mantziari S, St Amour P, Abboretti F, Teixeira-Farinha H, Gaspar Figueiredo S, Gronnier C, Schizas D, Demartines N, Schäfer M. A Comprehensive Review of Prognostic Factors in Patients with Gastric Adenocarcinoma. Cancers (Basel) 2023; 15:cancers15051628. [PMID: 36900419 PMCID: PMC10000968 DOI: 10.3390/cancers15051628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/07/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023] Open
Abstract
Gastric adenocarcinoma remains associated with a poor long-term survival, despite recent therapeutical advances. In most parts of the world where systematic screening programs do not exist, diagnosis is often made at advanced stages, affecting long-term prognosis. In recent years, there is increasing evidence that a large bundle of factors, ranging from the tumor microenvironment to patient ethnicity and variations in therapeutic strategy, play an important role in patient outcome. A more thorough understanding of these multi-faceted parameters is needed in order to provide a better assessment of long-term prognosis in these patients, which probably also require the refinement of current staging systems. This study aims to review existing knowledge on the clinical, biomolecular and treatment-related parameters that have some prognostic value in patients with gastric adenocarcinoma.
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Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
- Correspondence: ; Tel.: +41-21-3141-111
| | - Penelope St Amour
- Department of Visceral Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Francesco Abboretti
- Department of Visceral Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Hugo Teixeira-Farinha
- Department of Visceral Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Sergio Gaspar Figueiredo
- Department of Visceral Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Caroline Gronnier
- Oeso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600 Pessac, France
- Faculty of Medicine, Bordeaux Ségalen University, 33000 Bordeaux, France
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
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St-Amour P, Mantziari S, Dromain C, Winiker M, Godat S, Schoepfer A, Demartines N, Schäfer M. Preoperative hiatal hernia in esophageal adenocarcinoma; does it have an impact on patient outcomes? Surg Oncol 2023; 46:101904. [PMID: 36640590 DOI: 10.1016/j.suronc.2023.101904] [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: 08/27/2022] [Revised: 12/17/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND The impact of hiatal hernia (HH) on oncologic outcomes of patients with esophageal adenocarcinoma (AC) remains unclear. The aim of this study was to assess the effect of pre-existing HH (≥3 cm) on histologic response after neoadjuvant treatment (NAT), overall (OS) and disease-free survival (DFS). METHODS All consecutive patients with oncological esophagectomy for AC from 2012 to 2018 in our center were eligible for assessment. Categorical variables were compared with the X2 or Fisher's test, continuous ones with the Mann-Whitney-U test, and survival with the Kaplan-Meier and log-rank test. RESULTS Overall, 101 patients were included; 33 (32.7%) had a pre-existing HH. There were no baseline differences between HH and non-HH patients. NAT was used in 81.8% HH and 80.9% non-HH patients (p = 0.910), most often chemoradiation (63.6% and 57.4% respectively, p = 0.423). Good response to NAT (TRG 1-2) was observed in 36.4% of HH versus 32.4% of non-HH patients (p = 0.297), whereas R0 resection was achieved in 90.9% versus 94.1% respectively (p = 0.551). Three-year OS was comparable for the two groups (52.4% in HH, 56.5% in non-HH patients, p = 0.765), as was 3-year DFS (32.7% for HH versus 45.6% for non-HH patients, p = 0.283). CONCLUSION HH ≥ 3 cm are common in patients with esophageal AC, concerning 32.7% of all patients in this series. However, its presence was neither associated with more advanced disease upon diagnosis, worse response to NAT, nor overall and disease-free survival. Therefore, such HH should not be considered as risk factor that negatively affects oncological outcome after multimodal treatment of esophageal AC.
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Affiliation(s)
- Pénélope St-Amour
- University Hospital of Lausanne, Department of Visceral Surgery, Lausanne, Switzerland
| | - Styliani Mantziari
- University Hospital of Lausanne, Department of Visceral Surgery, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne UNIL, Switzerland.
| | - Clarisse Dromain
- Faculty of Biology and Medicine, University of Lausanne UNIL, Switzerland; University Hospital of Lausanne, Institute of Radiodiagnosis and Interventional Radiology, Lausanne, Switzerland
| | - Michael Winiker
- University Hospital of Lausanne, Department of Visceral Surgery, Lausanne, Switzerland
| | - Sebastien Godat
- Faculty of Biology and Medicine, University of Lausanne UNIL, Switzerland; University Hospital of Lausanne, Division of Gastroenterology and Hepatology, Lausanne, Switzerland
| | - Alain Schoepfer
- Faculty of Biology and Medicine, University of Lausanne UNIL, Switzerland; University Hospital of Lausanne, Division of Gastroenterology and Hepatology, Lausanne, Switzerland
| | - Nicolas Demartines
- University Hospital of Lausanne, Department of Visceral Surgery, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne UNIL, Switzerland
| | - Markus Schäfer
- University Hospital of Lausanne, Department of Visceral Surgery, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne UNIL, Switzerland
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Lázaro-Fontanet E, Deslarzes P, Grass F, Mantziari S, Demartines N, Teixeira Farinha H. [Surgery: what's new in 2022]. Rev Med Suisse 2023; 19:202-206. [PMID: 36723648 DOI: 10.53738/revmed.2023.19.812.202] [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: 02/02/2023]
Abstract
During 2022 a lot of efforts were developed to reduce health-costs by reducing complications and length of hospital stay. Same-day surgery is becoming the standard for all patients scheduled for elective surgery in CHUV. Outpatient colectomy also become a new standard. During 2022, endoscopic bariatric surgery became increasingly used. Not widely performed yet in Switzerland, these treatments deserve to be recognized and considered in various situations. Finally, 2022 saw a promising development of robotic surgery with the acquisition of Da Vinci and Dexter robots after allowing various high-precision surgical procedures.
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Affiliation(s)
- Enrique Lázaro-Fontanet
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Philip Deslarzes
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Fabian Grass
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Styliani Mantziari
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Nicolas Demartines
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Hugo Teixeira Farinha
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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Dietz M, Dunet V, Mantziari S, Pomoni A, Dias Correia R, Testart Dardel N, Boughdad S, Nicod Lalonde M, Treglia G, Schafer M, Schaefer N, Prior JO. Comparison of integrin α vβ 3 expression with 68Ga-NODAGA-RGD PET/CT and glucose metabolism with 18F-FDG PET/CT in esophageal or gastroesophageal junction cancers. Eur J Hybrid Imaging 2023; 7:3. [PMID: 36720731 PMCID: PMC9889587 DOI: 10.1186/s41824-023-00162-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The primary aims of this study were to compare in patients with esophageal or esophagogastric junction cancers the potential of 68Ga-NODAGA-RGD PET/CT with that of 18F-FDG PET/CT regarding tumoral uptake and distribution, as well as histopathologic examination. METHODS Ten 68Ga-NODAGA-RGD and ten 18F-FDG PET/CT were performed in nine prospectively included participants (1 woman; aged 58 ± 8.4 y, range 40-69 y). Maximum SUV (SUVmax) and metabolic tumor volumes (MTV) were calculated. The Mann-Whitney U test and Spearman correlation analysis (ρ) were used. RESULTS 68Ga-NODAGA-RGD PET/CT detected positive uptake in 10 primary sites (8 for primary tumors and 2 for local relapse suspicion), 6 lymph nodes and 3 skeletal sites. 18F-FDG PET/CT detected positive uptake in the same sites but also in 16 additional lymph nodes and 1 adrenal gland. On a lesion-based analysis, SUVmax of 18F-FDG was significantly higher than those of 68Ga-NODAGA-RGD (4.9 [3.7-11.3] vs. 3.2 [2.6-4.2] g/mL, p = 0.014). Only one participant showed a higher SUVmax in an osseous metastasis with 68Ga-NODAGA-RGD as compared to 18F-FDG (6.6 vs. 3.9 g/mL). Correlation analysis showed positive correlation between 18F-FDG and 68Ga-NODAGA-RGD PET parameters (ρ = 0.56, p = 0.012 for SUVmax, ρ = 0.78, p < 0.001 for lesion-to-background ratios and ρ = 0.58, p = 0.024 for MTV). We observed that 18F-FDG uptake was homogenous inside all the confirmed primary sites (n = 9). In contrast, 68Ga-NODAGA-RGD PET showed more heterogenous uptake in 6 out of the 9 confirmed primary sites (67%), seen mostly in the periphery of the tumor in 5 out of the 9 confirmed primary sites (56%), and showed slight extensions into perilesional structures in 5 out of the 9 confirmed primary sites (56%). CONCLUSIONS In conclusion, 68Ga-NODAGA-RGD has lower potential in the detection of esophageal or esophagogastric junction malignancies compared to 18F-FDG. However, the results suggest that PET imaging of integrin αvβ3 expression may provide complementary information and could aid in tumor diversity and delineation. TRIAL REGISTRATION Trial registration: NCT02666547. Registered January 28, 2016-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02666547 .
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Affiliation(s)
- Matthieu Dietz
- grid.8515.90000 0001 0423 4662Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland ,grid.25697.3f0000 0001 2172 4233INSERM U1060, CarMeN Laboratory, University of Lyon, Lyon, France
| | - Vincent Dunet
- grid.8515.90000 0001 0423 4662Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204University of Lausanne, Lausanne, Switzerland
| | - Styliani Mantziari
- grid.9851.50000 0001 2165 4204University of Lausanne, Lausanne, Switzerland ,grid.8515.90000 0001 0423 4662Department of Visceral Surgery, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Anastasia Pomoni
- grid.8515.90000 0001 0423 4662Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Ricardo Dias Correia
- grid.8515.90000 0001 0423 4662Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Nathalie Testart Dardel
- grid.8515.90000 0001 0423 4662Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Sarah Boughdad
- grid.8515.90000 0001 0423 4662Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Marie Nicod Lalonde
- grid.8515.90000 0001 0423 4662Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204University of Lausanne, Lausanne, Switzerland
| | - Giorgio Treglia
- grid.8515.90000 0001 0423 4662Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204University of Lausanne, Lausanne, Switzerland ,grid.469433.f0000 0004 0514 7845Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland ,grid.29078.340000 0001 2203 2861Università Della Svizzera Italiana, Lugano, Switzerland
| | - Markus Schafer
- grid.9851.50000 0001 2165 4204University of Lausanne, Lausanne, Switzerland ,grid.8515.90000 0001 0423 4662Department of Visceral Surgery, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Niklaus Schaefer
- grid.8515.90000 0001 0423 4662Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204University of Lausanne, Lausanne, Switzerland
| | - John O. Prior
- grid.8515.90000 0001 0423 4662Nuclear Medicine and Molecular Imaging Department, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland ,grid.9851.50000 0001 2165 4204University of Lausanne, Lausanne, Switzerland
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Mantziari S, Thomopoulos T, Abboretti F, Gaspar-Figueiredo S, Dayer A, Demartines N, Suter M. Long-term weight loss and metabolic benefit from Roux-en-Y gastric bypass in patients with superobesity. BJS Open 2022; 6:6855490. [PMID: 36453093 PMCID: PMC9713229 DOI: 10.1093/bjsopen/zrac145] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/09/2022] [Accepted: 09/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Although Roux-en-Y gastric bypass (RYGB) is widely performed worldwide, its efficacy in patients with a body mass index (BMI) greater than 50 kg/m2 remains controversial. The aim of the present paper was to assess long-term (10 years or more) weight loss and metabolic results of RYGB in patients with superobesity (SO; BMI > 50 kg/m2), compared with patients with morbid obesity (MO; BMI 35-50 kg/m2). METHODS This study involved retrospective analysis of a prospectively followed cohort of adult patients operated on for a primary RYGB between 1999 and 2008. Long-term weight loss and metabolic parameters were compared between SO and MO patients, with a sex-specific subgroup analysis in SO patients. Multiple logistic regression assessed independent predictors of poor long-term weight loss. RESULTS Among the 957 included patients, 193 (20.2 per cent) were SO (mean BMI 55.3 kg/m2versus 43.3 kg/m2 in MO). Upon 10-year follow-up, which was complete in 86.3 per cent of patients, BMI remained higher in SO patients (mean 39.1 kg/m2versus 30.8 kg/m2, P < 0.001) although total bodyweight loss (per cent TBWL) was similar (28.3 per cent versus 28.8 per cent, P = 0.644). Male SO patients had a trend to higher 10-year per cent TBWL, while initial BMI greater than 50 kg/m2 and low 5-year per cent TBWL were independent predictors of long-term TBWL less than 20 per cent. Diabetes remission was observed in 39 per cent SO and 40.9 per cent MO patients (P = 0.335) at 10 years, and all patients had a significant lipid profile improvement. CONCLUSION Substantial improvement in co-morbidities was observed in all patients 10 years after RYGB. Total weight loss was similar in SO and MO patients, leaving SO patients with higher BMI. Suboptimal TBWL 5 years after surgery in SO, especially female patients, may warrant prompt reassessment to improve long-term outcomes.
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Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine, University of Lausanne (UNIL),Lausanne, Switzerland
| | - Theodoros Thomopoulos
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Francesco Abboretti
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Anna Dayer
- Department of Surgery, Hospital of Riviera Chablais, Rennaz, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine, University of Lausanne (UNIL),Lausanne, Switzerland
| | - Michel Suter
- Correspondence to: Michel Suter, MD, FACS, Chief Surgeon, Hospital of Riviera Chablais, Rte des Tilles 6A, 1847 Rennaz, Switzerland (e-mail: )
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Zandirad E, Teixeira Farinha H, Barberá-Carbonell B, Geinoz S, Demartines N, Schäfer M, Mantziari S. Neoadjuvant Chemoradiotherapy versus Chemotherapy for Gastroesophageal Junction Adenocarcinoma; Which Is the Optimal Treatment Option? Cancers (Basel) 2022; 14:cancers14235856. [PMID: 36497338 PMCID: PMC9736946 DOI: 10.3390/cancers14235856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/18/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Locally advanced gastroesophageal junction adenocarcinoma (GEJ) is treated with either perioperative chemotherapy (CT) or preoperative radiochemotherapy (RCT) followed by surgery. The aim of this study was to compare pathologic response and long-term outcomes in junction adenocarcinoma treated with neoadjuvant RCT versus CT. Methods: All patients with locally advanced GEJ adenocarcinoma treated with neoadjuvant treatment (NAT) followed by surgery between 2009 and 2018 were retrospectively analyzed. Results: A total of 94 patients were included, 67 (71.2%) RCT and 27 (28.8%) CT. Complete pathologic response was more frequent in RCT patients (13.4% vs. 7.4%, p = 0.009) with a trend to better lymph node control (ypN0) (55.2% vs. 33.3%; p = 0.057). RCT offered no benefit in R0 resection (66.7% vs. 72.1% CT, p = 0.628) and was related to higher postoperative cardiovascular complications (35.8% vs. 11.1%; p = 0.017). Long-term overall and disease-free survival were similar (5-year OS 61.1% RCT vs. 75.7% CT, p = 0.259; 5-year DFS 33.5% RCT vs. 22.8% CT; p = 0.763). NAT type was neither independently associated with pathologic response nor long-term survival. Discussion: Patients with locally advanced GEJ adenocarcinoma treated with RCT had more postoperative cardiovascular complications but higher rates of complete pathologic response and a trend to superior locoregional lymph node control. This did not translate in a survival or recurrence benefit.
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Veziant J, Gagnière J, Gronnier C, Mariette C, Tzedakis S, Fuks D, Piessen G, Cabau M, Jougon J, Badic B, Lozach P, Cappeliez S, Lebreton G, Alves A, Flamein R, Pezet D, Pipitone F, Iuga BS, Contival N, Pappalardo E, Mantziari S, Hec F, Vanderbeken M, Tessier W, Briez N, Fredon F, Gainant A, Mathonnet M, Bigourdan JM, Mezoughi S, Ducerf C, Baulieux J, Pasquer A, Baraket O, Poncet G, Vaudoyer D, Enfer PJ, Villeneuve L, Glehen O, Coste T, Fabre JM, Marchal F, Frisoni R, Ayav A, Brunaud L, Bresler L, Cohen C, Aze O, Venissac N, Pop D, Mouroux J, Donici I, Prudhomme M, Felli E, Lisunfui S, Seman M, Petit GG, Karoui M, Tresallet C, Ménégaux F, Hannoun L, Malgras B, Lantuas D, Pautrat K, Pocard M, Valleur P. Non-occlusive Small Bowel Ischemia Related to Postoperative Feeding Jejunostomy Tube Use After Esophagectomy for Cancer: Propensity Score Analysis of the AFC-FREGAT Database. J Gastrointest Surg 2022; 26:1760-1763. [PMID: 35318593 DOI: 10.1007/s11605-021-05223-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/30/2021] [Indexed: 01/31/2023]
Affiliation(s)
- J Veziant
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, Cochin Hospital, APHP, Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - J Gagnière
- Department of Digestive and Hepato-Biliary Surgery, University Hospital Center of Clermont-Ferrand, Clermont-Ferrand, France
| | - C Gronnier
- Eso-Gastric Surgery Unit, Department of Digestive Surgery, Magellan Center, Bordeaux University Hospital, 33600, Pessac, France
| | - C Mariette
- Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille Cedex, France
| | - S Tzedakis
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, Cochin Hospital, APHP, Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - D Fuks
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, Cochin Hospital, APHP, Centre, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Lille Cedex, France.,University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance To Therapies, 59000, Lille, France
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Teixeira Farinha H, Mattille D, Mantziari S, Demartines N, Hübner M. Early postoperative outcomes of staging laparoscopy for peritoneal metastases with or without pressurized intra-peritoneal aerosol chemotherapy (PIPAC). BMC Surg 2022; 22:122. [PMID: 35354404 PMCID: PMC8969273 DOI: 10.1186/s12893-022-01572-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/24/2022] [Indexed: 11/12/2022] Open
Abstract
Background Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been introduced for palliative treatment of peritoneal surface malignancies (PSM) and is currently tested also in the neoadjuvant and prophylactic setting. The aim was therefore to compare safety and tolerance of staging laparoscopy with or without PIPAC. Methods This retrospective analysis compared consecutive patients undergoing staging laparoscopy alone for oesogastric cancer with patients having PIPAC for suspected PSM of various origins from January 2015 until January 2020. Safety was assessed by use of the Clavien classification for complications and CTCAE for capturing of adverse events. Pain and nausea were documented by use of a visual analogue scale (VAS: 0–10: maximal intensity). Results Overall, 25 PIPAC procedures were compared to 24 staging laparoscopies. PIPAC procedures took a median of 35 min (IQR: 25–67) longer. Four patients experienced at least one complication in either group (p = 0.741). No differences were noted for postoperative nausea (p = 0.961) and pain levels (p = 0.156). Median hospital stay was 2 (IQR: 1–3) for PIPAC and 1 (IQR: 1–2) for the laparoscopy group (p = 0.104). Conclusions The addition of PIPAC did not jeopardize safety and postoperative outcomes of staging laparoscopy alone. Further studies need to clarify its oncological benefits.
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Affiliation(s)
- Hugo Teixeira Farinha
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland
| | - Daphné Mattille
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland.
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Gaspar-Figueiredo S, Mantziari S, Suter M, Thomopoulos T. [Bariatric surgery: role of sleeve gastrectomy in 2022]. Rev Med Suisse 2022; 18:531-534. [PMID: 35343122 DOI: 10.53738/revmed.2022.18.774.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Two main procedures currently dominate the panel of bariatric interventions. Sleeve gastrectomy is technically easier and the most widely performed in the world. It shows slightly inferior results and is also associated with a slightly lower morbidity compared to gastric bypass. This is counterbalanced by its irreversibility and a high prevalence of postoperative gastro-esophageal reflux. For this reason, gastric bypass remains the dominant procedure in Switzerland, thanks to its good long-term weight and metabolic results. Sleeve gastrectomy is also an important option in bariatric surgery, with some specific indications.
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Affiliation(s)
| | - Styliani Mantziari
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Michel Suter
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne
- Service de chirurgie, Hôpital Riviera-Chablais, 1847 Rennaz
| | - Theodoros Thomopoulos
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne
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31
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Piotet LM, Mantziari S, Uldry E, Demartines N, Clerc D. [Surgery Sustainability in surgical practice : the "green surgery" concept and its innovations]. Rev Med Suisse 2022; 18:152-155. [PMID: 35107887 DOI: 10.53738/revmed.2022.18.767.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Awareness of climate change grows in the population and people develop eco-responsible habits in their daily and professional life. The health care system is nowadays responsible for 4.6% of global greenhouse gases emissions, and most of them comes from hospital activity. The operating room is one of the greatest contributors of the overall energetic cost and generates a large amount of hospital waste. As an example, all laparoscopic procedures in the US has an energy cost similar to an 80'000 inhabitants city during one year. A better understanding of the environmental impact of surgery is necessary to identify what can be done to limit the ecological impact of surgery without compromising standards of care.
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Affiliation(s)
- Laure-Méline Piotet
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Styliani Mantziari
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Emilie Uldry
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Nicolas Demartines
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne
| | - Daniel Clerc
- Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne
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32
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Farinha HT, Mattille D, Mantziari S, Demartines N, Hübner M. Comparison of staging laparoscopy for peritoneal metastases with or without Pressurized Intra-Peritoneal Aerosol Chemotherapy (PIPAC). European Journal of Surgical Oncology 2022. [DOI: 10.1016/j.ejso.2021.12.323] [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: 11/27/2022]
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33
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Gero D, Vannijvel M, Okkema S, Deleus E, Lloyd A, Lo Menzo E, Tadros G, Raguz I, San Martin A, Kraljević M, Mantziari S, Frey S, Gensthaler L, Sammalkorpi H, Garcia-Galocha JL, Zapata A, Tatarian T, Wiggins T, Bardisi E, Goreux JP, Seki Y, Vonlanthen R, Widmer J, Thalheimer A, Kasama K, Himpens J, Hollyman M, Welbourn R, Aggarwal R, Beekley A, Sepulveda M, Torres A, Juuti A, Salminen P, Prager G, Iannelli A, Suter M, Peterli R, Boza C, Rosenthal R, Higa K, Lannoo M, Hazebroek EJ, Dillemans B, Clavien PA, Puhan M, Raptis DA, Bueter M. Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures. Ann Surg 2021; 274:821-828. [PMID: 34334637 DOI: 10.1097/sla.0000000000005117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/26/2022]
Abstract
OBJECTIVE To define "best possible" outcomes for secondary bariatric surgery (BS). BACKGROUND Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. METHODS Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years. RESULTS The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ± 10 years, 8.4 ± 5.3 years after primary BS, with a BMI 35.2 ± 7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation. CONCLUSION Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marie Vannijvel
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Sietske Okkema
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands
| | - Ellen Deleus
- Department of General Surgery, University Hospital Leuven, Leuven, Belgium
| | - Aaron Lloyd
- Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, California
| | - Emanuele Lo Menzo
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - George Tadros
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Ivana Raguz
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Andres San Martin
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Las Condes, Santiago, Chile
| | - Marko Kraljević
- Department of Visceral Surgery, Clarunis: St.Clara Hosptital, Basel, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Sebastien Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d'Azur, Nice, France
| | - Lisa Gensthaler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Henna Sammalkorpi
- Department ofGastroenterological Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - José Luis Garcia-Galocha
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Amalia Zapata
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Las Condes, Santiago, Chile
| | - Talar Tatarian
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Tom Wiggins
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Ekhlas Bardisi
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | | | - Yosuke Seki
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - René Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Jeannette Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan
| | - Jacques Himpens
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
- Department of Surgery, Delta CHIREC Hospital, Brussels, Belgium
- The European School of Laparoscopic Surgery, St Pierre University Hospital, Brussels, Belgium
| | - Marianne Hollyman
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - Rajesh Aggarwal
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alec Beekley
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Matias Sepulveda
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Las Condes, Santiago, Chile
| | - Antonio Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Anne Juuti
- Department ofGastroenterological Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | | | - Gerhard Prager
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d'Azur, Nice, France
| | - Michel Suter
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Ralph Peterli
- Department of Visceral Surgery, Clarunis: St.Clara Hosptital, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Camilo Boza
- Bariatric and Metabolic Center, Department of Surgery, Clinica Las Condes, Las Condes, Santiago, Chile
| | - Raul Rosenthal
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Kelvin Higa
- Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, California
| | - Matthias Lannoo
- Department of General Surgery, University Hospital Leuven, Leuven, Belgium
| | - Eric J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, The Netherlands
| | - Bruno Dillemans
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dimitri A Raptis
- Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, UK
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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St-Amour P, Winiker M, Sempoux C, Fasquelle F, Demartines N, Schäfer M, Mantziari S. ASO Visual Abstract: The 'Real R0': A Resection Margin < 0.1 cm is Associated with Poor Prognosis After Oncological Esophagectomy. Ann Surg Oncol 2021. [PMID: 34176058 DOI: 10.1245/s10434-021-10160-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Penelope St-Amour
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Michael Winiker
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - François Fasquelle
- Institute of Pathology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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St-Amour P, Winiker M, Sempoux C, Fasquelle F, Demartines N, Schäfer M, Mantziari S. Correction to: The ''Real R0'': A Resection Margin Smaller Than 0.1 cm is Associated with a Poor Prognosis After Oncologic Esophagectomy. Ann Surg Oncol 2021; 28:882. [PMID: 34115254 DOI: 10.1245/s10434-021-10284-8] [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: 11/18/2022]
Affiliation(s)
- Penelope St-Amour
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Michael Winiker
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - François Fasquelle
- Institute of Pathology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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36
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Mantziari S, Piazza G, Mayol J, Demartines N. Preserving Surgical Professionalism in Social Media; Long Live the Media, But Let Live the Surgeon. Ann Surg Open 2021; 2:e058. [PMID: 37636556 PMCID: PMC10455197 DOI: 10.1097/as9.0000000000000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/12/2021] [Indexed: 11/27/2022] Open
Abstract
The positive impact of social media in surgery is ever increasing, although they present some challenging aspects, as preservation of medical professionalism. Physicians should respect patient privacy and integrity through their online presence. However, their personal expression also deserves respect, not being labeled "unprofessional" just for conveying private attitudes and beliefs.
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Affiliation(s)
- Styliani Mantziari
- From the Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland
| | - Giulia Piazza
- From the Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Julio Mayol
- Department of Surgery, Hospital Clinico San Carlos de Madrid, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Martín-Lagos S/N, Madrid, Spain
| | - Nicolas Demartines
- From the Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
- Faculty of Biology and Medicine, Lausanne University (UNIL), Lausanne, Switzerland
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37
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Zandirad E, Teixeira-Farinha H, Demartines N, Schäfer M, Mantziari S. Multimodal management of gastroesophageal junction adenocarcinoma: Which type of neoadjuvant treatment? Br J Surg 2021. [DOI: 10.1093/bjs/znab202.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
The current treatment for locally advanced gastroesophageal junction (GEJ) adenocarcinoma consists of neoadjuvant treatment (NAT) followed by surgery. Preoperative chemotherapy (CT) and radio-chemotherapy (RCT) are both valid options, but comparative data for their efficacy remain scarce. This study aimed to assess the efficacy of RCT and CT to achieve a complete pathologic response (CPR) for locally advanced GEJ adenocarcinoma. Secondary endpoints were R0 resection rates, postoperative complications, long-term survival and recurrence.
Methods
All consecutive patients with locally advanced GEJ adenocarcinoma treated with CT or RCT and oncologic resection from 2009 to 2018 were included. A CPR was defined with the Mandard tumor regression score. Standard statistical tests were used as appropriate. Overall and disease-free survival were compared with the Kaplan Meier method and log-rank test. Multivariate analysis was performed to define independent predictors of CPR, and long-term survival.
Results
Among the 94 patients (84%male, median age 62 years [IQR 9.7]), 67 (71.3%) received preoperative RCT and 27 (28.7%) CT. Patient’s characteristics and pretreatment tumor stages were comparable. Surgical approach was thoracoabdominal Lewis resection in 95.5% RCT and 81.5% CT patients (P = 0.085). CPR was more frequent in the RCT than the CT group (13.4% vs 7.4%, P = 0.009), but R0 resection rates were similar (72.1% vs 66.7%, P = 0.628). There was a trend to higher ypN0 stage in the RCT group (55.2% vs 33.3%; P = 0.057). Postoperatively, RCT patients presented more cardiovascular complications (35.8% vs 11.1%; P = 0.017), although overall morbidity was similar (68.6% vs 62.9%, P = 0.988). 5-year overall survival was comparable (61.1% RCT vs 75.7% CT, P = 0.259), as was 5-year disease-free survival (33.5% RCT vs 22.8% CT, P = 0.763). Isolated loco-regional recurrence occurred in 2.9% RCT vs 3.7% CT patients (P = 0.976). NAT type was not an independent predictor for complete pathologic response nor long-term survival in the multivariate analysis. Median follow-up was 30 months [95%CI 21.3-38.8] for all patients.
Conclusion
Patients with locally advanced GEJ adenocarcinoma demonstrated higher rates of CPR after RCT than CT, and a trend to a better lymph node sterilization, although this did not translate in a significant survival benefit or decreased recurrence rate.
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Affiliation(s)
- E Zandirad
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - H Teixeira-Farinha
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
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38
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Gero D, Vannijvel M, Okkema S, Deleus E, Lloyd A, Lo Menzo E, Tadros G, Raguz I, San Martin A, Kraljević M, Mantziari S, Frey S, Gensthaler L, Sammalkorpi H, Garcia-Galocha JL, Zapata A, Tatarian T, Wiggins T, Bardisi E, Goreux JP, Vonlanthen R, Widmer J, Thalheimer A, Himpens J, Hollymann M, Welbourn R, Aggarwal R, Beekley A, Sepulveda M, Torres A, Juuti A, Salminen P, Prager G, Iannelli A, Suter M, Peterli R, Boza C, Rosenthal R, Higa K, Lannoo M, Hazebroek EJ, Dillemans B, Clavien PA, Puhan M, Raptis DA, Bueter M. Defining global benchmarks in elective secondary bariatric surgery comprising conversional, revisional and reversal procedures. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
Management of poor response and of long-term complications after bariatric surgery (BS) is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. Benchmarking uses best performance in a given field as reference point for improvement. Our aim was to define ‘‘best possible’’ outcomes for elective secondary BS.
Methods
The establishment of benchmarks in secondary BS followed a standardized methodology, based on recommendations of a Delphi consensus panel of experts. This multicenter study analyzed patients undergoing elective secondary BS in 18 high-volume centers on 4 continents from 06/2013 to 05/2019. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers. Benchmark cases had no: previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI>50kg/m2 or age>65 years. Descriptive statistics, multivariate logistic regression and data visualization were performed using the R software.
Results
Out of 44’884 elective bariatric procedures performed in the participating centers, 5’328 secondary BS cases were identified. The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8±10 years, 8.4±5.3 years after primary BS, with a body mass index 35.2±7kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.57% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.36) and after conversional or revisional procedures with gastrointestinal suture/stapling (OR 1.7). Benchmark cutoffs at 90-days postoperatively were ≤5.8% re-intervention and ≤8.8% re-operation rate. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation.
Conclusion
Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
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Affiliation(s)
- D Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Vannijvel
- Department of General Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - S Okkema
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - E Deleus
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - A Lloyd
- Department of Minimally Invasive and Bariatric Surgery, Fresno Heart and Surgical Hospital, Fresno, USA
| | - E Lo Menzo
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - G Tadros
- The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, USA
| | - I Raguz
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A San Martin
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - M Kraljević
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Frey
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - L Gensthaler
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - H Sammalkorpi
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - J L Garcia-Galocha
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Zapata
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - T Tatarian
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - T Wiggins
- Bariatric and Metabolic Surgery Center, Musgrove Park Hospital, Taunton, United Kingdom
| | - E Bardisi
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - J -P Goreux
- Department of Surgery, Delta CHIREC Hospital, Brussels, Belgium
| | - R Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Widmer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - A Thalheimer
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - J Himpens
- Department of Surgery, St Blasius Hospital, Dendermonde, Belgium
| | - M Hollymann
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - R Aggarwal
- Bariatric and Metabolic Surgery Department, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - A Beekley
- Bariatric and Metabolic Surgery Center, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - M Sepulveda
- Bariatric and Metabolic Surgery Center, Dipreca Hospital, Santiago de Chile, Chile
| | - A Torres
- Department of Surgery, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - A Juuti
- Department of Surgery, University Hospital of Helsinki, Helsinki, Finland
| | - P Salminen
- Department of Surgery, University of Turku, Turku, Finland
| | - G Prager
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | - A Iannelli
- Digestive Surgery and Liver Transplantation Unit, University Hospital Nice, University Côte d’Azur, Nice, France
| | - M Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - R Peterli
- Department of Visceral Surgery, Clarunis - University Abdominal Center, Basel, Switzerland
| | - C Boza
- Department of Surgery, Clinica Las Condes, Santiago de Chile, Chile
| | - R Rosenthal
- Bariatric and Metabolic Surgery Department, Cleveland Clinic Florida, Weston, USA
| | - K Higa
- Bariatric and Metabolic Surgery Center, Fresno Heart and Surgical Hospital, Fresno, USA
| | - M Lannoo
- Department of Surgery, University Hospital Leuven, Leuven, Belgium
| | - E J Hazebroek
- Department of Surgery, Rijnstate Hospital/Vitalys Clinics, Arnhem, Netherlands
| | - B Dillemans
- Department of Surgery, AZ Sint Jan Brugge-Oostende, Bruges, Belgium
| | - P -A Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - M Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - D A Raptis
- Department of Hepatobiliary and Pancreas Surgery and Liver Transplantation, Royal Free Hospital, London, United Kingkom
| | - M Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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St-Amour P, Mantziari S, Dromain C, Winiker M, Godat S, Schöpfer A, Demartines N, Schäfer M. Preoperative hiatal hernia in oesophageal adenocarcinoma: An impact on patient outcomes? Br J Surg 2021. [DOI: 10.1093/bjs/znab202.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objective
Uncontrolled gastroesophageal reflux and the often-associated hiatal hernia (HH) are frequently encountered in oesophageal adenocarcinoma patients. Previous data suggest unfavourable long-term oncologic outcomes in the presence of a HH, but the evidence remains scarce. The aim of this study was to assess the potential impact of preoperative HH on histologic response after neoadjuvant treatment (NAT), as well as on overall and disease-free survival.
Methods
All patients operated for an adenocarcinoma of the oesophagus or gastro-oesophageal junction (GOJ) between 2012-2018 were assessed. Baseline endoscopy and CT-scan images were retrospectively reviewed to identify the presence of a clinically significant HH (≥3cm). Response to neoadjuvant treatment (Mandard TRG grade), postoperative outcomes and survival were compared between HH and non-HH patients. Categorical variables were compared with the x2 or Fisher’s test, whereas continuous ones with the Mann-Whitney-U test. Survival analyses were performed with the Kaplan-Meier method and log-rank test.
Results
Overall, 101 patients were included (84.1% male, median age 63 years); among them, 33 (32.7%) had a HH ≥ 3cm at diagnosis of oesophageal cancer. There were no significant baseline differences in demographics and tumour stages between the two groups. NAT was used in 80.9% of non-HH versus 81.8% HH patients (P = 0.910), most often chemoradiation (57.3% in non-HH versus 63.6% in HH patients, P = 0.423). Surgical approach and postoperative complication rates were similar in all patients. Good response to NAT (TRG 1-2) was observed in 32.3% of non-HH, versus 33.3% of HH patients (P = 0.297), whereas R0 resection was achieved in 94.1% vs 90.9% of patients respectively (P = 0.551). Overall survival was comparable between HH (median 28 mo, 95%CI 22-NA) and non-HH patients (median 41mo, 95% CI 29-NA) (P = 0.605). Disease-free survival was also similar (median 18 mo, 95%CI 12-NA for HH, vs 34mo, 95%CI 14-NA for non-HH patients, P = 0.283), although HH patients experienced higher rates of distant (51.6% vs 29.2% for non-HH, P = 0.033), but not locoregional recurrence.
Conclusion
A clinically significant HH is encountered in almost a third of patients with oesophageal adenocarcinoma. However, in our study, it was not associated with a worse response to NAT, nor did it lead to a worse overall and disease-free survival.
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Affiliation(s)
- P St-Amour
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - C Dromain
- Institute of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - M Winiker
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - S Godat
- Institute of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - A Schöpfer
- Institute of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - N Demartines
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
| | - M Schäfer
- Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Faculty of Biology and Medecine, University of Lausanne, Lausanne, Switzerland
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St-Amour P, Winiker M, Sempoux C, Fasquelle F, Demartines N, Schäfer M, Mantziari S. The "Real R0": A Resection Margin Smaller Than 0.1 cm is Associated with a Poor Prognosis After Oncologic Esophagectomy. Ann Surg Oncol 2021; 28:7095-7106. [PMID: 34041624 PMCID: PMC8519834 DOI: 10.1245/s10434-021-10121-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 12/09/2022]
Abstract
Background Although resection margin (R) status is a widely used prognostic factor after esophagectomy, the definition of positive margins (R1) is not universal. The Royal College of Pathologists considers R1 resection to be a distance less than 0.1 cm, whereas the College of American Pathologists considers it to be a distance of 0.0 cm. This study assessed the predictive value of R status after oncologic esophagectomy, comparing survival and recurrence among patients with R0 resection (> 0.1-cm clearance), R0+ resection (≤ 0.1-cm clearance), and R1 resection (0.0-cm clearance). Methods The study enrolled all eligible patients undergoing curative oncologic esophagectomy between 2012 and 2018. Clinicopathologic features, survival, and recurrence were compared for R0, R0+, and R1 patients. Categorical variables were compared with the chi-square or Fisher’s test, and continuous variables were compared with the analysis of variance (ANOVA) test, whereas the Kaplan-Meier method and Cox regression were used for survival analysis. Results Among the 160 patients included in this study, 113 resections (70.6%) were R0, 34 (21.3%) were R0+, and 13 (8.1%) were R1. The R0 patients had a better overall survival (OS) and disease-free survival (DFS) than the R0+ and R1 patients. The R0+ resection offered a lower long-term recurrence risk than the R1 resection, and the R status was independently associated with DFS, but not OS, in the multivariate analysis. Both the R0+ and R1 patients had significantly more adverse histologic features (lymphovascular and perineural invasion) than the R0 patients and experienced more distant and locoregional recurrence. Conclusions Although R status is an independent predictor of DFS after oncologic esophagectomy, the < 0.1-cm definition for R1 resection seems more appropriate than the 0.0-cm definition as an indicator of poor tumor biology, long-term recurrence, and survival. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10121-y.
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Affiliation(s)
- Penelope St-Amour
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Michael Winiker
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - François Fasquelle
- Institute of Pathology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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St-Amour P, Schäfer M, Mantziari S. ASO Author Reflections: R0 Resection After Oncologic Esophagectomy-Cutting on the Edge (0 cm) is Not Enough. Ann Surg Oncol 2021; 28:7107-7108. [PMID: 34019182 PMCID: PMC8519883 DOI: 10.1245/s10434-021-10167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Penelope St-Amour
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Markus Schäfer
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital of Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
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Mantziari S, Dayer A, Duvoisin C, Demartines N, Allemann P, Calmes JM, Favre L, Fournier P, Suter M. Long-Term Weight Loss, Metabolic Outcomes, and Quality of Life at 10 Years After Roux-en-Y Gastric Bypass Are Independent of Patients' Age at Baseline. Obes Surg 2021; 30:1181-1188. [PMID: 32008256 DOI: 10.1007/s11695-019-04181-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 12/13/2022]
Abstract
BACKGROUND Conflicting data have been published for bariatric surgery in older patients, with no long-term large-scale studies available. Our aim was to provide long-term (> 10 years) results on weight loss, metabolic outcomes, and quality of life in a large homogenous series of Roux-en-Y gastric bypass (RYGB) patients, according to age at baseline. PATIENTS AND METHODS All consecutive patients who underwent primary RYGB between 1999 and 2007, and therefore eligible for 10-year follow-up, were retrospectively analyzed. According to their age at baseline, they were divided into three groups: A (< 40 years), B (40-54 years), and C (≥ 55 years). Categorical variables were compared with the χ2 test and continuous variables with ANOVA. RESULTS Our series consisted of 820 patients, with a 10-year follow-up of 80.6%. Although group C (11% of all patients) had significantly more comorbidities at baseline, there was no difference in postoperative morbidity and mortality between groups. Weight loss was significantly less for group C patients up to the 7th postoperative year, but no difference remained thereafter. 10-year %total weight loss was 32.2, 32.9, and 32.3 respectively in groups A, B, and C. After 10 years, glycemic control and lipid profile improved similarly, rates of partial or complete remission of diabetes and hypertension were identical, and quality of life presented a significant improvement for all patients with no inter-group difference. CONCLUSION Our results suggest similar short- and long-term outcomes after RYGB for patients ≥ 55 years compared to younger ones; the relative benefit might even be higher for older patients, given their increased comorbidity at baseline.
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Affiliation(s)
- Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Anna Dayer
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland.,Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland
| | - Céline Duvoisin
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pierre Allemann
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jean-Marie Calmes
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Lucie Favre
- Department of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pierre Fournier
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Michel Suter
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland. .,Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland.
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Rrupa D, Piotet LM, Mantziari S, Demartines N, Suter M, Thomopoulos T. [Super obesity, an exponentially growing epidemic : surgical treatment options and expectations]. Rev Med Suisse 2021; 17:576-581. [PMID: 33760420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Obesity is a major health problem with a prevalence that has tripled since 1976, affecting a large portion of the population across all ages. Bariatric surgery is currently considered as the most efficient and durable treatment in terms of weight loss and remission of long-term co-morbidities. The objective of this article is to describe briefly the different surgical options for patients with severe obesity and to report their effectiveness, as well as to provide primary care physicians with simple instructions, regarding initial management and the appropriate guidance of their patients to a specialized service.
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Affiliation(s)
- Djana Rrupa
- Département de chirurgie viscérale, CHUV, 1011 Lausanne
| | | | - Styliani Mantziari
- Département de chirurgie viscérale, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1015 Lausanne
| | | | - Michel Suter
- Département de chirurgie viscérale, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1015 Lausanne
- Département de chirurgie générale, Hôpital Riviera-Chablais, 1847 Rennaz
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Theochari NA, Theochari CA, Kokkinidis DG, Kechagias A, Lyros O, Giannopoulos S, Mantziari S, Schizas D. Venous thromboembolism after esophagectomy for cancer: a systematic review of the literature to evaluate incidence, risk factors, and prophylaxis. Surg Today 2021; 52:171-181. [PMID: 33713198 DOI: 10.1007/s00595-021-02260-2] [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: 10/02/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Although esophagectomy remains the preferred treatment for esophageal cancer, it is still associated with a number of complications, including post-operative venous thromboembolism (VTE). The aim of this study was to summarize the reported incidence of VTE after esophagectomy, its risk factors, and prevention strategies. METHODS We conducted a systematic search of the literature in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Fourteen studies met our inclusion criteria and were selected in the present review. Overall, we identified 9768 patients who underwent esophagectomy, with a post-operative VTE rate of 4% (440 patients). The reported risk factors for VTE included advanced age, American Society of Anesthesiologists (ASA) class III or IV, a history of cardiovascular or pulmonary disease, and the implementation of preoperative chemo-radiotherapy. Postoperative acute respiratory distress syndrome was also associated with VTE. No universally applied prevention strategies for VTE after esophagectomy were identified in the literature. CONCLUSIONS Despite advances in perioperative care, VTE after esophagectomy still represents a source of morbidity for about 4% of patients. Low molecular weight heparin is suggested as the routine standard prophylactic regimen after esophageal cancer surgery.
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Affiliation(s)
- Nikoletta A Theochari
- Department of Surgery, Amalia Fleming General Hospital, 29 Parnithos, 16344, Athens, Ilioupolis, Greece.
| | - Christina A Theochari
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Thoracic Diseases General Hospital Sotiria, Athens, Greece
| | - Damianos G Kokkinidis
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aristotelis Kechagias
- Department of Gastrointestinal Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | | | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Martin D, Mantziari S, Demartines N, Hübner M. Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members. World J Surg 2021; 44:2211-2219. [PMID: 32172309 DOI: 10.1007/s00268-020-05476-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Major surgery is a term frequently used but poorly defined. The aim of the present study was to reach a consensus in the definition of major surgery within a panel of expert surgeons from the European Surgical Association (ESA). METHODS A 3-round Delphi process was performed. All ESA members were invited to participate in the expert panel. In round 1, experts were inquired by open- and closed-ended questions on potential criteria to define major surgery. Results were analyzed and presented back anonymously to the panel within next rounds. Closed-ended questions in round 2 and 3 were either binary or statements to be rated on a Likert scale ranging from 1 (strong disagreement) to 5 (strong agreement). Participants were sent 3 reminders at 2-week intervals for each round. 70% of agreement was considered to indicate consensus. RESULTS Out of 305 ESA members, 67 (22%) answered all the 3 rounds. Significant comorbidities were the only preoperative factor retained to define major surgery (78%). Vascular clampage or organ ischemia (92%), high intraoperative blood loss (90%), high noradrenalin requirements (77%), long operative time (73%) and perioperative blood transfusion (70%) were procedure-related factors that reached consensus. Regarding postoperative factors, systemic inflammatory response (76%) and the need for intensive or intermediate care (88%) reached consensus. Consequences of major surgery were high morbidity (>30% overall) and mortality (>2%). CONCLUSION ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.
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Affiliation(s)
- David Martin
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Labgaa I, Mantziari S, Genety M, Elliott JA, Kamiya S, Kalff MC, Winiker M, Pasquier J, Allemann P, Messier M, van Berge Henegouwen MI, Nilsson M, Reynolds JV, Piessen G, Hübner M, Demartines N, Schäfer M. Early postoperative decrease of albumin is an independent predictor of major complications after oncological esophagectomy: A multicenter study. J Surg Oncol 2020; 123:462-469. [PMID: 33289149 DOI: 10.1002/jso.26317] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/07/2020] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Serum albumin perioperative decrease (∆Alb) may reflect the magnitude of the physiological stress induced by surgery. Studies highlighted its value to predict adverse postoperative outcomes, but data in esophageal surgery are scant. This study aimed to investigate the role of ∆Alb to predict major complications after esophagectomy for cancer. METHODS Multicenter retrospective study conducted in five high-volume centers, including consecutive patients undergoing an esophagectomy for cancer between 2006 and 2017. Patients were randomly assigned to a training (n = 696) and a validation (n = 350) cohort. Albumin decrease was calculated on postoperative day 1 and defined as ΔAlb. The primary endpoint was major complications according to Clavien classification. RESULTS In the training cohort, esophagectomy induced a rapid drop of albumin. Cut-off of ΔAlb was established at 11 g/L and allowed to distinguish patients with adverse outcomes. On multivariable analysis, ΔAlb was identified as an independent predictor of major complications (OR, 1.06; 95% CI, 1.01-1.11; p = .014). Higher BMI and laparoscopy were associated with lower ΔAlb. Analysis of the validation cohort provided consistent findings. CONCLUSIONS ΔAlb appeared as a promising biomarker after oncological esophagectomy, allowing prediction of potential adverse outcomes.
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Affiliation(s)
- Ismail Labgaa
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Switzerland
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Switzerland
| | - Maxime Genety
- Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, Lille, France
| | - Jessie A Elliott
- Department of Surgery, Trinity Translational Medicine Institute, St. James's Hospital, Dublin, Ireland
| | - Satoshi Kamiya
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Marianne C Kalff
- Department of Surgery, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Michaël Winiker
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Pierre Allemann
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Switzerland
| | - Marguerite Messier
- Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, Lille, France
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - John V Reynolds
- Department of Surgery, Trinity Translational Medicine Institute, St. James's Hospital, Dublin, Ireland
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University of Lille, Claude Huriez University Hospital, Lille, France
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Switzerland
| | | | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Switzerland
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Thomopoulos T, Mantziari S, St-Amour P, Uldry E, Suter M. Management of a Complicated Internal Herniation After Roux-en-Y Gastric Bypass in a 28-Week Pregnant Woman. Obes Surg 2020; 30:5177-5178. [PMID: 32996100 DOI: 10.1007/s11695-020-04997-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Small bowel obstruction (SBO) due to internal hernia (IH) is a well-known late complication after laparoscopic Roux-en-Y gastric bypass (LRYGB), with an incidence between 0.5 and 10% as reported by Iannelli et al. (Obes Surg. 17(10):1283-6, 2007). It is reported most frequently 1-2 years after surgery because of the greater weight loss at that time, with rapid loss of the mesenteric fat consequently as discussed by Stenberg et al. (Lancet. 387(10026):1397-404, 2016). Currently, women constitute more than 50% of the patients undergoing bariatric surgery and most of them are of childbearing age as reported by the World Health Organization (2015). SBO, due to IH, is a rare complication during pregnancy, mostly occurring during the third trimester as discussed by Torres-Villalobos et al. (Obes Surg 19(7):944-50, 2009), and can result in fetal and maternal morbidity and even mortality as reported by Vannevel et al. (Obstet Gynecol. 127(6):1013-20, 2016). Moreover, the physiologic changes of pregnancy can mask the symptoms of SBO after LRYGB, leading to significant diagnostic and therapeutic delays as detailed by Wax et al. (Am J Obstet Gynecol 208(4):265-71, 2013). Therefore, an early surgical exploration is necessary in this particular and uncommon situation as discussed by Webster et al. (Ann R Coll Surg Engl 97(5):339-44, 2015). METHODS A 32-year-old female patient, with Ehlers-Danlos syndrome and chronic pain, was in the 28th week of her first pregnancy after bariatric surgery. She had had an antecolic LRYGB 6 years ago in another institution, resulting in a 35-kg weight loss. She presented to the emergency department with severe and persistent epigastric pain associated with nausea and vomiting during 24 h. On physical examination, her abdomen was painful and tender at the epigastrium and left hypochondrium, and her vital signs were normal. The blood tests were in the normal range except the white blood cell count at 12'000 G/l. The obstetric and neonatal team was involved, and fetal heart monitoring was normal. Abdominal ultrasonography ruled out other causes of pain. An abdominal MRI was performed and displayed a distended proximal small bowel, free abdominal fluid, and bowel mesenteric edema in the left upper quadrant with compression of the superior mesenteric vein. Internal hernia with intestinal suffering was suspected, and the patient consented for emergency laparoscopy. RESULTS The laparoscopic exploration, reduction of the internal hernia, and closure of the mesenteric defects are demonstrated step-by-step in the presented intraoperative video. The postoperative course was uncomplicated for both patient and fetus. Oral feeding was resumed at day 1, with no residual symptom, and the patient was discharged on postoperative day 3. At 1-month follow-up, she had no complaint and her pregnancy had resumed a normal course. She delivered a healthy baby at 36 weeks without any complication. CONCLUSIONS Internal herniation after LRYGB represents a rare, high-risk complication during pregnancy. A low threshold for imaging, preferably by abdominal MRI, is recommended. Multidisciplinary management, including obstetricians and bariatric surgeons, is necessary in order to avoid maternal and fetal adverse outcomes. During surgery, recognition of the anatomy is often difficult, and parts of the bowel are distended and fragile. Starting to run the bowel backwards from the ileocecal valve is a crucial surgical step for reducing internal hernias during LRYGB, and reduces both the risk to worsen the situation and of bowel injury, making its management less hazardous.
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Affiliation(s)
- Theodoros Thomopoulos
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland.
| | - Styliani Mantziari
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland
| | - Penelope St-Amour
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland
| | - Emilie Uldry
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland
| | - Michel Suter
- Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland
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Khallouf J, Mantziari S, Uldry E. Shock after thoracic drainage. Surgery 2020. [DOI: 10.1016/j.surg.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Khallouf J, Gaspar Figueiredo S, Demartines N, Schoepfer A, Schäfer M, Mantziari S. [Gastroesophageal reflux disease in obese patients ; current management]. Rev Med Suisse 2020; 16:1287-1291. [PMID: 32608585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Gastroesophageal reflux disease (GERD) has a high prevalence in the obese population with a direct correlation between increased BMI and GERD. This correlation is multifactorial, with also more complicated forms (esophagitis and metaplasia) present in obese patients, even in the absence of frank reflux symptoms. Therapeutic success largely depends on weight loss, and bariatric surgery is the cornerstone of treatment for both diseases. Roux-en-Y gastric bypass is the intervention of choice for obese patients suffering from GERD, while sleeve gastrectomy can on the contrary induce increased reflux in the long term. Classic anti-reflux surgery (fundoplication) can also be offered to these patients, while being aware of the high risk of recurrent symptoms for BMI > 30-35 kg/m2.
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Affiliation(s)
- Joe Khallouf
- Service de chirurgie viscérale, CHUV, 1011 Lausanne
| | | | | | - Alain Schoepfer
- Service de gastroentérologie et hépatologie, CHUV, 1011 Lausanne
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Legros-Lefeuvre A, Clair C, Schwarz J, Schäfer M, Demartines N, Mantziari S. [Groin hernia in female patients: sex-specific management]. Rev Med Suisse 2020; 16:1305-1309. [PMID: 32608588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Groin hernia in women is an entity whose clinical manifestations can be quite subtle, and which therefore risks to go unnoticed. Imaging studies by ultrasound or dynamic CT/MRI is strongly recommended in case of a clinical doubt. Optimal treatment consists of laparoscopic surgery, even in oligosymptomatic patients, because the risk of incarceration, and subsequent morbidity and mortality is high especially in cases of femoral hernia, which are frequent and often overlooked in women. During pregnancy, the risk of developing a groin hernia is very low (around 0,1%) and a wait-and-see attitude is to be preferred as much as possible, except in the case of an acute complication (incarceration).
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Affiliation(s)
- Alexina Legros-Lefeuvre
- Unité médecine et genre, Département formation, recherche et innovation, Unisanté, Rue du Bugnon 44, 1011 Lausanne
| | - Carole Clair
- Unité médecine et genre, Département formation, recherche et innovation, Unisanté, Rue du Bugnon 44, 1011 Lausanne
| | - Joëlle Schwarz
- Unité médecine et genre, Département formation, recherche et innovation, Unisanté, Rue du Bugnon 44, 1011 Lausanne
| | - Markus Schäfer
- Service de chirurgie viscérale, Département de chirurgie et d'anesthésiologie, CHUV, 1011 Lausanne
| | - Nicolas Demartines
- Service de chirurgie viscérale, Département de chirurgie et d'anesthésiologie, CHUV, 1011 Lausanne
| | - Styliani Mantziari
- Service de chirurgie viscérale, Département de chirurgie et d'anesthésiologie, CHUV, 1011 Lausanne
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