Now showing 1 - 10 of 27
  • Publication
    Subclinical activation of coagulation and fibrinolysis in laparoscopic cholecystectomy: Do risk factors exist?
    (2011-03-22) ;
    Sergentanis, Theodoros Nikolaos
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    Georgiopoulos, Ioannis S.
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    Papadopoulou, Eleni
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    Liasis, Lambros
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    Kritikos, Emmanuel
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    Tzardis, Periklis J.
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    Laopodis, Vasilios
    Purposes: This study examines whether inherent patient-related risk factors (age, gender) modify the effect of laparoscopic cholecystectomy (LC) upon the coagulation and fibrinolysis cascades. Methods: This observational study included 119 low-risk for deep vein thrombosis (DVT) patients undergoing elective LC, without thromboprophylaxis. Pre-operatively and 24 h post-operatively we measured PT-INR, aPTT, FDP, d-dimer, and fibrinogen. Color Doppler scan of the lower extremity was performed the 1st post-operative day. Differences before and after surgery were analyzed with respect to risk factors. Results: No clinically or ultrasound evident DVT was observed. INR (1.04 ± 0.06 vs. 1.12 ± 0.11, p < 0.0001), d-dimer (0.38 ± 0.36 vs. 0.9 ± 0.64, p < 0.0001), plasma fibrinogen (380.8 ± 74.9 vs. 403.8 ± 78.8, p = 0.0001) and FDP positivity exhibited statistically significant increase after surgery. The levels of aPTT did not exhibit any significant change. Concerning d-dimer, older age was associated with higher pre-operative concentrations; older patients accordingly exhibited more intense increase in d-dimer and FDP positivity after surgery. Male sex was associated with higher PT-INR and aPTT before surgery, as well as with more pronounced increase in PT- INR postoperatively; similarly, older age was associated only with higher PT-INR before surgery. Conclusions: Despite no DVT, significant increase in PT-INR, d-dimer, FDP and fibrinogen appeared after LC. This may be attributed to surgical trauma and pneumoperitoneum effects on the portal vein flow. Elderly subjects and males seem particularly vulnerable, demonstrating more sizeable changes.
  • Publication
    Pathologic response to non-surgical locoregional therapies as potential selection criteria for liver transplantation for hepatocellular carcinoma
    (2013-11-13)
    Cantù, Massimiliano
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    Piardi, Tullio
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    Sommacale, Daniele
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    Ellero, Bernard
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    Woehl-Jaeglè, Marie Lorraine
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    Audet, Maxime
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    Wolf, Phillippe
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    Pessaux, Patrick
    Background: Preoperative locoregional treatments (PLT) are performed to avoid progression before liver transplantation for hepatocellular carcinoma (HCC). The objective of this study was to analyze the prognostic factors affecting the outcome in patients who received PLT. Material/Methods: A retrospective analysis of patients who underwent liver transplantation (LT) was performed. All patients who underwent PLT with confirmed pathological diagnosis of HCC were included. The rate of tumor necrosis (TN) was assessed by microscopic histological examination. Results: From January 1997 to December 2010, PLT was performed in 154 patients ROC analysis individuated a TN cut-off value at 40%. Ninety-one patients (59.1%) of the patients presented TN>40%. At multivariate analysis, TN<40% (HR=1.76; p=0.04) and vascular invasion (VI) (HR=2.16; p<0.01) were associated with lower Overall Survival (OS). At multivariate analysis, TN<40% (HR=1.59; p=0.001) and VI (HR=2.51; p=0.001) were significant associated with lower Disease Free Survival (DFS). One, 3 and 5 years OS was 87.9%, 82.0% and 69.1% for patients with TN>40% and 82.5%, 64.2% and 53.2% for those with TN<40% (p=0.02). Tumour size <5 cm (p=0.02); age <55 years (p=0.02); absence of VI (p=0.02) and multiple procedures (p=0.04) were predictive factors for TN>40%. Conclusions: Response to preoperative locoregional treatment can be used as potential selection criteria for LT.
  • Publication
    Identification and Validation of Risk Factors for Postoperative Infectious Complications Following Hepatectomy
    (2013-11-01)
    Pessaux, Patrick
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    Van Den Broek, Maartje A.J.
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    Wu, Tao
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    Damink, Steven W.M.Olde
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    Piardi, Tullio
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    Dejong, Cornelis H.C.
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    ;
    Van Dam, Ronald M.
    Summary: Postoperative infectious complications (PICs) are associated with significant morbidity after abdominal surgery. Using multivariate analysis of data from a prospective database, our study focused on the risk factors for PICs and the prevention of these complications after hepatectomy, with the goal of improving outcomes and reducing the length of hospital stays. Background: PICs following surgery are associated with significant morbidity, increase the length of hospital stays, and have a negative impact on long-term oncological outcome. The aim of this study was to determine the risk factors for PICs following partial hepatectomy and to validate these results with an external database. Methods: Between January 2006 and December 2009, 555 patients underwent elective partial hepatectomy. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. The dependent variables studied were the occurrence of PICs, defined as development of one or more of the following conditions: pneumonia, sepsis, Central line-associated bloodstream infection, urinary tract infection, wound infection, and infected intra-abdominal fluid collection. PICs were devised in medical (PIMCs) and surgical (PISCs) complications. The incidence of PICs and validation of the predictive score were determined using an external prospective database of 342 patients. Results: The multivariate analysis identified three independent risk factors for PICs: the presence of a nasogastric tube (OR = 1.8), blood transfusion (OR = 1.9), and diabetes (OR = 2.4). The multivariate analysis identified only one independent risk factor for PISCs: an associated portal venous resection (OR = 5.5). The multivariate analysis identified four independent risk factors for PIMCs: presence of a biliary drainage (OR = 1.9), blood transfusion (OR = 2.1), diabetes (OR = 2.9), and presence of atrial fibrillation (OR = 3.6). According to the three predictive factors, the observed rates of PICs ranged from 18.8 % to 77.8 % and ranged from 24.2 % to 100 % in the external database. Predicted and observed risks of PICs were not statistically different. Conclusions: The correction of modifiable risk factors among the identified factors could reduce the incidence of PICs and, as a consequence, improve patient outcomes and reduce the length of hospital stays.
  • Publication
    Robotic resection of duodenal adenoma
    (2011-03-01)
    Marzano, Ettore
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    Addeo, Pietro F.
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    Oussoultzoglou, Elíe
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    Jaeck, Daniel
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    Pessaux, Patrick
    Background: Duodenal sporadic adenomatous polyps are rare findings during upper endoscopy. Resection is indicated due to their malignant potential. +Methods: A 55 year-old male patient was diagnosed with a 3 cm duodenal adenomatous polyp with low-grade dysplasia, which could not be safely resected by endoscopy. A transduodenal submucosal robotic-assisted polypectomy was performed. +Results: The operative time was 4.5 h, with an estimated blood loss of 200 ml. The patient had a normal bowel transit on postoperative day 3 and he was discharged on postoperative day 7. Three months follow-up was uneventful. The final histological finding revealed a completely resected duodenal adenomatous polyp without signs of malignancy. +Conclusion: Robotic-assisted resection of duodenal polyps is a feasible technique that may be indicated for the local excision of duodenal lesions that cannot be endoscopically resected. Compared to the open and laparoscopic approach, it offers many technical advantages.
  • Publication
    Outcomes of Rehepatectomy for Colorectal Liver Metastases: A Contemporary Multi-Institutional Analysis from the French Surgical Association Database
    (2016-12-01)
    Hallet, Julie
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    Sa Cunha, Antonio
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    Ádám, René A.
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    Goéré, Diane
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    Azoulay, Daniel
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    Mabrut, Jean Yves
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    Muscari, Fabrice
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    Laurent, Christophe
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    Navarro, Françis
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    Pessaux, Patrick
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    Cossé, Cyril
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    Lignier, Delphine
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    Régimbeau, Jean Marc
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    Barbieux, Julien P.
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    Lermite, Émilie
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    Hamy, Antoine P.
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    Mauvais, François
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    Laurent, Christophe
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    Al Naasan, Irchid
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    Laurent, Alexis
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    Azoulay, Daniel
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    Compagnon, Philippe
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    Lim, Chetana
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    Mohammed, Sbai Idrissi
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    Martin, Frédéric
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    Atger, Jérôme
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    Mohammed, Sbai Idrissi
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    Martin, Frédéric
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    Baulieux, Jacques
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    Darnis, Benjamin
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    Mabrut, Jean Yves
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    Kepenekian, V.
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    Périnel, Julie
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    Adham, Mustapha
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    Gléhen, Olivier J.
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    Rivoire, Michel L.
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    Hardwigsen, Jean
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    Palen, Anaïs
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    Grégoire, Émilie
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    LeTreut, Yves Patrice
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    Delpéro, Jean Robert
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    Turrini, Olivier
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    Herrero, Astrid
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    Navarro, Françis
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    Panaro, Fabrizio
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    Ayav, Ahmet
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    Bresler, L.
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    Rauch, P.
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    Guillemin, F.
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    Marchal, F.
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    Gugenheim, J.
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    Iannelli, A.
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    Bicêtre, K.
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    Benoist, S.
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    Brouquet, A.
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    Pocard, M.
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    Lo Dico, R.
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    Gayet, Brice
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    Fuks, D.
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    Pessaux, Patrick
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    Mutter, Didier
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    Marescaux, Jacques F.
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    Raoux, L.
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    Suc, B.
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    Muscari, Fabrice
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    Elhomsy, G.
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    Gelli, M.
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    Sa Cunha, Antonio
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    Castaing, D.
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    Cherqui, Daniel
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    Scatton, O.
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    Vaillant, J.-C.
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    Piardi, Tullio
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    Sommacale, Daniele
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    Kianmanesh, R.
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    Comy, M.
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    Bachellier, Philippe
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    Oussoultzoglou, Elíe
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    Addeo, Pietro F.
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    Pittau, G.
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    Ciacio, O.
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    Vibert, E.
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    Elias, D.
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    Goéré, Diane
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    Vittadello, F.
    Background: Recurrence remains frequent after curative-intent hepatectomy for colorectal liver metastases (CRLM). We sought to define short- and long-term outcomes, and identify prehepatectomy factors associated with survival, following rehepatectomy (RH) for recurrence. Methods: We conducted a multi-institutional cohort study of hepatectomy for CRLM over 2006–2013. Second-stage resections were excluded. Primary outcomes were overall survival (OS) and recurrence-free survival (RFS) assessed using Kaplan–Meier methods. Secondary outcomes included 30-day overall morbidity and mortality, and survival from recurrence. Outcomes of RH and initial hepatectomy (IH) were compared. Results: Of 2771 hepatectomies included in the study, 447 were RH. Median operative time, 30-day morbidity, mortality, and median length of stay did not differ for RH and IH. Five-year OS did not statistically differ, i.e. 56.5 % from RH and 67.6 % from IH [adjusted hazard ratio (HR) 0.9, 95 % confidence interval (CI) 0.5–1.7], and 5-year RFS was inferior after RH (18.5 vs. 28.8 %; adjusted HR 1.3, 95 % CI 1.0–1.7). In patients who eventually recurred, 5-year survival from the time of recurrence did not differ whether it was after RH (46.5 %) or after IH (60.3 %) (adjusted HR 1.1, 95 % CI 0.8–1.8). Rectal primary tumor (HR 1.4, 95 % CI 1.0–2.1) and metastasis ≥3 cm (HR 1.3, 95 % CI 1.1–2.7) were independently associated with RFS, but not OS, after RH. Conclusion: Short-term outcomes of RH did not differ from IH. While recurrence was more frequent after RH than IH, it did not impact OS. Survival from the time of recurrence did not differ whether recurrence occurred after RH or after IH. CRLM recurrence can be treated with curative intent with excellent long-term outcomes.
  • Publication
    Arc of Bühler: the surgical significance of a rare anatomical variation
    (2018-01-01)
    Michalinos, Adamantios
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    Schizas, Dimitrios
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    Filippou, Dimitrios Konstantinos
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    Troupis, Theodore G.
    Purpose: The arc of Bühler, an anastomotic vessel between celiac artery and superior mesenteric artery, is a rare anatomic variation. Various radiologic and surgical procedures can be affected by its existence. We aim to review all available information and identify possible clinical implications. Methods: A systematic review was conducted in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. The following terms were utilized in various combinations: “Bühler”, “arc of Bühler”, “visceral aneurysm”, “pancreaticoduodenal arcades”. Results: Only 53 cases have been described until today in the literature. The arc of Bühler enhances collateral circulation between celiac artery and superior mesenteric artery alongside with pancreaticoduodenal arcades and dorsal pancreatic artery. Computerized tomography and angiography are the main studies used for its detection and evaluation. Aneurysms of Bühler’s arc have been rarely described and seem to share common pathophysiological mechanisms with aneurysms of the pancreaticoduodenal arcades. Conclusions: Various radiologic and surgical procedures such as embolization or pancreaticoduodenectomy are potentially affected by its existence.
  • Publication
    New insights into irritable bowel syndrome: From pathophysiology to treatment
    (2019-11-15)
    Hadjivasilis, Alexandros
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    Michalinos, Adamantios
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    Christodoulou, Dimitrios K.
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    Agouridis, Aris P.
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    Hadjivasilis, Alexandros
    Irritable bowel syndrome (IBS) is the most common reason to visit a gastroenterologist. IBS was believed to be a functional disease, but many possible pathophysiologic mechanisms can now explain the symptoms. IBS patients are classified into subtypes according to their predominant bowel habit, based on the Rome IV criteria. These include diarrhea-predominant and constipation-predominant IBS, as well as the mixed type, a combination of the two. Usually, IBS treatment is based on the predominant symptoms, with many options for each subtype. A new promising treatment option, fecal microbiota transplantation, seems to have beneficial effects on IBS. However, treating the pathophysiological causative agent responsible for the symptoms is an emerging approach. Therefore, before the appropriate therapeutic option is chosen for treating IBS, a clinical evaluation of its pathophysiology should be performed.
  • Publication
    Splenic vein-inferior mesenteric vein anastomosis to lessen left-sided portal hypertension after pancreaticoduodenectomy with concomitant vascular resection
    (2011-12-01)
    Ferreira, Nélio
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    Oussoultzoglou, Elíe
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    Fuchshuber, Pascal R.
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    Narita, Masato
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    Rather, Mudassir
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    Rosso, Edoardo
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    Addeo, Pietro F.
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    Pessaux, Patrick
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    Jaeck, Daniel
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    Bachellier, Philippe
    Hypothesis: A splenic vein (SV)-inferior mesenteric vein (IMV) anastomosis reduces congestion of the stomach and spleen after pancreaticoduodenectomy with resection of the SV-mesenteric vein confluence but carries a risk of left-sided venous hypertension. Design: Comparative retrospective study. Setting: Department of Digestive Surgery and Transplantation, University of Strasbourg, Strasbourg, France. Patients: FromJanuary 1, 2002, to February 28, 2010, 39 patients underwent pancreaticoduodenectomy with resection of the SV-mesenteric vein confluence for pancreatic adenocarcinoma. All patients had a terminoterminal portalvein- superiormesentericveinanastomosis.TheSVblood flow into the portal vein was preserved in 11 patients by reimplantation of theSVinto the portal vein. Sixteen patients underwent surgical reconstruction of the SV-IMV confluence by anastomosis (group 1), and in 12 patients the natural SV-IMV confluence was preserved (group 2). Main Outcome Measures: Preoperative and postoperative spleen volume and platelet count. Results: Demographic characteristics, preoperative tumor staging, pathological outcome, and postoperative complications were comparable in both groups. There was no difference in platelet count between groups 1 and 2 preoperatively (mean [SD], 293.13 [125.37] vs 241.09 [49.12]×10 3/μL [to convert to ×10 9/L, multiply by 1.0], respectively; P=.21) or postoperatively (mean [SD], 231.75 [156.39] vs 164.31 [76.46]×10 3/μL, respectively; P=.32). Likewise, no difference was found in the spleen volume preoperatively (mean [SD], 258.96 [179.23] vs 237.31 [122.46] mL, respectively; P=.76) and on postoperative day 15 (mean [SD], 279.08 [158.10] vs 299.12 [153.11] mL, respectively; P=.78). Conclusion: Early assessment shows that SV-IMV anastomosis is as feasible and as safe as the preservation of a natural SV-IMV confluence in patients undergoing pancreaticoduodenectomy with vascular resection for pancreatic head adenocarcinoma.
  • Publication
    Primary Tumor Versus Liver-First Approach for Synchronous Colorectal Liver Metastases: An Association Française de Chirurgie (AFC) Multicenter-Based Study with Propensity Score Analysis
    (2018-12-01)
    Esposito, Francesco
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    Lim, Chetana
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    Sa Cunha, Antonio
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    Pessaux, Patrick
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    Navarro, Françis
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    Azoulay, Daniel
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    Cossé, Cyril
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    Lignier, Delphine
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    Régimbeau, Jean Marc
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    Barbieux, Julien P.
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    Lermite, Émilie
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    Hamy, Antoine P.
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    Mauvais, François
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    Laurent, Christophe
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    Naasan, Irchid Al
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    Azoulay, Daniel
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    Salloum, Chady
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    Compagnon, Philippe
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    Idrissi, Mohammed Sbai
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    Martin, Frédéric
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    Atger, Jérôme
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    Baulieux, Jacques
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    Darnis, Benjamin
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    Mabrut, Jean Yves
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    Képénékian, Vahan
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    Périnel, Julie
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    Adham, Mustapha
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    Gléhen, Olivier J.
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    Rivoire, Michel L.
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    Hardwigsen, Jean
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    Palen, Anaïs
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    Grégoire, Émilie
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    LeTreut, Yves Patrice
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    Delpéro, Jean Robert
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    Turrini, Olivier
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    Herrero, Astrid
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    Panaro, Fabrizio
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    Ayav, Ahmet
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    Bresler, Laurent
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    Rauch, P.
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    Guillemin, F.
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    Marchal, F.
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    Gugenheim, J.
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    Iannelli, A.
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    Benoist, S.
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    Brouquet, A.
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    Pocard, M.
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    Dico, R.L.
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    Gayet, Brice
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    Fuks, D.
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    Scatton, O.
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    Soubrane, O.
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    Vaillant, J.-C.
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    Piardi, Tullio
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    Sommacale, Daniele
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    Kianmanesh, R.
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    Comy, M.
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    Bachellier, Philippe
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    Oussoultzoglou, Elíe
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    Addeo, Pietro F.
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    Mutter, Didier
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    Marescaux, Jacques F.
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    Raoux, L.
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    Suc, B.
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    Muscari, Fabrice
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    Elhomsy, G.
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    Gelli, M.
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    Cunha, A.S.
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    Ádám, René A.
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    Castaing, D.
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    Cherqui, Daniel
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    Pittau, G.
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    Ciacio, O.
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    Vibert, E.
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    Elias, D.
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    Goéré, Diane
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    Vittadello, F.
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    On behalf of the French Colorectal Liver Metastases Working Group, Association Francaise de Chirurgie (AFC)
    Objectives: Multicenter studies comparing the reverse strategy (RS) with the classical strategy (CS) for the management of stage IVA liver-only colorectal cancer (CCR) are scarce. The aim of this study was to compare long-term survival and recurrence patterns following use of the CS and RS. Method: This retrospective multicenter review collected data from all consecutive patients with stage IVA liver-only CCR who underwent staged resection of CCR and liver metastases (LM) at 24 French hospitals between 2006 and 2013 and were retrospectively analyzed. Patients who underwent simultaneous liver and CCR resection, those with synchronous extrahepatic metastasis, and those who underwent emergent CCR resection were excluded. Overall survival (OS) and recurrence-free survival (RFS) rates and recurrence patterns were investigated before and after propensity score matching (PSM). Results: A total of 653 patients were included: 587 (89.9%) in the CS group and 66 (10.1%) in the RS group. Compared with the CS patients, RS patients were more likely to have rectal cancer (43.9 vs. 24.9%; p = 0.006), larger liver tumor size (52.5 ± 38.6 vs. 39.6 ± 30 mm; p = 0.01), and more positive lymph nodes (62.1 vs. 44.8%; p = 0.009). OS was not different between the two groups (75 vs. 72% at 5 years; p = 0.77), while RFS was worse in the RS group (24 vs. 33% at 5 years; p = 0.01). Time to recurrence at any site (1.8 vs. 2.4 years, p = 0.024) and intrahepatic recurrence (1.7 vs. 2.2 years, p = 0.014) were significantly shorter in the RS group than in the CS group. After PSM (63 patients in each group), no significant difference was found between the two groups in OS (p = 0.35), RFS (p = 0.62), time to recurrence at any site (p = 0.19), or intrahepatic recurrence (p = 0.13). Conclusions: In this study, approximately 10% of patients with CCR and synchronous LM were offered surgery with the RS. Both strategies ensured similar oncological outcomes.
  • Publication
    Clip and snare countertraction technique for rectal submucosal dissection
    (2017-01-01)
    Mavrogenis, Georgios
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    Georgousis, Nikolaos
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    Mavrogiorgis, Anastasios