Background and study aim: Over the last 20 years, cytoreductive surgery (CRS) combined with hyper... more Background and study aim: Over the last 20 years, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has progressively become a therapeutic option for peritoneal carcinomatosis thanks to its favourable oncologic results. The aim of this study is to analyse the overall survival and recurrence-free survival, after complete CRS and closed abdomen technique HIPEC for peritoneal carcinomatosis from colorectal cancer. Patients and methods: This retrospective study collected the data from all patients who underwent a CRS with HIPEC for colorectal cancer at “Cliniques universitaires Saint Luc” from October 2007 to December 2020. Ninety-nine patients were included. Results: The median follow-up was 34 months. Post-operative mortality and Clavien-Dindo grade III/IV morbidity rates were 2.0% and 28.3%. The overall 2-year and 5-year survival rates were 80.1% and 54.4%. Using the multivariate analysis, age at surgery, liver metastases and PCI score >13...
Background The management of ulcerative colitis (UC) has been improved due to progresses in medic... more Background The management of ulcerative colitis (UC) has been improved due to progresses in medical and surgical practices during the past twenty years. Yet the impact of new therapies on the evolution of the three colectomy’s indications in UC (severe acute colitis, refractory ulcerative colitis and (pre-)neoplastic complication) is still not well established. The aim of this study was to compare the evolution of the surgical indications within the last two decades. Methods This was an observational retrospective study carried out in two tertiary hospitals. All patients with UC who underwent total or segmental colectomy between 2001 and 2020 were included, without age restriction. Two periods were compared: 2001–2010 and 2011–2020. Endpoints were to compare the colectomy indications, patients’ characteristics, surgical procedures, and rates of postoperative complication between the two cohorts. Results Among the 286 patients included (57% were men; median age of 40 years; 60.5% of ...
Laparoscopic surgery is associated with reduced surgical trauma, therefore with acute-phase respo... more Laparoscopic surgery is associated with reduced surgical trauma, therefore with acute-phase response of lower magnitude as compared with open surgery. We hypothesized that NOTES might induce reduced immune response as compared with laparoscopy. To compare acute-phase reactants in a controlled trial of laparoscopic peritoneoscopy and ultrasonography versus transgastric or transcolonic NOTES peritoneoscopy and intraperitoneal endoscopic US. Eighteen pigs were divided in 3 groups: laparoscopy, transgastric and transcolonic NOTES. Serum levels of IL-6 and TNF-α were determined preoperatively and at day 2. Serum levels of haptoglobin and IL-6 mRNA levels from isolated white blood cells were measured by RT-PCR at days 0, 1, 2 and 7. Necropsy was performed at sacrifice, with peritoneal fluid microbiological analysis, macroscopic and microscopic examinations on gastrotomy/colotomy or abdominal wall closure sites, liver and parietal peritoneum biopsy sites and any area suggestive of infectio...
Transanal endoscopic microsurgery (TEM) was developed in the early 1980s as a minimally invasive ... more Transanal endoscopic microsurgery (TEM) was developed in the early 1980s as a minimally invasive technique allowing the resection of benign rectal adenomas. For this indication, TEM was reported to be safe and effective and even exceeded the results compared to classical local excision. Unsurprisingly, the indication expanded to small rectal cancer. There is still much debate, though, whether it is oncologically safe to perform TEM for rectal cancer. Much has been published about the need for proper patient selection, i.e. patients presenting a low-risk T1 rectal cancer seem to be the most adequate subgroup for this technique. Nevertheless, TEM remains controversial concerning high-risk T1 rectal adenocarcinomas and deeper infiltrating tumors. Several retrospective case series and a small prospective study suggest that radiochemotherapy before local excision reduces recurrence to a level comparable with classic radical surgery (total mesorectal excision). However, these studies are ...
ABSTRACT Objectifs L’étude avait pour but de comparer les résultats de la prise en charge selon u... more ABSTRACT Objectifs L’étude avait pour but de comparer les résultats de la prise en charge selon un protocole de réhabilitation rapide (fast-track) avec ceux d’une prise en charge traditionnelle en chirurgie colorectale. Les paramètres analysés étaient la durée d’hospitalisation, la morbidité postopératoire et la satisfaction des patients. Matériel et Méthode Deux cents quarante-trois patients consécutifs ayant eu une chirurgie colorectale ont été inclus. Le groupe fast-track (FT) (124 patients) a été comparé à une cohorte rétrospective de 119 patients (groupe contrôle - CONT), ayant été traités de façon conventionnelle. Les critères d’exclusion étaient les suivants : score ASA IV, score AFC ≥ 3, chirurgie pour pathologie rectale ou nécessitant la confection d’une stomie. La voie d’abord était préférentiellement laparoscopique dans les deux groupes (96,8 % pour le group FT et 91,8 % pour le group CONT) (p = ns). Une analyse multivariée par régression logistique a été réalisée pour identifier les facteurs influençant la durée d’hospitalisation et le taux de complication. Le niveau de satisfaction des patients a été évalué au moyen d’un questionnaire spécifique. Résultats La mortalité était de 0 % dans le groupe FT et de 0,8 % dans le groupe CONT (p = ns). La morbidité était respectivement de 30,6 % (FT) et de 38,6 % (CONT) (p = ns). La durée médiane d’hospitalisation a été de 3 jours [2-16] dans le groupe FT et de 6 jours [3-29] dans le groupe CONT (p < 0,001). Le taux d’admission dans le service des urgences après FT étaient de 16,9 % et de 7,6 % pour le groupe CONT (p < 0,05) ; le taux de ré-hopitalisation ne différait pas de manière significative (8 % vs 4,2 %, p = ns). La satisfaction globale des patients était plus élevée dans le groupe FT. L’analyse multivariée à mis en évidence trois facteurs pronostiques indépendants favorable pour la durée d’hospitalisation, à savoir un âge < 69 ans (p = 0,001), l’approche laparoscopique (p = 0,001) et le programme FT (p < 0,0001). Conclusion La réhabilitation rapide après chirurgie colorectale réduit significativement la durée d’hospitalisation sans augmenter la morbidité. Nos résultats nous permettent de moduler le programme FT en fonction de l’âge et de la voie d’abord. Enfin, la satisfaction des patients FT est élevée.
Background and study aim: Over the last 20 years, cytoreductive surgery (CRS) combined with hyper... more Background and study aim: Over the last 20 years, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has progressively become a therapeutic option for peritoneal carcinomatosis thanks to its favourable oncologic results. The aim of this study is to analyse the overall survival and recurrence-free survival, after complete CRS and closed abdomen technique HIPEC for peritoneal carcinomatosis from colorectal cancer. Patients and methods: This retrospective study collected the data from all patients who underwent a CRS with HIPEC for colorectal cancer at “Cliniques universitaires Saint Luc” from October 2007 to December 2020. Ninety-nine patients were included. Results: The median follow-up was 34 months. Post-operative mortality and Clavien-Dindo grade III/IV morbidity rates were 2.0% and 28.3%. The overall 2-year and 5-year survival rates were 80.1% and 54.4%. Using the multivariate analysis, age at surgery, liver metastases and PCI score >13...
Background The management of ulcerative colitis (UC) has been improved due to progresses in medic... more Background The management of ulcerative colitis (UC) has been improved due to progresses in medical and surgical practices during the past twenty years. Yet the impact of new therapies on the evolution of the three colectomy’s indications in UC (severe acute colitis, refractory ulcerative colitis and (pre-)neoplastic complication) is still not well established. The aim of this study was to compare the evolution of the surgical indications within the last two decades. Methods This was an observational retrospective study carried out in two tertiary hospitals. All patients with UC who underwent total or segmental colectomy between 2001 and 2020 were included, without age restriction. Two periods were compared: 2001–2010 and 2011–2020. Endpoints were to compare the colectomy indications, patients’ characteristics, surgical procedures, and rates of postoperative complication between the two cohorts. Results Among the 286 patients included (57% were men; median age of 40 years; 60.5% of ...
Laparoscopic surgery is associated with reduced surgical trauma, therefore with acute-phase respo... more Laparoscopic surgery is associated with reduced surgical trauma, therefore with acute-phase response of lower magnitude as compared with open surgery. We hypothesized that NOTES might induce reduced immune response as compared with laparoscopy. To compare acute-phase reactants in a controlled trial of laparoscopic peritoneoscopy and ultrasonography versus transgastric or transcolonic NOTES peritoneoscopy and intraperitoneal endoscopic US. Eighteen pigs were divided in 3 groups: laparoscopy, transgastric and transcolonic NOTES. Serum levels of IL-6 and TNF-α were determined preoperatively and at day 2. Serum levels of haptoglobin and IL-6 mRNA levels from isolated white blood cells were measured by RT-PCR at days 0, 1, 2 and 7. Necropsy was performed at sacrifice, with peritoneal fluid microbiological analysis, macroscopic and microscopic examinations on gastrotomy/colotomy or abdominal wall closure sites, liver and parietal peritoneum biopsy sites and any area suggestive of infectio...
Transanal endoscopic microsurgery (TEM) was developed in the early 1980s as a minimally invasive ... more Transanal endoscopic microsurgery (TEM) was developed in the early 1980s as a minimally invasive technique allowing the resection of benign rectal adenomas. For this indication, TEM was reported to be safe and effective and even exceeded the results compared to classical local excision. Unsurprisingly, the indication expanded to small rectal cancer. There is still much debate, though, whether it is oncologically safe to perform TEM for rectal cancer. Much has been published about the need for proper patient selection, i.e. patients presenting a low-risk T1 rectal cancer seem to be the most adequate subgroup for this technique. Nevertheless, TEM remains controversial concerning high-risk T1 rectal adenocarcinomas and deeper infiltrating tumors. Several retrospective case series and a small prospective study suggest that radiochemotherapy before local excision reduces recurrence to a level comparable with classic radical surgery (total mesorectal excision). However, these studies are ...
ABSTRACT Objectifs L’étude avait pour but de comparer les résultats de la prise en charge selon u... more ABSTRACT Objectifs L’étude avait pour but de comparer les résultats de la prise en charge selon un protocole de réhabilitation rapide (fast-track) avec ceux d’une prise en charge traditionnelle en chirurgie colorectale. Les paramètres analysés étaient la durée d’hospitalisation, la morbidité postopératoire et la satisfaction des patients. Matériel et Méthode Deux cents quarante-trois patients consécutifs ayant eu une chirurgie colorectale ont été inclus. Le groupe fast-track (FT) (124 patients) a été comparé à une cohorte rétrospective de 119 patients (groupe contrôle - CONT), ayant été traités de façon conventionnelle. Les critères d’exclusion étaient les suivants : score ASA IV, score AFC ≥ 3, chirurgie pour pathologie rectale ou nécessitant la confection d’une stomie. La voie d’abord était préférentiellement laparoscopique dans les deux groupes (96,8 % pour le group FT et 91,8 % pour le group CONT) (p = ns). Une analyse multivariée par régression logistique a été réalisée pour identifier les facteurs influençant la durée d’hospitalisation et le taux de complication. Le niveau de satisfaction des patients a été évalué au moyen d’un questionnaire spécifique. Résultats La mortalité était de 0 % dans le groupe FT et de 0,8 % dans le groupe CONT (p = ns). La morbidité était respectivement de 30,6 % (FT) et de 38,6 % (CONT) (p = ns). La durée médiane d’hospitalisation a été de 3 jours [2-16] dans le groupe FT et de 6 jours [3-29] dans le groupe CONT (p < 0,001). Le taux d’admission dans le service des urgences après FT étaient de 16,9 % et de 7,6 % pour le groupe CONT (p < 0,05) ; le taux de ré-hopitalisation ne différait pas de manière significative (8 % vs 4,2 %, p = ns). La satisfaction globale des patients était plus élevée dans le groupe FT. L’analyse multivariée à mis en évidence trois facteurs pronostiques indépendants favorable pour la durée d’hospitalisation, à savoir un âge < 69 ans (p = 0,001), l’approche laparoscopique (p = 0,001) et le programme FT (p < 0,0001). Conclusion La réhabilitation rapide après chirurgie colorectale réduit significativement la durée d’hospitalisation sans augmenter la morbidité. Nos résultats nous permettent de moduler le programme FT en fonction de l’âge et de la voie d’abord. Enfin, la satisfaction des patients FT est élevée.
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