Intraperitoneal chemohyperthermia (IPCH) with Cytoreductive surgery (CS) has been used in Centre ... more Intraperitoneal chemohyperthermia (IPCH) with Cytoreductive surgery (CS) has been used in Centre Hospitalier et Universitaire Lyon Sud (CHLS) since 1989. Up to 2005, 420 patients were involved in different phase II studies for peritoneal carcinomatosis (PC) from colorectal, gastric or ovarian origin, as well as for pseudomyxoma peritonei and peritoneal mesothelioma. Encouraging results were achieved in case of optimal PC cytoreduction. The CHLS experience, as well as the Dutch randomized trial and the international registration, underline the advantage of such an aggressive combined therapy for selected patients in experienced multidisciplinary centers.
Splenectomy for massive splenomegaly is frequently performed for hematologic disorders for diagno... more Splenectomy for massive splenomegaly is frequently performed for hematologic disorders for diagnostic and therapeutic indications. The role of splenectomy is complex and controversial. The aims of our retrospective study were to focus on postoperative complications and advantages of splenectomy for massive splenomegaly. Thirty six patients with splenomegaly weighing 1000 g or more, underwent splenectomy at Centre Hospitalier Universitaire Lyon Sud, from January 1st, 1982, to December 31, 1995. Thirty-one (85%) of these patients had hematologic malignancy and more than half of them were older than sixty years. The main indications for splenectomy were hypersplenism (18 patients) and diagnosis (14). Preliminary ligation of the splenic artery was performed in 25 patients (42%). All patients had drainage. The mortality and morbidity rates were 5.5% and 20%, respectively. No major septic or thromboembolic complications occurred. There was only one major bleeding complication. The advanta...
Objectifs Evaluer l’interet de la TEP en complement de la TDM dans le diagnostic de la carcinose ... more Objectifs Evaluer l’interet de la TEP en complement de la TDM dans le diagnostic de la carcinose peritoneale. Materiels et methodes Chez 16 patients presentant des lesions de carcinose peritoneale sur la TEP, les TDM et leur comptes-rendus ont ete analyses retrospectivement (l’intervalle de temps separant les deux examens etant court). L’etude portait sur 8 colons, 1 rectum, 6 ovaires, 1 pancreas, operes et surveilles par TEP. Dans 6 cas la carcinose etait presente au moment du geste operatoire et donc connue. Resultats Les lesions de carcinose peritoneale decrites sur les examens TEP ont ete retrouvees a la relecture orientee des TDM dans 100 % des cas. Dans 12 cas sur 16 (75 %) le compte rendu TDM ne les signalait pas. Quand la carcinose etait d’emblee connue (6 cas) le compte rendu ne les decrivait que dans 2 cas (33 %). Conclusion Le diagnostic TDM de la carcinose peritoneale est difficile et souvent meconnu. Il necessite une lecture specialisee. Cet ecueil peut etre ameliore par la realisation complementaire d’une TEP et leve par la realisation d’une TEP-TDM.
Objectifs Evaluer l’interet de la TEP en complement de la TDM dans le diagnostic de la carcinose ... more Objectifs Evaluer l’interet de la TEP en complement de la TDM dans le diagnostic de la carcinose peritoneale. Materiels et methodes Chez 16 patients presentant des lesions de carcinose peritoneale sur la TEP, les TDM et leur comptes-rendus ont ete analyses retrospectivement (l’intervalle de temps separant les deux examens etant court). L’etude portait sur 8 colons, 1 rectum, 6 ovaires, 1 pancreas, operes et surveilles par TEP. Dans 6 cas la carcinose etait presente au moment du geste operatoire et donc connue. Resultats Les lesions de carcinose peritoneale decrites sur les examens TEP ont ete retrouvees a la relecture orientee des TDM dans 100 % des cas. Dans 12 cas sur 16 (75 %), le compte rendu TDM ne les signalait pas. Quand la carcinose etait d’emblee connue (6 cas), le compte rendu ne les decrivait que dans 2 cas (33 %). Conclusion Le diagnostic TDM de la carcinose peritoneale est difficile et souvent meconnu. Il necessite une lecture specialisee. Cet ecueil peut etre ameliore par la realisation complementaire d’une TEP et leve par la realisation d’une TEP-TDM.
Ovarian cancer remains the fourth leading cause of cancer death in women in France. It is all too... more Ovarian cancer remains the fourth leading cause of cancer death in women in France. It is all too often diagnosed at an advanced stage with peritoneal carcinomatosis (PC), but remains confined to the peritoneal cavity throughout much of its natural history. Because of cellular selection pressure over time, most tumor recurrences eventually develop resistance to systemic platinum. Options for salvage therapy include alternative systemic chemotherapies and further cytoreductive surgery (CRS), but the prognosis remains poor. Over the past two decades, a new therapeutic approach to PC has been developed that combines CRS with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment strategy has already been shown to be effective in non-gynecologic carcinomatosis in numerous reports. There is a strong rationale for the use of HIPEC for PC of ovarian origin. On the one hand, three prospective randomized trials have demonstrated the superiority of intraperitoneal chemotherapy (without hyperthermia) in selected patients compared to systemic chemotherapy. Moreover, retrospective studies and case-control studies of HIPEC have reported encouraging survival data, especially when used to treat chemoresistant recurrence. However, HIPEC has specific morbidity and mortality; this calls for very careful selection of eligible patients by a multidisciplinary team in specialized centers. HIPEC needs to be evaluated by means of randomized trials for ovarian cancer at different developmental stages: as first line therapy, as consolidation, and for chemoresistant recurrence. Several European phase III studies are currently ongoing.
Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have demonstrat... more Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have demonstrated promising results in the treatment of peritoneal carcinomatosis (PC). The purpose of this study was to assess the impact of this combined procedure on quality of life (QoL). A prospective single centre study of 216 consecutive patients treated with CRS and HIPEC was conducted using the Gastro-Intestinal Quality of Life Index questionnaire (GIQLI), completed preoperatively and at 1, 3, 6 and 12 months. Questionnaire compliance was 81%, 90%, 89%, 89% and 74% at baseline, 1, 3, 6 and 12 months respectively. QoL was significantly decreased up to 6 months and returned to baseline at 12 months. In multivariate analysis, factors decreasing QoL were origin of PC at 3 months, presence of stoma at 6 months and length of surgery over 270 min and disease recurrence at 12 months. Despite morbidity associated with CRS and HIPEC, QoL returned to baseline at one year after surgery. This treatment strategy should be considered for the treatment of peritoneal carcinomatosis.
Intraperitoneal chemohyperthermia (IPCH) with Cytoreductive surgery (CS) has been used in Centre ... more Intraperitoneal chemohyperthermia (IPCH) with Cytoreductive surgery (CS) has been used in Centre Hospitalier et Universitaire Lyon Sud (CHLS) since 1989. Up to 2005, 420 patients were involved in different phase II studies for peritoneal carcinomatosis (PC) from colorectal, gastric or ovarian origin, as well as for pseudomyxoma peritonei and peritoneal mesothelioma. Encouraging results were achieved in case of optimal PC cytoreduction. The CHLS experience, as well as the Dutch randomized trial and the international registration, underline the advantage of such an aggressive combined therapy for selected patients in experienced multidisciplinary centers.
Splenectomy for massive splenomegaly is frequently performed for hematologic disorders for diagno... more Splenectomy for massive splenomegaly is frequently performed for hematologic disorders for diagnostic and therapeutic indications. The role of splenectomy is complex and controversial. The aims of our retrospective study were to focus on postoperative complications and advantages of splenectomy for massive splenomegaly. Thirty six patients with splenomegaly weighing 1000 g or more, underwent splenectomy at Centre Hospitalier Universitaire Lyon Sud, from January 1st, 1982, to December 31, 1995. Thirty-one (85%) of these patients had hematologic malignancy and more than half of them were older than sixty years. The main indications for splenectomy were hypersplenism (18 patients) and diagnosis (14). Preliminary ligation of the splenic artery was performed in 25 patients (42%). All patients had drainage. The mortality and morbidity rates were 5.5% and 20%, respectively. No major septic or thromboembolic complications occurred. There was only one major bleeding complication. The advanta...
Objectifs Evaluer l’interet de la TEP en complement de la TDM dans le diagnostic de la carcinose ... more Objectifs Evaluer l’interet de la TEP en complement de la TDM dans le diagnostic de la carcinose peritoneale. Materiels et methodes Chez 16 patients presentant des lesions de carcinose peritoneale sur la TEP, les TDM et leur comptes-rendus ont ete analyses retrospectivement (l’intervalle de temps separant les deux examens etant court). L’etude portait sur 8 colons, 1 rectum, 6 ovaires, 1 pancreas, operes et surveilles par TEP. Dans 6 cas la carcinose etait presente au moment du geste operatoire et donc connue. Resultats Les lesions de carcinose peritoneale decrites sur les examens TEP ont ete retrouvees a la relecture orientee des TDM dans 100 % des cas. Dans 12 cas sur 16 (75 %) le compte rendu TDM ne les signalait pas. Quand la carcinose etait d’emblee connue (6 cas) le compte rendu ne les decrivait que dans 2 cas (33 %). Conclusion Le diagnostic TDM de la carcinose peritoneale est difficile et souvent meconnu. Il necessite une lecture specialisee. Cet ecueil peut etre ameliore par la realisation complementaire d’une TEP et leve par la realisation d’une TEP-TDM.
Objectifs Evaluer l’interet de la TEP en complement de la TDM dans le diagnostic de la carcinose ... more Objectifs Evaluer l’interet de la TEP en complement de la TDM dans le diagnostic de la carcinose peritoneale. Materiels et methodes Chez 16 patients presentant des lesions de carcinose peritoneale sur la TEP, les TDM et leur comptes-rendus ont ete analyses retrospectivement (l’intervalle de temps separant les deux examens etant court). L’etude portait sur 8 colons, 1 rectum, 6 ovaires, 1 pancreas, operes et surveilles par TEP. Dans 6 cas la carcinose etait presente au moment du geste operatoire et donc connue. Resultats Les lesions de carcinose peritoneale decrites sur les examens TEP ont ete retrouvees a la relecture orientee des TDM dans 100 % des cas. Dans 12 cas sur 16 (75 %), le compte rendu TDM ne les signalait pas. Quand la carcinose etait d’emblee connue (6 cas), le compte rendu ne les decrivait que dans 2 cas (33 %). Conclusion Le diagnostic TDM de la carcinose peritoneale est difficile et souvent meconnu. Il necessite une lecture specialisee. Cet ecueil peut etre ameliore par la realisation complementaire d’une TEP et leve par la realisation d’une TEP-TDM.
Ovarian cancer remains the fourth leading cause of cancer death in women in France. It is all too... more Ovarian cancer remains the fourth leading cause of cancer death in women in France. It is all too often diagnosed at an advanced stage with peritoneal carcinomatosis (PC), but remains confined to the peritoneal cavity throughout much of its natural history. Because of cellular selection pressure over time, most tumor recurrences eventually develop resistance to systemic platinum. Options for salvage therapy include alternative systemic chemotherapies and further cytoreductive surgery (CRS), but the prognosis remains poor. Over the past two decades, a new therapeutic approach to PC has been developed that combines CRS with hyperthermic intraperitoneal chemotherapy (HIPEC). This treatment strategy has already been shown to be effective in non-gynecologic carcinomatosis in numerous reports. There is a strong rationale for the use of HIPEC for PC of ovarian origin. On the one hand, three prospective randomized trials have demonstrated the superiority of intraperitoneal chemotherapy (without hyperthermia) in selected patients compared to systemic chemotherapy. Moreover, retrospective studies and case-control studies of HIPEC have reported encouraging survival data, especially when used to treat chemoresistant recurrence. However, HIPEC has specific morbidity and mortality; this calls for very careful selection of eligible patients by a multidisciplinary team in specialized centers. HIPEC needs to be evaluated by means of randomized trials for ovarian cancer at different developmental stages: as first line therapy, as consolidation, and for chemoresistant recurrence. Several European phase III studies are currently ongoing.
Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have demonstrat... more Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) have demonstrated promising results in the treatment of peritoneal carcinomatosis (PC). The purpose of this study was to assess the impact of this combined procedure on quality of life (QoL). A prospective single centre study of 216 consecutive patients treated with CRS and HIPEC was conducted using the Gastro-Intestinal Quality of Life Index questionnaire (GIQLI), completed preoperatively and at 1, 3, 6 and 12 months. Questionnaire compliance was 81%, 90%, 89%, 89% and 74% at baseline, 1, 3, 6 and 12 months respectively. QoL was significantly decreased up to 6 months and returned to baseline at 12 months. In multivariate analysis, factors decreasing QoL were origin of PC at 3 months, presence of stoma at 6 months and length of surgery over 270 min and disease recurrence at 12 months. Despite morbidity associated with CRS and HIPEC, QoL returned to baseline at one year after surgery. This treatment strategy should be considered for the treatment of peritoneal carcinomatosis.
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