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Intra-operative peritoneal lavage for colorectal cancer

World Journal of Gastroenterology 2014年第8期20卷 1935-1939页

作者： Guillaume Passot Kayvan Mohkam eddy cotte Olivier Glehen Departement of General and Surgical Oncology Hospices Civils de Lyon69495 Pierre BéniteFrance EMR 3738 Université Lyon 1F-69364 LyonFrance

Free cancer cells can be detected in peritoneal fluid at the time of colorectal surgery. Peritoneal lavage in colorectal surgery for cancer is not used in routine, and the prognostic significance of intraperitoneal free cancer cells (IPCC) remains unclear. Data concerning the technique of peritoneal lavage to detect IPCC and its timing regarding colorectal resection are scarce. However, positive IPCC might be the first step of peritoneal spread in colorectal cancers, which could lead to early specific treatments. Because of the important heterogeneity of IPCC determination in reported studies, no treatment have been proposed to patients with positive IPCC. Herein, we provide an overview of IPCC detection and its impact on recurrence and survival, and we suggest further multi-institutional studies to evaluate new treatment strategies.

关键词： Peritoneal carcinomatosis Colorectal cancer Free intraperitoneal cells Immunocytochemistry

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Selection of patients and staging of peritoneal surface malignancies

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World Journal of Gastrointestinal Oncology 2010年第1期2卷 31-35页

作者： eddy cotte Guillaume Passot Franois-Noёl Gilly Olivier Glehen Department of Digestive Surgery Lyon-Sud HospitalF-69495 Pierre Bénite Cédex équipe Accueil 3738 Claude Bernard Lyon 1 University Department of Digestive Surgery Lyon-Sud HospitalF-69495 Pierre Bénite Cédex

Peritoneal carcinomatosis (PC) is a common evolution of cancer of the gastrointestinal tract, and has been traditionally regarded as a terminal disease with short median survival. During the last 20 years, thanks to its favourable oncologic results, a new loco-regional therapeutic approach, combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), has an important development. Due to its significant, but acceptable, morbidity and mortality, and high cost, this comprehensive management plan requires knowledgeable patient selection. Quantitative prognostic indicators are required to assess a patient’s eligibility. Large multicenter studies have identified several prognostic factors, which can be used for a better selection of patients who would benefit from the combination of cytoreductive surgery with HIPEC. Indications for treatment of PC with cytoreduction and HIPEC are now validated for several diseases: peritoneal mesothelioma, pseudomyxoma peritonei, PC from the appendix, and colorectal cancer. Indications are still under discussion for gastric and ovarian carcinomatosis. Computed tomography is the best radiological for staging the disease. The extent of peritoneal carcinomatosis is, however, difficult to evaluate preoperatively, and precise evaluation is most often performed during surgical exploration. Cytoreductive surgery associated with HIPEC for the treatment of peritoneal carcinomatosis should be performed for young patients with limited and resectable carcino-matosis, in specialized institutions involved in the management of peritoneal surface malignancies.

关键词： Peritoneal carcinomatosis Staging Selection Performance status Peritoneal Cancer Index

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Laparoscopic total colectomy: Does the indication influence the outcome?

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World Journal of Gastrointestinal Surgery 2011年第11期3卷 177-182页

作者： eddy cotte Faheez Mohamed Stéphane Nancey Yves Franois Olivier Glehen Bernard Flourié Jean-Christophe Saurin Gilles Poncet Department of Digestive Surgery Centre Hospitalo-Universitaire Lyon Sud Hospices Civils de Lyon EA 3738 Université Claude Bernard Lyon1 Faculté de Médecine Lyon Sud Colorectal Research Unit Basingstoke and North Hampshire Foundation Trust Department of Gastro-enterology Centre Hospitalo-Universitaire Lyon-Sud Hospices Civils de Lyon Digestive Federation Centre Hospitalo-Universitaire Edouard Herriot Hospices Civils de Lyon

AIM: To assess and compare outcomes of laparoscopic total colectomy performed for a variety of indications. METHODS: Sixty six patients underwent laparoscopic total colectomy for inflammatory bowel disease (IBD) (13) and other diseases (53). Data on demographics, pre and post-operative outcomes were collected ***: Mean operative time was 4.5 h. Conversion rate was 13.6%. Total colectomy performed for IBD was associated with a signifi cantly higher anastomotic leak rate (23.1% vs 1.9%, P < 0.05). On univariate analysis, hand sewn anastomosis and treatment with more than 20 mg of prednisolone for at least 3 mo was associated with a higher anastomotic leak rate (P < 0.05). No signifi cant difference was found in return of gut function and overall morbidity between disease groups. CONCLUSION: Laparoscopic total colectomy is feasible and outcomes are equivalent whatever the indica- tion, except for anastomotic leak rate which is higher for patients with IBD.

关键词： Colectomy Inflammatory bowel disease Laparoscopy Familial adenomatous polyposis Constipation Colonic neoplasms Hereditary nonpolyposis Diverticulosis Treatment outcomes

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