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Recent trends in the treatment of well-differentiated endocrine carcinoma of the small bowel

World Journal of Gastroenterology 2010年第14期16卷 1696-1706页

作者： gilles poncet Jean-Luc Faucheron Thomas Walter Department of Digestive Surgery Edouard Herriot Hospital 69437 Lyon cedex 03 France Department of Colorectal Surgery Michallon Hospital 38043 Grenoble cedex France Department of Medical Oncology Pavillon H Edouard Herriot Hospital 69437 Lyon Cedex 03 France

Well-differentiated endocrine carcinomas of the small bowel are fairly rare neoplasms that present many clinical challenges. They secrete peptides and neuroamines that may cause carcinoid syndrome. However, many are clinically silent until late presentation with major effects. Initial treatment aims to control carcinoid syndrome with somatostatin analogs. Even if there is metastatic spread, surgical resection of the primitive tumor should be discussed in cases of retractile mesenteritis, small bowel ischemia or subocclusive syndrome in order to avoid any acute complication, in particular at the beginning of somatostatin analog treatment. The choice of treatment depends on the symptoms, general health of the patient, tumor burden, degree of uptake of radionuclide, histological features of the tumor, and tumor growth. Management strategies include surgery for cure (which is rarely achieved) or for cytoreduction, radiological interventions (transarterial embolization or radiofrequency ablation), and chemotherapy (interferon and somatostatin analogs). New biological agent and radionuclide targeted therapies are under investigation. Diffuse and non-evolving lesions should also be simplymonitored. Finally, it has to be emphasized that it is of the utmost importance to enroll these patients with a rare disease in prospective clinical trials assessing new therapeutic strategies.

关键词： Gastrointestinal neoplasms Neuroendocrine carcinoma Carcinoid tumor Somatostatin analogs Therapeutic chemoembolization Surgery

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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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