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Role of immunosuppression and tumor differentiation in predicting recurrence after liver transplantation for hepatocellular carcinoma: A multicenter study of 412 patients

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World Journal of Gastroenterology 2006年第45期12卷 7319-7325页

作者： Thomas decaens Franoise Roudot-Thoraval Solange Bresson-Hadni Carole Meyer Jean Gugenheim Francois Durand Pierre-Henri Bernard Olivier Boillot Philippe Compagnon Yvon Calmus Jean Hardwigsen Christian Ducerf Georges Philippe Pageaux Sébastien Dharancy Olivier Chazouillères Daniel Cherqui Christophe Duvoux service d'Hépatologie et de Gastroentérologie AP-HP Hpital Henri Mondor Créteil Unité INSERM 581 France Département de Santé Publique AP-HP Hpital Henri Mondor Créteil France service d’Hépatologie Hpital Jean Minjoz Besanon France service de Transplantation Hpital HautefeuilleStrasbourg France service de chirurgie digestive Hpital L’Ar-chet 2 Nice France service d’Hépatologie AP-HP Hpital Beau-jon Clichy France service d’Hépatologie et de Gastroentéro-logie H?pital Pellegrin Bordeaux France service de chirurgie digestive Hpital Edouard Herriot Lyon France service de chirurgie digestive Hpital Ponchaillou Rennes France service de chirurgie digestive AP-HP HpitalCochin Paris France service de chirurgie digestive Hpital laConception Marseille France service de chirurgie digestive Hpital de laCroix Rousse Lyon France Fédération Médico-Chirurgicale deMaladies de l’Appareil Digestif Hpital Saint-Eloi MontpellierFrance service d’Hépatologie et de Gastroentérologie H?pital Claude Huriez Lille France service d’Hépatologie AP-HP Hpital SAntoine Paris France service de chirurgie Générale et digestive APHP Hopital Henri Mondor Créteil France

AIM： To assess pre-orthotopic liver transplantation （OLT） factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma （HCC） recurrence and disease-free survival after liver transplantation （LT）.METHODS： Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence. RESULTS： Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were： presence of cirrhosis （P = 0.001）, etiology of liver disease （P = 0.03）, α fetoprotein level （〈 200, 200 to 2000, or 〉 2000; P 〈 0.0001）, y-GT activity （N, N to 2N or 〉 2N; P = 0.02）, the number of nodules （1, 2-3 or ≥ 4; P = 0.02）, maximal diameter of the largest nodule （〈 3 cm, 3 to 5 cm or 〉 5 cm; P 〈 0.0001）, the sum of the diameter of the nodules （〈 3 cm, 3 to 5 cm, 5 to 10 cm or 〉10 cm; P 〈 0.0001）, bilobar location （P = 0.01）, preoperative portal thrombosis （P 〈 0.0001）, peri-operative treatment of the tumor （P = 0.002） and chemoembolization （P = 0.03）, tumor differentiation （P = 0.01）, initial type of calcineurin inhibitor （P = 0.003）, the use of antilymphocyte antibodies （P = 0.02）, rejection episodes （P = 0.003） and period of LT （P 〈 0.0001）. By multivariate analysis, 6 variables were independently associated with HCC recurrence： maximal diameter of the largest nodule （P 〈 0.0001）, time of LT （P 〈 0.0001）, tumor differentiation （P 〈 0.0001）, use of anti-lymphocyte antibody （ATG） or anti-CD3 antibody （OKT3）（P = 0.005）, preoperative portal thrombosis （P = 0.06） and the number of nodules （P = 0.06）. CONCLUSION： This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recur

关键词： Immunosuppression Hepatocellular carcinoma Tumor differentiation Liver transplantation

Contribution of alpha-fetoprotein in liver transplantation for hepatocellular carcinoma

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World Journal of Hepatology 2016年第21期8卷 881-890页

作者： Bérénice Charrière Charlotte Maulat Bertrand Suc Fabrice Muscari department of Visceral Surgery Toulouse-Rangueil University Hospital service de chirurgie digestive CHU Toulouse Rangueil

Alpha-fetoprotein(AFP) is the main tumor biomarker available for the management of hepatocellular carcinoma(HCC). Although it is neither a good screening test nor an accurate diagnostic tool for HCC, it seems to be a possible prognostic marker. However, its contribution in liver transplantation for HCC has not been fully determined, although its use to predict recurrence after liver transplantation has been underlined by international societies. In an era of organ shortages, it could also have a key role in the selection of patients eligible for liver transplantation. Yet unanswered questions remain. First, the cut-off value of serum AFP above which liver transplantation should not be performed is still a subject of debate. We show that a concentration of 1000 ng/m L could be an exclusion criterion, whereas values of dence is lacking regarding the values that should be used. Today, the real input of AFP seems to be its integration into new criteria to select patients eligible for a liver transplantation. These recent tools have associated AFP values with morphological criteria, thus refining pre-existing criteria, such as Milan, University of California, San Francisco, or "up-to-seven". We provide a review of the different criteria submitted within the past years. Finally, AFP can be used to monitor recurrence after transplantation, although there is little evidence to support this claim. Future challenges will be to draft new international guidelines to implement the use of AFP as a selection tool, and to determine a clear cut-off value above which liver transplantation should not be performed.

关键词： Hepatocellular carcinoma Downstaging Alpha-fetoprotein Liver transplantation Selection criteria

Predictive factors for compliance with transanal irrigation for the treatment of defecation disorders

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World Journal of Gastroenterology 2017年第11期23卷 2029-2036页

作者： Clémence Bildstein ChloéMelchior Guillaume Gourcerol Estelle Boueyre Valérie Bridoux Eric Vérin Anne-Marie Leroi INSERM U1073 Service de Physiologie DigestiveCHU Rouen INSERM U1073 Service de Chirurgie DigestiveCHU Rouen EA 3830 Pole 3RCHU RouenGroupe de Recherche sur le Handicap Ventilatoire INSERM CIC 0204

AIM To investigate compliance with transanal irrigation(TAI) one year after a training session and to identify predictive factors for *** The compliance of one hundred eight patients [87 women and 21 men; median age 55 years(range 18-83)] suffering from constipation or fecal incontinence(FI) was retrospectively assessed. The patients were trained in TAI over a four-year period at a single institution. They were classified as adopters if they continued using TAI for at least one year after beginning the treatment or as non-adopters if they stopped. Predictive factors of compliance with TAI were based on pretreatment assessments and trainingprogress. The outcomes of the entire cohort of patients who had been recruited for the TAI treatment were expressed in terms of *** Forty-six of the 108(43%) trained patients continued to use TAI one year after their training session. The patients with FI had the best results, with 54.5% remaining compliant with TAI. Only one-third of the patients who complained of slow transit constipation or obstructed defecation syndrome continued TAI. There was an overall discontinuation rate of 57%. The most common reason for discontinuing TAI was the lack of efficacy(41%). However, 36% of the patients who discontinued TAI gave reasons independent of the efficacy of the treatment such as technical problems(catheter expulsion, rectal balloon bursting, instilled water leakage or retention, pain during irrigation, anal bleeding, anal fissure) while 23% said that there were too many constraints. Of the patients who reported discontinuing TAI, the only predictive factor was the progress of the training(OR = 4.9, 1.3-18.9, P = 0.02).CONCLUSION The progress of the training session was the only factor that predicted patient compliance with TAI.

关键词： Neurogenic bowel dysfunction Fecal incontinence Constipation Obstructed defecation Transanal irrigation

Acute ulcerative jejunal diverticulitis:Case report of an uncommon entity

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World Journal of Gastroenterology 2008年第40期14卷 6265-6267页

作者： Wojciech Staszewicz Michel Christodoulou Stefania Proietti Nicolas demartines service de chirurgie Viscerale Centre Hospitalier Universitaire Vaudois service de Radiologie Centre Hospitalier Universitaire Vaudois

Jejunal diverticulosis is a rare entity with variable clinical and anatomical *** reported incidence varies from 0.05% to 6%.Although there is no consensus on the management of asymptomatic jejunal diverticular disease,some complications are potentially life threatening and require early surgical *** report a case of an 88-year-old man investigated for acute abdominal pain with a high biological inflammatory *** of multiple giant jejunal diverticulum was discovered at abdominal computed tomography (CT).As a result of the clinical and biological signs of early peritonitis,an emergency surgical exploration was *** first jejunal loop showed clear signs of jejunal *** segmental jejunum resection with end-to-end anastomosis was *** report confirmed an ulcerative jejunal diverticulitis with imminent perforation and acute local *** patient made an excellent rapid postoperative *** diverticulum is rare but may cause serious *** should be considered a possible etiology of acute abdomen,especially in elderly patients with unusual *** CT is the diagnostic tool of *** best treatment is emergency surgical management.

关键词： Jejunal diverticulum Diverticulitis Surgery Tomography

Role of near-infrared fluorescence in colorectal surgery

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World Journal of Gastroenterology 2021年第31期27卷 5189-5200页

作者： Elodie Zocola Jeremy Meyer Niki Christou Emilie Liot Christian Toso Nicolas Christian Buchs Frederic Ris Medical School University of GenevaGenève 1205Switzerland Division of digestive Surgery University Hospitals of GenevaGenève 1205Switzerland service de chirurgie digestive Endocrinienne et GénéraleCHU de LimogesLimoges Cedex 87025France

Near-infrared fluorescence(NIRF)is a technique of augmented reality that,when applied in the operating theatre,allows the colorectal surgeon to visualize and assess bowel vascularization,to identify lymph nodes draini... 详细信息

关键词： Fluorescence Enhanced reality Anastomotic leak Ureter Anastomosis

How to identify better candidate to radioembolization in case of hepatocellular carcinoma and portal vein tumoral thrombosis

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Hepatobiliary Surgery and Nutrition 2019年第1期8卷 63-64页

作者： Giovanni Battista Levi Sandri Michel Rayar department of Surgical Sciences Sapienza University of RomeRomeItaly service de chirurgie Hépatobiliaire et digestive CHU RennesRennesFrance

Hepatocellular carcinoma(HCC)is the most common primary liver cancer and the fifth most common malignant tumor *** resection is a curative treatment for HCC and can be safety performed by a minimally invasive procedure in all liver segments without size limitations(1,2).Nevertheless,some patients are diagnosed with HCC and portal vein tumor thrombosis(PVTT).According to the staging system of the Barcelona Clinic Liver Cancer(BCLC),patients with macrovascular invasion are staged as *** those patients,the prognosis is generally ***,the management of HCC with macrovascular invasion is still ***,recent studies proposed different surgical procedure such as one-stage resection or associating liver partition and portal vein ligation,with promising results(3-5).

关键词： invasion thrombosis Liver

Lateral lymph node dissection for low rectal cancer: Is it necessary?

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World Journal of Gastroenterology 2019年第31期25卷 4294-4299页

作者： Niki Christou Jeremy Meyer Christian Toso Frédéric Ris Nicolas Christian Buchs service de chirurgie digestive Endocrinienne et GénéraleCHU de LimogesLimoges Cedex 87042France Division of digestive Surgery University Hospitals of GenevaGenève 1211Switzerland Unit of Surgical Research University of GenevaGenève 1206Switzerland

Rectal cancer constitutes a major public health *** mesorectal excision has remained the gold standard treatment for mid and low rectal tumors since its introduction in the late *** of all lymph nodes located in the mesorectum has indeed improved pathological and oncological ***,when cancer spreads to the lateral lymph nodes(located along the iliac and obturator arteries)Western and Japanese practices *** the Western guidelines consider this condition as an advanced form of the disease and use neoadjuvant radiochemotherapy liberally,the Japanese guidelines define it as a local disease and proceed to lateral lymph node dissection with or without neoadjuvant ***,we review the current literature regarding both therapeutic strategies,with the aim of contributing to potential improvements in treatment and outcome for patients with low and mid rectal cancer.

关键词： Total mesorectum excision Mesorectal resection Lateral node metastasis Extended lymphadenectomy

Pancreatic head cancer in patients with chronicpancreatitis

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Hepatobiliary & Pancreatic Diseases International 2014年第2期13卷 192-197页

作者： Aude Merdrignac Laurent Sulpice Michel Rayar Tanguy Rohou Emmanuel Quéhen Ayman Zamreek Karim Boudjema Bernard Meunier service de chirurgie Hépatobiliaire et digestive H pital PontchaillouCentre Hospitalier Universitaire INSERM UMR991 FoieMétabolismes et Cancer service d'Imagerie Médicale H pital Pontchaillou

BACKGROUND: Chronic pancreatitis (CP) is a risk factor of pancreatic adenocarcinoma (PA). The discovery of a pancreatic head lesion in CP frequently leads to a pancreaticoduo denectomy (PD) which preceded by a multidisciplinary meeting(MM). The aim of this study was to evaluate the relevance between this indication of PD and the definitive pathological ***: Between 2000 and 2010, all patients with CP who underwent PD for suspicion of PA without any histological proof were retrospectively analyzed. The operative decision has always been made at an MM. The definitive pathological finding was retrospectively confronted with the decision made at an MM, and patients were classified in two groups according to this concordance (group 1) or not (group 2). Clinical and biological parameters were analyzed, preoperative imaging were reread and confronted to pathological findings in order to identify predictive factors of malignant ***: During the study period, five of 18 (group 1) patients with CP had PD were histologically confirmed to have PA, and the other 13 (group 2) did not have PA. The median age was52.5 ±8.2 years (gender ratio 3.5). The main symptoms were pain (94.4%) and weight loss (72.2%). There was no patient’s death. Six (33.3%) patients had a major complication (ClavienDindo classification ≥3). There was no statistical difference in clinical and biological parameters between the two groups. The rereading of imaging data could not detect efficiently all patients with ***: Our results confirmed the difficulty in detecting malignant transformation in patients with CP before surgery and therefore an elevated rate of unnecessary PD was found. A uniform imaging protocol is necessary to avoid PD as a less invasive treatment could be proposed.

关键词： chronic pancreatitis adenocarcinoma pancreaticoduodenectomy

VEGF in hepatocellular carcinoma and surrounding cirrhotic liver tissues

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World Journal of Gastroenterology 2006年第5期12卷 830-831页

作者： Muriel Mathonnet Bernard descottes denis Valleix Francois Labrousse Yves denizot service de Chimrgie DigestiveEndocrinienne et GénéraleCHU DupuytrenLimogesFrance service de Chirurgie Viscérale et TransplantationCHU DupuytrenLimogesFrance service d'Anatomo-Pathologie CHU DupuytrenLimogesFrance UMR CNRS 6101Faculté de MédecineLimogesFrance

We read with a great interest the recent work of deli and colleagues. in the World Journal of Gastroenterology reporting vascular endothelial growth factor （VEGF） expression in hepatocellular carcinoma （HCC） and cirrhotic liver tissues. This well-documented work shows that VEGF was significantly higher in surrounding cirrhotic liver tissues than in HCC. Authors assessed VEGF expression using immunohistochemistry. The immunohistochemical staining is an efficient tool to assess the percentage of cells stained positively for VEGF but is not really efficient to estimate their true VEGF content. Evaluation of the VEGF protein by an enzyme-linked immunosorbent assay 0ELISA） has been reported, by us and others, to be an efficient tool in order to assess tissue VEGF expression. We have, thus, tested whether the ELISA method might be an efficient tool in order to confirm data reporting higher amounts of VEGF in surrounding cirrhotic liver tissues than in HCC. deli and colleagues. also correctly pointed out that basic fibroblast growth factor （bFGF） has been reported to act cooperatively on VEGF expression. We have, thus, also assessed bFGF tissue levels in order to search for a putative link between VEGF and bFGF levels in cirrhotic tissues.

关键词： Vascular endothelial growth factor Hepatocellular carcinoma, Cirrhotic liver tissues