Liver resection and vascular reconstruction under protective intraportal cooling during a total liver clampage

in Acta Chirurgica Belgica (2012, May), 112(3), 10216

Esophageal cancer surgery in patients older than 75: long term results.

in Acta Chirurgica Belgica (2011), 111(1), 12-7

PURPOSE: The purpose of this study was to evaluate short and long term results after esophageal cancer resection in patients older than 75. METHODS: We retrospectively analyzed the database of esophageal ... [more ▼]

PURPOSE: The purpose of this study was to evaluate short and long term results after esophageal cancer resection in patients older than 75. METHODS: We retrospectively analyzed the database of esophageal cancer surgically treated in our department between January 2003 and December 2009 to identify patients older than 75. The preoperative, operative, postoperative and long term characteristics were analyzed. RESULTS: Among 137 patient, 23 were older than 75. The histological subtype was adenocarcinoma in 100%. The surgical techniques were a "Lewis-Santy" procedure in 43%, a trans-hiatal resection in 22%, a "Sweet" procedure in 13%, a stripping in 13% and a McKeown procedure in 9%. The in-hospital postoperative mortality was 13%. The in-hospital postoperative morbidity (Dindo-Clavien Grade >2, deceased patients included) was 26%. In univariate analysis, no statistically significant risk factor of morbidity was found. A Charlson Comorbidity Index >2 was, in univariate analysis, the sole risk factor of postoperative mortality (p = 0.0362). The mean hospital stay was 22 +/- 12 days. The median survival was 24.2 months. The 5-year overall survival was 39% and the 5-year disease free survival was 26%.57% of long-term deaths were not cancer related. CONCLUSION: Esophageal surgery performed in selected patients older than 75 has an acceptable morbidity and mortality but when a severe complication occurs, it leads to death in half of the cases. Surgery enables a long term survival benefit. This study confirmed our attitude of not considering age as a contra-indication for esophageal surgery but rather considering general status, self-reliance and associated comorbidities for patients' selection. [less ▲]

Pseudoanevrisme de l'artere gastrique gauche.

in Journal de Chirurgie (2009), 146(4), 413-5

We report the case of a 65-year-old man admitted for an upper-GI hemorrhage. A CT scan performed with vascular reconstructions demonstrated a pseudoaneurysm of the left gastric artery. Proximal vascular ... [more ▼]

We report the case of a 65-year-old man admitted for an upper-GI hemorrhage. A CT scan performed with vascular reconstructions demonstrated a pseudoaneurysm of the left gastric artery. Proximal vascular control of the celiac axis was obtained by balloon occlusion with a Fogarty balloon inserted retrograde via the femoral artery: the pseudoaneurysm was then successfully controlled with direct suture. [less ▲]

Surgical management of hepatic metastases of colorectal origin.

in Acta Gastro-Enterologica Belgica (2009), 72(3), 321-6

Colorectal cancer is the most frequent digestive cancer. Prognosis is greatly depending on the TNM stage at the time of diagnosis. Fifty percent of all patients shall develop, synchronously or ... [more ▼]

Colorectal cancer is the most frequent digestive cancer. Prognosis is greatly depending on the TNM stage at the time of diagnosis. Fifty percent of all patients shall develop, synchronously or metachronously, liver metastases. Different means such as chemotherapy, targeted therapies, radiofrequency ablation, portal vein embolization and two-stage hepatectomy may be used to make these metastases eventually resectable and to increase overall survival. This is a short review of these different methods used to increase resectability but also on the integration of these parameters in a larger approach of colorectal liver metastasis surgery especially insisting on multidisciplinary discussion. [less ▲]

Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

in European Journal of Cardio - Thoracic Surgery (2007), 31(4), 600-605

Objective: To assess factors influencing operative and tong-term outcome in octogenarians undergoing aortic valve surgery (AVR). Methods: Records of 220 consecutive octogenarians having AVR between 1992 ... [more ▼]

Objective: To assess factors influencing operative and tong-term outcome in octogenarians undergoing aortic valve surgery (AVR). Methods: Records of 220 consecutive octogenarians having AVR between 1992 and 2004 were reviewed, and follow-up obtained (99% complete). Of the group (mean age: 82.8 years; 174 females), 142 patients (65%) were in New York Heart Association (NYHA) class III-IV, 22 (10%) had previous myocardial infarction, 11 (5%) had previous coronary artery bypass grafting (CABG), and 8 (4%) had percutaneous aortic valvuloplasty. There were 44 urgent procedures (20%), and additional CABG was performed in 58 patients (26%). Results: Operative mortality was 13% (9% for AVR, 24% for AVR + CABG). Among the 29 patients who died, 14 (48%) were operated on urgently (32% mortality for urgent procedures). Causes of hospital death were respiratory insufficiency or infection in 16 patients (16/29 = 55%), myocardial, infarction in 8 (28%), stroke in 2 (7%), sepsis in 2 (7%), and renal failure in 1 (3%). Significant postoperative complications were atrial fibrillation in 48 patients (22%), respiratory insufficiency in 46 (21%), permanent atrio-ventricular bloc in 12 (5%), myocardial infarction in 10 (5%), hemodialysis in 4 (2%), and stroke in 4 (2%). Mean hospital and intensive care unit (ICU) stays were 17.6 +/- 5.2 and 6.9 +/- 3.4 days, respectively. Multivariate predictors (p < 0.05) of hospital death were urgent procedure, associated CABG, NYHA class IV, and percutaneous aortic valvuloplasty. Age, associated CABG, and urgent procedure were predictors of prolonged ICU stay. Mean follow-up was 58.2 months and actuarial 5-year survival was 73.2 +/- 6.9%. Age, preoperative myocardial infarction, urgent procedure, and duration of ICU stay were independent predictors of late death. Among 130 patients alive at follow-up, 91% were angina free and 81% in class I-II. Conclusions: AVR in octogenarians can be performed with acceptable mortality, although significant morbidity. These results stress the importance of early operation on elderly patients with aortic valve disease, avoiding urgent procedures. Associated coronary artery disease is a harbinger of poor operative outcome. Long-term survival and functional recovery are excellent. (c) 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. [less ▲]

L'echinococcose alveolaire: une zoonose d'apparition recente en Wallonie

in Revue Médicale de Liège (2005), 60(11), 867-74

Alveolar echinococcosis is a serious parasitic disease, leading to large hepatic lesions. It must be distinguished from cystic echinococcosis, or hydatic cyst, caused by Echinococcus granulosus. Early ... [more ▼]

Alveolar echinococcosis is a serious parasitic disease, leading to large hepatic lesions. It must be distinguished from cystic echinococcosis, or hydatic cyst, caused by Echinococcus granulosus. Early diagnosis may allow surgical removal of the lesions by segmental hepatectomy, the only curative treatment. Parasitostatic medical treatment with albendazole may promote stabilization of the disease. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis, as no human case was reported, despite up to 51% of fox infection in southern Belgium autopsy series. Recently four patients presented with alveolar echinococcosis at the University Hospital Center of Liege, leading to the fear of a possible alveolar echinococcosis endemy in southern Belgium. Two of these patients underwent curative hepatectomy, but the other two had already pulmonary metastases at diagnosis and received palliative albendazole therapy. This article presents these cases, and reviews the clinical features of this parasitic disease. [less ▲]

Endemic alveolar echinococcosis in southern Belgium?

in Acta Gastro-Enterologica Belgica (2005), 68(1, Jan-Mar), 1-4

Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis. However it was recently demonstrated by necropsy series that, in some parts of southern Belgium (Wallonia), up to ... [more ▼]

Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis. However it was recently demonstrated by necropsy series that, in some parts of southern Belgium (Wallonia), up to 51% of the red foxes (Vulpes vulpes) may be infected by E. multilocaris. The authors, working in a university hospital in southern Belgium, described in 2002 the first autoctuthonous Belgian case of hepatic alveolar echinococcosis. More importantly, in 2004, they diagnosed three other patients with alveolar echinococcosis. One underwent surgical resection, but two others had bilateral pulmonary involvement at time of definite diagnosis. Palliative albendazole therapy was initiated. These patients had been diagnosed with hepatic mass from unknown origin for several months. The previous experience with the first case allowed the authors to consider and to confirm alveolar echinococcosis diagnosis, made by pathology and/or serological tests and imaging. These four patients with alveolar echinococcosis were living either in the Liege or the Luxembourg province. Considering the high prevalence of E. multilocaris infection of red foxes and the recent increase of the fox population due to rabies vaccination in southern Belgium, and also the presence of E. multilocaris infection of red foxes in northern Belgium, it is likely that not only Wallonia, but also maybe the whole Belgium, may face endemic alveolar echinococcosis in the next years. [less ▲]

Liver transplantation for metastatic colon adenocarcinoma: report of a case with 10 years of follow-up without recurrence

in Transplant International (2003), 16(9), 692-693

Because of dismal mid-term and long-term results, secondary liver cancer is considered an absolute contra-indication to cadaveric liver transplantation, with the relative exception of metastases of ... [more ▼]

Because of dismal mid-term and long-term results, secondary liver cancer is considered an absolute contra-indication to cadaveric liver transplantation, with the relative exception of metastases of symptomatic neuro-endocrine cancers. The authors present in this report the case of a patient who has been enjoying 10 years of cancer-free survival after liver transplantation as rescue therapy for acute liver failure after liver resection for isolated hepatic metastasis of colon adenocarcinoma. This case shows that in some highly selected cases, liver transplantation may be curative in patients with liver metastases of colon carcinoma. [less ▲]