Early Stage Results after Oesophageal Resection for Malignancy - Colon Interposition Vs. Gastric Pull-Up

in European Journal of Cardio - Thoracic Surgery (2000), 18(3), 293-300

OBJECTIVE: The aims of our study were to determine if using the colon as a digestive transplant after oesophagectomy for cancer was associated with increased postoperative complications, and to assess the ... [more ▼]

OBJECTIVE: The aims of our study were to determine if using the colon as a digestive transplant after oesophagectomy for cancer was associated with increased postoperative complications, and to assess the impact of preoperative radiochemotherapy on postoperative hospital outcome. METHODS: From January 1990 to December 1998, 130 patients underwent oesophageal resection for malignancy. There were 103 males and 27 females (age: 61.3+/-11.5 years). Indications were squamous cell carcinoma in 69 patients and adenocarcinoma in 61. Preoperatively 30 patients (eight in stage IIB, 18 in stage III, and four in stage IV) received radiochemotherapy. There were 84 subtotal oesophagectomies, with anastomosis in the neck in 44 patients and at the thoracic inlet in 40, and 46 distal oesophageal resections. Digestive continuity was restored with the stomach in 92 patients (age: 63.4+/-10.2 years) and the colon in 38 (age: 52.3+/-12.8 years). With the exception of age (P<0.0001), there was no significant preoperative difference between gastric and colonic groups. RESULTS: Hospital mortality was 8.5% (11 patients), decreasing from 18.5% (before 1993) to 3.8% (since 1993). One patient (2.5%) died in the colonic graft group and ten (11%) in the gastric pull-up group (P=0.17). Postoperative complications occurred in 40 patients (31%), respectively, in ten (26%) and 30 (33%) patients after colonic and gastric transplants (P=0.48), and were pulmonary insufficiency or infection in 29 patients, anastomotic fistula in six, myocardial infarction in five, recurrent nerve palsy in four, renal insufficiency in three, and cerebrovascular accident in one. All fistulas occurred in the gastric pull-up group. The incidence of postoperative pulmonary complications was 70% (21/30 patients) in the subgroup who received preoperative radiochemotherapy, as compared to 11% (5/44 patients) in the subgroup of comparable staging, but without preoperative treatment (P<0.001). CONCLUSIONS: Colonic grafts are not associated with increased postoperative mortality or complications. Our results suggest that preoperative neoadjuvant treatment significantly increases postoperative pulmonary complications. [less ▲]

Acute Mesenteric Ischaemia: Minimal Invasive Management by Combined Laparoscopy and Percutaneous Transluminal Angioplasty

in European Journal of Surgery. Acta Chirurgica (2000), 166(4), 345-7

Clinical biliary complications after adult liver transplantation: a prospective study

in Acta Gastro-Enterologica Belgica (2000, March), 63(1), 56

Autoimmune pancreatitis mimicking cancer of the pancreas

in Acta Gastro-Enterologica Belgica (2000, January), 63(1), 57

Intérêt de la tomographie a émission de positons dans l'évaluation des tumeurs digestives

in Revue Médicale de Liège (1999), 54(12), 925-30

Imaging and endoscopic techniques have taken an increasing part in the management of gastroenterological disorders. Among these techniques, FDG-PET imaging has emerged as a powerful tool in the management ... [more ▼]

Imaging and endoscopic techniques have taken an increasing part in the management of gastroenterological disorders. Among these techniques, FDG-PET imaging has emerged as a powerful tool in the management of several cancer diseases, including tumors of the digestive tract. In particular, the role of PET for diagnosing and staging recurrent colorectal cancers, and for differentiating mass forming pancreatitis from carcinoma is now well established. In this review, we will briefly discuss the place of PET imaging in the work-up of the tumors of the digestive tract. [less ▲]

Interet clinique de la tomographie a emission de positons dans la detection et le bilan d'extension des recidives des cancers colorectaux

in Gastroentérologie Clinique et Biologique (1999), 23(3), 323-9

BACKGROUND: Positron emission tomography (PET) has been shown useful for the staging of patients with various carcinomas. METHODS: We have applied this technique to 54 cases of colorectal carcinoma and ... [more ▼]

BACKGROUND: Positron emission tomography (PET) has been shown useful for the staging of patients with various carcinomas. METHODS: We have applied this technique to 54 cases of colorectal carcinoma and compared it to conventional imaging techniques. RESULTS: PET had moderately higher sensitivity and specificity than conventional techniques to detect individual lesion sites (75% vs 70.8% and 63% vs 21% respectively). It detected the same number of patients with recurrences (35/39) but overestimated disease less frequently (5 cases vs 12). PET favorably influenced therapeutic management in 17 patients, indicating different or additional surgery in 9 while avoiding surgery with curative intent or unnecessary surgery in 8. In 5 cases, erroneous information provided by PET could be corrected by conventional imaging techniques. CONCLUSION: We conclude that PET appears to provide complementary information useful for staging patients with colorectal carcinomas. It can significantly modify patients management. These data should be confirmed by a prospective study. [less ▲]

Surgical management of hepatic cystic echinococcosis

in Acta Gastro-Enterologica Belgica (1999, January), 62(1), 64

Transplantation combinée du foie et du coeur chez un patient souffrant de thalassémie majeure

in Médecine & Chirurgie Digestives (1999), 28(3), 109-110

Analysis of Factors Influencing Long-Term Survival after Surgical Resection for Oesophageal Squamous Cell Carcinoma

in Acta Chirurgica Belgica (1999), 99(3, May-Jun), 113-8

OBJECTIVE: We evaluated prognostic factors in 34 patients discharged from hospital after surgical resection for oesophageal squamous cell carcinoma. MATERIAL AND METHODS: There were 22 males and 12 ... [more ▼]

OBJECTIVE: We evaluated prognostic factors in 34 patients discharged from hospital after surgical resection for oesophageal squamous cell carcinoma. MATERIAL AND METHODS: There were 22 males and 12 females; mean age was 59.3 years (range 42-77 years). Preoperative neoadjuvant treatment consisted in chemotherapy alone in three patients and in combined radiochemotherapy in 14. Digestive continuity was restored with a gastric transplant in 26 patients and a colonic graft in 8. Surgery was curative in 28 patients and palliative in 6. There were three stage I, 14 stage II, 13 stage III, and 4 stage IV diseases. In 19 patients the lymph nodes were invaded. The tumour was well differentiated in 17 patients, moderately in 9, and poorly in 8. RESULTS: Follow-up ranged from 2 to 100 months. Overall median postoperative survival was 21 months. By univariate analysis, factors influencing survival were curative surgery (p = 0.04), stage (p = 0.006), and nodal involvement (p = 0.0003). Nodal involvement was an independent prognostic factor by multivariate analysis (p = 0.0002). Patient age and sex, perioperative transfusion, digestive transplant, tumour local extension, grade of differentiation, and distant metastasis did not influence survival. Also, we did not observe any significant benefit of preoperative or postoperative chemotherapy or radiochemotherapy. CONCLUSIONS: Nodal involvement was the most important prognostic factor influencing survival. Therefore, an earlier diagnosis of oesophageal cancer in a less advanced stage is important to improve survival rates. Our study could not confirm the benefit of neoadjuvant therapy in terms of late survival. [less ▲]

Transplantation hépatique: expérience et résultats du programme de l'Université de Liège

in Revue Médicale de Liège (1998), 53(12), 735-7

The orthotopic liver transplantation (OLT) program of the University of Liege was initiated in 1986. Between 1986 and December 1998, 150 adult OLT have been performed in our institution, including 18 ... [more ▼]

The orthotopic liver transplantation (OLT) program of the University of Liege was initiated in 1986. Between 1986 and December 1998, 150 adult OLT have been performed in our institution, including 18 liver retransplantations, 1 combined heart and liver transplantation and 3 combined liver and kidney transplantations. The aim of this study was to report the last 3 years of our experience. From January 1996 to November 1998, we performed 50 OLT on 49 patients. Three were retransplantations and two were combined liver and kidney transplantations. Fourty-three patients were transplanted for chronic liver disease and 6 for acute or subacute hepatopathy. Mean waiting time on the list was 4 weeks. Immunosuppression was based on triple therapy (cyclosporin A/tacrolimus, steroids, azathioprine), with steroid and azathioprine withdrawal in most of the patients after 3 months. In the chronic liver disease group, operative (< 30 days) survival was 95% (peroperative myocardial infarction in 2 patients). In the acute liver disease group, postoperative survival was 66%. No perioperative death occurred in 1997 and 1998. Actuarial one year survival was 87%. In our experience, OLT has become a safe procedure. [less ▲]