Publications by authors named "Bernard Sastre"

36 Publications

Complication of bariatric surgery: Legal complaints in France.

Int J Surg 2016 May 11;29:36-7. Epub 2016 Mar 11.

Department of Forensic Pathology APHM, CHU Timone, 13385 Cedex 5, Marseille, France; Aix-Marseille Université, CNRS, EFS, ADES UMR 7268, 13916, Marseille, France.

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http://dx.doi.org/10.1016/j.ijsu.2016.03.021DOI Listing
May 2016

Postoperative biological and clinical outcomes following uncomplicated pancreaticoduodenectomy.

Korean J Hepatobiliary Pancreat Surg 2016 Feb 19;20(1):23-31. Epub 2016 Feb 19.

Unité de Chirurgie Hépatobiliaire et Pancréatique, Nouvel Hôpital Civil, Université de Strasbourg, IHU MixSurg, IRCAD, France.

Backgrounds/aims: The aim of this study was to describe clinical and biological changes in a group of patients who underwent pancreaticoduodenectomy (PD) without any complication during the postoperative period. These changes reflect the "natural history" of PD, and a deviation should be considered as a warning sign.

Methods: Between January 2000 and December 2009, 131 patients underwent PD. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. Postoperative variables were validated using an external prospective database of 158 patients.

Results: The mean postoperative length of hospital stay was 20.3±4 days. The mean number of days until removal of nasogastric tube was 6.3±1.6 days. The maximal fall in hemoglobin level occurred on day 3 and began to increase after postoperative day (POD) 5, in patients with or without transfusions. The white blood cell count increased on POD 1 and persisted until POD 7. There was a marked rise in aminotransferase levels at POD 3. The peak was significantly higher in patients with hepatic pedicle occlusion (866±236 IU/L versus 146±48 IU/L; p<0.001). For both γ-glutamyl transpeptidase and alkaline phosphatase, there was a fall on POD1, which persisted until POD 5, followed with a stabilization. Bilirubin decreased progressively from POD 1 onwards.

Conclusions: This study facilitates a standardized biological and clinical pathway of follow-up. Patients who do not follow this recovery indicator could be at risk of complications and additional exams should be made to prevent consequences of such complications.
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http://dx.doi.org/10.14701/kjhbps.2016.20.1.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767268PMC
February 2016

Medico-legal analysis of legal complaints in bariatric surgery: a 15-year retrospective study.

Surg Obes Relat Dis 2016 May 22;12(4):903-909. Epub 2015 Oct 22.

Department of Forensic Pathology APHM, CHU Timone, Marseille, France; Aix-Marseille Université, CNRS, EFS, ADES UMR 7268, 13916, Marseille, France.

Background: Bariatric surgery for severe obesity has become an effective and accepted treatment for sustained weight loss.

Objectives: The aim of our study was to analyze the complications and issues raised by the experts on which jury or judges' decisions were made for the different types of bariatric surgery.

Setting: University Hospital, France.

Materials And Methods: We have carried out a retrospective study of 59 expert review dossiers over a period of 15 years (1999-2014) on the different types of bariatric surgery (laparoscopic adjustable gastric band [LAGB], sleeve gastrectomy [SG], Roux-en-Y gastric bypass [RYGB], vertical banded gastroplasty [VBG], and gastric plication [GP]).

Results: Of the cases, 81% were women and the average age was 39 years old (range 19 to 68 years). Among the procedures giving rise to the complaints, 40% were for LAGB, 28% for RYGB, and 23% for SG. The most common initial complications were perforations (30%), fistulae (27%), bowel obstruction (14%), vascular injuries (9.5%), and infections (peritonitis, pleurisy, abscesses, and so forth) (8%). Revision surgery was required in 78% of patients, and perioperative complications accounted for 28.5% of dossiers. The experts concluded that fault had occurred in 40% of case. Negligence arising from an error deemed to be an act of negligence was found in 30% of cases, 67% of which were because of delayed diagnosis. Major long-term complications accounted for 8% of dossiers and minor long-term complications for 22%. Forty-seven percent of patients completely recovered.

Conclusion: Delayed diagnosis was the main error established by the experts. Surgeons should remain vigilant postoperatively after every bariatric surgical procedure.
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http://dx.doi.org/10.1016/j.soard.2015.10.067DOI Listing
May 2016

Legal Claims in Bariatric Surgery.

Obes Surg 2016 Mar;26(3):624-5

Department of forensic pathology APHM, CHU Timone, 13385 Cedex 5, Marseille, France.

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http://dx.doi.org/10.1007/s11695-015-2021-zDOI Listing
March 2016

The origin and concentration of circulating microparticles differ according to cancer type and evolution: A prospective single-center study.

Int J Cancer 2016 Feb 1;138(4):939-48. Epub 2015 Oct 1.

Aix Marseille Université, INSERM UMR-S1076, VRCM, Marseille, France.

Microparticles are plasma membrane vesicles produced by apoptotic or activated cells and resting cancer cells. The concentration, origin and procoagulant properties of circulating microparticles are reported to differ according to pathological settings (inflammation, cancer and cardiovascular diseases). In case of cancer, different studies have reported a variation in the concentration of circulating microparticles, with an increase in procoagulant and tumor-associated antigen-bearing microparticles. However, the cancer specificity of these results remains unknown. The objective was to establish a specific signature of colorectal and pancreatic cancers (CRC, PC) by characterizing circulating microparticles. Patients presenting with CRC, PC, inflammatory bowel or pancreatic diseases, and healthy subjects, were prospectively included. Circulating microparticles were analyzed by flow cytometry, combining the analysis of Annexin V-positive with characterization of their origin and determination of their procoagulant activities. We included 85, 36, 15, 18 and 20 patients presenting with CRC, PC, inflammatory bowel or pancreatic diseases, and healthy subjects, respectively. Here, we depict a specific signature, which differed between CRC, PC, associated inflammatory bowel and pancreatic diseases and healthy subjects. Furthermore, in patients with remission, this signature returned to the levels observed in associated inflammatory or healthy patients. Our results indicate that circulating microparticles differ depending on the evolution of a cancer. The analysis of the circulating microparticles reveals the specificity of the signature and can be used as a new complex biomarker reflecting the evolution of the disease.
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http://dx.doi.org/10.1002/ijc.29837DOI Listing
February 2016

Further characterization of HDAC and SIRT gene expression patterns in pancreatic cancer and their relation to disease outcome.

PLoS One 2014 2;9(9):e108520. Epub 2014 Oct 2.

Aix-Marseille University, CRO2, UMR_S 911, Marseille, France; INSERM UMR 911, Marseille, France.

Ductal adenocarcinoma of the pancreas is ranking 4 for patient' death from malignant disease in Western countries, with no satisfactory treatment. We re-examined more precisely the histone deacetylases (HDAC) and Sirtuin (SIRT) gene expression patterns in pancreatic cancer with more pancreatic tumors and normal tissues. We also examined the possible relationship between HDAC gene expression levels and long term disease outcome. Moreover, we have evaluated by using an in vitro model system of human pancreatic tumor cell line whether HDAC7 knockdown may affect the cell behavior. We analyzed 29 pancreatic adenocarcinoma (PA), 9 chronic pancreatitis (CP), 8 benign pancreatic (BP) and 11 normal pancreatic tissues. Concerning pancreatic adenocarcinoma, we were able to collect biopsies at the tumor periphery. To assess the possible involvement of HDAC7 in cell proliferation capacity, we have generated recombinant human Panc-1 tumor which underexpressed or overexpressed HDAC7. The expression of HDAC1,2,3,4,7 and Nur77 increased in PA samples at levels significantly higher than those observed in the CP group (p = 0.0160; 0.0114; 0.0227; 0.0440; 0.0136; 0.0004, respectively). The expression of HDAC7, was significantly greater in the PA compared with BP tissue samples (p = 0.05). Mean mRNA transcription levels of PA for HDAC7 and HDAC2 were higher when compared to their counterpart biopsies taken at the tumor periphery (p = 0.0346, 0.0053, respectively). Moreover, the data obtained using confocal microscopy and a quantitative method of immunofluorescence staining strongly support the HDAC7 overexpression in PA surgical specimens. The number of deaths and recurrences at the end of follow up were significantly greater in patients with overexpression of HDAC7. Interestingly, the rate of growth was significantly reduced in the case of cell carrying shRNA construct targeting HDAC7 encoding gene when compared to the parental Panc-1 tumor cells (p = 0.0015) at 48 h and 96 h (p = 0.0021). This study strongly support the notion that HDAC7play a role in pancreatic adenocarcinoma progression.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0108520PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4183483PMC
June 2015

Pelvic radiation disease management by hyperbaric oxygen therapy: prospective study of 44 patients.

Gastroenterol Res Pract 2014 27;2014:108073. Epub 2014 Jan 27.

Aix-Marseille University, UMR 911, Campus Santé Timone, 13005 Marseille, France ; Hyperbaric Medicine, Sainte Marguerite Hospital, Aix-Marseille University, UMR MD2, 13385 Marseille, France.

Pelvic radiation disease (PRD) occurs in 2-11% of patients undergoing pelvic radiation for urologic and gynecologic malignancies. Hyperbaric oxygen therapy (HBOT) has previously been described as a noninvasive therapeutic option for the treatment of PRD. the purpose of study was to analyze prospectively the results of HBOT in 44 consecutive patients with PRD who were resistant to conventional oral or topical treatments. Material and Methods. The median age of the cohort was 65.7 years (39-85). Twenty-seven percent of patients required blood transfusion (n = 12). The median of delay between radiotherapy and HBOT was 26 months (3-175). We evaluated the results of HBOT, using SOMA-LENT Scale. Results. SOMA-LENT score was decreased in 59% of patient. The median of SOMA-LENT score before HBOT was significantly higher, being equal to 14 (0-36), than after HBOT with the SOMA-LENT score of 12 (0-38) (P = 0.003). Tenesmus (P = 0.02), bleeding (P = 0.0001), and ulceration (P = 0.001) significantly decreased after HBOT. Regarding patients with colostomy, 33% (n = 4) benefited from colostomies closure. HBOT was generally well tolerated. Only one patient stopped precociously due to transient myopia. Conclusion. This study is in favor of the interest of HBOT in pelvic radiation disease treatment (PRD).
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http://dx.doi.org/10.1155/2014/108073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922018PMC
March 2014

Assistance for the prescription of nutritional support must be required in nonexperienced nutritional teams.

J Nutr Metab 2013 17;2013:450469. Epub 2013 Dec 17.

Department of Digestive Surgery, Timone Hospital, 13385 Marseille, France ; Aix Marseille University, UMR 911, Campus Santé Timone, 13385 Marseille, France.

The aim of the study was to determine the current practices of nutritional support among hospitalized patients in nonspecialized hospital departments. Materials and Methods. During an observation period of 2 months, a surgeon and a gastroenterologist designated in each of the two departments concerned, not "specialized" in nutritional assistance, have treated patients in which nutritional support seemed necessary. Assessing the degree of malnutrition of the patient, the therapeutic decision and the type of product prescribed by the doctors were secondarily compared to the proposals of a structured computer program according to the criteria and standards established by the institutions currently recognized. Results. The study included 120 patients bearing a surgical disease in 86.7% of cases and 10% of medical cases. 50% of the patients had cancer. Nutritional status was correctly evaluated in 38.3% by the initial doctors' diagnosis-consistent with the software's evaluation. The strategy of nutrition was concordant with the proposals of the software in 79.2% of cases. Conclusions. Despite an erroneous assessment of the nutritional status in more than two-thirds of cases the strategy of nutritional management was correct in 80% of cases. Malnutrition and its consequences can be prevented in nonexperienced nutritional teams by adequate nutritional support strategies coming from modern techniques including computerized programs.
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http://dx.doi.org/10.1155/2013/450469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877633PMC
February 2014

Characteristics and natural history of patients with colorectal cancer complicated by infectious endocarditis. Case control study of 25 patients.

Anticancer Res 2014 Jan;34(1):349-53

Service de Chirurgie Digestive et viscérale, Pôle DACCORD, Hopital Timone .264 rue saint Pierre, 13385 Marseille, France.

Unlabelled: Association between streptococcal endocarditis and gastrointestinal disease has been well-documented in the literature. However oncological impact of this complicated presentation has not yet been reported. We have conducted to our knowledgethe first case-control study on this subject.

Patients And Methods: Two groups of five patients with colorectal cancer and either active endocarditis (CRC E+), or without endocarditis (CRC, n=20) were matched 1:4 for age, sex, and location of colorectal tumor.

Results: All 25 patients were male, with a median age of 63 (range: 53-85) years. Twenty (80%) had colon cancer and 5 (20%) rectal cancer. There was no post-operative mortality in this population. The overall morbidity was 28% (n=7). The overall 3-year survival and recurrence rates were similar in both groups 80% and 95%; 0% and 30% for group CRC E+ and CRC (p=0.4603).

Conclusion: This is the first case-control study demonstrating that during the first two years of follow-up, occurrence of endocarditis did not alter the prognosis of patients with CRC.
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January 2014

Is routine splenic flexure mobilization always mandatory for left colectomy? A comparative study of 80 patients with adenocarcinoma of the sigmoid colon.

Am Surg 2013 Dec;79(12):1305-8

AP-HM Hôpital Timone Service de Chirurgie Digestive et Générale Pôle d'oncologie et Spécialités Médico-chirurgicales; Marseille, France; Aix Marseille University, Marseille, France; Atelier Provençal d'écriture Médicale, Aix Marseille University, Marseille, France.

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December 2013

Patients with brain metastases from colorectal cancer are not condemned.

Anticancer Res 2013 Dec;33(12):5645-8

Department of Digestive and Oncological Surgery, Timone Hospital, Aix-Marseille University, Marseille, France

Background: Brain metastases (BMs) from colorectal cancer are rare (2-3%). They usually occur in advanced stages of the disease and their prognosis is poor. The aim of this study was to assess the impact of surgical resection of BMs from colorectal cancer in terms of overall survival.

Patients And Methods: A retrospective bi-centric study included all patients with resected BMs from primary colorectal adenocarcinoma from 1998 to 2009.

Results: Twenty-eight patients [13 males, median: 62 (range: 44-86) years old) were included. Fifteen patients presented with other metastatic sites (lung, liver). BMs were metachronous in 16/28 (57%) of patients [median: 19 months (range: 7-97)]. Median overall survival reached 12 months. Brain recurrences occurred in 32% of patients and were treated by curative intent in 5/9 cases.

Conclusion: When indicated, an aggressive management based on surgical resection of BMs from colorectal cancer, must be performed, in order to improve overall survival to at least 12 months.
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December 2013

Ductal adenocarcinoma of the pancreatic head: a focus on current diagnostic and surgical concepts.

World J Gastroenterol 2012 Jun;18(24):3058-69

Centre for Research in Oncology and Oncopharmacologie, Aix Marseille University, 13005 Marseille, France.

Complete surgical resection still remains the only possibility of curing pancreatic cancer, however, only 10% of patients undergo curative surgery. Pancreatic resection currently remains the only method of curing patients, and has a 5-year overall survival rate between 7%-34% compared to a median survival of 3-11 mo for unresected cancer. Pancreatic surgery is a technically demanding procedure requiring highly standardized surgical techniques. Nevertheless, even in experienced hands, perioperative morbidity rates (delayed gastric emptying, pancreatic fistula etc.) are as high as 50%. Different strategies to reduce postoperative morbidity, such as different techniques of gastroenteric reconstruction (pancreatico-jejunostomy vs pancreatico-gastrostomy), intraoperative placement of a pancreatic main duct stent or temporary sealing of the main pancreatic duct with fibrin glue have not led to a significant improvement in clinical outcome. The perioperative application of somatostatin or its analogues may decrease the incidence of pancreatic fistulas in cases with soft pancreatic tissue and a small main pancreatic duct (< 3 mm). The positive effects of external pancreatic main duct drainage and antecolic gastrointestinal reconstruction have been observed to decrease the rate of pancreatic fistulas and delayed gastric emptying, respectively. Currently, the concept of extended radical lymphadenectomy has been found to be associated with higher perioperative morbidity, but without any positive impact on overall survival. However, there is growing evidence that portal vein resections can be performed with acceptable low perioperative morbidity and mortality but does not achieve a cure.
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http://dx.doi.org/10.3748/wjg.v18.i24.3058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3386319PMC
June 2012

HDAC gene expression in pancreatic tumor cell lines following treatment with the HDAC inhibitors panobinostat (LBH589) and trichostatine (TSA).

Pancreatology 2012 Mar-Apr;12(2):146-55. Epub 2012 Feb 25.

Aix Marseille Univ, UMR 911, Campus Santé Timone, Marseille F-13005, France.

Background: In this study, the effect of LBH589 and trichostatin (TSA), a standard histone deacetylase inhibitor (HDACi) toward the growth of pancreatic cancer cell lines was studied. Thus, we examined for the first time, the HDAC family gene expression levels before and after drug treatment.

Methods: Several human pancreatic cancer cell lines (Panc-1, BxPC-3, SOJ-6) and a normal human pancreatic duct immortalized epithelial cell line (HPDE/E6E7) were used as target cells. The cell growth was measured by MTT assay, cell cycle alteration, membrane phosphatidylserine exposure, DNA fragmentation, mitochondrial membrane potential loss, RT-PCR and Western blots were done using standard methods. The effect of drugs on tumor growth in vivo was studied using subcutaneous xenograft model.

Results: Except in the case of certain HDAC gene/tumor cell line couples: (SIRT1/HPDE-SOJ6/TSA- or LBH589-treated cells; LBH589-treated Panc-1 Cells; HDAC2/BxPC-3/LBH589-treated cells or TSA-treated SOJ-6-1 cells), there were no major significant changes of HDACs genes transcription in cells upon drug treatment. However, significant variation in HDACs and SIRTs protein expression levels could be seen among individual cell samples. The in vivo results showed that LBH589 formulation exhibited similar tumor reduction efficacy as the commercial drug gemcitabine.

Conclusion: Our data demonstrate that LBH589 induced the death of pancreatic tumor cell by apoptosis. In line with its in vitro activity, LBH589 achieved a significant reduction in tumor growth in BxPC-3 pancreatic tumor cell line subcutaneous xenograft mouse model. Furthermore, exploring the impact of LBH589 on HDACs encoding genes expression revealed for the first time that some of them, depending on the cell line considered, seem to be regulated during translation.
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http://dx.doi.org/10.1016/j.pan.2012.02.013DOI Listing
November 2012

External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial.

Ann Surg 2011 May;253(5):879-85

Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre, Université de Strasbourg, France.

Objective: Pancreatic fistula (PF) is a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). The aim of this multicenter prospective randomized trial was to compare the results of PD with an external drainage stent versus no stent.

Methods: Between 2006 and 2009, 158 patients who underwent PD were randomized intraoperatively to either receive an external stent inserted across the anastomosis to drain the pancreatic duct (n = 77) or no stent (n = 81). The criteria of inclusion were soft pancreas and a diameter of wirsung <3 mm. The primary study end point was PF rate defined as amylase-rich fluid (amylase concentration >3 times the upper limit of normal serum amylase level) collected from the peripancreatic drains after postoperative day 3. CT scan was routinely done on day 7.

Results: The 2 groups were comparable concerning demographic data, underlying pathologies, presenting symptoms, presence of comorbid illness, and proportion of patients with preoperative biliary drainage. Mortality, morbidity, and PF rates were 3.8%, 51.8%, and 34.2%, respectively. Stented group had a significantly lower overall PF (26% vs. 42%; P = 0.034), morbidity (41.5% vs. 61.7%; P = 0.01), and delayed gastric emptying (7.8% vs. 27.2%; P = 0.001) rates compared with nonstented group. Radiologic or surgical intervention for PF was required in 9 patients in the stented group and 12 patients in the nonstented group. There were no significant differences in mortality rate (3.7% vs. 3.9%; P = 0.37) and in hospital stay (22 days vs. 26 days; P = 0.11).

Conclusion: External drainage of pancreatic duct with a stent reduced. PF and overall morbidity rates after PD in high risk patients (soft pancreatic texture and a nondilated pancreatic duct).
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http://dx.doi.org/10.1097/SLA.0b013e31821219afDOI Listing
May 2011

Rationale for possible targeting of histone deacetylase signaling in cancer diseases with a special reference to pancreatic cancer.

J Biomed Biotechnol 2011 25;2011:315939. Epub 2010 Oct 25.

Service de Chirurgie Digestive Pôle d'Oncologie et Spécialités Médico-Chirurgicales, Hôpital Timone, Assistance Pubique-Hôpitaux de Marseille, Marseille, France.

There is ongoing interest to identify signaling pathways and genes that play a key role in carcinogenesis and the development of resistance to antitumoral drugs. Given that histone deacetylases (HDACs) interact with various partners through complex molecular mechanims leading to the control of gene expression, they have captured the attention of a large number of researchers. As a family of transcriptional corepressors, they have emerged as important regulators of cell differentiation, cell cycle progression, and apoptosis. Several HDAC inhibitors (HDACis) have been shown to efficiently protect against the growth of tumor cells in vitro as well as in vivo. The pancreatic cancer which represents one of the most aggressive cancer still suffers from inefficient therapy. Recent data, although using in vitro tumor cell cultures and in vivo chimeric mouse model, have shown that some of the HDACi do express antipancreatic tumor activity. This provides hope that some of the HDACi could be potential efficient anti-pancreatic cancer drugs. The purpose of this review is to analyze some of the current data of HDACi as possible targets of drug development and to provide some insight into the current problems with pancreatic cancer and points of interest for further study of HDACi as potential molecules for pancreatic cancer adjuvant therapy.
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http://dx.doi.org/10.1155/2011/315939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964042PMC
June 2011

Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse.

World J Gastroenterol 2010 Jun;16(24):3011-5

Department of Visceral- and Oncological Surgery, Timone Hospital, 13385 Marseille, France.

Aim: To communicate our findings on successful treatment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP).

Methods: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with prosthetic reinforcement.

Results: All patients complained about ongoing vaginal infections and febrile episodes. These symptoms were reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anastomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.

Conclusion: In our experience, the definitive treatment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.
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http://dx.doi.org/10.3748/wjg.v16.i24.3011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890941PMC
June 2010

Portal vein thrombosis due to factor 2 leiden in the post-operative course of a laparoscopic sleeve gastrectomy for morbid obesity.

Obes Surg 2009 Oct 15;19(10):1464-7. Epub 2009 Jul 15.

Digestive Surgical Department, CHU Timone, 264 rue Saint Pierre, 13385, Marseille, France.

Portal vein thrombosis can occur after laparoscopic operations. This complication has not been yet reported after laparoscopic sleeve gastrectomy. We report the case of a patient who presented mild abdominal pains 2 weeks after a laparoscopic sleeve gastrectomy achieved to cure morbid obesity. Computed tomography led to the diagnosis of portal vein thrombosis bound to a genetic disorder due to heterozygote Leiden 2 factor which impaired coagulation. Recommendations for post-surgical follow-up are discussed.
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http://dx.doi.org/10.1007/s11695-009-9910-yDOI Listing
October 2009

[Spontaneous transvaginal small-bowel evisceration].

Presse Med 2010 Apr 12;39(4):513-5. Epub 2009 Jun 12.

Service de chirurgie viscérale, Hôpital de Sainte-Marguerite, Assistance Publique-Hôpitaux de Marseille, F-13009 Marseille, France.

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http://dx.doi.org/10.1016/j.lpm.2008.12.036DOI Listing
April 2010

Surgical anatomy of the extrapelvic part of the pudendal nerve and its applications for clinical practice.

Surg Radiol Anat 2009 Dec 3;31(10):769-73. Epub 2009 Jun 3.

Department of Digestive Surgery, Hôpital La Timone, 264 rue Saint-Pierre, 13385, Marseille Cedex 05, France.

Purpose: This study aims to report the topography of the extrapelvic part of the pudendal nerve (EPPN) and its relationship with the sacrospinous ligament and the pudendal artery.

Methods: The pudendal nerve (PN) was dissected by a gluteal approach in 40 cases. The morphology of the EPPN, its topography and the relationship between the PN on the one hand, and the pudendal artery and the tip of the ischial spine on the other hand were reported.

Results: The length and the diameter of the EPPN were identical on the right and on the left side. The PN was a single trunk in 3/4 of cases. The PN was medial to the pudendal artery in 32 cases and crossed the sacrospinous ligament in 32 cases and the ischial spine in 6 cases.

Conclusions: The topographic variations of the EPPN are large and complicate its surgical and radiological approach.
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http://dx.doi.org/10.1007/s00276-009-0518-7DOI Listing
December 2009

Pancreatic cancer and pancreaticoduodenectomy in elderly patient: morbidity and mortality are increased. Is it the real life?

Hepatogastroenterology 2008 Nov-Dec;55(88):2242-6

Pôle d'oncologie et spécialités Médico-chirurgicales, Service de chirurgie digestive et oncologique, Hôpital Timone, Marseille, France.

Background/aims: The aim of this study was to compare post-operative outcomes of two groups of patients aged more or less than 70 years old

Methodology: From January 1990 to January 2006, 150 patients underwent pancreaticoduodenectomy (PD) for pancreatic adenocarcinomas (PA) were reviewed at the Department of Digestive Surgery of University Hospital. Twenty five patients Group A> or =70 and Group B<70 years old, were well matched for gender, diagnosis, body mass index, American Society of Anesthesiologists (ASA) score, and texture of pancreatic parenchyma.

Results: There was no intraoperative death. Mean operative hospital and intensive care unit stays were in Group A, B: 21+/-9; 4.5+/-8 vs. 19+/-7; 3+/-3 NS respectively. There were four deaths in A and no death in B at three months of hospital discharge. More patients had complications in Group A (56% vs 36% NS). Medical complications seem to be more frequent in Group A (40%vs 12% NS). The median survivals were 20 and 27 months for A and B, respectively.

Conclusion: We observed an increased rate of morbidity and mortality in patients aged more than 70 years.
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April 2009

Monoclonal antibody 16D10 to the COOH-terminal domain of the feto-acinar pancreatic protein targets pancreatic neoplastic tissues.

Mol Cancer Ther 2009 Feb 3;8(2):282-91. Epub 2009 Feb 3.

INSERM UMR 911-CRO2, Aix-Marseille Université, Faculté de Médecine-Timone, Marseille, France.

We have shown that the 16D10 antigen located on the mucin-like COOH-terminal domain of the feto-acinar pancreatic protein (FAPP) is expressed at the surface of human pancreatic tumor cell lines such as SOJ-6 cell line. Furthermore, an in vivo study indicates that targeting this cell-membrane glycopeptide by the use of the monoclonal antibody (mAb) 16D10 inhibits the growth of SOJ-6 xenografts in nude mice. To validate the potential use of the mAb16D10 in immune therapy, this study examined the expression of 16D10 antigens at the surface of human pancreatic adenocarcinomas versus control tissues. We examined the reactivity of mAb16D10 and mAb8H8 with pancreatic ductal adenocarcinomas (PDAC) compared with controls by using immunohistochemistry and confocal laser scanning microscopy. mAb8H8 does react with control or nontumoral human pancreatic tissues. mAb16D10 has a strong and specific reactivity with PDAC and does not react with other cancers of epithelia or normal tissues tested. Notable, mAb16D10 mostly recognizes membrane of tumoral cells. Furthermore, mAb8H8 and mAb16D10 recognized a protein of 110 to 120 kDa in homogenates of nontumoral and tumoral human pancreatic tissues, respectively. This size correlates with that of FAPP or with that of the normal counterpart of FAPP, the so-called bile salt-dependent lipase. The results suggest that mAb16D10 presents a unique specificity against PDAC; consequently, it could be effective in immune therapy of this cancer. Furthermore, mAb16D10 and mAb8H8 pair might be useful for diagnosis purpose in discriminating tumoral from nontumoral human pancreatic tissues.
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http://dx.doi.org/10.1158/1535-7163.MCT-08-0471DOI Listing
February 2009

Advantage of vacuum assisted closure on healing of wound associated with omentoplasty after abdominoperineal excision: a case report.

World J Surg Oncol 2008 Dec 23;6:136. Epub 2008 Dec 23.

Service de Chirurgie Digestive et Oncologique, Pôle d'Oncologie et de Spécialités Médicales et Chirurgicales, Hôpital De Timone, Marseille, France.

Background: Primary closure of the perineum with drainage after abdominoperineal excision of the rectum for carcinoma, is widely accepted. However hematoma, perineal abscess and re-operation are significantly more frequent after primary closure than after packing of the perineal cavity. Those complications are frequently related to the patients' clinical antecedent (i.e radiotherapy, diabetes, smoking).

Case Presentation: In the present report, vacuum assisted drainage was used after abdominoperineal excision for carcinoma in the very first step due to intraoperative gross septic contamination during tumor resection. The first case: A 57-years old man with a 30-years history of peri-anal Crohn's disease, the adenocarcinoma of the lowest part of the rectum and Crohn colitis with multiple area of severe dysplasia required panproctocolectomy with a perineal resection. The VAC system was used during 12 days (changed every 3 days). We observed complete healing 18 days after surgery. The second case: A 51-year-old man, with AIDS. An abdominoperineal resection was performed for recurrence epidermoid anal cancer. The patient was discharged at day 25 and complete healing was achieved 30 days later after surgery.

Conclusion: The satisfactory results showed in the present report appear to be favored by association of omentoplasty and VAC system. Those findings led us to favor VAC system in the case of pelvic exenteration associated with high risk of infection.
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http://dx.doi.org/10.1186/1477-7819-6-136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2621222PMC
December 2008

Therapeutic anticoagulant does not modify thromboses rate vein after venous reconstruction following pancreaticoduodenectomy.

Gastroenterol Res Pract 2008 23;2008:896320. Epub 2008 Nov 23.

Service de Chirurgie Digestive et Oncologique, Pôle d'Oncologie et de Spécialité Médicale et Chirurgicale, Hôpital Timone, 13385 Marseille, France.

Recommendations for anticoagulation following major venous reconstruction for pancreatic adenocarcinoma (PA) are not clearly established. The aim of our study was to find out the relation between postoperative anticoagulant treatment and thrombosis rate after portal venous resection. Materials and methods. Between 1986 and 2006, twenty seven portal vein resections were performed associated with pancreaticoduodenectomies (n = 27) (PD).We defined four types of venous resection: type I was performed 1 cm above the confluent of the superior mesenteric vein (SMV) (n = 12); type II lateral resection and venorrhaphy at the level of the confluent SMV (n = 12); type III (n = 1) resulted from a primary end-to-end anastomosis above confluent and PTFE graph was used for reconstruction for type IV (n = 2). Curative anticoagulant treatment was always indicated after type IV (n = 2) resection, and after resection of type II when the length of venous resection was longer than >/=2 cm. Results. Venous thrombosis rate reached: 0%, 41%, and 100% for type I, II, IV resections, respectively. Among them four patients received curative anticoagulant treatment. Conclusion. After a portal vein resection was achieved in the course of a PD, curative postoperative anticoagulation does not prevent efficiently the onset of thrombosis.
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http://dx.doi.org/10.1155/2008/896320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586661PMC
December 2009

Experience of two trauma-centers with pancreatic injuries requiring immediate surgery.

Hepatogastroenterology 2008 May-Jun;55(84):817-20

Service de Chirurgie Digestive et Oncologique, Pôle d'Oncologie et de Spécialité Médicale et Chirurgicale Hôpital Timone, Marseille, France.

Background/aims: Pancreatic injury from blunt trauma is infrequent. The aim of the present study was to evaluate a simplified approach of management of pancreatic trauma injuries requiring immediate surgery consisting of either drainage in complex situation or pancreatectomy in the other cases.

Methodology: From January 1986 to December 2006, 40 pancreatic traumas requiring immediate surgery were performed. Mechanism of trauma, clinical and laboratories findings were noted upon admission, classification of pancreatic injury according to Lucas' classification were considered. Fifteen (100%) drainages were performed for stage I (n=15), 60% splenopancreatectomies and 40% drainage was achieved for stage II (n=18), 3 Pancreaticoduonectomies and 2 exclusion of duodenum with drainage and 2 packing were performed for stage IV (n=7).

Results: There were 30 men and 10 women with mean age of 29+/-13 years (15-65). Thirty-eight patients had multiple trauma. Overall, mortality and global morbidity rate were 17% and 65% respectively, and the rates increased with Lucas' pancreatic trauma stage.

Conclusions: Distal pancreatectomy is indicated for distal injuries with duct involvement, and complex procedures such as pancreaticoduodenectomy should be performed in hemodynamically stable patients.
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December 2008

High histone deacetylase 7 (HDAC7) expression is significantly associated with adenocarcinomas of the pancreas.

Ann Surg Oncol 2008 Aug 28;15(8):2318-28. Epub 2008 May 28.

Service de Chirurgie Digestive et Oncologique, Pôle d'Oncologie et Spécialité Médico-Chirurgicales, Assistance Pubique-Hôpitaux de Marseille, Hôpital Timone, 264 Rue Saint Pierre, Marseille 13000, France.

Background: Alterations in HDACs gene expression have been reported in a number of human cancers. No information is available concerning the status of HDACs in pancreatic cancer tumors. The aim of the present study was to evaluate the expression levels of members of class I (HDAC1, 2,, 3), class II (HDAC4, 5, 6, and 7), and class III (SIRT1, 2, 3, 4, 5, and 6) in a set of surgically resected pancreatic tissues.

Methods: Total RNA was isolated from 11 pancreatic adenocarcinomas (PA): stage 0 (n = 1), IB (n = 1), IIB (n = 6), III (n = 1), IV (n = 2), one serous cystadenoma (SC), one intraductal papillary mucinous tumor of the pancreas (IMPN), one complicating chronic pancreatitis (CP), and normal pancreas (NP) obtained during donor liver transplantation. Moreover, six other control pancreatic were included. HDACs gene expression was conducted using quantitative real-time polymerase chain reaction (qPCR). Protein expression levels were analyzed by Western blot and their localization by immunohistochemistry analyses of cancer tissues sections.

Results: Remarkably, 9 of the 11 PA (approximately 81%) showed significant increase of HDAC7 mRNA levels. In contrast to PA samples, message for HDAC7 was reduced in CP, SC, and IMPN specimens. The Western blot analysis showed increased expression of HDAC7 protein in 9 out of 11 PA samples, in agreement with the qPCR data. Most of the PA tissue sections examined showed intense labeling in the cytoplasm when reacted against antibodies to HDAC7.

Conclusion: The data showed alteration of HDACs gene expression in pancreatic cancer. Increased expression of HDAC7 discriminates PA from other pancreatic tumors.
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http://dx.doi.org/10.1245/s10434-008-9940-zDOI Listing
August 2008

[Retroperitoneal non-secreting paraganglioma. Apropos of a case].

Gastroenterol Clin Biol 2007 Mar;31(3):307-8

Service de chirurgie générale et digestive, Hôpital Sainte-Marguerite, Marseille.

Paragangliomas are rare tumors arising from extraadrenal chromaffin cells. These tumors are most commonly found in the adrenal gland but other locations are possible. A 79-year-old woman with abdominal pain underwent computed tomography (CT scan). Surgery was indicated because of the increase in the size of the tumor. Histopathological examination revealed a non secreting paraganglioma in the left retroperitoneum. Paragangliomas are rare neuroendocrine tumors. They have a greater potential for malignancy than pheochromocytomas due to metastases or local recurrence making surgical excision the treatment of choice.
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http://dx.doi.org/10.1016/s0399-8320(07)89380-8DOI Listing
March 2007

Frey procedure in the treatment of chronic pancreatitis: short-term results.

Pancreas 2006 Nov;33(4):354-8

Department of Digestive Surgery, University Hospital, Angers, France.

Objective: The aim of this multicenter study was to report the short-term results of the Frey procedure in the treatment of chronic pancreatitis.

Methods: For the period between September 2000 and January 2005, 34 Frey procedures were performed for chronic pancreatitis in 4 university hospitals. This study includes 31 men (91%) and 3 women (9%), with a mean age of 48 +/- 6 years (range, 32-58 years). The etiology of chronic pancreatitis was chronic alcohol ingestion in 32 patients (94%) and hereditary chronic pancreatitis in 2 patients. The indications of surgery were abdominal pain in all patients, requiring opiates in 59% (n = 20) and associated with a weight loss in 79% (n = 27).

Results: There was no mortality. Eleven postoperative surgical complications occurred in 7 patients (20%). Three patients had a single complication, and 4 patients had 2 complications. Pancreatic fistula occurred in 4 patients and healed under conservative management in all cases. One patient had massive bleeding from the stump of gastroduodenal artery requiring reoperation. The mean hospital stay was 16 +/- 8 days (range, 9-40 days). The mean follow-up was 15 +/- 12 months (range, 3-37 months). At the time of the last follow-up visit, the examiner judged that 19 patients (56%) have complete pain relief and 11 patients (32%) have substantial pain relief. No patient used narcotic analgesics postoperatively. Seven patients developed diabetes mellitus, requiring insulin (n = 1), oral hypoglycemic agents (n = 5), and diet adjustment (n = 1). Four patients developed exocrine insufficiency. Weight increases with a mean of 4.8 +/- 5.4 kg (range, 1-24 kg) in 27 patients (79%).

Conclusions: Frey procedure appears as a safe technique with low mortality and morbidity rates and allows effective pain relief in about 90% of patients.
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http://dx.doi.org/10.1097/01.mpa.0000236736.77359.3aDOI Listing
November 2006

Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients.

Surgery 2006 May;139(5):591-8

Gastrointestinal Surgery Unit, Hôpital de Rangueil, Toulouse, France.

Background: Studies of risk factors after pancreatoduodenectomy are few: some concern restricted populations and others are based on administrative data.

Methods: Multicenter clinical data were collected for 300 patients undergoing pancreatoduodenectomy to determine (by univariate and multivariate analysis) preoperative and intraoperative risk factors for mortality and intra-abdominal complications (IACs), including pancreatic fistula. Fourteen factors including the center and volume effect were analyzed.

Results: In univariate analysis, mortality was increased with age 70 years or more, extended resection(s), and volume and center effects. IACs occurred more often with main pancreatic duct diameter of 3 mm or less, normal parenchyma texture, extended resection(s), and the center effect. Pancreatic fistula was more frequent with main pancreatic duct diameter of 3 mm or less, normal parenchyma texture, and the center effect. In multivariate analysis, independent risk factor(s) for mortality were age greater than 70 years (odds ratio [OR], 3; 95% confidence interval [CI], 1.3-8) and extended resection (OR, 5; 95% CI, 1.2-22), risk factors for IACs were extended resection (OR, 5; 95% CI, 1.2-22) and main pancreatic duct diameter of 3 mm or less (OR, 2; 95% CI, 1.1-3), and the risk factor for pancreatic fistula was main pancreatic duct diameter of 3 mm or less (OR, 2.5; 95% CI, 1.2-4.6).

Conclusions: Age more than 70 years, extended resections, and main pancreatic duct diameter less than 3 mm are independent risk factors that should be considered in indications for and techniques of pancreatoduodenectomy.
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http://dx.doi.org/10.1016/j.surg.2005.08.012DOI Listing
May 2006

Long-term outcome after ampullectomy for ampullary lesions associated with familial adenomatous polyposis.

Dis Colon Rectum 2005 Dec;48(12):2192-6

Department of General Surgery, Hospital Sainte Marguerite, Marseille , France.

Purpose: Up to 90 percent of patients with familial adenomatous polyposis develop adenomas in the upper gastrointestinal tract. Besides pancreaticoduodenectomy, which remains indicated in duodenal and ampullary cancer, less aggressive surgical procedure (such as ampullectomy) must be evaluated in selected patients with familial adenomatous polyposis patients presenting low-risk benign duodenal adenomas.

Methods: From 1995 to 2000, we performed a retrospective, observational study, which included eight patients (5 females) with familial adenomatous polyposis underwent ampullectomy (with frozen sections) for presumed benign polyposis lesions. Six patients had an ileal pouch-anal anastomosis performed 2 to 27 years before ampullectomy. The remaining two patients had ampullectomy during the same operation than ileal pouch-anal anastomosis.

Results: No patient died postoperatively. Mean hospital stay was 15 +/- 6.5 (range, 10-21) days. There was one major complication (pancreatic fistula), which was treated conservatively. Final pathologic examination of the specimens revealed that three patients had a severe dysplasia. Mean follow-up of the patients was 58 +/- 37 (range, 24-119) months. During endoscopic follow-up, although all the patients underwent endoscopic resection of duodenal polyps, none presented recurrence at the ampullectomy site.

Conclusions: Ampullectomy could be safely proposed in selected familial adenomatous polyposis patients. Our low morbidity and the absence of recurrence after almost five years of follow-up suggests that such conservative treatment could be proposed before pancreaticoduodenectomy in patients with high-risk ampullary adenomas without invasive carcinoma.
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http://dx.doi.org/10.1007/s10350-005-0187-5DOI Listing
December 2005
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