Publications by authors named "Guillaume Piessen"

117 Publications

Esophageal Cancer in Elderly Patients, Current Treatment Options and Outcomes; A Systematic Review and Pooled Analysis.

Cancers (Basel) 2021 Apr 27;13(9). Epub 2021 Apr 27.

Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, University of Lille, F-59000 Lille, France.

Esophageal cancer, despite its tendency to increase among younger patients, remains a disease of the elderly, with the peak incidence between 70-79 years. In spite of that, elderly patients are still excluded from major clinical trials and they are frequently offered suboptimal treatment even for curable stages of the disease. In this review, a clear survival benefit is demonstrated for elderly patients treated with neoadjuvant treatment, surgery, and even definitive chemoradiation compared to palliative or no treatment. Surgery in elderly patients is often associated with higher morbidity and mortality compared to younger patients and may put older frail patients at increased risk of autonomy loss. Definitive chemoradiation is the predominant modality offered to elderly patients, with very promising results especially for squamous cell cancer, although higher rates of acute toxicity might be encountered. Based on the all the above, and although the best available evidence comes from retrospective studies, it is not justified to refrain from curative treatment for elderly patients based on their age alone. Thorough assessment and an adapted treatment plan as well as inclusion of elderly patients in ongoing clinical trials will allow better understanding and management of esophageal cancer in this heterogeneous and often frail population.
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http://dx.doi.org/10.3390/cancers13092104DOI Listing
April 2021

Predictive value of 4th post-operative-day CRP in the early detection of complications after laparoscopic bowel resection for endometriosis.

J Gynecol Obstet Hum Reprod 2021 Apr 16;50(9):102148. Epub 2021 Apr 16.

Centre Hospitalier Régional Universitaire de Lille, Hôpital Jeanne de Flandre, 2 avenue Oscar Lambret 59000 Lille, France; Université Lille CHRU Lille F-59000 Lille, France.

Objective: Post-operative CRP on postoperative day 4 (POD) is used for the early detection of complications after colorectal surgery for cancer, but there is no evidence yet that justifies the use of this marker for bowel resection in case of endometriosis.

Study Design: We retrospectively included 66 consecutive patients who underwent bowel resection for endometriosis (stage 4) in Lille university hospital, France, from August 1, 2015 until January 31, 2017. The composite endpoint of our study included anastomotic leakages, infectious or thrombo-embolic complications, hematomas, bowel stenosis, rectorrhagia, voiding dysfunction, and rehospitalization for related symptoms.

Results: CRP on POD 4 presents a satisfying area under the curve of 0.85, for the composite endpoint. A CRP cut off value of 56 mg/L yielded a sensitivity of 0.61 (IC95%: 0.36 to 0.83) and a specificity of 0.98 (IC95%: 0.89 to 1). The negative and positive predictive values were 0.87 and 0.92.

Conclusion: The negative predictive value of the CRP on POD 4 after bowel resection for endometriosis is a useful early indicator for detecting a complication. Therefore, this biomarker might be safely used as an additional criterion for a safe discharge from hospital after colorectal resection in endometriosis.
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http://dx.doi.org/10.1016/j.jogoh.2021.102148DOI Listing
April 2021

Technique of open and minimally invasive intrathoracic reconstruction following esophagectomy-an expert consensus based on a modified Delphi process.

Dis Esophagus 2021 Jan 16. Epub 2021 Jan 16.

Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany.

Background: In recent years, minimally invasive Ivor Lewis (IL) esophagectomy with high intrathoracic anastomosis has emerged as surgical standard of care for esophageal cancer in expert centers. Alongside this process, many divergent technical aspects of this procedure have been devised in different centers. This study aims at achieving international consensus on the surgical steps of IL reconstruction using Delphi methodology.

Methods: The expert panel consisted of specialized esophageal surgeons from 8 European countries. During a two-round Delphi process, a detailed analysis and consensus on key steps of intrathoracic gastric tube reconstruction (IL esophagectomy) was performed.

Results: Response rates in Delphi rounds 1 and 2 were 100% (22 of 22 experts) and 83.3% (20 of 24 experts), respectively. Three essential technical areas of intrathoracic gastric tube reconstruction were identified: first, vascularization of the gastric conduit, second, gastric mobilization, tube formation and pull-up, and third, anastomotic technique. In addition, 3 main techniques for minimally invasive intrathoracic anastomosis are currently practiced: (i) end-to-side circular stapled, (ii) end-to-side double stapling, and (iii) side-to-side linear stapled technique. The step-by-step procedural analysis unveiled common approaches but also different expert practice.

Conclusion: This precise technical description may serve as a clinical guideline for intrathoracic reconstruction after esophagectomy. In addition, the results may aid to harmonize the technical evolution of this complex surgical procedure and thereby facilitate surgical training.
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http://dx.doi.org/10.1093/dote/doaa127DOI Listing
January 2021

Limited Resection Versus Pancreaticoduodenectomy for Duodenal Gastrointestinal Stromal Tumors? Enucleation Interferes in the Debate: A European Multicenter Retrospective Cohort Study.

Ann Surg Oncol 2021 Apr 10. Epub 2021 Apr 10.

Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, CHU de Lille, Lille, France.

Background: The optimal surgical procedure for duodenal gastrointestinal stromal tumors (D-GISTs) remains poorly defined. Pancreaticoduodenectomy (PD) allows for a wide resection but is associated with a high morbidity rate.

Objectives: The aim of this study was to compare the short- and long-term outcomes of PD versus limited resection (LR) for D-GISTs and to evaluate the role of tumor enucleation (EN).

Methods: In this retrospective European multicenter cohort study, 100 patients who underwent resection for D-GIST between 2001 and 2013 were compared between PD (n = 19) and LR (n = 81). LR included segmental duodenectomy (n = 47), wedge resection (n = 21), or EN (n = 13). The primary objective was to evaluate disease-free survival (DFS) between the groups, while the secondary objectives were to analyze the overall morbidity and mortality, radicality of resection, and 5-year overall survival (OS) and recurrence rates between groups. Furthermore, the short- and long-term outcomes of EN were evaluated.

Results: Baseline characteristics were comparable between the PD and LR groups, except for a more frequent D2 tumor location in the PD group (68.3% vs. 29.6%; p = 0.016). Postoperative morbidity was higher after PD (68.4% vs. 23.5%; p < 0.001). OS (p = 0.70) and DFS (p = 0.64) were comparable after adjustment for D2 location and adjuvant therapy rate. EN was performed more in American Society of Anesthesiologists (ASA) stage III/IV patients with tumors < 5 cm and was associated with a 5-year OS rate of 84.6%, without any disease recurrences.

Conclusions: For D-GISTs, LR should be the procedure of choice due to lower morbidity and similar oncological outcomes compared with PD. In selected patients, EN appears to be associated with equivalent short- and long-term outcomes. Based on these results, a surgical treatment algorithm is proposed.
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http://dx.doi.org/10.1245/s10434-021-09862-7DOI Listing
April 2021

ASO Author Reflections: Proposed Algorithm for Surgical Treatment of Localized Duodenal GIST.

Ann Surg Oncol 2021 Apr 5. Epub 2021 Apr 5.

Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, University Lille, 59000, Lille, France.

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http://dx.doi.org/10.1245/s10434-021-09938-4DOI Listing
April 2021

Is the Postsurgical Quality of Life of Patients With Esophageal or Gastric Cancer Influenced by Emotional Competence and Neoadjuvant Treatments?

Cancer Nurs 2021 Mar 16. Epub 2021 Mar 16.

Author Affiliations: Pôle cancérologie et spécialités médicales-Centre Hospitalier de Valenciennes, Valenciennes (Dr Baudry); Univ. Lille, CNRS, UMR 9193 - SCALab -Sciences Cognitives et Sciences Affectives (Dr Baudry, Dr Gehenne, Dr Grynberg, Dr Lelorain, and Pr Christophe), Lille, France; Institut Universitaire de France, Paris (Dr Grynberg); UMR-S 1172-JPARC-Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, University Lille (Pr Piessen), Lille, France; Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, University Lille (Pr Piessen), Lille, France; and Human and Social Sciences Department, Centre Léon Bérard, Lyon, France (Pr Christophe).

Background: Emotional competence (EC) via anxiety and depressive symptoms impacts the postoperative health-related quality of life (HRQoL) of esophageal and gastric cancer patients after surgery.

Objective: The aim of this study was to confirm the involvement of emotional processes in postsurgery HRQoL according to the presence or absence of neoadjuvant treatments.

Methods: After diagnosis (T1) and after surgery (T2), 271 patients completed 3 questionnaires, assessing their intrapersonal and interpersonal EC, HRQoL, and anxiety and depressive symptoms. Patients were categorized into 2 groups: patients with only surgery (group 1) and patients who received neoadjuvant treatment in addition to surgery (group 2). Analyses were based on hierarchical regression analyses and the SPSS PROCESS Macro to test the indirect effect of EC on HRQoL through anxiety and depression.

Results: Results showed an increase in depressive symptoms and a decrease in both anxiety symptoms and HRQoL between diagnosis and surgery, regardless of neoadjuvant treatment. At T1 and T2, EC predicted fewer anxiety and depressive symptoms and a less impaired HRQoL in the surgery-only group (group 1). Emotional competence, particularly intrapersonal EC, showed a significant indirect effect on HRQoL after surgery via fewer depressive symptoms.

Conclusion: Emotional competence promotes fewer anxiety and depressive symptoms and less impaired HRQoL after diagnosis and after surgery, especially for patients without neoadjuvant treatments.

Implications For Practice: It is important for oncology nurses and other clinicians to consider the role of emotional processes in postsurgical HRQoL in relation to the type of received treatments and to reinforce the use of EC by cancer patients to improve their adjustment.
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http://dx.doi.org/10.1097/NCC.0000000000000946DOI Listing
March 2021

Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer.

N Engl J Med 2021 04;384(13):1191-1203

From the Charles A. Sammons Cancer Center at Baylor University Medical Center, Dallas (R.J.K.), and the University of Texas M.D. Anderson Cancer Center, Houston (J.A.A.); Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland (J.K., P.K.); the University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen-Bonn-Cologne-Duesseldorf, Gastrointestinal Cancer Group Cologne, Cologne (T.Z.), and University Medical Center of Johannes Gutenberg-University Mainz (M.M.) - both in Germany; University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven (E.V.C.), and Ghent University Hospital, Ghent (K.G.) - both in Belgium; University Lille, Claude Huriez University Hospital, Lille (G.P.), and Pontchaillou University Hospital, Department of Gastroenterology, University of Rennes 1, INSERM Unité 1242, Rennes (A.L.) - both in France; Fundación Favaloro, Buenos Aires (G.M.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (J.F.); Akita University Hospital, Akita, Japan (S.M.); Duke Cancer Institute, Durham, NC (H.U.); Princess Margaret Cancer Centre, Toronto (E.E.), and Queen Elizabeth II Health Sciences Centre, Halifax, NS (S.S.) - both in Canada; the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam (C.G.); Florida Cancer Specialists and Research Institute, Fort Myers (S.Z.); University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco (A.H.K.); St. John of God Murdoch Hospital, Murdoch, WA, Australia (K.F.); Sfantul Nectarie Oncology Center, Craiova, Romania (M.S.); Bristol Myers Squibb, Princeton, NJ (J.Z., L.Z., M.L., P.S., K.K.); and Dana-Farber Cancer Institute, Boston (J.M.C.).

Background: No adjuvant treatment has been established for patients who remain at high risk for recurrence after neoadjuvant chemoradiotherapy and surgery for esophageal or gastroesophageal junction cancer.

Methods: We conducted CheckMate 577, a global, randomized, double-blind, placebo-controlled phase 3 trial to evaluate a checkpoint inhibitor as adjuvant therapy in patients with esophageal or gastroesophageal junction cancer. Adults with resected (R0) stage II or III esophageal or gastroesophageal junction cancer who had received neoadjuvant chemoradiotherapy and had residual pathological disease were randomly assigned in a 2:1 ratio to receive nivolumab (at a dose of 240 mg every 2 weeks for 16 weeks, followed by nivolumab at a dose of 480 mg every 4 weeks) or matching placebo. The maximum duration of the trial intervention period was 1 year. The primary end point was disease-free survival.

Results: The median follow-up was 24.4 months. Among the 532 patients who received nivolumab, the median disease-free survival was 22.4 months (95% confidence interval [CI], 16.6 to 34.0), as compared with 11.0 months (95% CI, 8.3 to 14.3) among the 262 patients who received placebo (hazard ratio for disease recurrence or death, 0.69; 96.4% CI, 0.56 to 0.86; P<0.001). Disease-free survival favored nivolumab across multiple prespecified subgroups. Grade 3 or 4 adverse events that were considered by the investigators to be related to the active drug or placebo occurred in 71 of 532 patients (13%) in the nivolumab group and 15 of 260 patients (6%) in the placebo group. The trial regimen was discontinued because of adverse events related to the active drug or placebo in 9% of the patients in the nivolumab group and 3% of those in the placebo group.

Conclusions: Among patients with resected esophageal or gastroesophageal junction cancer who had received neoadjuvant chemoradiotherapy, disease-free survival was significantly longer among those who received nivolumab adjuvant therapy than among those who received placebo. (Funded by Bristol Myers Squibb and Ono Pharmaceutical; CheckMate 577 ClinicalTrials.gov number, NCT02743494.).
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http://dx.doi.org/10.1056/NEJMoa2032125DOI Listing
April 2021

Together or Sequentially? A Curative Approach of Colorectal Liver and Peritoneal Metastasis Treatment is Possible.

Ann Surg Oncol 2021 Feb 26. Epub 2021 Feb 26.

Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France.

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http://dx.doi.org/10.1245/s10434-021-09749-7DOI Listing
February 2021

Five-Year Survival Outcomes of Hybrid Minimally Invasive Esophagectomy in Esophageal Cancer: Results of the MIRO Randomized Clinical Trial.

JAMA Surg 2021 Apr;156(4):323-332

Department of Digestive and Oncological Surgery, Hôpital Claude Huriez, Centre Hospitalier Universitaire (CHU) de Lille, Lille, France.

Importance: Available data comparing the long-term results of hybrid minimally invasive esophagectomy (HMIE) with that of open esophagectomy are conflicting, with similar or even better results reported for the minimally invasive esophagectomy group.

Objective: To evaluate the long-term, 5-year outcomes of HMIE vs open esophagectomy, including overall survival (OS), disease-free survival (DFS), and pattern of disease recurrence, and the potential risk factors associated with these outcomes.

Design, Setting, And Participants: This randomized clinical trial is a post hoc follow-up study that analyzes the results of the open-label Multicentre Randomized Controlled Phase III Trial, which enrolled patients from 13 different centers in France and was conducted from October 26, 2009, to April 4, 2012. Eligible patients were 18 to 75 years of age and were diagnosed with resectable cancer of the middle or lower third of the esophagus. After exclusions, patients were randomized to either the HMIE group or the open esophagectomy group. Data analysis was performed on an intention-to-treat basis from November 19, 2019, to December 4, 2020.

Interventions: Hybrid minimally invasive esophagectomy (laparoscopic gastric mobilization with open right thoracotomy) was compared with open esophagectomy.

Main Outcomes And Measures: The primary end points of this follow-up study were 5-year OS and DFS. The secondary end points were the site of disease recurrence and potential risk factors associated with DFS and OS.

Results: A total of 207 patients were randomized, of whom 175 were men (85%), and the median (range) age was 61 (23-78) years. The median follow-up duration was 58.2 (95% CI, 56.5-63.8) months. The 5-year OS was 59% (95% CI, 48%-68%) in the HMIE group and 47% (95% CI, 37%-57%) in the open esophagectomy group (hazard ratio [HR], 0.71; 95% CI, 0.48-1.06). The 5-year DFS was 52% (95% CI, 42%-61%) in the HMIE group vs 44% (95% CI, 34%-53%) in the open esophagectomy group (HR, 0.81; 95% CI, 0.55-1.17). No statistically significant difference in recurrence rate or location was found between groups. In a multivariable analysis, major intraoperative and postoperative complications (HR, 2.21; 95% CI, 1.41-3.45; P < .001) and major pulmonary complications (HR, 1.94; 95% CI, 1.21-3.10; P = .005) were identified as risk factors associated with decreased OS. Similarly, multivariable analysis of DFS identified overall intraoperative and postoperative complications (HR, 1.93; 95% CI, 1.28-2.90; P = .002) and major pulmonary complications (HR, 1.85; 95% CI, 1.19-2.86; P = .006) as risk factors.

Conclusions And Relevance: This study found no difference in long-term survival between the HMIE and open esophagectomy groups. Major postoperative overall complications and pulmonary complications appeared to be independent risk factors in decreased OS and DFS, providing additional evidence that HMIE may be associated with improved oncological results compared with open esophagectomy primarily because of a reduction in postoperative complications.

Trial Registration: ClinicalTrials.gov Identifier: NCT00937456.
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http://dx.doi.org/10.1001/jamasurg.2020.7081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7890455PMC
April 2021

Does neoadjuvant FOLFOX chemotherapy improve the prognosis of high-risk Stage II and III colon cancers? Three years' follow-up results of the PRODIGE 22 phase II randomized multicentre trial.

Colorectal Dis 2021 Feb 13. Epub 2021 Feb 13.

Department of Hepato-gastroenterology and Digestive Oncology, Hôpital Européen Georges Pompidou, AP-HP, Paris University, Paris, France.

Aim: Neoadjuvant chemotherapy has proven valuable in locally advanced resectable colon cancer (CC) but its effect on oncological outcomes is uncertain. The aim of the present paper was to report 3-year oncological outcomes, representing the secondary endpoints of the PRODIGE 22 trial.

Method: PRODIGE 22 was a randomized multicentre phase II trial in high-risk T3, T4 and/or N2 CC patients on CT scan. Patients were randomized between 6 months of adjuvant FOLFOX (upfront surgery) or perioperative FOLFOX (four cycles before surgery and eight cycles after; FOLFOX perioperative). In wild-type RAS patients, a third arm testing perioperative FOLFOX-cetuximab was added. The primary endpoint was the tumour regression grade. Secondary endpoints were 3-year overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS) and time to recurrence (TTR).

Results: Overall, 120 patients were enrolled. At interim analysis, the FOLFOX-cetuximab arm was stopped for futility. The remaining 104 patients represented our intention-to-treat population. In the perioperative group, 96% received the scheduled four neoadjuvant cycles and all but one had adjuvant FOLFOX for eight cycles. In the control arm, 38 (73%) patients received adjuvant FOLFOX. The median follow-up was 54.3 months. Three-year OS was 90.4% in both arms [hazard ratio (HR) = 0.85], 3-year DFS, RFS and TTR were, respectively, 76.8% and 69.2% (HR=0.94), 73% and 69.2% (HR = 0.86) and 82% and 72% (HR = 0.67) in the perioperative and control arms, respectively. Forest plots did not show any subgroup with significant difference for survival outcomes. No benefit from adding cetuximab was observed.

Conclusion: Perioperative FOLFOX has no detrimental effect on long-term oncological outcomes and may be an option for some patients with locally advanced CC.
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http://dx.doi.org/10.1111/codi.15585DOI Listing
February 2021

Study Protocol of the PreFiPS Study: Prevention of Postoperative Pancreatic Fistula by Somatostatin Compared With Octreotide, a Prospective Randomized Controlled Trial.

Front Med (Lausanne) 2020 15;7:488. Epub 2021 Jan 15.

Department of Digestive, Hepatobiliary and Endocrine Surgery, Paris Descartes University, Cochin Hospital, Paris, France.

Pancreatic fistula (PF), i. e., a failure of the pancreatic anastomosis or closure of the remnant pancreas after distal pancreatectomy, is one of the most feared complications after pancreatic surgery. PF is also one of the most common complications after pancreatic surgery, occurring in about 30% of patients. Prevention of a PF is still a major challenge for surgeons, and various technical and pharmacological interventions have been investigated, with conflicting results. Pancreatic exocrine secretion has been proposed as one of the mechanisms by which PF occurs. Pharmacological prevention using somatostatin or its analogs to inhibit pancreatic exocrine secretion has shown promising results. We can hypothesize that continuous intravenous infusion of somatostatin-14, the natural peptide hormone, associated with 10-50 times stronger affinity with all somatostatin receptor compared with somatostatin analogs, will be associated with an improved PF prevention. A French comparative randomized open multicentric study comparing somatostatin vs. octreotide in adult patients undergoing pancreaticoduodenectomy (PD) or distal pancreatectomy with or without splenectomy. Patients with neoadjuvant radiation therapy and/or neoadjuvant chemotherapy within 4 weeks before surgery are excluded from the study. The main objective of this study is to compare 90-day grade B or C postoperative PF as defined by the last ISGPF (International Study Group on Pancreatic Fistula) classification between patients who receive perioperative somatostatin and octreotide. In addition, we analyze overall length of stay, readmission rate, cost-effectiveness, and postoperative quality of life after pancreatic surgery in patients undergoing PD. The PreFiPS study aims to evaluate somatostatin vs. octreotide for the prevention of postoperative PF.
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http://dx.doi.org/10.3389/fmed.2020.00488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844059PMC
January 2021

The value of enhanced CT scanning for predicting lymph node metastasis along the right recurrent laryngeal nerve in esophageal squamous cell carcinoma.

Ann Transl Med 2020 Dec;8(24):1632

Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.

Background: The right recurrent laryngeal nerve (RRLN) is the region most prone to lymph node metastasis in esophageal squamous cell carcinoma (ESCC). Nodal involvement may be underestimated by traditional imaging prediction criteria, such as a short axis diameter of 10 mm. The purpose of this study was to determine a more accurate imaging criterion to guide clinical treatment strategy selection.

Methods: The clinical data of 307 patients with thoracic ESCC who underwent surgery at Shanghai Chest Hospital between January 2018 and December 2018 were retrospectively analyzed. Utilizing 1-mm layer thickness enhanced computed tomography (CT), the RRLN lymph node short diameter (LNSD) size was measured. Univariate and multivariate analyses were performed to determine the risk factors for lymph node metastasis along the RRLN.

Results: In our study, RRLN lymph node metastasis occurred in 60 (19.5%) patients and general lymph node metastasis occurred in 150 (48.9%) patients. Of the resected lymph nodes along the RRLN, 14.5% (121/832) were positive. Multivariate analysis identified LNSD [odds ratio (OR), 1.236] as an independent risk factor for RRLN lymph node metastasis. In CT evaluation, a short diameter of 6.5 mm in the RRLN lymph nodes is a critical predictor of metastasis at this site (sensitivity =50%, specificity =83.4%) and a larger short diameter was associated with a higher risk of metastasis (P<0.001).

Conclusions: A 6.5 mm cutoff in LNSD can be applied to clinically predict lymph node metastasis in the RRLN region for patients with ESCC.
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http://dx.doi.org/10.21037/atm-20-4991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812183PMC
December 2020

Early postoperative decrease of albumin is an independent predictor of major complications after oncological esophagectomy: A multicenter study.

J Surg Oncol 2021 Feb 1;123(2):462-469. Epub 2020 Dec 1.

Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Switzerland.

Background And Objectives: Serum albumin perioperative decrease (∆Alb) may reflect the magnitude of the physiological stress induced by surgery. Studies highlighted its value to predict adverse postoperative outcomes, but data in esophageal surgery are scant. This study aimed to investigate the role of ∆Alb to predict major complications after esophagectomy for cancer.

Methods: Multicenter retrospective study conducted in five high-volume centers, including consecutive patients undergoing an esophagectomy for cancer between 2006 and 2017. Patients were randomly assigned to a training (n = 696) and a validation (n = 350) cohort. Albumin decrease was calculated on postoperative day 1 and defined as ΔAlb. The primary endpoint was major complications according to Clavien classification.

Results: In the training cohort, esophagectomy induced a rapid drop of albumin. Cut-off of ΔAlb was established at 11 g/L and allowed to distinguish patients with adverse outcomes. On multivariable analysis, ΔAlb was identified as an independent predictor of major complications (OR, 1.06; 95% CI, 1.01-1.11; p = .014). Higher BMI and laparoscopy were associated with lower ΔAlb. Analysis of the validation cohort provided consistent findings.

Conclusions: ΔAlb appeared as a promising biomarker after oncological esophagectomy, allowing prediction of potential adverse outcomes.
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http://dx.doi.org/10.1002/jso.26317DOI Listing
February 2021

End Colostomy With or Without Mesh to Prevent a Parastomal Hernia (GRECCAR 7): A Prospective, Randomized, Double Blinded, Multicentre Trial.

Ann Surg 2021 Jan 7;Publish Ahead of Print. Epub 2021 Jan 7.

Department of Digestive Surgery, CHU Nimes, Univ Montpellier, Nimes, France Department of Digestive Surgery, GH Sud Haut-Lévêque - CHU de Bordeaux, Pessac, France Department of Digestive Surgery, L'Hôpital Jean Minjoz, CHRU de Besançon, Besançon, France Department of Digestive Surgery, Center Hospitalier Lyon-Sud, Lyon, France Department of Colorectal Surgery, AP-HP Hôpital Beaujon, Clichy, France Department of Digestive Surgery, Hôpital Pontchaillou, Rennes, France Department of Oncologic Surgery, Center Régional de Lutte Contre le Cancer CRLC Val d'Aurelle - Paul Lamarque, Montpellier, France Department of Digestive Surgery, Hôpital Charles-Nicolle, CHU de Rouen, Rouen, France Department of Oncologic Surgery, Center Oscar Lambret, Lille, France Department of Digestive Surgery, Hôpital Rangueil - CHU de Toulouse, Toulouse, France Department of Digestive Surgery, CHRU Clermont- Ferrand Hôtel - Dieu, Clermont-Ferrand, France and Department of Digestive Surgery, CH de Vichy, Vichy, France Department of Digestive Surgery, AP-HM Hôpital de la Timone, Marseille, France Department of Digestive Surgery, AP-HP Hôpital Saint Antoine, Paris, France Department of Digestive Surgery, Hôpital Albert Michallon, CHU de Grenoble, Grenoble, France Department of Digestive Surgery, Center Hospitalier Universitaire Hôtel-Dieu - CHU de Nantes, Nantes, France Department of Oncologic Surgery, Center Régional de Lutte contre le Cancer Institut Paoli-Calmettes, Marseille, France Department of Digestive Surgery, Hôpital Claude Huriez, Center Hospitalier Régional Universitaire, (CHRU) de Lille, Lille, France Department of Digestive Surgery, Hôpital La Pitié Salpetrière, (AP-HP), Paris, France Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France.

Objective: To evaluate whether systematic mesh implantation upon primary colostomy creation was effective to prevent PSH.

Summary Of Background Data: Previous randomized trials on prevention of PSH by mesh placement have shown contradictory results.

Methods: This was a prospective, randomized controlled trial in 18 hospitals in France on patients aged ≥18 receiving a first colostomy for an indication other than infection. Participants were randomized by blocks of random size, stratified by center in a 1:1 ratio to colostomy with or without a synthetic, lightweight monofilament mesh. Patients and outcome assessors were blinded to patient group. The primary endpoint was clinically diagnosed PSH rate at 24 months of the intention-to-treat population. This trial was registered at ClinicalTrials.gov, number NCT01380860.

Results: From November 2012 to October 2016, 200 patients were enrolled. Finally, 65 patients remained in the no mesh group (Group A) and 70 in the mesh group (Group B) at 24 months with the most common reason for drop-out being death (n = 41). At 24 months, PSH was clinically detected in 28 patients (28%) in Group A and 30 (31%) in Group B [P = 0.77, odds ratio = 1.15 95% confidence interval = (0.62;2.13)]. Stoma-related complications were reported in 32 Group A patients and 37 Group B patients, but no mesh infections. There were no deaths related to mesh insertion.

Conclusion: We failed to show efficiency of a prophylactic mesh on PSH rate. Placement of a mesh in a retro-muscular position with a central incision to allow colon passage cannot be recommended to prevent PSH. Optimization of mesh location and reinforcement material should be performed.
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http://dx.doi.org/10.1097/SLA.0000000000004371DOI Listing
January 2021

Panel gene profiling of small bowel adenocarcinoma: Results from the NADEGE prospective cohort.

Int J Cancer 2021 Apr 4;148(7):1731-1742. Epub 2021 Jan 4.

Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, Paris, France.

Small bowel adenocarcinoma (SBA) is a rare tumour. Large genomic analyses with prognostic assessments are lacking. The NADEGE cohort has enrolled 347 patients with all stage SBA from 2009 to 2012. Next-generation sequencing investigates the presence of 740 hotspot somatic mutations in a panel of 46 genes involved in carcinogenesis. The mismatch repair (MMR) status was assessed by immunochemistry. We have collected 196 tumour samples and 125 had conclusive results for mutation analysis. The number of mutations was 0 in 9.6% of tumours, only 1 in 32.0%, 2 in 26.4% and ≥3 in 32.0%. Overall, at least one genomic alteration was observed in 90.4% of tumour. The most frequent genomic alteration was in KRAS (44.0%), TP53 (38.4%), PIK3CA (20.0%), APC (18.4%), SMAD4 (14.4%) and ERBB2 (7.2%) genes. KRAS mutations were more frequent in synchronous metastatic tumours than in localised tumours (72.7% vs 38.2%, P = .003). There was no significant difference in the mutation rates according to primary location for the most frequently altered gene. ATM, FGFR3 and FGFR1 gene alterations were associated with Lynch syndrome and IDH1 mutations with Crohn disease. dMMR tumours were associated with younger age, localised tumours, less KRAS but more SMARCB1 mutations. No genomic alteration was associated with overall survival. There is a trend for better survival in patient with dMMR tumours. In conclusion, there is a different genomic alteration profile in SBA according to predisposing diseases. No association between genomic alterations and prognoses was observed except for a trend of better prognoses associated with dMMR.
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http://dx.doi.org/10.1002/ijc.33392DOI Listing
April 2021

Is nonanatomic rectal resection a valid therapeutic option for rectal gastrointestinal stromal tumors? A proposed decision algorithm.

J Surg Oncol 2020 Dec 16;122(8):1639-1646. Epub 2020 Sep 16.

Department of Digestive Surgery, Strasbourg University, Strasbourg, France.

Background And Objectives: The best surgical approach to rectal gastrointestinal stromal tumors (GISTs) is still debated, and both nonanatomic rectal resection (NARR) and anatomic rectal resection (ARR) are applied. The aim of this study was to evaluate the feasibility and oncological outcomes of NARR and ARR for rectal GISTs (R-GISTs).

Methods: Through a large French multicentre retrospective study, 35 patients were treated for R-GIST between 2001 and 2013. Patients who underwent NARR and ARR were compared.

Results: There were 23 (65.7%) patients in group ARR and 12 (34.3%) in group NARR. Significantly more patients in the group with ARR had a neoadjuvant treatment (86%) with tyrosine kinase inhibitor (TKI) (imatinib) compared to those with NARR (25%) (p < .01). The median preoperative tumor size was significantly different between the groups without and with neoadjuvant TKI: 30 ± 23 mm versus 64 ± 44.4 mm, respectively (p < .001). Overall postoperative morbidity was 20% (n = 7) (26% for ARR vs. 8% for NARR; p = .4). After a median follow-up of 60.2 (3.2-164.3) months, the 5-year disease-free survival rates were 79.5% (confidence interval [CI] 95%: 54-100) for the NARR group and 68% (CI 95%: 46.4-89.7) for the ARR group (p = .697), respectively.

Conclusion: The use of NARR for small R-GIST's does not seem to impair the oncological prognosis.
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http://dx.doi.org/10.1002/jso.26215DOI Listing
December 2020

Surgical Outcomes After Neoadjuvant Chemoradiation Followed by Curative Surgery in Patients With Esophageal Cancer: An Intergroup Phase lll Trial of the Swiss Group for Clinical Cancer Research (SAKK 75/08).

Ann Surg 2020 Aug 26. Epub 2020 Aug 26.

*University Hospital Basel, Basel, Switzerland Universitätsspital, Basel, Switzerland †Indiana University School of Medicine South Bend, Goshen Center for Cancer Care, Goshen, Indiana ‡Charité - University Medicine, Berlin, Germany now at Klinikum Ernst von Bergmann gemeinnützige GmbH, Potsdam, Germany §SAKK Coordinating Center, Bern, Switzerland ¶Cantonal hospital St. Gallen Kantonsspital St. Gallen, St. Gallen, Switzerland ||Cantonal Hospital Winterthur, Kantonsspital Winterthur, Winterthur, Switzerland **University Hospital Giessen and Marburg, Universitätsklinikum Giessen und Marburg GmbH, Giessen, Germany ††City Hospital Triemli Stadtspital Triemli, Zürich, Switzerland ‡‡University Hospital Düsseldorf, Dusseldorf Germany §§University Hospital Lille Centre Hospitalier Régional Universitaire de Lille, Lille Cedex, France ¶¶Cantonal hospital Olten, Olten, Switzerland Kantonsspital Olten, Switzerland, now at chirurgieaarau, Aarau, Switzerland ||||Lausanne University Hospital, Lausanne, Switzerland ***Elisabethinen Hospital Linz Krankenhaus der Elisabethinen Linz, Linz, Austria †††Eberhard Karls University Tübingen, Tübingen, Germany ‡‡‡University Hospital Bern Inselspital Bern, Bern, Switzerland §§§Cantonal Hospital Graubunden Kantonsspital Graubünden, Chur, Switzerland ¶¶¶Kliniken Essen-Mitte, Essen, Germany ||||||Cantonal Hospital St. Gallen, St. Gallen Kantonsspital St. Gallen, Switzerland, now at Brustzentrum Ostschweiz, St. Gallen, Switzerland.

Objective: To assess the impact of surgical technique in regard to morbidity and mortality after neoadjuvant treatment for esophageal cancer.

Background: The SAKK trial 75/08 was a multicenter phase III trial (NCT01107639) comparing induction chemotherapy followed by chemoradiation and surgery in patients with locally advanced esophageal cancer.

Methods: Patients in the control arm received induction chemotherapy with cisplatin and docetaxel, followed by concomitant chemoradiation therapy with cisplatin, docetaxel, and 45Gy. In the experimental arm, the same regimen was used with addition of cetuximab. After completion of neoadjuvant treatment, patients underwent esophagectomy. The experimental arm received adjuvant cetuximab. Surgical outcomes and complications were prospectively recorded and analyzed.

Results: Total of 259 patients underwent esophagectomy. Overall complication rate was 56% and reoperation rate was 15% with no difference in complication rates for transthoracic versus transhiatal resections (56% vs 54%, P = 0.77), nor for video assisted thoracic surgeries (VATS) versus open transthoracic resections (67% vs 55%, P = 0.32). There was a trend to higher overall complication rates in squamous cell carcinoma versus adenocarcinoma (65% vs 51%, P = 0.035), and a significant difference in ARDS in squamous cell carcinoma with 14% versus 2% in adenocarcinoma (P = 0.0002). For patients with involved lymph nodes, a lymph node ratio of ≥0.1 was an independent predictor of PFS (HR 2.5, P = 0.01) and OS (HR 2.2, P = 0.03).

Conclusions: This trial showed no difference in surgical complication rates between transthoracic and transhiatal resections. For patients with involved lymph nodes, lymph node ratio was an independent predictor of progression free survival and overall survival.
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http://dx.doi.org/10.1097/SLA.0000000000004334DOI Listing
August 2020

[Dosimetric factors related to postoperative pulmonary complications in locally advanced esophageal cancers treated with preoperative chemoradiotherapy: Literature review].

Bull Cancer 2020 Oct 22;107(10):982-990. Epub 2020 Sep 22.

Centre Oscar-Lambret, département universitaire de radiothérapie, 3, rue F.-Combemale, 59020 Lille, France; Université de Lille, CRIStAL UMR 9189, Lille, France.

Introduction: Preoperative chemoradiotherapy is an option for locally advanced esophageal cancer. Radiation therapy may increase postoperative pulmonary complications. Usual lungs dose constraints in radiotherapy are old and used by extrapolation of lung cancer management. Our objective is to review the literature on correlations between postoperative lung toxicity and dosimetric factors.

Method: This literature review identified and selected studies published between 1987 and 2019 using the PRISMA method. The articles were identified on the basis of a PubMed search and the author's knowledge, using the following terms: "esophageal cancer"; "chemoradiotherapy"; "dosimetric factors"; "postoperative pulmonary complications".

Results: Fourteen articles were selected, and five did not demonstrate a correlation between dosimetric factors and the postoperative pulmonary complications rate. The V20 (lung volume receiving more than 20Gy) was identified in three studies, like the V10, V15 and mean lung dose (around 10Gy) in two studies. The V30≥20% was identified in one study.

Discussion: The most frequently identified dosimetric predictors for postoperative pulmonary complications are the V20 and the mean lung dose. Results of prospective studies would lead us to specify which of these parameters is most relevant for predicting the risk of postoperative pulmonary complications.
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http://dx.doi.org/10.1016/j.bulcan.2020.07.001DOI Listing
October 2020

Hybrid Minimally Invasive Esophagectomy to the Rescue: A Valid Alternative for Phased Dissemination of TMIE?

J Clin Oncol 2021 Jan 18;39(1):91-92. Epub 2020 Sep 18.

Frederiek Nuytens, MD, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France; Thibault Voron, MD, PhD, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France, and Department of General and Digestive Surgery, Centre Hospitalier Universitaire Saint-Antoine, Sorbonne University, Paris, France; and Guillaume Piessen, MD, PhD, Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France, and University Lille, Centre National de la Recherche Scientifique, INSERM, Centre Hospitalier Universitaire Lille, UMR9020-U1277, Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France.

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http://dx.doi.org/10.1200/JCO.20.01964DOI Listing
January 2021

Creating scripted video-vignettes in an experimental study on two empathic processes in oncology: Reflections on our experience.

Patient Educ Couns 2021 Mar 6;104(3):654-662. Epub 2020 Sep 6.

Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France. Electronic address:

Objective: The aims were to: (1) apply the guidelines to develop and test the validity of video-vignettes manipulating empathy and context in oncology; (2) compare lay people's and patients' assessments of validity; (3) reflecting on our experiment METHODS: Guidelines were followed: (1) deciding whether video-vignettes were appropriate; (2) developing a valid script; (3) designing valid manipulations; (4) converting the scripted consultations into videos. One hundred sixteen lay people and 46 cancer patients filled in the Video Engagement Scale, the CARE, and ad hoc questionnaires on realism and emotions.

Results: The video-vignettes are valid for experimental use. Differences appeared in the emotions participants reported. The empathic processes were successfully manipulated and perceived. Lay people's and patients' assessments were equivalent, except for video-vignettes in neutral consultations. Participants' comments on nonverbal behavior, camera perspective, scripts and empathy assessment were reported.

Conclusion: Patients' assessments are impacted by their personal experiences. Researchers should control for this in analogue patient studies.

Practice Implications: Based on this experience, we reflect on: (1) adopting congruent nonverbal behavior throughout the video-vignettes; (2) alternating camera perspectives; (3) avoiding the sole use of written scripts; (4) using quantitative and qualitative analysis to validate scripts and video-vignettes.
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http://dx.doi.org/10.1016/j.pec.2020.08.041DOI Listing
March 2021

Outcomes of a new slowly resorbable biosynthetic mesh (Phasix™) in potentially contaminated incisional hernias: A prospective, multi-center, single-arm trial.

Int J Surg 2020 Nov 12;83:31-36. Epub 2020 Sep 12.

Erasmus University Medical Centre Rotterdam, Department of Surgery, Rotterdam, The Netherlands.

Background: Resorbable biomaterials have been developed to reduce the amount of foreign material remaining in the body after hernia repair over the long-term. However, on the short-term, these resorbable materials should render acceptable results with regard to complications, infections, and reoperations to be considered for repair. Additionally, the rate of resorption should not be any faster than collagen deposition and maturation; leading to early hernia recurrence. Therefore, the objective of this study was to collect data on the short-term performance of a new resorbable biosynthetic mesh (Phasix™) in patients requiring Ventral Hernia Working Group (VHWG) Grade 3 midline incisional hernia repair.

Materials And Methods: A prospective, multi-center, single-arm trial was conducted at surgical departments in 15 hospitals across Europe. Patients aged ≥18, scheduled to undergo elective Ventral Hernia Working Group Grade 3 hernia repair of a hernia larger than 10 cm were included. Hernia repair was performed with Phasix™ Mesh in sublay position when achievable. The primary outcome was the rate of surgical site occurrence (SSO), including infections, that required intervention until 3 months after repair.

Results: In total, 84 patients were treated with Phasix™ Mesh. Twenty-two patients (26.2%) developed 32 surgical site occurrences. These included 11 surgical site infections, 9 wound dehiscences, 7 seromas, 2 hematomas, 2 skin necroses, and 1 fistula. No significant differences in surgical site occurrence development were found between groups repaired with or without component separation technique, and between clean-contaminated or contaminated wound sites. At three months, there were no hernia recurrences.

Conclusion: Phasix™ Mesh demonstrated acceptable postoperative surgical site occurrence rates in patients with a Ventral Hernia Working Group Grade 3 hernia. Longer follow-up is needed to evaluate the recurrence rate and the effects on quality of life. This study is ongoing through 24 months of follow-up.
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http://dx.doi.org/10.1016/j.ijsu.2020.08.053DOI Listing
November 2020

Incidence and Grading of Complications After Gastrectomy for Cancer Using the GASTRODATA Registry: A European Retrospective Observational Study.

Ann Surg 2020 11;272(5):807-813

Department of Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom.

Objective: Utilizing a standardized dataset based on a newly developed list of 27 univocally defined complications, this study analyzed data to assess the incidence and grading of complications and evaluate outcomes associated with gastrectomy for cancer in Europe.

Summary Background Data: The absence of a standardized system for recording gastrectomy-associated complications makes it difficult to compare results from different hospitals and countries.

Methods: Using a secure online platform (www.gastrodata.org), referral centers for gastric cancer in 11 European countries belonging to the Gastrectomy Complications Consensus Group recorded clinical, oncological, and surgical data, and outcome measures at hospital discharge and at 30 and 90 days postoperatively. This retrospective observational study included all consecutive resections over a 2-year period.

Results: A total of 1349 gastrectomies performed between January 2017 and December 2018 were entered into the database. Neoadjuvant chemotherapy was administered to 577 patients (42.8%). Total (46.1%) and subtotal (46.4%) gastrectomy were the predominant resections. D2 or D2+ lymphadenectomy was performed in almost 80% of operations. The overall complications' incidence was 29.8%; 402 patients developed 625 complications, with the most frequent being nonsurgical infections (23%), anastomotic leak (9.8%), other postoperative abnormal fluid from drainage and/or abdominal collections (9.3%), pleural effusion (8.3%), postoperative bleeding (5.6%), and other major complications requiring invasive treatment (5.6%). The median Clavien-Dindo score and Comprehensive Complications Index were IIIa and 26.2, respectively. In-hospital, 30-day, and 90-day mortality were 3.2%, 3.6%, and 4.5%, respectively.

Conclusions: The use of a standardized platform to collect European data on perioperative complications revealed that gastrectomy for gastric cancer is still associated with heavy morbidity and mortality. Actions are needed to limit the incidence of, and to effectively treat, the most frequent and most lethal complications.
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http://dx.doi.org/10.1097/SLA.0000000000004341DOI Listing
November 2020

Testing two competitive models of empathic communication in cancer care encounters: A factorial analysis of the CARE measure.

Eur J Cancer Care (Engl) 2020 Nov 9;29(6):e13306. Epub 2020 Sep 9.

CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Univ. Lille, Lille, France.

Objective: The mechanisms associating physician empathy (PE) with patient outcomes remain unclear. PE can be considered as a whole (one process) or three subcomponents can be identified (an establishing rapport process; an emotional process; a cognitive process). The objective was to test two competitive models of PE in cancer care: a three-process model adapted from Neumann's model versus a one-process model, with the use of the Consultation and Relational Empathy measure (CARE).

Methods: The CARE was completed by 488 oesogastric cancer patients from the national French database FREGAT. A confirmatory factor analysis (CFA) and a bifactor model were performed to test the two competitive models.

Results: The CFA revealed that the one-factor structure showed a moderate fit to the data whereas the three-factor structure showed a good fit. However, the bifactor model favoured unidimensionality.

Conclusion: We cannot provide a clear-cut conclusion about whether PE should be considered as on unique process or not. Further work is still needed. Meanwhile, one should not preclude the use of three subscores in cancer care if specific elements of the encounter need to be assessed.
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http://dx.doi.org/10.1111/ecc.13306DOI Listing
November 2020

Centralization and Oncologic Training Reduce Postoperative Morbidity and Failure-to-rescue Rates After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Surface Malignancies: Study on a 10-year National French Practice.

Ann Surg 2020 11;272(5):847-854

Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France.

Objective: Evaluate at a national level the postoperative mortality (POM), major morbidity (MM) and failure-to-rescue (FTR) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) across time and according to hospital-volume.

Background: CRS/HIPEC is an effective therapeutic strategy commonly used to treat peritoneal surface malignancies. However, this aggressive approach has the reputation to be associated with a high POM and MM.

Methods: All patients treated with CRS/HIPEC between 2009 and 2018 in France were identified through a national medical database. Patients and perioperative outcomes were analyzed. A cut-off value of the annual CRS/HIPEC caseload affecting the 90-day POM was calculated using the Chi-squared Automatic Interaction Detector method. A multivariable logistic model was used to identify factors mediating 90-day POM.

Results: A total of 7476 CRS/HIPEC were analyzed. Median age was 59 years with a mean Elixhauser comorbidity index of 3.1, both increasing over time (P < 0.001). Ninety-day POM was 2.6%. MM occurred in 44.2% with a FTR rate of 5.1%. The threshold of CRS/HIPEC number per center per year above which the 90-day POM was significantly reduced was 45 (3.2% vs 1.9%, P = 0.01). High-volume centers had more extended surgery (P < 0.001) with increased MM (55.8% vs 40.4%, P < 0.001) but lower FTR (3.1% vs 6.3%, P = 0.001). After multivariate analysis, independent factors associated with 90-day POM were: age >70 years (P = 0.002), Elixhauser comorbidity index ≥8 (P = 0.006), lower gastro-intestinal origin, (P < 0.010), MM (P < 0.001), and <45 procedures/yr (P = 0.002).

Conclusion: In France, CRS/HIPEC is a safe procedure with an acceptable 90-day POM that could even be improved through centralization in high-volume centers.
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http://dx.doi.org/10.1097/SLA.0000000000004326DOI Listing
November 2020

Hybrid minimally invasive esophagectomy: a goal or a step?

J Thorac Dis 2020 Jul;12(7):3908-3910

Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France.

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http://dx.doi.org/10.21037/jtd-20-821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399417PMC
July 2020

Oesophageal-pericardial fistula: a rare complication of radiation-induced oesophagitis.

Eur J Cardiothorac Surg 2020 11;58(5):1097-1099

Department of Digestive and Oncological Surgery, Hôpital Claude Huriez, CHRU de Lille, Lille, France.

Oesophageal-pericardial fistula after radiation therapy for lung cancer is a rare complication associated with a high mortality. In this case report, we present the case of 52-year-old women with late radiation-induced oesophagitis after chemoradiotherapy for a pulmonary adenocarcinoma, complicated by an oesophageal-pericardial fistula for which a transthoracic oesophagectomy with pericardial drainage was performed. The postoperative course was complicated by a fatal hypovolaemic shock due to a perforation of the descending aorta near the initial fistula track. In this case report, we illustrate the importance of thorough inspection of diagnostic images in this context and emphasize the role of endovascular repair in case an associated aortic perforation is suspected.
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http://dx.doi.org/10.1093/ejcts/ezaa173DOI Listing
November 2020

The Profile of Emotional Competence (PEC): A French short version for cancer patients.

PLoS One 2020 18;15(6):e0232706. Epub 2020 Jun 18.

French National Platform Quality of Life and Cancer, France.

Background: Intrapersonal and interpersonal Emotional Competence (EC) predicts better health and disease adjustment. This study aimed to validate a short version of the Profile of Emotional Competence (PEC) scale for cancer patients.

Methods: Five hundred and thirty-five patients with cancer completed a self-reported questionnaire assessing their intra- and interpersonal EC (PEC), their anxiety and depression symptoms (HADS), and their health-related quality of life (QLQ-C30). Confirmatory factor analyses and Item Response Theory models with the Partial Credit Model were performed to validate and reduce the scale.

Findings: The Short-PEC (13 items), composed of 2 sub-scores of intra- (6 items) and interpersonal (7 items) EC, showed an improved factorial structure (Root Mean Square Error of Approximation (RMSEA) = 0.075 (90% confidence interval 0.066-0.085), comparative fit index = 0.915) with good psychometric properties.

Discussion: Future studies should use the Short-PEC to explain and predict the adjustment of cancer patients. The short-PEC could be also used in clinical routine to assess the level of EC of patients and to adapt psychosocial intervention.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232706PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302700PMC
August 2020

Surgical Management and Outcomes of Rectal Cancer with Synchronous Prostate Cancer: A Multicenter Experience from the GRECCAR Group.

Ann Surg Oncol 2020 Oct 4;27(11):4286-4293. Epub 2020 Jun 4.

Department of Digestive Surgical Oncology - Liver Transplantation Unit, University Hospital of Besançon, Besançon Cedex, France.

Background: Synchronous prostate cancer (PC) and rectal cancer (RC) is a rare clinical situation. While combining curative-intent management for both cancers can be challenging, available data for guiding the multidisciplinary strategy are lacking.

Methods: Consecutive patients undergoing rectal resection for a mid-low RC with synchronous PC treated at 9 tertiary-care centers between 2008 and 2018 were included. Management strategy and data on postoperative and long-term outcomes were retrospectively analyzed.

Results: Overall, 25 patients underwent curative-intent RC resection combined with PC management. Nine (36%), 10 (40%) and 6 (24%) patients had low-, intermediate-, and high-risk PC, respectively. Management mostly consisted of chemoradiotherapy combined in 18 patients (72%) with either TME in 12 patients or pelvic exenteration for resection of both cancers in 6 patients. Most patients underwent RC resection using a laparoscopic approach (n = 16, 64%). Anastomosis was performed in 18 patients (72%) of whom 13 received diverting ileostomy. The complete R0 resection rate was 96% (n = 24). The overall morbidity rate was 64% (n = 16) and 5 patients (20%) experienced severe surgical morbidity of which two died within 90 days of surgery after pelvic exenteration. Among patients with anastomosis, 2 patients (11%) experienced anastomotic leak requiring surgical management. After a median follow-up of 31.2 months, 3-year OS and RFS were 80.2% (CI 95% 58.8-92.2) and 68.6% (CI 95% 42.3-84.8), respectively.

Conclusions: This series is the largest to report that simultaneous curative-intent management of synchronous PC and RC is feasible and safe. Pelvic exenteration might be a better option when RC complete resection seems not achievable through TME.
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http://dx.doi.org/10.1245/s10434-020-08683-4DOI Listing
October 2020

Enteral versus parenteral nutrition in the conservative treatment of upper gastrointestinal fistula after surgery: a multicenter, randomized, parallel-group, open-label, phase III study (NUTRILEAK study).

Trials 2020 Jun 2;21(1):448. Epub 2020 Jun 2.

Department of Visceral Surgery, Bichat Hospital, Paris, France.

Background: Postoperative upper gastrointestinal fistula (PUGIF) is a devastating complication, leading to high mortality (reaching up to 80%), increased length of hospital stay, reduced health-related quality of life and increased health costs. Nutritional support is a key component of therapy in such cases, which is related to the high prevalence of malnutrition. In the prophylactic setting, enteral nutrition (EN) is associated with a shorter hospital stay, a lower incidence of severe infectious complications, lower severity of complications and decreased cost compared to total parenteral nutrition (TPN) following major upper gastrointestinal (GI) surgery. There is little evidence available for the curative setting after fistula occurrence. We hypothesize that EN increases the 30-day fistula closure rate in PUGIF, allowing better health-related quality of life without increasing the morbidity or mortality.

Methods/design: The NUTRILEAK trial is a multicenter, randomized, parallel-group, open-label phase III trial to assess the efficacy of EN (the experimental group) compared with TPN (the control group) in patients with PUGIF. The primary objective of the study is to compare EN versus TPN in the treatment of PUGIF (after esophagogastric resection including bariatric surgery, duodenojejunal resection or pancreatic resection with digestive tract violation) in terms of the 30-day fistula closure rate. Secondary objectives are to evaluate the 6-month postrandomization fistula closure rate, time of first fistula closure (in days), the medical- and surgical treatment-related complication rate at 6 months after randomization, the fistula-related complication rate at 6 months after randomization, the type and severity of early (30 days after randomization) and late fistula-related complications (over 30 days after randomization), 30-day and 6-month postrandomization mortality rate, nutritional status at day 30, day 60, day 90 and day 180 postrandomization, the mean length of hospital stay, the patient's health-related quality of life (by self-assessment questionnaire), oral feeding time and direct costs of treatment. A total of 321 patients will be enrolled.

Discussion: The two nutritional supports are already used in daily practice, but most surgeons are reluctant to use the enteral route in case of PUGIF. This study will be the first randomized trial testing the role of EN versus TPN in PUGIF.

Trial Registration: ClinicalTrials.gov: NCT03742752. Registered on 14 November 2018.
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http://dx.doi.org/10.1186/s13063-020-04366-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265255PMC
June 2020

Lasting Symptoms After Esophageal Resection (LASER): European Multicenter Cross-sectional Study.

Ann Surg 2020 Nov 17. Epub 2020 Nov 17.

Department of Upper GI Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

Objective: To identify the most prevalent symptoms and those with greatest impact upon health-related quality of life (HRQOL) among esophageal cancer survivors.

Background: Long-term symptom burden after esophagectomy, and associations with HRQOL, are poorly understood.

Patients And Methods: Between 2010 and 2016, patients from 20 European Centers who underwent esophageal cancer surgery, and were disease-free at least 1 year postoperatively were asked to complete LASER, EORTC-QLQ-C30, and QLQ-OG25 questionnaires. Specific symptom questionnaire items that were associated with poor HRQOL as identified by EORTC QLQ-C30 and QLQ-OG25 were identified by multivariable regression analysis and combined to form a tool.

Results: A total of 876 of 1081 invited patients responded to the questionnaire, giving a response rate of 81%. Of these, 66.9% stated in the last 6 months they had symptoms associated with their esophagectomy. Ongoing weight loss was reported by 10.4% of patients, and only 13.8% returned to work with the same activities.Three LASER symptoms were correlated with poor HRQOL on multivariable analysis; pain on scars on chest (odds ratio (OR) 1.27; 95% CI 0.97-1.65), low mood (OR 1.42; 95% CI 1.15-1.77) and reduced energy or activity tolerance (OR 1.37; 95% CI 1.18-1.59). The areas under the curves for the development and validation datasets were 0.81 ± 0.02 and 0.82 ± 0.09 respectively.

Conclusion: Two-thirds of patients experience significant symptoms more than 1 year after surgery. The 3 key symptoms associated with poor HRQOL identified in this study should be further validated, and could be used in clinical practice to identify patients who require increased support.
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http://dx.doi.org/10.1097/SLA.0000000000003917DOI Listing
November 2020