Publications by authors named "Pascal Berna"

49 Publications

Lymphatic drainage of lung cancer follows an intersegmental pathway within the visceral pleura.

Lung Cancer 2021 04 22;154:118-123. Epub 2021 Feb 22.

Department of Thoracic Surgery, Amiens University Hospital, Amiens, France.

Objectives: Lung cancer tumors are known to be highly lymphophilic. There are two different pattern of lymphatic drainage of the lung: one peribronchial lymphatic pathway, and another one within the visceral pleura which appears to be more intersegmental than the peribronchial pathway. We aimed to assess the prevalence of an intersegmental pathway in the lymphatic drainage of lung tumors within the visceral pleura and determine potential influential factors.

Methods: In this prospective study, we included all patients for whom a major pulmonary resection (lobar) was indicated and performed for suspected or proven lung cancer. An immediate ex-vivo evaluation of the surgical specimen after resection was conducted by trans-pleural injection of blue dye within the tumor. The pathways followed by the lymphatic vessels under the visceral pleura were assessed to define the occurrence of an intersegmental pathway, which was defined by the presence of blue dye within the lymphatic vessel crossing to a neighboring pulmonary segment, distinct from the tumorous segment.

Results: Fifty-three patients met the inclusion criteria and were assessed over a three-year period. Lymphatic drainage within the visceral pleura followed an intersegmental pathway in 35 of 53 patients (66 %). When the lymphatic drainage of the tumor was intersegmental, it drained in a single other segment in 21/35 cases and two or more in 14/35 cases. Logistic regression with multivariate analysis showed a peripheral location of the tumor to be a risk factor for the intersegmental pathway of visceral pleura lymphatic drainage (OR = 0.87 [079-0.95], p = 0.003).

Conclusion: These results confirm that lymphatic drainage of lung cancer in the visceral pleura appears to largely follow an intersegmental pathway, especially when the tumor is peripheral, close to the visceral pleura.
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http://dx.doi.org/10.1016/j.lungcan.2021.02.023DOI Listing
April 2021

Intraoperative conversion during video-assisted thoracoscopy resection for lung cancer does not alter survival.

Interact Cardiovasc Thorac Surg 2021 Feb 15. Epub 2021 Feb 15.

Department of Thoracic Surgery, Amiens University Hospital, Amiens, France.

Objectives: The aim of this study was to assess the long-term outcomes of patients treated by anatomical pulmonary resection with the video-assisted thoracoscopic surgery (VATS) approach, VATS requiring intraoperative conversion to thoracotomy or an upfront open thoracotomy for lung cancer surgery.

Methods: We performed a retrospective single-centre study that included consecutive patients between January 2011 and December 2018 treated either by VATS (with or without intraoperative conversion) or open thoracotomy for non-small-cell lung cancer (NSCLC). Patients treated for a benign or metastatic condition, stage IV disease, multiple primary lung cancer or by resection, such as pneumonectomies or angioplastic/bronchoplastic/chest wall resections, were excluded.

Results: Among 1431 patients, 846 were included: 439 who underwent full-VATS, 94 who underwent VATS-conversion (21 emergent, 73 non-emergent) and 313 treated with upfront open thoracotomy. The median follow-up was 37 months. There were no statistical differences in stage-specific overall survival between the full-VATS, VATS-conversion, and open thoracotomy groups, with 5-year OS for stage I NSCLC of 76%, 72.3% and 69.4%, respectively (P = 0.47). There was a difference in disease-free survival for stage I NSCLC, with 71%, 60.2% and 53%, respectively at 5 years (P = 0.013). Fewer complications occurred in the full-VATS group (pneumonia, arrhythmia, length of stay), but complication rates were similar between the VATS-conversion and thoracotomy groups.

Conclusions: VATS resection for NSCLC with intraoperative conversion does not appear to alter the long-term oncological outcome relative to full-VATS or open upfront thoracotomy. Postoperative complications were higher than for full-VATS and comparable to those for thoracotomy. VATS should be favoured when possible.
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http://dx.doi.org/10.1093/icvts/ivab044DOI Listing
February 2021

Long-term follow-up of a patient with type 2 Timothy syndrome and the partial efficacy of mexiletine.

Gene 2021 Apr 29;777:145465. Epub 2021 Jan 29.

Cardiology, Arrhythmia, and Cardiac Stimulation Service, Amiens-Picardie University Hospital, Amiens, France.

We report a detailed case of type 2 TS due to a p.(Gly402Ser) mutation in exon 8 of the CACNA1C gene. The patient shows a marked prolongation of repolarization with a mean QTc of 540 ms. He shows no structural heart disease, syndactyly, or cranio-facial abnormalities. However, he shows developmental delays, without autism, and dental abnormalities. The cardiac phenotype is very severe, with a resuscitated cardiac arrest at 2.5 years of age, followed by 26 appropriate shocks during nine years of follow-up. Adding mexiletine to nadolol resulted in a reduction of the QTc and a slight decrease in the number of appropriate shocks.
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http://dx.doi.org/10.1016/j.gene.2021.145465DOI Listing
April 2021

Guidelines on enhanced recovery after pulmonary lobectomy.

Anaesth Crit Care Pain Med 2021 Feb 13;40(1):100791. Epub 2021 Jan 13.

Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France. Electronic address:

Objective: To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS).

Design: A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence.

Methods: Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method.

Results: The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions.

Conclusions: A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
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http://dx.doi.org/10.1016/j.accpm.2020.100791DOI Listing
February 2021

Outcomes after Contralateral Anatomic Surgical Resection in Multiple Lung Cancer.

Thorac Cardiovasc Surg 2020 May 22. Epub 2020 May 22.

Department of Thoracic Surgery, Amiens University Hospital, Amiens, France.

Background:  Patients treated surgically for lung cancer may present synchronous or metachronous lung cancers. The aim of this study was to evaluate outcomes after a second contralateral anatomic surgical resection for lung cancer.

Methods:  We performed a retrospective two-center study, based on a prospective indexed database. Included patients were treated surgically by bilateral anatomic surgical resection for a second primary lung cancer. We excluded nonanatomic resections, benign lesions, and ipsilateral second surgical resections.

Results:  Between January 2011 and September 2018, 55 patients underwent contralateral anatomic surgical resections for lung cancer, mostly for metachronous cancers. The first surgical resection was a lobectomy in most cases (45 lobectomies: 81.8%, 9 segmentectomies: 16.4%, and 1 bilobectomy: 1.8%), and a video-assisted thoracic surgery (VATS) procedure was used in 23 cases (41.8%). The mean interval between the operations was 38 months, and lobectomy was less frequent for the second surgical resection (35 lobectomies: 63.6% and 20 segmentectomies: 36.4%), with VATS procedures performed in 41 cases (74.5%). Ninety-day mortality was 10.9% ( = 6), and 3-year survival was 77%. Risk factor analysis identified the number of resected segments during the second intervention or the total number of resected segments, extent of resection (lobectomy vs. segmentectomy), surgical approach (thoracotomy vs. VATS), tumor stage, and nodal involvement as potential prognostic factors for long-term survival.

Conclusion:  A second contralateral anatomic surgical resection for multiple primary lung cancer is possible, with a higher early mortality rate, but acceptable long-term survival, and should be indicated for carefully selected patients.
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http://dx.doi.org/10.1055/s-0040-1710068DOI Listing
May 2020

Lung Cancer Screening by Low-Dose CT Scan: Baseline Results of a French Prospective Study.

Clin Lung Cancer 2020 03 31;21(2):145-152. Epub 2019 Oct 31.

Department of Pulmonology, CHU Amiens, Amiens, France.

Background: Lung cancer mortality has been found to decrease significantly with low-dose (LD) computed tomographic (CT) screening among current or former smokers. However, such a screening program is not implemented in France. This study assessed the feasibility of a lung cancer screening program using LD CT scan in a French administrative territory. We report here the results of the first screening round.

Patients And Methods: DEP KP80 was a single-arm prospective study initiated in May 2016. Participants aged 55 to 74 years, current or former smokers of ≥ 30 pack-years, were recruited. An annual LD CT scan was scheduled. Our algorithms considered nodules < 5 mm as negative findings and nodules > 10 mm as positive; for intermediate nodules between 5 and 10 mm, 3-month CT scan with doubling time measurement was recommended. All general practitioners, pulmonologists, and radiologists from the Somme department were solicited to participate. Subjects were selected by general practitioners or pulmonologists who checked the inclusion criteria and prescribed the CT scan.

Results: Over a 2.5-year period, 1307 subjects were recruited. Screening was negative in 733 cases (77.2%), positive in 54 (5.7%), and indeterminate in 162 (17.1%). After the 3-month scans, 57 subjects screened positive: 26 patients exhibited 31 lung cancers (67.7% of stage 0 to I), of whom 76.9% underwent surgical resection, and 29 had no cancer (false-positive rate = 3.1%). The prevalence of lung cancer was 2.7%.

Conclusion: This study demonstrated the feasibility of organized lung cancer screening using LD CT scan within a real-life context in the general population.
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http://dx.doi.org/10.1016/j.cllc.2019.10.014DOI Listing
March 2020

Intraoperative conversion: it happens, we should smartly deal with it.

J Thorac Dis 2019 Aug;11(8):E123-E124

Department of Thoracic Surgery, Amiens University Hospital, Amiens, France.

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http://dx.doi.org/10.21037/jtd.2019.08.25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753403PMC
August 2019

Intraoperative conversion during video-assisted thoracoscopy does not constitute a treatment failure†.

Eur J Cardiothorac Surg 2019 Apr;55(4):660-665

Department of Thoracic Surgery, Amiens University Hospital, Amiens, France.

Objectives: Intraoperative conversion may be required during video-assisted thoracoscopic surgery (VATS) for lung cancer. We evaluated the morbidity and mortality rates associated with VATS for anatomical pulmonary resection with conversion to thoracotomy and compared this technique with full VATS and an open thoracotomic approach.

Methods: We performed a retrospective, single-centre study between January 2011 and January 2017 and included 610 consecutive patients having undergone either VATS (with or without intraoperative conversion) or open thoracotomy for anatomical pulmonary resection. Pneumonectomies and angioplastic/bronchoplastic/chest wall resections were excluded. After propensity score adjustment, we assessed the 90-day mortality and determined whether the surgical approach was a risk factor for mortality.

Results: Of the 610 patients, 253 patients underwent full VATS, 56 patients underwent VATS + conversion and 301 patients underwent up-front open thoracotomy. Relative to the open thoracotomy group, the VATS + conversion group had a higher incidence of cardiac or respiratory comorbidities and was more likely to have an early-stage tumour. Following adjustment, the 90-day postoperative mortality rate was 5.4% (n = 3/56) in the VATS + conversion group and 3.7% (n = 11/301) in the open thoracotomy group (P = 0.58). Likewise, the morbidity rate was similar in these 2 groups. In a multivariable analysis, the surgical approach was not a risk factor for postoperative mortality.

Conclusions: Following anatomical resection for lung cancer, VATS with conversion and open thoracotomy were associated with similar early postoperative morbidity and mortality rates. When in doubt, VATS should be preferred to thoracotomy; it potentially provides the patient with benefits of a fully VATS-based resection but is not disadvantageous when intraoperative conversion is required.
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http://dx.doi.org/10.1093/ejcts/ezy343DOI Listing
April 2019

Successful Bronchial Replacement Using a Thoracodorsal Artery Perforator Flap.

Ann Thorac Surg 2018 09 24;106(3):e129-e131. Epub 2018 Feb 24.

Department of Thoracic Surgery, Amiens University Hospital, Amiens, France.

Pneumonectomy is known to be associated with a high rate of morbidity and mortality and may be contraindicated in patients with altered lung function. Sleeve lobectomy is a treatment option, but it may be technically impossible in cases of large bronchial involvement. Here, we describe a patient with impaired lung function and right upper lobe lung cancer that involved the intermediate bronchial trunk. The patient was treated successfully with a right upper sleeve lobectomy and bronchial replacement with the use of a thoracodorsal artery perforator flap and a temporary endostent. Clinical outcomes were favorable, and no recurrence has been observed in the 4 years since the operation.
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http://dx.doi.org/10.1016/j.athoracsur.2018.01.056DOI Listing
September 2018

Quantitative computed tomography to predict postoperative FEV1 after lung cancer surgery.

J Thorac Dis 2017 Aug;9(8):2413-2418

Department of Thoracic Surgery, Amiens University Hospital, University of Picardy, F-80054 Amiens Cedex 01, France.

Background: Predicted postoperative FEV1 (ppoFEV1) must be estimated preoperatively prior to surgery for non-small cell lung cancer (NSCLC). We evaluated a lung volumetry approach based on chest computed tomography (CT).

Methods: A prospective study was conducted over a period of one year in eligible lung cancer patients to evaluate the difference between ppoFEV1 and the 3-month postoperative FEV1 (poFEV1). Patients in whom CT was performed in another hospital and those with factors influencing poFEV1, such as atelectasis, pleural effusion, pneumothorax, or pneumonia, were excluded. A total of 23 patients were included and ppoFEV1 was calculated according to 4 usual Methods: Nakahara formula, Juhl and Frost formula, ventilation scintigraphy, perfusion scintigraphy, and a fifth method based on quantitative CT. Lung volume was calculated twice and separately by 2 radiologists. Tumor volume, and emphysema defined by a -950 HU limit were subtracted from the total lung volume in order to estimate ppoFEV1.

Results: We compared 5 methods of ppoFEV1 estimation and calculated the mean volume difference between ppoFEV1 and poFEV1. A better correlation was observed for quantitative CT than for Nakahara formula, Juhl and Frost formula, perfusion scintigraphy and ventilation scintigraphy with respectively: R=0.79 0.75, 0.75, 0.67 and 0.64 with a mean volume difference of 266±229 mL (P<0.01) 320±262 mL (P<0.01), 332±251 mL (P<0.01), 304±295 mL (P<0.01) and 312±303 mL (P<0.01).

Conclusions: Quantitative CT appears to be a satisfactory method to evaluate ppoFEV1 evaluation method, and appears to be more reliable than other approaches. Estimation of ppoFEV1, as part of the preoperative assessment, does not involve additional morphologic examinations, particularly scintigraphy. This method may become the reference method for ppoFEV1 evaluation.
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http://dx.doi.org/10.21037/jtd.2017.06.118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594129PMC
August 2017

Three-dimensional CT angiography of anatomic variations in the pulmonary arterial tree.

Surg Radiol Anat 2018 Jan 30;40(1):45-53. Epub 2017 Aug 30.

Thoracic Surgery Department, Amiens University Hospital, University of Picardy, 80054, Amiens cedex 01, France.

Purpose: Anatomic variations of the pulmonary arterial tree can cause technical difficulties during pulmonary lobectomy in general and video-assisted thoracic surgery (VATS). Using CT angiography and 3D reconstruction, we sought to identify anatomic variations of the pulmonary arterial tree and assess their respective frequencies.

Methods: We retrospectively studied 88 pulmonary arterial trees in 44 patients having undergone VATS lobectomy for lung cancer over an 18-month period in Amiens University Hospital's Department of Thoracic Surgery. Each CT angiography with 3D reconstruction of the pulmonary arterial tree was performed by two experienced operators, according to a standardized procedure.

Results: On the right side, the upper lobe was supplied with blood by a mediastinal artery in 100% of cases and by one or more fissural arteries in 88.6%. The middle lobe was usually supplied by two arteries (54.5%). The upper segment of the right lower lobe was usually supplied by a single artery (90.9%). We identified 11 variations in the vasculature of the basal segments. On the left side, the upper lobe was supplied by four arteries in 50% of cases, three culminal arteries (50%), and a fissural lingular artery (77.3%). The upper segment of the left lower lobe was usually supplied by a single artery (65.9%). We identified 15 anatomic variations in the vasculature of the basal segments. We observed that the origin of the apical artery of the right lower lobe was proximal to the origin of the middle lobe artery in 38.6% of cases. The origin of the apical artery of the left lower lobe artery was proximal to the origin of the lingular fissural artery in 65.9% of cases.

Conclusion: The findings of the present CT angiography/3D reconstruction study agreed with the reference works on the anatomy of the pulmonary arterial tree and defined the frequency of anatomic variations. It is essential to assess the anatomy of the pulmonary arterial tree before VATS lobectomy.
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http://dx.doi.org/10.1007/s00276-017-1914-zDOI Listing
January 2018

Lymphatic drainage of lung segments in the visceral pleura: a cadaveric study.

Surg Radiol Anat 2018 Jan 19;40(1):15-19. Epub 2017 Aug 19.

Department of Thoracic Surgery, Amiens University Hospital, University of Picardy, 80054, Amiens Cedex 01, France.

Purpose: Although peribronchial lymphatic drainage of the lung has been well characterized, lymphatic drainage in the visceral pleura is less well understood. The objective of the present study was to evaluate the lymphatic drainage of lung segments in the visceral pleura.

Methods: Adult, European cadavers were examined. Cadavers with a history of pleural or pulmonary disease were excluded. The cadavers had been refrigerated but not embalmed. The lungs were surgically removed and re-warmed. Blue dye was injected into the subpleural area and into the first draining visceral pleural lymphatic vessel of each lung segment.

Results: Twenty-one cadavers (7 males and 14 females; mean age 80.9 years) were dissected an average of 9.8 day postmortem. A total of 380 dye injections (in 95 lobes) were performed. Lymphatic drainage of the visceral pleura followed a segmental pathway in 44.2% of the injections (n = 168) and an intersegmental pathway in 55.8% (n = 212). Drainage was found to be both intersegmental and interlobar in 2.6% of the injections (n = 10). Lymphatic drainage in the visceral pleura followed an intersegmental pathway in 22.8% (n = 13) of right upper lobe injections, 57.9% (n = 22) of right middle lobe injections, 83.3% (n = 75) of right lower lobe injections, 21% (n = 21) of left upper lobe injections, and 85.3% (n = 81) of left lower lobe injections.

Conclusion: In the lung, lymphatic drainage in the visceral pleura appears to be more intersegmental than the peribronchial pathway is-especially in the lower lobes. The involvement of intersegmental lymphatic drainage in the visceral pleura should now be evaluated during pulmonary resections (and especially sub-lobar resections) for lung cancer.
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http://dx.doi.org/10.1007/s00276-017-1910-3DOI Listing
January 2018

Usefulness of a routine endoscopic assessment of laryngeal lesions after lung cancer surgery.

Respirology 2018 01 4;23(1):107-110. Epub 2017 Aug 4.

Department of Thoracic Surgery, Amiens University Hospital, Amiens, France.

Background And Objective: Laryngeal pathology following lung cancer surgery is associated with post-operative morbidity and mortality. The aim of our study was to evaluate the usefulness of routine endoscopic assessment.

Methods: We prospectively evaluated vocal cord pathology using laryngeal endoscopy within 24 h post-surgery. Over 25 months, 276 patients underwent thoracic surgery. We excluded 26 patients with previous laryngectomy or vocal cord paralysis, early post-operative reintubation or patients who did not consent to an endoscopy. Endoscopic data were reported using a standardized procedure, recording vocal cord paralysis, swallowing disorders with aspiration, detected using a blue-coloured water test and vocal cord haematoma.

Results: Among 250 patients, vocal cord paralysis was diagnosed in 13 patients (5.2%) and was associated with a higher rate of post-operative pneumonia (P = 0.03), post-operative bronchoscopy (P = 0.01), reintubation (P = 0.007) and a trend towards an increased 90-day mortality rate (P = 0.09). Swallowing disorders with aspiration were diagnosed in 18 patients (7.2%) and were associated with a higher rate of post-operative pneumonia (P = 0.007), post-operative bronchoscopy (P = 0.01), reintubation (P = 0.004) and 90-day mortality (P = 0.03). Vocal cord haematomas were diagnosed in 28 patients (11.2%) and were not associated with an increased post-operative morbidity or mortality.

Conclusion: Post-operative endoscopic laryngeal assessment is effective for diagnosing laryngeal pathology following thoracic surgery. Routine laryngeal endoscopic assessment may detect clinically silent swallowing disorders early to allow prompt treatment, which may prevent respiratory complications.
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http://dx.doi.org/10.1111/resp.13139DOI Listing
January 2018

Delayed-onset tension hemothorax following blunt trauma and the rupture of a previously undiagnosed aberrant right subclavian artery.

J Thorac Dis 2017 Mar;9(3):E245-E248

Department of Thoracic Surgery, Amiens University Hospital, Jules Verne University of Picardy, F-80054 Amiens, France.

An arteria lusoria is a well-known anatomic variant of the right subclavian artery. We describe a patient in whom an arteria lusoria injury was revealed by delayed-onset tension hemothorax following blunt trauma to the thorax.
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http://dx.doi.org/10.21037/jtd.2017.02.87DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5394085PMC
March 2017

GLUT1: A novel tool reflecting proliferative activity of lung neuroendocrine tumors?

Pathol Int 2017 Jan 20;67(1):32-36. Epub 2016 Dec 20.

Department of Pathology, Amiens University Hospital, Amiens, France.

Lung neuroendocrine tumors (LNT) represents approximately 20% of all lung cancers. The classification of LNT relies upon morphology. Recently, in the World Health Organization (WHO) classification, Ki-67 rate has been proposed for classification. It is, however, known that Ki-67 count has a poor interlaboratory reproducibly. For that reason, our team has looked for a new biomarker. GLUT1 protein a facilitative glucose transporter protein which has ubiquitous expression in mammalian. GLUT1 is overexpressed in many human cancers. But, no study has evaluated the GLUT1 staining as an aid diagnosis in LNT. Our team have assessed the GLUT1 immunohistochemical staining in 36 LNT and to assess its diagnostic value. GLUT1 staining was higher in neuroendocrine carcinoma than in carcinoid tumor. A positive predictive value in a priori and posteriori testing for diagnosis of LNT is demonstrated. GLUT1 staining could aid in the diagnosis and should be validated in a large prospective cohort.
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http://dx.doi.org/10.1111/pin.12486DOI Listing
January 2017

Cavo-atrial bypass with a polytetrafluoroethylene graft for the treatment of a complete, traumatic transection of the suprahepatic inferior vena cava.

Interact Cardiovasc Thorac Surg 2017 02;24(2):307-309

Department of Digestive Surgery, Amiens University Medical Center, Amiens, France.

In the event of injury to the vena cava, the surgeon's goal is to control the bleeding and then repair the vascular damage. Given the wide range of lesions observed, the repair step has not been standardized. There are a few case reports of simple venoplasty or cavocaval bypass with a polytetrafluoroethylene graft. The present report introduces another treatment option for total avulsion of the suprahepatic inferior vena cava when a lack of remnant venous tissue below the heart prevents direct repair: cavo-atrial bypass with a polytetrafluoroethylene graft.
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http://dx.doi.org/10.1093/icvts/ivw265DOI Listing
February 2017

Complete thoracoscopic lobectomy for cancer: comparative study of three-dimensional high-definition with two-dimensional high-definition video systems †.

Interact Cardiovasc Thorac Surg 2015 Jun 3;20(6):820-3. Epub 2015 Mar 3.

Department of Thoracic Surgery, Amiens Picardie University Hospital, Amiens, France.

Objectives: Common video systems for video-assisted thoracic surgery (VATS) provide the surgeon a two-dimensional (2D) image. This study aimed to evaluate performances of a new three-dimensional high definition (3D-HD) system in comparison with a two-dimensional high definition (2D-HD) system when conducting a complete thoracoscopic lobectomy (CTL).

Methods: This multi-institutional comparative study trialled two video systems: 2D-HD and 3D-HD video systems used to conduct the same type of CTL. The inclusion criteria were T1N0M0 non-small-cell lung carcinoma (NSCLC) in the left lower lobe and suitable for thoracoscopic resection. The CTL was performed by the same surgeon using either a 3D-HD or 2D-HD system. Eighteen patients with NSCLC were included in the study between January and December 2013: 14 males, 4 females, with a median age of 65.6 years (range: 49-81). The patients were randomized before inclusion into two groups: to undergo surgery with the use of a 2D-HD or 3D-HD system. We compared operating time, the drainage duration, hospital stay and the N upstaging rate from the definitive histology.

Results: The use of the 3D-HD system significantly reduced the surgical time (by 17%). However, chest-tube drainage, hospital stay, the number of lymph-node stations and upstaging were similar in both groups.

Conclusions: The main finding was that 3D-HD system significantly reduced the surgical time needed to complete the lobectomy. Thus, future integration of 3D-HD systems should improve thoracoscopic surgery, and enable more complex resections to be performed. It will also help advance the field of endoscopically assisted surgery.
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http://dx.doi.org/10.1093/icvts/ivv031DOI Listing
June 2015

Management of gastrobronchial fistula after laparoscopic sleeve gastrectomy.

Surg Obes Relat Dis 2014 May-Jun;10(3):460-7. Epub 2013 Sep 11.

Departments of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France. Electronic address:

Background: Gastric fistula (GF) is a serious complication after laparoscopic sleeve gastrectomy (LSG). Furthermore, gastrobronchial fistula (GBF) may appear some time after a primary LSG. The objective of this study was to characterize GBF after LSG and establish standardized treatment procedures.

Methods: All patients undergoing surgery for GBF after LSG at a public university medical center in France between November 2004 and January 2013 were included in this study. Surgical and perioperative care was standardized. The primary efficacy criterion was the complication rate. Secondary efficacy criteria were the mortality rate, surgical data, types of complications, and the length of stay (LOS) in hospital.

Results: Six patients were treated for GBF after LSG: 2 presented GBF after primary LSG performed in our institution and 4 had been referred by tertiary centers. The median (range) time to onset of GBF after LSG was 136 days (99-238 d). Preoperative refeeding was performed in 5 cases. The median time interval between the discovery of GBF and its surgical treatment was 31 days (7-137 d). Five patients underwent simultaneous abdominal and thoracic procedures. The abdominal procedures consisted of total gastrectomy (n = 1) and 60-cm Roux-en-Y gastrojejunal anastomosis (n = 6). There were no postoperative mortalities. Four postoperative complications occurred (66.6%), 2 of which were postoperative fistulas (33.3%) requiring revisional surgery. The median time to oral refeeding was 10 days (8-65 d) and the median LOS was 14 days (13-25 d).

Conclusions: Our treatment of GBF is based on effective drainage with endoscopic procedures, allowing optimal preoperative refeeding before combined abdominal and thoracic surgery. For the abdominal procedure, we prefer a 60-cm Roux-en-Y gastrojejunal anastomosis to total gastrectomy, because the former is simpler and minimizes the long-term risk of postoperative malabsorption.
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http://dx.doi.org/10.1016/j.soard.2013.08.015DOI Listing
May 2015

Combined endovascular treatment of aorto-oesophageal fistula with mediastinitis.

Interact Cardiovasc Thorac Surg 2013 Jan 5;16(1):93-4. Epub 2012 Oct 5.

Department of Thoracic Surgery, Amiens South Hospital, University of Picardie, Amiens, France.

False aortic aneurysm is an uncommon complication after oesophageal perforation and results in a high rate of mortality. A 63-year-old patient presented with acute chest pain. Biochemical tests (cardiac enzymes) and electrocardiogram were normal. A thoracic and abdominal CT scan was performed, and showed a foreign body in the posterior mediastinum, with mediastinal cellulitis and a false aortic aneurysm. Surgical endovascular management was performed, with stenting of the thoracic aorta and oesophageal exploration.
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http://dx.doi.org/10.1093/icvts/ivs385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523623PMC
January 2013

Nutritional status and postoperative outcome after pneumonectomy for lung cancer.

Ann Thorac Surg 2013 Feb 26;95(2):392-6. Epub 2012 Jul 26.

Georges Pompidou European Hospital, Rene Descartes University, Paris, France.

Background: The influence of nutritional status on outcome after major lung resection remains controversial. Nutritional assessment is not included as a major recommendation in lung cancer guidelines. The purpose of this study was to assess the nutritional status of patients referred for pneumonectomy and to assess the predictive value of malnutrition in determining the surgical outcome.

Methods: This study was a multicenter observational trial. The eligibility criterion for participants was pneumonectomy for lung cancer. Criteria for group classification according to nutritional status were albumin and transthyretin levels. Predicted outcomes were major infectious and noninfectious complications and 90-day mortality. Univariate analysis identified independent variables for the predictive model of age, sex, induction chemotherapy, extended resections, treatment side, smoking, and malnutrition. Predictive variables were then included in a logistic regression model.

Results: Between January 2010 and December 2011, 86 (mean age, 61.5 years) consecutive patients referred for pneumonectomy (left side, n = 58; right side, n = 28) at 4 thoracic surgery centers were included. The malnutrition group included 33 patients (39%) and the normal nutritional status group included 53 patients. Univariate analysis elected malnutrition, recent active smoking, and extended resection to be included in a multivariate analysis. Multivariate analysis identified malnutrition, recent smoking, and extended resection as predictive variables for major complications and mortality.

Conclusions: The frequency of malnutrition detected by biological markers was dramatically high. Malnutrition, as well as recent active smoking and extended resection, is a predictive factor for infectious complications and mortality after pneumonectomy. Nutritional assessment with appropriate markers should be considered before pneumonectomy.
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http://dx.doi.org/10.1016/j.athoracsur.2012.06.023DOI Listing
February 2013

Use of the thoracodorsal artery perforator flap for bronchial reinforcement in patients with previous posterolateral thoracotomy.

Ann Thorac Surg 2012 May;93(5):1743-5

Department of Thoracic Surgery, Amiens South Hospital, Amiens, France.

The thoracodorsal artery perforator flap (TDAP flap) allows raising the same cutaneous island as in the classical latissimus dorsi musculocutaneous flap without its muscular part. All patients who underwent a completion pneumonectomy with reinforcement of bronchial stump with a TDAP flap from December 2009 to October 2010 were followed prospectively. The 30-day mortality and the procedure-related morbidity as well as bronchial fistula and TDAP flap were analyzed. The TDAP flap was used in 6 cases without failure or fistula formation. At 1 month, all patients were alive, and there was no morbidity (seroma, hematoma, fistula, or shoulder dysfunction). Computed tomography scans were performed at 1 month and 3 months postoperatively and showed viable nonatrophic flap. This type of flap has been described in the field of plastic surgery, and this is the first description of its use in the chest. Deepithelialized fasciocutaneous TDAP flap is safe and reliable. It is available even if the latissimus dorsi has been previously divided. It is now our first-line option to reinforce the bronchial stump.
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http://dx.doi.org/10.1016/j.athoracsur.2011.12.005DOI Listing
May 2012

Evolving characteristics of lung cancer: a surgical appraisal.

Eur J Cardiothorac Surg 2012 May 20;41(5):1019-24. Epub 2012 Mar 20.

General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France.

Objective: Lung cancer management has changed due to emergence of new imaging techniques and of multimodal therapies. Our purpose was to analyse how lung cancer evolved in surgical practice.

Methods: The records of patients who underwent surgical resection for lung cancer from 1983 to 2006 in two centres were reviewed. Data were split into four time periods of 6 years. We analysed and compared the epidemiological, pathological and prognostic characteristics of each period.

Results: There were 832, 1148, 1493 and 1195 patients during the periods 1983-88, 1989-94, 1995-2000 and 2001-06, respectively. The main changed characteristics were increasing numbers of older patients, females, past history of another cancer and/or cardio-vascular disease, adenocarcinomas and undifferentiated large-cell carcinomas, smaller tumour size, T1-T2, N0 (47.2-61.2%) and neoadjuvant therapy (NAT) (3.8-24.9%). There were also a decreasing number of exploratory thoracotomies, pneumonectomies and adjuvant therapy (AT) (48.5-30%). The 5-year survival rates improved (34.5-46.3%, P < 10(-6)), mainly after lobectomy, and in the case of adenocarcinoma, N0 and N2 patients. Multivariate analysis confirmed that time trend was an independent factor of prognosis (P < 10(-6)), just as important as N involvement, complete resection (R0), tumour size, age, another cancer history and more significant than the type of resection, histology, NAT and AT.

Conclusions: During the last 25 years, the clinico-pathological features of operated patients have progressively changed and the results following surgery improved. Earlier stage diagnosis might explain overall survival improvement, and play a more major role than associated peri-operative treatments. Therefore, it is advisable to consider the time-related factor in future studies on lung cancer surgery.
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http://dx.doi.org/10.1093/ejcts/ezr189DOI Listing
May 2012

A new option for autologous anterior chest wall reconstruction: the composite thoracodorsal artery perforator flap.

Ann Thorac Surg 2012 Mar;93(3):e67-9

Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospital Amiens, and Unit of Research and Innovation for Surgical Expertise, Amiens Medical School, Amiens, France.

Sternal chondrosarcoma is rare and often requires total or subtotal sternectomy. The authors describe the case of a 70-year-old man with sternoclavicular joint chondrosarcoma who underwent subtotal sternectomy with partial resection of the two clavicles and anterior arches of first to third right ribs. Anterior chest wall reconstruction was performed with a composite thoracodorsal artery perforator free flap with sixth and seventh ribs vascularized on serratus muscle. The postoperative course was uneventful. Seven months after surgery, the patient was doing well. This surgical procedure is a new option for autologous reconstruction without prosthetic material after extensive sternectomy.
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http://dx.doi.org/10.1016/j.athoracsur.2011.10.003DOI Listing
March 2012

Lung cancer invading the fissure to the adjacent lobe: more a question of spreading mode than a staging problem.

Eur J Cardiothorac Surg 2012 May 20;41(5):1047-51. Epub 2011 Dec 20.

Department of Thoracic Surgery, Paris Descartes University, Paris, France.

Objectives: Lung cancer invading beyond the interlobar pleura, classified as T2a in the new TNM, is a rare entity with a poor outcome. Our purpose was a better understanding of the mechanisms of this particular behaviour and its prognostic value.

Methods: Patients who underwent surgery between 1984 and 2007 were reviewed. We focused on T1 and T2 tumours. Tumours not traversing the pleural elastic layer were defined as PL0, extending through the layer as PL1 and extending to the surface of the visceral pleura as PL2. We considered three groups: group 1, tumours invading the lobar fissure, group 2, PL0-tumours and group 3, PL1 + PL2 tumours and studied their pathology and prognostic characteristics.

Results: The distribution was as follows: group 1 n = 154, group 2 n = 2310 and group 3 n = 651. Pneumonectomy was necessary in 55.2% and bilobectomy in 19.5% of group 1, and N-involvement was present in 55.8% (significantly more than other groups). The mean tumour size (42.7 ± 12 mm) was bigger in group 1. Post-operative mortality was as follows: -5.2, -3.5 and 3.2% in groups 1, 2 and 3, respectively (P = 0.49). Five-year survival rates were: group 1: 38.9%, group 2: 52.5% and group 3: 43.4%; P = 0.00002. Survival was not different between groups concerning pN1 and pN2, but poorer in groups 1 and 3 than in group 2 in pN0 patients, P = 0.0057. Survival was 48.1, 37.9 and 38.4% for tumours between 31 and 70 mm in groups 2, 1 and 3, respectively, P = 0.0024 (but P = 0.65 between groups 1 and 3). Pneumonectomy was a poor prognostic factor in all groups, but survival between pneumonectomy and bilobectomy was not different in group 1. Multivariate analysis confirmed intralobar invasion to be an independent factor of poor prognosis, as well as visceral pleura invasion.

Conclusions: Tumours invading through the fissure have a significant effect on long-term survival in the first stages of lung cancer but also in all stages because of their size and important locoregional spread. Their prognostic value is due to pleural invasion, whose role in lung cancer dissemination is worth further research.
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http://dx.doi.org/10.1093/ejcts/ezr143DOI Listing
May 2012

Use of Macrolane to treat pectus excavatum.

Ann Thorac Surg 2012 Jan;93(1):e17-8

Department of Plastic, Reconstructive, and Aesthetic Surgery, University Hospital Amiens, Unit of Research and Innovation for Surgical Expertise, Amiens Medical School, Amiens, France.

The use of subcutaneous hyaluronic acid injection in cosmetic surgery is a popular and well-accepted technique. A new highly reticulated, nonanimal, stabilized hyaluronic acid has been recently developed for high-volume enhancement, especially breast augmentation. We describe this technique for funnel chest treatment.
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http://dx.doi.org/10.1016/j.athoracsur.2011.09.054DOI Listing
January 2012

Successfully treated descending necrotizing mediastinitis through thoracotomy using a pedicled muscular serratus anterior flap.

Interact Cardiovasc Thorac Surg 2011 Oct 26;13(4):456-8. Epub 2011 Jul 26.

Department of Thoracic and Vascular Surgery, Amiens South Hospital, University of Picardie, Place Victor Pauchet, 80054 Amiens, Cedex 01, France.

Descending necrotizing mediastinitis (DNM) is rare and aggressive. A 68-year-old female with no medical history, was admitted to our institution for cervical cellulitis. After a conventional medical treatment, multiple abscesses of the upper mediastinum appeared on computed tomography (CT) findings. Although two cervicotomies were performed, a new necrotic abscess appeared in the anterior upper and middle mediastinum. An extensive debridement of cellulitis and abscess extended to the pericardium was made by thoracotomy. Middle mediastinum and pericardium were covered and reconstructed by a right pedicled serratus anterior flap. After radical surgery, follow-up was uneventful. Early extensive and complete debridement of cervical and mediastinal collections and irrigation with broad-spectrum intravenous antibiotics is essential. Combined surgery is the best approach in DNM. The use of a pedicled muscular flap helps control the sepsis. In such cases, serratus anterior flap is a flap of choice because it is reliable and always available even in a skinny patient, contrary to omentum. In this life-threatening disease, an early aggressive combined surgery with debridement of all necrotic tissues extended to the pericardium if necessary associated with a pedicled flap is mandatory.
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http://dx.doi.org/10.1510/icvts.2011.273813DOI Listing
October 2011