Publications by authors named "Romain Coriat"

220 Publications

Local treatment of pancreatic cancer metastases: A multicenter French study of the AGEO group.

Clin Res Hepatol Gastroenterol 2021 Mar 1;45(6):101607. Epub 2021 Mar 1.

Department of Oncology, Institute Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France.

Objective: This study reports the efficacy and safety of local treatment of metastases of pancreatic ductal adenocarcinoma (PDAC), with a curative intent.

Methods: We retrospectively included patients with histologically proven PDAC, who underwent a local treatment for metastases between January 1, 2000 and December 31, 2017, from 11 French hospitals. Complications of local treatment were reported. Univariate Cox models were performed to identify prognosis factors associated with overall survival (OS) and disease-free survival (DFS).

Results: We included 52 patients treated for 68 metastases; 33 (64%) of whom had metachronous metastases. Metastatic sites treated were: 39 (57%) hepatic, 18 (27%) pulmonary and 11 (16%) others. Metastases treatments were: 45 (66%) surgery, 9 (13%) radiofrequency and 14 (21%) other procedures. The rates of severe complications and mortality were respectively 10% and 4%. The median OS and DFS after local treatment were 36.5 months and 12.7 months, respectively. Prognosis factors associated with a shorter OS were: liver metastases when compared with lung metastases (HR 4.04; 95%CI: 1.18-13.81), N2 status of primary pancreatic tumor when compared to N0-N1 (HR 9.43; 95%CI: 2.44-36.36) and synchronous metastases when compared to metachronous metastases (HR 2.34; 95%CI: 1.05-5.23). N2 status of primary pancreatic tumor was associated with a shorter DFS when compared to N0-N1 (HR 2.82; 95%CI: 1.05-7.58).

Conclusion: In this series of highly selected patients, local treatment of metastases from PDAC is associated with prolonged survival. The rate of severe complications was low. Factors associated with shorter OS were liver metastases, N2 status and synchronous metastases.
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http://dx.doi.org/10.1016/j.clinre.2020.101607DOI Listing
March 2021

Air circulation in a gastrointestinal light source box and endoscope in the era of SARS-CoV-2 and airborne transmission of microorganisms.

Endosc Int Open 2021 Mar 22;9(3):E482-E486. Epub 2021 Feb 22.

Department of Gastroenterology and Endoscopy Unit, Cochin Teaching Hospital, AP-HP, and University of Paris, Paris, France.

 The role that air circulation through a gastrointestinal endoscopy system plays in airborne transmission of microorganisms has never been investigated. The aim of this study was to explore the potential risk of transmission and potential improvements in the system.  We investigated and described air circulation into gastrointestinal endoscopes from Fujifilm, Olympus, and Pentax.  The light source box contains a lamp, either Xenon or LED. The temperature of the light is high and is regulated by a forced-air cooling system to maintain a stable temperature in the middle of the box. The air used by the forced-air cooling system is sucked from the closed environment of the patient through an aeration port, located close to the light source and evacuated out of the box by one or two ventilators. No filter exists to avoid dispersion of particles outside the processor box. The light source box also contains an insufflation air pump. The air is sucked from the light source box through one or two holes in the air pump and pushed from the air pump into the air pipe of the endoscope through a plastic tube. Because the air pump does not have a dedicated HEPA filter, transmission of microorganisms cannot be excluded.  Changes are necessary to prevent airborne transmission. Exclusive use of an external CO pump and wrapping the endoscope platform with a plastic film will limit scatter of microorganisms. In the era of pandemic virus with airborne transmission, improvements in gastrointestinal ventilation systems are necessary to avoid contamination of patients and health care workers.
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http://dx.doi.org/10.1055/a-1336-3280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899790PMC
March 2021

Endoscopic ultrasound efficacy in staging gastric linitis plastica lesion: a retrospective multicentric French study.

Ann Transl Med 2021 Jan;9(1):50

Gastroenterology and digestive oncology unit, Hôpital Cochin, Paris, France.

Background: Endoscopic ultrasound (EUS) is a key imaging technique in gastric cancer (GC). The aim of this study was to evaluate the performance of EUS in the staging of parietal and lymph node involvement in linitis plastica (LP) compared to "classical" GC.

Methods: A retrospective multicentric French study was conducted on patients with no metastatic LP and operated by gastrectomy. A 2/1 matching based on pTNM stage and center was performed with GC.

Results: Forty-three patients were included, sixteen patients in the LP group and 27 in the control group. Sensitivity and specificity of EUS for diagnosis of T3-T4 parietal invasion were 77% and 100% respectively in the LP group and 89% and 56% respectively in the control group. Sensitivity and specificity of EUS for diagnosis of lymph node involvement were 73% and 80%, respectively in the LP group and 88% and 50%, respectively in the control group. Patients from LP group had significantly more advanced histological lesion, and frequent undiagnosed peritoneal carcinomatosis.

Conclusions: This study evaluated for the first time in a European population, the preoperative EUS performance in LP. Our study identified a similar sensitivity and specificity of the EUS in LP compared to "classical" GC paving for a broader use of EUS in preoperative settings.
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http://dx.doi.org/10.21037/atm-20-3474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859799PMC
January 2021

Artificial intelligence: a critical review of current applications in pancreatic imaging.

Jpn J Radiol 2021 Feb 6. Epub 2021 Feb 6.

Department of Radiology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, 27 Rue du Faubourg Saint-Jacques, Paris, France.

The applications of artificial intelligence (AI), including machine learning and deep learning, in the field of pancreatic disease imaging are rapidly expanding. AI can be used for the detection of pancreatic ductal adenocarcinoma and other pancreatic tumors but also for pancreatic lesion characterization. In this review, the basic of radiomics, recent developments and current results of AI in the field of pancreatic tumors are presented. Limitations and future perspectives of AI are discussed.
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http://dx.doi.org/10.1007/s11604-021-01098-5DOI Listing
February 2021

Management of esophageal strictures after endoscopic resection for early neoplasia.

Therap Adv Gastroenterol 2021 18;14:1756284820985298. Epub 2021 Jan 18.

Department Gastroenterology and Digestive Oncology, Cochin Hospital, 27 Rue du Faubourg Saint Jacques, 75014 Paris, France.

Background: Endoscopic resection of extensive esophageal neoplastic lesions is associated with a high rate of esophageal stricture. Most studies have focused on the risk factors for post-endoscopic esophageal stricture, but data on the therapeutic management of these strictures are scarce. Our aim is to describe the management of esophageal strictures following endoscopic resection for early esophageal neoplasia.

Methods: We included all patients with an endoscopic resection for early esophageal neoplasia followed by endoscopic dilatation at a tertiary referral center. We recorded the demographic, endoscopic, and histological characteristics, and the outcomes of the treatment of the strictures.

Results: Between January 2010 and December 2019, we performed 166 endoscopic mucosal resections and 261 endoscopic submucosal dissections for early esophageal neoplasia, and 34 (8.0%) patients developed an esophageal stricture requiring endoscopic treatment. The indication for endoscopic resection was Barrett's neoplasia in 15/34 (44.1%) cases and squamous cell neoplasia (SCN) in 19/34 (55.9%) cases. The median [(interquartile range) (IQR)] number of endoscopic dilatations was 2.5 (2.0-4.0). Nine of 34 (26.5%) patients required only one dilatation, and 22/34 (65%) had complete dysphagia relief following three endoscopic treatment sessions. The median number of dilatations was significantly higher for SCN [3.0 (2-7); range 1-17;  = 0.02], and in the case of circumferential resection [4.0 (3.0-7.0);  = 0.03]. Endoscopic dilatation allowed a sustained dysphagia relief in 33/34 (97.0%) patients after a mean follow-up of 25.3 ± 22 months.

Conclusion: Refractory post-endoscopic esophageal stricture is a rare event. After a median of 2.5 endoscopic dilatations, 97.0% of patients were permanently relieved of dysphagia. Circumferential endoscopic esophageal resections should be considered when indicated.
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http://dx.doi.org/10.1177/1756284820985298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816530PMC
January 2021

CT features of lung metastases from pancreatic adenocarcinoma: Correlation with histopathologic findings.

Diagn Interv Imaging 2020 Dec 22. Epub 2020 Dec 22.

Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France.

Purpose: The purpose of this study was to evaluate the prevalence of an atypical, alveolar presentation of pulmonary metastases from pancreatic adenocarcinoma (PDAC) on computed tomography (CT) and to correlate CT features with those obtained at histopathologic analysis.

Material And Methods: A total of 76 patients with lung metastases from PDAC over a 10-year period (2009-2019) in a French university hospital were retrospectively included. There were 34 men and 42 women with a mean age of 67.6±11.3 (SD) years (range: 38-89 years). CT features of PDAC were classified according to their presentations as usual metastatic pattern or atypical alveolar pattern; the atypical alveolar pattern corresponding to either ground glass nodules or opacities, solid nodules with a halo sign, "air-space" nodules with air bronchogram, or parenchymal consolidation. Imaging-histopathologic correlation was performed when tissue samples were available.

Results: Pulmonary metastases were synchronous in 36 patients (36/76; 47%) and metachronous in 40 patients (40/76; 53%). A predominant alveolar presentation on CT was observed in 17 patients (17/76, 22%). Nodules with halo sign were the predominant alveolar pattern in 7 patients (7/17; 41%), air-space nodules were predominant in 4 patients (4/17; 24%) whereas pure ground glass nodules and consolidations were observed as predominant features in 3 patients (3/17; 18%) each. For 5 patients who had histopathological confirmation, alveolar metastases of PDAC were characterized by columnar tumor cells lining the alveolar wall, which was not seen in other radiological presentations, whereas there were no differences regarding mucin secretion between pulmonary metastases with alveolar presentation and those with typical pattern.

Conclusions: Lung metastases from PDAC may present with a so-called "alveolar" pattern on CT. This misleading CT features is found in 22% of patients with lung metastases from PDAC and is due to lepidic growth of the metastatic cells.
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http://dx.doi.org/10.1016/j.diii.2020.11.015DOI Listing
December 2020

Organ Preservation after Endoscopic Resection of Early Esophageal Cancer with a High Risk of Lymph Node Involvement.

Cancers (Basel) 2020 Dec 2;12(12). Epub 2020 Dec 2.

Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France.

: Esophagectomy is recommended after endoscopic resection of an early esophageal cancer when pejorative histoprognostic criteria indicate a high risk of lymph node involvement. Our aim was to analyze the clinical outcomes of a non-surgical, organ preserving management in this clinical setting. : This retrospective study was performed in two tertiary centers from 2015 to 2020. Patients were included if they had histologically complete resection of an early esophageal cancer, with poor differentiation, lymphovascular invasion or deep submucosal invasion. Endoscopic resection was followed by chemoradiotherapy or follow-up in case of surgical contraindications or patient refusal. Outcome measures were disease-free survival (DFS), overall survival (OS), cancer specific survival (CSS) and toxicity of chemoradiotherapy. : Forty-one patients (36 with squamous cell carcinoma and 5 with adenocarcinomas) were included. The estimated high risk of lymph node involvement was based on poor differentiation (10/41; 24%), lympho-vascular invasion (11/41; 27%), muscularis mucosa invasion or deep sub-mucosal invasion (38/41; 93%). Thirteen patients (13/41; 32%) were closely monitored, and 28 (28/41; 68%) were treated by chemoradiotherapy or radiotherapy alone. In the close follow-up group, DFS, OS and CSS were 92%, 92% and 100%, respectively vs. 75%, 79% and 96%, respectively in the chemoradiotherapy group at the end of the follow-up. Serious adverse events related to chemoradiotherapy occurred in 10% of the patients. There were no treatment-related deaths. : Our study shows that close follow-up may be an alternative to systematic esophagectomy after endoscopic resection of early esophageal cancer with a predicted high risk of lymph node involvement.
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http://dx.doi.org/10.3390/cancers12123598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761405PMC
December 2020

MRI may be able to identify the origin of neuroendocrine tumor liver metastases.

Neuroendocrinology 2020 Nov 13. Epub 2020 Nov 13.

Objectives: To discriminate hepatic metastases from pancreatic neuroendocrine tumors (pNET) and hepatic metastases from midgut neuroendocrine tumors (mNET) with magnetic resonance imaging (MRI).

Methods: MRI examinations of 24 patients with hepatic metastases from pNET were quantitatively and qualitatively assessed by two blinded readers and compared to those obtained in 23 patients with hepatic metastases from mNET. Inter-reader agreement was calculated with kappa and intraclass correlation coefficient (ICC). Sensitivity, specificity and accuracy of each variable for the diagnosis of hepatic metastasis from pNET were calculated. Associations between variables and primary tumor (i.e., pNET vs. mNET) were assessed at univariate and multivariate analysis. A nomogram was developed and validated using an external cohort of 20 patients with pNET and 20 patients with mNET.

Results: Interobserver agreement was strong to perfect (k=0.893-1) for qualitative criteria and excellent for quantitative variables (ICC: 0.9817-0.9996). At univariate analysis, homogeneity on T1-weighted images was the most discriminating variable for the diagnosis of pNET (OR, 6.417; P=0.013) with greatest sensitivity (88%; 21/24; 95% CI: 68-97%). At multivariate analysis, tumor homogeneity on T1-weighted images (P=0.007; OR, 17.607; 95%CI: 2.179-142.295) and target sign on DW images (P=0.007; OR, 19.869; 95%CI: 2.305-171.276) were independently associated with pNET. Nomogram yielded a corrected AUC of 0.894 (95%CI: 0.796-0.992) for the diagnosis of pNET in the training cohort and 0.805 (95%CI: 0.662-0.948) in the validation cohort.

Conclusions: MRI provides qualitative features that can help discriminate between hepatic metastases from pNET and those from mNET.
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http://dx.doi.org/10.1159/000513015DOI Listing
November 2020

CT and MRI of pancreatic tumors: an update in the era of radiomics.

Jpn J Radiol 2020 Dec 21;38(12):1111-1124. Epub 2020 Oct 21.

Department of Radiology, Cochin Hospital, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.

Radiomics is a relatively new approach for image analysis. As a part of radiomics, texture analysis, which consists in extracting a great amount of quantitative data from original images, can be used to identify specific features that can help determining the actual nature of a pancreatic lesion and providing other information such as resectability, tumor grade, tumor response to neoadjuvant therapy or survival after surgery. In this review, the basic of radiomics, recent developments and the results of texture analysis using computed tomography and magnetic resonance imaging in the field of pancreatic tumors are presented. Future applications of radiomics, such as artificial intelligence, are discussed.
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http://dx.doi.org/10.1007/s11604-020-01057-6DOI Listing
December 2020

Intraoperative high-resolution esophageal manometry during peroral endoscopic myotomy.

Sci Rep 2020 08 26;10(1):14198. Epub 2020 Aug 26.

Gastroenterology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, 27 rue du Faubourg St Jacques, 75014, Paris, France.

Peroral endoscopic myotomy is an accepted treatment of achalasia. Some of the treatment failures can be attributable to an insufficient length of the myotomy on the gastric side, because of a more technically challenging submucosal dissection. We assessed the feasibility and the impact of an intraoperative esophageal manometry during the peroral endoscopic myotomy procedure. A high-resolution manometry catheter was introduced through the nostril before the endoscope, and left in place during the peroral endoscopic myotomy procedure. The lower esophageal sphincter pressure was recorded throughout the peroral endoscopic myotomy. The myotomy was extended on the gastric side until the lower esophageal sphincter pressure dropped below 10 mmHg. We included 10 patients (mean age = 55 years old, 3 men) treated by peroral endoscopic myotomy for type I (3/10), type II (3/10), type III achalasia (3/10) or esophagogastric junction outflow obstruction (1/10). Manometric recording was possible in all patients. The median (IQR) lower esophageal sphincter resting pressure was 23 (17-37) mmHg before myotomy, 15 (13-19) mmHg at the end of the tunnel, and 7 (6-11) mmHg at the end of the myotomy. In 4 patients out of 10, the myotomy was extended on the base of the intraoperative manometry findings. High-resolution esophageal manometry is feasible during the peroral endoscopic myotomy procedure, and leads to increase the length of the gastric myotomy in 4 out of 10 patients. However, the cumbersome nature of intraoperative high-resolution manometry during peroral endoscopic myotomy and the high frequency of gastro-esophageal reflux disease after extended gastric myotomy suggest to limit this technique to selected patients refractory to a first myotomy.
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http://dx.doi.org/10.1038/s41598-020-71136-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450054PMC
August 2020

The Role of Interventional Radiology for the Treatment of Hepatic Metastases from Neuroendocrine Tumor: An Updated Review.

J Clin Med 2020 Jul 20;9(7). Epub 2020 Jul 20.

Department of Radiology, Cochin Hospital, AP-HP, 27 rue du Faubourg Saint- Jacques, 75014 Paris, France.

Interventional radiology plays an important role in the management of patients with neuroendocrine tumor liver metastasis (NELM). Transarterial embolization (TAE), transarterial chemoembolization (TACE), and selective internal radiation therapy (SIRT) are intra-arterial therapies available for these patients in order to improve symptoms and overall survival. These treatment options are proposed in patients with NELM not responding to systemic therapies and without extrahepatic progression. Currently, available data suggest that TAE should be preferred to TACE in patients with NELM from extrapancreatic origin because of similar efficacy and better patient tolerance. TACE is more effective in patients with pancreatic NELM and SIRT has shown promising results along with good tolerance. However, large randomized controlled trials are still lacking in this setting. Available literature mainly consists in small sample size and retrospective studies with important technical heterogeneity. The purpose of this review is to provide an updated overview of the currently reported endovascular interventional radiology procedures that are used for the treatment of NELM.
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http://dx.doi.org/10.3390/jcm9072302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408651PMC
July 2020

Evaluation of Nurses' and Patients' Overall Satisfaction with New and Previous Formulations of Octreotide Long-acting Release (Sandostatin LAR): A French Observational Study.

Adv Ther 2020 09 18;37(9):3901-3915. Epub 2020 Jul 18.

Hepatogastroenterology and Digestive Oncology Unit, University Hospital of Reims, Reims, France.

Introduction: The first long-acting release (LAR) formulation of octreotide was marketed in France in the late 1990s. An injectable formulation of Sandostatin LAR (Novartis SAS) with a new diluent has been developed to facilitate its preparation and administration and to improve its use in practice.

Methods: We conducted an observational, cross-sectional and multicenter study in France whose main outcome was to compare nurses' satisfaction with the preparation and administration of both previous and new formulations of octreotide LAR. Secondary outcomes included assessment of patient satisfaction (quality of life and pain felt during the injection) and product tolerance. Data were collected at two time points (one for the first formulation group and one for the second formulation group) through paper questionnaires administered to physicians, patients and nurses including a visual analog scale (VAS) from 0 (unsatisfied) to 10 (very satisfied).

Results: Results showed that overall nurse satisfaction improved from 5.3 (95% CI 4.9-5.8) with the previous formulation to 7.5 (95% CI 7-7.9) with the new formulation (p < 0.0001). Regarding secondary outcomes, the simplicity of the injection increased (84% for the previous formulation and 94% for the new formulation) and the purge problem disappeared (36% for the previous formulation and 4% for the new formulation).

Conclusion: The improvement due to the new formulation of Sandostatin LAR was reported in terms of handling, ease of use and overall nurse satisfaction. The new formulation greatly reduced treatment administration problems associated with the previous formulation, while maintaining low injection site pain and an equivalent safety profile in both indications.
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http://dx.doi.org/10.1007/s12325-020-01429-4DOI Listing
September 2020

Gemcitabine plus nab-paclitaxel until progression or alternating with FOLFIRI.3, as first-line treatment for patients with metastatic pancreatic adenocarcinoma: The Federation Francophone de Cancérologie Digestive-PRODIGE 37 randomised phase II study (FIRGEMAX).

Eur J Cancer 2020 09 2;136:25-34. Epub 2020 Jul 2.

Department of Hepato-gastroenterology, Sorbonne Paris City, Paris Descartes University, Georges Pompidou European Hospital, Paris, France. Electronic address:

Background: Chemotherapy is effective in metastatic pancreatic adenocarcinoma (mPA), but new approaches are still needed to improve patients' survival and quality of life. We have previously published good efficacy and tolerability results on a sequential treatment strategy of gemcitabine followed by an intensified FOLFIRI (5FU+irinotecan) regimen. In the present study, we evaluated the same sequence but replaced gemcitabine by the new gemcitabine + nab-paclitaxel standard first-line combination.

Patients And Methods: We randomised chemotherapy-naive patients with proven mPA, bilirubin levels ≤1.5 upper limit of normal values and performance status 0-2 to alternately receive gemcitabine + nab-paclitaxel for 2 months then FOLFIRI.3 for 2 months in arm A, or gemcitabine + nab-paclitaxel alone until progression in arm B. The primary objective was to increase the 6-month progression-free survival (PFS) rate from 40% (H) to 60% (H); using the binomial exact method, 124 patients were required. Analyses were carried out in preplanned modified intention-to-treat (mITT) and per-protocol (PP) populations.

Results: Between November 2015 and November 2016, 127 patients were enrolled. Main grade III-IV toxicities (% in arm A/B) were: diarrhoea (12.5/1.7), neutropenia (46.9/31, including febrile neutropenia: 1.6/0), skin toxicity (6.3/13.8), and peripheral neuropathy (6.3/8.6). No toxic deaths occurred. The objective response rate was 40.3% (95% confidence interval [CI]: 28.1-53.6) in arm A and 26.7% (95% CI: 16.1-39.7) in arm B. The primary end-point (6-month PFS rate) was 45.2% [one-sided 95% CI: 34.3-56.4] in arm A and 23.3% in arm B [one-sided 95% CI: 14.3-32.3] in the mITT population. In the PP population, median PFS and OS were 7.6 months and 6 months and 14.5 months and 12.2 months in arm A and B, respectively.

Conclusions: The FIRGEMAX strategy with gemcitabine + nab-paclitaxel alternating with FOLFIRI.3 every 2 months, appears feasible and effective, with manageable toxicities, in patients able to reach >2mo of treatment.

Trial Registration Information: EudraCT: 2014-004449-28: NCT: 0282701.
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http://dx.doi.org/10.1016/j.ejca.2020.05.018DOI Listing
September 2020

Endoscopic treatment of Zenker's diverticulum by complete septotomy: initial experience in 19 patients.

Endosc Int Open 2020 Jul 16;8(7):E885-E890. Epub 2020 Jun 16.

Department of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.

Endoscopic treatment of Zenker's Diverticulum (ZD) using a flexible endoscope and a diverticuloscope consists of myotomy of the cricopharyngeus muscle, sparing the lower part of the diverticular septum. However, recurrence occurs in up to 54 % of patients at 4 years. We assessed the feasibility and safety of a complete septotomy in endoscopic treatment of ZD. We conducted a retrospective analysis of a prospectively collected database at a single referral center. All consecutive patients treated by complete resection of the diverticular wall were included. The endoscopic technique used a distal attachment cap and division of the ZD septum using a Dual Knife or a Triangle Tip knife in endocut mode, until the esophageal muscularis propria was seen and no residual diverticulum remained. Symptoms were evaluated using the Augsburger questionnaire. Nineteen patients, 10 of whom were men with mean age 79 ± 12 years, were treated by complete septotomy for a symptomatic ZD with a median size of 2.5 cm (range 1-5 cm). The clinical success rate was 100 % and the complication rate was 10 % (one pneumonia and one atrial fibrillation). Median hospital stay was 2 days (range 1-3 days). On Day 1 esophagogram, no extraesophageal contrast leakage was seen, periesophageal CO was still visible in two patients, and complete ZD regression was seen in 63 % of patients. The 6-month clinical success rate was 100 %, with two patients lost to follow-up, and a median symptom score of 0 (range 0-4). After a mean ± SD follow-up of 9 ± 5 months, the clinical success rate was 94 % (16/17). Complete endoscopic septotomy is a feasible and safe therapeutic modality in patients with symptomatic ZD that does not require use of a diverticuloscope, and with good short-term efficacy. The complete regression of the diverticulum observed on Day 1 in 63 % of patients could be a marker of long-term clinical success.
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http://dx.doi.org/10.1055/a-1153-8985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7297605PMC
July 2020

Medical Treatment of Advanced Pancreatic Neuroendocrine Neoplasms.

J Clin Med 2020 Jun 15;9(6). Epub 2020 Jun 15.

Gastroenterology and Digestive Oncology Department, Cochin Hospital, 75014 Paris, France.

Pancreatic neuroendocrine neoplasms (panNENs) are relatively rare but their incidence has increased almost sevenfold over the last four decades. Neuroendocrine neoplasms are classified according to their histologic differentiation and their grade. Their grade is based on their Ki-67 proliferation index and mitotic index. Their prognosis is highly variable according to these elements and treatments also vary according to their classification. Surgery is the only curative treatment for localized and advanced panNENs and offers a better prognosis than non-surgical treatments. In the case of an advanced panNEN without the possibility of resection and/or ablation, medical treatment remains the cornerstone for improving survival and preserving quality-of-life. PanNENs are considered as chemosensitive tumors, unlike midgut neuroendocrine tumors. Thus, panNENs can be treated with chemotherapy, but targeted therapies and somatostatin analogs are also treatment options. The scarcity and heterogeneity of NENs make their management difficult. The present review aims to clarify the medical treatments currently available for advanced panNENs, based on their characteristics, and to propose a treatment algorithm.
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http://dx.doi.org/10.3390/jcm9061860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355438PMC
June 2020

Well Differentiated Grade 3 Neuroendocrine Tumors of the Digestive Tract: A Narrative Review.

J Clin Med 2020 Jun 1;9(6). Epub 2020 Jun 1.

Department of Gastroenterology and digestive oncology, Cochin Teaching Hospital, AP-HP, 75014 Paris, France.

The 2017 World Health Organization (WHO) classification of neuroendocrine neoplasms (NEN) of the digestive tract introduced a new category of tumors named well-differentiated grade 3 neuroendocrine tumors (NET G-3). These lesions show a number of mitosis, or a Ki-67 index higher than 20% with a well-differentiated morphology, therefore separating them from neuroendocrine carcinomas (NEC) which are poorly differentiated. It has become clear that NET G-3 show differences not only in morphology but also in genotype, clinical presentation, and treatment response. The incidence of digestive NET G-3 represents about one third of NEN G-3 with main tumor sites being the pancreas, the stomach and the colon. Treatment for NET G-3 is not yet standardized because of lack of data. In a non-metastatic setting, international guidelines recommend surgical resection, regardless of tumor grading. For metastatic lesion, chemotherapy is the main treatment with similar regimen as NET G-2. Sunitinib has also shown some positive results in a small sample of patients but this needs confirmation. Peptide receptor radionuclide therapy (PRRT) and immunotherapy could be future available treatments after ongoing studies. The goal of this review was to sum up the latest data on the epidemiology and management of digestive NET G-3.
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http://dx.doi.org/10.3390/jcm9061677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357105PMC
June 2020

Underwater peroral endoscopic myotomy.

Endoscopy 2021 Jan 29;53(1):94-95. Epub 2020 May 29.

Gastroenterology Department, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris and University of Paris, Paris, France.

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http://dx.doi.org/10.1055/a-1173-7953DOI Listing
January 2021

Reasons for chemotherapy discontinuation and end-of-life in patients with gastrointestinal cancer: A multicenter prospective AGEO study.

Clin Res Hepatol Gastroenterol 2021 Jan 11;45(1):101431. Epub 2020 May 11.

Department of hepatogastroenterology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.

Background: Previous research on chemotherapy discontinuation has mainly focused on predictive factors and outcomes. Few data are available on the reasons for chemotherapy discontinuation. The main objective was to identify the reasons for chemotherapy discontinuation in patients with gastrointestinal cancer. The secondary objectives were to describe the announcement of chemotherapy discontinuation and the time between chemotherapy discontinuation and death.

Methods: This prospective multicenter French cohort included patients with advanced gastrointestinal cancer, for whom chemotherapy was discontinued between May 2016 and January 2018.

Results: One hundred and fourteen patients were analyzed. The first cause of chemotherapy discontinuation was the impairment of general condition (asthenia, cachexia). Complications such as sepsis, jaundice or occlusion, were the second most frequent cause. Progression was observed at chemotherapy discontinuation in two-thirds of cases. The announcement of the chemotherapy discontinuation was made formally in 74% of cases, with a follow-up by a palliative care team initiated in 50% of cases. Sixty-nine percent of the patients received chemotherapy during the last three months of life and 26% during the last month. The median time between chemotherapy discontinuation and death was 65 days (IQR: 36.5-109): 44% of patients died at the hospital, 39% in a palliative care unit and 16% at home.

Conclusion: Impairment of general condition was the major reason for chemotherapy discontinuation in patients with gastrointestinal cancers. Complications such as jaundice, sepsis or occlusion, were important reasons for discontinuation and could explain our shorter time between chemotherapy discontinuation and death, compared to other oncology sub-specialties.
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http://dx.doi.org/10.1016/j.clinre.2020.03.029DOI Listing
January 2021

Oral therapies in digestive oncology (Review).

Oncol Rep 2020 Jun 20;43(6):1719-1728. Epub 2020 Mar 20.

Department of Gastroenterology, Cochin Teaching Hospital, 75014 Paris, France.

Targeted therapy and oral chemotherapy indications are increasing in the realm of digestive oncology. Oral intake of cancer agents is sometimes compulsory (no i.v. equivalent) or is preferred by the patient or the physician. Although oral chemotherapy facilitates the treatment of oncology patients, the treatment diversity, risk of pharmaceutical interactions and monitoring of side effects are potentially challenging and need to be fully acknowledged by the physician. We offer here a literature review of the indications, doses, side effects and monitoring of every oral therapy indicated in Digestive Oncology. We suggest a prescription algorithm including therapeutic education by the physician or a trained nurse, and pharmaceutical counseling.
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http://dx.doi.org/10.3892/or.2020.7555DOI Listing
June 2020

Digestive Neuroendocrine Neoplasms (NEN): French Intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, GTE, RENATEN, TENPATH, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFR).

Dig Liver Dis 2020 05 28;52(5):473-492. Epub 2020 Mar 28.

Department of Hepato-Gastroenterology and Digestive Oncology, Robert Debré University Hospital, Reims, France. Electronic address:

Introduction: This document is a summary of the French Intergroup guidelines regarding the management of digestive neuroendocrine neoplasms (NEN) published in February 2020 (www.tncd.org).

Methods: All French medical societies involved in the management of NEN took part in this work. Recommendations were graded into four categories (A, B, C or D), according to the level of evidence found in the literature until May 2019.

Results: The management of NEN is challenging because of their heterogeneity and the increasing complexity of diagnostic and therapeutic procedures. Pathological analysis is required for their diagnostic and prognostic characterization, which mainly relies on differentiation, grade and stage. The two main emergency situations are functioning syndromes and poorly-differentiated carcinoma. Chromogranin A is the main biochemical marker of NET, although of limited clinical interest. Initial characterization relies on morphological and isotopic imaging. The treatment of localized NET relies on watchful follow-up and local or surgical resection depending on its supposed aggressiveness. Treatment options for metastatic disease include surgery, somatostatin analogues, chemotherapy, targeted therapies, organ-driven locoregional therapies and peptide-receptor radionuclide therapy. As specific predictive factors of treatment efficacy are yet to be identified and head-to-head comparisons have not or only rarely been performed, the therapeutic strategy currently depends on prognostic factors. Cumulative toxicity and the impact of treatment on quality of life must be considered since survival is relatively long in most patients with NET.

Conclusion: These guidelines are proposed to achieve the most beneficial therapeutic strategy in clinical practice as the therapeutic landscape of NEN is becoming ever more complex. These recommendations are permanently being reviewed.
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http://dx.doi.org/10.1016/j.dld.2020.02.011DOI Listing
May 2020

Meglumine diatrizoate esophagogram after peroral endoscopic myotomy (POEM): identification of imaging findings associated with clinical complications and longer hospital stay.

Eur Radiol 2020 Aug 13;30(8):4175-4181. Epub 2020 Mar 13.

University of Paris, Descartes Paris 5, 75006, Paris, France.

Objectives: Esophageal peroral endoscopic myotomy (POEM) is the treatment of reference of major obstructive esophageal motility disorders but the detection of early complications remains challenging. Our aim was to report the radiological findings on meglumine diatrizoate esophagograms after esophageal POEM and identify variables associated with patient outcomes.

Methods: The imaging and clinical files of 106 patients who underwent POEM for achalasia or other major obstructive esophageal motility disorders were retrospectively analyzed. Post POEM esophagograms were reviewed for the presence of pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips. Associations between length of hospital stay and radiological findings were searched for using a Cox multivariate analysis.

Results: A total of 106 patients (M/F = 56/50; mean age = 50 ± 2 [SD] years) underwent 106 POEM procedures with a meglumine diatrizoate esophagogram on postoperative day 1. Overall median hospital stay was 3 days (range 1-20 days). Pneumoperitoneum, pleural effusion, extraesophageal contrast leakage, and dislocated clips were observed in 90/106 (84.9%), 12/106 (11.3%), 4/106 (3.8%), and 0/106 (0%) patients, respectively. At multivariate analysis, pleural effusion (p = 0.005; adjusted hazard ratio [aHR] = 0.35 [95% CI 0.17-0.73]) and extraesophageal contrast leakage (p = 0.039; aHR = 0.27 [95% CI 0.08-0.94]) were associated with a prolonged hospital stay. Pneumoperitoneum was not associated with unfavorable outcome (p = 0.99).

Conclusions: Pneumoperitoneum is a common finding after POEM and is not indicative of unfavorable patient outcome. Conversely, post POEM pleural effusion and extraesophageal contrast leakage are associated with a longer hospital stay.

Key Points: • Water-soluble esophagogram is a valid diagnostic modality to diagnose early complications after esophageal endoscopic myotomy for esophageal motility disorders. • At multivariate analysis, pleural effusion and extraesophageal contrast leakage are associated with a prolonged hospital stay after peroral endoscopic myotomy. • Pneumoperitoneum is not associated with unfavorable outcome after peroral endoscopic myotomy.
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http://dx.doi.org/10.1007/s00330-020-06758-0DOI Listing
August 2020

Withholding the Introduction of Anti-Epidermal Growth Factor Receptor: Impact on Outcomes in RAS Wild-Type Metastatic Colorectal Tumors: A Multicenter AGEO Study (the WAIT or ACT Study).

Oncologist 2020 02 2;25(2):e266-e275. Epub 2019 Oct 2.

Department of Gastroenterology, Cochin Hospital, Paris, France.

Background: Patients with RAS wild-type (WT) nonresectable metastatic colorectal cancer (mCRC) may receive either bevacizumab or an anti-epidermal growth factor receptor (EGFR) combined with first-line, 5-fluorouracil-based chemotherapy. Without the RAS status information, the oncologist can either start chemotherapy with bevacizumab or wait for the introduction of the anti-EGFR. Our objective was to compare both strategies in a routine practice setting.

Materials And Methods: This multicenter, retrospective, propensity score-weighted study included patients with a RAS WT nonresectable mCRC, treated between 2013 and 2016 by a 5-FU-based chemotherapy, with either delayed anti-EGFR or immediate anti-vascular endothelial growth factor (VEGF). Primary criterion was overall survival (OS). Secondary criteria were progression-free survival (PFS) and objective response rate (ORR).

Results: A total of 262 patients (129 in the anti-VEGF group and 133 in the anti-EGFR group) were included. Patients receiving an anti-VEGF were more often men (68% vs. 56%), with more metastatic sites (>2 sites: 15% vs. 9%). The median delay to obtain the RAS status was 19 days (interquartile range: 13-26). Median OS was not significantly different in the two groups (29 vs. 30.5 months, p = .299), even after weighting on the propensity score (hazard ratio [HR] = 0.86, 95% confidence interval [CI], 0.69-1.08, p = .2024). The delayed introduction of anti-EGFR was associated with better median PFS (13.8 vs. 11.0 months, p = .0244), even after weighting on the propensity score (HR = 0.74, 95% CI, 0.61-0.90, p = .0024). ORR was significantly higher in the anti-EGFR group (66.7% vs. 45.6%, p = .0007).

Conclusion: Delayed introduction of anti-EGFR had no deleterious effect on OS, PFS, and ORR, compared with doublet chemotherapy with anti-VEGF.

Implications For Practice: For RAS/RAF wild-type metastatic colorectal cancer, patients may receive 5-fluorouracil-based chemotherapy plus either bevacizumab or an anti-epidermal growth factor receptor (EGFR). In daily practice, the time to obtain the RAS status might be long enough to consider two options: to start the chemotherapy with bevacizumab, or to start without a targeted therapy and to add the anti-EGFR at reception of the RAS status. This study found no deleterious effect of the delayed introduction of an anti-EGFR on survival, compared with the introduction of an anti-vascular endothelial growth factor from cycle 1. It is possible to wait one or two cycles to introduce the anti-EGFR while waiting for RAS status.
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http://dx.doi.org/10.1634/theoncologist.2019-0328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011620PMC
February 2020

Early esophageal signet ring cell carcinoma: A contraindication to endoscopic resection?

Clin Res Hepatol Gastroenterol 2020 10 6;44(5):e98-e102. Epub 2020 Feb 6.

Gastroenterology and Digestive Oncology Department, Cochin Hospital, 75014 Paris, France; University of Paris, Paris, France.

Introduction: Endoscopic resection is a standard-of-care for early esophageal neoplasia. Early gastric signet ring cell carcinoma (SRCC) can be safely managed by endoscopic resection, if the early SRCC is limited to the mucosa and less than 15mm, with a low lymph node metastasis rate. It is not known if esophageal signet ring cell carcinoma is amenable to endoscopic resection.

Methods: We retrospectively collected demographic, procedural, oncologic and follow-up data from all patients with esophageal SRCC resected endoscopically at our institution, and compared them to those of patients with endoscopically resected poorly differentiated esophageal adenocarcinomas.

Results: Between 2016 and 2018, 170 endoscopic resections were performed for esophageal neoplasms, among which 7 patients with SRCC and 6 patients with poorly differentiated early adenocarcinomas were identified. The histologically complete (R0) resection rate was 28.6% (2/7) for SRCC vs. 100% for poorly differentiated adenocarcinomas (P=0.04). The presence of lymphovascular invasion or deep submucosal invasion led to curative resection rates of 14.2% (1/7) and 66.6% (4/6) for SRCC and poorly differentiated adenocarcinomas, respectively (P=0.1).

Conclusion: Endoscopic resection of early esophageal SRCC is neither histologically complete, nor curative in the majority of cases. These data argue against upfront endoscopic resection when SRCC is evidenced on esophageal biopsies.
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http://dx.doi.org/10.1016/j.clinre.2020.01.004DOI Listing
October 2020

Prognosis and chemosensitivity of deficient MMR phenotype in patients with metastatic colorectal cancer: An AGEO retrospective multicenter study.

Int J Cancer 2020 07 13;147(1):285-296. Epub 2020 Feb 13.

Sorbonne University and Medical Oncology Department, Saint Antoine Hospital, Paris, France.

Mismatch repair-deficient (dMMR) and/or microsatellite instability-high (MSI) colorectal cancers (CRC) represent about 5% of metastatic CRC (mCRC). Prognosis and chemosensitivity of dMMR/MSI mCRC remain unclear. This multicenter study included consecutive patients with dMMR/MSI mCRC from 2007 to 2017. The primary endpoint was the progression-free survival (PFS) in a population receiving first-line chemotherapy. Associations between chemotherapy regimen and survival were evaluated using a Cox regression model and inverse of probability of treatment weighting (IPTW) methodology in order to limit potential biases. Overall, 342 patients with dMMR/MSI mCRC were included. Median PFS and overall survival (OS) on first-line chemotherapy were 6.0 and 26.3 months, respectively. For second-line chemotherapy, median PFS and OS were 4.4 and 21.6 months. Longer PFS (8.1 vs. 5.4 months, p = 0.0405) and OS (35.1 vs. 24.4 months, p = 0.0747) were observed for irinotecan-based chemotherapy compared to oxaliplatin-based chemotherapy. The association was no longer statistically significant using IPTW methodology. In multivariable analysis, anti-VEGF as compared to anti-EGFR was associated with a trend to longer OS (HR = 1.78, 95% CI 1.00-3.19, p = 0.0518), whatever the backbone chemotherapy used. Our study shows that dMMR/MSI mCRC patients experienced short PFS with first-line chemotherapy with or without targeted therapy. OS was not different according to the chemotherapy regimen used, but a trend to better OS was observed with anti-VEGF. Our study provides some historical results concerning chemotherapy in dMMR/MSI mCRC in light of the recent nonrandomized trials with immune checkpoint inhibitors.
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http://dx.doi.org/10.1002/ijc.32879DOI Listing
July 2020

Small bowel adenocarcinoma: Results from a nationwide prospective ARCAD-NADEGE cohort study of 347 patients.

Int J Cancer 2020 Aug 22;147(4):967-977. Epub 2020 Jan 22.

Department of Oncology, Saint Antoine Hospital, APHP, Paris, France.

Small bowel adenocarcinoma (SBA) is a rare tumour. We conducted a prospective cohort to describe the prevalence, survival and prognostic factors in unselected SBA patients. The study enrolled patients with all stages of newly diagnosed or recurrent SBA at 74 French centres between January 2009 and December 2012. In total, 347 patients were analysed; the median age was 63 years (range 23-90). The primary tumour was in the duodenum (60.6%), jejunum (20.7%) and ileum (18.7%). The prevalence of predisposing disease was 8.7%, 6.9%, 1.7%, 1.7% and 0.6% for Crohn disease, Lynch syndrome, familial adenomatous polyposis, celiac disease and Peutz-Jeghers syndrome, respectively. At diagnosis, 58.9%, 5.5% and 35.6% of patients had localised and resectable, locally advanced unresectable and metastatic disease, respectively. Crohn disease was significantly associated with younger age, poor differentiation and ileum location, whereas Lynch syndrome with younger age, poor differentiation, early stage and duodenum location. Adjuvant chemotherapy (oxaliplatin-based in 89.9%) was performed in 61.5% of patients with locally resected tumours. With a 54-months median follow-up, the 5-year overall survival (OS) was 87.9%, 78.2% and 55.5% in Stages I, II and III, respectively. The median OS of patients with Stage IV was 12.7 months. In patients with resected tumours, poor differentiation (p = 0.047) and T4 stage (p = 0.001) were associated with a higher risk of death. In conclusion, our study showed that the prognosis of advanced SBA remains poor. Tumour characteristics differed according to predisposing disease. In SBA-resected tumours, the prognostic factors for OS were grade and T stage.
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http://dx.doi.org/10.1002/ijc.32860DOI Listing
August 2020

McCune Albright syndrome is a genetic predisposition to intraductal papillary and mucinous neoplasms of the pancreas associated pancreatic cancer in relation with GNAS somatic mutation - a case report.

Medicine (Baltimore) 2019 Dec;98(50):e18102

Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité.

Rationale: Intraductal papillary and mucinous neoplasms of the pancreas (IPMN) are preneoplastic lesions diagnosed with an increasing incidence. Recently, several groups have described, in up to 70% of IPMN, activating mutations of the G-protein alpha stimulatory sub-unit (Gsα subunit) gene (GNAS). GNAS-activating somatic, post-zygotic, mutations are also associated with McCune-Albright syndrome (MCAS) characterized by fibrous dysplasia, precocious puberty, and café-au-lait spots.

Patient Concerns: We herein report a patient with McCune Albright Syndrome that presented with malignant IPMN and underwent pancreatic resection.

Diagnoses And Interventions: Leucocyte and duodenum juice DNA analysis, endoscopically collected from secretin-stimulated pancreatic juice revealed the same (GNAS) activating mutation also found in the invasive pancreatic colloid adenocarcinoma arising from intestinal subtype IPMN.

Outcomes: Thirty months after surgery, the patient was alive with recurrence (bone only metastasis).

Lessons: In this observation, we show that MCAS should be view as a new genetic predisposition to IPMN associated pancreatic cancer, and consequently a targeted screening in this high-risk population might be proposed.
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http://dx.doi.org/10.1097/MD.0000000000018102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6922479PMC
December 2019

Outcomes of esophagectomy after noncurative endoscopic resection of early esophageal cancer.

Therap Adv Gastroenterol 2019 8;12:1756284819892556. Epub 2019 Dec 8.

Department of Gastroenterology and Digestive Oncology, Cochin Hospital, 27, Rue du Faubourg St Jacques, 75014 Paris, France.

Background: Current guidelines recommend performing esophagectomy after endoscopic resection for early esophageal cancer when the risk of lymph node metastasis or residual cancer is found to be significant and endoscopic treatment is therefore noncurative. Our aim was to assess the safety and oncological outcomes of esophagogastric resection in this specific clinical setting.

Patients And Methods: A retrospective review from 2012 to 2018 was performed at four tertiary referral centers. All patients had a noncurative endoscopic resection of a clinical T1 esophageal cancer, followed by esophagectomy. Outcome measures were the rates of T0N0 specimens, overall survival, disease-free and cancer-specific survival, postoperative morbidity and mortality.

Results: A total of 30 patients (13 with squamous cell carcinoma and 17 with adenocarcinoma) were included. The reasons for noncurative endoscopic resection were: positive vertical margins ( = 12), squamous cell carcinoma with muscularis mucosae or submucosal layer invasion ( = 3 and 9), adenocarcinoma with deep submucosal invasion ( = 11), poorly differentiated tumor ( = 6) and lymphovascular invasion ( = 6). Overall, 63% of the esophagi were T0N0: most residual lesions were T1a metachronous lesions, and four (13%) patients had advanced pT status ( = 3) or lymph node metastases ( = 2). Overall survival, disease-free survival and cancer-specific survival were 83%, 75%, and 90% respectively. A total of 43% of patients had severe postoperative complications, and postoperative mortality was 7%.

Conclusion: In this cohort, esophagectomy allowed the resection of residual advanced cancer or lymph node metastases in 13% of cases, at the cost of 43% severe morbidity and 7% mortality. Therefore, the possibility of close follow up needs to be balanced with a highly morbid surgical management in these patients.
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http://dx.doi.org/10.1177/1756284819892556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902379PMC
December 2019

Surgical management of pancreatic neuroendocrine tumors: an introduction.

Expert Rev Anticancer Ther 2019 12 17;19(12):1089-1100. Epub 2019 Dec 17.

Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France.

: Neuroendocrine tumors of the pancreas (pNETs) represent only 1% to 2% of all pancreatic neoplasms. These tumors can be classified as functional or nonfunctional tumors; as sporadic or from a genetic origin; as neuroendocrine neoplasms or carcinoma. Over the last decade, diagnosis of pNETs has increased significantly mainly due to the widespread use of cross-sectional imaging. Those tumors are usually associated with a good prognosis. Surgery, the only curative option for those patients, should always be discussed, ideally in a multidisciplinary team setting.: We discuss ), the preoperative management of pNETs and the importance of accurate diagnosis, localization, grading and staging with computed tomography, magnetic resonance imaging, endoscopic ultrasound, and nuclear medicine imaging; ), surgical indications and ), the surgical approach (standard pancreatectomy pancreatic-sparing surgery).: The treatment option of all patients presenting with pNETs should be discussed in a multidisciplinary team setting with surgeon's experienced in both pancreatic surgery and neuroendocrine tumor management. A complete preoperative imaging assessment - morphological and functional - must be performed. Surgery is usually recommended for functional pNETs, nonfunctional pNETs >2 cm (nf-pNETs) or for symptomatic nf-pNETs.
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http://dx.doi.org/10.1080/14737140.2019.1703677DOI Listing
December 2019

Oxaliplatin-induced neuropathy: the preventive effect of a new super-oxide dismutase modulator.

Oncotarget 2019 Nov 5;10(60):6418-6431. Epub 2019 Nov 5.

Département "Development, Reproduction and Cancer", Institut Cochin, Paris Descartes Université, Sorbonne Paris Cité, INSERM U1016, Paris, France.

By using the differential in level of oxidative status between normal and cancer cells, SuperOxide Dismutase (SOD) mimetics can have anti-tumor efficacy and prevent oxaliplatin-induced peripheral neuropathy. Our objective was to evaluate the neuroprotective efficacy of MAG, a new SOD mimic. , the effects of MAG alone or with oxaliplatin were studied on colon cancer cells (HT29 and CT26) and on normal fibroblast cells (NIH3T3). The cell viability (by crystal violet) as well as the production of reactive forms of oxygen and glutathione (by spectrofluorimetric assay) was measured. , efficacy on tumor growth was assessed in mice grafted with CT26 colon cancer cells. The effects on induced neurotoxicity were measured by specific behavioral Von Frey nociception, cold-plate tests, specific functional neuromuscular assay and electron microscopy. , MAG induced a production of hydrogen peroxide in all cells. At 24 h-incubation, MAG exhibits a cytotoxic activity in all cell lines. A cytotoxic additive effect of MAG and oxaliplatin was observed through oxidative burst. , oxaliplatin-treated mice associated with MAG did not counteract oxaliplatin's antitumoral efficacy. After 4 weeks of treatment with oxaliplatin combined with MAG, behavioral and functional tests showed a decrease in peripheral neuropathy induced by oxaliplatin . Electron microscopy analyses on sciatic nerves revealed an oxaliplatin-induced demyelination which is prevented by the association of MAG to this chemotherapy. In conclusion, MAG prevents the appearance of sensitive axonal neuropathy and neuromuscular disorders induced by oxaliplatin without affecting its antitumor activity.
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http://dx.doi.org/10.18632/oncotarget.27248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849645PMC
November 2019

Management of arterial bleeding after endoscopic resection of a neuroendocrine gastric tumor.

VideoGIE 2019 Nov 30;4(11):505-507. Epub 2019 Aug 30.

Department of Gastroenterology, Cochin Hospital, Paris, France.

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http://dx.doi.org/10.1016/j.vgie.2019.07.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835008PMC
November 2019