Publications by authors named "Sébastien Gaujoux"

154 Publications

Prognostic transcriptome classes of duodenopancreatic neuroendocrine tumors.

Endocr Relat Cancer 2021 Jun 21;28(8):563-571. Epub 2021 Jun 21.

Université de Paris, Institut Cochin, Inserm U1016, CNRS UMR8104, F-75014, Paris, France.

Duodenopancreatic neuroendocrine tumors (DPNETs) aggressiveness is heterogeneous. Tumor grade and extension are commonly used for prognostic determination. Yet, grade classes are empirically defined, with regular updates changing the definition of classes. Genomic screening may provide more objective classes and reflect tumor biology. The aim of this study was to provide a transcriptome classification of DPNETs. We included 66 DPNETs, covering the entire clinical spectrum of the disease in terms of secretion, grade, and stage. Three distinct molecular groups were identified, associated with distinct outcomes (log-rank P < 0.01): (i) better-outcome DPNETs with pancreatic beta-cell signature. This group was mainly composed of well-differentiated, grade 1 insulinomas; (ii) poor-outcome DPNETs with pancreatic alpha-cell and hepatic signature. This group included all neuroendocrine carcinomas and grade 3 DPNETs, but also some grade 1 and grade 2 DPNETs and (iii) intermediate-outcome DPNETs with pancreatic exocrine and progenitor signature. This group included grade 1 and grade 2 DPNETs, with some insulinomas. Fibrinogen gene FGA expression was one of the topmost expressed liver genes. FGA expression was associated with disease-free survival (HR = 1.13, P = 0.005) and could be validated on two independent cohorts. This original pathophysiologic insight provides new prognostic classification perspectives.
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http://dx.doi.org/10.1530/ERC-21-0051DOI Listing
June 2021

Surgical management of insulinoma over three decades.

HPB (Oxford) 2021 Apr 27. Epub 2021 Apr 27.

Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, 75014 Paris, France; Université de Paris, 75006 Paris, France. Electronic address:

Background: This paper reports our experience of the perioperative management of patients with sporadic, non-malignant, pancreatic insulinoma.

Methods: A retrospective monocentric cohort study was performed from January 1989 to July 2019, including all the patients who had been operated on for pancreatic insulinoma. The preoperative work-up, surgical management, and postoperative outcome were analyzed.

Results: Eighty patients underwent surgery for sporadic pancreatic insulinoma, 50 of which were female (62%), with a median age of 50 (36-70) years. Preoperatively, the tumors were localized in 76 patients (95%). Computed tomography (CT) and magnetic resonance imaging allowed exact preoperative tumor localization in 76% of the patients (64-85 and 58-88 patients, respectively), increasing to 96% when endoscopic ultrasonography was performed. Forty-one parenchyma-sparing pancreatectomies (PSP) (including enucleation, caudal pancreatectomy, and uncinate process resection) and 39 pancreatic resections were performed. The mortality rate was 6% (n = 5), with a morbidity rate of 72%, including 24 severe complications (30%) and 35 pancreatic fistulas (44%). No differences were found between formal pancreatectomy and PSP in terms of postoperative outcome procedures. The surgery was curative in all the patients.

Conclusion: CT used in combination with endoscopic ultrasonography allows accurate localization of insulinomas in almost all patients. When possible, a parenchyma-sparing pancreatectomy should be proposed as the first-line surgical strategy.
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http://dx.doi.org/10.1016/j.hpb.2021.04.013DOI Listing
April 2021

Severe acute respiratory syndrome coronavirus 2 vaccination for patients with solid cancer: Review and point of view of a French oncology intergroup (GCO, TNCD, UNICANCER).

Eur J Cancer 2021 06 1;150:232-239. Epub 2021 Apr 1.

Digestive Oncology Department, CHU Reims University Hospital, TNCD, Reims, France.

The impacts of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on cancer care are multiple, entailing a high risk of death from coronavirus disease 2019 (COVID-19) in patients with cancer treated by chemotherapy. SARS-CoV-2 vaccines represent an opportunity to decrease the rate of severe COVID-19 cases in patients with cancer and also to restore normal cancer care. Patients with cancer to be targeted for vaccination are difficult to define owing to the limited contribution of these patients in the phase III trials testing the different vaccines. It seems appropriate to vaccinate not only patients with cancer with ongoing treatment or with a treatment having been completed less than 3 years ago but also household and close contacts. High-risk patients with cancer who are candidates for priority access to vaccination are those treated by chemotherapy. The very high-priority population includes patients with curative treatment and palliative first- or second-line chemotherapy, as well as patients requiring surgery or radiotherapy involving a large volume of lung, lymph node and/or haematopoietic tissue. When possible, vaccination should be carried out before cancer treatment begins. SARS-CoV-2 vaccination can be performed during chemotherapy while avoiding periods of neutropenia and lymphopenia. For organisational reasons, vaccination should be performed in cancer care centres with messenger RNA vaccines (or non-replicating adenoviral vaccines in non-immunocompromised patients). Considering the current state of knowledge, the benefit-risk ratio strongly favours SARS-CoV-2 vaccination of all patients with cancer. To obtain more data concerning the safety and effectiveness of vaccines, it is necessary to implement cohorts of vaccinated patients with cancer.
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http://dx.doi.org/10.1016/j.ejca.2021.03.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015403PMC
June 2021

[Vaccination against COVID-19 in patients with solid cancer: Review and point of view from a French oncology inter-group (CGO, TNCD, UNICANCER)].

Bull Cancer 2021 Jun 12;108(6):614-626. Epub 2021 Apr 12.

CHU de Reims, Reims, service d'oncologie digestive, TNCD, Rue du Général Koenig, 51100 Reims, France.

The COVID-19 pandemic has a major impact at all stages of cancer treatment. Risk of death from COVID-19 in patients treated for a cancer is high. COVID-19 vaccines represent a major issue to decrease the rate of severe forms of the COVID-19 cases and to maintain a normal cancer care. It is difficult to define the target population for vaccination due to the limited data available and the lack of vaccine doses available. It appears theoretically important to vaccinate patients with active cancer treatment or treated since less than three years, as well as their family circle. In France, patients actually defined at "high risk" for priority access to vaccination are those with a cancer treated by chemotherapy. A panel of experts recently defined another "very high-priority" population, which includes patients with curative or palliative first or second-line chemotherapy, as well as patients requiring surgery or radiotherapy involving a large lung volume, lymph nodes and/or of hematopoietic tissue. Ideally, it is best to vaccinate before cancer treatment. Despite the lack of published data, COVID-19 vaccines can also be performed during chemotherapy by avoiding periods of bone marrow aplasia and if possible, to do it in cancer care centers. It is necessary to implement cohorts with immunological and clinical monitoring of vaccinated cancer patients. To conclude, considering the current state of knowledge, the benefit-risk ratio strongly favours COVID-19 vaccination of all cancer patients.
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http://dx.doi.org/10.1016/j.bulcan.2021.03.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041180PMC
June 2021

Preoperative Detection of Liver Involvement by Right-Sided Adrenocortical Carcinoma Using CT and MRI.

Cancers (Basel) 2021 Mar 31;13(7). Epub 2021 Mar 31.

Department of Diagnostic and Interventional Imaging, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France.

The major prognosis factor of adrenocortical carcinoma (ACC) is the completeness of surgery. The aim of our study was to identify preoperative imaging features associated with direct liver involvement (DLI) by right-sided ACC. Two radiologists, blinded to the outcome, independently reviewed preoperative CT and MRI examinations for eight signs of DLI, in patients operated for right-sided ACC and retrospectively included from November 2007 to January 2020. DLI was confirmed using surgical and histopathological findings. Kappa values were calculated. Univariable and multivariable analyses were performed by using a logistic regression model. Receiver operating characteristic (ROC) curves were built for CT and MRI. Twenty-nine patients were included. Seven patients had DLI requiring resection. At multivariable analysis, focal ACC bulge was the single independent sign associated with DLI on CT (OR: 60.00; 95% CI: 4.60-782.40; < 0.001), and ACC contour disruption was the single independent sign associated with DLI on MRI (OR: 126.00; 95% CI: 6.82-2328.21; < 0.001). Both signs were highly reproducible, with respective kappa values of 0.85 and 0.91. The areas under ROC curves of MRI and CT models were not different ( = 0.838). Focal ACC bulge on CT and ACC contour disruption on MRI are independent and highly reproducible signs, strongly associated with DLI by right-sided ACC on preoperative imaging. MRI does not improve the preoperative assessment of DLI by comparison with CT.
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http://dx.doi.org/10.3390/cancers13071603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036813PMC
March 2021

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

Jpn J Radiol 2021 Jun;39(6):524-526

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

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http://dx.doi.org/10.1007/s11604-021-01102-yDOI Listing
June 2021

Pancreatoduodenectomy for Neuroendocrine Tumors in Patients with Multiple Endocrine Neoplasia Type 1: An AFCE (Association Francophone de Chirurgie Endocrinienne) and GTE (Groupe d'étude des Tumeurs Endocrines) Study.

World J Surg 2021 06 1;45(6):1794-1802. Epub 2021 Mar 1.

Department of Digestive and Endocrine Surgery, Dijon University Hospital, University of Burgundy, Dijon, France.

Aim: To assess postoperative complications and control of hormone secretions following pancreatoduodenectomy (PD) performed on multiple endocrine neoplasia type 1 (MEN1) patients with duodenopancreatic neuroendocrine tumors (DP-NETs).

Background: The use of PD to treat MEN1 remains controversial, and evaluating the right place of PD in MEN1 disease makes sense.

Methods: Thirty-one MEN1 patients from the Groupe d'étude des Tumeurs Endocrines MEN1 cohort who underwent PD for DP-NETs between 1971 and 2013 were included. Early and late postoperative complications, secretory control and overall survival were analyzed.

Results: Indication for surgery was: Zollinger-Ellison syndrome (n = 18; 58%), nonfunctioning tumor (n = 9; 29%), insulinoma (n = 2; 7%), VIPoma (n = 1; 3%) and glucagonoma (n = 1; 3%). Mean follow-up was 141 months (range 0-433). Pancreatic fistulas occurred in 5 patients (16.1%), distant metastases in 6 (mean onset of 43 months; range 13-110 months), postoperative diabetes mellitus in 7 (22%), and pancreatic exocrine insufficiency in 6 (19%). Five-year overall survival was 93.3% [CI 75.8-98.3] and ten-year overall survival was 89.1% [CI 69.6-96.4]. After a mean follow-up of 151 months (range 0-433), the biochemical cure rate for MEN-1 related gastrinomas was 61%.

Conclusion: In MEN1 patients, pancreatoduodenectomy can be used to control hormone secretions (gastrin, glucagon, VIP) and to remove large NETs. PD was found to control gastrin secretions in about 60% of cases.
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http://dx.doi.org/10.1007/s00268-021-06005-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093175PMC
June 2021

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

Jpn J Radiol 2021 Jun 6;39(6):514-523. 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
June 2021

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

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

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

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

Management of Asymptomatic Sporadic Nonfunctioning Pancreatic Neuroendocrine Neoplasms (ASPEN) ≤2 cm: Study Protocol for a Prospective Observational Study.

Front Med (Lausanne) 2020 23;7:598438. Epub 2020 Dec 23.

National NET Centre and ENETS Centre of Excellence, St Vincent's University Hospital, Dublin, Ireland.

The optimal treatment for small, asymptomatic, nonfunctioning pancreatic neuroendocrine neoplasms (NF-PanNEN) is still controversial. European Neuroendocrine Tumor Society (ENETS) guidelines recommend a watchful strategy for asymptomatic NF-PanNEN <2 cm of diameter. Several retrospective series demonstrated that a non-operative management is safe and feasible, but no prospective studies are available. Aim of the ASPEN study is to evaluate the optimal management of asymptomatic NF-PanNEN ≤2 cm comparing active surveillance and surgery. ASPEN is a prospective international observational multicentric cohort study supported by ENETS. The study is registered in ClinicalTrials.gov with the identification code NCT03084770. Based on the incidence of NF-PanNEN the number of expected patients to be enrolled in the ASPEN study is 1,000 during the study period (2017-2022). Primary endpoint is disease/progression-free survival, defined as the time from study enrolment to the first evidence of progression (active surveillance group) or recurrence of disease (surgery group) or death from disease. Inclusion criteria are: age >18 years, the presence of asymptomatic sporadic NF-PanNEN ≤2 cm proven by a positive fine-needle aspiration (FNA) or by the presence of a measurable nodule on high-quality imaging techniques that is positive at Gallium DOTATOC-PET scan. The ASPEN study is designed to investigate if an active surveillance of asymptomatic NF-PanNEN ≤2 cm is safe as compared to surgical approach.
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http://dx.doi.org/10.3389/fmed.2020.598438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785972PMC
December 2020

Authors' Reply: 18F-fluorocholine PET/CT in MEN1 Patients with Primary Hyperparathyroidism.

World J Surg 2021 04 1;45(4):1256. Epub 2021 Jan 1.

Hopital Cochin - Université de Paris, Paris, France.

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http://dx.doi.org/10.1007/s00268-020-05896-2DOI Listing
April 2021

Management of digestive cancers during the COVID-19 second wave: A French intergroup point of view (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, SFR).

Dig Liver Dis 2021 03 17;53(3):306-308. Epub 2020 Dec 17.

Digestive Oncology Department, Reims University Hospital, Reims, France.

Introduction: The COVID-19 pandemic has major impact of healthcare systems, including cancer care pathways. The aim of this work is to discuss in a multidisciplinary approach the therapeutic and/or strategies adaptations for patients treated for a digestive cancer during the European second wave of COVID-19 pandemic.

Methods: A collaborative work was performed by several French societies to answer how to preserve digestive cancer care with no loss of chance during the second wave of COVID-19. In this context, all recommendations are graded as expert's agreement according to level evidence found in literature until October 2020 and the experience of the first wave of the COVID-19 pandemic.

Results: As far as possible, no therapeutic modification should be carried out. If necessary, therapeutic adjustments may be considered if they do not constitute a loss of chance for patients. Considering the level of evidence all therapeutic modifications need to be discussed in multidisciplinary tumor board meeting and with patient consent. By contrast to first wave cancer prevention, cancer screening, supportive care and clinical trials should be continued.

Conclusion: Recommendations proposed could limit cancer excess mortality due to the COVID-19 pandemic but should be adapted according to the situation in each hospital.
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http://dx.doi.org/10.1016/j.dld.2020.11.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836265PMC
March 2021

Preoperative assessment of patient comorbidities before left colectomy: Comparison between ASA performance status scale and a new computed tomography physical status score.

Diagn Interv Imaging 2021 May 27;102(5):313-319. Epub 2020 Nov 27.

Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, Descartes-Paris 5, 75006 Paris, France.

Purpose: To compare a newly developed preoperative computed tomography physical status (CT-PS) score with the American Society of Anesthesiology performance status (ASA-PS) scale in the assessment of patient preoperative health status and stratification of perioperative risk before left colectomy.

Materials And Methods: Preoperative chest-abdomen-pelvis CT examinations of patients who were scheduled to undergo elective laparoscopic left colonic resection for cancer in two centers were reviewed by two radiologists blinded to clinical data for the presence of several key imaging features in order to assess general, cardiac, pulmonary, abdominal, renal, vascular and musculoskeletal status. CT examinations of patients from center 1 were used to build a CT-PS score to predict ASA-PS≥III. CT-PS score was further validated using an external cohort of patients from center 2.

Results: During a 2-year period, 117 consecutive patients (63 men, 54 women; mean age, 65±13 [SD] years; age range: 53-90 years) who underwent laparoscopic left colectomy for cancer in center 1 (66 patients, building cohort) and center 2 (51 patients, validation cohort) were retrospectively included. Ninety-one percent of patients were ASA-PS 1-2. Overall postoperative morbidity was 23% and severe morbidity 12%. The area under the receiver operating characteristic curve of CT-PS score was 0.968 (95% CI: 0.901-1.000) in the building cohort and 0.828 (95% CI: 0.693-0.963) in the validation cohort. The optimal thresholds yielded 87% (95% CI: 83-91%) sensitivity and 100% (95% CI: 91-100%) specificity in the building cohort and 75% (95% CI: 69-81%) sensitivity and 83% (95% CI: 77-88%) specificity in the validation cohort for the prediction of ASA-PS.

Conclusion: Preoperative chest-abdomen-pelvis CT thoroughly and wisely read is highly accurate to differentiate patients with ASA-PS I/II from those with ASA-PS III/IV before left colectomy.
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http://dx.doi.org/10.1016/j.diii.2020.11.001DOI Listing
May 2021

Postoperative Outcome of Surgery with Pancreatic Resection for Retroperitoneal Soft Tissue Sarcoma: Results of a Retrospective Bicentric Analysis on 50 Consecutive Patients.

J Gastrointest Surg 2020 Nov 24. Epub 2020 Nov 24.

Department of Surgical Oncology, Gustave Roussy, 114, rue Edouard Vaillant, 94805, Villejuif, France.

Backgrounds: Multivisceral resection is the standard treatment for retroperitoneal sarcoma (RPS) during which pancreas resection may be necessary.

Methods: All consecutive patients operated for RPS with pancreatectomy in 2 expert centers between 1993 and 2018 were retrospectively analyzed.

Results: Fifty patients (median age: 57 years, IQR: [46-65]) with a primary (n = 33) or recurrent (n = 17) RPS underwent surgery requiring pancreas resection (distal pancreatectomy (DP) (n = 43), pancreaticoduodenectomy (PD) (n = 5), central pancreatectomy (n = 1), and atypical resection (n = 1)). Severe postoperative morbidity (Clavien-Dindo III-IV) was observed in 14 patients (28%), and 7 of them (14%) required reoperation for anastomotic bowel leakage (n = 5), gastric volvulus (n = 1), or hemorrhage (n = 1). Pancreas-related complications occurred in 25 patients (50%): 10 postoperative pancreatic fistulas (POPF) (grade A (n = 12), grade B (n = 6), grade C (n = 1)), 13 delayed gastric emptying (grade A (n = 8), grade B (n = 4), grade C (n = 1)), 1 hemorrhage (grade C). Postoperative mortality was 4% (n = 2), all following PD, caused by a massive intraoperative air embolism and by a multiple organ failure after anastomotic leakage. Pathological analysis confirmed pancreatic involvement in 17 (34%) specimens. Microscopically complete resection (R0) was achieved in 22 (44%) patients. After a follow-up of 60 months, 36 patients (75%) were still alive, among whom 27 without recurrence (56%).

Conclusion: Pancreatic resection during RPS surgery is associated with significant postoperative morbidity and mortality. PD should be avoided whenever possible while other procedures seemed achievable without excessive morbidity and with long-term survival.
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http://dx.doi.org/10.1007/s11605-020-04882-2DOI Listing
November 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

Systematic Review with Meta-Analysis: Endoscopic and Surgical Resection for Ampullary Lesions.

J Clin Med 2020 Nov 10;9(11). Epub 2020 Nov 10.

Medical Department II, Division of Gastroenterology, University of Leipzig Medical Center, 04103 Leipzig, Germany.

Ampullary lesions (ALs) can be treated by endoscopic (EA) or surgical ampullectomy (SA) or pancreaticoduodenectomy (PD). However, EA carries significant risk of incomplete resection while surgical interventions can lead to substantial morbidity. We performed a systematic review and meta-analysis for R0, adverse-events (AEs) and recurrence between EA, SA and PD. Electronic databases were searched from 1990 to 2018. Outcomes were calculated as pooled means using fixed and random-effects models and the Freeman-Tukey-Double-Arcsine-Proportion-model. We identified 59 independent studies. The pooled R0 rate was 76.6% (71.8-81.4%, I = 91.38%) for EA, 96.4% (93.6-99.2%, I = 37.8%) for SA and 98.9% (98.0-99.7%, I = 0%) for PD. AEs were 24.7% (19.8-29.6%, I = 86.4%), 28.3% (19.0-37.7%, I = 76.8%) and 44.7% (37.9-51.4%, I = 0%), respectively. Recurrences were registered in 13.0% (10.2-15.6%, I = 91.3%), 9.4% (4.8-14%, I = 57.3%) and 14.2% (9.5-18.9%, I = 0%). Differences between proportions were significant in R0 for EA compared to SA ( = 0.007) and PD ( = 0.022). AEs were statistically different only between EA and PD ( = 0.049) and recurrence showed no significance for EA/SA or EA/PD. Our data indicate an increased rate of complete resection in surgical interventions accompanied with a higher risk of complications. However, studies showed various sources of bias, limited quality of data and a significant heterogeneity, particularly in EA studies.
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http://dx.doi.org/10.3390/jcm9113622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7696506PMC
November 2020

Correction to: A pheochromocytoma wrapped in an IgG4-related disease.

Eur J Nucl Med Mol Imaging 2021 Mar;48(3):949-950

Department of Endocrinology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France.

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http://dx.doi.org/10.1007/s00259-020-05067-4DOI Listing
March 2021

CT, MRI and PET/CT features of abdominal manifestations of cutaneous melanoma: a review of current concepts in the era of tumor-specific therapies.

Abdom Radiol (NY) 2021 05 2;46(5):2219-2235. Epub 2020 Nov 2.

Department of Abdominal & Interventional Radiology, Hôpital Cochin, AP-HP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France.

Abdominal manifestations in patients with cutaneous melanoma include involvement due to metastatic spread and immune checkpoint inhibitor induced adverse events. The purpose of this review is to provide a critical overview of abdominal manifestations in patients with cutaneous melanoma and highlight the current imaging challenges in the era of tumor-specific therapies. Immune checkpoint inhibitors represent a treatment with demonstrated efficacy in the treatment of advanced cutaneous melanoma but are associated with several abdominal adverse events that must be recognized. CT has a role in the identification of colitis, enteritis and pancreatitis, whereas MRI has an important role in the diagnosis of autoimmune pancreatitis. Current evidence demonstrates that MRI should be the preferred imaging technique for the detection and characterization of hepatic and splenic metastases from cutaneous melanoma. The role of F-FDG-PET/CT should be further evaluated but current literature suggests an efficacy in the detection of pancreatic metastases not seen on CT and MRI.
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http://dx.doi.org/10.1007/s00261-020-02837-4DOI Listing
May 2021

Going Above and Beyond the Pancreatic Neuroendocrine Tumor Classification.

JCO Oncol Pract 2020 11 21;16(11):731-732. Epub 2020 Oct 21.

Department of General, Visceral, and Endocrine Surgery, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.

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http://dx.doi.org/10.1200/OP.20.00809DOI 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

What should we trust to define, predict and assess pancreatic fistula after pancreatectomy?

Pancreatology 2020 Dec 13;20(8):1779-1785. Epub 2020 Oct 13.

Department of Digestive, Hepato-biliary and Endocrine Surgery, La Pitié-Salpétrière Hospital, APHP, Paris, France; Médecine Sorbonne Université, Paris, France. Electronic address:

Objective: The ISGPF postoperative pancreatic fistula (POPF) definition using amylase drain concentration is widely used. However, the interest of lipase drain concentration, daily drain output and absolute enzyme daily production (concentration x daily drain volume) have been poorly investigated.

Material And Methods: These predictive on postoperative day (POD) 1, 3, 5 and 7 were analyzed in a development cohort, and subsequently tested in an independent validation cohort.

Results: Of the 227 patients of the development cohort, 17% developed a biochemical fistula and 34% a POPF (Grade B/C). Strong correlation was found between amylase/lipase drain concentration at all postoperative days (ρ = 0.90; p = 0.001). Amylase and lipase were both significantly higher in patients with a POPF (p < 0.001) presenting an equivalent under the ROC curve area (0.85 vs 0.84; p = 0.466). Combining POD1 and POD3 threefold enzyme cut-off value increased significantly POPF prediction sensibility (97.4% vs 77.8%) and NPV (97.1% vs 86.3%). These results were also confirmed in the validation cohort of 554 patients. Finally, absolute enzyme daily production and daily drain output were significantly higher in patients with a POPF (p < 0.001) but did not add clinical value when compared to drain enzyme concentration.

Conclusion: Lipase is as effective as amylase drain concentration to define POPF. Absolute enzyme daily production or daily drain output do not help to better predict clinically significant POPF occurrence and severity. Lipase and amylase should mainly be used for their negative predictive value to predict the absence of clinically significant POPF and could allow early drain removal and hospital discharge.
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http://dx.doi.org/10.1016/j.pan.2020.10.036DOI Listing
December 2020

Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy?

Cancers (Basel) 2020 Sep 30;12(10). Epub 2020 Sep 30.

Department of Digestive Surgery, Rouen University Hospital, 1 rue de Germont, F-76031 Rouen, CEDEX, France.

(1) Background: preoperative biliary drainage before pancreaticoduodenectomy (PD) is associated with bacterial biliary contamination (>85%) and a significant increase in global and infectious complications. In view of the lack of published data, the aim of our study was to investigate the impact of fungal biliary contamination after biliary drainage on the complication rate after PD. (2) Methods: a multicentric retrospective study that included 224 patients who underwent PD after biliary drainage with intraoperative biliary culture. (3) Results: the global rate of positive intraoperative biliary sample was 92%. Respectively, the global rate of biliary bacterial contamination and the rate of fungal contamination were 75% and 25%, making it possible to identify two subgroups: bacterial contamination only (B+, = 154), and bacterial and fungal contamination (BF+, = 52). An extended duration of preoperative drainage (62 vs. 49 days; = 0.08) increased the risk of fungal contamination. The overall and infectious complication rates were not different between the two groups. In the event of postoperative infectious or surgical complications, the infectious samples taken did not reveal more fungal infections in the BF+ group. (4) Conclusions: fungal biliary contamination, although frequent, does not seem to increase the rate of global and infectious complications after PD, preceded by preoperative biliary drainage.
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http://dx.doi.org/10.3390/cancers12102814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599947PMC
September 2020

Surgical Management of Neuroendocrine Tumours of the Pancreas.

J Clin Med 2020 Sep 16;9(9). Epub 2020 Sep 16.

Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, 47-83 Avenue de l'Hôpital, 75013 Paris, France.

Neuroendocrine tumours of the pancreas (pNET) are rare, accounting for 1-2% of all pancreatic neoplasms. They develop from pancreatic islet cells and cover a wide range of heterogeneous neoplasms. While most pNETs are sporadic, some are associated with genetic syndromes. Furthermore, some pNETs are 'functioning' when there is clinical hypersecretion of metabolically active peptides, whereas others are 'non-functioning'. pNET can be diagnosed at a localised stage or a more advanced stage, including regional or distant metastasis (in 50% of cases) mainly located in the liver. While surgical resection is the cornerstone of the curative treatment of those patients, pNET management requires a multidisciplinary discussion between the oncologist, radiologist, pathologist, and surgeon. However, the scarcity of pNET patients constrains centralised management in high-volume centres to provide the best patient-tailored approach. Nonetheless, no treatment should be initiated without precise diagnosis and staging. In this review, the steps from the essential comprehensive preoperative evaluation of the best surgical approach (open versus laparoscopic, standard versus sparing parenchymal pancreatectomy, lymphadenectomy) according to pNET staging are analysed. Strategies to enhance the short- and long-term benefit/risk ratio in these particular patients are discussed.
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http://dx.doi.org/10.3390/jcm9092993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565036PMC
September 2020

Distal Pancreatectomy with Celiac Axis Resection-with Posterior Ramps Approach-for Locally Advanced Pancreatic Adenocarcinoma with Celiac Trunk Infiltration (Modified Appleby Procedure) (with Video).

J Gastrointest Surg 2021 02 1;25(2):571-573. Epub 2020 Sep 1.

Department of Pancreatic and Endocrine Surgery, Cochin Hospital, APHP, Paris, France.

With the advent of FOLFIRINOX and neoadjuvant radiotherapy, the surgical indications for adenocarcinoma have expanded. Locally advanced pancreatic adenocarcinomas of the body/tail with infiltration of the celiac trunk which have a good clinical, biological, and radiological response to neoadjuvant treatment may therefore be eligible for caudal pancreatectomy with resection of the celiac trunk (modified Appleby procedure). In addition to rigorous patient selection and surgical expertise, this procedure also requires experience in interventional radiology.
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http://dx.doi.org/10.1007/s11605-020-04782-5DOI Listing
February 2021

Intratumor heterogeneity of prognostic DNA-based molecular markers in adrenocortical carcinoma.

Endocr Connect 2020 Jul;9(7):705-714

Université de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.

Background: The prognosis of adrenocortical carcinoma (ACC) is heterogeneous. Genomic studies have identified ACC subgroups characterized by specific molecular alterations, including features measured at DNA level (somatic mutations, chromosome alterations, DNA methylation), which are closely associated with outcome. The aim of this study was to evaluate intratumor heterogeneity of prognostic molecular markers at the DNA level.

Methods: Two different tissue samples (primary tumor, local recurrence or metastasis) were analyzed in 26 patients who underwent surgery for primary or recurrent ACC. DNA-related biomarkers with prognostic role were investigated in frozen and paraffin-embedded samples. Somatic mutations of p53/Rb and Wnt/β-catenin pathways were assessed using next-generation sequencing (n = 26), chromosome alteration profiles were determined using SNP arrays (n = 14) and methylation profiles were determined using four-gene bisulfite pyrosequencing (n = 12).

Results: Somatic mutations for ZNRF3, TP53, CTNN1B and CDKN2A were found in 7, 6, 6 and 4 patients, respectively, with intratumor heterogeneity in 8/26 patients (31%). Chromosome alteration profiles were 'Noisy' (numerous and anarchic alterations) in 8/14 and 'Chromosomal' (extended patterns of loss of heterozygosity) in 5/14 of the study samples. For these profiles, no intratumor heterogeneity was observed. Methylation profiles were hypermethylated in 5/12 and non-hypermethylated in 7/12 of the study samples. Intratumor heterogeneity of methylation profiles was observed in 2/12 patients (17%).

Conclusions: Intratumor heterogeneity impacts DNA-related molecular markers. While somatic mutation can differ, prognostic DNA methylation and chromosome alteration profile seem rather stable and might be more robust for the prognostic assessment.
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http://dx.doi.org/10.1530/EC-20-0228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424337PMC
July 2020

F-fluorocholine PET/CT in MEN1 Patients with Primary Hyperparathyroidism.

World J Surg 2020 Nov 17;44(11):3761-3769. Epub 2020 Jul 17.

Université de Paris, Paris, France.

Background: Primary hyperparathyroidism (HPT1) is the most frequent endocrinopathy in multiple endocrine neoplasia type 1 (MEN1). Its surgical management is challenging. We aimed to describe and compare the imaging findings of parathyroid ultrasound (US), sestaMIBI scintigraphy (sestaMIBI), and F-fluorocholine (FCH) PET/CT in a series of MEN1 patients with HPT1.

Methods: Retrospective analysis of a cohort of MEN1 patients with HPT1 assessed by parathyroid US, sestaMIBI scintigraphy and SPECT/CT, and FCH-PET/CT for potential surgery between 2015 and 2019.

Results: Twenty-two patients with a confirmed diagnosis of MEN1 who presented with HPT1 and were assessed by the 3 imaging modalities were included. After imaging workups, 11 patients were operated on for the first time, 4 underwent a redo surgery, and 7 did not undergo an operation. The overall patient-based positivity rate of imaging was 91% (20 of 22) for parathyroid US and 96% (21 of 22) for both sestaMIBI and FCH-PET/CT. The 3 imaging modalities demonstrated negative findings in 1/22 patient who did not undergo surgery. Overall, 3 pathologic glands were not detected by any imaging technique. SestaMIBI and FCH-PET/CT both resulted in the same 3 false-positive results in ectopic areas with a significant uptake on two thymic carcinoid tumors and one inflammatory lymph node. FCH-PET/CT provided more surgically relevant data than sestaMIBI in 4/11 patients with initial surgery and in 1/4 patient who underwent redo surgery.

Conclusions: Compared to sestaMIBI scintigraphy, FCH-PET/CT provides additional information regarding the number of pathologic parathyroid glands and their localization in MEN1 patients with HPT1.
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http://dx.doi.org/10.1007/s00268-020-05695-9DOI Listing
November 2020

A pheochromocytoma wrapped in an IgG4-related disease.

Eur J Nucl Med Mol Imaging 2021 03 15;48(3):929-930. Epub 2020 Jul 15.

Department of Endocrinology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France.

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http://dx.doi.org/10.1007/s00259-020-04959-9DOI Listing
March 2021

Pancreaticoduodenectomy following endoscopic ultrasound-guided choledochoduodenostomy with electrocautery-enhanced lumen-apposing stents an ACHBT - SFED study.

HPB (Oxford) 2021 Jan 6;23(1):154-160. Epub 2020 Jul 6.

Service de Gastroentérologie, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.

Background: After ERCP failure or if ERCP is declined for preoperative biliary drainage before pancreaticoduodenectomy, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with electrocautery-enhanced lumen-apposing stents (ECE-LAMS) might be needed. The aim of the present study was to assess the technical feasibility and short-term outcomes of pancreaticoduodenectomy (PD) following endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) with electrocautery-enhanced lumen-apposing stents (ECE-LAMS).

Methods: A retrospective study of all EUS-CDS procedures with ECE-LAMS followed by PD performed in France since the availability of the device in 2016.

Results: 21 patients underwent PD in 9 departments of surgery following EUS-CDS with ECE-LAMS. The median bilirubin level at endoscopic procedure was 292 μmol/L. A 6 mm diameter stent was used in 20 cases. No complications occurred during the procedure. During the waiting time, 1 patient had an acute pancreatitis post ERCP and 3 patients developed cholangitis, treated by either an additional percutaneous biliary drainage, or an endoscopic procedure to extract a bezoar occluding the stent, or antibiotics, respectively. PD with a curative intent was performed in all cases. Overall, postoperative mortality was nil and postoperative morbidity occurred in 17 patients (81%), including 3 with severe complications (14%). No patient developed postoperative biliary fistula. In the 21 patients followed at least 6 months, no biliary complications occurred, and no tumor recurrence developed on the hepaticojejunostomy/hepatic pedicle.

Conclusion: Pancreaticoduodenectomy following EUS-CDS with ECE-LAMS is technically feasible with acceptable short-term postoperative outcome, including healing of biliary anastomosis.
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http://dx.doi.org/10.1016/j.hpb.2020.06.001DOI Listing
January 2021
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