Radiation therapy of the primary tumour and/or metastases of digestive metastatic cancers.

Metastatic gastrointestinal cancer is not an uncommon situation, especially for pancreatic, gastric, and colorectal cancers. In this setting, few data are available on the impact of the treatment of the primary tumour. Oligometastatic disease is associated with longer survival in comparison with more advanced disease. Metastasis-directed therapy, such as stereotactic body radiotherapy, seems related to better outcomes, but the level of evidence is low. In most tumour locations, prospective data are very scarce and inclusion in ongoing trials is strongly recommended.

[Inflammatory bowel diseases and upper gastrointestinal tract]. / Les maladies inflammatoires chroniques intestinales (MICI) et tube digestif haut.

Inflammatory bowel diseases (IBD), Crohn's disease and ulcerative colitis are inflammatory diseases with a flare-up evolution and an unknown etiology. Inflammatory lesions of the upper gastrointestinal tract are more and more often described in Crohn's disease and ulcerative colitis. The aim of this article was to review the inflammatory lesions of the esophagus, stomach and duodenum currently described in the IBD.

Evaluation of the prevalence of stomach ulcers in slaughtered pigs in a Swiss -abattoir.

INTRODUCTION: The development of gastric ulcers in pigs has various reasons. In Switzerland, the last survey on the prevalence of gastric ulcers and possible risk factors was performed in 2005. We aimed to reassess gastric ulcers prevalence today, in 2021. A total of 1005 stomachs from fattening pigs from 136 batches and around 87 herds were evaluated at a Swiss abattoir. The Pars oesophagea of the stomach was scored from 0=healthy to 10=severe ulceration and strictures. Scores were compared between pigs produced under the labels «Integrierte Produktion Schweiz¼ (IPS, n=242 stomachs, 18 farms) and «Qualitätsmanagement-Schweizerfleisch¼ (QM, n=649, 58 farms) and others (n=114). The results showed a prevalence of 27,2 % mild mucosal changes (Scores 1-3), 14,9 % moderate mucosal changes (Scores 4-6) and 19,1 % severe mucosal changes (Scores 7-10). Only 38,8 % of the stomachs were rated 0 and thus considered healthy. Compared to the results from 2005, there is no difference concerning the lowest scores (0-2) and the highest scores (9-10). However, there was a shift from the medium scores (3-4) to higher scores (5-8). Stomach scores turned out to be herd specific. There were differences (p < 0,01) between labels, indicating that IPS pigs had less affected stomachs. Stomachs that were empty at slaughter showed higher scores (p < 0,001). The mean carcass weight of the pigs in the slaughter groups was negatively correlated (p < 0,05) to their median stomach score. Confiscations were not related to stomach scores. The results suggest that pig stomach health has not improved since 2005. The differences between labels seem to have resulted from different regulations prescribing a minimum particle size of enrichment material in IPS. The reasons for gastric ulcer development, including those on the individual herd within label, still have to be further clarified in order to allow targeted countermeasures. Given apparent farm-specificity, scoring of a limited number of stomachs per herd during the slaughter process could facilitate the establishment of a feedback scheme.

INTRODUCTION: Le développement d'ulcères gastriques chez les porcs a des causes diverses. En Suisse, la dernière enquête sur la prévalence des ulcères gastriques et les facteurs de risque possibles a été réalisée en 2005. Nous avons voulu réévaluer la prévalence des ulcères gastriques en 2021. Un total de 1005 estomacs de porcs d'engraissement provenant de 136 lots et d'environ 87 troupeaux ont été évalués dans un abattoir suisse. La Pars œsophagea de l'estomac a été notée de 0=sain à 10=ulcérations et sténoses sévères. Les scores ont été comparés entre les porcs produits sous les labels «Production Intégrée Suisse¼ (IPS, n=242 estomacs, 18 exploitations) et «Assurance Qualité Viande Suisse¼ (QM, n=649, 58 exploitations) et les autres (n=114). Les résultats ont montré une prévalence de 27,2 % de modifications muqueuses légères (scores 1­3), 14,9 % de modifications muqueuses modérées (scores 4­6) et 19,1 % de modifications muqueuses sévères (scores 7­10). Seuls 38,8 % des estomacs ont été classés 0 et donc considérés comme sains. Par rapport aux résultats de 2005, il n'y a pas de différence entre les scores les plus bas (0­2) et les scores les plus élevés (9­10). Cependant, on constate un glissement des scores moyens (3­4) vers les scores plus élevés (5­8). Les scores d'estomac se sont avérés être spécifiques au troupeau. Il y avait des différences (p < 0,01) entre les étiquettes, indiquant que les porcs IPS avaient des estomacs moins affectés. Les estomacs qui étaient vides à l'abattage présentaient des scores plus élevés (p < 0,001). Le poids moyen de la carcasse des porcs dans les groupes d'abattage était négativement corrélé (p < 0,05) à leur score gastrique médian. Les confiscations n'étaient pas liées aux scores gastriques. Les résultats suggèrent que la santé de l'estomac des porcs ne s'est pas améliorée depuis 2005. Les différences entre les labels semblent résulter de réglementations différentes prescrivant une taille minimale des particules de matériau d'enrichissement dans les IPS. Les raisons de l'apparition d'ulcères gastriques, y compris celles concernant un lot individuel au sein d'un label, doivent encore être clarifiées afin de permettre des contre-mesures ciblées. Étant donné l'apparente spécificité des exploitations, la notation d'un nombre limité d'estomacs par troupeau au cours du processus d'abattage pourrait faciliter l'établissement d'un système de retour d'information.

[Gastric and pancreatic cancers: Will neoadjuvant (chemo)radiotherapy replace adjuvant chemoradiotherapy?] / Cancers gastriques et pancréatiques : la (chimio)radiothérapie néoadjuvante remplacera-t-elle la chimioradiothérapie adjuvante ?

For many years, adjuvant chemoradiotherapy remained essential in the therapeutic management of gastric and pancreatic adenocarcinomas. For these tumours, surgical excision, the only hope of offering the patient prolonged survival, is only possible in 20% of cases. The median survival of operated patients is only 12 to 20 months due to the frequency of locoregional and/or metastatic recurrences. For stomach cancers, adjuvant chemoradiotherapy is justified by the results of the phase III trial Intergroup 0116 published by MacDonald et al. The gain in survival was at the cost of significant toxicity. This treatment was supplanted in the early 2000s by perioperative chemotherapy. Currently, neoadjuvant chemoradiotherapy clinical studies are ongoing with the aim of improving treatments observance and tolerance. For pancreatic cancers, the role of adjuvant chemoradiotherapy has long been discussed because of trials with contradictory results. Neoadjuvant radiotherapy has many advantages in terms of efficacy and tolerance. It increases the chances of subsequent complete tumour resection. Several prospective trials are currently ongoing to clarify its place in the therapeutic arsenal.

[Hereditary gastric cancer: Challenges for the pathologist in 2020]. / Les cancers gastriques héréditaires: rôle du pathologiste en 2020.

Gastric cancer is the third most common cancer worldwide. The majority of gastric cancers are sporadic but familial clustering is seen in more than 10% of cases. This manuscript is divided into two parts. The first part is dedicated to the non-syndromic hereditary gastric cancer, particularly the hereditary diffuse gastric cancer (HDGC) and other gastric polyposes including the recently described GAPPS (Gastric adenocarcinoma and proximal polyposis of the stomach). The second part concerns the syndromic gastric cancer, namely the HNPCC syndrome (Hereditary Non Polyposis Colorectal Cancer) occurring as part of a genetic predisposition syndrome to cancer. Recent advances in oncogenetics and next generation sequencing technology have enabled the identification of new entities. This enhancement in knowledge regarding inherited syndromes predisposing to gastric cancer has consequently improved the management of patients and their families. In this context, pathologists play a major role in identifying particular morphologic entities prompting genetic investigation. The aim of this manuscript is to provide an update on the current knowledge about hereditary gastric cancer.

[Localized MSI/dMMR gastric cancer patients, perioperative immunotherapy instead of chemotherapy: The GERCOR NEONIPIGA phase II study is opened to recruitment]. / Patients atteints d'un cancer gastrique localisé MSI/dMMR, pas de chimiothérapie mais une immunothérapie périopératoire : l'essai de phase II GERCOR NEONIPIGA vient d'être ouvert au recrutement.

INTRODUCTION: Perioperative chemotherapy is the standard strategy for localized gastric cancers. Nevertheless, this strategy seems to be inefficient, if not deleterious, for patients with tumors harboring microsatellite instability (MSI) and/or mismatch repair deficiency (dMMR), a tumor phenotype predictive for the efficacy of immune checkpoint inhibitors (ICKi). AIM: The GERCOR NEONIPIGA single-arm phase II study (NCT04006262; EUDRACT 2018-004712-22) aims at evaluating the efficacy of a peri-operative strategy with nivolumab and ipilimumab in neoadjuvant setting, then nivolumab alone after surgery for patients with resectable MSI/dMMR gastric cancer. MATERIAL AND METHODS: Main inclusion criteria are: gastric and oesogastric junction adenocarcinoma (GOA), T2-T4, all N stage and M0, MSI/dMMR. Patients will be treated with nivolumab 240mg Q2W, 6 infusions, and ipilimumab 1mg/kg Q6W, 2 infusions in neoadjuvant setting. Following surgery, patients with TRG 1-2-3 (Mandard tumor regression grade), acceptable tolerance of neoadjuvant treatment and postoperative ECOG performance status 0-1, will be treated with adjuvant nivolumab 480mg Q4W, 9 infusions. RESULTS: The primary endpoint is pathological complete response rate (pCR-R). Based on a Fleming design, with α=5% and ß=20%, 27 patients have to be evaluated (H0=5%; H1=20%). Secondary endpoints include disease-free survival, overall survival and safety. CONCLUSION: This study is planned to include 32 patients to evaluate the pCR-R with the combination of nivolumab and ipilimumab in neoadjuvant setting for MSI/dMMR localized GOA. The MSI/MMR status should be systematically assessed on diagnostic biopsies of all GOA. If it meets its primary endpoint, the GERCOR NEONIPIGA study might mark a turning point in the management of localized MSI/dMMR GOA patients.

[Does the FLOT regimen a new standard of perioperative chemotherapy for localized gastric cancer?] / Le protocole FLOT est-il le nouveau standard de chimiothérapie péri-opératoire des cancers de l'estomac ?

FLOT-4 study recently reports that in patients with gastric cancer, perioperative chemotherapy with 5-fluorouracile, leucovorin, oxaliplatin and docetaxel (FLOT regimen) increases survival over standard ECF/ECX regimen (epirubicine, cisplatine and 5-fluorouracile [or capecitabine]). Does this study, make FLOT a new standard of perioperative chemotherapy for localized gastric cancer? Seven hundred and sixteen patients were included into that randomized study. Thirty seven per cent and 46% of the patients received the full planned treatment in the ECF/ECX group and in the FLOT group, respectively. The primary aim of FLOT-4 was met as FLOT significantly reduced the relative risk of death vs. ECF/ECX (HR: 0.77; 95% CI: 0.63-0.94; P=0.012). Median survival is increased by 15 months with FLOT (50 months vs. 35 months). FLOT also provided better complete resection rates, better complete pathological response rates, and better disease-free survival than ECF/ECX. FLOT is more likely associated with the following adverse events: diarrheas, leuco-neutropenia (including 51% of severe ones), infections (including 18% of severe ones), and peripheral neuropathy. On the contrary, ECF/ECX provided more likely severe nausea and vomiting, severe anemia, and thromboembolic events. Overall, the number of patients with related serious adverse events (including those that occurred during hospital stay for surgery) was similar in the two groups, as was the number of toxic deaths and postoperative deaths. FLOT should be regarded as the recommended perioperative chemotherapy for patients with gastric cancer or adenocarcinoma of the gastro-esophageal junction. However, some doubts remain as regards of its use in the daily practice for unselected patients.

[Does sentinel lymph node identification has indication in digestive cancers?] / La recherche de ganglion sentinelle a-t-elle des indications dans les cancers digestifs ?

Despite being a standard of care in several cancers, sentinel lymph node (SLN) is not widespread in digestive cancers. European guidelines do not recommend its use for any digestive cancers. Particularity of the lymphatic vessel, intimately linked to blood vessel, may explain part of this phenomenon. Nevertheless, more indication could arise in the near future with the early diagnosis of tumor induced by cancer screening. Ruling out the lymphatic invasion could allow preserving the organ currently resected because of risk of lymph node positivity. This procedure is well studied in early gastric cancer in Korea and Japan. Several study have demonstrated that, a dual-tracer (isotopic and dye) allows to accurately identify the SLN. A randomized phase 3 trial is currently active in Korea to evaluate the oncological results of the procedure. Similar indication could arise for T1 tumor of the low-rectum, but currently available data are insufficient to recommend its use outside of a study. SLN may also be used to detect aberrant lymphatic drainage (rectum, ileum) but have been tested so far only in a few dozen of patients. Finally, SLN is disappointing in colon cancer, due to its low sensitivity and the absence of modification of the surgical procedure induced.

[Results of a retrospective study on radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma]. / Place de la radiothérapie pour les lymphomes du mucosa-associated lymphoid tissue gastriques : résultats d'une étude rétrospective.

PURPOSE: We aimed to evaluate therapeutic results of radiotherapy for gastric mucosa-associated lymphoid tissue (MALT) lymphomas. PATIENTS AND METHODS: We reviewed retrospectively the records of 11 patients presenting with gastric MALT lymphoma treated between 1993 and 2014. Patients with low-grade lymphoma in failure after helicobacter eradication had exclusive gastric external radiotherapy. Chemotherapy followed by radiotherapy were indicated in case of high grade lymphoma. Radiotherapy doses range between 30 and 40Gy (2Gy per fraction, five fractions per week). RESULTS: All tumours were IE stage. Seven patients with low-grade lymphoma had radiotherapy. Four patients with high-grade lymphoma received chemotherapy then radiotherapy. Ten patients are in complete remission after treatment achievement. Five and 10 years disease-free survival are 100%. No severe toxicity was seen. CONCLUSION: Eradication of Helicobacter pylori is the mainstay of treatment of gastric MALT. External irradiation is an effective and well-tolerated treatment modality in case of resistance to helicobacter eradication.

[Chemotherapy and chemoradiotherapy indications in the treatment of locally advanced gastric carcinoma]. / Place de la chimiothérapie et de la chimioradiothérapie dans le cancer de l'estomac localement évolué.

Currently, there is no international consensus on the best treatment regimen for patients with advanced resectable gastric carcinoma. Three approaches exist abroad continents. In France and Europe, perioperative chemotherapy and gastrectomy with D1.5 lymph-node dissection is the current standard. In Japan and South Korea, postoperative adjuvant chemotherapy after surgery with D2 lymph-node dissection is the standard treatment. In the United States, where limited lymph-node dissection is frequently performed, adjuvant chemoradiotherapy after surgery is the standard treatment. In France, postoperative chemoradiotherapy indications are discussed in limited settings: patients with locally advanced gastric cancer or lymph node involvement discovered on the pathologic report of the gastrectomy without preoperative chemotherapy delivery or in case of non-carcinologic resection (R1). Exclusive chemoradiotherapy can be proposed in patients unfit for surgery.

[Metastatic stomach cancer: Clinical trials in Asia and in Occident]. / Cancer de l'estomac métastatique : les essais cliniques en Asie et en Occident.

Although cytotoxic chemotherapy is the main therapeutic option to treat gastric cancer in the metastatic setting, molecular targeted agents have recently been introduced in an effort to improve survival outcomes which in average do not exceed 1 year. Trastuzumab and ramucirumab, antibodies directed against HER2 and VEGFR2, respectively, may provide clinical benefit for some patients. Results of clinical studies show that Asian patients have increased survival compared to Caucasian patients. Differences between populations, and in particular the presence of polymorphisms capable of influencing the availability of fluorouracil, have been suggested as possible explanations. Other factors including histology, surgical procedures, administration of neoadjuvant chemotherapy in Western countries and screening programs in Asia have also been suggested. However, none of these elements can fully explain this phenomenon. The aim of this article is to present the main protocols used in clinical practice, the perspectives of metastatic gastric cancer treatment and the particularities observed in Asian and Caucasian patients.

[FREGAT: French clinico-biological database dedicated to esogastric cancers]. / FREGAT : base clinicobiologique nationale française dédiée à la recherche sur les cancers œsogastriques.

Even though esogastric cancers are estimated at 1.5 million new cases worldwide with an expected 2.11 million new cases by 2025, prognosis remains poor and research is unsatisfactory compared to other cancers. There is an urgent need to intensify research via innovative and ambitious programs to improve patient's survival and quality of life. Incidence of esogastric cancers is particularly high in France, and the creation of a national clinicobiological database prospectively collecting epidemiological, human and social, clinical, pathological, biological data, sustained by biobanks of blood and tissues, is a critical point to improve research and care for these cancers considering all determinants of the disease with a more integrated approach. FREGAT clinicobiological database, funded and labeled by the French NCI in 2012, gathers the vast majority of university hospitals and cancer centers in France. This research relies on preexisting networks ensuring its efficacy and quality. Beyond significant increase of inclusions opened since January 2015, the establishment of public multiprivate industrial partnerships and creation of numerous French and European scientific projects, make FREGAT a decisive tool for research on esogastric cancers.

[Radiotherapy in cancers of the oesophagus, the gastric cardia and the stomach]. / Radiothérapie des cancers de l'œsophage, du cardia et de l'estomac.

Localized oesophageal and gastric cancers have a poor prognosis. In oesophageal cancer, external radiotherapy combined with concomitant chemotherapy is accepted as part of the therapeutic armamentarium in a curative intent in the preoperative setting for resectable tumours; or without surgery in inoperable patients or non-resectable tumours due to wide local and/or regional extension. Data from the literature show conflicting results with no clinical evidence in favour of either a unique dose protocol or consensual target volume definition in the setting of exclusive chemoradiation. In the preoperative setting, chemoradiotherapy has become the standard in oesophageal cancer, even though there is no evidence that surgery may be beneficial in locally advanced tumours that respond to radiotherapy and chemotherapy. The main cause of failure after exclusive chemoradiotherapy in oesophageal cancer is locoregional relapse suggesting that doses and volumes usually considered may be inadequate. In gastric cancer, radiotherapy may be indicated postoperatively in patients with resected tumours that include less than D2 lymph node dissection or in the absence of perioperative chemotherapy. Preoperative chemoradiotherapy in gastric cancers is still under investigation. The evolving techniques of external radiotherapy, such as image-guided radiotherapy (IMRT) and volumetric modulated arctherapy (VMAT) have reduced the volume of lung and heart exposed to radiation, which seems to have diminished radiotherapy-related morbi-mortality rates. Given this, quality assurance for radiotherapy and protocols for radiotherapy delivery must be better standardized. This article on the indications for radiotherapy and the techniques used in oesophageal and gastric cancers is included in a special issue dedicated to national recommendations from the French society of radiation oncology (SFRO) on radiotherapy indications, planning, dose prescription, and techniques of radiotherapy delivery.

[Contribution of ultrasonography for the preoperative assessment of gastric contents]. / Apport de l'échographie pour l'évaluation préopératoire du contenu gastrique.

The assessment of the risk of pulmonary aspiration of gastric contents may be difficult in the preoperative period, apart from typical circumstances. The development of ultrasonography in anesthesia and critical care has led to consider ultrasonic imaging of gastric contents for preoperative risk assessment of "full" stomach in clinical practice. Ultrasonography of the body of the stomach allows direct visualization of the gastric contents. However, the stomach is often difficult to identify, particularly when it is empty. Moreover, quantitative assessment of gastric volume is delicate, and no standardized method of ultrasonography of the body of the stomach for preoperative assessment of gastric contents was described. On the contrary, ultrasonography of the antral cross-sectional area, which was initially described for the assessment of gastric emptying as an alternative method to repeated measurements of the variations of antropyloric volume after ingestion of a test meal, is easy to perform and is highly reproducible through using the aorta and the left lobe of the liver as internal landmarks. Qualitative assessment of the gastric antrum allows easily diagnosis of a "full" stomach. The measurement of antral area may allow a more accurate estimate of the presence or absence of gastric contents at risk of lung injury in the event of regurgitation and aspiration (gastric volume >0.8 ml/kg and/or with solid particles), defining the "risk" stomach. The use of antral ultrasonography may help the anesthesiologist to assess the risk of pulmonary aspiration according to clinical history of the patient, in order to choose an appropriate strategy minimizing the occurrence of this complication.

[Metastatic breast cancer to the stomach: An uncommon evolution of breast carcinoma]. / La linite gastrique métastatique: une évolution peu connue des carcinomes mammaires.

Breast carcinoma exceptionally leads to metastatic linitis plastica. Distinguishing a breast cancer metastasis to the stomach from a primary gastric cancer on the basis of clinical and radiological signs is very challenging. Thanks to being cognizant of the previous history of invasive lobular carcinoma and the gastric biopsy followed by immunohistochemical analysis, gastric metastasis can be diagnosed. Despite the use of chemotherapy and hormonal therapy, gastric metastasis remains often associated with poor prognosis. We present a case where gastric biopsy allowed a metastatic breast cancer to the stomach to be diagnosed and we discuss its clinical, diagnostic, pathological and therapeutic particularities.

[Epidemiological characteristics and prognosis of gastric Cancer in urban areas of Mali]. / Les caracteristiques epidemiologiques et pronostiques du cancer de l'estomac en milieu urbain au Mali.

Stomach cancer remains a public health problem. It is increasingly found in our regions, probably because of the greater availability and improvement of diagnostic facilities.The goal of this work was to study the epidemiological characteristics and prognosis of gastric cancer in the hepato-gastroenterology and general surgery wards of the Gabriel Toure university hospital. METHODS: We conduct a descriptive retrospective study on patients from June 2008 to May 2009, and the enrollment of patients lasted from June 2009 to May 2010. RESULTS: We examined the records of 68 cases of gastric cancer in 115 cases of digestive cancers a frequency of 59.1%.The mean age of patients was 56.51 ± 14.8 years with extremes of 27 and 90 years. The sex ratio was 1.6 in favor for men. The social and professional groups (housewives and farmers) were the most represented with 50 cases (73.5%). Salting, smoking, consumption of tô (cereal dough) with potash were the most found risk factors in 80.9%, 94.2% and 80.6% of cases respectively. The localization of antro-pyloric site was most represented (60.3%). Adenocarcinoma was the most common histological type (94.1%), one case of Gastrointestinal Stromal Tumor (GIST), two cases of non hodgkin malignant lymphoma were found.The curative surgery was performed in 8.9% of our patients. The overall survival rate after any surgery with two-year follow-up was 9.4%. Post curative surgery survival was 83.3% at two years follow-up. CONCLUSION: Stomach cancer is common in our context, but its management is suffering from delayed diagnosis.

Le cancer de l'estomac reste un problème de santé publique.Il est de plus en plus constaté dans nos régions, du fait probablement de la disponibilité plus importante des moyens diagnostiques.Le but de ce travail était d'étudier les caractéristiques épidémiologiques et pronostiques du cancer de l'estomac dans les services d'hépato-gastroentérologie et de Chirurgie générale du CHU Gabriel Touré.Il s'agissait d'une étude rétrospective descriptive ayant porté sur les malades colligés de juin 2008 à mai 2009 et l'étude des dossiers de ces malades a duré de juin 2009 à mai 2010. Nous avons consulté les dossiers de 68 cas de cancers de l'estomac sur 115 cas de cancers digestifs soit une fréquence de 59,1%. L'âge moyen des patients était de 56,51±14,8 ans avec des extrêmes de 27 et 90 ans .Le sexratio était de 1,6 en faveur des hommes. Les couches socioprofessionnelles (ménagères et cultivateurs) étaient les plus représentées avec 50 cas soit 73,5%. La salaison, le fumage, la consommation de tô (pâte de céréales) avec potasse ont été les facteurs de risque les plus retrouvés dans respectivement 80,9%;94,2% et 80,6% des cas. Le siège antro-pylorique a été plus représenté (60,3%). L'adénocarcinome a été le type histologique le plus fréquent (94,1%), un cas de tumeur stromale, deux cas de lymphome malin non hogdkinien ont été retrouvés. La chirurgie à visée curative a été réalisée chez 8,9% de nos patients. Le taux de survie globale après toute chirurgie confondue à deux ans de suivi a été de 9,4%. La survie post chirurgie curative a été de 83,3% à deux ans de suivi. CONCLUSION: Le cancer de l'estomac est fréquent dans notre contexte mais sa prise en charge souffre du retard diagnostique.

[Treatment of malignant gastric tumors in the surgery "a" department of the Point G teaching hospital: 84 cases]. / Prise en charge des tumeurs malignes gastriques dans le service de chirurgie «a¼ du CHU du Point G a propos de 84 cas.

OBJECTIVE: To evaluate the short-term results of the treatment of malignant gastric tumors. PATIENTS AND METHODS: A 3-year retrospective study from january 2007 to december 2010 was conducted in the Surgery "A" department of the Point G Teaching Hospital. The clinical records of 84 patients with gastric cancers were collected. Included in this study were patients who underwent surgery for malignant gastric tumors confirmed by histology. Patients who did not undergo surgery and those who presented tumors of the cardia were not included in this study. RESULTS: The treatment consisted of a subtotal gastrectomy with ganglionic curettage taking out the first and the second relays in 33 patients (39.28%), total gastrostomy in 3 patients (3.57%), and the remaining 48 patients (57.14%) underwent gastro-entero anastomosis. Morbidity was 10.7%, represented by 7 cases of parietal suppuration and 2 cases of evisceration. Mortality rate was 11.11%, due to poor general condition of the patients. The global 1-year survival rate was 36.9%. The one and two-year survival rates after subtotal gastrostomy were 93.9% and 75.75%, respectively. No survival case was noticed one year after total gastrectomy and gastric enteric anastomosis. CONCLUSION: Partial gastrectomy with ganglionic curettage when possible associated with an early diagnosis could allow a sharp improvement of the gastric tumors' survival rate.

BUT: évaluer les résultats à court terme de la prise en charge des tumeurs malignes gastriques. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective sur une période de 3 ans (janvier 2007 à décembre 2010) dans le service de chirurgie «A ¼ du CHU du Point G. Les dossiers cliniques de 84 malades atteints de cancers gastriques ont été colligés. Ont été inclus dans l'étude les malades opérés pour tumeurs malignes gastriques confirmées à l'histologie. Les malades non opérés et ceux présentant de tumeurs du cardia n'ont pas été inclus dans l'étude. RÉSULTATS: Une gastrectomie subtotale était réalisée chez 33 patients (39,28%) avec curage ganglionnaire emportant le premier et le deuxième relais, 3 gastrectomies totale (3,57%) et le reste du traitement a consisté en une gastro-entero-anastomose chez 48 malades (57,14 %). La morbidité était de 10,7 % représentée par 7 cas de suppuration pariétale, et 2 cas d'éviscération. Le taux de mortalité a été de 11,11% liée au mauvais état général des malades. Le taux de survie global à 1 an était de 36,90%. Le taux de survie à 1 an après gastrectomie subtotale était de 93,9%, et 75,75 % à 2 ans. Aucun cas de survie n'était enregistré à 1 an après gastrectomie totale et gastro-entero-anastomose. CONCLUSION: La gastrectomie partielle avec curage ganglionnaire chaque fois que sa réalisation est possible associée à un diagnostic précoce pourrait permettre une nette amélioration du taux de survie des tumeurs gastriques.

[Rare complication of a post-traumatic left diaphragmatic hernia]. / Complication rare d'une hernie diaphragmatique gauche post-traumatique.

Diaphragmatic hernia is a post-traumatic lesion specific trauma that may go unnoticed. The left hemidiaphragm is the most frequently affected. The diagnosis is then made at the occasion of a complication, especially gastric volvulus. The authors report the case of a young man aged 26 years old with a gastric volvulus on post-traumatic diaphragmatic hernia diagnosed by CT.

[Peritonitis by perforation on gastric cancer at the Gabriel Touré teaching hospital]. / Peritonites par perforation sur cancers Gastriques au CHU Gabriel Toure.

OBJECTIVE: Describe the therapeutic and diagnostic aspects of gastric cancer perforations at the general surgery department of the Gabriel Touré teaching hospital. PATIENTS AND METHOD: A retrospective survey was conducted over 11 years (January 1999 to December 2010). It included all patients having had surgery for peritonitis by gastric cancer perforation at the service during that time frame. RESULTS: We found 14 cases of peritonitis due to gastric perforation, of which 9 were male and 5 female. The main clinical symptoms were abdominal pain (100%), weight loss (100%) and abdominal contraction (98.8%). Endoscopy allowed to note a pyloric antrum budding tumor in 4 patients before perforation. Radiography of the abdomen without preparation showed pneumoperitoneum in 8 cases. In all cases, the histological type recorded was adenocarcinoma. The antral seat was the most common (64.3%). Palliative surgery was immediately performed in all cases. We recorded two cases of fistula tract and 3 cases of infection of the lining, as well as 2 cases of postoperative mortality. CONCLUSION: Gastric cancer perforation is rare and of bad prognosis as it survives on advanced cancer.

OBJECTIF: Décrire les aspects diagnostiques et thérapeutiques de la perforation du cancer de l'estomac dans le service de chirurgie générale du CHU GABRIEL TOURE. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective s'étalant sur 11 ans (Janvier 1999 à Décembre 2010). Elle a concerné tous les malades opérés pour péritonite par perforation du cancer de l'estomac pendant la même période dans le service de chirurgie générale du CHU GABRIEL TOURE. RESULTATS: Nous avons trouvé 14 cas de péritonite par perforation gastrique parmi lesquels 9 étaient de sexe masculin et 5 de sexe féminin. Les principaux signes cliniques ont été la douleur abdominale(100%),l'amaigrissement (100%) et la contracture abdominale (98,8%).La fibroscopie a permis d'objectiver une tumeur bourgeonnante antro-pylorique chez 4 malades avant la perforation. La radiographie de l'abdomen sans préparation a révélé le pneumopéritoine dans 8 cas. L'adénocarcinome était le type histologique dans tous les cas. Le siège antral était le plus fréquent (64,3%). Le geste chirurgical à visée palliative a été effectué en urgence dans tous les cas. Nous avons enregistré 2 cas de fistule digestive et 3 cas d'infection de la paroi, 2 cas de mortalité postopératoire. CONCLUSION: La perforation de cancer gastrique est rare et de mauvais pronostic car elle survient sur le cancer avancé.