Patient management after primary rectal cancer diagnosis. Special focus on surgical treatment for non-metastatic disease.

Background: Rectal cancer is a public health priority. Primary objectives of this study were to evaluate the quality of care for non-metastatic rectal cancer using process and outcome indicators. Delay of management, length of stay and readmission rate, sphincter preservation, morbidity, number of examined lymph nodes, mortality, overall and disease-free survivals were evaluated. Secondary objectives were to estimate the relationship between possible predictive parameters for (1) anastomotic leakage (logistic regression), (2) overall or disease-free survivals (cox regression).Methods: We performed a retrospective study on 312 consecutive patients diagnosed with primary rectal cancer between 2016 and 2019. We focused on the 163 patients treated by surgery for non-metastatic cancer.Results: The treatment began within 33 days (range 0-264) after incidence, resection rate was 67%. Digestive continuity rate in lower, middle and upper rectum was 30%, 87% and 96%. Median of 14 lymph nodes (range 1-46) was analyzed. Length of stay and readmission rate were 11 days (range 3-56) and 4%, respectively. Within 90 postoperative days, clinical anastomotic leakage occurred in 9.2% of cases, major morbidity rate was 17%, mortality 1.2%. Multivariate analysis revealed that stoma decreased the risk of anastomotic leakage [hazard ratio: 0.16; 95% confidence intervals: 0.04-0.63; p = 0.008]. The 5-year overall survival after surgery was 85 ± 4%, disease-free survival 83 ± 4%. Patients with major complications, male gender and R1/R2 resection margin had a poorer prognosis.Conclusion: This work showed encouraging results in rectal cancer treatment in our institution, our results were in line with recommendations at the time.

Long-term results after laparoscopic reoperation for failed antireflux procedures.

BACKGROUND: Surgery for failed antireflux procedures is technically more demanding than primary fundoplication. The success rate does not equal that of the primary procedures. This retrospective analysis aimed to assess long-term subjective and objective outcomes in patients who underwent laparoscopic surgery for fundoplication failure. METHODS: Objective and subjective outcomes were assessed by radiological and endoscopic methods, symptom questionnaire and quality-of-life index at a minimum follow-up of 12 (mean 75·8) months. RESULTS: The study included 129 consecutive patients who had laparoscopic redo surgery after fundoplication had failed. The most frequent patterns of failure were hiatal herniation (50 patients) and slippage (45). Resolution of the symptoms that led to redo surgery was achieved in 27 of 37 and 11 of 16 patients operated for recurrence and for dysphagia respectively. Objective failure was demonstrated in 16 of 39 patients with herniation and six of 22 with slippage. Seven patients underwent an additional surgical procedure. CONCLUSION: Long-term assessment of objective and subjective results after laparoscopic repair for failed fundoplication revealed a high failure rate that increased with the length of follow-up. Unexpected and untreated oesophageal shortening may be responsible for this failure rate.

Angiosarcoma associated with radiation therapy after treatment of breast cancer. Retrospective study on ten years.

PURPOSE: The breast sarcoma induced by radiation therapy is rare but increasing, given the increased long-term survival of patients receiving radiation therapy. Fibrosarcoma, histiocytofibroma and angiosarcoma are the most common breast sarcoma. Angiosarcoma is the most common after breast cancer treated by radiation therapy, often diagnosed too late, with a severe prognosis and a high rate of recurrence. However, because of the low incidence of angiosarcoma associated with radiation therapy (AAR), the benefit of radiation therapy in breast cancer treatment outweighs the risk to develop angiosarcoma. The aim of this study is to evaluate these rare cases of AAR diagnosed in eastern Belgium in comparison to the data from the literature. PATIENTS AND METHODS: Nine cases of AAR after radiation for breast ductal carcinoma were included in this retrospective study. AAR was diagnosed according to Cahan criteria between January 2007 and December 2016. Latency, incidence, management and prognosis are comparable to the literature. RESULTS, CONCLUSION: The median latency was 10 (4-24) years, the incidence of AAR in the East Belgian area was 0.09% of the patients irradiated on the same period. Patients were treated by surgery with wide local excision with or without reconstructive surgery, without radiotherapy and chemotherapy treatment. Kaplan-Meier analysis showed median overall survival of 61.8 months, patient survival of 55.6% at one year and 29.6% at five years. With the constant progress of medicine and its technologies, it would be possible to limit the occurrence of AAR or to diagnose it at an earlier stage.

Is there a proper way to treat shortened oesophagus? About a series of 67 patients.

INTRODUCTION AND OBJECTIVE: During the work-up of gastro-oesophageal reflux disease (GORD) patients, barium swallow may show a shortened oesophagus with a non-reducible gastro-oesophageal junction. In our department, in such cases, a Collis-Nissen operation is usually planned. But, the proper reducibility of the gastro-oesophageal junction (GOJ) in the abdomen is difficult to assess peroperatively. The aim of this study is to compare retrospectively the follow-up of an oesophageal lengthening procedure (Collis-Nissen gastroplasty) versus a standard Nissen in the management of patients with primary short oesophagus or secondary to previous Nissen fundoplication. PATIENTS AND METHODS: Between 01/2000 and 12/2009, 67 patients with a short oesophagus on X-Ray were operated on for proven GORD: 27 (Group A) underwent a Collis-Nissen fundoplication. In 40 patients (Group B), the GOJ was reduced easily and a standard Nissen fundoplication was judged sufficient by the experimented surgeon. Follow up included Quality of Life evaluation using the Gastrointestinal Quality of Life Index (GIQLI) and a barium swallow. RESULTS: 64 patients agreed to participate. Mean follow up was 46 months (4-122). Mean postoperative GIQLI score was 108 in group A, 97 in group B. Barium swallow was performed in 61 patients. In group A, seven patients out of 25 (28%) presented a intrathoracic migration on X-Ray while in group B, it was noted in 20 patients (55%). CONCLUSION: According literature, Collis gastroplasty allows a tension-free fundoplication to be performed to correct a shortened oesophagus. Though our series of brachy-oesophagus is small, it confirms a better outcome after a Collis-Nissen gastroplasty, compared to the classical Nissen fundoplication.

Potential benefits of laparoscopic aorto-bifemoral bypass surgery.

BACKGROUND: This series aims to prove the positive impact of laparoscopic approach in aortofemoral bypass grafting. METHODS: It concerns a retrospective non randomized study comparing 58 consecutive patients treated with laparoscopic procedure (n = 30) and with a standard open procedure (n = 28) in a single center. The different operating times, the complications and the follow-up of these two groups are compared RESULTS: The demographics and angiographic data of the two groups were comparable. Operating time was longer in the laparoscopic group. However, we noticed a significant shorter hospitalisation stay (p < 0.0001) after the laparoscopic procedure with a mean 5.1 days. There was no significant difference of morbidity. CONCLUSION: We suggest that the trans-peritoneal approach is the best way in laparoscopic procedure in term of exposure and ergonomics. Laparoscopic aortofemoral bypass grafting is feasible, safe and effective. Shortening of operating time is observed as surgeon's experience grows.

Progesterone receptor activation. an alternative to SERMs in breast cancer.

Data regarding the effects of progesterone and a progestagen on human normal breast epithelial cell proliferation and apoptosis are presented here. In postmenopausal women, adding progesterone to percutaneously administrated oestradiol significantly reduces the proliferation induced by oestradiol. In vitro and in premenopausal women, stopping the administration of nomegestrol acetate triggers a peak of apoptosis. Fibro-adenoma and cancerous cells do not show this regulation of apoptosis. Progesterone seems to be important in normal breast homeostasis.

Effects of a progestogen on normal human breast epithelial cell apoptosis in vitro and in vivo.

Many investigators have reported cyclic proliferation of normal human breast epithelial cells. A delicate balance between proliferation and apoptosis (programmed cell death) ensures breast homeostasis. Both the follicular and luteal phases of the menstrual cycle are characterized by proliferation, whereas apoptosis occurs only at the end of the latter phase. In this study, we observed that the withdrawal of a synthetic progestin (nomegestrol acetate or NOMAC), but not continuous treatment with it, induced apoptosis of normal human breast epithelial cells in vitro and in women who applied NOMAC gel to their breasts. Furthermore, this apoptotic response was specific to normal breast cells, since withdrawal of NOMAC did not induce apoptosis of tumoral T47D cells in vitro or of fibroadenoma cells in women. These observations open up new perspectives in the prevention of hyperplasia and breast cancer.

[Homograft mitral valve replacement]. / Remplacement valvulaire mitral par homogreffe.

The total homograft replacement of the left AV valve and subvalvular apparatus constitutes a delicate operation, which may prove beneficial in young patients with extensive bacterial endocarditis. The case of a staphylococcal endocarditis in a young drug addicted patient, operated three years previously of mitral valve repair for the same pathology, is presented. In addition to the complete excision of infected tissues and valvular substitution with biological material, this technique has the advantage of avoiding long term anticoagulation. The history, technical key points, and current indications of mitral homograft in the surgery of the left atrio-ventricular valves are reviewed.