[Prognostic value of extensive lymph node excision in curative resections of stomach cancers. Apropos of a series of 100 patients]. / Valeur pronostique du curage ganglionnaire élargi (R2) dans les résections curatives des cancers de l'estomac. A propos d'une série de 100 patients.

UNLABELLED: The aim of this work was to determine the frequency and localization of lymph node involvement and the prognostic value of extensive node dissection on survival in patients with cancer of the stomach. TYPE OF STUDY: Prospective study from 1981 to 1991 evaluating node dissection in adenocarcinoma of the stomach. PATIENTS: There were 179 gastrectomies during the 10-years study period including 100 performed as a curative treatment. The tumour was located in the lower part of the stomach in 48 cases, in the upper part in 25 cases in the middle part in 22 cases and involved the entire organs in 5 cases. METHODS: Distal subtotal gastrectomy (DSG) was performed in 45 cases, total gastrectomy (TG) in 16 and total gastrectomy extended beyond the stomach (TGE) in 33 cases. Polar gastrectomy (PG) was used in 6 cases. Type R2 node dissection was done for 90 patients and R1 dissection for 10. RESULTS: The tumour extended to the mucosa-submucosa (T1) in 17 cases, the musculosa (T2) in 22 cases, the serous membrane (T3) in 45 cases and to adjacent organs (T4) in 16 cases. A mean 18 nodes was examined per surgical specimen and node involvement was found in 59. The localizations showed that the coronary and hepatic chains (n. 7 and 8) were invaded at a rate comparable with the perigastric nodes (n. 3 and 6). The splenic chain was invaded in 1 patient out of 5 with localizations in the mid and upper portions. Corrected overall survival was 49% at 5 years. Survival depended on the node extension (p < 0.0002): survival reached 73% when no metastasis was found and fell to 48% with perigastric node involvement and 30% when the pedicular nodes were invaded. Survival was also a function of tumour stage (p < 0.0002): for T1 tumours it was 89%, for T2 86% and for T3 32%. Multivariance analysis (Cox) showed that parietal extension and node involvement were risk factors with a relative risk of 3.53 and 1.44 respectively. CONCLUSION: Extensive node dissection of the pedicular chains should improve survival without increasing morbidity or mortality in the treatment of cancer of the stomach.

[Pedicular clamping in major hepatectomies: clamping "of principle" or "of necessity"? A comparative study]. / Le clampage pédiculaire au cours des hépatectomies majeures: clampage "de principe" ou "de nécessité"? Une étude comparative.

Fifty-two consecutive patients undergoing major hepatic resection for liver tumor were divided into two groups according to the operative procedure. Group A consisted of 34 patients in whom vascular inflow occlusion was performed "de principle" during parenchymal division and intrahepatic approach of the portal structures; the mean duration of the portal triad clamping was 43 mn (ranged 17 to 70 mn). Group B patients (18 cases) had hilar division of the structures of that portion of the liver due to be removed, prior to parenchymal division was performed without vascular arrest, except in five "de necessitate" cases during 5 to 22 mn. Groups A and B were comparable in terms of patient age or status, of king of liver tumors and extent of resection. Mean operating duration (215 vs 263 mn), volume of intraoperative blood transfusion (557 vs 1019 ml), intensive care (2.5 vs 4.2 days) and total hospital stays (19.6 vs 30.5 days) were significantly reduced in group A. A higher but transient increase of amino-transferase level was the only biochemical consequence of liver ischemia in group A, whereas postoperative disturbance in serum bilirubin, prothrombin time, fibrinogen, and total protein were significantly greater in group B, probably because of the greater volume of blood transfusion in this group. Thus, routine vascular inflow occlusion with transhepatic approach of the portal structures may be an effective and innocuous procedure for major liver resection.

Eikenella corrodens, a rare cause of pancreatic abscess: two case reports and review.

Eikenella corrodens, a slowly growing gram-negative bacillus that is a normal inhabitant of dental plaque, has been recognized as an infrequent cause of invasive disease. To date, only one case of pancreatic abscess due to E. corrodens in association with other bacteria from the oropharynx has been described. We report herein two cases of pancreatic abscess due to E. corrodens. In one case E. corrodens and Escherichia coli were found in the abscess specimens; in the other case no other pathogen was associated with E. corrodens. In addition, we review descriptions from the literature of abdominal infections caused by E. corrodens.

[Cystic lymphangioma of the adrenal gland. Three misleading cases]. / Lymphangiome kystique de la surrénale. Trois observations trompeuses.

Three cases of adrenal cystic lymphangioma are reported. In 1 patient the lesion was complicated by intracystic haemorrhage. The remaining 2 patients had a hepatic lesion which was treated in the same surgical operation as the adrenal cyst. Ultrasonography and computerized tomography play a major role in the exploration of these cysts. Their unexpected discovery has become more frequent since these methods have multiplied, and this raises therapeutic problems. The nature of adrenal cysts is determined at histology. In asymptomatic cysts percutaneous needle aspiration can only have an indicative value.

[Malignant endocrine tumor of the pancreas associated with high blood thyrocalcitonin levels]. / Tumeur maligne endocrine du pancréas associée à des taux sériques élevés de thyrocalcitonine.

A case of thyrocalcitonin-secreting endocrine tumour of the pancreas is reported. Endocrine pancreatic tumours are neoplasias evolving over a long period; most of them are multisecreting, usually with a predominant secretion responsible for clinical symptoms. In this particular case the retrospective diagnosis of a thyrocalcitonin-secreting tumour of the pancreas was made by immunocytochemical study of the pancreatectomy specimen. One year after pancreatectomy, the persistence of clinical signs and a plasma thyrocalcitonin level higher than 25,000 pg/ml led to the discovery of a liver metastasis. An immunocytochemical study of the segmental hepatectomy specimen showed a single population of thyrocalcitonin-secreting cells identical with those found in the pancreatic tumour. In this context, radioimmunological assays of peptides and immunocytochemistry seem to be the best diagnostic methods.

[Survival after gastrectomy for cancer. 209 cases]. / Survie après gastrectomie pour cancer. 209 observations.

The long-term results of 209 gastrectomies performed for adenocarcinoma, including 117 which were prospectively collected, are presented. Resection was curative in 154 cases (73.6 percent). The TNM distribution of the tumours was: stage I (TxNOMO) 75 cases, stage II (TxN1MO) 46 cases, stage III (TxN2MO) 33 cases and stage IV (TxNxM1) 55 cases. Lymph node involvement was more frequent in the prospective than in the retrospective study. With a more than 5 years' follow-up of 80 percent of the patients operated upon, the actuarial survival rate at 5 years (operative mortality included) was 38 percent for all lesions, 52 percent for curative resection and 2 percent for palliative resection. Following curative resection, the survival rates for tumours of the upper, middle and lower thirds of the stomach were 40, 60 and 55 percent respectively. These rates were 60 percent for stage I tumours, 54 percent for stage II tumours and 25 percent for stage III tumours. The results obtained in this series, where most of the curative gastrectomies included excision of N1 and N2 lymph nodes, show that lymph node involvement has no significant importance for the prognosis when it is proximal (N1) and is not incompatible with prolonged survival when it is pedicular (N2).

Chlormezanone-induced fulminant hepatitis in a pregnant woman: successful delivery and liver transplantation.

The case of a 29 year old woman affected by fulminant hepatitis during the third trimester of pregnancy, after a 3 week administration of chlormezanone is reported. Following induced Caesarean delivery, the patient underwent an orthotopic liver transplantation. The mother and her baby were in good condition 26 months after liver transplantation. In this case, chlormezanone was probably responsible for the fulminant hepatitis.

[Cancer of the pancreas. A plea for resection. 162 operated patients]. / Cancer du pancréas. Plaidoyer pour l'exérèse. 162 malades opérés.

Between 1970 and 1990, 162 patients with carcinoma of the pancreas or the periampullary region were operated upon. A prospective study was conducted in 85 of them who underwent surgery after 1983. The tumour was resected in 63 patients (ductal adenocarcinoma in 43, periampullary carcinoma in 20). Biliary and/or gastrointestinal bypass was performed in 76 patients, and exploratory laparotomy in 23. The operative mortality rate was 3 percent (2/63) among patients with resection and 24 percent (24/99) among those with laparotomy with or without bypass. The longest survival (median: 33 months) was obtained in patients with periampullary tumours; it was 12 months after resection in patients with ductal adenocarcinoma and 4 months in the other cases. The preoperative estimate of unresectability was erroneous in 36.5 percent of the cases. Periampullary tumours were diagnosed only after pathological examination of the lesion removed in 47 percent. These results are in favour of radical surgery, especially since the operative mortality of resection is low and since resection, even palliative, gives a better survival rate than mere bypass.

[Resection of the portal vein in pancreatectomy for cancer: technical considerations. Apropos of 4 cases]. / Résection de la veine porte au cours des pancréatectomies pour cancer: aspects techniques. A propos de quatre observations.

Out of 150 carcinomas of the pancreas operated from 1970 through 1989, 50 pancreatectomies were performed, including 4 cases of segmental resection of portal vein with total pancreatectomy (2 cases) or duodenopancreatectomy (2 cases). The technical procedure is described and discussed. Segmental resection of portal vein is rare in our experience and has been always performed out of necessity because of the over estimation of the resectability. However, mortality and post-operative stay are not increased.

[Severe hepatic trauma. Initial non-operative treatment. A case report]. / Traumatisme hépatique grave. Traitement initial non opératoire. Une observation.

The emergency surgical treatment of severe hepatic traumas still carries a high mortality risk. We report a case of severe blunt trauma of the liver managed without surgery under CT guidance. This attitude--which does not exclude surgery as a later resort--requires haemodynamic stability of the patient, close monitoring in a surgical intensive care unit and repeated CT scans.

[Gastrocolonic excision of cancer. Retrospective analysis of the immediate postoperative course and long-term survival in 18 patients]. / Les exérèses gastrocoliques pour cancer. Analyse rétrospective des suites immédiates et de la survie éloignée chez dix-huit malades.

Eighteen patients underwent gastrocolic resection for cancer. Thirteen had primary gastric cancer and 5 had primary colon cancer (two of these 5 patients had local-regional recurrence after right hemicolectomy). Twelve resections were curative and 6 palliative. Twelve patients had more than 2 organs resected. Involvement of adjacent tissues or organs was present in 15 patients (11/13 gastric cancer and 4/5 colon cancer: 83%). All patients had immediate colonic anastomosis. The mean duration of postoperative stay was 22 +/- 8 days (SD). Mortality was 5.6% (1/18). Seven patients had post-operative complications (41%; 7/17); 3 of these 7 patients had anastomotic leakage (one colonic and two pancreatic fistulae; 3/17: 17.6%); the mean duration of postoperative stay for these three patients was 27 +/- 4 jours, (p less than 0.004). One colonic fistula complicated the 18 colonic anastomoses (5.5%). There was no reoperation in this series. The estimated 2-year survival for the entire group was 20%. The median survival was 9.5 mois; the median survival was 13.5 months after curative resections and 5 months after palliative procedure (p less than 0.01). The median survival was 8 months for gastric adenocarcinoma and 36 months for colon adenocarcinoma (p less than 0.05). Despite the poor results in gastric cancer extending to adjacent organs, complete excision is still recommended whenever feasible. Complete excision of advanced colon cancer may lead to prolonged disease-free survival depending on the lymph node status. With an acceptably low mortality, resection remains a better procedure than palliative diversion or exclusion for these advanced tumours.

[Excision of colorectal cancers: what can be expected of lymph node excision?]. / Résection des cancers colo-rectaux: que peut-on attendre du curage ganglionnaire?

We report a series of 413 patients with colo-rectal adenocarcinoma. 328 had a curative resection and 277 of them had elective lymphadenectomy; 51 had no lymphadenectomy because of either age or poor general status. Operative morbidity and mortality were not increased by lymphadenectomy. Survival was related to the lymph node involvement: 70.6% 5 year survival in patients without lymph node metastases, 49.3% 5 year survival in patients with lymph node metastases (P less than 0.001). However lymphadenectomy did not affect the survival rate of the patients. We conclude that lymphadenectomy had no deleterious effect. However, its real benefit on long term survival must be evaluated in further prospective randomised studies.

[Budd-Chiari syndrome and Behçet's disease. A case treated by mesenterico-atrial prosthesis]. / Syndrome de Budd-Chiari et maladie de Behçet. Une observation traitée par prothèse mésentérico-atriale.

A 36 year-old North African man, with Behçet's syndrome complicated by an inferior vena caval thrombosis, developed a chronic Budd-Chiari syndrome associated with bleeding esophageal varices. He was treated by an emergency mesoatrial shunt. Results at 2 years were good. Analysis of this case and the 13 other similar cases with associated Budd-Chiari syndrome and Behçet's syndrome found in the literature showed that hepatic veins thrombosis: a) is often due to inferior vena caval thrombosis or membranous obstruction; b) has a high spontaneous mortality rate by acute liver failure; c) remains a potential indication for porto-systemic shunt, as are other causes of Budd-Chiari syndrome.

[Esophagojejunal anastomoses with the EEA stapler after total gastrectomy. Technic and immediate results apropos of a recent series of 32 cases]. / Anastomoses oeso-jéjunales à la pince EEA après gastrectomie totale. Technique et résultats immédiats à propos d'une série récente de 32 cas.

32 consecutive total gastrectomies for cancer (20 extended total gastrectomies) were carried out through an abdominal approach. Reconstruction using a Rouxen-Y loop (28 cases) or an interposed jejunal loop (four cases) was done with an EEA stapled oesophago jejunostomy: 25 end to side and 5 end to end anastomosis were performed and two technical failures led to complete manual anastomosis. All patients have had post-operative X-ray examination: there was no anastomotic leakage in this series, even in the 3 patients (10%) who have died during the post-operative course. A critical study of this series and eight others one from elsewhere is presented: it is concluded that the stapling device allows an easier and safer oesophagojejunostomy than manual procedure, when great care is taken of technical details.

[Adenocarcinoma of the duodenojejunal angle. Diagnostic and therapeutic problems]. / Les adénocarcinomes de l'angle duodéno-jéjunal. Problèmes diagnostiques et thérapeutiques.

The duodenojejunal is a rare site for the development of tumors. Diagnosis is difficult but two cases are reported in which the presence of a tumor was determined by small intestine follow through radiography and confirmed on endoscopy. Surgical treatment is limited by size of lesion. The two cases reported were treated by resection and the patients have survived for 8 months and 5 years respectively.

[Extensive excision of fixed cancers of the colon. A retrospective study of 44 cases]. / L'exérèse élargie des cancers fixés du côlon. Etude rétrospective de 44 cas.

Out of 268 resections for colonic carcinoma, 44 were extended because of an involvement to adjacent tissues or organs. Abdominal wall (14 cases), vesical dome (12 cases) and small bowel (11 cases) were most frequently resected. Post-operative mortality (15.9%) and five years survival rates (57.5%) of this radical procedures do not significantly differ compared to results after conventional procedures (15.3 and 64.3% respectively). Carcinomatous adhesions are difficult to distinguish from inflammatory ones at the time of laparotomy. They were found in 47% of the specimens only. This had a lesser prognostic significance than lymph nodes involvement. This results are in favour of extensive surgery for locally advanced tumours of the colon.