RESUMO
Esophageal cancer is the 19th most common cancer in the European Union. Its prognosis remains poor with a 5-year survival rate estimated between 15 % and 25 %. Accurate diagnosis and pre-therapeutic assessment are essential and should allow a rapid start of therapy. Current treatment is based on multimodal management of which surgery remains the cornerstone. Since 2019, Belgium has started an agreement to centralize esophageal surgery in order to improve surgical outcomes. One year after implementation of centralization, our centre shows a low rate of severe complications (Clavien-Dindo classification IIIb-V) of 20 % and a 0 % mortality rate at 30 and 90 postoperative days. Our patients have benefited from a full minimally invasive or hybrid surgical procedure, contributing to those positive results. In the future, all our efforts must be done to improve collaboration between hospitals in order to provide best medical and surgical treatments.
Le cancer de l'oesophage est le 19ème cancer le plus fréquent dans l'Union Européenne. Son pronostic reste sombre avec un taux de survie à 5 ans estimé entre 15 % et 25 %. La précocité du diagnostic et la qualité du bilan pré-thérapeutique sont essentielles et doivent permettre d'initier un traitement rapide. Le traitement repose sur une prise en charge multidisciplinaire et multimodale dont la chirurgie reste la pierre angulaire. En Belgique, le taux de mortalité à 30 et 90 jours post-opératoires étaient de 4,1 % et 9,5 %, respectivement, pour la période allant de 2008 à 2016. Dans une perspective d'amélioration de cette prise en charge, depuis 2019, la Belgique a concentré la chirurgie de l'oesophage dans 10 centres de référence, incluant le CHU de Liège. Un an après centralisation, notre centre présente un taux de complications sévères selon Clavien-Dindo (IIIb-V) de 20 % et des taux de mortalité à 30 et 90 jours de 0 %. Le bilan d'évaluation initial de chaque patient est discuté en concertation multidisciplinaire. Une prise en charge nutritionnelle est discutée avant l'instauration du traitement. Tous nos patients bénéficient d'une approche systématique totalement mini-invasive ou hybride, participant à l'amélioration des résultats sur la morbidité et la mortalité. Une collaboration croissante avec nos hôpitaux partenaires permet d'harmoniser les mises au point et les plans de traitement oncologiques pour le bénéfice des patients.
Assuntos
Neoplasias Esofágicas , Complicações Pós-Operatórias , Bélgica/epidemiologia , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/terapia , Humanos , Taxa de SobrevidaRESUMO
Obesity is a chronic disease that has become a major public health problem with a prevalence that has doubled in the past two decades in most industrialized and developing countries. Currently, bariatric surgery represents the most effective treatment for extreme or severe overweight (BMI ? 40 kg/m² or ? 35 kg/m2 with weight-related comorbidities). Pre-operative bariatric surgery psychiatric and psychological assessment is essential for various reasons. In addition to the selection of candidates for the operation, its objectives are to prepare patients for future postoperative changes as well as to optimize their psychological and psychiatric care. This article describes a standardized tool, the BIPASS (Bariatric Interprofessional Psychosocial Assessment Suitability Scale), which allows a quality assessment in the field.
L'obésité est une maladie chronique devenue un problème de santé publique majeur, avec une prévalence qui a doublé au cours des deux dernières décennies dans la majaorité des pays industrialisés et en voie de développement. Actuellement, la chirurgie bariatrique représente le traitement le plus efficace afin de remédier à cette problématique de surcharge pondérale sévère (IMC ? 40 ou ? 35 kg/m² avec complications). L'évaluation psychiatrique et psychologique préopératoire dans le cadre d'une chirurgie bariatrique s'impose pour divers enjeux. Outre la sélection des candidats à l'opération, ses objectifs sont, notamment, de préparer au mieux les patients aux changements futurs postopératoires ainsi que d'optimiser leur prise en charge psychologique et, éventuellement, psychiatrique. Cet article décrit un outil standardisé, le BIPASS (Bariatric Interprofessional Psychosocial Assessment Suitability Scale), qui permet une évaluation de qualité dans le domaine.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Comorbidade , Humanos , Obesidade , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Resultado do TratamentoRESUMO
During the last decade minimal invasive approach progressed in all sectors of abdominal surgery. Technological improvements allowed to perform more complex procedures laparoscopically with increased safety. The implementation of pre-, per- and postoperative protocols with an adaptation of surgical, anesthetic and analgesia methods and the patient's involvement in the healing process led to enhanced recovery after surgery. The centralization of complex esophageal and pancreatic surgery established the CHU of Liège as a tertiary referral institution for complex oncological surgery thanks to a large cooperation with regional hospitals.
La dernière décennie a vu progresser l'approche mini-invasive dans tous les domaines de la chirurgie abdominale. Les améliorations technologiques permettent de réaliser des interventions toujours plus complexes en laparoscopie avec une sécurité accrue. La systématisation de la prise en charge pré-, per- et postopératoire, avec une adaptation des techniques de chirurgie, d'anesthésie et d'analgésie, et une implication du patient dans ce processus ont abouti à une réhabilitation accélérée. La centralisation de la chirurgie complexe de l'oesophage et du pancréas a permis de créer une structure de référence en chirurgie oncologique complexe au CHU de Liège grâce à une large collaboration interhospitalière régionale.
Assuntos
Laparoscopia , Participação do Paciente , Abdome/cirurgia , HumanosRESUMO
Hereditary diffuse gastric cancer is a form of gastric cancer associated, in about 40 % of cases, with a germline mutation of the CDH1 gene. The management of patients with a pathogenic mutation of this gene is based on total prophylactic gastrectomy because, until proven otherwise, endoscopic monitoring is insufficient. We report a series of eight patients with pathogenic CDH1 mutation who underwent total prophylactic gastrectomy in our centre.
Le cancer gastrique diffus héréditaire est une forme de cancer gastrique associé, dans 40 % des cas environ, à une mutation germinale du gène CDH1. La prise en charge des patients porteurs d'une mutation pathogène de ce gène repose sur la gastrectomie totale prophylactique car, jusqu'à preuve du contraire, la surveillance endoscopique est insuffisante. Nous rapportons une série de huit patients porteurs d'une mutation pathogène de CDH1 ayant bénéficié d'une gastrectomie totale prophylactique dans notre centre. Mots-clés : Gastrectomie prophylactique - Cancer gastrique diffus héréditaire - Mutation CDH1.
Assuntos
Mutação em Linhagem Germinativa , Neoplasias Gástricas , Gastrectomia , Predisposição Genética para Doença , Humanos , Mutação , Neoplasias Gástricas/genética , Neoplasias Gástricas/cirurgiaRESUMO
Since several decades, radiotherapy plays a crucial role in the management and local control of the rectal adenocarcinoma. The local recurrences pattern of the rectal tumor has completely changed with the systematic use of the Total Mesorectal Excision surgery (TME). In this context, the rate of radiotherapy needs to be reviewed. In this article we propose an overview of the main studies using radiotherapy in a pre- or post-operative setting in the context ofTME surgery. This will help to better define the indications of radiotherapy in rectal cancer.
Assuntos
Adenocarcinoma/radioterapia , Neoplasias Retais/radioterapia , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Humanos , Recidiva Local de Neoplasia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Resultado do TratamentoRESUMO
Age acts as a major risk factor of cancer. In the near future, with the aging of the population, we will treat more and more elderly patients with oncologic disease. Unfortunately, these patients are often excluded from randomized trials. How can we, therefore, define guidelines for this particular population of patients? Moreover, older patients often present multiple morbidities synchronously with the oncologic disease. This constellation of diseases makes the therapeutic strategy even more difficult. The highest incidence of rectal cancer is observed at 80 years old or above. This is significantly older than the mean age of the population included in clinical trials. Although, the prognosis of young patients with rectal cancer has improved over the past few decades, this is not the case for patients over 75 years old. A geriatric evaluation, as a part of a multidisciplinary approach, may allow to better select patient able to benefit from a combined treatment. Radiotherapy plays a crucial role in the treatment of rectal cancer. There are no solid data currently available on the real impact of radiotherapy on survival in an elderly population with rectal cancer. Do these patients really benefit from this treatment and what is the impact of radiotherapy on their quality of life? This review will try to give some answers to these important questions.
Assuntos
Guias de Prática Clínica como Assunto , Qualidade de Vida , Neoplasias Retais/radioterapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Humanos , Incidência , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Neoplasias Retais/epidemiologia , Neoplasias Retais/patologia , Fatores de Risco , Resultado do TratamentoRESUMO
OBJECTIVE: In this study, we have evaluated the organ procurement and transplantation activity from donors after cardiac death (DCD) at our institution over an 8-year period. Our aim was to determine whether this program influenced transplantation programs, or donation after brain death (DBD) activity. METHODS: We prospectively collected our procurement and transplantation statistics in a database for retrospective review. RESULTS: We observed an increasing trend in potential and actual DCD number. The mean conversion rate turning potential into effective donors was 58.1%. DCD accounted for 16.6% of the deceased donor (DD) pool over 8 years. The mean age for effective DCD donors was 53.9 years (range, 3-79). Among the effective donors, 63.3% (n = 31) came from the transplant center and 36.7% (n = 18) were referred from collaborative hospitals. All donors were Maastricht III category. The number of kidney and liver transplants using DCD sources tended to increase. DCD kidney transplants represented 10.8% of the DD kidney pool and DCD liver transplants made up 13.9% of the DD liver pool over 8 years. The DBD program activity increased in the same time period. In 2009, 17 DCD and 33 DBD procurements were performed in a region with a little >1 million inhabitants. CONCLUSION: The establishment of a DCD program in our institution enlarged the donor pool and did not compromise the development of the DBD program. In our experience, DCD are a valuable source for abdominal organ transplantation.
Assuntos
Morte , Doadores de Tecidos , Adulto , Idoso , Criança , Pré-Escolar , Feminino , História do Século XV , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
Colorectal cancer is the most frequent digestive cancer. Prognosis is greatly depending on the TNM stage at the time of diagnosis. Fifty percent of all patients shall develop, synchronously or metachronously, liver metastases. Different means such as chemotherapy, targeted therapies, radiofrequency ablation, portal vein embolization and two-stage hepatectomy may be used to make these metastases eventually resectable and to increase overall survival. This is a short review of these different methods used to increase resectability but also on the integration of these parameters in a larger approach of colorectal liver metastasis surgery especially insisting on multidisciplinary discussion.
Assuntos
Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , HumanosRESUMO
Short- and long-term results of liver transplantation in morbidly obese patients may be impaired compared with the general transplant population. As a consequence, severe obesity has been considered to be a relative contraindication to liver transplantation in many centers. Surgically, liver transplantation in severe obesity may be challenging. Moreover, obesity may lead to an increased rate of early and late medical complications. Herein we have reported successful liver transplantation in a super-obese patient (body mass index, 55.1 kg/m(2)) who had developed terminal acute-on-chronic liver disease. In the first 6 months of follow-up, the patient underwent a severe diet that led to a significant weight loss reduction to a body mass index of 39 kg/m(2). This report of successful liver transplantation in a super-obese patient suggests that severe obesity should not be considered to be an absolute contraindication to liver transplantation.
Assuntos
Cirrose Hepática/cirurgia , Transplante de Fígado/métodos , Obesidade Mórbida/cirurgia , Dieta Redutora , Feminino , Hepatite B/complicações , Hepatite B/cirurgia , Hérnia Abdominal/etiologia , Hérnia Abdominal/cirurgia , Humanos , Cirrose Hepática/virologia , Pessoa de Meia-Idade , Obesidade Mórbida/dietoterapia , Complicações Pós-Operatórias , Resultado do TratamentoRESUMO
Acute nocturnal and recurrent pain of the limb in children or "growing pains" constitute a poorly known pathological entity. Growing pains occur in 20% of children aged 2 to 12. The diagnosis is made after ruling out all organic pathology: inflammatory, infectious, post-infectious, traumatic, metabolic, tumoral, vascular, hematologic, orthopaedic and benign pathology of children. The treatment requires analgesics and soft massage.