Christophe Penna

Colorectal metastasis (liver and lung)

Distant metastases are the major cause of death for colorectal carcinoma patients. Depending on the primary tumors stage, liver metastases occur in 20% to 70% of patients and lung metastases in 10% to 20%. Unlike many other cancers, the presence of distant metastases from colorectal cancer does not preclude curative treatment. Surgical resection remains the only treatment that can ensure long-term survival and cure in some patients, but only a minority of liver metastases are amenable to surgery. New treatment modalities including portal vein embolization, perioperative chemotherapy and local destruction with cryotherapy or radiofrequency ablation may make more patients suitable for surgical resection of hepatic metastases and may prolong survival in cases of nonresectabilitv. The availability of new active drugs has changed the treatment of liver metastases from colorectal cancer.

Surgical results of left lobectomy and left hepatectomy in 70 noncirrhotic patients: a preliminary evaluation before performing liver transplantation from living related donors

As a preliminary step before performing liver transplantation using living related donors, a comparative study was undertaken to determine the specific operative risk of left lobectomy (n = 54) compared to left hepatectomy (n = 16) in noncirrhotic patients. No postoperative death was observed in either group and no patients required reoperation. The mean hospital stay was longer after left hepatectomy than after left lobectomy (23 = 15 days vs 10 = 3 days, P < 0.05). The postoperative course was uneventful in 94 % of the patients after left lobectomy and in 44 % after left hepatectomy (P < 0.001). The peroperative transfusion rate was higher after left hepatectomy than after left lobectomy (38% vs 4%, P= 0.001). The postoperative collection rate was higher after left hepatectomy than after left lobectomy (25 % vs 6%, NS). No biliary fistulas or subphrenic abscesses were noted after left lobectomy; however, these were observed in 19% and 12% of the cases, respectively, after left hepatectomy. Although conventional liver resection is quite different from graft harvesting in living related transplantation, our study demonstrates that the morbidity rate is significantly higher after left hepatectomy than after left lobectomy.

The accuracy of preoperative imaging in measuring the length of the ileocolic segment affected by Crohn's disease: a prospective cohort study

The study aimed to evaluate the accuracy of imaging for measurement of the length of the ileocolic segment affected by Crohns disease.

Cancer du rectum avec métastases synchrones non résécables : les arguments du choix thérapeutique

Environ 4 000 patients sont pris en charge chaque annee en France pour un cancer du rectum avec des metastases synchrones jugees non resecables en reunion de concertation pluridisciplinaire (RCP). Il nexiste pas de consensus sur la strategie therapeutique a proposer et parmi les trois options possibles, les criteres de choix restent relativement imprecis. - La chirurgie premiere est certes le meilleur traitement pour controler les symptomes rectaux mais elle na pas demontre quelle augmentait la survie et la resecabilite secondaire des metastases par rapport aux autres options et comporte un risque de resection incomplete, de complications pouvant retarder ou empecher la chimiotherapie, de progression acceleree de la maladie metastatique et de mortalite comprise entre 1 et 5 %. - La radio-chimiotherapie premiere suivie dune chirurgie permet le controle des symptomes rectaux mais retarde la chimiotherapie pour les metastases qui dominent le pronostic ; elle expose aux memes risques de complications que la chirurgie premiere. - La chimiotherapie premiere nous parait interessante en absence de complications locales severes (occlusion, hemorragie) ; elle est potentiellement efficace sur les metastases a distance qui conditionnent le pronostic et sur la tumeur primitive qui repond souvent de maniere similaire ; elle ne fige pas la strategie et offre la possibilite de ladapter a chaque evaluation selon la reponse, la tolerance et les possibilites de resection (tumeur primitive et metastases). Dans tous les cas, il est fondamental de discuter ces dossiers au cas par cas en RCP pour adapter la strategie therapeutique aux caracteristiques du patient, de la tumeur primitive et de lextension metastatique, ainsi qua la reponse obtenue aux traitements proposes successivement.