Guillaume Piessen

Oesophagogastric junction adenocarcinoma: which therapeutic approach?

Gastric and oesophageal cancers are among the leading causes of cancer-related death worldwide. By contrast with the decreasing prevalence of gastric cancer, incidence and prevalence of oesophagogastric junction adenocarcinoma (OGJA) are rising rapidly in developed countries. We provide an update about treatment strategies for resectable OGJA. Here we review findings from the latest randomised trials and meta-analyses, and propose guidelines regarding endoscopic, surgical, and perioperative treatments. Through a team approach, members from all diagnostic and therapeutic disciplines, such as gastroenterologists, surgeons, oncologists, radiologists, and radiotherapists, can effectively administer a range of treatment modalities.

Open versus laparoscopically-assisted oesophagectomy for cancer: a multicentre randomised controlled phase III trial - the MIRO trial

BackgroundOpen transthoracic oesophagectomy is the standard treatment for infracarinal resectable oesophageal carcinomas, although it is associated with high mortality and morbidity rates of 2 to 10% and 30 to 50%, respectively, for both the abdominal and thoracic approaches. The worldwide popularity of laparoscopic techniques is based on promising results, including lower postoperative morbidity rates, which are related to the reduced postoperative trauma. We hypothesise that the laparoscopic abdominal approach (laparoscopic gastric mobilisation) in oesophageal cancer surgery will decrease the major postoperative complication rate due to the reduced surgical trauma.Methods/DesignThe MIRO trial is an open, controlled, prospective, randomised multicentre phase III trial. Patients in study arm A will receive laparoscopic-assisted oesophagectomy, i.e., a transthoracic oesophagectomy with two-field lymphadenectomy and laparoscopic gastric mobilisation. Patients in study arm B will receive the same procedure, but with the conventional open abdominal approach. The primary objective of the study is to evaluate the major postoperative 30-day morbidity. Secondary objectives are to assess the overall 30-day morbidity, 30-day mortality, 30-day pulmonary morbidity, disease-free survival, overall survival as well as quality of life and to perform medico-economic analysis. A total of 200 patients will be enrolled, and two safety analyses will be performed using 25 and 50 patients included in arm A.DiscussionPostoperative morbidity remains high after oesophageal cancer surgery, especially due to major pulmonary complications, which are responsible for 50% of the postoperative deaths. This study represents the first randomised controlled phase III trial to evaluate the benefits of the minimally invasive approach with respect to the postoperative course and oncological outcomes in oesophageal cancer surgery.Trial RegistrationNCT00937456 (ClinicalTrials.gov)

Publishing in surgery: how and why?

IntroductionEvidence-based medicine continues to have an increasingly important impact on all surgical departments, with the art of publication becoming a skill in its own right and occupying an ever more central role. However, it remains a challenge for any surgeon to publish their work.PurposeThe aims of this educational review are to understand why, what and where surgeons should publish and to provide surgeons with a guide regarding the publication process and the rules to be adhered to.MethodologyThis review targets (1) any surgeon beginning their scientific publication activity, (2) more experienced surgeons who wish to optimise their ability to have their work published and finally (3) leaders of research departments who aspire to improve the quality of their publications and their research productivity and profile.

Obituary of Professor Christophe Mariette

It is with great sadness that we announce the death of Professor Christophe Mariette. OnWednesdaymorning, July 19th 2017, the Claude Huriez University Hospital gradually entered a state of somber astonishment. The news had spread over night; people already informed arrive at their posts, silent and shocked. The staff of his department was informed by his mentor, Professor Jean Pierre Triboulet; ChristopheMariette suddenly passed away on July 18th at the age of 47. Professor Mariette was the model of the modern surgeon, researcher, and a worldwide reference on upper gastrointestinal surgery. With brilliant spirit and sharp intelligence, he conceived and carried out several inspiring projects together with fellow surgeons and oncologists. His hard work, scientific rigor, and charismatic personality will stay inmemory for all who knew him. Born on November 16th 1969, Christophe studied medicine at the Necker Faculty of Medicine in Paris from 1987 to 1994 and was then appointed resident at the Lille University Hospital from 1994 to 2001. During his residency, he met Professor Jean-Pierre Triboulet who became his mentor. They developed a close collaboration and built a department dedicated to oncological, and more specifically to esophagogastric surgery. Appointed Senior Resident in 2001, he conducted a PhD thesis dedicated to carcinogenesis of esophageal adenocarcinoma, and obtained his PhD title in 2004. He then became Professor at the University of Lille in 2006 and was appointed Head of theDepartment ofDigestive andOncological Surgery in 2012 after the retirement of hismentor, Professor Triboulet. In clinical research just as in translational research and in everyday practice, the patient remained at the center of his concerns. On a regional level, Professor Mariette became the Coordinator of the ‘Integrated Research Center in Oncology: ONCOLille axe 1: resistance to locoregional treatments’, labeled by the French National Cancer Institute (INCa). On a national level, Professor Mariette’s innate dynamism and enthusiasm was the origin of the creation of the FRench EsoGastric Tumours (FREGAT) clinical network, promoting research in esogastric cancer in France since 2011. This network, associated with the FREGAT clinicobiological database∗, was funded by the French National Cancer Institute (INCa) in 2013 and opened in January 2015. It combines as of today 46 clinical teams from 33 hospitals in France. The FREGAT under his continuous leadership became one of the most successful esophagogastric project groups worldwide and has been internationally admired for its amazing productivity and scientific excellence. Professor Mariette was also a member of the French University National Council (CNU section 52.02) since 2012 and became its Chairman in 2014. Since 2013 he was Chairman of the French Federation of Surgical Research (FRENCH), in charge of the design of surgical national clinical trials and the teaching of clinical research methodology. In addition, Professor Mariette was a Member of the administrative council and Scientific Committee of the French Federation of Digestive Oncology (FFCD—PRODIGE), coordinating several clinical trials, and encouraging multidisciplinary collaboration between surgeons, oncologists, and related specialties. On an international scale, Professor Mariette was a member of several prestigious scientific societies, including the European Surgical Association (ESA), the European Society for Diseases of the Esophagus (ESDE, executive board member and treasurer since 2013), and the International Society for Diseases of the Esophagus (ISDE). He participated in the Editorial Board of several journals including the Annals of Surgery, Gastric Cancer, European Journal of Surgical Oncology, and Journal of Visceral Surgery. As