Jean-Baptiste Delhorme

Treatment that follows guidelines closely dramatically improves overall survival of patients with anal canal and margin cancers

BACKGROUND To assess relevance of ESMO-ESSO-ESTRO treatment guidelines in a retrospective analysis of patients with anal canal or anal margin cancers. MATERIAL AND METHODS 155 patients were separated into standard treatment group (STG), treated according to or closely the guidelines, and an altered treatment group (ATG). RESULTS The median follow-up time was 50.7 months. In the STG, the 5- and 10-year LR-DFS rates were 75.2% and 72.7%; in the ATG, they were 66.8% and 61.2%, respectively. In the STG, the 5- and 10-year OS rates were 81.8% and 68%; in the ATG, they were 63.3% and 49.5%, respectively (p=0.037). In the multivariate analysis, favorable prognostic factors for OS included the standard treatment, age <60, tumor 50.4Gy. CONCLUSION This study identifies the superiority of treatment according to standard guidelines compared to altered treatment. Our results corroborate the guidelines.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei of appendicular and extra-appendicular origin: Treatment of appendicular and extra-appendicular pseudomyxoma peritonei

The prognostic value of the primary neoplasm responsible for pseudomyxoma peritonei (PMP) remains poorly studied. The aim of this study was to determine the prognosis for patients with extra‐appendicular PMP (EA‐PMP) treated optimally with complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Proposal of a new preliminary scoring tool for early identification of significant blunt bowel and mesenteric injuries in patients at risk after road traffic crashes

PurposeBlunt bowel and mesenteric injuries (BBMI) are regularly missed by abdominal computed tomography (CT) scans. The aim of this study was to develop a risk assessment tool for BBMI to help clinicians in decision-making for blunt trauma after road traffic crashes (RTCs).MethodsSingle-center retrospective study of trauma patients from January 2010 to April 2015. All patients admitted to our hospital after blunt trauma following RTCs and CT scan at admission were assessed.ResultsOf the 394 patients included, 78 (19.8%) required surgical exploration and 34 (43.6%) of these had a significant BBMI. A univariate and multivariate analysis were performed comparing patients with BBMI (n = 34) and patients without BBMI (n = 360). A score with a range from 0 to 13 was created. Scores from 8 to 9 were associated with 5–25% BBMI risk. The power of this new score ≥ 8 to predict a surgically significant BBMI had a sensitivity of 96%, specificity of 86.4%, positive predictive value (PPV) of 48% and negative predictive value (NPV) of 99.4%.ConclusionThis score could be a valuable tool for the management of blunt trauma patients after RTA without a clear indication for laparotomy but at risk for BBMI. The outcome of this study suggests selective diagnostic laparoscopy for a score ≥ 8 in obtunded patients and ≥ 10 in all other. To assess the value and accuracy of this new score, a prospective validation of these retrospective findings is due.

Surgery Is an Effective Option after Failure of Chemoradiation in Cancers of the Anal Canal and Anal Margin

Background: Surgery for anal canal cancer (ACC) and anal margin cancer (AMC) is the only curative option after failure of chemoradiotherapy (CRT). This study aimed to determine the efficacy of surgery for ACC or AMC after failed CRT. Methods: This was a single-centre, retrospective study of 161 patients initially treated with CRT. We compared the survival rates of patients successfully treated by CRT with those of patients whose CRT failed (both surgically salvaged and treated palliatively). Results: Thirty-one patients underwent surgery with curative intent, 20 received palliative treatment after failure of CRT, and 110 had effective CRT. The 5-year overall survival (OS) rate was significantly higher among patients with successful CRT than among patients who underwent surgery with curative intent (86 vs. 66%, p < 0.001). On the other hand, the 5-year OS of patients treated with curative surgery was significantly better than that of patients who underwent palliative treatment (66 vs. 13.5%, p < 0.001). The postoperative morbidity and mortality rates were 32 and 3%, respectively. Considering patients with failed CRT, curative surgery was the only factor prognostic of favourable OS in the multivariate analysis. Conclusion: Curative surgery after failure of CRT for ACC or AMC remains an effective treatment to improve survival in two-thirds of cases, resulting in high but manageable morbidity.

Prise en charge des fistules périanales dans la maladie de Crohn

Plus de 20 % des malades ayant une maladie de Crohn (MC) vont avoir une complication perineale durant le cours de leur maladie, en particulier une ou plusieurs fistules perianales. Ces fistules sont responsables de symptomes penibles et invalidants (douleurs anales, ecoulements, episodes d’incontinence, etc.) et exposent certains malades a des actes chirurgicaux radicaux comme une stomie de diversion ou encore une proctectomie. Malheureusement, la litterature est pauvre dans ce domaine, les etudes concernant souvent de faibles effectifs de malades et etant rarement prospectives controlees. Aujourd’hui, le diagnostic et l’evaluation de la severite des fistules perianales dans la MC repose essentiellement sur la combinaison d’une imagerie par resonance magnetique nucleaire (et/ou d’une echoendoscopie endorectale) et d’un examen sous anesthesie generale. Le traitement consiste, dans la grande majorite des situations, en la combinaison de traitements medicaux (en particulier les anticorps monoclonaux anti-TNF) et de certaines procedures chirurgicales qui doivent etre realisees avec prudence pour eviter d’eventuelles complications irreversibles. La decision therapeutique resulte essentiellement d’une discussion multidisciplinaire associant gastroenterologue, chirurgien digestif et radiologue. Les objectifs de cette mini-revue sont de resumer les donnees essentielles existant dans le domaine diagnostique et therapeutique de cette manifestation particulierement invalidante de la MC.