63 results on '"Jonathan Garnier"'
Search Results
2. Impact on survival of sarcopenia, systemic inflammatory response and anthropometric factors after pancreatectomy for resectable pancreatic adenocarcinoma
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Kaja Balcer, Jonathan Garnier, Yasmina Richa, Christophe Bruneel-Zupanc, Guillaume Piessen, Olivier Turrini, Stephanie Truant, and Mehdi El Amrani
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Pancreatic adenocarcinoma ,Sarcopenia ,Systemic inflammatory response ,Obesity ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Introduction Pancreatic adenocarcinoma (PDAC) is becoming a public health issue with a 5-years survival rate around 10%. Patients with PDAC are often sarcopenic, which impacts postoperative outcome. At the same time, overweight population is increasing and adipose tissue promotes tumor related-inflammation. With several studies supporting independently these data, we aimed to assess if they held an impact on survival when combined. Methods We included 232 patients from two university hospitals (CHU de Lille, Institut Paoli Calmette), from January 2011 to December 2018, who underwent Pancreaticoduodenectomy (PD) for resectable PDAC. Preoperative CT scan was used to measure sarcopenia and visceral fat according to international cut-offs. Neutrophil to lymphocyte (NLR) and platelet to lymphocyte ratios (PLR) were used to measure inflammation. For univariate and multivariate analyses, the Cox proportional-hazard model was used. P-values below 0.05 were considered significant. Results Sarcopenic patients with visceral obesity were less likely to survive than the others in multivariate analysis (OS, HR 1.65, p= 0.043). Cutaneous obesity did not influence survival. We also observed an influence on survival when we studied sarcopenia with visceral obesity (OS, p= 0.056; PFS, p = 0.014), sarcopenia with cutaneous obesity (PFS, p= 0.005) and sarcopenia with PLR (PFS, p= 0.043). This poor prognosis was also found in sarcopenic obese patients with high PLR (OS, p= 0.05; PFS, p= 0.01). Conclusion Sarcopenic obesity was associated with poor prognosis after PD for PDAC, especially in patients with systemic inflammation. Pre operative management of these factors should be addressed in pancreatic cancer patients. more...
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- 2024
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3. Diagnostic Accuracy of Lipase as Early Predictor of Postoperative Pancreatic Fistula: Results from the LIPADRAIN study
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Béranger Doussot, MD, Alexandre Doussot, MD, PhD, Ahmet Ayav, MD, PhD, Nicolas Santucci, MD, Sophie Deguelte, MD, Amadou Khalilou Sow, MD, Mehdi El Amrani, MD, PhD, Laurence Duvillard, MD, PhD, Guillaume Piessen, MD, PhD, Edouard Girard, MD, PhD, Jean-Yves Mabrut, MD, PhD, Jonathan Garnier, MD, PhD, Pablo Ortega-Deballon, MD, PhD, Isabelle Fournel, MD, PhD, and Olivier Facy, MD, PhD more...
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Surgery ,RD1-811 - Abstract
Objective:. To evaluate the diagnostic accuracy of drain fluid lipase as an early predictor of postoperative pancreatic fistula and establish the most appropriate day for their measure. Background:. Clinically relevant postoperative pancreatic fistula remains a potentially life-threatening complication after pancreatic surgery. Early detection strategies remain key to reduce both the incidence and the burden of pancreatic fistula. Methods:. The LIPAse DRAIN (LIPADRAIN) study is a multicenter, prospective diagnostic study conducted in 7 tertiary university hospitals. Drain fluid values to detect clinically relevant postoperative pancreatic fistula from postoperative day 1 to postoperative day 6 were evaluated using receiver operating characteristic curve analysis. A biomarker was considered to be relevant for clinical use if its area under the curve (AUC) was greater than 0.75. Results:. Of the 625 patients included in the analysis, clinically relevant postoperative pancreatic fistula occurred in 203 (32%) patients. On postoperative days 3 and 4, drain fluid lipase was a reliable biomarker to detect clinically relevant postoperative pancreatic fistula (AUC: 0.761; 95% confidence interval [CI]: 0.761–0.799 and AUC: 0.784; 95% CI: 0.743–0.821, respectively). On postoperative day 3, with a threshold of 299 units/L, drain fluid lipase yielded a negative predictive value of 51%, sensitivity of 78%, and specificity of 63% for the detection of clinically relevant postoperative pancreatic fistula. Conclusions:. In this multicenter prospective study, drain fluid lipase is a reliable biomarker at postoperative days 3 and 4 for the diagnosis of clinically relevant postoperative pancreatic fistula after pancreatic surgery and should be systematically measured on postoperative day 3. more...
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- 2024
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4. Management and outcomes of brain metastases from pancreatic adenocarcinoma: a pooled analysis and literature review
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Etienne Gouton, Marine Gilabert, Simon Launay, Elika Loir, Marguerite Tyran, Philippe Rochigneux, Olivier Turrini, Jonathan Garnier, Emmanuel Mitry, and Brice Chanez
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pancreatic cancer ,brain metastases ,brain surgery ,machine learning ,data mining ,big data ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundBrain metastases (BM) are rare in pancreatic ductal adenocarcinoma (PDAC) and little data exists concerning these patients and their outcomes.AimWe aimed to analyze the management, practices, and outcomes of patients presenting BM from PDAC both in our institution and in all cases reported in the literature.MethodsWe conducted a retrospective, monocentric analysis using a data mining tool (ConSoRe) to identify all patients diagnosed with PDAC and BM in our comprehensive cancer center (Paoli-Calmettes Institute), from July 1997 to June 2022 (cohort 1). Simultaneously, we reviewed and pooled the case reports and case series of patients with PDAC and BM in the literature (cohort 2). The clinical characteristics of patients in each cohort were described and survival analyses were performed using the Kaplan-Meier method.ResultsIn cohort 1, 19 patients (0.3%) with PDAC and BM were identified with a median age of 69 years (range: 39-81). Most patients had metastatic disease (74%), including 21% with BM, at diagnosis. Lung metastases were present in 58% of patients. 68% of patients had neurological symptoms and 68% were treated by focal treatment (surgery: 21%, radiotherapy: 42%, Gamma Knife radiosurgery: 5%). In cohort 2, among the 61 PDAC patients with BM described in the literature, 59% had metastatic disease, including 13% with BM at diagnosis. Lung metastases were present in 36% of patient and BM treatments included: surgery (36%), radiotherapy (36%), radiosurgery (3%), or no local treatment (25%). After the pancreatic cancer diagnosis, the median time to develop BM was 7.8 months (range: 0.0-73.9) in cohort 1 and 17.0 months (range: 0.0-64.0) in cohort 2. Median overall survival (OS) in patients of cohort 1 and cohort 2 was 2.9 months (95% CI [1.7,4.0]) and 12.5 months (95% CI [7.5,17.5]), respectively.ConclusionBM are very uncommon in PDAC and seem to occur more often in younger patients with lung metastases and more indolent disease. BM are associated with poor prognosis and neurosurgery offers the best outcomes and should be considered when feasible. more...
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- 2024
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5. An optimised liver-first strategy for synchronous metastatic rectal cancer leads to higher protocol completion and lower surgical morbidity
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Julien Bonnet, Hélène Meillat, Jonathan Garnier, Serge Brunelle, Jacques Ewald, Anaïs Palen, Cécile de Chaisemartin, Olivier Turrini, and Bernard Lelong
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Rectal adenocarcinoma ,Synchronous liver metastases ,Liver-first ,Rectal preservation ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Introduction The optimal management of rectal cancer with synchronous liver metastases remains debatable. Thus, we propose an optimised liver-first (OLF) strategy that combines concomitant pelvic irradiation with hepatic management. This study aimed to evaluate the feasibility and oncological quality of the OLF strategy. Materials and methods Patients underwent systemic neoadjuvant chemotherapy followed by preoperative radiotherapy. Liver resection was performed in one step (between radiotherapy and rectal surgery) or in two steps (before and after radiotherapy). The data were collected prospectively and analysed retrospectively as intent to treat. Results Between 2008 and 2018, 24 patients underwent the OLF strategy. The rate of treatment completion was 87.5%. Three patients (12.5%) did not proceed to the planned second-stage liver and rectal surgery because of progressive disease. The postoperative mortality rate was 0%, and the overall morbidity rates after liver and rectal surgeries were 21% and 28.6%, respectively. Only two patients developed severe complications. Liver and rectal complete resection was performed in 100% and 84.6%, respectively. A rectal-sparing strategy was performed in 6 patients who underwent local excision (n = 4) or a watch and wait strategy (n = 2). Among patients who completed treatment, the median overall and disease-free survivals were 60 months (range 12–139 months) and 40 months (range 10–139 months), respectively. Eleven patients (47.6%) developed recurrence, among whom five underwent further treatment with curative intent. Conclusion The OLF approach is feasible, relevant, and safe. Organ preservation was feasible for a quarter of patients and may be associated with reduced morbidity. more...
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- 2023
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6. A single-center experience with pancreatic cystic neuroendocrine tumors
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Ange Khalil, Jacques Ewald, Ugo Marchese, Aurélie Autret, Jonathan Garnier, Patricia Niccoli, Gilles Piana, Flora Poizat, Marc Giovannini, Jean-Robert Delpero, and Olivier Turrini
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Pancreatic neuroendocrine tumor ,Survival ,Cystic component ,Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Pancreatic neuroendocrine tumors (PNET) are rare, with a significant malignant potential. This study aimed to determine outcomes of patients with resected PNETs according to the cystic component and confirm the accuracy of preoperative staging. Methods From 1997 to 2016, 106 patients underwent resection of PNETs, including 73 purely solid (S-PNETs, 69%), 21 mixed (M-PNETs, 20%), and 12 purely cystic lesions (C-PNETs, 11%). To ensure consistent comparisons of overall (OS) and disease-free (DFS) survival outcomes between the 3 groups, the patients were matched according to the World Health Organization (WHO) grade and tumor height. Results Overall, the rate of correlation between the preoperative and pathological diagnoses was low in the C-PNET group (33%, P = 0.03). None of the 24 patients (23%) with metastatic disease at the time of surgery were in the C-PNET group. Furthermore, significantly more parenchyma-sparing resections (P = 0.039) and fewer enlarged resections (P = 0.019) were achieved in the C-PNET group. C-PNET group had a significantly lower node invasion rate than the S-PNET and M-PNET groups (8% vs. 41% and 24%, P = 0.004). Although median OS was comparable in all 3 groups before (P = 0.3) and after (P = 0.18) matching, higher median DFS was observed in the C-PNET group than in the other groups after matching (P = 0.038). Conclusion C-PNET was associated with a better prognosis than PNET with a solid component. The results support a wait-and-see policy in cases wherein a reliable preoperative diagnosis remains challenging. more...
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- 2020
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7. Outcomes of patients with initially locally advanced pancreatic adenocarcinoma who did not benefit from resection: a prospective cohort study
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Jonathan Garnier, Jacques Ewald, Ugo Marchese, Marine Gilabert, Simon Launay, Laurence Moureau-Zabotto, Flora Poizat, Marc Giovannini, Jean-Robert Delpero, and Olivier Turrini
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Pancreatic cancer ,Locally advanced ,Chemotherapy ,Chemoradiation ,Survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background The current study aimed to evaluate the outcomes of patients with unresectable non-metastatic locally advanced pancreatic adenocarcinoma (LAPA) who did not benefit from resection considering the treatment strategy in the clinical settings. Methods Between 2010 and 2017, a total of 234 patients underwent induction chemotherapy for LAPA that could not be treated with surgery. After oncologic restaging, continuous chemotherapy or chemoradiation (CRT) was decided for patients without metastatic disease. The Kaplan–Meier method was used to determine overall survival (OS), and the Wilcoxon test to compare survival curves. Multivariate analysis was performed using the stepwise logistic regression method. Results FOLFIRINOX was the most common induction regimen (168 patients, 72%), with a median of 6 chemotherapy cycles and resulted in higher OS, compared to gemcitabine (19 vs. 16 months, hazard ratio (HR) = 1.2, 95% confidence interval: 0.86–1.6, P = .03). However, no difference was observed after adjusting for age (≤75 years) and performance status score (0–1). At restaging, 187 patients (80%) had non-metastatic disease: CRT was administered to 126 patients (67%) while chemotherapy was continued in 61 (33%). Patients who received CRT had characteristics comparable to those who continued with chemotherapy, with similar OS. They also had longer progression-free survival (median 13.3 vs. 9.6 months, HR = 1.38, 95% confidence interval: 1–1.9, P more...
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- 2020
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8. Effect of clinical status on survival in patients with borderline or locally advanced pancreatic adenocarcinoma
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Pauline Duconseil, Jonathan Garnier, Victoria Weets, Jacques Ewald, Ugo Marchese, Marine Gilabert, Laurence Moureau-Zabotto, Flora Poizat, Marc Giovannini, Jean-Robert Delpero, and Olivier Turrini
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Surgery ,RD1-811 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Objective To determine the effect of clinical status (weight variation and performance status [PS]) at diagnosis and during induction treatment on resectability and overall survival (OS) rates in patients with borderline resectable (BRPC) or locally advanced pancreatic cancer (LAPC). Methods From 2005 to 2017, 454 consecutive patients were diagnosed with LAPC or BRPC. We evaluated the PS (0–1 or 2–3), body mass index at diagnosis, and weight loss (WL) > 5% at initial staging and after induction treatment and separated continuous weight loss (CWL) from weight stabilization. Results A total of 294 patients (64.8%) presented with WL, and 57 patients (12.6%) presented with a PS of 2–3. At restaging, 60 patients (13.2%) presented with CWL. Independent factors that poorly influenced the OS were a PS of 2–3 at diagnosis (P < .01), CWL at restaging (P < .01), and absence of resection (P < .01). Factors independently impeding resection were LAPC (P < .01), PS > 1 at diagnosis (P < .01), and CWL (P = .01). In total, 142 patients (31.3%) underwent pancreatectomy. Independent factors that poorly influenced the OS in the resected group were PS > 0 at diagnosis (P = .01) and obesity (P < .01). For the 312 unresected cancer patients (68.7%), CWL (P < .01) was identified as an independent factor that poorly influenced the OS. Conclusion Clinical parameters that are easy to measure and monitor are independent factors of poor prognosis. The variation of weight during the induction treatment, more than WL at diagnosis, significantly precluded resection and was an independent factor of shorter OS in unresected patients. more...
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- 2019
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9. Aspiration pneumonia following oncologic digestive surgery: Proposal for a classification
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Jonathan Garnier, Djamel Mokart, Jacques Ewald, Bernard Lelong, Cecile De Chaisemartin, Ugo Marchese, Helene Meillat, Jerome Guiramand, Abdallah Al Faraï, Jean‐Robert Delpero, and Olivier Turrini
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Medicine - Published
- 2021
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10. Pancreatic Adenocarcinoma Therapeutic Targets Revealed by Tumor-Stroma Cross-Talk Analyses in Patient-Derived Xenografts
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Rémy Nicolle, Yuna Blum, Laetitia Marisa, Celine Loncle, Odile Gayet, Vincent Moutardier, Olivier Turrini, Marc Giovannini, Benjamin Bian, Martin Bigonnet, Marion Rubis, Nabila Elarouci, Lucile Armenoult, Mira Ayadi, Pauline Duconseil, Mohamed Gasmi, Mehdi Ouaissi, Aurélie Maignan, Gwen Lomberk, Jean-Marie Boher, Jacques Ewald, Erwan Bories, Jonathan Garnier, Anthony Goncalves, Flora Poizat, Jean-Luc Raoul, Veronique Secq, Stephane Garcia, Philippe Grandval, Marine Barraud-Blanc, Emmanuelle Norguet, Marine Gilabert, Jean-Robert Delpero, Julie Roques, Ezequiel Calvo, Fabienne Guillaumond, Sophie Vasseur, Raul Urrutia, Aurélien de Reyniès, Nelson Dusetti, and Juan Iovanna more...
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patient-derived xenograft ,pancreatic ductal adenocarcinoma ,genomics ,transcriptomics ,molecular subtypes ,tumor microenvironment ,Biology (General) ,QH301-705.5 - Abstract
Preclinical models based on patient-derived xenografts have remarkable specificity in distinguishing transformed human tumor cells from non-transformed murine stromal cells computationally. We obtained 29 pancreatic ductal adenocarcinoma (PDAC) xenografts from either resectable or non-resectable patients (surgery and endoscopic ultrasound-guided fine-needle aspirate, respectively). Extensive multiomic profiling revealed two subtypes with distinct clinical outcomes. These subtypes uncovered specific alterations in DNA methylation and transcription as well as in signaling pathways involved in tumor-stromal cross-talk. The analysis of these pathways indicates therapeutic opportunities for targeting both compartments and their interactions. In particular, we show that inhibiting NPC1L1 with Ezetimibe, a clinically available drug, might be an efficient approach for treating pancreatic cancers. These findings uncover the complex and diverse interplay between PDAC tumors and the stroma and demonstrate the pivotal role of xenografts for drug discovery and relevance to PDAC. more...
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- 2017
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11. LATE POSTPANCREATICODUODENECTOMY HEMORRHAGE: INCIDENCE, RISK FACTORS, MANAGEMENT AND OUTCOME
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Mathieu, Jacquemin, Djamel, Mokart, Marion, Faucher, Jacques, Ewald, Maxime, Tourret, Clément, Brun, Marie, Tezier, Damien, Mallet, Lam, Nguyen Duong, Sylvie, Cambon, Camille, Pouliquen, Florence, Ettori, Antoine, Sannini, Frédéric, Gonzalez, Magali, Bisbal, Laurent, Chow-Chine, Luca, Servan, Jean Manuel, de Guibert, Jean Marie, Boher, Olivier, Turrini, and Jonathan, Garnier more...
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Risk Factors ,Incidence ,Sepsis ,Clinical Studies as Topic ,Emergency Medicine ,Humans ,Hemorrhage ,Critical Care and Intensive Care Medicine ,Retrospective Studies - Abstract
Background:Postpancreaticoduodenectomy (PD) hemorrhage (PPH) is a life-threatening complication after PD. The main objective of this study was to evaluate incidence and factors associated with late PPH as well as the management strategy and outcomes. Methods: Between May 2017 and March 2020, clinical data from 192 patients undergoing PD were collected prospectively in the CHIRPAN Database (NCT02871336) and retrospectively analyzed. In our institution, all patients scheduled for a PD are routinely admitted for monitoring and management in intensive/intermediate care unit (ICU/IMC). Results: The incidence of late PPH was 17% (32 of 192), whereas the 90-day mortality rate of late PPH was 19% (6 of 32). Late PPH was associated with 90-day mortality (P = 0.001). Using multivariate analysis, independent risk factors for late PPH were postoperative sepsis (P = 0.036), and on day 3, creatinine (P = 0.025), drain fluid amylase concentration (P = 0.023), lipase concentration (P0.001), and C-reactive protein (CRP) concentration (P0.001). We developed two predictive scores for PPH occurrence, the PANCRHEMO scores. Score 1 was associated with 68.8% sensitivity, 85.6% specificity, 48.8% predictive positive value, 93.2% negative predictive value, and an area under the receiver operating characteristic curves of 0.841. Score 2 was associated with 81.2% sensitivity, 76.9% specificity, 41.3% predictive positive value, 95.3% negative predictive value, and an area under the receiver operating characteristic curve of 0.859. Conclusions: Routine ICU/IMC monitoring might contribute to a better management of these complications. Some predicting factors such as postoperative sepsis and biological markers on day 3 should help physicians to determine patients requiring a prolonged ICU/IMC monitoring. more...
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- 2022
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12. ASO Author Reflections: How to Tackle the Vascular Risk of Celiac Axis Resection for Pancreatic Cancer?
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Jonathan Garnier and Olivier Turrini
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Oncology ,Surgery - Published
- 2023
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13. ASO Visual Abstract: Two-Stage Class Ia Celiac Axis Resection with Superior Mesenteric Vein Reconstruction
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Jonathan Garnier, Anaïs Palen, Vincent Niziers, Emilien Mauny, Jean Izaaryene, Jacques Ewald, Jean-Robert Delpero, and Olivier Turrini
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Oncology ,Surgery - Published
- 2023
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14. Two-Stage Class Ia Celiac Axis Resection with Superior Mesenteric Vein Reconstruction
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Jonathan Garnier, Anaïs Palen, Vincent Niziers, Emilien Mauny, Jean Izaaryene, Jacques Ewald, Jean-Robert Delpero, and Olivier Turrini
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Oncology ,Surgery - Published
- 2023
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15. Establishment and external validation of neutrophil-to-lymphocyte ratio in excluding postoperative pancreatic fistula after pancreatoduodenectomy
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Jonathan Garnier, Marie-Sophie Alfano, Fabien Robin, Jacques Ewald, Abdallah Al Farai, Anais Palen, Amine Sebai, Djamel Mokart, Jean-Robert Delpero, Laurent Sulpice, Christophe Zemmour, and Olivier Turrini more...
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General Medicine - Abstract
Background Factors excluding postoperative pancreatic fistula (POPF), facilitating early drain removal and hospital discharge represent a novel approach in patients undergoing enhanced recovery after pancreatic surgery. This study aimed to establish the relevance of neutrophil-to-lymphocyte ratio (NLR) in excluding POPF after pancreatoduodenectomy (PD). Methods A prospectively maintained database of patients who underwent PD at two high-volume centres was used. Patients were divided into three cohorts (training, internal, and external validation). The primary endpoints of this study were accuracy, optimal timing, and cutoff values of NLR for excluding POPF after PD. Results From 2012 to 2020, in a 2:1 ratio, 451 consecutive patients were randomly sampled as training (n = 301) and validation (n = 150) cohorts. Additionally, the external validation cohort included 197 patients between 2018 and 2020. POPF was diagnosed in 135 (20.8 per cent) patients. The 90-day mortality rate was 4.1 per cent. NLR less than 8.5 on postoperative day 3 (OR, 95 per cent c.i.) was significantly associated with the absence of POPF in the training (2.41, 1.19 to 4.88; P = 0.015), internal validation (5.59, 2.02 to 15.43; P = 0.001), and external validation (5.13, 1.67 to 15.76; P = 0.004) cohorts when adjusted for relevant clinical factors. Postoperative outcomes significantly differed using this threshold. Conclusion NLR less than 8.5 on postoperative day 3 may be a simple, independent, cost-effective, and easy-to-use criterion for excluding POPF. more...
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- 2023
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16. Double purse-string telescoped pancreaticogastrostomy is not superior in preventing pancreatic fistula development in high-risk anastomosis: a 6-year single-center case–control study
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Anaïs Palen, Jean-Robert Delpero, Djamel Mokart, Ugo Marchese, Olivier Turrini, Gilles Piana, Jonathan Garnier, Jacques Ewald, Département de Chirurgie Oncologique [Institut Paoli-Calmettes, Marseille], Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Institut J. Paoli-I. Calmettes more...
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medicine.medical_specialty ,Fistula ,Octreotide ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Anastomosis ,Single Center ,Pancreaticoduodenectomy ,Pancreatic Fistula ,Postoperative Complications ,Pancreaticojejunostomy ,Humans ,Medicine ,ComputingMilieux_MISCELLANEOUS ,Pancreatic duct ,business.industry ,Incidence (epidemiology) ,Mortality rate ,Anastomosis, Surgical ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Pancreatic fistula ,Case-Control Studies ,business ,medicine.drug - Abstract
PURPOSE The double purse-string telescoped pancreaticogastrostomy (PG) technique has been suggested as an alternative approach to reduce the risk of postoperative pancreatic fistula (POPF). Its efficacity in high-risk situations has not yet been explored. This study compared the incidence of clinically relevant POPF (CR-POPF) between patients with high-risk anastomosis undergoing PG and those undergoing pancreaticojejunostomy (PJ). METHODS From 2013 to 2019, 198 consecutive patients with high-risk anastomosis, an updated alternative fistula risk score > 20%, and who underwent pancreatoduodenectomy with the PJ (165) or PG (33) technique were included. Optimal mitigation strategy (external stenting/octreotide omission) was applied for all patients. The primary endpoint was the incidence of CR-POPF. RESULTS The mean ua-FRS was 33%. CR-POPF (grade B/C) was found in 42 patients (21%) and postoperative hemorrhage in 30 (15%); the mortality rate was 4%. CR-POPF rates were comparable between the PJ (19%) and PG (33%) groups (P = 0.062). The PG group had a higher rate of POPF grade C (24% vs. 10%; P = 0.036), longer operative time (P = 0.019), and a higher transfusion rate (P more...
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- 2021
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17. Postoperative day 1 combination of serum C-reactive protein and drain amylase values predicts risks of clinically relevant pancreatic fistula. The '90-1000' score
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Edouard Girard, Olivier Turrini, Jonathan Garnier, David Jérémie Birnbaum, O. Risse, Mircea Chirica, Théophile Guilbaud, Vincent Moutardier, and Jacques Ewald
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Gastroenterology ,Pancreatic Fistula ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Prospective Studies ,Amylase ,Pancreas ,Aged ,Pancreatic duct ,biology ,Receiver operating characteristic ,business.industry ,C-reactive protein ,Gold standard (test) ,Middle Aged ,medicine.disease ,Multivariate logistic regression model ,C-Reactive Protein ,medicine.anatomical_structure ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Amylases ,biology.protein ,Female ,Surgery ,France ,business - Abstract
Several scoring systems predict risks of clinically relevant postoperative pancreatic fistula after pancreatectomy, but none have emerged as the gold standard. This study aimed to evaluate the accuracy of postoperative day 1 drain amylase and serum C-reactive protein levels in predicting clinically relevant postoperative pancreatic fistula compared with intraoperative pancreatic characteristics.Patients who underwent pancreatectomy between 2017 and 2019 were included prospectively. Cutoff values were determined using receiver operating characteristic curves, and a score combining postoperative day 1 drain amylase and serum C-reactive protein was tested in a multivariate logistic regression model to evaluate clinically relevant postoperative pancreatic fistula risk.A total of 274 pancreatic resections (182 pancreaticoduodenectomies and 92 distal pancreatectomies) were included. The pancreatic gland texture was "soft" in 47.8% (n = 131), and 55.8% (n = 153) had a small size main pancreatic duct (≤3 mm). Clinically relevant postoperative pancreatic fistula occurred in 58 patients (21.2%). Drain amylase ≥1,000 UI/L and serum C-reactive protein ≥90 mg/L were identified as the optimal cutoffs to predict clinically relevant postoperative pancreatic fistula. On multivariate analysis these cutoffs were independent predictors of clinically relevant postoperative pancreatic fistula after both pancreaticoduodenectomies (drain amylase: P.001, serum C-reactive protein: P = .006) and distal pancreatectomies (drain amylase: P = .009, serum C-reactive protein: P = .001). The postoperative day 1 "90-1000" model, a 2-value score relying on these cutoffs, significantly (P.001) outperformed intraoperative pancreatic parenchymal characteristics in predicting clinically relevant postoperative pancreatic fistula after both pancreaticoduodenectomies and distal pancreatectomies. A postoperative day 1 "90-1000" score = 0 had a negative predictive value of 97% and 94%, respectively, after pancreaticoduodenectomy and distal pancreatectomies.A combined score relying on postoperative day 1 values of drain amylase and serum C-reactive protein levels was accurate in predicting risks of clinically relevant postoperative pancreatic fistula after pancreatectomy. more...
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- 2021
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18. Standardized salvage completion pancreatectomy for grade C postoperative pancreatic fistula after pancreatoduodenectomy (with video)
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Jean-Robert Delpero, Olivier Turrini, Jacques Ewald, Ugo Marchese, Jonathan Garnier, Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC) more...
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medicine.medical_specialty ,medicine.medical_treatment ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,030230 surgery ,Anastomosis ,Pancreaticoduodenectomy ,Pancreatic Fistula ,03 medical and health sciences ,Standardized technique ,Pancreatectomy ,Postoperative Complications ,0302 clinical medicine ,Blood loss ,Pancreaticojejunostomy ,medicine.artery ,medicine ,Humans ,Superior mesenteric artery ,Pancreas ,ComputingMilieux_MISCELLANEOUS ,Retrospective Studies ,Hepatology ,business.industry ,Gastroenterology ,Perioperative ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Pancreatic fistula ,030220 oncology & carcinogenesis ,business - Abstract
Background Emergency completion pancreatectomy (CP) after pancreatoduodenectomy (PD) is a technically demanding procedure. We report our experiences with a four-step standardized technique used at our center since 2012. Methods In the first step, the gastrojejunostomy is divided with a stapler to quickly access the pancreatic anastomosis and permit adequate exposure, especially in cases of active bleeding. Second, the bowel loops connected to the pancreatic anastomosis is divided in cases of pancreaticojejunostomy. Third, the pancreatectomy is completed with or without the splenic vessels and spleen conservation according to the local conditions. Finally, the fourth step reconstructs in a Roux-en-Y fashion and ensures drainage. Results From January 2012 to December 2019, 450 patients underwent PD at our center. Reintervention for grade C postoperative pancreatic fistula was decided for 30 patients, and CP was performed in 21 patients. The mean intraoperative blood loss and operative duration were relatively low (600 ml and 240 min, respectively). During the perioperative period, three patients died from multiple organ failure, and two patients died intraoperatively from a cataclysmic hemorrhage originating from the superior mesenteric artery. Discussion Our standardized procedure appears to be relatively safe, reproducible, and could be particularly useful for young surgeons. more...
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- 2021
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19. Effect of the Use of Reinforced Stapling on the Occurrence of Pancreatic Fistula After Distal Pancreatectomy: Results of the REPLAY (REinforcement of the Pancreas in distaL pAncreatectomY) Multicenter Randomized Clinical Trial
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Aude Merdrignac, Jonathan Garnier, Safi Dokmak, Nicolas Regenet, Mickaël Lesurtel, Jean Yves Mabrut, Antonio Sa Cunha, David Fuks, Damien Bergeat, Fabien Robin, Estelle Le Pabic, Karim Boudjema, Olivier Turrini, Bruno Laviolle, and Laurent Sulpice more...
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Pancreatic Fistula ,Pancreatectomy ,Postoperative Complications ,Risk Factors ,Humans ,Surgery ,Prospective Studies ,Pancreas - Abstract
The aim of the study was to evaluate the impact of the use of a reinforced stapler (RS) during distal pancreatectomy (DP) on postoperative outcomes.DP remains associated with significant postoperative morbidity owing to pancreatic fistula (PF). To date, there is no consensus on the management of the pancreatic stump. The use of an RS potentially represents a simple way to decrease the rate of PF.The REPLAY study (NCT03030170) is a prospective, multicenter, randomized study. Patients who underwent DP were randomized (1:1 ratio) in 2 groups for the use of a standard stapler (SS) or an RS to close remnant pancreatic parenchyma. The primary endpoint was the rate of overall PF. Secondary endpoints included severity of PF, length of hospital stay, overall morbidity, and rate of readmission for a PF within 90 days. Participants were blinded to the procedure actually carried out.A total of 199 were analyzed (SS, n=99; RS, n=100). One patient who did not undergo surgery was excluded. Baseline characteristics were comparable in both groups. The rate of overall PF was higher in RS group (SS: 67.7%, RS: 83%, P =0.0121), but the rate of clinically relevant PF was similar (SS: 11.1%, RS: 14%, P =0.5387). Mean length of total hospital stay, readmission for PF, postoperative morbidity, and mortality at 90 days were similar.The results of this randomized clinical trial did not favor the use of RS during DP to reduce the rate of PF. more...
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- 2022
20. Pancreatectomy with Vascular Resection After Neoadjuvant FOLFIRINOX: Who Survives More Than a Year After Surgery?
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Laurent Sulpice, Ugo Marchese, Jacques Ewald, Jean-Robert Delpero, Damien Bergeat, Fabien Robin, Olivier Turrini, Karim Boudjema, Jonathan Garnier, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), CHU Pontchaillou [Rennes], Université de Rennes (UR), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES) more...
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retrospective study ,medicine.medical_treatment ,folfirinox ,030230 surgery ,vascular surgery ,fluorouracil ,granulocyte colony stimulating factor ,cause of death ,0302 clinical medicine ,hospital readmission ,Antineoplastic Combined Chemotherapy Protocols ,collateral circulation ,cancer survival ,ComputingMilieux_MISCELLANEOUS ,capecitabine ,low molecular weight heparin ,adult ,adjuvant therapy ,perineural invasion ,backache ,3. Good health ,adjuvant chemotherapy ,Oxaliplatin ,aged ,Oncology ,Pancreatic Ductal ,030220 oncology & carcinogenesis ,Pancreatectomy ,pancreas fistula ,Carcinoma, Pancreatic Ductal ,hospitalization ,neoadjuvant chemotherapy ,medicine.medical_specialty ,folinic acid ,heart infarction ,Article ,pancreas tumor ,multiple cycle treatment ,proper hepatic artery ,03 medical and health sciences ,cancer combination chemotherapy ,Adjuvant therapy ,neutropenia ,Humans ,human ,Retrospective Studies ,anticoagulant therapy ,tumor invasion ,Vascular surgery ,medicine.disease ,major clinical study ,body weight loss ,intensity modulated radiation therapy ,CA 19-9 antigen ,Pancreatic Neoplasms ,Surgery ,pancreaticoduodenectomy ,multiple organ failure ,FOLFIRINOX ,[SDV]Life Sciences [q-bio] ,hepatic artery ,gastric artery ,Leucovorin ,morbidity ,mortality rate ,heparin ,heparinization ,postoperative period ,chemoradiotherapy ,cancer mortality ,antineoplastic agent ,irinotecan ,Neoadjuvant therapy ,predictive value ,continuous infusion ,Pancreaticoduodenectomy ,Neoadjuvant Therapy ,female ,cancer surgery ,lung embolism ,overall survival ,failure to thrive ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,reoperation ,length of stay ,male ,medicine ,Carcinoma ,follow up ,controlled study ,peritonitis ,pancreas carcinoma ,business.industry ,postoperative inflammation ,postoperative hemorrhage ,pancreas adenocarcinoma ,lymph node ratio ,business ,Chemoradiotherapy - Abstract
International audience; Background: Experienced pancreatic surgeons, for whom complexity is not an issue, must decide at the end of neoadjuvant therapy whether to continue or discontinue surgery, when pancreatectomy with vascular resection is planned in patients with pancreatic ductal adenocarcinoma (PDAC). Objective: Our study aimed to determine preoperative factors that can predict short postoperative survival in such situations. Methods: Overall, 105 patients with borderline or locally advanced PDAC received neoadjuvant FOLFIRINOX (followed by chemoradiation in 22% of patients) and underwent pancreatectomy with segmental venous and/or arterial resection at two high-volume centers. The primary endpoint was overall survival (OS) of < 1 year after surgery for patients who did not die from the surgery. Results: Tumors were classified as borderline in 78% of cases and locally advanced in 22% of cases. Mean CA19-9 at diagnosis was 934 U/mL, which significantly decreased to 213 U/mL (p < 0.01) after a median of six cycles of FOLFIRINOX. Pancreaticoduodenectomy was performed most often (76%). The vast majority of patients underwent venous resection (92%), and a simultaneous arterial resection was performed in 16 patients (15%). The severe morbidity rate and 30- and 90-day mortality rates were 21%, 8.5%, and 10.4%, respectively. The median OS after surgery was 23 months. In the multivariate analysis, preoperative CA19-9 ≥ 450 U/mL was the only preoperative factor independently associated with OS of < 1 year (p = 0.044). Conclusion: The preoperative CA19-9 value should be considered in the clinical decision-making process when complex vascular resection is required. © 2021, Society of Surgical Oncology. more...
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- 2021
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21. Borderline or locally advanced pancreatic adenocarcinoma: A single center experience on the FOLFIRINOX induction regimen
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Jacques Ewald, Flora Poizat, Marc Giovannini, Ugo Marchese, Laurence Moureau-Zabotto, Olivier Turrini, Jean-Robert Delpero, Jonathan Garnier, and Marine Gilabert
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Adult ,Male ,medicine.medical_specialty ,FOLFIRINOX ,medicine.medical_treatment ,Leucovorin ,Locally advanced ,Irinotecan ,Single Center ,03 medical and health sciences ,0302 clinical medicine ,Pancreatic cancer ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Neoadjuvant therapy ,Aged ,Aged, 80 and over ,business.industry ,Mortality rate ,Induction Chemotherapy ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Oxaliplatin ,Pancreatic Neoplasms ,Regimen ,Oncology ,030220 oncology & carcinogenesis ,Adenocarcinoma ,Female ,030211 gastroenterology & hepatology ,Fluorouracil ,business ,Carcinoma, Pancreatic Ductal - Abstract
This study aimed to determine the impact of FOLFIRINOX neoadjuvant therapy on patients with non-metastatic borderline/locally advanced (BL/LA) pancreatic ductal adenocarcinoma (PDAC), in current practice.From 2010 to 2017, 258 patients with BL/LA PDAC from a single high-volume institution received FOLFIRINOX neoadjuvant treatment.The 258 patients received a median number of 6 cycles of FOLFIRINOX (range, 3-16); 98 (38%) patients underwent curative surgery, and 160 (62%) continued medical treatment. A venous resection was performed in 57 patients (58%), and an arterial resection in 12 (12%). The postoperative 30- and 90-day mortality rates were 6.1% and 8.2%, respectively. Adjuvant chemotherapy was performed in 57 patients (59%). The median overall survival (OS) in patients who did (n = 98) or did not (n = 160) undergo surgical resection were 39 months and 19 months, respectively (P 0.001). In resected patients, the ASA 3 score (P 0.01), venous resection (P 0.01), hemorrhage (P 0.01), and R1 margin status (P = 0.03) were found to negatively influence the OS. The median OS was significantly higher in patients who did not require a venous resection (not reached vs. 26.5 months, P 0.001).Neoadjuvant FOLFIRINOX provided a survival benefit in BL/LA PDAC patients, particularly in those who did not ultimately require venous resection. more...
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- 2020
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22. Has the non-resection rate decreased during the last two decades among patients undergoing surgical exploration for pancreatic adenocarcinoma?
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Catherine Mattevi, Jacques Ewald, Flora Poizat, Jean-Robert Delpero, Gilles Piana, Ugo Marchese, Olivier Turrini, Marine Gilabert, and Jonathan Garnier
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Adult ,Male ,medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,Staging ,medicine.medical_treatment ,Urology ,lcsh:Surgery ,030230 surgery ,Adenocarcinoma ,Resection ,Metastasis ,Liver MRI ,03 medical and health sciences ,0302 clinical medicine ,Pancreatectomy ,Pancreatic tumor ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,General Medicine ,lcsh:RD1-811 ,Middle Aged ,medicine.disease ,Diffusion-Weighted Magnetic Resonance Imaging ,Surgery ,Pancreatic Neoplasms ,Diffusion Magnetic Resonance Imaging ,030220 oncology & carcinogenesis ,Female ,Lymph ,business ,Pancreatic adenocarcinoma ,Research Article ,Carcinoma, Pancreatic Ductal ,CT - Abstract
Purpose To determine if improvement in imaging reduces the non-resection rate (NRR) among patients with pancreatic ductal adenocarcinoma (PDAC). Methods From 2000 to 2019, 751 consecutive patients with PDAC were considered eligible for a intention-to-treat pancreatectomy and entered the operating room. In April 2011, our institution acquired a dual energy spectral computed tomography (CT) scanner and liver diffusion weighted magnetic resonance imaging (DW-MRI) was included in the imaging workup. We consequently considered 2 periods of inclusion: period #1 (February 2000–March 2011) and period #2 (April 2011–August 2019). Results All patients underwent a preoperative CT scan with a median delay to surgery of 18 days. Liver DW-MRI was performed among 407 patients (54%). Median delay between CT and surgery decreased (21 days to 16 days, P P P P P P Conclusions Due to changes in our therapeutic strategies, the NRR did not decrease during two decades despite imaging improvement. more...
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- 2020
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23. Readmission after pancreaticoduodenectomy: Birmingham score validation
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Anaïs Palen, Jonathan Garnier, Jacques Ewald, Jean-Robert Delpero, and Olivier Turrini
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Hepatology ,Gastroenterology - Abstract
The Birmingham score predicts the risk of hospital readmission after pancreaticoduodenectomy (PD). This study aimed to validate the risk score in a different healthcare cohort.From 2017 to 2021, 301 patients underwent PD. The Birmingham score was applied to 276 patients. Postoperative deceased patients (n = 7) or those requiring a completion of pancreatectomy (n = 18) were excluded.Forty-seven (17%) patients were readmitted after a median delay of 9 (range 1-49) days and stayed for 5 (range 1-27) days; 4 (8.5%) died during the hospital stay. The leading cause of readmission was a septic condition (53%), mostly resolved by medical treatment (77%). A multivariate analysis identified the occurrence of a clinically relevant postoperative pancreatic fistula, the score criteria, and the score itself as independent factors favouring readmission. Readmission rates in patients with low [n = 97 (35%)], intermediate [n = 98 (36%)], and high [n = 81 (29%)] scores were 5%, 17%, and 31%, respectively (P 0.01).This study confirmed the relevance and robustness of the Birmingham risk score. Patients with a high risk of readmission after PD, identified based on the score, were discharged to a partnership medical centre close to the pancreatic centre to plan readmission and avoid futile unplanned hospitalisation. more...
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- 2022
24. Will Patients With Liver Metastasis From Aggressives Cancers Benefit From Surgical Resection?
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Abdallah Al Farai, Jonathan Garnier, Anais Palen, Jacques Ewald, Jean-Robert Delpero, Olivier Turrini, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS) more...
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Cancer Research ,Oncology ,[SDV]Life Sciences [q-bio] - Abstract
Background: We aimed to evaluate the outcomes of resections for liver metastases (LMs) originating from pancreatic ductal adenocarci-noma (PDAC), non-small cell lung cancer (NSCLC), and esophagus/ gastric cancers (EGCs), which we label as major killers (MKs; overall survival (OS) under 10%). We hypothesized that LM resection must provide the patient with almost a year of OS postoperatively that is considered beneficial. Methods: From January 2005 to December 2020, 23 patients under-went resection for isolated LM from MKs. These patients underwent surgery after a multidisciplinary discussion about their performance status, disease evolution during prolonged medical treatment, and the existence or absence of extrahepatic metastases. Results: LM originated from an PDAC, EGC, or NSCLC in 10 pa-tients (43%), nine patients (39%), and four patients (18%), respective-ly. The median delay between primary cancer and LM diagnoses was 12 months, and the median delay between LM diagnosis and liver re-section was 10 months. Most patients, who had objectively responded to medical treatment (57%), had a solitary (61%) and unilobar (70%) LM. Severe morbidity and 90-day mortality rates were 13% and 4.3%, respectively. Margin-free resection was achieved in 16 patients (70%). After liver resection, the median OS was 24 months without a statistical difference when considering the primary tumor site; 1, 3-, and 5-year OS were 70%, 23%, and 23%, respectively. Conclusion: Selection based on criteria such as good clinical condi-tion, response to treatment, and long observation period helped iden-tify patients with LM of MKs who seemed to benefit from resection. more...
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- 2022
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25. Relaparotomy for pancreatic fistula after pancreatoduodenectomy: timing is key: Reply to: Groen et al. (2021) Pancreas-preserving surgical interventions during relaparotomy for pancreatic fistula after pancreatoduodenectomy
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Jonathan, Garnier and Olivier, Turrini
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Reoperation ,Pancreatic Fistula ,Postoperative Complications ,Humans ,Pancreas ,Pancreaticoduodenectomy - Published
- 2021
26. Patient outcome according to the 2017 international consensus on the definition of borderline resectable pancreatic ductal adenocarcinoma
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Jean-Robert Delpero, Jacques Ewald, Jonathan Garnier, Marine Gilabert, Marc Giovannini, U. Marchese, S. Launay, Olivier Turrini, Flora Poizat, and J. Medrano
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Adult ,Male ,medicine.medical_specialty ,Consensus ,Pancreatic ductal adenocarcinoma ,FOLFIRINOX ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Leucovorin ,Irinotecan ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,Borderline resectable ,Regional lymph node metastasis ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Back pain ,Humans ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Hepatology ,Performance status ,business.industry ,Gastroenterology ,Induction chemotherapy ,Middle Aged ,Reference Standards ,Survival Analysis ,Oxaliplatin ,Pancreatic Neoplasms ,Treatment Outcome ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Fluorouracil ,Radiology ,medicine.symptom ,business ,Carcinoma, Pancreatic Ductal - Abstract
We evaluated the usefulness of the 2017 definition of borderline pancreatic ductal adenocarcinoma (BR-PDAC) in fit patients (performance status 0-1) based on anatomical (A) and biological dimensions (B).From 2011 to 2018, 139 resected patients with BR-PDAC according to the 2017 definition were included: 18 patients underwent upfront pancreatectomy (CA 19-9 500 U/mL and/or regional lymph node metastasis; BR-B group), and 121 received FOLFIRINOX (FX) induction chemotherapy and were divided into BR-A (CA 19-9 500 U/mL, no regional lymph node metastasis; n = 68) and BR-AB (CA 19-9 500 U/mL and/or regional lymph node metastasis; n = 53) groups.The 3 groups were comparable according to patient characteristics (except for back pain (P .01) and CA 19-9 (P .01)), intraoperative data, and postoperative courses. BR-AB patients required more venous resections (P .01). The 3 groups were comparable on pathologic findings, except that BR-B patients had more lymph node invasions (P = .02). Median overall survival (OS) of the 121 patients was 45 months. In multivariate analysis, venous resection (P = .039) and R1 resection (P = .012) were poorly linked with OS, whereas BR-A classification (P .01) independently favored OS. Median survival times of BR-A, BR-AB, and BR-B groups were undetermined, 27 months, and 20 months (P.001), respectively.The 2017 definition was relevant for sub-classifying patients with BR-PDAC. The anatomical dimension (BR-A) was a favorable prognostic factor, whereas the biological dimension (BR-AB and BR-B) poorly impacted survival. more...
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- 2020
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27. Is progression in the future liver remnant a contraindication for second-stage hepatectomy?
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Ugo Marchese, Olivier Turrini, Jean-Robert Delpero, Lionel Jouffret, Gilles Piana, Djamel Mokart, Jonathan Garnier, Jacques Ewald, and Marine Gilabert
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Male ,Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Gastroenterology ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Overall survival ,Hepatectomy ,Humans ,Medicine ,Stage (cooking) ,Contraindication ,Neoplasm Staging ,Retrospective Studies ,Hepatology ,business.industry ,Liver Neoplasms ,Disease progression ,Middle Aged ,medicine.disease ,Embolization, Therapeutic ,Survival Rate ,030220 oncology & carcinogenesis ,Portal vein embolization ,Disease Progression ,Female ,030211 gastroenterology & hepatology ,Colorectal Neoplasms ,business - Abstract
Two-stage hepatectomy (TSH) strategy is used to treat patients with bilobar colorectal liver metastasis (CLM). However, many patients do not undergo the second hepatectomy owing to disease progression in the future liver remnant (FLR) after portal vein embolization (PVE). This study aimed to assess the impact of disease progression in the FLRs of patients who completed the first hepatectomy.68 consecutive patients underwent the first hepatectomy followed by PVE. Six patients (9%) dropped out after the PVE (two-stage failed [TSF] group) because of unresectable hepatic or general disease progression. Seventeen patients (25%) completed their second hepatectomy despite disease progression in the FLR (new CLM [nCLM] group) as it was considered resectable, while 45 patients (66%) underwent the second hepatectomy (control group).The 5-year overall survival rates in the TSF, nCLM, and control groups were 0%, 7%, and 60%, respectively (P 0.001). The median overall survival times between the TSF and nCLM groups were 26 months and 42 months (P = 0.005). Patients in the nCLM group whose hepatic disease progression was detected preoperatively versus intraoperatively had comparable survival rates.Resectable hepatic disease progression in the FLR after PVE should not be considered a contraindication for the second hepatectomy. more...
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- 2019
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28. ASO Visual Abstract: Venous Reconstruction During Pancreatectomy Using Polytetrafluoroethylene Grafts: A Single-Center Experience with Standardized Perioperative Management
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Ugo Marchese, Jean-Robert Delpero, Eddy Traversari, Jacques Ewald, Olivier Turrini, Jonathan Garnier, Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC) more...
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medicine.medical_specialty ,Polytetrafluoroethylene ,Perioperative management ,business.industry ,medicine.medical_treatment ,MEDLINE ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Single Center ,Surgery ,chemistry.chemical_compound ,Oncology ,chemistry ,Surgical oncology ,Pancreatectomy ,medicine ,business ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
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- 2021
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29. The iPhone, the reflex, and the vinyl record: is the smartphone taking the best intraoperative photographs?
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Anaïs Palen, Jonathan Garnier, Jacques Ewald, Olivier Turrini, Jean Robert Delpero, Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC) more...
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Visual Arts and Performing Arts ,Computer science ,Photography ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Health Professions (miscellaneous) ,Computer graphics (images) ,Reflex ,Humans ,Digital single-lens reflex camera ,Smartphone ,ComputingMilieux_MISCELLANEOUS ,Lighting - Abstract
Surgical field photography is a tough exercise: surgeons dedicate the required time for photography even during complex surgeries; the intense lighting of the operating field works against photography, and the surgeon has to utilise whatever equipment is available. We selected five complex interventions and two surgeons (one with an iPhone more...
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- 2021
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30. Prospective Evaluation of Resection Margins Using Standardized Specimen Protocol Analysis among Patients with Distal Cholangiocarcinoma and Pancreatic Ductal Adenocarcinoma
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Jean Robert Delpero, Jonathan Garnier, Flora Poizat, Anaïs Palen, Ugo Marchese, Eddy Traversari, Jacques Ewald, Olivier Turrini, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and NUNES, Jacques A more...
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medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,pancreatic ductal adenocarcinoma ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,030230 surgery ,Biliary Stenting ,Article ,Resection ,distal cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,margin ,medicine.artery ,Medicine ,Superior mesenteric artery ,Superior mesenteric vein ,business.industry ,Bile duct ,Mortality rate ,General Medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Resection margin ,R1 resection ,Radiology ,business - Abstract
Purpose: Using a standardized specimen protocol analysis, this study aimed to evaluate the resection margin status of patients who underwent resection for either distal cholangiocarcinoma (DC) or pancreatic ductal adenocarcinoma (PDAC). This allowed a precise millimetric analysis of each inked margin. Methods: From 2010 to 2018, 355 consecutively inked specimens from patients with PDAC (n = 288) or DC (n = 67) were prospectively assessed. We assessed relationships between the tumor and the following margins: transection of the pancreatic neck, bile duct, posterior surface, margin toward superior mesenteric artery, and the surface of superior mesenteric vein/portal vein groove. Resection margins were evaluated using a predefined cut-off value of 1 mm, however, clearances of 0 and 1.5 mm were also evaluated. Results: Patients with DC were mostly men (64% vs. 49%, p = 0.028), of older age (68 yo vs. 65, p = 0.033), required biliary stenting more frequently (93% vs. 77%, p <, 0.01), and received less neoadjuvant treatment (p <, 0.001) than patients with PDAC. The venous resection rate was higher among patients with PDAC (p = 0.028). Postoperative and 90-day mortality rates were comparable. Patients with PDAC had greater tumor size (28.6 vs. 24 mm, p = 0.01) than those with DC. The R1 resection rate was comparable between the two groups, regardless of the clearance margin. Among the three types of resection margins, a venous groove was the most frequent in both entities. In multivariate analysis, the R1 resection margin did not influence patient survival in either PDAC or DC. Conclusion: Our standardized specimen protocol analysis showed that the R1 resection rate was comparable in PDAC and DC. more...
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- 2021
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31. Shepherdess Warriors Vol. 1
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Jonathan Garnier, Amélie Fléchais, Jonathan Garnier, and Amélie Fléchais
- Abstract
It's been 10 years since the men of the village left to fight in The Great War. Ten years since they left the women, children, and the older generation for a conflict far away from home and that they knew almost nothing about, except that it was about the security of their nation, their valley, their families. Ten years have passed since anyone has had any news of the war... But the women quickly took charge of village matters. This is how the Order of Shepherdess Warriors was formed, a group of female fighters chosen among the most courageous and acrimonious, to protect not only their flocks, but also the village! Molly is happy because as soon as she turns 10, she can finally start training, and if she's good enough, she can join the order and work out why there are more and more ferocious wolves in the valley. This quest will take her far beyond the boundaries of the land she knows, into the sorcerers'forest and on the trail of her missing parents. Shepherdess Warriors is the odyssey of a young heroine living great adventures in a medieval-fantasy universe inspired by Celtic legends. An endearing story, suitable for most all ages, which gives pride of place to family and community ties, carried by warm, charming graphics and a scenario rich in humor with twists and turns. Winner of the 2022 Angouleme Prize - Best Title for Ages 8-12 & Up! more...
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- 2024
32. Correction to: Intraoperative frozen section analysis of para-aortic lymph nodes after neoadjuvant FOLFIRINOX: will it soon become useless?
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Jonathan Garnier, Cloe Magallon, Jacques Ewald, Anaïs Palen, Ugo Marchese, Jean Robert Delpero, and Olivier Turrini
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Surgery - Published
- 2022
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33. Aspiration pneumonia following oncologic digestive surgery: Proposal for a classification
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Olivier Turrini, Djamel Mokart, Bernard Lelong, Hélène Meillat, Jonathan Garnier, Ugo Marchese, Cécile de Chaisemartin, J. Guiramand, Jacques Ewald, Jean-Robert Delpero, Abdallah Al Faraï, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and NUNES, Jacques A more...
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medicine.medical_specialty ,Gastric emptying ,business.industry ,Mortality rate ,[SDV]Life Sciences [q-bio] ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,General Medicine ,Perioperative ,Aspiration Pneumonitis ,Aspiration pneumonia ,medicine.disease ,Research Letters ,Surgery ,[SDV] Life Sciences [q-bio] ,[SDV.CAN] Life Sciences [q-bio]/Cancer ,Research Letter ,Paralysis ,Medicine ,medicine.symptom ,Complication ,business ,ComputingMilieux_MISCELLANEOUS ,Pneumonitis - Abstract
Postoperative aspiration pneumonitis (POAP) is a rare (1%) but worrying complication with a high mortality rate (up to 30%). 1 , 2 , 3 General anesthesia combined with gastrointestinal surgery induces digestive tract paralysis with the risk of delayed gastric emptying and consequent POAP. In the last two decades, efforts to decrease perioperative opioid use, 4 together with the rise of minimally invasive surgery, have reduced the surgical impact on digestive motility. In contrast, enhanced recovery after digestive surgery leads to decreased routine gastric tube feeding and increased early postoperative feeding, 5 , 6 , 7 , 8 which may induce gastric emptying and increase the risk of POAP, which remains a constant risk after digestive surgery, with various effects ranging from isolated radiologic signs to severe pneumonitis with multiorgan failure. To date, there have been no definitions or grading schemes for POAP, and it is difficult to draw realistic comparisons among perioperative drugs or procedures that could be effective in reducing POAP. Therefore, the present study seeks to develop a simple and reliable POAP classification that could facilitate relevant comparisons of preventive measures and postoperative courses. more...
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- 2021
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34. Intraoperative frozen section analysis of para-aortic lymph nodes after neoadjuvant FOLFIRINOX: will it soon become useless?
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Jean-Robert Delpero, Jacques Ewald, Anaïs Palen, Jonathan Garnier, Ugo Marchese, Olivier Turrini, Cloe Magallon, Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Département de chirurgie digestive [Institut Paoli Calmettes], Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC) more...
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medicine.medical_specialty ,FOLFIRINOX ,Leucovorin ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Adenocarcinoma ,Irinotecan ,Neoadjuvant chemotherapy ,Metastasis ,Antineoplastic Combined Chemotherapy Protocols ,Medicine ,Frozen Sections ,Humans ,Contraindication ,Retrospective Studies ,business.industry ,Cancer ,Explorative laparotomy ,medicine.disease ,Prognosis ,Neoadjuvant Therapy ,Para-aortic lymph nodes ,Oxaliplatin ,Pancreatic Neoplasms ,Cardiothoracic surgery ,Lymphatic Metastasis ,Surgery ,Radiology ,Fluorouracil ,Lymph Nodes ,business ,Pancreatic adenocarcinoma ,Abdominal surgery - Abstract
Positive para-aortic lymph nodes (PALN) (station 16) are commonly detected in the final pathologic examination (ranging from 15 to 26%) among patients who undergo upfront pancreatoduodenectomy for resectable pancreatic ductal adenocarcinoma. However, after neoadjuvant treatment (NAT) the role of positive PALN as a watershed for surgical resection remains unclear. We aimed to determine the incidence of intraoperative detection of PALN after NAT with FOLFIRINOX for pancreatic head adenocarcinoma and its impact on survival, as our policy was to not resect the tumor in such situations. From January 2014 to December 2020, 136 patients with non-metastatic cancer who received neoadjuvant FOLFIRINOX and underwent explorative laparotomy were included. Intraoperative positive PALN were observed in 7 patients (5%). Patients had resectable (n = 5) or locally advanced (n = 2) disease at the time of surgery, but none of them underwent surgical resection. Positive PALN were significantly associated with a lower median number of FOLFIRINOX cycles (4 vs. 6, P = 0.05). There was no significant difference in overall survival between patients with positive loco-regional lymph nodes after resection and patients with non-resection owing to positive PALN (22 versus 16 months, P = 0.16), Overall survival with positive PALN, carcinomatosis, and liver metastasis was 16, 14, and 10 months, respectively (P > 0.05). Our results suggest that NAT may lower PALN involvement. We have modified our policy, positive PALN after NAT are no longer a contraindication to resection, rather a holistic picture of the disease guides management. more...
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- 2021
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35. ASO Author Reflections: Which Patient will Benefit from Complex Vascular Resection during Pancreatectomy?
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Laurent Sulpice, Jonathan Garnier, Olivier Turrini, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), CHU Pontchaillou [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES), Université de Rennes (UR), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS) more...
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medicine.medical_specialty ,surgical mortality ,030309 nutrition & dietetics ,recurrent disease ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,diarrhea ,laparoscopy ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,030209 endocrinology & metabolism ,vascular surgery ,Article ,pancreas tumor ,surgery ,03 medical and health sciences ,0302 clinical medicine ,Pancreatectomy ,Surgical oncology ,irreversible electroporation ,medicine ,Humans ,human ,Vascular resection ,ComputingMilieux_MISCELLANEOUS ,0303 health sciences ,business.industry ,General surgery ,DNA ,ablation therapy ,body weight loss ,Pancreatic Neoplasms ,CA 19-9 antigen ,Oncology ,quality of life ,immunotherapy ,business - Abstract
International audience; [No abstract available]
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- 2021
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36. Oncological relevance of major hepatectomy with inferior vena cava resection for intrahepatic cholangiocarcinoma
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Emilie Gregoire, Yves Patrice Le Treut, Jean-Robert Delpero, Olivier Turrini, Anaïs Palen, Christian Hobeika, Jacques Ewald, Jonathan Garnier, Jean Hardwigsen, Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Département de Chirurgie Oncologique [Institut Paoli-Calmettes, Marseille], Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC) more...
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medicine.medical_specialty ,Population ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Vena Cava, Inferior ,030230 surgery ,Inferior vena cava ,Resection ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,medicine ,Hepatectomy ,Humans ,education ,Severe complication ,Intrahepatic Cholangiocarcinoma ,ComputingMilieux_MISCELLANEOUS ,Retrospective Studies ,education.field_of_study ,Hepatology ,business.industry ,Gastroenterology ,Surgery ,Bile Ducts, Intrahepatic ,medicine.vein ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Propensity score matching ,cardiovascular system ,business ,Major hepatectomy - Abstract
Background This study aimed to investigate the short- and long-terms outcomes of patients undergoing major hepatectomy (MH) with inferior vena cava (IVC) resection for intrahepatic cholangiocarcinoma (ICC). Methods Data from all patients who underwent MH for ICC with or without IVC resection between 2010 and 2018 were analysed retrospectively. Postoperative outcomes, overall survival (OS), and recurrence-free survival (RFS) were compared in the whole population. A propensity score matching (PSM) analysis and an inverse probability weighting analysis (IPW) were performed to assess the influence of IVC resection on short- and long-terms outcomes. Results Among the 78 patients who underwent MH, 20 had IVC resection (IVC patients). Overall, the mortality and severe complication rate were 8% and 20%, respectively. IVC patients required more extended hepatectomies (p = 0.001) and had increased rates of transfusions (p = 0.001), however they did not experience increased postoperative morbidity, even after PSM. The 1-, 3- and 5-years OS and DFS were 78%, 45%, and 32% and 48%, 20%, and 16%, respectively. IVC was not associated with decreased OS (p = 0.52) and/or RFS (p = 0.85), even after IPW. Conclusion MH with IVC resection for ICC seems to provide acceptable short- and long-term results in a selected population of patients. more...
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- 2020
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37. Does pre-operative embolization of a replaced right hepatic artery before pancreaticoduodenectomy for pancreatic adenocarcinoma affect postoperative morbidity and R0 resection? A bi-centric French cohort study
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Jacques Ewald, Laurence Chiche, Jean-Philippe Adam, Jean-Robert Delpero, Arthur Marichez, Jonathan Garnier, Ugo Marchese, Bruno Lapuyade, Benjamin Fernandez, Olivier Turrini, and Christophe Laurent
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medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,030230 surgery ,Adenocarcinoma ,Pancreaticoduodenectomy ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Hepatic Artery ,medicine.artery ,medicine ,Humans ,Superior mesenteric artery ,Embolization ,Right hepatic artery ,Hepatology ,business.industry ,Septic shock ,Gastroenterology ,food and beverages ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,030220 oncology & carcinogenesis ,Morbidity ,business ,Cohort study - Abstract
Background Sacrificing a replaced right hepatic artery (rRHA) from the superior mesenteric artery is occasionally necessary to obtain an R0 resection after pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma (PA). Preoperative embolization (PEA) of the rRHA has been proposed to avoid the onset of postoperative biliary and ischemic liver complications. Methods Eighteen patients with cephalic PA with an rRHA underwent PEA of the rRHA from 2013 to 2019. The monitoring after embolization and PD was systematic and included a clinical-biological evaluation and a computed tomography scan. This study aimed to determine the feasibility of PEA of the rRHA, postoperative morbidity at 90 days, and quality of oncologic resection after PD. Results Feasibility of PEA was 100% without complications. A PD was performed in 16/18 patients. Mortality was 2/16 with one death after septic shock with hepatic ischemia without an arterial obstruction. Overall morbidity was 44% including one hepatic abscess after hepatic ischemia (6%). Two resections were R1 ( Conclusion PEA of the rRHA before PD was safe and reproducible. PEA of the rRHA followed by en bloc PD resection seems to limit the risk of bilio-hepatic ischemia and could facilitate oncologic resection. more...
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- 2020
38. Is percutaneous destruction of a solitary liver colorectal metastasis as effective as a resection?
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Jean-Robert Delpero, Olivier Turrini, Jonathan Garnier, Jacques Ewald, Hélène Meillat, Gilles Piana, Bernard Lelong, Ugo Marchese, Héloïse Seux, and Cecile de Chaisemartin
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medicine.medical_specialty ,Percutaneous ,Radiofrequency ablation ,Left liver ,Resection ,law.invention ,Metastasis ,Liver metastases ,Microwave ablation ,law ,Medicine ,Transplantation ,Hepatology ,business.industry ,Gastroenterology ,medicine.disease ,Hepatic resection ,Surgery ,Original Article ,Solitary ,business ,Colorectal metastasis ,Kras mutation - Abstract
Backgrounds/Aims Surgical resection remains the gold standard in the treatment of colorectal liver metastasis. However, when a patient presents with a deep solitary colorectal liver metastasis (S-CLM), the balance between the hepatic volume sacrificed and the S-CLM volume is sometimes clearly unappropriated. Thus, alternatives to surgery, such as operative and percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA), have been developed. This study aimed to identify the prognostic factors affecting survival of patients with S-CLM who undergo curative-intent liver resection or local destruction (RFA or MWA). Methods We retrospectively identified 211 patients with synchronous or metachronous S-CLM who underwent either surgical resection (n=182) or local destruction (RFA or MWA; n=29) according to the S-CLM size, location, and surrounding Glissonian structures. Results Patients who underwent RFA or MWA had S-CLM of a smaller size than those who underwent resection (mean 19.7 vs. 37.3 mm, p more...
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- 2020
39. Relaparotomy for pancreatic fistula after pancreatoduodenectomy: timing is key
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Olivier Turrini and Jonathan Garnier
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medicine.medical_specialty ,medicine.anatomical_structure ,Hepatology ,business.industry ,Pancreatic fistula ,Gastroenterology ,medicine ,Pancreas ,business ,medicine.disease ,Surgical interventions ,Surgery - Published
- 2022
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40. Reconstruction veineuse mésentérico-porte par prothèse en PTFE (Goretex©) au cours d’une pancréatectomie
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Jacques Ewald, Jonathan Garnier, O. Turrini, Anaïs Palen, J.R. Delpero, E. Traversari, and Ugo Marchese
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Surgery - Abstract
Introduction Lors d’une pancreatectomie avec resection veineuse tronculaire, une reconstruction par interposition d’un greffon prothetique en polytetrafluoroethylene (PTFE) peut etre une option meme si un taux de thrombose eleve est souvent craint. Nous rapportons les resultats d’une serie monocentrique de reconstruction par PTFE avec un protocole d’anticoagulation postoperatoire standardise. Methode De 2014 a 2019, 19 reconstruction veineuse par PTFE ont ete realise. La permeabilite prothetique etait evaluee par scanner avant la sortie puis lors des consultations iteratives. Resultats La duodenopancreatectomie cephalique (DPC) representait l’intervention la plus realisee (15 patients, 79 %) et l’adenocarcinome etait l’histologie principale (17 patients, 89 %). La prothese avait un diametre et une longueur mediane de 1 cm et 8 cm, respectivement. La duree mediane de clampage etait de 25 min. La morbidite severe et la mortalite a 90 jours etaient de 21 % et 10 %, respectivement. Aucune infection de prothese n’a ete diagnostique meme en cas de fistule pancreatique ou biliaire. Il n’y a pas eu d’accident d’anticoagulation. Une thrombose precoce ( Conclusion La reconstruction veineuse par une prothese en PTFE au cours d’une pancreatectomie est efficiente et sans risque infectieux. Notre protocole standardise permettait une permeabilite a long terme acceptable. En cas de pancreatectomie gauche, une reconstruction autologue est a recommander. more...
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- 2021
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41. Local Ablative Therapy Associated with Immunotherapy in Locally Advanced Pancreatic Cancer: A Solution to Overcome the Double Trouble?—A Comprehensive Review
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Jonathan Garnier, Olivier Turrini, Anne-Sophie Chretien, Daniel Olive, Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS) more...
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[SDV]Life Sciences [q-bio] ,General Medicine - Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains a major killer and is a challenging clinical research issue with abysmal survival due to unsatisfactory therapeutic efficacy. Two major issues thwart the treatment of locally advanced nonresectable pancreatic cancer (LAPC): high micrometastasis rate and surgical inaccessibility. Local ablative therapies induce a systemic antitumor response (i.e., abscopal effect) in addition to local effects. Thus, the incorporation of additional therapies could be key to improving immunotherapy’s clinical efficacy. In this systematic review, we explore recent applications of local ablative therapies combined with immunotherapy to overcome immune resistance in PDAC and discuss future perspectives and challenges. Particularly, we describe four chemoradiation studies and nine reports on irreversible electroporation (IRE). Clinically, IRE is the ablative therapy of choice, utilized in all but two clinical trials, and may create a favorable microenvironment for immunotherapy. Various immunotherapies have been used in combination with IRE, such as NK cell- or γδ T cell-based therapy, as well as immune checkpoint inhibitors. The results of the clinical trials presented in this review and the advancement potential of these therapies to phase II/III trials remain unknown. A multiple treatment approach involving chemotherapy, local ablation, and immunotherapy holds promise in overcoming the double trouble of LAPC. more...
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- 2022
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42. Adénocarcinome du pancréas localement avancé non métastatique et non résécable après chimiothérapie d’induction : poursuite de la chimiothérapie ou radiochimiothérapie ?
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J.R. Delpero, O. Turrini, Marine Gilabert, Laurence Moureau-Zabotto, Jacques Ewald, Jonathan Garnier, and Ugo Marchese
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Surgery - Abstract
But Evaluer le devenir des patients avec un adenocarcinome du pancreas localement avance (ADKLA) non reseque en fonction de la strategie therapeutique adoptee. Materiel Entre 2010 et 2017, 234 patients ont eu une chimiotherapie d’induction (FOLFIRINOX pour 72 % d’entre eux) pour ADKLA et n’etaient pas accessibles a la resection chirurgicale ; 47 patients etaient metastatiques a la reevaluation et chez 187 il etait decide soit la poursuite de la chimiotherapie (61 patients, groupe CT), soit une radiochimiotherapie (126 patients, groupe RCT) de cloture. Resultats Les deux groupes etaient comparables selon les caracteristiques cliniques. Une progression metastatique etait observee chez 90 patients (71 %) du groupe RCT et 26 patients (43 %) du groupe CT (p = 0,01). Les survies globales des 2 groupes etaient comparables (survie mediane de 19 mois) mais la survie sans progression etait meilleure pour le groupe RCT (mediane 13,3 vs 9,6 mois, p Conclusion Chez les patients avec un ADKLA non resecable et non metastatique apres chimiotherapie d’induction, la poursuite d’une CT ou la realisation d’une RCT procuraient une survie globale identique. La RCT entrainait une survie sans progression plus longue avec moins de toxicite. more...
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- 2020
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43. Outcomes of patients with initially locally advanced pancreatic adenocarcinoma who did not benefit from resection: a prospective cohort study
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Ugo Marchese, Laurence Moureau-Zabotto, Simon Launay, Flora Poizat, Marc Giovannini, Olivier Turrini, Marine Gilabert, Jean-Robert Delpero, Jacques Ewald, and Jonathan Garnier
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Oncology ,Male ,Cancer Research ,Survival ,FOLFIRINOX ,Leucovorin ,Deoxycytidine ,0302 clinical medicine ,Antineoplastic Combined Chemotherapy Protocols ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Aged, 80 and over ,Hazard ratio ,Middle Aged ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Oxaliplatin ,Treatment Outcome ,Chemoradiation ,030220 oncology & carcinogenesis ,Female ,Fluorouracil ,medicine.drug ,Research Article ,Adult ,medicine.medical_specialty ,Adenocarcinoma ,Irinotecan ,lcsh:RC254-282 ,03 medical and health sciences ,Internal medicine ,Genetics ,medicine ,Humans ,Chemotherapy ,Survival analysis ,Aged ,Neoplasm Staging ,Performance status ,business.industry ,Induction chemotherapy ,Pancreatic cancer ,Survival Analysis ,Gemcitabine ,Pancreatic Neoplasms ,Regimen ,Locally advanced ,business - Abstract
Background The current study aimed to evaluate the outcomes of patients with unresectable non-metastatic locally advanced pancreatic adenocarcinoma (LAPA) who did not benefit from resection considering the treatment strategy in the clinical settings. Methods Between 2010 and 2017, a total of 234 patients underwent induction chemotherapy for LAPA that could not be treated with surgery. After oncologic restaging, continuous chemotherapy or chemoradiation (CRT) was decided for patients without metastatic disease. The Kaplan–Meier method was used to determine overall survival (OS), and the Wilcoxon test to compare survival curves. Multivariate analysis was performed using the stepwise logistic regression method. Results FOLFIRINOX was the most common induction regimen (168 patients, 72%), with a median of 6 chemotherapy cycles and resulted in higher OS, compared to gemcitabine (19 vs. 16 months, hazard ratio (HR) = 1.2, 95% confidence interval: 0.86–1.6, P = .03). However, no difference was observed after adjusting for age (≤75 years) and performance status score (0–1). At restaging, 187 patients (80%) had non-metastatic disease: CRT was administered to 126 patients (67%) while chemotherapy was continued in 61 (33%). Patients who received CRT had characteristics comparable to those who continued with chemotherapy, with similar OS. They also had longer progression-free survival (median 13.3 vs. 9.6 months, HR = 1.38, 95% confidence interval: 1–1.9, P Conclusions The median survival of patients who could not undergo surgery was 19 months. Hence, CRT should not be eliminated as a treatment option and may be useful as a part of optimised sequential chemotherapy for both local and metastatic disease. more...
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- 2019
44. International Study Group of Pancreatic Surgery type 3 and 4 venous resections in patients with pancreatic adenocarcinoma:the Paoli-Calmettes Institute experience
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Laurence Moureau-Zabotto, Abdallah Al Faraï, Flora Poizat, Jean-Robert Delpero, Jacques Ewald, Ugo Marchese, Marine Gilabert, Marc Giovannini, Jonathan Garnier, and Olivier Turrini
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Male ,medicine.medical_specialty ,FOLFIRINOX ,medicine.medical_treatment ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Mesenteric Veins ,Pancreatectomy ,medicine ,Humans ,In patient ,Pathological ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Portal Vein ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Survival Rate ,Regimen ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Adenocarcinoma ,Female ,Folfirinox Regimen ,France ,Segmental resection ,business ,Vascular Surgical Procedures ,Carcinoma, Pancreatic Ductal - Abstract
A new neoadjuvant regimen, together with more aggressive surgeries, appears to have increased the resectability rate in patients with pancreatic ductal adenocarcinoma (PDAC). Our study aimed to evaluate the outcomes of patients who underwent venous resection (VR) during pancreatectomies for PDAC.Between 2005 and 2017, 130 patients underwent pancreatectomies with type 3 or 4 (i.e., segmental resection without or with graft interposition, respectively) VR for PDAC. Patients' characteristics, surgical techniques, perioperative management, pathological findings, and outcomes were recorded and compared during 2 inclusion periods: the landmark year for the introduction of the FOLFIRINOX regimen and the hyperspecialization of our pancreatic-surgery team was 2010.Performance of pancreatectomies with VR steadily increased through the 2 inclusion periods. In the overall series (n = 130), the median overall survival time and the 5-year survival proportion were 26.3 months and 21%, respectively. Upon multivariate analysis, ASA score 3 (P = 0.01) and R1 resection margins (P 0.01) were found to be negative independent factors influencing survival. Patients who underwent upfront VR (n = 47) had survival rates similar to those of patients who received neoadjuvant treatment (n = 83). After 2010, more complex VR were performed; however, no difference was found between the 2 periods with respect to postoperative courses, pathologic findings, or survival after a matching process based on patients' characteristics and tumor stages.Over the last 2 decades, VR during pancreatectomy has been confirmed as a safe procedure despite the increase in technical complexity. Disappointingly, we did not observe any dramatic survival improvement. more...
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- 2019
45. Totalisation pancréatique pour fistule grade C après duodénopancréatectomie céphalique : résultats d’une technique standardisée
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Ugo Marchese, O. Turrini, J.R. Delpero, Jacques Ewald, Anaïs Palen, and Jonathan Garnier
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Surgery - Abstract
Introduction La totalisation pancreatique (TP) en urgence apres duodenopancreatectomie cephalique (DPC) pour fistule grade C est une procedure difficile notamment pour les jeunes chirurgiens. Nous rapportons les resultats d’une technique standardisee en 4 etapes etablie afin de permettre une reintervention rapide meme par un chirurgien non-senior. Methode Lorsqu’une reintervention etait decidee, elle etait toujours validee par un chirurgien senior ; le chirurgien non-senior pouvait debuter l’intervention sans attendre l’arrivee du chirurgien responsable, qui venait toujours en renfort. La premiere etape est de deconnecter la gastro-entero-anastomose pour acceder rapidement a l’anastomose pancreatique et permettre ainsi une exposition adequate, particulierement en cas d’hemorragie active. La deuxieme etape, en cas d’anastomose pancreatico-jejunale, est de deconnecter l’anse pancreatique depuis l’anastomose hepatico-jejunale. Troisiemement, la totalisation pancreatique est effectuee avec ou sans preservation des vaisseaux spleniques et de la rate en fonction des conditions locales. Enfin, la quatrieme etape est la reconstruction digestive a l’aide d’une anse en Y, associee a un drainage large. Resultats De 2012 a 2019, 450 patients ont eu une DPC, et une reintervention pour fistule grade C etait decidee chez 30 patients : une TP a ete effectuee chez 21 patients (4,7 %) apres un delais moyen de 12 jours. Les pertes sanguines et la duree operatoire etaient de 600 mL et 4 h respectivement, en moyenne. La mortalite postoperatoire etait de 24 %. Conclusion La mortalite etait elevee mais inferieure a celle rapportee par d’autres series. Notre procedure standardisee semble donc fiable et reproductible, et peut etre particulierement utile pour les chirurgiens non-seniors. more...
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- 2021
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46. Anastomose pancréatico-gastrique intussuceptée versus anastomose pancréatico-jéjunale chez les patients à haut risque de fistule : une étude cas-témoins
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Ugo Marchese, G. Piana, Anaïs Palen, J.R. Delpero, O. Turrini, Jacques Ewald, Jonathan Garnier, and Djamel Mokart
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Surgery - Abstract
Introduction En 2013, l’anastomose pancreatico-gastrique intussusceptee (PGI) etait decrite comme diminuant le taux de fistule pancreatique mais chez des patients ayant un risque variable. Le but de notre etude etait de comparer l’incidence de la fistule pancreatique cliniquement significative (FPC ; grade B ou C) chez les patients ayant une anastomose a haut risque (updated alternative-fistula risk score [ua-FRS] > 20 %) selon qu’ils aient eu une PGI ou une pancreatico-jejunale (PJ). Methodes De 2013 a 2019, 198 patients consecutifs ayant un ua-FRS moyen de 33 % ont ete inclus. Notre equipe avait une experience avec les PG directe mais une PGI n’etait realisee (n = 33) que lorsque les conditions etaient optimales (pancreas facilement mobilisable et exposition facile) en suivant la technique publiee. Les patients ont ensuite ete apparies sur l’IMC, le diametre du canal pancreatique, et l’ua-FRS avec 165 PJ. Resultats Pour l’ensemble des patients, une FPC etait diagnostiquee chez 42 patients (21 %), et une complication hemorragique chez 30 patients (15 %). La mortalite postoperatoire etait de 4 %. Le taux de FPC dans les groupes PJ et PGI etait de 19 % versus 33 % (p = 0,062), respectivement. Dans le groupe PGI, on notait une incidence plus elevee des FP grade C (24 versus 10 % ; p = 0,036), une duree operatoire plus longue (p = 0,019), et un taux de transfusion plus eleve (p Conclusion La PGI n’etait pas superieure a la PJ pour la prevention des FPC et, dans cette indication, a ete abandonnee par notre equipe. more...
- Published
- 2021
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47. Timo the Adventurer
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Jonathan Garnier and Jonathan Garnier
- Abstract
Having read every book in his tiny village, young Timo decides it is time to leave home and become a hero. And while that is easier said than done, Timo is determined to succeed. When he rescues an enchanted beast named Broof, Timo gains a gruff and reluctant ally. But little does good-hearted Timo suspect that Broof's mysterious past will bring complications to his journey.... An engaging hero, surprising plot twists, and a host of fantastical creatures keep readers turning the pages of this spell-binding fantasy. more...
- Published
- 2020
48. A pancreatic ductal adenocarcinoma subpopulation is sensitive to FK866, an inhibitor of NAMPT
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Marine Barraud, Flora Poizat, Juan L. Iovanna, Jean-Robert Delpero, Aurélie Maignan, Marc Giovannini, Celine Loncle, Vincent Moutardier, Véronique Secq, Nelson Dusetti, Olivier Turrini, N. Guibert, Marine Gilabert, Philippe Grandval, Pauline Duconseil, Charlotte Lequeue, Benjamin Bian, Stéphane Garcia, Mohamed Gasmi, Jonathan Garnier, Mehdi Ouaissi, Sophie Vasseur, Martin Bigonnet, and Odile Gayet more...
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Male ,0301 basic medicine ,FK866 ,pancreatic cancer ,Nicotinamide phosphoribosyltransferase ,chemotherapy ,NAMPT ,Mice ,chemistry.chemical_compound ,0302 clinical medicine ,Piperidines ,Tumor Cells, Cultured ,Enzyme Inhibitors ,Nicotinamide Phosphoribosyltransferase ,Aged, 80 and over ,Middle Aged ,Oncology ,030220 oncology & carcinogenesis ,Cytokines ,Biomarker (medicine) ,Female ,Carcinoma, Pancreatic Ductal ,Research Paper ,medicine.drug ,Adult ,medicine.medical_specialty ,Stromal cell ,Antineoplastic Agents ,03 medical and health sciences ,Pancreatic cancer ,Biomarkers, Tumor ,medicine ,Animals ,Humans ,Viability assay ,Aged ,Acrylamides ,business.industry ,Cancer ,medicine.disease ,Xenograft Model Antitumor Assays ,Gemcitabine ,Surgery ,Oxaliplatin ,Pancreatic Neoplasms ,030104 developmental biology ,chemistry ,Drug Resistance, Neoplasm ,Cancer research ,business - Abstract
Treating pancreatic cancer is extremely challenging due to multiple factors, including chemoresistance and poor disease prognosis. Chemoresistance can be explained by: the presence of a dense stromal barrier leading to a lower vascularized condition, therefore limiting drug delivery; the huge intra-tumoral heterogeneity; and the status of epithelial-to-mesenchymal transition. These factors are highly variable between patients making it difficult to predict responses to chemotherapy. Nicotinamide phosphoribosyl transferase (NAMPT) is the main enzyme responsible for recycling cytosolic NAD+ in hypoxic conditions. FK866 is a noncompetitive specific inhibitor of NAMPT, which has proven anti-tumoral effects, although a clinical advantage has still not been demonstrated. Here, we tested the effect of FK866 on pancreatic cancer-derived primary cell cultures (PCCs), both alone and in combination with three different drugs typically used against this cancer: gemcitabine, 5-Fluorouracil (5FU) and oxaliplatin. The aims of this study were to evaluate the benefit of drug combinations, define groups of sensitivity, and identify a potential biomarker for predicting treatment sensitivity. We performed cell viability tests in the presence of either FK866 alone or in combination with the drugs above-mentioned. We confirmed both inter- and intra-tumoral heterogeneity. Interestingly, only the in vitro effect of gemcitabine was influenced by the addition of FK866. We also found that NAMPT mRNA expression levels can predict the sensitivity of cells to FK866. Overall, our results suggest that patients with tumors sensitive to FK866 can be identified using NAMPT mRNA levels as a biomarker and could therefore benefit from a co-treatment of gemcitabine plus FK866. more...
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- 2016
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49. Venous Reconstruction during Pancreatectomy Using Polytetrafluoroethylene Grafts: A Single-center Experience with Standardized Perioperative Management
- Author
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Jacques Ewald, Ugo Marchese, J.R. Delpero, Anaïs Palen, E. Traversari, O. Turrini, and Jonathan Garnier
- Subjects
medicine.medical_specialty ,Polytetrafluoroethylene ,Hepatology ,Perioperative management ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Single Center ,Surgery ,chemistry.chemical_compound ,chemistry ,Pancreatectomy ,Medicine ,business - Published
- 2021
- Full Text
- View/download PDF
50. Protective Peritoneal Patch for Arteries during Pancreatoduodenectomy: Good Value for Money
- Author
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Jacques Ewald, Jean-Robert Delpero, Anaïs Palen, Jonathan Garnier, Olivier Turrini, Centre de Recherche en Cancérologie de Marseille (CRCM), Aix Marseille Université (AMU)-Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut Paoli-Calmettes, and Fédération nationale des Centres de lutte contre le Cancer (FNCLCC) more...
- Subjects
medicine.medical_specialty ,Fistula ,[SDV.CAN]Life Sciences [q-bio]/Cancer ,Anastomosis ,Pancreaticoduodenectomy ,Gastroduodenal artery ,Pancreatic Fistula ,Hepatic Artery ,Pancreatectomy ,Postoperative Complications ,Risk Factors ,medicine.artery ,Value for money ,medicine ,Humans ,ComputingMilieux_MISCELLANEOUS ,Retrospective Studies ,Framingham Risk Score ,Hepatology ,business.industry ,Mortality rate ,Gastroenterology ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Pancreatic fistula ,business ,Artery - Abstract
Purpose This study proposes and details a simple and inexpensive protective technique of wrapping the hepatic and gastroduodenal artery stumps with a peritoneal patch during pancreatoduodenectomy (PD) in order to decrease post-pancreatectomy hemorrhage (PPH). Methods Among the 85 patients who underwent PD between July 2020 and March 2021, 16 patients with high-risk pancreatic anastomosis received a peritoneal patch. The Updated Alternative Fistula Risk Score (ua-FRS) was calculated. Post-operative pancreatic fistula (POPF) and PPH were diagnosed and graded according to the International Study Group of Pancreatic Surgery. The mortality rate was calculated up to 90 days after PD. Results The mean ua-FRS of the 16 patients was 43% (range: 21-63%). Among them, 6 (38%) experienced clinically relevant-POPF, and a PPH was observed in two patients (13%). In these two patients who required re-intervention, the peritoneal patch was remarkably intact, and neither the gastroduodenal stump nor hepatic artery was involved. None of the patients experienced 90-day mortality. Conclusion Although the outcomes are encouraging, the evaluation of a larger series to assess the effectiveness of the peritoneal protective patch for arteries in a high-risk pancreatic anastomosis is ongoing. more...
- Published
- 2021
- Full Text
- View/download PDF
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