91 results on '"Lefèvre JH"'
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2. Impact of diverting ileostomy on functional outcome and quality of life after restorative proctocolectomy and ileal pouch anal anastomosis.
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Martin G, Voron T, Collard M, O'Connell L, Challine A, Chafai N, Lefèvre JH, and Parc Y
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- Humans, Male, Female, Retrospective Studies, Adult, Middle Aged, Treatment Outcome, Postoperative Complications etiology, Postoperative Complications epidemiology, Anastomotic Leak etiology, Anastomotic Leak epidemiology, Anastomosis, Surgical methods, Anastomosis, Surgical adverse effects, Proctocolectomy, Restorative methods, Proctocolectomy, Restorative adverse effects, Quality of Life, Ileostomy methods, Ileostomy adverse effects, Colonic Pouches adverse effects
- Abstract
Aim: Diverting ileostomy (DS) after restorative proctocolectomy (RPC) can be omitted in selected patients. Its omission could improve functional outcomes and quality of life (QoL), as has been demonstrated in patients after proctectomy. The aim of this study was to report the impact of diverting ileostomy on functional outcomes and QoL after ileal pouch-anal anastomosis (IPAA)., Methods: This was a retrospective study including all patients operated (2015-2020) for RPC with IPAA. Functional outcome was evaluated by validated scores (LARS, Wexner, Öresland, pouch functional score [PFS] and the ileoanal pouch syndrome severity [IPSS] score). Global health-related QoL was evaluated with the SF-36. We also analysed demographic characteristics, morbidity, correlation between functional outcomes and QoL., Results: Among 179 eligible patients, 150 responded (84%): S- (no stoma = 78; 52%) and S+ (had stoma = 72; 48%). Overall morbidity and anastomotic leak rates were 46% and 9.3%, respectively without difference between the groups. Medians for the functional scores were comparable between the S- and S+ group, respectively: 18 [12.5-31] versus 18 [11-31], p = 0.48 for LARS; 9 [7-11] versus 9 [7-12], p = 0.23 for Wexner's score; 6 [3-13] versus 8 [5-11], p = 0.22 for Öresland's score, 6 [3-13] versus 6.8 [4-12], p = 0.174 for PFS score, and 40 [35-45] versus 46 [42-51], p = 0.045 for IPSS score. The SF-36 summary score was comparable between the two groups without any difference in eight specific health dimensions. After propensity score matching, results were still comparable between the two groups for all scores. Linear regression found a significant correlation between all QoL domains and all functional scores (p < 0.001)., Conclusion: DS for IPAA does not alter either functional outcomes or QoL and can be omitted in selected patients., (© 2024 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.) more...
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- 2024
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3. Early ileal resection in Crohn's disease is not associated with severe long-term outcomes: The ERIC study.
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Grellier N, Kirchgesner J, Uzzan M, Mclellan P, Stefanescu C, Lefèvre JH, Treton X, Panis Y, Sokol H, Beaugerie L, and Seksik P
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- Humans, Male, Female, Retrospective Studies, Adult, Treatment Outcome, Middle Aged, Young Adult, Time Factors, Reoperation statistics & numerical data, Crohn Disease surgery, Ileum surgery, Ileum pathology, Recurrence
- Abstract
Background: Early complicated Crohn's disease (CD) may require ileal resection as first-line treatment., Aim: To evaluate the long-term outcomes of patients who underwent early ileal resection., Methods: We conducted a retrospective study in two inflammatory bowel diseases (IBD) referral centres, including patients with ileocaecal resection and segmental ileal resection within 5 years of CD diagnosis. Early resection was defined as within 6 months of diagnosis, intermediate resection between 6 months and 2 years, and late resection between 2 and 5 years. The primary outcome was the cumulative risk of a second ileal surgery. Secondary outcomes included the use of postoperative treatments and morphological recurrence after initial surgery (Rutgeerts score ≥i2, or recurrence on imaging)., Results: Among 393 patients who underwent ileal resection within 5 years of diagnosis, 130, 128 and 135, respectively, had early, intermediate and late resection. The cumulative risk of second surgery at 10 years was not significantly different in the early resection group (25.0% [95% CI 17.4-35.2]), than the intermediate (16.8% [95% CI 10.5-26.2]; p = 0.17) or late resection group (22.7% [95% CI 15.1-33.3]; p = 0.83). The early resection group required fewer postoperative treatments than the late resection group with median survivals without treatments of 3.7 and 0.9 years, respectively (p = 0.002). Patients who had early resection had significantly less morphological recurrence than the late resection group (p = 0.02)., Conclusion: Early ileal resection in CD is not associated with a higher risk of a second resection. It may be associated with reduced use of medical treatments and fewer morphological recurrences., (© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.) more...
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- 2024
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4. Performances of preoperative CT scan to predict the pTN stage for MSI/dMMR localized colon cancers.
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Duval M, Vanderbecq Q, Phou V, Cervantes B, Mas L, Bachet JB, Goumard C, Parc Y, André T, Lefèvre JH, Lucidarme O, Arrivé L, Cohen R, and Wagner M
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- Humans, Female, Male, Middle Aged, Aged, Retrospective Studies, Predictive Value of Tests, DNA Mismatch Repair, Neoadjuvant Therapy methods, Preoperative Care methods, Adult, Colonic Neoplasms diagnostic imaging, Colonic Neoplasms pathology, Tomography, X-Ray Computed methods, Microsatellite Instability, Neoplasm Staging
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Background: Neoadjuvant immunotherapy emerges as a promising strategy for patients with localized colon cancer (CC) harboring microsatellite instability/mismatch repair deficiency (MSI/dMMR). The aim of this study is to evaluate the concordance between clinical cTN stage assessed by preoperative computed tomography (CT) scan and pTN stage of MSI/dMMR CC., Patients and Methods: Consecutive patients diagnosed for localized MSI/dMMR CC and treated with upfront surgery between 2013 and 2022 in two French centers were eligible. Two independent radiologists, blinded to pathological findings, reviewed all preoperative CT scans and assessed cTN stage, with a third radiologist reviewing discordant cases. Radiological predictive diagnostic accuracy for pT4 and pN+ (N+ = N1 or N2) were calculated., Results: One hundred and thirteen patients were included (right CCs = 79%). CT scan diagnostic performances for pT4 were sensitivity (Se) = 33.3%; specificity (Sp) = 94.0%; positive predictive value (PPV) = 66.7%; and negative predictive value (NPV) = 79.6% and for pN+ were Se = 70.3%; Sp = 59.2%; PPV = 45.6%; and NPV = 80.4%. When pT-pN were combined, 37.5% of tumors identified as cT4 and/or cN+ were actually pT1-3 and pN0, and 23.1% of the pT4 and pN+ population was not identified as such radiologically., Conclusion: The ability of preoperative CT scan to predict pT and pN stages is limited for localized MSI/dMMR CCs. Reassessing neoadjuvant strategies' benefit-risk balance in this population is needed., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.) more...
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- 2024
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5. What is the rate of definitive stoma after subtotal colectomy for inflammatory bowel disease? A nationwide study of 1860 patients.
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Deyrat J, Challine A, Voron T, O'Connell LV, Collard MK, Tzedakis S, Jaquet R, Lazzati A, Parc Y, and Lefèvre JH
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- Humans, Middle Aged, Female, Male, France epidemiology, Retrospective Studies, Adult, Risk Factors, Inflammatory Bowel Diseases surgery, Surgical Stomas statistics & numerical data, Surgical Stomas adverse effects, Reoperation statistics & numerical data, Postoperative Complications epidemiology, Postoperative Complications etiology, Colitis, Ulcerative surgery, Crohn Disease surgery, Colectomy methods, Colectomy statistics & numerical data, Colectomy adverse effects, Ileostomy statistics & numerical data, Ileostomy adverse effects
- Abstract
Aim: Some patients with inflammatory bowel disease (IBD) require subtotal colectomy (STC) with ileostomy. The recent literature reports a significant number of patients who do not undergo subsequent surgery and are resigned to living with a definitive stoma. The aim of this work was to analyse the rate of definitive stoma and the cumulative incidence of secondary reconstructive surgery after STC for IBD in a large national cohort study., Method: A national retrospective study (2013-2021) was conducted on prospectively collected data from the French Medical Information System Database (PMSI). All patients undergoing STC in France were included. The association between definitive stoma and potential risk factors was studied using univariate and multivariate analyses., Results: A total of 1860 patients were included (age 45 ± 9 years; median follow-up 30 months). Of these, 77% (n = 1442) presented with ulcerative colitis. Mortality and morbidity at 90 days after STC were 5% (n = 100) and 47% (n = 868), respectively. Reconstructive surgery was identified in 1255 patients (67%) at a mean interval of 7 months from STC. Seveny-four per cent (n = 932) underwent a completion proctectomy with ileal pouch anal anastomosis and 26% (n = 323) an ileorectal anastomosis. Six hundred and five (33%) patients with a definitive stoma had an abdominoperineal resection (n = 114; 19%) or did not have any further surgical procedure (n = 491; 81%). Independent risk factors for definitive stoma identified in multivariate analysis were older age, Crohn's disease, colorectal neoplasia, postoperative complication after STC, laparotomy and a low-volume hospital., Conclusion: We found that 33% of patients undergoing STC with ileostomy for IBD had definitive stoma. Modifiable risk factors for definitive stoma were laparotomy and a low-volume hospital., (© 2024 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.) more...
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- 2024
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6. SafeHeal Colovac Colorectal Anastomosis Protection Device evaluation (SAFE-2) pivotal study: an international randomized controlled study to evaluate the safety and effectiveness of the Colovac Colorectal Anastomosis Protection Device.
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Hain E, Lefèvre JH, Ricardo A, Lee S, Zaghiyan K, McLemore E, Sherwinter D, Rhee R, Wilson M, Martz J, Maykel J, Marks J, Marcet J, Rouanet P, Maggiori L, Komen N, De Hous N, Lakkis Z, Tuech JJ, Attiyeh F, Cotte E, and Sylla P more...
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- Adult, Aged, Female, Humans, Male, Middle Aged, Ileostomy instrumentation, Ileostomy adverse effects, Ileostomy methods, Postoperative Complications prevention & control, Proctectomy adverse effects, Proctectomy methods, Proctectomy instrumentation, Prospective Studies, Quality of Life, Treatment Outcome, Anastomosis, Surgical instrumentation, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Anastomotic Leak prevention & control, Colon surgery, Rectal Neoplasms surgery, Rectum surgery
- Abstract
Aim: Although proximal faecal diversion is standard of care to protect patients with high-risk colorectal anastomoses against septic complications of anastomotic leakage, it is associated with significant morbidity. The Colovac device (CD) is an intraluminal bypass device intended to avoid stoma creation in patients undergoing low anterior resection. A preliminary study (SAFE-1) completed in three European centres demonstrated 100% protection of colorectal anastomoses in 15 patients, as evidenced by the absence of faeces below the CD. This phase III trial (SAFE-2) aims to evaluate the safety and effectiveness of the CD in a larger cohort of patients undergoing curative rectal cancer resection., Methods: SAFE-2 is a pivotal, multicentre, prospective, open-label, randomized, controlled trial. Patients will be randomized in a 1:1 ratio to either the CD arm or the diverting loop ileostomy arm, with a recruitment target of 342 patients. The co-primary endpoints are the occurrence of major postoperative complications within 12 months of index surgery and the effectiveness of the CD in reducing stoma creation rates. Data regarding quality of life and patient's acceptance and tolerance of the device will be collected., Discussion: SAFE-2 is a multicentre randomized, control trial assessing the efficacy and the safety of the CD in protecting low colorectal anastomoses created during oncological resection relative to standard diverting loop ileostomy., Trial Registration: NCT05010850., (© 2024 Association of Coloproctology of Great Britain and Ireland.) more...
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- 2024
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7. [An update on total neoadjuvant treatment of adenocarcinoma of the rectum].
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Medioni M, Cervantes B, Huguet F, Bachet JB, Parc Y, André T, Lefèvre JH, and Cohen R
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- Humans, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Induction Chemotherapy, Progression-Free Survival, Fluorouracil administration & dosage, Fluorouracil therapeutic use, Capecitabine administration & dosage, Randomized Controlled Trials as Topic, Leucovorin administration & dosage, Leucovorin therapeutic use, Organoplatinum Compounds administration & dosage, Organoplatinum Compounds therapeutic use, Neoadjuvant Therapy, Rectal Neoplasms therapy, Rectal Neoplasms pathology, Rectal Neoplasms mortality, Adenocarcinoma therapy, Adenocarcinoma pathology, Adenocarcinoma mortality, Neoplasm Recurrence, Local therapy
- Abstract
A major advance has been made in the management of rectal cancer, with the emergence in 2021 of total neoadjuvant treatment. The main publications from the RAPIDO and PRODIGE-23 trials reported a significant improvement in progression-free survival and the pathological complete response rate. The aim of this review is to synthesize recent data on neoadjuvant treatment of rectal cancer, to explain the long-term results of the RAPIDO and PRODIGE-23 trials, and to put them into perspective, considering current advances in de-escalation strategies. The update of the 5-year survival data from the RAPIDO trial highlights an increased risk of loco-regional relapse, with 11.7% of relapses in the experimental group and 8.1% in the control group, while the update of the PRODIGE-23 trial confirms the benefits of this treatment regimen, with a significant improvement in overall survival. In addition, the results of the OPRA and PROPSPECT trials confirm the benefit of total neoadjuvant treatment with induction chemotherapy, as well as the possibility of surgical de-escalation in the OPRA trial and radiotherapy in the PROSPECT trial. The challenge for the future is to identify patients who require total neoadjuvant treatment with the aim of curative surgery to obtain a cure without local or distant relapse, and those for whom therapeutic de-escalation can be envisaged., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.) more...
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- 2024
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8. MIRO study: Do the results of a randomized controlled trial apply in a real population?
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Challine A, Kirouani M, Markar SR, Tzedakis S, Jaquet R, Piessen G, Dabakoyo-Yonli TS, Lefèvre JH, Lazzati A, and Voron T
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- Adult, Humans, Cohort Studies, Postoperative Complications epidemiology, Postoperative Complications etiology, Randomized Controlled Trials as Topic, Esophagectomy methods, Esophageal Neoplasms surgery
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Background: The aim of our study was to evaluate the external validity of the MIRO randomized controlled trial findings in a similar nationwide setting "real life" population, especially the benefit of a hybrid approach in esophageal resection for pulmonary complication. The external validity of randomized controlled trial findings to the general population with the same condition remains problematic because of the inherent selection bias and rigid inclusion criteria., Methods: This study was a cohort study from a National Health Database (Programme de Medicalisation des Systemes d'Informations) between 2010 and 2022. All adult patients operated on using Ivor Lewis resection for esophageal cancer were included. We first validated the detection algorithm of postoperative complications in the health database. Then, we assessed the primary outcome, which was the comparison of postoperative severe pulmonary complications, leak rate, and 30-day mortality between the 2 surgical approaches (hybrid versus open) over a decade., Results: Between 2010 and 2012, 162 of 205 patients in the MIRO trial were anonymously identified in the health care database. No difference between randomized controlled trials and healthcare database measurements was found within severe respiratory complications (24% vs 22%, respectively) nor within leak rate (10% vs 9%, respectively). After application of selection criteria according to the MIRO trial, 3,852 patients were included between 2013 and 2022. The hybrid approach was a protective factor against respiratory complications after adjustment for confounding variables (odds ratio = 0.83; 95% confidence interval = 0.71-0.98, P = .025). No significant difference in the 30-day mortality rate or 30-day leakage rate between the types of approach was reported., Conclusion: This national cohort study demonstrates the external validity of the MIRO randomized controlled trial findings in a real-life population within France., (Copyright © 2023 Elsevier Inc. All rights reserved.) more...
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- 2024
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9. Pathogenic alterations in PIK3CA and KMT2C are frequent and independent prognostic factors in anal squamous cell carcinoma treated with salvage abdominoperineal resection.
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Hamza A, Masliah-Planchon J, Neuzillet C, Lefèvre JH, Svrcek M, Vacher S, Bourneix C, Delaye M, Goéré D, Dartigues P, Samalin E, Hilmi M, Lazartigues J, Girard E, Emile JF, Rigault E, Dangles-Marie V, Rioux-Leclercq N, de la Fouchardière C, Tougeron D, Casadei-Gardini A, Mariani P, Peschaud F, Cacheux W, Lièvre A, and Bièche I more...
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- Humans, Class I Phosphatidylinositol 3-Kinases genetics, Mutation, Papillomavirus Infections complications, Papillomavirus Infections genetics, Phosphatidylinositol 3-Kinases genetics, Prognosis, Anus Neoplasms genetics, Anus Neoplasms pathology, Anus Neoplasms surgery, Carcinoma, Squamous Cell genetics, Carcinoma, Squamous Cell surgery, Carcinoma, Squamous Cell pathology, Proctectomy
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The management of anal squamous cell carcinoma (ASCC) has yet to experience the transformative impact of precision medicine. Conducting genomic analyses may uncover novel prognostic biomarkers and offer potential directions for the development of targeted therapies. To that end, we assessed the prognostic and theragnostic implications of pathogenic variants identified in 571 cancer-related genes from surgical samples collected from a homogeneous, multicentric French cohort of 158 ASCC patients who underwent abdominoperineal resection treatment. Alterations in PI3K/AKT/mTOR, chromatin remodeling, and Notch pathways were frequent in HPV-positive tumors, while HPV-negative tumors often harbored variants in cell cycle regulation and genome integrity maintenance genes (e.g., frequent TP53 and TERT promoter mutations). In patients with HPV-positive tumors, KMT2C and PIK3CA exon 9/20 pathogenic variants were associated with worse overall survival in multivariate analysis (Hazard ratio (HR)
KMT2C = 2.54, 95%CI = [1.25,5.17], P value = .010; HRPIK3CA = 2.43, 95%CI = [1.3,4.56], P value = .006). Alterations with theragnostic value in another cancer type was detected in 43% of patients. These results suggest that PIK3CA and KMT2C pathogenic variants are independent prognostic factors in patients with ASCC with HPV-positive tumors treated by abdominoperineal resection. And, importantly, the high prevalence of alterations bearing potential theragnostic value strongly supports the use of genomic profiling to allow patient enrollment in precision medicine clinical trials., (© 2023 UICC.) more...- Published
- 2024
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10. Impact of interhospital competition on mortality of patients operated on for colorectal cancer faced to hospital volume and rurality: A cross-sectional study.
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Goro S, Challine A, Lefèvre JH, Epaud S, and Lazzati A
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- Humans, Female, Middle Aged, Aged, Aged, 80 and over, Cross-Sectional Studies, Retrospective Studies, Patients, Hospital Mortality, Hospitals, Colorectal Neoplasms surgery
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Introduction: Contradictions remain on the impact of interhospital competition on the quality of care, mainly the mortality. The aim of the study is to evaluate the impact of interhospital competition on postoperative mortality after surgery for colorectal cancer in France., Methods: We conducted a retrospective cross-sectional study from 2015 to 2019. Data were collected from a National Health Database. Patients operated on for colorectal cancer in a hospital in mainland France were included. Competition was measured using number of competitors by distance-based approach. A mixed-effect model was carried out to test the link between competition and mortality., Results: Ninety-five percent (n = 152,235) of the 160,909 people operated on for colorectal cancer were included in our study. The mean age of patients was 70.4 ±12.2 years old, and female were more represented (55%). A total of 726 hospitals met the criteria for inclusion in our study. Mortality at 30 days was 3.6% and we found that the mortality decreases with increasing of the hospital activity. Using the number of competitors per distance method, our study showed that a "highly competitive" and "moderately competitive" markets decreased mortality by 31% [OR: 0.69 (0.59, 0.80); p<0.001] and by 12% respectively [OR: 0.88 (0.79, 0.99); p<0.03], compared to the "non-competitive" market. High hospital volume (100> per year) was also associated to lower mortality rate [OR: 0.74 (0.63, 0.86); p<0.001]., Conclusions: The results of our studies show that increasing hospital competition independently decreases the 30-day mortality rate after colorectal cancer surgery. Hospital caseload, patients' characteristics and age also impact the post-operative mortality., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Goro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.) more...
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- 2024
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11. Surprisingly High Rate of Incomplete Resection in the Control Arm.
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Cohen R, André T, and Lefèvre JH
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- Humans, Treatment Outcome, Retrospective Studies, Colonoscopy
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- 2023
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12. Fissurectomy with mucosal advancement flap anoplasty: The end of a dogma?
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Skoufou M, Lefèvre JH, Fels A, Fathallah N, Benfredj P, and de Parades V
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Introduction: The goal was to compare fissurectomy with mucosal advancement flap anoplasty to fissurectomy alone in the surgical treatment of anal fissure., Patients and Methods: This study included patients who underwent surgery in 2019 for solitary, idiopathic, non-infected, posterior anal fissure, after failure of medical treatment. The choice to perform advancement flap anoplasty was based on surgeon preference and did not depend on the fissure itself. The main endpoint was the time to relief of pain., Results: Of 599 fissurectomies performed during the study period, 226 patients (37.6% women, mean age 41.7±12.0 years old) underwent fissurectomy alone (n=182) or associated with advancement flap anoplasty (n=44). The two groups differed as to their sex ratio (33.5 vs. 54.5% women, P=0.01), body mass index (25.3±4.0 vs. 23.6±3.9, P=0.013) and Bristol score (3.2 vs. 3.4, P=0.038). Time to relief of pain, time to disappearance of bleeding and time to healing were 1.1 (0.5-2.3), 1.0 (0.5-2.1) and 2.0 (1.1-3.6) months, respectively. The rate of healing was 93.8% and the complication rate was 6.2%. The differences between the two groups for these outcomes were not statistically significant. The risk factors associated with absence of healing were age ≥ 40 years (Odds ratio (OR): 3.84; 95% CI, 1.12-17.68) and pre-surgical duration of fissure<35.6 weeks (OR: 6.54; 95% CI: 1.69-43.21)., Conclusion: Mucosal advancement flap anoplasty does not provide any added value to fissurectomy alone., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.) more...
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- 2023
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13. Outcomes of surgical resection in microsatellite instable colorectal cancer after immune checkpoint inhibitor treatment.
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Challine A, Karoui M, De La Fouchardière C, André T, Svrcek M, Meeus P, Dupré A, Paye F, Benoit S, Denet C, Eveno C, Lefèvre JH, and Parc Y
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- Humans, Microsatellite Instability, Microsatellite Repeats genetics, Immune Checkpoint Inhibitors therapeutic use, Colorectal Neoplasms drug therapy, Colorectal Neoplasms genetics, Colorectal Neoplasms surgery
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- 2023
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14. Effective initial management of anastomotic leak in the maintenance of functional colorectal or coloanal anastomosis.
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Nassar A, Challine A, O'Connell L, Voron T, Chafaï N, Debove C, Parc Y, and Lefèvre JH
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- Humans, Anastomotic Leak surgery, Colon surgery, Anal Canal surgery, Anastomosis, Surgical adverse effects, Rectum surgery, Retrospective Studies, Colorectal Neoplasms surgery, Rectal Neoplasms surgery
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Purpose: The present study assessed the factors associated with the maintenance of a functional anastomosis in a large consecutive series of patients with anastomotic leakage (AL)., Methods: All consecutive patients presenting with AL after colorectal or coloanal anastomosis (2012-2019) were analyzed. The primary end point was a functional anastomosis without a stoma at 1 year., Results: A total of 156 patients were included. AL was initially treated by antibiotics (38%), drainage (43%) or urgent surgery (19%). Initial treatment of AL was not adequate in 24.3%, and reintervention in the form of drainage or surgery was required. A total of 60.9% of patients had a functional anastomosis without a stoma 1 year after surgery. Factors associated with the risk of anastomotic failure at 1 year were diabetes (odds ratio [OR] = 4.24 [95% confidence interval {CI} 1.39-14.24] p = 0.014), neoadjuvant chemoradiotherapy (OR = 3.03 [95% CI 1.14-8.63] p = 0.03) and Grade B (OR = 6.49 [95% CI 2.23-21.74] p = 0.001) or C leak (OR = 35.35 [95% CI 9.36-168.21] p < 0.001). Among patients treated initially by drainage, side-to-end or J-pouch anastomoses were significantly associated with revision of the anastomosis compared to end-to-end (OR = 12.90, p = 0.04)., Conclusion: After acute AL following coloanal or colorectal anastomosis, 60.9% of patients had a functional anastomosis without a stoma at the 1 year of follow-up. The type of treatment of AL influenced the risk of anastomotic failure., (© 2022. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.) more...
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- 2023
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15. Ambulatory appendectomy for acute appendicitis: Can we treat all the patients? A prospective study of 451 consecutive ambulatory appendectomies out of nearly 2,000 procedures.
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Raimbert P, Voron T, Laroche S, O'Connell L, Debove C, Challine A, Parc Y, and Lefèvre JH
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- Humans, Appendectomy adverse effects, Appendectomy methods, Prospective Studies, Retrospective Studies, Patient Selection, Acute Disease, Ambulatory Surgical Procedures methods, Length of Stay, Appendicitis diagnostic imaging, Appendicitis surgery, Laparoscopy
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Background: Acute appendicitis represents the leading cause of acute gastrointestinal disorders, but only a small series regarding ambulatory appendectomies are available. The aim of this study was to report the results of ambulatory (day-case) appendectomy for acute appendicitis in a large consecutive cohort and to improve selection criteria in order to extend the indications., Methods: All appendectomy procedures for acute appendicitis (March 2013 to June 2020) were included retrospectively. Criteria to select patients eligible for ambulatory appendectomy were based on our clinico-radiological St-Antoine's score ≥4., Results: In total, 1,730 consecutive patients had an appendectomy for acute appendicitis: 1,279 (74%) in conventional settings and 451 (26%) in ambulatory settings. In the conventional group, 360 (28%) patients had surgery deferred to the next morning, whereas in the ambulatory group, 309 patients (70%) were readmitted the next morning (P < .0001). In the ambulatory group, 376 (83%) patients satisfied the criteria (score ≥4), and 90.9% were discharged on postoperative day 0. Rates of unplanned consultation and readmission were not significantly different (5.1% vs 6.6% P = .243). Multivariate analysis of the entire cohort confirmed absence of radiological perforation as highly predictive of early discharge (odds ratio = 6.073). In our cohort, these patients had an early discharge rate of 86.4% compared to 90.2% in those with a St-Antoine's score ≥4. Considering only radiological evidence of perforation as a selection criterion for ambulatory appendectomy, 581 more patients would be eligible for ambulatory surgery (+60%)., Conclusion: Ambulatory surgery for acute appendicitis based on St-Antoine's score is safe. We propose to extend the indication for ambulatory management to all patients without radiological evidence of perforation., (Copyright © 2023 Elsevier Inc. All rights reserved.) more...
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- 2023
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16. Does an Ileoanal Anastomosis Decrease the Rate of Successful Pregnancy Compared With an Ileorectal Anastomosis? A National Study of 1491 Patients.
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Challine A, Voron T, O'Connell L, Chafai N, Debove C, Collard MK, Parc Y, and Lefèvre JH
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- Pregnancy, Humans, Female, Child, Adolescent, Young Adult, Adult, Middle Aged, Cohort Studies, Rectum surgery, Anastomosis, Surgical, Postoperative Complications surgery, Proctocolectomy, Restorative, Colorectal Neoplasms surgery, Inflammatory Bowel Diseases surgery
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Objective: Report the rate of successful pregnancy in a national cohort of women with either an ileal pouch anal (IPAA) or ileorectal (IRA) anastomosis constructed after colectomy for inflammatory bowel disease (IBD) or polyposis., Background: Fertility after IPAA is probably impaired. All available data are corroborated by only small sample size studies. It is not known whether construction of IPAA versus IRA influences the odds of subsequently achieving a successful pregnancy, especially with increased utilization of the laparoscopic approach., Methods: All women (age: 12-45 y) undergoing IRA or IPAA in France for polyposis or IBD, between 2010-2020, were included. A control population was defined as women aged from 12 to 45 years undergoing laparoscopic appendicectomy during the same period. The odds of successful pregnancy were studied using an adjusted survival analysis., Results: A total of 1491 women (IPAA=872, 58%; IRA=619, 42%) were included. A total of 220 deliveries (15%) occurred during the follow-up period of 71 months (39-100). After adjustment, the odds of successful pregnancy was not significantly associated with type of anastomosis (after IPAA: Hazard Ratio [HR]=0.79, 95% confidence interval=0.56-1.11, P =0.17). The laparoscopic approach increased the odds of achieving successful pregnancy (HR=1.79, 95% confidence interval=1.20-2.63, P =0.004). IRA and IPAA significantly impacted fertility when compared with the control population ( P <0.001)., Conclusions: In this large cohort study, total colectomy for polyposis or IBD was associated with reduced fertility compared with the general population. No difference in odds of achieving successful pregnancy was found between IRA and IPAA after adjustment. This analysis suggests laparoscopic surgery may be associated with greater likelihood of pregnancy., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.) more...
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- 2023
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17. Surgery for synchronous and metachronous colorectal cancer: segmental or extensive colectomy?
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Nguyen J, Lefèvre JH, Bouchet-Doumenq C, Creavin B, Voron T, Chafaï N, Debove C, and Parc Y
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- Humans, Male, Middle Aged, Colectomy, Retrospective Studies, Colorectal Neoplasms, Hereditary Nonpolyposis, Colorectal Neoplasms surgery, Proctocolectomy, Restorative, Neoplasms, Second Primary surgery
- Abstract
Purpose: To assess the impact of surgical approach on morbidity, mortality, and the oncological outcomes of synchronous (SC) and metachronous (MC) colorectal cancer (CRC)., Methods: All patients undergoing resection for double location CRC (SC or MC) between 2006 and 2020 were included. The exclusion criteria were polyposis or SC located on the same side., Results: Sixty-seven patients (age, 64.8 years; male, 78%) with SC (n = 41; 61%) or MC (n = 26; 39%) were included. SC was treated with segmental colectomy (right and left colectomy/proctectomy; n = 19) or extensive colectomy (subtotal/total colectomy or restorative proctocolectomy with pouch; n = 22). Segmental colectomy was associated with a higher incidence of anastomotic leakage (47.4 vs. 13.6%; p = 0.04) and a higher rate of medical morbidity (47.4 vs. 16.6%; p = 0.04). The mean number of lymph nodes harvested was similar. For MC, the second cancer was treated by iterative colectomy (n = 12) or extensive colectomy (n = 14) and there was no significant difference in postoperative outcomes between the two surgical approaches. The median follow-up period was 42.4 ± 29.1 months. The 5-year overall and disease-free survival of the SC and MC groups did not differ to a statistically significant extent., Conclusions: Extensive colectomy should be preferred for SC to reduce morbidity and improve the prognosis. In contrast, iterative colectomy can be performed safely for patients with MC., (© 2022. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.) more...
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- 2023
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18. StomaCare: quality of life impact after enhanced follow-up of ostomy patients by a home healthcare nursing service-a multicentre, randomized, controlled trial.
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de Ponthaud C, Roupret M, Vernerey D, Audenet F, Brouquet A, Cotte E, Cuvillier X, Kanso F, Meurette G, Ledaguenel P, Maggiori L, Neuzillet Y, Ouaissi M, Roumiguié M, Phé V, Vuong NS, Parc Y, and Lefèvre JH more...
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- Humans, Quality of Life, Follow-Up Studies, Surveys and Questionnaires, Delivery of Health Care, Ostomy, Nursing Services
- Abstract
Aim: A stoma exposes patients to several complications which could impair their quality of life (QoL). In the last decade, the market for stoma therapy in France has evolved, with a significant increase in the activities of home health providers, meeting a need for patient follow-up and companionship. International studies have demonstrated the impact of the stoma therapist (ST) follow-up on the improvement of an ostomy patient's QoL. However, the impact of home stoma nurse management has not been analysed. In this context we would like to assess the added value on health-related QoL from the enhanced follow-up of ostomy patients by STs., Methods: This is a randomized, controlled, open, national and multicentre trial (12 centres) which includes patients with an ostomy who benefit from either standard follow-up or from an enhanced and personalized follow-up with, in particular, regular consultations with an ST after discharge. The primary end-point is the 3-month QoL score obtained from the Stoma-QoL questionnaire. The secondary end-points are satisfaction of the care, comparison of QoL scores (Stoma-QoL and EuroQuol EQ-5D) and the economic gains by calculating the consumption of resources between the two arms. There will be a modified intention-to-treat analysis with 6-month follow-up in both study arms., Discussion: The StomaCare trial will be the first randomized controlled study in France to evaluate the impact on QoL of an enhanced follow-up at home of ostomy patients by an ST., (© 2022 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.) more...
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- 2023
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19. Strangulated hedrocele after a fall.
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Payet L, Challine A, and Lefèvre JH
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- Humans, Hernia, Inguinal, Intestinal Obstruction
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- 2022
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20. The first year of Junior Doctors in visceral and digestive surgery in France: For what position and with which function?
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Challine A, Soubrane O, and Lefèvre JH
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- France, Humans, Medical Staff, Hospital, Digestive System Surgical Procedures, Internship and Residency
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- 2022
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21. Prognostic Value of Fusobacterium nucleatum after Abdominoperineal Resection for Anal Squamous Cell Carcinoma.
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Hilmi M, Neuzillet C, Lefèvre JH, Svrcek M, Vacher S, Benhaim L, Dartigues P, Samalin E, Lazartigues J, Emile JF, Rigault E, Rioux-Leclercq N, de La Fouchardière C, Tougeron D, Cacheux W, Mariani P, Courtois L, Delaye M, Dangles-Marie V, Lièvre A, and Bieche I more...
- Abstract
Main prognostic factors of anal squamous cell carcinoma (ASCC) are tumor size, differentiation, lymph node involvement, and male gender. However, they are insufficient to predict relapses after exclusive radiotherapy (RT) or chemoradiotherapy (CRT). Fusobacterium nucleatum has been associated with poor prognosis in several digestive cancers. In this study, we assessed the association between intratumoral F. nucleatum load and clinico-pathological features, relapse, and survival in patients with ASCC who underwent abdominoperineal resection (APR) after RT/CRT. We retrospectively analyzed surgical samples from a cohort of 166 patients with ASCC who underwent APR. F. nucleatum 16S rRNA gene sequences were quantified using real-time quantitative PCR. We associated F. nucleatum load with classical clinicopathological features, overall survival (OS), disease-free survival (DFS), and metastasis-free survival (MFS) using Cox regression univariate and multivariate analyses. Tumors harboring high loads of F. nucleatum (highest tercile) showed longer OS and DFS (median: not reached vs. 50.1 months, p = 0.01, and median: not reached vs. 18.3 months, p = 0.007, respectively). High F. nucleatum load was a predictor of longer OS (HR = 0.55, p = 0.04) and DFS (HR = 0.50, p = 0.02) in multivariate analysis. High F. nucleatum load is an independent favorable prognostic factor in patients with ASCC who underwent APR. more...
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- 2022
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22. New treatment strategies for non-metastatic rectal cancer.
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Abdalla S, Benoist S, Lefèvre JH, Penna C, and Brouquet A
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- Chemoradiotherapy, Humans, Neoadjuvant Therapy, Neoplasm Recurrence, Local, Neoplasm Staging, Salvage Therapy, Treatment Outcome, Proctectomy, Rectal Neoplasms therapy
- Abstract
The most widely practiced (standard) treatment of non-metastatic rectal cancer is based on proctectomy with mesorectal excision (partial or total according to the location of the tumor and commonly called TME). Surgery is preceded by CAP50-type chemoradiotherapy (capecitabineand 50 Grays radiation) and performed 6-8 weeks after the end of chemoradiotherapy. The development of new endoscopic, surgical, radiation-based and chemotherapeutic modalities leads surgeons to envisage customized treatment to find the best compromise between functional and oncologic results according to the locoregional extension of the tumor. Superficial lesions are amenable to transanal excision. T2-3 tumors<4cm are amenable to rectal preservation when neoadjuvant treatment obtains a complete response, allowing local excision or close surveillance. Intensification endocavitary radiotherapy and induction and consolidation chemotherapy regimens to avoid recourse to salvage abdomino-perineal resection (APR) are under investigation. For locally advanced rectal cancers (T3-4 and all N+ irrespective of T), the following scenarios can be envisaged: for initially resectable tumors (T3N0, T1-T3N+, circumferential resection margin>2mm), neoadjuvant chemotherapy alone aims to minimize the risk of local recurrence while avoiding the sequelae of radiotherapy. In case of initially non-resectable tumors (T4, circumferential resection margin<1mm), induction chemotherapy before chemoradiotherapy and consolidation chemotherapy after short course radiotherapy provide better results than standard treatment in terms of complete response and recurrence-free survival, and should be routinely proposed in this indication., (Copyright © 2021. Published by Elsevier Masson SAS.) more...
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- 2021
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23. Impact of coronavirus disease 2019 (COVID-19) lockdown on in-hospital mortality and surgical activity in elective digestive resections: A nationwide cohort analysis.
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Challine A, Dousset B, de'Angelis N, Lefèvre JH, Parc Y, Katsahian S, and Lazzati A
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- Aged, Aged, 80 and over, COVID-19 epidemiology, Case-Control Studies, Cohort Studies, Female, France epidemiology, Hospital Mortality, Humans, Male, Middle Aged, Postoperative Complications virology, COVID-19 complications, Digestive System Surgical Procedures mortality, Elective Surgical Procedures mortality, Postoperative Complications epidemiology, Quarantine statistics & numerical data
- Abstract
Background: The outbreak of coronavirus disease 2019 (COVID-19) infection has led to the reorganization of hospital care in several countries. The objective was to report the postoperative mortality after elective digestive resections in a nationwide cohort during the lockdown period., Methods: This analytic study was performed using a national billing database (the Programme de Médicalisation des Systèmes d'Informations). Patients who underwent elective digestive resections were divided in 2 groups: the lockdown group defined by hospital admissions between March 17 and May 11, 2020; and the control group, defined by hospital admissions during the corresponding period in 2019. Groups were matched on propensity score, geographical region, and surgical procedure. The primary outcome was the postoperative mortality., Results: The overall population included 15,217 patients: 9,325 patients in the control group and 5,892 in the lockdown group. The overall surgical activity was decreased by 37% during the lockdown period. The overall in-hospital mortality during the hospital stay was 2.7%. After matching and adjustment, no difference in mortality between groups was reported (OR = 1.05; 95% CI: 0.83-1.34; P = .669). An asymptomatic COVID-19 infection was a risk factor for a 2-fold increased mortality, whereas a symptomatic COVID-19 infection was associated with a 10-fold increased mortality., Conclusion: Despite a considerable reduction in the surgical activity for elective digestive resections during the lockdown period, mortality remained stable on a nationwide scale in COVID-free patients. These findings support that systematic COVID-19 screening should be advocated before elective gastrointestinal surgery and that all efforts should be made to maintain elective surgical resection for cancer during the second wave in COVID-free patients., (Copyright © 2021 Elsevier Inc. All rights reserved.) more...
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- 2021
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24. Reciprocal association between voting and the epidemic spread of COVID-19: observational and dynamic modeling study.
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Zeitoun JD, Faron M, Manternach S, Fourquet J, Lavielle M, and Lefèvre JH
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- Disease Outbreaks, Humans, Pandemics, Politics, SARS-CoV-2, COVID-19
- Abstract
Background: Whether voting is a risk factor for epidemic spread is unknown. Reciprocally, whether an epidemic can deter citizens from voting has not been often studied. We aimed to investigate such relationships for France during the coronavirus disease 19 (COVID-19) epidemic., Methods: We performed an observational study and dynamic modelling using a sigmoidal mixed effects model. All hospitals with COVID-19 patients were included (18 March 2020-17 April 2020). Abstention rate of a concomitant national election was collected., Results: Mean abstention rate in 2020 among departments was 52.5% ± 6.4% and had increased by a mean of 18.8% as compared with the 2014 election. There was a high degree of similarity of abstention between the two elections among the departments (P < 0.001). Among departments with a high outbreak intensity, those with a higher participation were not affected by significantly higher COVID-19 admissions after the elections. The sigmoidal model fitted the data from the different departments with a high degree of consistency. The covariate analysis showed that a significant association between participation and number of admitted patients was observed for both elections (2020: β = -5.36, P < 1e-9 and 2014: β = -3.15, P < 1e-6) contradicting a direct specific causation of the 2020 election. Participation was not associated with the position of the inflexion point suggesting no effect in the speed of spread., Conclusions: Our results suggest that the surrounding intensity of the COVID-19 epidemic in France did not have any local impact on participation to a national election. The level of participation had no impact on the spread of the pandemic., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.) more...
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- 2021
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25. Surgical Management of Retrorectal Tumors: A French Multicentric Experience of 270 Consecutives Cases.
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Aubert M, Mege D, Parc Y, Rullier E, Cotte E, Meurette G, Zerbib P, Trilling B, Lelong B, Sabbagh C, Lakkis Z, Ouaissi M, Lebreton G, Rouanet P, Manceau G, Tuech JJ, Piessen G, Bresler L, Beyer-Berjot L, Denost Q, Lefèvre JH, and Panis Y more...
- Subjects
- Adolescent, Adult, Aged, Female, France, Humans, Incidence, Male, Middle Aged, Rectal Neoplasms epidemiology, Retrospective Studies, Treatment Outcome, Young Adult, Laparoscopy methods, Laparotomy methods, Rectal Neoplasms surgery, Robotics methods
- Abstract
Objective: To report the largest multicentric experience on surgical management of retrorectal tumors (RRT)., Background: Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT., Methods: Patients operated for RRT in 18 academic French centers were retrospectively included (2000-2019)., Results: A total of 270 patients were included. Surgery was performed through abdominal (n = 72, 27%), bottom (n = 190, 70%), or combined approach (n = 8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, P = 0.02), larger [mean diameter = 60.5 ± 24 (range, 13-107) vs 51 ± 26 (20-105) mm, P = 0.02] and located above S3 vertebra (n = 3/42, 7% vs 0%, P = 0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n = 4/53, 7.5% vs 0%, P = 0.002) and rectal fistula (n = 3/53, 6% vs 0%, P=0.01) but less wound abscess (n = 1/53, 2% vs 24/169, 14%, P = 0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 ±39 (1-221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; P = 0.3)., Conclusions: Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.) more...
- Published
- 2021
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26. Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.
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Zaborowski AM, Abdile A, Adamina M, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Atallah S, Bach S, Bala M, Barussaud M, Bausys A, Bebington B, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Boutall A, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JWA, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D'Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Fleming F, Foppa C, Fowler G, Frasson M, Figueiredo N, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Gong J, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hoffmeister M, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, São Julião GP, Panaiotti L, Panis Y, Papamichael D, Park J, Patel S, Patrón Uriburu JC, Pera M, Perez RO, Petrov A, Pfeffer F, Phang PT, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Reyes Meneses JC, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Salido AJ, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shine R, Shlomina A, Sica GS, Singnomklao T, Siragusa L, Smart N, Solis A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Sunderland M, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Jiménez-Toscano M, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, and Winter DC more...
- Subjects
- Adult, Humans, Incidence, Middle Aged, Risk Factors, Age of Onset, Colorectal Neoplasms epidemiology, Colorectal Neoplasms pathology
- Abstract
Importance: The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer., Observations: Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts., Conclusions and Relevance: The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes. more...
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- 2021
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27. Postoperative outcomes after laparoscopic or open gastrectomy. A national cohort study of 10,343 patients.
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Challine A, Voron T, Dousset B, Creavin B, Katsahian S, Parc Y, Lazzati A, and Lefèvre JH
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Female, Hospitals, High-Volume, Hospitals, Low-Volume, Humans, Laparotomy, Male, Middle Aged, Mortality, Esophageal Stenosis epidemiology, Gastrectomy methods, Laparoscopy methods, Length of Stay statistics & numerical data, Postoperative Complications epidemiology, Reoperation statistics & numerical data, Stomach Neoplasms surgery
- Abstract
Background: Laparoscopy for gastric cancer has not been as popular compared with other digestive surgeries, with conflicting reports on outcomes. The aim of this study focuses on the surgical techniques comparing open and laparoscopy by assessing the morbi-mortality and long-term complications after gastrectomy., Methods: A retrospective study (2013-2018) was performed on a prospective national cohort (PMSI). All patients undergoing resection for gastric cancer with a partial gastrectomy (PG) or total gastrectomy (TG) were included. Overall morbidity at 90 post-operative days and long-term results were the main outcomes. The groups (open and laparoscopy) were compared using a propensity score and volume activity matching after stratification on resection type (TG or PG)., Results: A total of 10,343 patients were included. The overall 90-day mortality and morbidity were 7% and 45%, with reintervention required in 9.1%. High centre volume was associated with improved outcomes. There was no difference in population characteristics between groups after matching. An overall benefit for a laparoscopic approach after PG was found for morbidity (Open = 39.4% vs. Laparoscopy = 32.6%, p = 0.01), length of stay (Open = 14[10-21] vs. Laparoscopy = 11[8-17] days, p<0.0001). For TG, increased reintervention rate (Open = 10.8% vs. Laparoscopy = 14.5%, p = 0.04) and increased oesophageal stricture rate (HR = 2.54[1.67-3.85], p<0.001) were encountered after a laparoscopic approach. No benefit on mortality was found for laparoscopic approach in both type of resections after adjusted analysis., Conclusions: Laparoscopy is feasible for PG with a substantial benefit on morbidity and length of stay, however, laparoscopic TG should be performed with caution, with of higher rates of reintervention and oesophageal stricture., Competing Interests: Declaration of competing interest We certify that the authors have no conflict of interest to report., (Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.) more...
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- 2021
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28. Intraoperative random biopsies of strictureplasty sites can detect early small-bowel adenocarcinoma in patients with Crohn's disease.
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Martineau C, Lefèvre JH, Chafai N, O'Connell L, Svrcek M, and Beaugerie L
- Subjects
- Adenocarcinoma etiology, Adult, Constriction, Pathologic, Crohn Disease complications, Crohn Disease surgery, Early Detection of Cancer methods, Female, Humans, Intestinal Neoplasms etiology, Intestinal Obstruction etiology, Intestinal Obstruction pathology, Intestinal Obstruction surgery, Intestine, Small pathology, Intestine, Small surgery, Male, Pilot Projects, Adenocarcinoma diagnosis, Biopsy methods, Digestive System Surgical Procedures methods, Intestinal Neoplasms diagnosis, Intraoperative Care methods
- Published
- 2021
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29. Increased Long-term Risk of Anal Fistula After Proctologic Surgery: A Case-Control Study.
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Assaraf J, Lambrescak E, Lefèvre JH, de Parades V, Bourguignon J, Etienney I, Taouk M, Atienza P, and Zeitoun JD
- Abstract
Purpose: Anal fistula is a common condition in proctology, usually requiring surgical treatment. Few risk factors have been clearly identified based on solid evidence. Our research objective was to determine whether history of anal surgery was a risk factor for subsequent anal fistula., Methods: We conducted a case-control study from January 1, 2012 through December 31, 2013 in our tertiary center, comprising 280 cases that underwent surgery for anal fistula and 123 control patients seeking a consultation for upper gastrointestinal symptoms. Patients with inflammatory bowel disease were excluded. For both cases and controls, the following variables were recorded: sex, any prior anal surgery, diabetes mellitus, infection with human immunodeficiency virus, and smoking status. For each variable, confidence interval and odds ratio (OR) were calculated., Results: In univariate analysis, male sex (73.2% vs. 31.7%, P < 0.0001), active smoking (38.1% vs. 22%, P = 0.0015), and prior anal surgery (16.0% vs. 4.1%, P = 0.0008) were associated with higher risk of anal fistula. In multivariate analysis, only male sex (OR, 5.5; 95% confidence interval [CI], 5.42 to 9.10; P < 0.0001) and previous anal surgery (OR, 4.48; 95% CI, 1.79 to 13.7; P = 0.0008) remained independently associated with anal fistula occurrence., Conclusion: The epidemiology of anal fistula is poorly assessed despite the high frequency at which it is diagnosed. Our findings suggest that history of any kind of anal surgery is a risk factor for further onset of anal fistula. Surgeons and patients must be informed of this issue. more...
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- 2021
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30. Postoperative diagnostic revision for Crohn disease after subtotal colectomy for inflammatory bowel disease.
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Hermand H, Lefèvre JH, Shields C, Chafai N, Debove C, Beaugerie L, Svrcek M, and Parc Y
- Subjects
- Colectomy, Humans, Retrospective Studies, Colitis, Ulcerative diagnosis, Colitis, Ulcerative surgery, Crohn Disease diagnosis, Crohn Disease surgery, Inflammatory Bowel Diseases surgery
- Abstract
Purpose: Subtotal colectomy (STC) is performed for severe acute and refractory colitis. The diagnosis can be difficult even after the surgery when colectomy specimen has overlapping features of ulcerative colitis (UC) and Crohn's disease (CD). The aim of this study was to evaluate the rate of postoperative diagnostic revision to CD after surgery and determine predictor factors., Methods: Retrospective study of 110 patients who underwent STC (2005-2018)., Results: Preoperative diagnosis comprised UC = 80 (73%), CD = 11 (10%), and unclassified colitis (IBDU = 19, 17%). Initial diagnosis of IBDU and UC was modified to CD in 6 patients (6%) after STC. The final diagnosis after the follow-up of 10 ± 6 years switched from CD for 8 patients (9%). The multivariate analysis showed that patients with a colitis evolving for less than 10 years and initial diagnosis of IBDU were the two independent factors associated with an increased risk of diagnosis change to CD (p = 0.03; p = 0.016). At the end of the follow-up, 15 patients (14%) had a definitive stoma., Conclusions: In patients with IBD, attention must be paid to determine the right restorative strategy to patients with an evolution of the disease less than 10 years or with IBDU who are more at risk to have a diagnosis change to CD after STC. more...
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- 2021
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31. Impact of the local care environment and social characteristics on aggregated hospital fatality rate from COVID-19 in France: a nationwide observational study.
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Zeitoun JD, Faron M, and Lefèvre JH
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- Aged, Aged, 80 and over, Female, France epidemiology, Health Services Research, Humans, Intensive Care Units statistics & numerical data, Male, Middle Aged, Sociological Factors, COVID-19 mortality, Community Health Services organization & administration, Hospital Mortality trends, SARS-CoV-2, Socioeconomic Factors
- Abstract
Objectives: We aimed to investigate possible differences in the aggregated hospital fatality rate from coronavirus disease 2019 (COVID-19) in France at the early phase of the outbreak and to determine whether factors related to population or healthcare supply before the pandemic could be associated with outcome differences., Study Design: This is a nationwide observational study including all French hospitals from January 24, 2020, to April 11, 2020., Methods: We analyzed the aggregated hospital fatality rate. A Poisson regression was performed to investigate associations between characteristics pertaining to populational health, socio-economic context and local healthcare supply at baseline, and the chosen outcome., Results: On April 11, 2020, a total number of 30,960 patients were hospitalized among the 3046 French healthcare facilities, including 6832 patients in the intensive care unit (ICU). A total of 8581 deaths due to COVID-19 had been recorded, with a median mortality rate per 10,000 people per department of 0.53 (interquartile range: 0.29-1.90). There were significant variations between the 95 French departments even after adjusting for outbreak inception (P < 0.001). After multivariable analysis, four factors were independently associated with a significantly higher aggregated hospital fatality rate: a higher ICU capacity at baseline (estimate = 1.47; P = 0.00791), a lower density of general practitioners (estimate = 0.95; P = 0.0205), a lower fraction of activity from the for-profit private sector (estimate = 0.99; P < 0.001), and the ratio of people older than 75 years (estimate = 0.91; P = 0.0023)., Conclusions: The aggregated hospital fatality rate from COVID-19 in France seems to vary among geographic areas, with some factors pertaining to local healthcare supply being associated with the outcome., (Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.) more...
- Published
- 2020
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32. Human papillomavirus vaccine uptake among men in France: a national time series analysis for 2015-2018.
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Zeitoun JD, Duclos A, de Parades V, and Lefèvre JH
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- France, Homosexuality, Male, Humans, Male, Patient Acceptance of Health Care, Vaccination, Papillomavirus Infections prevention & control, Papillomavirus Vaccines, Sexual and Gender Minorities
- Abstract
While national authorities recommended and provided reimbursement for men who have sex with men under 27 in 2016 and 2017, respectively, we aimed to comprehensively analyze human papillomavirus (HPV) vaccine uptake in French men over a 4-year period surrounding these changes. Data regarding HPV vaccine sales to men in all French pharmacies from 2015 through 2018 were retrieved through query made to the national public insurance database. Data were classified according to the age of patients and the time of dispensation so as to display aggregate uptake according to age over time. Time-series analysis was conducted and an exponential smoothing extrapolation was selected to analyze the impact of the reimbursement. Overall, 12,814 HPV vaccines were dispensed in men over the study period. Age was available for the majority of cases (12,793; 99.8%), averaging 29. Dispensation data for each year were the following: 1,917 (2015), 1,921 (2016), 2,643 (2017), 6,312 (2018). Age analysis showed that vaccine uptake among men over 26 was substantial (n = 5974; 46.7%). The exponential increase in the number of vaccines sold started after the second quarter of 2017. In conclusion, we found that HPV vaccine uptake among French men is partly misaligned with recommendations and reimbursement in terms of age, and still moderate overall even though we found signs of marked increase in uptake over the most recent period, suggesting an effective impact of insurance coverage. more...
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- 2020
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33. Colon sparing resection versus extended colectomy for left-sided obstructing colon cancer with caecal ischaemia or perforation: a nationwide study from the French Surgical Association.
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Manceau G, Sabbagh C, Mege D, Lakkis Z, Bege T, Tuech JJ, Benoist S, Lefèvre JH, and Karoui M
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- Anastomosis, Surgical adverse effects, Colectomy, Colostomy, Humans, Ischemia etiology, Ischemia surgery, Retrospective Studies, Colonic Neoplasms complications, Colonic Neoplasms surgery, Intestinal Obstruction etiology, Intestinal Obstruction surgery
- Abstract
Aim: It is not known whether patients with obstructive left colon cancer (OLCC) with caecal ischaemia or diastatic perforation (defined as a blowout of the caecal wall related to colonic overdistension) should undergo a (sub)total colectomy (STC) or an ileo-caecal resection with double-barrelled ileo-colostomy. We aimed to compare the results of these two strategies., Method: From 2000 to 2015, 1220 patients with OLCC underwent surgery by clinicians who were members of the French Surgical Association. Of these cases, 201 (16%) were found to have caecal ischaemia or diastatic perforation intra-operatively: 174 patients (87%) underwent a STC (extended colectomy group) and 27 (13%) an ileo-caecal resection with double-end stoma (colon-sparing group). Outcomes were compared retrospectively., Results: In the extended colectomy group, 95 patients (55%) had primary anastomosis and 79 (45%) had a STC with an end ileostomy. In the colon-sparing group, 10 patients (37%) had simultaneous resection of their primary tumour with segmental colectomy and an anastomosis which was protected by a double-barrelled ileo-colostomy. The demographic data for the two groups were comparable. Median operative time was longer in the STC group (P = 0.0044). There was a decrease in postoperative mortality (7% vs 12%, P = 0.75) and overall morbidity (56% vs 67%, P = 0.37) including surgical (30% vs 40%, P = 0.29) and severe complications (17% vs 27%, P = 0.29) in the colon-sparing group, although these differences did not reach statistical significance. Cumulative morbidity included all surgical stages and the rate of permanent stoma was 66% and 37%, respectively, with no significant difference between the two groups. Overall survival and disease-free survival were similar between the two groups., Conclusion: The colon-sparing strategy may represent a valid and safe alternative to STC in OLCC patients with caecal ischaemia or diastatic perforation., (Colorectal Disease © 2020 The Association of Coloproctology of Great Britain and Ireland.) more...
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- 2020
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34. COVID-19 heath crisis: less colorectal resections and yet no more peritonitis or bowel obstruction as a collateral effect?
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Collard MK, Lefèvre JH, Batteux F, and Parc Y
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- Betacoronavirus, COVID-19, France epidemiology, Hospitals statistics & numerical data, Humans, Pandemics, Patient Acceptance of Health Care statistics & numerical data, SARS-CoV-2, Colectomy statistics & numerical data, Colorectal Surgery trends, Coronavirus Infections epidemiology, Intestinal Obstruction epidemiology, Peritonitis epidemiology, Pneumonia, Viral epidemiology
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- 2020
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35. Surgery for Crohn's disease during pregnancy: A nationwide survey.
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Germain A, Chateau T, Beyer-Berjot L, Zerbib P, Lakkis Z, Amiot A, Buisson A, Laharie D, Lefèvre JH, Nancey S, Stefanescu C, Bresler L, and Peyrin-Biroulet L
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- Adult, Birth Weight, Clinical Decision-Making, Colonoscopy statistics & numerical data, Crohn Disease diagnosis, Crohn Disease mortality, Female, France epidemiology, Gestational Age, Humans, Infant, Newborn, Maternal Mortality, Perinatal Mortality, Postoperative Complications etiology, Pregnancy, Pregnancy Complications diagnosis, Pregnancy Complications mortality, Retrospective Studies, Severity of Illness Index, Young Adult, Colonoscopy adverse effects, Crohn Disease surgery, Postoperative Complications epidemiology, Pregnancy Complications surgery, Pregnancy Outcome
- Abstract
Background and Aims: Crohn's disease (CD) frequently affects young women and may require surgery during pregnancy. Data regarding operation for CD in expectant mothers are scare., Materials and Methods: This was a retrospective nationwide survey from the GETAID Chirurgie. Any woman with CD undergoing surgery during pregnancy was eligible., Results: A total of 15 cases were collected between 1992 and 2015. Most operations were performed due to penetrating or stricturing complications. Mean gestational age at delivery was 34 weeks, with a mean birth weight of 2507 g. Maternal post-operative complications occurred in two-thirds of cases. Maternal mortality rate was 6.7% and neonatal mortality rate 9.1%., Conclusions: This is the largest case series of surgery for CD during pregnancy. This operation may have significant morbidity and mortality for mother, fetus, and newborn. Indication needs to be tailored to maternal status, disease severity, and gestational age. Surgery should be managed by experienced gynecologists, physicians, and surgeons. Active CD may be associated with a greater risk to the fetus than the surgical procedure itself. more...
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- 2020
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36. NORAD01-GRECCAR16 multicenter phase III non-inferiority randomized trial comparing preoperative modified FOLFIRINOX without irradiation to radiochemotherapy for resectable locally advanced rectal cancer (intergroup FRENCH-GRECCAR- PRODIGE trial).
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Brouquet A, Bachet JB, Huguet F, Karoui M, Artru P, Sabbagh C, Lefèvre JH, Vernerey D, Mariette C, Vicaut E, and Benoist S
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- Adult, Antineoplastic Combined Chemotherapy Protocols adverse effects, Chemoradiotherapy, Adjuvant adverse effects, Chemoradiotherapy, Adjuvant methods, Chemoradiotherapy, Adjuvant statistics & numerical data, Chemotherapy, Adjuvant adverse effects, Chemotherapy, Adjuvant methods, Chemotherapy, Adjuvant statistics & numerical data, Clinical Trials, Phase III as Topic, Disease-Free Survival, Drug Administration Schedule, Equivalence Trials as Topic, Female, Fluorouracil administration & dosage, Fluorouracil adverse effects, Follow-Up Studies, Humans, Irinotecan administration & dosage, Irinotecan adverse effects, Leucovorin administration & dosage, Leucovorin adverse effects, Male, Middle Aged, Multicenter Studies as Topic, Neoadjuvant Therapy methods, Neoadjuvant Therapy statistics & numerical data, Neoplasm Recurrence, Local prevention & control, Neoplasm Staging, Oxaliplatin administration & dosage, Oxaliplatin adverse effects, Patient Compliance statistics & numerical data, Postoperative Complications etiology, Preoperative Period, Proctectomy adverse effects, Progression-Free Survival, Quality of Life, Randomized Controlled Trials as Topic, Rectal Neoplasms mortality, Rectal Neoplasms pathology, Rectum drug effects, Rectum pathology, Rectum radiation effects, Rectum surgery, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Neoadjuvant Therapy adverse effects, Neoplasm Recurrence, Local epidemiology, Postoperative Complications epidemiology, Rectal Neoplasms therapy
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Background: Preoperative radiochemotherapy (RCT) is recommended in France prior to total mesorectal excision in patients with mid or low locally advanced rectal cancer (LARC) (cT3/T4 and/or N+) because it has been shown to improve local control. Preoperative RCT has also disadvantages including the absence of proven impact on metastatic recurrence and the risk of late side effects on bowel and genitourinary function. In patients with primarily resectable LARC, preoperative systemic chemotherapy without pelvic irradiation could be used as an alternative to RCT., Methods: This study is a multicenter, open-label randomized, 2-arm phase III non-inferiority trial. Patients with mid or low resectable LARC (cT3N0 or cT1-T3N+ with circumferential resection margin [CRM] > 2 mm on pretreatment MRI) will be randomized to either modified FOLFIRINOX for 3 months or RCT (Cap50 intensified-modulated radiotherapy). All patients have restaging MRI after preoperative treatment. The primary endpoint is 3-year progression-free survival (PFS) from the time to randomization including progression during preoperative treatment. Secondary endpoints are treatment related toxicity, treatment compliance, R0 resection rate, sphincter saving surgery rate, postoperative morbidity and mortality rates, loco-regional recurrence free survival, overall survival, bowel and sexual functions at diagnosis, quality of life, radiologic and pathologic response after preoperative treatment. The number of patients required is 574., Discussion: The choice of modified FOLFIRINOX for preoperative chemotherapy is supported by recent and consistent data on safety and efficacy of this regimen on rectal cancer. The use of preoperative chemotherapy instead of RCT could be associated with pronounced advantages in terms of functional results and quality of life in cancer survivors. However and first of all, the non-inferiority of preoperative chemotherapy compared to RCT on oncologic outcome has to be validated. If this study demonstrates the non-inferiority of chemotherapy compared to RCT, this can lead to a crucial change in clinical practice in a large subset of rectal cancer patients., Trial Registration: ClinicalTrials.gov NCT03875781 (March 15, 2019). Version 1.1. more...
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- 2020
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37. Can a Local Drainage Salvage a Failed Colorectal or Coloanal Anastomosis? A Prospective Cohort of 54 Patients.
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Challine A, Lefèvre JH, Creavin B, Benoit O, Chafai N, Debove C, Voron T, and Parc Y
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- Anastomosis, Surgical adverse effects, Anastomotic Leak etiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Anastomotic Leak therapy, Colectomy adverse effects, Colon surgery, Drainage methods, Rectal Neoplasms surgery, Rectum surgery, Salvage Therapy methods
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Background: Local drainages can be used to manage leakage in select patients without peritonitis., Objective: The aim of this study was to evaluate the efficacy of drainage procedures in maintaining a primary low anastomosis after anastomotic leakage., Design: A retrospective observational study was performed on a prospectively maintained database., Settings: The study was performed between 2014 and 2017 in a tertiary referral center., Patients: Patients undergoing rectal resections with either a colorectal or coloanal anastomosis with diverting stoma were identified. Anastomotic leakages requiring a radiological or transanal drainage without peritonitis were included., Main Outcome Measures: The primary outcome was the maintenance of the primary anastomosis after local drainage of an anastomotic leakage and stoma reversal., Results: A low anastomosis for rectal cancer with diverting stoma was performed in 326 patients. A total of 77 anastomotic leakages (24%) occurred, of which, 6 (8%) required abdominal surgery, 17 (22%) were treated conservatively (medical management), and 54 (70%) were managed by drainage. Surgical transanal drainage was performed in 21 patients (39%), with radiologic drainage procedures performed in 33 patients (61%). The median interval between surgery and drainage was 13 days (range, 9-21 d). Five patients (9%) required emergency abdominal surgery. Twenty-seven patients (50%) did not require any additional intervention after drainage procedure, whereas 21 patients (39%) underwent redo anastomotic surgery. Forty-three patients (80%) had no stoma at the end of follow-up. Failure to maintain the primary anastomosis after local drainage was associated with increased age (p = 0.04), a pelvic per-operative drainage (p = 0.05), a drainage duration >10 days (p = 0.002), the time between surgery and drainage >15 days (p = 0.03), a side-to-end or J-pouch anastomosis (p = 0.04), and surgical transanal drainage (p = 0.03)., Limitations: The small sample size of the study was the main limitation., Conclusions: Local drainage procedures maintained primary anastomosis in 50% of cases after an anastomotic leakage. See Video Abstract at http://links.lww.com/DCR/B57. ¿PUEDE UN DRENAJE LOCAL SALVAR UNA ANASTOMOSIS COLORRECTAL O COLOANAL FALLIDA? UNA COHORTE PROSPECTIVO DE 54 PACIENTES: Los drenajes locales se pueden utilizar para controlar las fugas en pacientes seleccionados sin peritonitis.El objetivo de este estudio fue evaluar la eficacia de los procedimientos de drenaje, para mantener una anastomosis primaria baja, después de una fuga anastomótica.Se realizó un estudio observacional retrospectivo en una base de datos mantenida prospectivamente.El estudio se realizó entre 2014-2017, en un centro de referencia terciaria.Se identificaron pacientes sometidos a resecciones rectales con anastomosis colorrectal o coloanal y estoma de derivación. Se incluyeron fugas anastomóticas sin peritonitis, que requirieron drenaje radiológico o transanal.El resultado primario fue el mantenimiento de la anastomosis primaria, después del drenaje local de una fuga anastomótica y la reversión del estoma.Se realizó una anastomosis baja para cáncer rectal con estoma derivativo en 326 pacientes. Se produjeron 77 (24%) fugas anastomóticas, de las cuales 6 (8%) requirieron cirugía abdominal, 17 (22%) fueron tratadas de forma conservadora (tratamiento médico) y 54 (70%) fueron manejadas por drenaje. Se realizó drenaje transanal en 21 pacientes (39%) y procedimientos de drenaje radiológico en 33 pacientes (61%). La mediana del intervalo entre la cirugía y el drenaje fue de 13 días [9-21]. 5 (9%) pacientes requirieron cirugía abdominal de emergencia. Veintisiete (50%) pacientes no requirieron ninguna intervención adicional después del procedimiento de drenaje, mientras que 21 pacientes (39%) se sometieron a una reparación quirúrgica anastomótica. 43 pacientes (80%) no tuvieron estoma al final del seguimiento. El fracaso para mantener la anastomosis primaria después del drenaje local, se asoció con un aumento de la edad (p = 0.04), un drenaje pélvico preoperatorio (p = 0.05), una duración del drenaje >10 días (p = 0.002), el tiempo entre la cirugía y el drenaje >15 días (p = 0.03), anastomosis termino lateral o bolsa en J (p = 0.04) y drenaje quirúrgico transanal (p = 0.03).El pequeño tamaño de la muestra del estudio fue la principal limitación.Después de la fuga anastomótica, los procedimientos del drenaje local conservaron la anastomosis primaria en el 50% de los casos. Vea el Resumen del Video en http://links.lww.com/DCR/B57. more...
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- 2020
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38. Is diverting loop ileostomy necessary for completion proctectomy with ileal pouch-anal anastomosis? A multicenter randomized trial of the GETAID Chirurgie group (IDEAL trial): rationale and design (NCT03872271).
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Beyer-Berjot L, Baumstarck K, Loubière S, Vicaut E, Berdah SV, Benoist S, and Lefèvre JH
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Anastomotic Leak, Cost-Benefit Analysis, Length of Stay, Postoperative Complications, Quality of Life, Reoperation, Treatment Outcome, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Colitis surgery, Colitis, Ulcerative surgery, Ileostomy adverse effects, Ileostomy economics, Ileostomy methods, Proctocolectomy, Restorative adverse effects, Proctocolectomy, Restorative economics, Proctocolectomy, Restorative methods, Rectum surgery
- Abstract
Background: There is no quality evidence of the benefit of defunctioning ileostomy (DI) in ileal pouch-anal anastomoses (IPAAs) performed for inflammatory bowel disease (IBD), but most surgical teams currently resort to DI. In the case of a staged procedure with subtotal colectomy first, completion proctectomy with IPAA is performed for healthy patients, namely, after nutritional support, inflammation reduction and immunosuppressive agent weaning. Therefore, the aim of this trial is to assess the need for systematic DI after completion proctectomy and IPAA for IBD., Methods/design: This is a multicenter randomized open trial comparing completion proctectomy and IPAA without (experimental) or with (control) DI in patients presenting with ulcerative colitis or indeterminate colitis. Crohn's disease patients will not be included. The design is a superiority trial. The main objective is to compare the 6-month global postoperative morbidity, encompassing both surgical and medical complications, between the two groups. The morbidity of DI closure will be included, as appropriate. The sample size calculation is based on the hypothesis that the overall 6-month morbidity rate is 30% in the case of no stoma creation (i.e., experimental group) vs. 55% otherwise (control group). With the alpha risk and power are fixed to 0.05 and 0.80, respectively, and considering a dropout rate of 10%, the objective is set to 194 patients. The secondary objectives are to compare both strategies in terms of morbi-mortality at 6 months and functional results as well as quality of life at 12 months, namely, the 6-month major morbidity and unplanned reoperation rates, 6-month anastomotic leakage rate, 6-month mortality, length of hospital stay, 6-month unplanned readmission rate, quality of life assessed 3 and 12 months from continuity restoration (i.e., either IPAA or stoma closure), functional results assessed 3 and 12 months from continuity restoration, 12-month pouch results, 12-month cost-utility analysis, and 12-month global morbidity., Discussion: The IDEAL trial is a nationwide multicenter study that will help choose the optimal strategy between DI and no ileostomy in completion proctectomy with IPAA for IBD., Trial Registration: ClinicalTrial.gov: NCT03872271, date of registration March 13th, 2019. more...
- Published
- 2019
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39. Multicenter phase III randomized trial comparing laparoscopy and laparotomy for colon cancer surgery in patients older than 75 years: the CELL study, a Fédération de Recherche en Chirurgie (FRENCH) trial.
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Manceau G, Brouquet A, Chaibi P, Passot G, Bouché O, Mathonnet M, Regimbeau JM, Lo Dico R, Lefèvre JH, Peschaud F, Facy O, Volpin E, Chouillard E, Beyert-Berjot L, Verny M, Karoui M, and Benoist S
- Subjects
- Aged, Aged, 80 and over, Clinical Trials, Phase III as Topic, Colectomy adverse effects, Colonic Neoplasms pathology, Geriatric Assessment, Humans, Laparoscopy, Laparotomy, Postoperative Complications epidemiology, Quality of Life, Randomized Controlled Trials as Topic, Colectomy methods, Colonic Neoplasms surgery
- Abstract
Background: Several multicenter randomized controlled trials comparing laparoscopy and conventional open surgery for colon cancer have demonstrated that laparoscopic approach achieved the same oncological results while improving significantly early postoperative outcomes. These trials included few elderly patients, with a median age not exceeding 71 years. However, colon cancer is a disease of the elderly. More than 65% of patients operated on for colon cancer belong to this age group, and this proportion may become more pronounced in the coming years. In current practice, laparoscopy is underused in this population., Methods: The CELL (Colectomy for cancer in the Elderly by Laparoscopy or Laparotomy) trial is a multicenter, open-label randomized, 2-arm phase III superiority trial. Patients aged 75 years or older with uncomplicated colonic adenocarcinoma or endoscopically unresectable colonic polyp will be randomized to either colectomy by laparoscopy or laparotomy. The primary endpoint of the study is overall postoperative morbidity, defined as any complication classification occurring up to 30 days after surgery. The secondary endpoints are: 30-day and 90-day postoperative mortality, 30-day readmission rate, quality of surgical resection, health-related quality of life and evolution of geriatric assessment. A 35 to 20% overall postoperative morbidity rate reduction is expected for patients operated on by laparoscopy compared with those who underwent surgery by laparotomy. With a two-sided α risk of 5% and a power of 80% (β = 0.20), 276 patients will be required in total., Discussion: To date, no dedicated randomized controlled trial has been conducted to evaluate morbidity after colon cancer surgery by laparoscopy or laparotomy in the elderly and the benefits of laparoscopy is still debated in this context. Thus, a prospective multicenter randomized trial evaluating postoperative outcomes specifically in elderly patients operated on for colon cancer by laparoscopy or laparotomy with curative intent is warranted. If significant, such a study might change the current surgical practices and allow a significant improvement in the surgical management of this population, which will be the vast majority of patients treated for colon cancer in the coming years., Trial Registration: ClinicalTrials.gov NCT03033719 (January 27, 2017). more...
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- 2019
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40. Mismatch Repair System Deficiency Is Associated With Response to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer.
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Meillan N, Vernerey D, Lefèvre JH, Manceau G, Svrcek M, Augustin J, Fléjou JF, Lascols O, Simon JM, Cohen R, Maingon P, Bachet JB, and Huguet F
- Subjects
- Age Factors, Aged, Female, Germ-Line Mutation, Humans, Male, Middle Aged, Neoplasm Staging, Progression-Free Survival, Propensity Score, Radiation Tolerance genetics, Rectal Neoplasms mortality, Rectal Neoplasms pathology, Retrospective Studies, Sex Factors, Treatment Outcome, Chemoradiotherapy, Adjuvant, DNA Mismatch Repair physiology, Neoadjuvant Therapy methods, Rectal Neoplasms genetics, Rectal Neoplasms therapy
- Abstract
Purpose: Defective mismatch repair system (dMMR) has been shown to have a favorable impact on outcome in patients with colorectal cancer treated with surgery or immunotherapy, with adjuvant chemotherapy being discouraged unless there is nodal involvement. Its impact on radiosensitivity is unknown in patients with colorectal cancer., Methods and Materials: Patients treated for locally advanced rectal cancer between 2000 and 2016 were studied. Reported points included age, sex, clinical and radiologic tumor stages at diagnosis, modalities of neoadjuvant treatment, posttreatment pathologic staging, tumor regression score, and local, distant relapse-free, and overall survival. An inverse probability of treatment weighting propensity score analysis was performed to evaluate the association of mismatch repair proficiency with surgical and clinical outcomes., Results: Among the 296 patients included, 23 (7.8%) had dMMR. Median follow-up was 43.0 months (interquartile range, 27.9-66.7). Patients with dMMR were significantly younger than the others. After inverse probability of treatment weighting propensity score matching, dMMR patients had higher pathologic downstaging rate (P < .0001), higher tumor regression grade (P = .024), and a longer recurrence-free survival (P < .0001)., Conclusions: dMRR was associated with significant tumor downstaging after neoadjuvant chemoradiation and with increased recurrence-free survival. dMMR patients may have more radiosensitive tumors., (Copyright © 2019 Elsevier Inc. All rights reserved.) more...
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- 2019
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41. Health as an independent predictor of the 2017 French presidential voting behaviour: a cross-sectional analysis.
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Zeitoun JD, Faron M, de Vaugrigneuse S, and Lefèvre JH
- Subjects
- Adult, Cross-Sectional Studies, Female, France, History, 21st Century, Humans, Linear Models, Male, Middle Aged, Multivariate Analysis, Young Adult, Chronic Disease psychology, Federal Government history, Health Status, Health Status Indicators, Politics
- Abstract
Background: It has been suggested that poor health has influenced vote for Brexit and the US presidential election. No such research has been published regarding the 2017 French presidential election., Methods: We performed a cross-sectional analysis using a comprehensive set of socioeconomic and health indicators, to be compared with voting outcome at the first round of the 2017 French presidential election. The 95 French departments were selected as the unit of analysis. Data were obtained from publicly available sources. The linear model was used for both univariate and multivariate analysis to investigate the relation between voting patterns and predictors. Sensitivity analyses were done using the elastic-net regularisation., Results: Emmanuel Macron and Marine Le Pen arrived ahead. When projected on the first factorial plane (~ 60% of the total inertia), Emmanuel Macron and Marine Le Pen tended to be in opposite directions regarding both socioeconomic and health factors. In the respective multivariate analyses of the two candidates, both socio-economic and health variables were significantly associated with voting patterns, with wealthier and healthier departments more likely to vote for Emmanuel Macron, and opposite departments more likely to vote for Marine Le Pen. Mortality (p = 0.03), severe chronic conditions (p = 0.014), and diabetes mellitus (p < 0.0001) were among the strongest predictors of voting pattern for Marine Le Pen. Sensitivity analyses did not substantially change those findings., Conclusions: We found that areas associated with poorer health status were significantly more likely to vote for the far-right candidate at the French presidential election, even after adjustment on socioeconomic criteria. more...
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- 2019
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42. Does A Longer Waiting Period After Neoadjuvant Radio-chemotherapy Improve the Oncological Prognosis of Rectal Cancer?: Three Years' Follow-up Results of the Greccar-6 Randomized Multicenter Trial.
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Lefèvre JH, Mineur L, Cachanado M, Denost Q, Rouanet P, de Chaisemartin C, Meunier B, Mehrdad J, Cotte E, Desrame J, Karoui M, Benoist S, Kirzin S, Berger A, Panis Y, Piessen G, Saudemont A, Prudhomme M, Peschaud F, Dubois A, Loriau J, Tuech JJ, Meurette G, Lupinacci R, Goasguen N, Creavin B, Simon T, and Parc Y more...
- Subjects
- Adenocarcinoma pathology, Aged, Analysis of Variance, Chemoradiotherapy methods, Disease-Free Survival, Female, Humans, Magnetic Resonance Imaging methods, Male, Middle Aged, Multivariate Analysis, Neoadjuvant Therapy mortality, Neoplasm Invasiveness pathology, Neoplasm Staging, Proctocolectomy, Restorative mortality, Prognosis, Rectal Neoplasms pathology, Survival Analysis, Time Factors, Treatment Outcome, Adenocarcinoma mortality, Adenocarcinoma therapy, Neoadjuvant Therapy methods, Proctocolectomy, Restorative methods, Rectal Neoplasms mortality, Rectal Neoplasms therapy
- Abstract
Objective: The aim of this study was to report the 3-year survival results of the GRECCAR-6 trial., Summary Background Data: Current data on the effect of an extended interval between radiochemotherapy (RCT) and resection for rectal cancer on the rate of complete pathological response (pCR = ypT0N0) is controversial. Furthermore, its effect on oncological outcomes is unknown., Methods: The GRECCAR-6 trial was a phase III, multicenter, randomized, open-label, parallel-group, controlled trial. Patients with cT3/T4 or TxN+ tumors of the mid or lower rectum who had received RCT (45-50 Gy with 5-fluorouracil or capecitabine) were included and randomized into a 7- or 11-week waiting period. Primary endpoint was the pCR rate. Secondary endpoints were 3-year overall (OS), disease-free survival (DFS), and recurrence rates., Results: A total of 265 patients from 24 participating centers were enrolled. A total of 253 patients underwent a mesorectal excision. Overall pCR rate was 17% (43/253). Mean follow-up from surgical resection was 32 ± 8 months. Twenty-four deaths occurred with an 89% OS at 3 years. DFS was 68.7% at 3 years (75 recurrences). Three-year local and distant recurrences were 7.9% and 23.8%, respectively. The randomization group had no impact on the 3-year OS (P = 0.8868) or DFS (P = 0.9409). Distant (P = 0.7432) and local (P = 0.3944) recurrences were also not influenced by the waiting period. DFS was independently influenced by 3 factors: circumferential radial margin (CRM) ≤1 mm [hazard ratio (HR) = 2.03; 95% confidence interval (CI), 1.17-3.51], ypT3-T4 (HR = 2.69; 95% CI, 1.19-6.08) and positive lymph nodes (HR = 3.62; 95% CI, 1.89-6.91)., Conclusion: Extending the waiting period by 4 weeks following RCT has no influence on the oncological outcomes of T3/T4 rectal cancers. more...
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- 2019
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43. Prognostic factors and patterns of recurrence after emergency management for obstructing colon cancer: multivariate analysis from a series of 2120 patients.
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Manceau G, Voron T, Mege D, Bridoux V, Lakkis Z, Venara A, Beyer-Berjot L, Abdalla S, Sielezneff I, Lefèvre JH, and Karoui M
- Subjects
- Adult, Aged, Aged, 80 and over, Colonic Neoplasms pathology, Emergencies, Female, France, Humans, Intestinal Obstruction pathology, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Prognosis, Retrospective Studies, Survival Rate, Colonic Neoplasms surgery, Intestinal Obstruction surgery
- Abstract
Purpose: At equal TNM stage, obstructing colon cancer (OCC) is associated with worse prognosis in comparison with uncomplicated cancer. Our aim was to identify prognostic factors of overall (OS) and disease-free survival (DFS) in patients treated for OCC., Methods: From 2000 to 2015, 2325 patients were treated for OCC in French surgical centers, members of the French National Surgical Association (AFC). Patients with palliative management were excluded. The main endpoints were OS and DFS. A multivariate analysis, using Cox proportional hazards regression model, was performed to determine independent prognostic factors., Results: The cohort included 2120 patients. The median of follow-up was 13.2 months. In multivariate analysis, age > 75 years, ASA score ≥ 3, ECOG score ≥ 3, right-sided colon cancer, presence of synchronous metastases, anastomotic leakage, and absence of adjuvant chemotherapy were independent OS factors. Age > 75 years, ASA score ≥ 3, right-sided colon cancer, presence of synchronous metastases, and absence of postoperative chemotherapy were independent factors of poor OS after exclusion of patients who died postoperatively. Age ≥ 75 years, ASA score ≥ 3, ECOG score ≥ 3, right-sided colon cancer, lymph node involvement, presence of vascular, lymphatic or perineural invasion, less than 12 harvested lymph nodes, and absence of adjuvant chemotherapy were independent DFS factors., Conclusions: Management of OCC should take into account prognostic factors related to the patient (age, comorbidities), tumor location, and tumor stage. Adjuvant chemotherapy administration plays an important role. For patients undergoing initial defunctionning stoma, neoadjuvant chemotherapy could be an option to improve prognosis. more...
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- 2019
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44. Hospital Readmissions After Urological Surgical Procedures in France: A Nationwide Cohort Study over 3 Years.
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Manach Q, Rouprêt M, Reboul-Marty J, Drouin SJ, Guillot-Tantay C, Matillon X, Parra J, Mozer P, Bitker MO, Lefèvre JH, and Phé V
- Subjects
- Aged, Comorbidity, Databases, Factual, Diagnosis-Related Groups statistics & numerical data, Female, France epidemiology, Hospitalization statistics & numerical data, Humans, Length of Stay statistics & numerical data, Male, Middle Aged, Outcome Assessment, Health Care, Postoperative Complications prevention & control, Risk Factors, Sex Factors, Time Factors, Hospitals classification, Hospitals standards, Patient Readmission statistics & numerical data, Postoperative Complications epidemiology, Urologic Surgical Procedures adverse effects, Urologic Surgical Procedures methods, Urologic Surgical Procedures statistics & numerical data
- Abstract
Background: Identifying the predictive factors for hospital readmission is required to target preventive measures., Objective: To assess the rate of surgical readmissions after a urological procedure and the risk factors associated with readmission., Design, Setting, and Participants: Data from all hospitalizations between January 2010 and November 2012 in France, regarding planned urological surgeries, were retrieved from the national medical database. To limit interactions between recent hospitalizations and surgical interventions, we selected only patients who were not hospitalized during the 12 mo preceding the urological procedure., Outcome Measurements and Statistical Analysis: Primary outcome was the rate of readmissions within 30 d after urological surgery. The following risk factors for readmission were assessed: sex, age, diagnosis-related group, length of stay of initial hospitalization, type of hospitalization (conventional or day surgery), hospital volume activity, hospital volume for day surgery, and hospital status. Logistic regression multivariate analysis was used to assess risk factors., Results and Limitations: Overall, 419 787 patients were included among whom 77 241 patients (18.40%) were readmitted within the following 30 d. After multivariate analyses, male sex (odds ratio [OR]=1.84, confidence interval [CI] 95%: 1.81-1.88), high level of comorbidity (diagnosis-related group 3-4 vs 1-2: OR=2.14, CI 95%: 2.10-2.21), and initial management in a private hospital (private vs university hospital: OR=1.13, CI 95%: 1.11-1.16; private vs public general hospital: OR=1.21, CI 95%: 1.18-1.23) were associated with a higher risk of readmission within 30 d., Conclusions: Reported readmission rate within 30 d after a planned a urological procedure was nearly 20%., Patient Summary: In this French national study, we investigated the readmission rate within 30 d after a planned urological procedure in a large French population and discovered it was nearly 20%., (Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.) more...
- Published
- 2018
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45. Identification of Positively and Negatively Selected Driver Gene Mutations Associated With Colorectal Cancer With Microsatellite Instability.
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Jonchere V, Marisa L, Greene M, Virouleau A, Buhard O, Bertrand R, Svrcek M, Cervera P, Goloudina A, Guillerm E, Coulet F, Landman S, Ratovomanana T, Job S, Ayadi M, Elarouci N, Armenoult L, Merabtene F, Dumont S, Parc Y, Lefèvre JH, André T, Fléjou JF, Guilloux A, Collura A, de Reyniès A, and Duval A more...
- Subjects
- Animals, Base Sequence, Cell Line, Tumor, Cohort Studies, Female, Heterografts, Humans, Male, Mice, Mice, Nude, Models, Statistical, Exome Sequencing, Carcinogenesis genetics, Colorectal Neoplasms genetics, Microsatellite Instability, Mutation genetics, Repetitive Sequences, Nucleic Acid genetics
- Abstract
Background & Aims: Recent studies have shown that cancers arise as a result of the positive selection of driver somatic events in tumor DNA, with negative selection playing only a minor role, if any. However, these investigations were concerned with alterations at nonrepetitive sequences and did not take into account mutations in repetitive sequences that have very high pathophysiological relevance in the tumors showing microsatellite instability (MSI) resulting from mismatch repair deficiency investigated in the present study., Methods: We performed whole-exome sequencing of 47 MSI colorectal cancers (CRCs) and confirmed results in an independent cohort of 53 MSI CRCs. We used a probabilistic model of mutational events within microsatellites, while adapting pre-existing models to analyze nonrepetitive DNA sequences. Negatively selected coding alterations in MSI CRCs were investigated for their functional and clinical impact in CRC cell lines and in a third cohort of 164 MSI CRC patients., Results: Both positive and negative selection of somatic mutations in DNA repeats was observed, leading us to identify the expected true driver genes associated with the MSI-driven tumorigenic process. Several coding negatively selected MSI-related mutational events (n = 5) were shown to have deleterious effects on tumor cells. In the tumors in which deleterious MSI mutations were observed despite the negative selection, they were associated with worse survival in MSI CRC patients (hazard ratio, 3; 95% CI, 1.1-7.9; P = .03), suggesting their anticancer impact should be offset by other as yet unknown oncogenic processes that contribute to a poor prognosis., Conclusions: The present results identify the positive and negative driver somatic mutations acting in MSI-driven tumorigenesis, suggesting that genomic instability in MSI CRC plays a dual role in achieving tumor cell transformation. Exome sequencing data have been deposited in the European genome-phenome archive (accession: EGAS00001002477). more...
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- 2018
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46. The Balance Between Cytotoxic T-cell Lymphocytes and Immune Checkpoint Expression in the Prognosis of Colon Tumors.
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Marisa L, Svrcek M, Collura A, Becht E, Cervera P, Wanherdrick K, Buhard O, Goloudina A, Jonchère V, Selves J, Milano G, Guenot D, Cohen R, Colas C, Laurent-Puig P, Olschwang S, Lefèvre JH, Parc Y, Boige V, Lepage C, André T, Fléjou JF, Dérangère V, Ghiringhelli F, de Reynies A, and Duval A more...
- Subjects
- Antigens, CD genetics, B7-H1 Antigen analysis, B7-H1 Antigen genetics, CD8 Antigens analysis, CTLA-4 Antigen genetics, Colon chemistry, Colorectal Neoplasms chemistry, Colorectal Neoplasms pathology, Female, Gene Expression, Hepatitis A Virus Cellular Receptor 2 genetics, Humans, Inducible T-Cell Co-Stimulator Protein genetics, Male, Microsatellite Instability, Middle Aged, Neoplasm Staging, Prognosis, Programmed Cell Death 1 Ligand 2 Protein genetics, Programmed Cell Death 1 Receptor genetics, Retrospective Studies, Survival Rate, Th1 Cells, Lymphocyte Activation Gene 3 Protein, Biomarkers, Tumor genetics, Biomarkers, Tumor immunology, Colorectal Neoplasms genetics, Colorectal Neoplasms immunology, Lymphocytes, Tumor-Infiltrating, T-Lymphocytes, Cytotoxic
- Abstract
Background: Immune checkpoint (ICK) expression might represent a surrogate measure of tumor-infiltrating T cell (CTL) exhaustion and therefore be a more accurate prognostic biomarker for colorectal cancer (CRC) patients than CTL enumeration as measured by the Immunoscore., Methods: The expression of ICKs, Th1, CTLs, cytotoxicity-related genes, and metagenes, including Immunoscore-like metagenes, were evaluated in three independent cohorts of CRC samples (260 microsatellite instable [MSI], 971 non-MSI). Their associations with patient survival were analyzed by Cox models, taking into account the microsatellite instability (MSI) status and affiliation with various Consensus Molecular Subgroups (CMS). PD-L1 and CD8 expression were examined on a subset of tumors with immunohistochemistry. All statistical tests were two-sided., Results: The expression of Immunoscore-like metagenes was statistically significantly associated with improved outcome in non-MSI tumors displaying low levels of both CTLs and immune checkpoints (ICKs; CMS2 and CMS3; hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.43 to 0.92, P = .02; and HR = 0.55, 95% CI = 0.34 to 0.90, P = .02, respectively), but clearly had no prognostic relevance in CRCs displaying higher levels of CTLs and ICKs (CMS1 and CMS4; HR = 0.46, 95% CI = 0.10 to 2.10, P = .32; and HR = 1.13, 95% CI = 0.79 to 1.63, P = .50, respectively), including MSI tumors. ICK metagene expression was statistically significantly associated with worse prognosis independent of tumor staging in MSI tumors (HR = 3.46, 95% CI = 1.41 to 8.49, P = .007). ICK expression had a negative impact on the proliferation of infiltrating CD8 T cells in MSI neoplasms (median = 0.56 in ICK low vs median = 0.34 in ICK high, P = .004)., Conclusions: ICK expression cancels the prognostic relevance of CTLs in highly immunogenic colon tumors and predicts a poor outcome in MSI CRC patients., (© The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com) more...
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- 2018
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47. Impact of resident and fellow changeovers on patient outcomes: a nationwide cross-sectional study.
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Zeitoun JD, Reboul-Marty J, and Lefèvre JH
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- Cross-Sectional Studies, Efficiency, Organizational, France, Gastrointestinal Hemorrhage therapy, Hospital Mortality, Hospitals, Teaching statistics & numerical data, Humans, Length of Stay statistics & numerical data, Myocardial Infarction therapy, Quality of Health Care statistics & numerical data, Stroke therapy, Surgical Procedures, Operative statistics & numerical data, Treatment Outcome, Continuity of Patient Care organization & administration, Continuity of Patient Care statistics & numerical data, Internship and Residency statistics & numerical data
- Abstract
Background: Findings regarding the association of cohort changeovers with patient outcomes are mixed. We sought to examine the association of resident and fellow changeovers with a comprehensive set of indicators., Methods: We performed a cross-sectional comparative study including all French teaching and non-teaching hospitals. All-cause mortality and length of stay were assessed. Focused analysis for three medical conditions (myocardial infarction, intestinal hemorrhage, stroke) and three surgical procedures (colorectal, vascular and spine surgery) was performed regarding other quality and efficiency indicators (readmissions, intensive care unit admission, transfers)., Results: Overall, 34 330 716 patients were admitted in 2011 and 2012. Within the month following cohort changeovers, no increase in mortality was observed in teaching hospitals. Length of stay was longer in May and November in teaching hospitals (P < 0.0001) whereas it was shorter in the private sector. When focusing on six selected causes of hospitalization, we observed significant differences associated with resident changeovers, suggesting a decreased efficiency. In particular, readmissions rates and lengths of stay were found to be significantly higher (P < 0.0005) after intestinal hemorrhage and with a trend toward worse efficiency (P < 0.005) after colorectal surgery and stroke in teaching hospitals., Conclusion: Our findings provide some reassurance regarding cohort changeover and mortality even if they suggest a loss of efficiency in some cases., (© The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.) more...
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- 2017
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48. Surveillance of Duodenal Polyposis in Familial Adenomatous Polyposis: Should the Spigelman Score Be Modified?
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Sourrouille I, Lefèvre JH, Shields C, Colas C, Bellanger J, Desaint B, Paye F, Tiret E, and Parc Y
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- Adenomatous Polyposis Coli pathology, Duodenal Neoplasms pathology, Duodenum pathology, Humans, Neoplasm Staging, Adenomatous Polyposis Coli diagnosis, Aftercare methods, Duodenal Neoplasms diagnosis, Duodenum diagnostic imaging, Endoscopy, Gastrointestinal
- Abstract
Background: Duodenal polyposis is a manifestation of adenomatous polyposis that predisposes to duodenal or ampullary adenocarcinoma. Duodenal polyposis is monitored by upper GI endoscopies and may require iterative resections and prophylactic radical surgical treatment when malignancy is threatening., Objective: The purpose of this study was to evaluate severity scoring for surveillance and treatment in a large series of duodenal polyposis., Design: From 1982 to 2014, every patient surveyed by upper GI endoscopies for duodenal polyposis was included., Settings: The study was conducted at a single tertiary care center., Patients: We performed 1912 upper GI endoscopies in 437 patients (median = 3; interquartile range, 2-6 endoscopies)., Main Outcome Measures: Conservative treatment was performed in 103 patients (159 endoscopic and 17 surgical resections), whereas radical surgical treatment (Whipple procedure or duodenectomy) was required in 52 (median age, 47.5 y; range, 43.0-57.3 y) because of high-grade dysplasia or unresectable lesions., Results: Genes involved were APC (n = 274; 62.7%) and MUTYH (n = 21; 4.8%). First upper GI endoscopies (median age, 32 y; range, 21-44 y) revealed duodenal polyposis in 190 (43.5%). Rates of low-grade dysplasia, high-grade dysplasia, and duodenal or ampulary adenocarcinoma at 5 years were 65% (range, 61.7%-66.9%), 12.1% (range, 10.3%-13.9%), and 2.4% (range, 1.5%-3.3%), whereas 10-year rates were 75.8% (range, 73.1%-78.5%), 20.8% (range, 18.2%-23.4%), and 5.4% (range, 3.8%-7.0%). The rate of ampullary abnormalities rose during surveillance from 18.3% at the first upper GI endoscopies to 47.4% at the fourth. Predictive factors for high-grade dysplasia were age at first upper GI endoscopy, type and age of colorectal surgery, Spigelman score, presence of an ampullary abnormality, and number of endoscopic treatments. In multivariate analysis, only age at first upper GI endoscopy and presence of an ampullary abnormality were independent predictive factors. Histologic analysis after radical surgical treatment showed high-grade dysplasia in 30 patients and duodenal or ampulary adenocarcinoma in 11 (4 patients had lymph node involvement)., Limitations: The study was limited by its retrospective analysis of a prospective database., Conclusions: More than 20% of patients developed high-grade dysplasia with duodenal polyposis after 10 years. Iterative endoscopic resections allowed extended control, but surgery remained necessary in 12% of the patients and happened too late in many cases; 20% of those operated had developed duodenal or ampulary adenocarcinoma, whereas 8% exhibited malignancy with lymph node involvement. The trigger for prophylactic surgery required a more accurate predictive score leading to closer endoscopic surveillance. Modifying the Spigelman score by accounting for ampullary abnormalities should be considered as a means to increase compliance with closer endoscopic follow-up in high-risk patients. See Video Abstract at http://links.lww.com/DCR/A430. more...
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- 2017
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49. Day Surgery for Acute Appendicitis in Adults: A Prospective Series of 102 Patients.
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Hobeika C, Hor T, Chereau N, Laforest A, Bachmann R, Sourouille I, Chafai N, Parc Y, Beaussier M, and Lefèvre JH
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- Acute Disease, Adult, Appendicitis diagnostic imaging, Feasibility Studies, Female, Humans, Length of Stay statistics & numerical data, Male, Operative Time, Postoperative Care, Prospective Studies, Tomography, X-Ray Computed, Ultrasonography, Young Adult, Ambulatory Surgical Procedures methods, Appendectomy methods, Appendicitis surgery
- Abstract
Aim: To report the results of a consecutive series of day surgery appendectomy (DSA) for acute appendicitis., Methods: Selection criteria for DSA were as follows: body mass index<28 kg/m, white cell count <15,000/mL, C-reactive protein<30 mg/L, no radiological signs of perforation, and appendix diameter ≤10 mm. All patients with radiologically proven appendicitis and 4 or 5 criteria were proposed for DSA and prospectively included., Results: A total of 102 patients (female=39.2%) were operated between January 1, 2013 and January 5, 2015 with a median age of 29.5 years [interquartile range (IQR), 23 to 37 y]. Diagnosis was mainly supported by computed tomographic scan (75.5%). About 60 patients (59%) were reconvened on the next morning for surgery with oral antibiotics. The median operative time was 40 minutes (IQR, 30 to 52 min), and 92 (90%) patients were discharged on day 0 after a postoperative period of 5h:12min (IQR, 4h:14min to 6h:33min). The overall median hospital length of stay was 8h:04min (IQR, 6h:46min to 10h:23min). Surgical morbidity was 6.9% (n=7), with 1.9% (n=2) major complications., Conclusions: DSA is a safe procedure for selected patients; it reduces the hospital length of stay without increasing morbidity. more...
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- 2017
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50. [Mesocolic excision for colonic adenocarcinoma].
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Debove C, Lefèvre JH, and Parc Y
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- Adenocarcinoma pathology, Colectomy methods, Colectomy mortality, Colonic Neoplasms pathology, Disease-Free Survival, Humans, Lymph Node Excision methods, Mesocolon pathology, Neoplasm Recurrence, Local, Postoperative Complications mortality, Treatment Outcome, Adenocarcinoma surgery, Colonic Neoplasms surgery, Mesocolon surgery
- Abstract
On the same principle than total mesorectal excision in rectal cancer, the effect of complete mesocolic excision on short and long-term outcomes is actually evaluated for colonic adenocarcinoma. This method, usually performed for left colectomy, offers a surgical specimen of higher quality, with a larger number of lymph nodes harvested. For right colectomy, surgical specifications make it less common complete mesocolic excision and conventional surgery offer comparable outcomes, as regards to postoperative morbidity and mortality rates. No differences are identified between laparoscopic and open surgery. On oncologic outcomes, only two studies report a higher free-disease survival after complete mesocolic excision. Then, there is evidence that complete mesocolic excision offers a higher rate of specimen with extensive lymph node resection, without increased morbidity rate. However, there is limited evidence that it leads to improve long-term oncological outcomes., (Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.) more...
- Published
- 2017
- Full Text
- View/download PDF
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