Sainte-Foy-lès-Lyon, France
Sainte-Foy-lès-Lyon, France

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Passot G.,Edouard Herriot Hospital HCL | Lebeau R.,Edouard Herriot Hospital HCL | Hervieu V.,Edouard Herriot Hospital HCL | Ponchon T.,Edouard Herriot Hospital HCL | And 2 more authors.
Pancreas | Year: 2012

Objective: The detection of intraductal papillary mucinous neoplasms (IPMN) has increased over the last decade, but still, management remains controversial. The main problems are their potential for malignancy and risk of recurrence. The purpose of this study was to determine the predictive factors of recurrence after surgical resection. Methods: All patients with IPMN who underwent pancreatectomy with curative intent were considered. Data were collected from a prospective base. Results: From 1994 to 2009, 104 patients underwent pancreatectomy. Twenty-one (20%) had recurrence, 15 on remnant pancreas (none on pancreatic cut surface) and 6 with distant metastases. Twelve patients had total pancreatectomy (1 awaiting surgery). Thirteen (38.2%) of 34 patients with invasive IPMN and 20 (25.9%) of 77 with main duct involvement (including combined type) had recurrence. In univariate analysis, American Society of Anesthesiologist score and histological and duct type had a significant impact on recurrence rate. In multivariate analysis, histological type (invasiveness) was the only significant predictive factor for recurrence. Conclusion: The risk of recurrence of IPMN after resection depends on the histological type. According to surgical margin, invasiveness, and the type of duct involved, we identified a high-risk group with invasive main duct lesion and a low-risk group with noninvasive branch duct lesion. Copyright © 2012 by Lippincott Williams & Wilkins.


Adham M.,Edouard Herriot Hospital HCL | Bredt L.C.,Edouard Herriot Hospital HCL | Robert M.,Edouard Herriot Hospital HCL | Perinel J.,Edouard Herriot Hospital HCL | And 3 more authors.
Langenbeck's Archives of Surgery | Year: 2014

Background: Surgery remains the only potential curative therapy for pancreatic cancer, but compromised physiological reserve and comorbidities may deny pancreatic resection from elderly patients. Methods: The medical records of all patients who underwent pancreatic resection at our institution (2005-2012) were retrospectively reviewed. Postoperative and long-term outcomes were compared between patients with cutoff age of 70 years. Results: A total of 228 (66 %) and 116 (34 %) patients were <70 and ≥70 years, respectively. Elderly group had worse ASA scores (P<0.0001) with higher rates of invasive malignant pathologies (75 vs. 67 %, P=0.14), mainly pancreatic ductal adenocarcinoma (58.6 vs. 44.7 %, P=0.01). The most common type of resection was pancreaticoduodenectomy (PD) (59 %), followed by distal pancreatectomy (19.8 %). Mean hospital stay was comparable. Elderly patients had less grade ≥IIIb postoperative complications (12 vs. 20.1 %; P=0.04) and higher postoperative mortality rates (12.9 vs. 3.9 %; P=0.04). In multivariable Cox proportional hazards model for postoperative mortality, age ≥70 years (HR, 3.5; 95 % CI, 1.3-9.3), pancreaticoduodenectomy (HR, 12.6; 95 % CI, 1.6-96), and intraoperative blood loss were significant (P=0.012; P=0.015, and P=0.005, respectively). The overall 5-year survival rates for all patients, for patients aged <70 and ≥70 years were 56, 55, and 41 %, respectively (P=0.003). Conclusions: Elderly patients are at higher risk of mortality after pancreatic resection than usually reported case series. Nonetheless, elderly patients can undergo pancreatic resection with acceptable 5-year survival results. Our results contribute for a better, informed decision-making for elderly patients and their family. © 2014 Springer-Verlag.


Golse N.,Edouard Herriot Hospital HCL | Lebeau R.,Edouard Herriot Hospital HCL | Lombard-Bohas C.,Edouard Herriot Hospital HCL | Hervieu V.,Edouard Herriot Hospital HCL | And 2 more authors.
Pancreas | Year: 2013

Objective: Surgery remains the standard therapy for curative management of pancreatic duct adenocarcinoma (PDA) involving the head of pancreas. This study aimed to report our experience in PDA about the prognostic value of lymph node (LN) invasion (N) at the root of the superior mesenteric artery (SMA) and in N2 subgroup. METHODS: From January 2005 to September 2009, 110 patients were included for pancreaticoduodenectomy or total pancreatectomy. RESULTS: Etiologies were PDA (n = 87) or ampullary carcinomas (n = 23). Sixty-five percent of patients were N, with N1/N2/N3 location, respectively, 63.6%, 9.1%, and 2.7%. Forty-four percent had a LN identified intraoperatively at the origin of the SMA, of whom only 12% were N. In multivariate analysis (whole series), complication grade greater than II, location of positive LN (N1 to N3) and vascular resection were associated with a poorer survival. In the exocrine PDA subgroup, only location of positive LN and vascular resection were associated with a poorer survival. N SMA was not statistically correlated with survival, recurrence, or disease-free survival. CONCLUSIONS: N at the origin of the SMA was not a significant prognostic factor for PDA and should no longer be considered as a formal contraindication for curative surgery. Conversely, N2 invasion remains an unfavorable prognostic. Copyright © 2013 Lippincott Williams & Wilkins.


The detection of intraductal papillary mucinous neoplasms (IPMN) has increased over the last decade, but still, management remains controversial. The main problems are their potential for malignancy and risk of recurrence. The purpose of this study was to determine the predictive factors of recurrence after surgical resection.All patients with IPMN who underwent pancreatectomy with curative intent were considered. Data were collected from a prospective base.From 1994 to 2009, 104 patients underwent pancreatectomy. Twenty-one (20%) had recurrence, 15 on remnant pancreas (none on pancreatic cut surface) and 6 with distant metastases. Twelve patients had total pancreatectomy (1 awaiting surgery). Thirteen (38.2%) of 34 patients with invasive IPMN and 20 (25.9%) of 77 with main duct involvement (including combined type) had recurrence. In univariate analysis, American Society of Anesthesiologist score and histological and duct type had a significant impact on recurrence rate. In multivariate analysis, histological type (invasiveness) was the only significant predictive factor for recurrence.The risk of recurrence of IPMN after resection depends on the histological type. According to surgical margin, invasiveness, and the type of duct involved, we identified a high-risk group with invasive main duct lesion and a low-risk group with noninvasive branch duct lesion.


PubMed | Edouard Herriot Hospital HCL
Type: Journal Article | Journal: Pancreas | Year: 2013

Surgery remains the standard therapy for curative management of pancreatic duct adenocarcinoma (PDA) involving the head of pancreas. This study aimed to report our experience in PDA about the prognostic value of lymph node (LN) invasion (N) at the root of the superior mesenteric artery (SMA) and in N2 subgroup.From January 2005 to September 2009, 110 patients were included for pancreaticoduodenectomy or total pancreatectomy.Etiologies were PDA (n = 87) or ampullary carcinomas (n = 23). Sixty-five percent of patients were N, with N1/N2/N3 location, respectively, 63.6%, 9.1%, and 2.7%. Forty-four percent had a LN identified intraoperatively at the origin of the SMA, of whom only 12% were N. In multivariate analysis (whole series), complication grade greater than II, location of positive LN (N1 to N3) and vascular resection were associated with a poorer survival. In the exocrine PDA subgroup, only location of positive LN and vascular resection were associated with a poorer survival. N SMA was not statistically correlated with survival, recurrence, or disease-free survival.N at the origin of the SMA was not a significant prognostic factor for PDA and should no longer be considered as a formal contraindication for curative surgery. Conversely, N2 invasion remains an unfavorable prognostic.

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