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Hôpital-Camfrout, France

Twenty-eight patients with squamous cell carcinoma of the anal canal were treated by preoperative radiation therapy and chemotherapy. The radiation therapy, 3,000 rad (30 Gy) at 200 rad per day, was given for five days a week to the primary tumor with margin and to the pelvic and inguinal lymph nodes. Chemotherapy was given in the form of 5-fluorouracilinfusion 1,000 mg/m2 on days 1-4 of the radiation therapy and repeated on days 29-32 of the treatment regimen. Mitomycin C was given in the form of intravenous bolus 15 mg/m2 on day 1. Surgery was done 4-6 weeks following the last day of radiation treatment. Twelve patients underwent anteroposterior resection, and seven of the 12 had no residual tumor in the surgical specimen, while one patient had microscopic tumor only. An additional 14 patients had complete clinical disappearance of their tumor, and, on excision of the scar, it was found free of microscopic cancer. Two other patients are clinically free of tumor but had no biopsy after therapy. While transient proctitis leukopenia and thrombocytopenia were moderate to severe, no serious complications were observed in these patients. Twenty-two patients were free of tumor and alive 1-8 years after treatment. One patient died a cardiac death without tumor four years after surgery. Four patients, all with residual tumor in the specimen, have died of cancer. Their primary lesions were more than 7 cm in maximum diameter at initial examination. One patient died of disseminated disease with no local recurrence after abdominal perineal resection. © Springer-Verlag France 2010.

Chalret Du Rieu M.,Service de Chirurgie Generale et Digestive | Baulieux J.,Service de chirurgie generale | Rode A.,Service de chirurgie generale | Mabrut J.Y.,Service de chirurgie generale
Journal de Chirurgie Viscerale | Year: 2011

Chylothorax is a rare but severe complication of both thoracic and esophageal surgery. The anatomical relationship of thoracic duct and its highly variable anatomy may explain the occurrence of thoracic duct injury during dissection of the posterior mediastinum. At early stage, it can lead to severe cardiorespiratory and volemic complications. In case of chronicization, malnutrition and immunologic complications can occur, responsible for a mortality rate of up to 50%. An optimal management of chylothorax can decrease mortality and is based on three options: conservative treatment, surgery and radiological treatment. Conservative treatment must be initiated since the diagnosis established and allows resolution of chylothorax in 50 to 70% of cases. In case of either high flow chylothorax or failure of conservative treatment, reoperation is indicated. Percutaneous embolization is an interesting and minimally invasive alternative to surgery. © 2011 Elsevier Masson SAS. All rights reserved.

Cunningham D.,Gastrointestinal Unit | Atkin W.,Imperial College London | Lenz H.-J.,University of Southern California | Lynch H.T.,Creighton University | And 3 more authors.
The Lancet | Year: 2010

Substantial progress has been made in colorectal cancer in the past decade. Screening, used to identify individuals at an early stage, has improved outcome. There is greater understanding of the genetic basis of inherited colorectal cancer and identification of patients at risk. Optimisation of surgery for patients with localised disease has had a major effect on survival at 5 years and 10 years. For rectal cancer, identification of patients at greatest risk of local failure is important in the selection of patients for preoperative chemoradiation, a strategy proven to improve outcomes in these patients. Stringent postoperative follow-up helps the early identification of potentially radically treatable oligometastatic disease and improves long-term survival. Treatment with adjuvant fluoropyrimidine for colon and rectal cancers further improves survival, more so in stage III than in stage II disease, and oxaliplatin-based combination chemotherapy is now routinely used for stage III disease, although efficacy must be carefully balanced against toxicity. In stage II disease, molecular markers such as microsatellite instability might help select patients for treatment. The integration of targeted treatments with conventional cytotoxic drugs has expanded the treatment of metastatic disease resulting in incremental survival gains. However, biomarker development is essential to aid selection of patients likely to respond to therapy, thereby rationalising treatments and improving outcomes. © 2010 Elsevier Ltd. All rights reserved.

Ben Ameur H.,Service de Chirurgie Generale et Digestive
Journal of visceral surgery | Year: 2011

Duodenal diverticulum is a common occurrence but most are asymptomatic. However, in some cases, they can cause mechanical biliary compression. We report the case of a duodenal diverticulum in a 64-year-old woman revealed by severe cholangitis with septic shock and a liver abscess. Associated annular pancreas was found. We discuss the various investigations to diagnose these two entities as well as the therapeutic strategy in this unique combination of disease. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Rahbari N.N.,University of Heidelberg | Weitz J.,University of Heidelberg | Hohenberger W.,Friedrich - Alexander - University, Erlangen - Nuremberg | Heald R.J.,Colorectal Research Unit | And 10 more authors.
Surgery | Year: 2010

Background: Anastomotic leakage represents a major complication after anterior resection of the rectum. The incidence of anastomotic leakage varies considerably among clinical studies in part owing to the lack of a standardized definition of this complication. The aim of the present article was to propose a definition and severity grading of anastomotic leakage after anterior rectal resection. Methods: After a literature review a consensus definition and severity grading of anastomotic leakage was developed within the International Study Group of Rectal Cancer. Results: Anastomotic leakage should be defined as a defect of the intestinal wall at the anastomotic site (including suture and staple lines of neorectal reservoirs) leading to a communication between the intra- and extraluminal compartments. Severity of anastomotic leakage should be graded according to the impact on clinical management. Grade A anastomotic leakage results in no change in patients' management, whereas grade B leakage requires active therapeutic intervention but is manageable without re-laparotomy. Grade C anastomotic leakage requires re-laparotomy. Conclusion: The proposed definition and clinical grading is applicable easily in the setting of clinical studies. It should be applied in future reports to facilitate valid comparison of the results of different studies. © 2010 Mosby, Inc. All rights reserved.

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