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Biomedical subjects

A Sauvanet

Publications and source records attributed to A Sauvanet.

At least 127 records · Page 7Linked to original sources
PubMed1994

Associated primary esophageal and lung carcinoma: a study of 39 patients.

From 1979 to 1992, of 1,294 patients with esophageal squamous cell carcinoma, 39 patients (3.2%) (38 male patients, 1 female patient; mean age, 58 years) had associated primary lung carcinoma. Criteria for the diagnosis of primary lung carcinoma were: (1) non-squamous cell carcinoma tumors, (2) tumors existing before the esophageal squamous cell carcinoma, and (3) solitary squamous cell carcinoma presenting with endobronchial involvement. The two tumors were observed synchronously in 22 patients (56%) and metachronously in 17, with a mean tumor-free interval of 46 months (range, 18 to 77 months). In patients with synchronous disease, 10 underwent nonoperative treatment or a palliative surgical procedure, and 12 (55%) underwent a curative operation. In patients with metachronous disease, a curative operation was performed in all for the first tumor and in 9 (53%) for the second tumor. The overall postoperative mortality rate was 15%. Two patients (10%) died after the curative operation. None of the patients died who underwent curative esophagectomy combined with lobectomy. For the patients with synchronous disease, the 5-year survival rate was 11% in those who underwent a curative operation, and the longest survival in those who received palliative treatment was 18 months. For the patients with metachronous disease, the 5-year survival rates from the date of the diagnosis of the second tumor were 17% for those who had a curative operation and 11% for those who received palliative treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1994

Esophageal cancer after mediastinal irradiation.

The authors report 4 patients, without a history of tobacco or alcohol abuse, who developed squamous cell carcinoma of the esophagus secondary to mediastinal irradiation. Carcinoma of the esophagus developed in 3 women 8-11 years after mediastinal radiotherapy for breast cancer and in a man 9 years after mediastinal radiotherapy for Hodgkin's disease. Three patients underwent resection, with intrathoracic anastomosis in 2 and cervical in 1. No fistulae were observed despite the presence of esophageal fibrosis. No mediastinal lymph node was metastatic. Patients survived 7, 16, and 26 months, respectively, after resection. This study confirms the concept of radiation-induced carcinogenesis. We conclude that patients with dysphagia and a history of previous mediastinal radiotherapy should undergo repeated endoscopy for biopsy.

Aged↗
PubMed1994

Budd-Chiari syndrome with extensive portal thrombosis: treatment with Senning's procedure.

A patient with Budd-Chiari syndrome and associated extensive portal thrombosis, precluding any kind of portosystemic shunt, was treated with Senning's procedure. This technique, which includes dorsocranial hepatic resection and direct hepatoatrial anastomosis under total vascular exclusion of the liver, resulted in prompt recovery from acute hepatic failure and esophageal bleeding. Peroperatively, the hemodynamic status was secured with a venous cavo-caval bypass. This observation suggests that Senning's procedure is strongly indicated in the case of Budd-Chiari syndrome with extensive portal thrombosis.

Adult↗
PubMed1994

A ten-year experience with hepatic resection in 338 patients: evolutions in indications and of operative mortality.

OBJECTIVE: To report changes in indications for, and operative mortality of, elective hepatic resection during the 10 year period 1980-1989. DESIGN: Retrospective study. SETTING: District hospital. SUBJECTS: 338 consecutive patients who underwent elective hepatic resection. INTERVENTIONS: During the first five years (1980-1984) 99 resections were done, 10 through a right thoracoabdominal incision, and the hepatic pedicle was clamped in 6. During the period 1985-1989 239 resections were done, only 7 (3%) through a thoracoabdominal incision, and the hepatic pedicle was occluded in 197 (82%). MAIN OUTCOME MEASURES: Changes in indications for operation and operative technique, and mortality. RESULTS: Indications for resection in the first period were: benign lesions (n = 39), primary hepatic cancer (n = 30-15 had hepatocellular carcinoma associated with cirrhosis), and metastatic disease (n = 30). Six patients died, five from uncontrollable bleeding during operation. Indications during the second half were: benign lesions (n = 105, 44%), primary hepatic cancer (n = 87, 36%-62 (29%) had hepatocellular carcinoma associated with cirrhosis), and metastatic disease (n = 47, 20%). There was only 1 death during operation (air embolism), and 9 cirrhotic patients died during the postoperative period. CONCLUSIONS: More hepatic resections are being done and the indications are changing, with more patients with cancer and benign tumours being operated on; increasing use of pedicle occlusion has resulted in a significant decrease in uncontrollable operative bleeding; and mortality is still related to the presence of associated cirrhosis.

Adolescent↗
PubMed1994

A simplified technique of ex situ hepatic surgical treatment.

A simplified technique of "ex situ" hepatic surgical treatment, indicated when conventional operation is precluded by a huge centrohepatic tumor or the need of suprahepatic vascular reconstruction, or both, is described. Wide access on all parts of the liver is provided by section of infrahepatic and suprahepatic vena cava, but the continuity of the portal triad is preserved. This technical modification reduces the duration of the anhepatic phase and avoids the risks of artery and biliary reconstruction.

Hepatectomy↗
PubMed1993

Surgical results of left lobectomy and left hepatectomy in 70 noncirrhotic patients. A preliminary evaluation before performing liver transplantation from living related donors.

As a preliminary step before performing liver transplantation using living related donors, a comparative study was undertaken to determine the specific operative risk of left lobectomy (n = 54) compared to left hepatectomy (n = 16) in noncirrhotic patients. No postoperative death was observed in either group and no patients required reoperation. The mean hospital stay was longer after left hepatectomy than after left lobectomy (23 +/- 15 days vs 10 +/- 3 days, P < 0.05). The postoperative course was uneventful in 94% of the patients after left lobectomy and in 44% after left hepatectomy (P < 0.001). The peroperative transfusion rate was higher after left hepatectomy than after left lobectomy (38% vs 4%, P = 0.001). The postoperative collection rate was higher after left hepatectomy than after left lobectomy (25% vs 6%, NS). No biliary fistulas or subphrenic abscesses were noted after left lobectomy; however, these were observed in 19% and 12% of the cases, respectively, after left hepatectomy. Although conventional liver resection is quite different from graft harvesting in living related transplantation, our study demonstrates that the morbidity rate is significantly higher after left hepatectomy than after left lobectomy.

Adult↗
PubMed1993

Drainage after elective hepatic resection. A randomized trial.

OBJECTIVE: This prospective randomized study determined the influence of closed-suction drainage on the incidence of postoperative complications after elective hepatic resection. SUMMARY BACKGROUND DATA: Routine drainage is no longer advocated after several intra-abdominal surgical procedures. METHODS: A series of 81 patients who underwent elective hepatic resection were randomly allocated to either a nondrainage group (n = 39) and a drainage group with closed-suction drainage (n = 42). Indications for resection were 42 benign lesions and 39 malignant tumors, including 19 with cirrhosis. Major hepatic resection was performed in 25 patients and minor resection, in 56. All patients underwent ultrasonography with puncture for bacteriologic cultures of all fluid collections within the first 5 postoperative days. RESULTS: One patient died in each group. Ultrasonography found a significantly higher rate of subphrenic collections in the drainage group compared with the nondrainage group (respectively, 36% vs. 15%, p < 0.05). These collections were more frequently infected in the drainage group (n = 6) than in the nondrainage group (n = 2). After major liver resection, the rate of intra-abdominal postoperative complications (i.e., subphrenic fluid collections, hematomas, and bilomas) was similar between the two groups. CONCLUSIONS: Minor liver resection is safer without drainage. Major liver resection can be performed with or without abdominal drainage.

Adult↗
PubMed1993

[Prognostic value of pre- and postoperative alpha-fetoprotein in the follow-up of patients with surgically-treated hepatocellular carcinoma].

A percentage ranging from 60 to 80% of hepatocarcinomas are associated with increased levels of alphafetoprotein (AFP). In the three years following surgical resection there was a 80% possibility of recidivation. The aims of the present study were: a) to evaluate the significance of preoperative AFP assay as a prognostic index of recidivation; b) to evaluate the importance of repeated assays during the postoperative period in order to ensure an early diagnosis of recidivation. Between 1982 and 1989, 62 patients underwent surgery for hepatocarcinoma. Thirty-one patients who had undergone so-called curative surgery were periodically controlled for a period varying between 6 and 55 months, and were included in the present study. The remaining 32 patients were excluded for the following reasons: palliative surgery, postoperative death, postoperative complications unrelated to tumoral recidivation. In all cases AFP assay was carried out preoperatively, one month after surgery, and then every six months. Recidivation was always confirmed on the basis of tomodensitometric and arteriographic data. Before surgery out of a group of 30 patients, 11 showed normal AFP levels (below 20 mg/ml), while 19 had levels between 49 and 7350 mg/ml. Twenty-three patients (74%) reported one case of recidivation during the period between 6 and 40 months. Among the 11 patients who had showed normal preoperative AFP levels, 5 had a recidivation between 12 and 36 months, and 3 of these showed high AFP levels. In 18 out of the 19 patients (90%) with high preoperative AFP levels recidivation was diagnosed between 4 and 40 months following surgery; 4 of these were not associated with a rise in AFP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Esophageal cancer after mediastinal irradiation.

The authors report 4 patients, without a history of tobacco or alcohol abuse, who developed squamous cell carcinoma of the esophagus secondary to mediastinal irradiation. Carcinoma of the esophagus developed in 3 women 8-11 years after mediastinal radiotherapy for breast cancer and in a man 9 years after mediastinal radiotherapy for Hodgkin's disease. Three patients underwent resection, with intrathoracic anastomosis in 2 and cervical in 1. No fistulae were observed despite the presence of esophageal fibrosis. No mediastinal lymph node was metastatic. Patients survived 7, 16, and 26 months, respectively, after resection. This study confirms the concept of radiation-induced carcinogenesis. We conclude that patients with dysphagia and a history of previous mediastinal radiotherapy should undergo repeated endoscopy for biopsy.

Aged↗
PubMed1993

[The Senning procedure in Budd-Chiari syndrome associated with complete portal vein thrombosis].

The authors report their experience of one case of Budd-Chiari syndrome with total thrombosis of the portal vein. The patient was undergoing hepatico-atrial anastomosis with Senning's procedure. The original technique utilised extracorporeal circulation with hypothermia; the authors utilised venovenous bypass from femoral vein to axillary vein. Anastomosis function is proved with nuclear magnetic resonance and echo-Doppler on year after operation. Senning's procedure is feasible in the case of Budd-Chiari syndrome with total portal thrombosis with venovenous bypass without extracorporeal circulation with hypothermia.

Adult↗
PubMed1992

[Liver transplantation without clamping of the inferior vena cava].

An original technique of orthotopic liver transplantation with preservation of the recipient's entire inferior vena cava and side-to-side caval anastomosis is described. This procedure was used in 21 consecutive patients. It has permitted to avoid vena caval occlusion and the need for venous bypass. No consequences on caval flow were observed during the anhepatic phase. Our technique avoids retrocaval dissection and requires only one caval anastomosis, reducing the duration of the anhepatic phase.

Anastomosis, Surgical↗
PubMed1992

[Cancer on an esophageal diverticulum].

Carcinoma is one of the most severe complications of oesophageal diverticula. Its incidence varies from almost zero to 4 percent. The authors report 4 cases of carcinoma arising in a pharyngo-oesophageal diverticulum and 2 cases involving a diverticulum of the oesophageal body. In this disease, the diagnosis is often delayed, which may be the reason for the low long-term survival rate. The risk of carcinoma is another justification for resection of the pharyngooesophageal diverticulum. The post-surgical morbidity of the oesophageal body diverticula is an obstacle to systematic resection of these lesions.

Adult↗
PubMed1992

Pancreaticogastrostomy after pancreatoduodenectomy.

The aim of this study was to evaluate the place of pancreaticogastrostomy (PG) in reducing pancreatic fistula after pancreatoduodenectomy. From January 1988 to June 1991, 32 consecutive patients (mean age, 57 years) were operated on, 25 for malignant disease (78%). The pancreatic remnant was normal in 17 patients (53%) and sclerotic in the others. There was one operative death (3.1%) unrelated to PG. Post-operative complications occurred in five patients (16%). Only two complications were related to PG: 1 patient had anastomotic intra-gastric bleeding and was reoperated on, 1 patient with a normal pancreatic remnant developed a pancreatic fistula (3.1%) treated conservatively. Reported series of PG, as well as our results, demonstrates that PG is associated with a dramatic decrease of both pancreatic fistula and mortality rates. The risk of anastomotic haemorrhage can be reduced by preventative ligation of submucosal gastric vessels. In conclusion, PG appears as a simple and reliable method of management of the pancreatic remnant after pancreatoduodenectomy.

Adult↗