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Biomedical subjects

E Tiret

Publications and source records attributed to E Tiret.

At least 37 records · Page 2Linked to original sources
PubMed2001

Primary adenosquamous carcinoma of the rectum. Report of 4 cases and review of the literature.

OBJECTIVE: To review the experience of two referral centres in the management of an infrequent condition: primary adenosquamous carcinoma of the rectum, a rare disease. MATERIALS AND METHODS: Four cases of primary adenosquamous carcinomas of the rectum are reported with a review of the literature. No preoperative diagnosis of adenosquamous carcinoma was established. All tumours were located in the rectum. Two patients presented with liver metastasis. No preoperative therapies were indicated. All patients underwent surgery. RESULTS: Patients underwent anterior resections (n=2), recto-sigmoid resection (n=1) and abdomino-perineal excision (n=1). All resected specimens had positive lymph nodes and metastatic liver disease was confirmed in the two cases. No adjuvant therapy was carried out after surgery and patients died within 8 months after surgical treatment. CONCLUSIONS: Adenosquamous carcinoma of the rectum is a rare and aggressive tumour characterized by coexisting of malignant glandular and squamous components. Presentation is usually at an advanced stage. The tumour is aggressive and metastatic disease at the time of diagnosis is common. Surgery is the treatment of choice. Adjuvant therapy is difficult to evaluate prospectively due to the rarity of the condition. Survival is less than 50% than that for adenocarcinoma.

Journal Article↗
PubMed2001

Familial adenomatous polyposis: prevalence of adenomas in the ileal pouch after restorative proctocolectomy.

OBJECTIVES: To determine the prevalence of adenomas in ileal pouches from patients with familial adenomatous polyposis (FAP) and to determine whether a correlation exists between the presence of pouch adenomas and duodenal adenomas and the site of the adenomatous polyposis coli gene mutation. SUMMARY BACKGROUND DATA: Restorative proctocolectomy can markedly reduce the risk of colorectal adenocarcinoma in FAP patients. However, adenomas with the potential to progress to adenocarcinoma can develop in the duodenum, ileum, and continent ileostomy after restorative proctocolectomy. More recently, adenomas have been described in the ileal pouch after ileoanal anastomosis. METHODS: Pouch endoscopy was offered to 167 patients with FAP who had undergone restorative proctocolectomy between January 1984 and December 1996. RESULTS: Adenomas were found in 35% of the 85 ileal pouches examined. No invasive carcinomas were noted. The risk of developing one or more adenomas at 5, 10, and 15 years was 7%, 35%, and 75%, respectively. Patients with adenomas were more likely to have duodenal and ampullary adenomas. No correlation was detected between adenoma development and the site of the adenomatous polyposis coli mutation. CONCLUSIONS: Adenomas are frequently found in the ileal pouch of patients after restorative proctocolectomy for FAP. Regular endoscopic surveillance of the pouch is recommended at a frequency similar to that of upper gastrointestinal endoscopy.

Adenomatous Polyposis Coli↗
PubMed2001

Adenocarcinoma complicating Crohn's disease of the duodenum.

Duodenal obstruction is a classic complication of Crohn's disease with duodenal involvement. However, malignant transformation of duodenal lesions has very rarely been reported, and diagnosis of such a transformation is rarely made preoperatively. We report the case of a 32-year-old patient with an 8-year history of Crohn's disease who underwent bypass gastrojejunostomy for a duodenal stricture. A year later, weight loss and biliary obstruction led to a further laparotomy. At operation, an advanced carcinoma with peritoneal seedings was confirmed. Of the three patients previously reported in the literature with duodenal cancer arising in Crohn's disease stricture, only one had a preoperative diagnosis of malignancy made from endoscopic biopsies. When considering the surgical bypass of Crohn's duodenal stricture, if preoperative endoscopy and biopsy cannot be performed on account of duodenal stricturing, we suggest performing a peroperative endoscopy via a jejunotomy in order to eliminate the diagnosis of associated duodenal malignancy.

Adenocarcinoma↗
PubMed2001

Endometrial stromal sarcoma of the rectosigmoid colon arising in extragonadal endometriosis and revealed by portal vein thrombosis.

Malignant transformation is an infrequent complication of endometriosis. The ovary is the primary site in 76% of cases, and extragonadal sites are identified in 24%. Endometrioid carcinoma is the most common histologic type; sarcoma is very rare. We report a case of low-grade endometrial stromal sarcoma of the rectosigmoid colon presenting with epigastric pain due to portal vein thrombosis. This tumor arose from extragonadal endometriosis in a 61-year-old woman and was treated by surgical resection. The main differential diagnosis of this unusual colonic neoplasm includes primary mesenchymal tumors, such as gastrointestinal stromal tumors.

Cell Transformation, Neoplastic↗
PubMed1999

[Radio- and chemotherapy of cancer of the esophagus].

Surgical resection has been the mainstay of therapy for localised carcinoma of the oesophagus. However, the five-year survival rate after curative resection is only 20 to 30%, and other treatments have been tried to improve these results. Radiotherapy, chemotherapy and sequential or combined chemoradiotherapy have been used, either alone or in combination with surgery. Radiotherapy and chemotherapy do not improve survival and are restricted to very limited cases. Results of exclusive combined chemoradiotherapy are very similar to those of surgery, with five-year survival rate of 20%. The promising results of chemoradiotherapy followed by surgery need to be confirmed by further trials. Good survival rates obtained for responders to chemoradiotherapy require to find better means for identifying such patients before treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Rectal excision and colonic pouch-anal anastomosis for rectal cancer: oncologic results at five years.

PURPOSE: Preservation of the anal sphincter is now accepted as a primary aim in surgical treatment of rectal cancer. The use of colonic J-pouch-anal anastomosis after complete rectal excision is one method that permits retention of continence without compromising oncologic principles. This study aimed to assess carcinologic results of rectal excision followed by colonic J-pouch anal anastomosis, with particular reference to rate of locoregional recurrence. METHOD: From 1984 to 1990 complete rectal excision and colonic pouch-anal anastomosis were performed in 167 patients for cancer of the middle or low rectum. A total of 154 patients were followed for this study for a minimum of five years, with evaluation of the frequency of locoregional recurrence. RESULTS: Sixty-five patients died during the period of surveillance, giving a five-year survival rate of 68.8 percent. Twenty patients (13 percent) presented with locoregional recurrence at an average of 31 months after surgery. In 11 cases (7 percent) the local recurrence was not associated with metastatic disease, and six of these patients underwent further curative surgery. CONCLUSIONS: These results confirm that coloanal anastomosis after complete rectal excision is a valuable option in the surgical treatment of rectal cancer and is accompanied by a frequency of isolated locoregional recurrence of less than 7 percent, of which half underwent surgical resection with curative intent.

Anal Canal↗
PubMed1999

Restorative proctocolectomy for distal ulcerative colitis.

BACKGROUND: Chronic distal colitis may cause troublesome symptoms and alter quality of life. When medical treatment fails to control symptoms, patients and doctors are often reluctant to consider surgical resection because of the relatively small portion of the large bowel affected by the disease. AIM: To assess the outcome of restorative proctocolectomy (RP) in patients with distal colitis who required surgery for chronic debilitating symptoms and failed medical management. PATIENTS/METHODS: From 1986 to 1996, of 263 patients receiving RP for ulcerative colitis, 27 (16 men) were operated on for distal ulcerative colitis limited to the rectum and sigmoid colon. Bowel function and quality of life were compared before and one year after RP. RESULTS: The mean (SD) duration of ulcerative colitis was 11 (6) years. RP was performed at a mean age of 46 (10) years. All the pouches were J-shaped, and a diverting loop ileostomy was always performed. Mean (SD) hospital stay was 25 (10) days. Seven complications occurred in six patients. Previously unknown severe dysplasia was discovered on the colectomy specimen in two patients. After RP there was a significant decrease in mean (SD) daytime stool frequency (8.2 (4) v 4.7 (2), p<0.05), night-time stool frequency (2 (2) v 1 (1), p = 0.05), and the number of patients with urgency to defecate (26/27 v 1/27, p<0.001). Sex life was improved in eight patients, social life in 26, and professional life in eight. Twenty six patients were satisfied with the results, and 25 wished that they had received surgery earlier in the course of their disease. CONCLUSION: RP can improve bowel function and quality of life in patients with disabling chronic symptoms of distal ulcerative colitis.

Adult↗
PubMed1999

[Total excision of the mesorectum and preservation of the genitourinary innervation in surgery of rectal cancer].

Locoregional recurrence is one of the most important problems after surgery for rectal cancer. Four to five per cent local recurrence rates have been reported after total mesorectal excision with autonomic nerve preservation. After an anatomic description, the authors describe the surgical technique of total mesorectal excision with nerve preservation. Carcinologic and functional results are reported, before concluding that this technique should be performed for mid or low rectal tumours with a distance to anorectal junction less than 5 cm.

Autonomic Nervous System↗
PubMed1999

Contribution of endoscopic retrograde pancreatography in management of complications following distal pancreatic trauma.

Pancreatic trauma is associated with high morbidity and mortality. Treatment of this condition is controversial. This retrospective study aimed to evaluate the management of distal pancreatic trauma and its complications, assessing the role of endoscopic retrograde cholangiopancreatography (ERCP). The clinical course and surgical management of 38 patients with distal pancreatic trauma were analyzed in a university hospital in Paris, France. Twenty-five patients were referred after initial treatment elsewhere. As initial treatment, patients underwent external drainage (n = 25), pancreatic resection (n = 6), laparotomy alone (n = 5), and no surgery (n = 2). Nineteen patients with pancreatic duct injury and no pancreatic resection developed fistulae (n = 14) or pseudocysts (n = 5). Only four of these patients recovered without a subsequent pancreatic resection or internal drainage procedure. In the absence of duct injury, patients recovered without the need for pancreatic resection. ERCP was performed in 16 cases and provided critical information on duct status influencing surgical management. We conclude that the presence of pancreatic trauma duct injury is a major determinant of complications and outcome after pancreatic trauma. It is optimally managed by pancreatic resection. ERCP is valuable in providing a definitive diagnosis of duct injury, thereby directing treatment.

Abdominal Injuries↗
PubMed1998

Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch-anal anastomosis.

OBJECTIVE: The purpose of this study was to compare long-term functional results of two methods of reconstruction after anterior rectal resection for cancer: low colorectal anastomosis and colonic J-pouch-anal anastomosis. SUMMARY BACKGROUND DATA: After anterior resection for mid or low rectal cancer, the decision to perform low colorectal or coloanal anastomosis is made intraoperatively, depending on the distance of the tumor from the anal verge. Functional results of these operations are considered to be similar one to two years after surgery. No study to date has compared long-term functional results after rectal excision followed by either low colorectal anastomosis or colonic J-pouch-anal anastomosis. METHODS: From 1987 to 1992, 173 patients underwent anterior resection for cancer located between 2 to 12 cm from the anal verge. All patients alive without recurrence were contacted by telephone interview for assessment of functional results. There were 47 patients with colonic J-pouch-anal anastomosis and 34 patients with low colorectal anastomosis. Minimum follow-up was three years for all patients (mean, 5 years). RESULTS: The two groups were well matched for gender, age, histologic stage, and use of adjuvant therapies. Patients with colonic J-pouch-anal anastomosis displayed significantly better function in terms of frequency of defecation (1.57+/-1 vs. 2.79+/-1; P=0.001) and presence of irregular transit or stool "clustering" (30 vs. 71 percent; P=0.003). Patients who underwent colonic J-pouch-anal anastomosis were significantly less likely to require constipating agents (4 vs. 21 percent; P=0.03) or need to follow a restricted diet (14 vs. 41 percent; P=0.01). Results concerning the need to defecate again within one hour and disruption of social or professional life as a consequence of surgery showed a tendency in favor of colonic J-pouch-anal anastomosis. CONCLUSION: Colonic J-pouch-anal anastomosis offers superior long-term function compared with low colorectal anastomosis after radical treatment of rectal cancer. Preservation of a short rectal segment followed by a straight colorectal anastomosis does not offer any clinical advantage over colonic J-pouch-anal anastomosis.

Aged↗
PubMed1998

Results of salvage abdominoperineal resection for anal cancer after radiotherapy.

PURPOSE: Nonsurgical treatment of anal cancer by radiotherapy alone or combined with chemotherapy is the standard therapy for epidermoid carcinoma of the anal canal. Surgery is only recommended for treatment failures. Very few studies have been devoted to the outcome of this salvage surgery. The aim of this study is to evaluate these results. METHODS: A retrospective review from 1986 to 1995 revealed 21 patients with residual or recurrent anal canal carcinoma after initial radiotherapy, operated on by abdominoperineal resection. Patients were reviewed as to age, gender, initial treatment, any symptoms of recurrence, duration until recurrence, any diagnosis imaging, treatment, and outcome. RESULTS: None of these 21 patients had known lymph node involvement or metastases at radiotherapy or at salvage abdominoperineal resection. Eleven patients had residual disease (positive biopsy less than 6 months after the end of radiotherapy) and 10 had tumor recurrence (more than 6 months after cessation of treatment). Recurrence occurred at a mean of 15 (range, 9-41) months after radiotherapy. All 21 patients underwent an abdominoperineal resection. Pathologic examination of the 21 specimens showed complete excision in all cases except one and lymph node metastases in two cases. There was no perioperative mortality. The mean follow-up after surgery was 40 months; no patients were lost to follow-up. Of the 21 patients, 10 died and 11 lived, of whom 9 are disease free. The overall survival rate at three years after salvage abdominoperineal resection was 58 percent. The overall survival rate for patients with residual disease (vs. recurrence) at three years was 72 percent (vs. 29 percent) and at five years was 60 percent (vs. 0 percent; P = 0.06). CONCLUSIONS: Salvage abdominoperineal resection for anal cancer can be expected to yield a number of survivors from residual disease, but the low rate of survival after abdominoperineal resection for recurrent disease suggests the need for additional postoperative treatment if salvage abdominoperineal resection is performed.

Adult↗
PubMed1998

Effects of aging on the functional outcome of coloanal anastomosis with colonic J-pouch.

BACKGROUND: Many low rectal cancers can be treated radically by proctectomy with total mesorectal excision followed by colonic J-pouch anal anastomosis (CPAA). In elderly patients, the fear of poor function might reduce indications for CPAA in favor of abdomino-perineal excision with end stoma. METHODS: Among 198 patients with CPAA operated on for low rectal cancer between 1984 and 1992, 20 patients over 75 years old were alive without recurrence at the time of telephone interview (July 1995). Minimal follow-up was 3 years (mean 8) for all patients. Their functional results were compared with those of 37 younger patients operated consecutively during the last 5 years of the study period. RESULTS: The two groups were well matched for gender, tumor distance from the anal verge, histologic staging, and use of adjuvant radiotherapy. Follow-up was longer in the elderly group than in the young group (96 versus 63 months, respectively). The elderly group had a median of 1 bowel movement per day and the young group a median of 1.5 (P = 0.13). The presence of irregular intestinal transit was reported in 48% of the aged and in 35% of the young group (P = 0.6), but fragmented defecation was less frequent (25% versus 47%, respectively; P = 0.15). Urgency was noted, respectively, in 15% and 22% of elderly and young patients (P = 0.7) and constipation in 40% and 22% (P = 0.2). Incontinence for feces (15%) and for flatus (40%) in elderly were not significantly different from the younger group (14% and 46%, P = 1.0 and P = 0.8, respectively). Laxatives were used in 32% of elderly and 17% of young patients (P = 0.3). CONCLUSION: Functional outcome may be good to excellent in elderly patients after CPAA and compares well with that obtained in younger patients. Constipation, however, may be more frequent in the elderly. Age is not a contraindication for CPAA if the sphincter tone is clinically normal.

Adenocarcinoma↗
PubMed1998

Surgical treatment of severe duodenal polyposis in familial adenomatous polyposis.

BACKGROUND: Patients with familial adenomatous polyposis (FAP) are at risk for adenomas and cancers in the duodenum but the ideal management of duodenal polyposis remains uncertain. METHODS: The outcome of surgical resection was analysed in 18 patients with FAP who had severe duodenal polyposis. RESULTS: Duodenotomy and clearance of duodenal adenomas was performed seven times in six patients. There were two duodenal leaks and, after a mean follow-up of 53 (range 36-72) months, duodenal adenomas recurred in all patients and five had severe polyposis. Pancreatoduodenectomy was performed in seven patients with severe duodenal polyposis. Histology of the specimens revealed two unsuspected duodenal carcinomas at an early stage. After a mean follow-up of 42 months all patients were alive and well, and there was no case of jejunal polyposis. Pancreatoduodenectomy was attempted in five patients with duodenal cancer and only one survived more than 4 years. CONCLUSION: Surgical excision of duodenal adenomas should be discussed before carcinoma occurs. Surgical polypectomy fails to guarantee a polyp-free duodenum and carries a risk of postoperative complications whereas pancreatoduodenectomy eliminates the risk of duodenal cancer with an acceptable morbidity rate. Pancreatoduodenectomy could be offered to some patients with large or multiple villous duodenal adenomas repeatedly showing severe dysplasia.

Adenoma↗
PubMed1998

Soave's procedure: the final sphincter-saving solution for iatrogenic rectal lesions.

BACKGROUND: Restoring intestinal continuity in the presence of radiation-induced rectal lesions and following low colorectal anastomotic complications or low Hartmann's procedure may be fraught with difficulties. Soave's procedure avoids potentially hazardous perirectal dissection. This study examined the morbidity and mortality as well as functional results. METHODS: Between January 1978 and July 1994 30 consecutive patients underwent Soave's operation as a final attempt to restore coloanal continuity. The pathology was radiation-induced lesions in 15 patients, low colorectal anastomotic complications in nine and low Hartmann's reconstruction in six. RESULTS: Mean length of follow-up was 4.2 (range 1-16) years. There was no operative mortality. Early complications included one patient with postoperative haemorrhage, one with small bowel obstruction and four with pelvic or perineal sepsis. Late complications included four incisional hernias, three anastomotic strictures which were treated by dilatation, and one recurrent ischaemic colitis. Continence was normal in 19 of 23 evaluable patients. CONCLUSION: Soave's procedure obviates the need for extensive pelvic dissection, providing good technical and functional results in both the long and short term.

Adult↗
PubMed1998

Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis.

BACKGROUND: Anal sphincter function is increasingly preserved following rectal excision for cancer and provides a better quality of life for patients than does a permanent colostomy. However, anastomotic complications may cause considerable morbidity and mortality. This retrospective study examined the incidence of anastomotic complications following two forms of reconstruction after resection for mid-rectal cancer: colonic pouch-anal anastomosis (CPAA) and low colorectal anastomosis (LCRA). METHODS: Some 258 consecutive patients with mid-rectal cancers between 6 and 11 cm from the anal verge underwent proctectomy with mesorectal excision and either CPAA or LCRA. The incidence of clinical and radiological leaks was determined in these patients who were considered in three groups: LCRA (defunctioning stoma), LCRA (no defunctioning stoma) and CPAA (all defunctioned). RESULTS: In the LCRA group without a defunctioning stoma, a clinical leak occurred in 17.0 per cent, compared with two of 30 in the LCRA group with a defunctioning stoma. In the CPAA group a clinical leak occurred in 4.9 per cent of patients, which was not significantly different from the rate in those with a defunctioned LCRA. Patients with a non-defunctioned LCRA were more likely to suffer a clinical anastomotic leak (P=0.01), peritonitis (P=0.001) and require unscheduled reoperation (P=0.006) than those with a defunctioned LCRA and/or CPAA. CONCLUSION: The use of a protective defunctioning stoma is advocated in conjunction with LCRAs.

Aged↗