[Colorectal neoplasms. Anatomo-clinical aspects].
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Colorectal Neoplasms↗
Biomedical subjects
H Baumel
Publications and source records attributed to H Baumel.
Colorectal carcinoma in patients aged 75 years and more: factors influencing short and long-term operative mortality.
A review of 238 patients aged over 75 years and operated on for colorectal cancer was undertaken to analyse factors influencing short and long-term operative mortality. Operative mortality in the first postoperative month was 13% (n = 31) and 17% (n = 35) in the first year. Four factors influenced significantly postoperative mortality in the first month: postoperative complications (p = 0.0001) related to medical complications (p = 0.0001), emergency surgery (p = 0.007), type of anesthesia (p = 0.01). Mortality during the first year (excluding patients who died in the first month) was higher in females (p = 0.05), in patients subjected to emergency operation (p = 0.004), in patients with preexisting, cerebrovascular accident (p = 0.04) and in patients with Dukes C staging (p = 0.0001). A multivariate analysis with Cox's model revealed 3 prognostic factors: Dukes staging (p = 0.0001), medical complications in the postoperative period (p = 0.0001) and type of anesthesia (p = 0.0009). Age as an isolated factor is not a contraindication to colorectal surgery in elderly patients presenting colonic or rectal carcinoma. Prognosis in elderly patients is first correlated to the control of postoperative mortality undergoing until the first year and then to the cancer itself.
Aged↗
[Laparoscopic treatment of gastroesophageal reflux by the modified Toupet technique. Preliminary results apropos of 55 cases].
Between October 1992 and July 1994, 55 patients with gastrooesophagal reflux disease underwent laparoscopic 270 degrees posterior fundoplication. The technique used was exactly the same as for the conventional approach. There were no deaths but there were 2 peroperative complications requiring conversions to laparotomy: one oesophagal perforation and one pleural perforation. The mean operative time was 150 min, ranging from 90 to 240 min. The mean hospital stay was 2.5 days, ranging from 1 to 14 days. One patient had to be operated on the 15th postoperative day because of a dysphagia secondary to an oesophagal motility disorder. One other patient underwent a laparoscopic treatment of a bowel obstruction on 30th postoperative day. None patient had dysphagia for more than 1 month after laparoscopy. The mean postoperative follow-up was 10 months with a good clinical result in 90% of the patients at 6 months. Four of our 15 first patients complained of recurrence of reflux symptoms. These preliminary results indicate that laparoscopic Toupet procedure can be performed safely and with similar results as for the open approach if the surgeon is well trained.
Adult↗
Cancer of the exocrine pancreas. A plea for resection.
BACKGROUND/AIMS: The aim of this retrospective multicentric study was to compare the results of resections with those of surgical palliative procedures. MATERIAL AND METHODS: The 3231 patients included had histologically proven adenocarcinoma of the pancreas and were operated on between 1982 and 1988. Seven hundred eighty-seven underwent surgical resection, and 2444 a palliative procedure. Step by step logistic regression was used to determine variables having the greatest impact on post operative mortality. Survivals were compared with the logRank test. A semi parametric Cox model was applied to estimate adjusted relative risk of death. RESULTS: After resection and bypass, postoperative mortality was 10% and 15% (P < 0.001), morbidity 35% and 27% (P < 0.001), and mean survival times 19.5 months (SE = 1.1), and 8.8 months (SE = 0.3) (P < 0.001) respectively. In patients without metastases, survival was better after resection than after bypass, even in patients with involvement of lymph nodes adjacent to or distant from the tumor (P = 0.001). CONCLUSIONS: In spite of the retrospective nature of such comparisons, these results acredit the idea that in patients with pancreatic cancer without metastases, resection should be attempted whenever possible.
Adenocarcinoma↗