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Biomedical subjects

M Huguier

Publications and source records attributed to M Huguier.

At least 73 records · Page 4Linked to original sources
PubMed1996

Surgery for left-sided pancreatic cancer.

A total of 590 exocrine pancreatic cancers of the body or tail of the pancreas, operated on between January 1982 and December 1988, were analysed. There were 128 pancreatic resections (group 1), 164 palliative bypasses (group 2) and 293 exploratory laparotomies which included 74 splanchnicectomies (group 3). The mortality rate was lower in group 1 (9 per cent) than in group 2 (19 per cent) (P = 0.012). The mortality rate exceeded 40 per cent in groups 1 and 2 for patients aged more than 70 years with pre-existing organ failure. The morbidity rate was 32 per cent in group 1 and 29 per cent in group 2. Patients with metastases had a median survival of 3.4 months, whatever the operative treatment. In the presence of lymph node involvement there was no significant difference in survival between groups 1 and 2. Patients with no metastases and no lymph node involvement had 1- and 3-year survival rates of 38 and 12 per cent respectively after pancreatic resection. Only patients with a small tumour (< or = 4 cm), no lymph node involvement and no metastases achieved a significantly better survival after resection (P = 0.049). Curative resection should be reserved for a small tumour confined to the pancreas. Fewer than 10 per cent of patients will be suitable for surgery. For the other cases, resection must be considered as a palliative procedure without a significant improvement in survival. It seems justified to limit palliative surgery to candidates for digestive bypass and to use non-surgical palliation for the remainder.

Aged↗
PubMed1996

[Cystic tumors of the pancreas. Cystadenomas and cystadenocarcinomas. Diagnosis and management].

Thirteen cases of cystic tumours of the pancreas were studied: serous cystadenomas (CS) = 4, mucinous cystadenomas (MC) = 4 and cystadenocarcinomas (CC) = 5. There were 9 females and 4 males, mean age 60 years (range 44 to 89 years). Two patients had no clinical manifestations, six (2 MC and 4 CC) had a weight loss (3-10 kg). One patient with CC had jaundice. Tumours of the pancreas were diagnosed with sonographic or CT-scan examinations. Eight were localized in the head of the pancreas, two in the body and three in the tail. The cystic tumour remained unknown after preoperative explorations in three cases. The exact nature of the tumour was identified preoperatively in four cases (SC, MC and two CC). Final diagnosis was obtained after histological examination of the surgical specimen in nine cases, by surgical puncture in one case and due to the presence of liver metastases in one case and ultrasound guided needle biopsy in one other. One patient refused all surgery. Ten patients were operated: four had duodenopancreatectomy (SC and three CC), three had tumour exeresis (SC and two MC), two had caudal splenopancreatectomy (MC and CC) and one had surgical puncture (SC). Clinical surveillance is justified in cases with asymptomatic. SC if certain diagnosis has been obtained. Other cystic tumours of the pancreas should be removed, either because there is doubt as to the exact nature of the tumour; because of symptoms induced by SC or because a MC or CC has been identified. In this latter case, the prognosis appears to be better than for non-metastasis exocrine cancer of the pancreas.

Adult↗
PubMed1996

[Operative mortality in diverticular sigmoiditis].

From 1984 to 1993, 200 patients (mean age 68 years) were hospitalized for complicated diverticulosis of the colon. Hospitalization was motivated in 81 patients for a programmed procedure (40%), by an acute complication requiring emergency surgery in 56 (29%) and by acute complication treated medically in 63 (31%). Among the 81 electively operated patients, one died post-operatively. For the 56 patients operated in an emergency situation, there were 8 post-operative deaths (14%). Six of the 8 deaths occurred in patients over 80 years. The natural history of colonic diverticulosis suggests that it would be logical to operate those patients with two episodes of sigmoiditis of those who have clinical manifestations (47 cases in our series). The other indication for planned surgery are colonic stenosis (17 cases), sequellae of abscesses (16 cases) and fistulae (11 cases). In patients with peritonitis and pelvi-peritonitis (35 cases) for whom exeresis is not a technical risk, it appears to be preferable to colostomy with drainage. Abscesses should be drained under ultrasonic or scan control. Finally, patients with massive haemorrhage should have an emergency angiography to guide the colectomy.

Adult↗
PubMed1996

[Intraoperative radiotherapy in cancers of the pancreas and in recurrent colorectal cancers].

The aim of this study was to evaluate intraoperative radiotherapy in exocrine pancreatic cancer (n = 10) and in recurrent colorectal carcinoma (n = 11). Radiotherapy was delivered with electron beams (energy from 9 MeV to 20 MeV). Doses ranged from 15 Gy to 25 Gy. All patients with pancreatic cancer also received 40 Gy external beam irradiation and 5-Fluorouracil (500 mg/m2) and eight patients with recurrent colorectal carcinoma received postoperative external beam irradiation (20 Gy to 60 Gy). There were no postoperative deaths or complication. In pancreatic cancers, pain relief (7 cases) until death was observed in all cases. After palliative procedures (9 cases), the median survival time was 6 months (ranging from 4 months to 14 months). One patient is alive with a follow-up of 5 years and 6 months following total pancreatectomy. 5 patients with recurrent colorectal carcinoma, died with a median survival time of 13 months (ranging from 2 months to 25 months), and six patients are alive. Two of them have recurrence, and four are free of recurrence with a mean follow-up of 21 months (ranging from 3 months to 54 months). In conclusion, our results for pancreatic cancer agree with the disappointing results reported by other institutions. On the other hand, recurrence of colorectal carcinoma seems to be a good indication for intra-operative radiotherapy even when resection is incomplete.

Actuarial Analysis↗
PubMed1995

[Palliative treatment of cancers of the head of the pancreas. Surgery versus endoscopy].

Cancers of the head of the pancreas are only resectable in 10 to 25% of cases. The majority of patients are therefore candidates for a palliative treatment jaundice, pain or upper gastro-intestinal obstruction. Palliative surgical bypasses offer a durable efficiency for patients with a relatively short-term life expectancy. Endoscopic placement of biliary stents for jaundice is an alternative but leads to frequent complications and does not act on other clinical symptoms. Controlled trials did not show any statistical difference between surgical or endoscopic treatments. We only recommend endoscopic procedures for patients unfit for surgery with poor general status or distant metastases.

Biliopancreatic Diversion↗
PubMed1995

[Antibiotic prophylaxis in biliary surgery].

Prophylactic antibiotics in gallbladder surgery is designed to reduce the incidence of postoperative wound infections. Bacteria isolated from the biliary tract are generally the same as those found in the pus of wounds. Prospective and placebo-controlled trials have shown the efficacy of prophylactic antibiotics in high-risk patients presenting one or more of the following criteria: age over 70 years, recent episode of acute chollecystitis, emergency cholecystectomy, presence of common duct stones, jaundice or diabetes mellitus in patients with no risk factors for gallbladder surgery, prophylactic antibiotics may not be essential. The efficacy of antibiotics in the prevention of wound infections has been demonstrated with first, second and third generation cephalosporins, ampicillin associated with clavulanate, ureido-penicillins, aminoglycosides, sulfonamides and quinolones. A single injection of antibiotic given one hour before incision is as effective as multiple-dose regimens. Currently, the choice of antibiotic should be mainly based on its cost. There is no evidence at the present time for systematic prophylactic antibiotics in laparoscopic surgery. Endoscopic procedures of the biliary tract do not require prophylactic antibiotics when obstruction has not been demonstrated.

Anti-Bacterial Agents↗
PubMed1994

Results of resection for cancer of the exocrine pancreas: a study from the French Association of Surgery.

A multicentre retrospective study was carried out to analyse short- and long-term results of 787 pancreatic resections performed for cancer between 1982 and 1988. The postoperative mortality rate was 10 per cent and the morbidity rate 35 per cent. Age above 70 years and systemic organ failure independently influenced operative mortality. In patients surviving more than 30 days the median survival was 12.3 months and the actuarial survival rate at 5 years 12 per cent. The 5-year survival rate was lower for patients with lymph node involvement than for those without (4 versus 20 per cent, P = 0.001). The operative mortality rate was higher after total pancreatectomy than pancreatoduodenectomy (17 versus 8 per cent, P = 0.015). The median survival time and 5-year survival rate after total pancreatectomy and pancreatoduodenectomy were 11 versus 14 months and 3 versus 15 per cent respectively. Of the clinical and pathological factors studied, location of the tumour in the left pancreas was most strongly related to survival, with no survivors at 4 years. These results suggest that resection should be avoided in patients over 70 years old with systemic organ failure. Pancreatoduodenectomy remains the best procedure for resection, total pancreatectomy being performed only in patients with multifocal carcinoma or those in whom a safe pancreatic anastomosis cannot be constructed.

Aged↗
PubMed1994

Should patients over 80 years old be operated on for colorectal or gastric cancer?

One hundred and three patients aged 80 years or more were operated on for colorectal cancer (n = 80) or gastric cancer (n = 23). The postoperative mortality rate was 8%. Hospital mortality (12%) was not influenced by the factors age or emergency procedure, but by the factors ASA score (P = 0.06), palliative procedure (p = 0.08), and gastric surgery (P = 0.05). The overall 5-year survival rate was 23% after colorectal surgery, and 10% after gastric surgery (P = 0.001). After colorectal surgery, long-term survivals were observed, even in presence of serosal and/or lymph nodes involvement. Thirteen patients were alive more than five years after surgery. In contrast, after gastric surgery, all patients, except those with early carcinoma, died within one year. Indications for operation must be wide in colorectal cancers, and more restrictive in gastric cancers. Long-term survivals were observed after colorectal surgery in the elderly, even in the presence of lymph node involvement. In contrast, after gastric surgery, all patients, except those with early carcinoma, died within one year.

Age Factors↗
PubMed1994

[Training of surgeons for laboratory research].

A degree in surgical research has been set up in 1986 in France. It includes a one-year full time work in a research laboratory, and seminars (one to three days long, each). General surgical research objectives are gathered in a first seminar. Then, candidates select one among four optional subjects: biomaterials-artificial organs, transplantation, oncology, and neurosciences. Two prerequisites are necessary in order to register. The first is to write a research project according to standardized rules, and the second is to attend two seminars, one dealing with scientific communication and the other with methodology in clinical research. A nation-wide valid Academic degree is delivered to candidates who pass an oral presentation of their research report and who attended all seminars according to the optional subject that they selected. From 1986 to 1993, 434 students attended the formation. They came from different regions of France, proving the nation-wide characteristic of the degree, and some from foreign countries. Seminars were held in different French University towns. An increasing number of students become Ph.D.

Education, Medical, Graduate↗
PubMed1994

[Surgical managements and cancer of the exocrine pancreas. Survey of the French Association of Surgery].

In a French national enquiry, 3761 cases of cancer of the exocrine pancreas operated between 1982 and 1989 were collected. The aim of the part of the enquiry presented in this study was to define the various surgical attitudes. Surgical techniques significantly differed from one department to an another (P < 0.001). Resections were performed in 21 per cent of cases (range 6-45 per cent). Causes of unresectability, choice of a biliary by-pass, indications for gastro-jejunostomy, and use of spanchnicectomy varied from one Surgical Department to another (P < 0.001). The magnitude of these differences can be explained only by different habits or skillfulness for a rarely curable disease. These findings would justify a consensus about the indications for various procedures in the treatment of cancer of the exocrine pancreas.

Biliopancreatic Diversion↗
PubMed1993

Hepatic flow scintigraphy in evaluation of hepatic metastases in patients with gastrointestinal malignancy.

OBJECTIVE: To assess the value of hepatic flow scintigraphy for occult metastases. DESIGN: Prospective study, 2 years of follow-up. SETTING AND STUDY PARTICIPANTS: One hundred twenty-nine patients undergoing surgery for gastrointestinal cancer. INTERVENTION: Preoperative hepatic flow scintigraphy (3mCi of technetium-99m). MAIN OUTCOME MEASURE: Development of hepatic metastases. RESULTS: Hepatic flow scintigraphy had a sensitivity of 92% and a specificity of 34%. The positive and negative predictive values were 15% and 97%, respectively. CONCLUSIONS: Hepatic flow scintigraphy could therefore be useful in identifying patients who are at low risk of developing metachronous liver metastases and thus avoid unnecessary adjuvant chemotherapy following resection of the primary tumor.

Female↗
PubMed1993

Surgical palliation for unresected cancer of the exocrine pancreas.

Opinions are still divided regarding the optimal palliative procedures in patients with cancer of the pancreas. This retrospective, multicentric study, involving 2493 patients operated on between January 1982 and December 1988 compares the results of various procedures aimed at palliation for pancreatic cancer. Cholecystoenteric bypasses (n = 237) in comparison to choledochoenteric bypasses (n = 1770) were associated with a higher post-operative mortality (20% vs 14%), a lower long-term morbidity (26% vs 35%), and a lower survival rate (means: 3.2 vs 5.2 months). Choledochoduodenostomy (n = 1159) and choledochojejunostomy (n = 611) had similar rates of post-operative mortality (14% vs 13%), morbidity (26% vs 27%), incidence of recurrent jaundice (8% vs 7%), and median survival (5.4 vs 5.0 months). Surgically placed biliary stents (n = 114) were followed by the highest post-operative mortality (27%), morbidity (46%), rate of recurrent jaundice (14%), and the shortest median survival (2.6 months). Post-operative mortality in patients undergoing a choledochoenteric bypass and a gastrojejunostomy (n = 1134) was similar to that observed in patients who had only a biliary bypass (n = 636) (16% and 12%), but among the patients who had a biliary bypass alone, 16% developed a gastric obstruction. For the relief of pancreatic pain, radiotherapy was more effective than other symptomatic treatments (P = 0.02). In conclusion, these results and other previous reports suggest the need (1) in patients with obstructive jaundice to perform a choledochoduodenostomy rather than other biliary bypasses, (2) a routine prophylactic gastrojejunostomy to prevent gastric outlet obstruction, (3) and for the relief of pancreatic pain to perform radiotherapy or splanchnicectomy.

Aged↗