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Olivier Turrini

Publications and source records attributed to Olivier Turrini.

5 recordsLinked to original sources
PubMed2005

Hemorrhage after duodenopancreatectomy: impact of neoadjuvant radiochemotherapy and experience with sentinel bleeding.

Postoperative hemorrhage (PH) after duodenopancreatectomy (DP) is frequently lethal. The aim of this study was to delineate guidelines of management. Between August 1994 and July 2003, 172 patients underwent DP for cancer. Altogether, 26 patients were subjected to an institutional protocol (IP) with standard-dose chemoradiation (CRT) and 4 patients to an extrainstitutional protocol (EIP) with high-dose CRT. Sixteen patients (9.3%) were reoperated for PH. Hemorrhage occurred in 23% of irradiated patients (4 EIP, 3 IP) and in 6% of nonirradiated patients [confidence interval (CI) 1.8-6.5]. Pancreatic leak occurred in nine patients with PH (56%). Sentinel bleeding (SB) was noted in eight patients (50%) with a mean delay of 10 days after DP. Overall mortality after hemorrhage was 56%. Morality rates of patients with EIP or IP were, respectively, 100% and 0%. Mortality rates of patients with or without SB were similar. Mortality rates of axial bleeding (hepatic artery, mesenteric vessels) or lateral bleeding (pancreas remnant, splenic vessels) were, respectively, 88% and 25% (CI 1.6-8.6). Completion of pancreatectomy was achieved in 75% without rebleeding. Preoperative high-dose CRT increased the risk of fatal PH. Because SB occurs before massive hemorrhage, prompt reoperation could reduce mortality. Completion of pancreatectomy was essential during reintervention. Axial bleeding supports high mortality. Moving to the left, the pancreatojejunostomy could avoid contact of pancreatic juice with axial vessels in the case of pancreatic leakage. Ligating the gastroduodenal artery during DP had to leave a stump of around 1 cm to facilitate hemorrhage control without ligating the common hepatic artery.

Adenocarcinoma↗
PubMed2004

Assessment of pathologic response after preoperative chemoradiotherapy and surgery in pancreatic adenocarcinoma.

PURPOSE: The benefits provided by preoperative chemoradiotherapy (CRT) in pancreatic ductular adenocarcinoma (PDA) are still controversial. However, in most reports from referral centers, improvement in local control and survival appears to be provided in selected patients. The aim of this retrospective study was to analyze the radiation-induced pathologic effects of preoperative CRT in patients with resectable PDA and determine the precise long-term outcome of the responding patients. METHODS AND MATERIALS: Between November 1996 and October 2003, 61 patients underwent preoperative CRT for resectable PDA. The tumor location was the pancreatic head in 49 patients and pancreatic body in 12 patients. Of the 61 patients, 21 (34.5%) did not undergo surgery because of disease progression and 40 (65.5%) underwent pancreatic resection, including pancreaticoduodenectomy in 32 (80%) and distal pancreatectomy in 8 (20%). RESULTS: A major pathologic response was noted in 9 patients, including three complete responses, and was found only in patients with tumor of the pancreatic head. The local control rate was similar in patients with and without a major pathologic response. Survival in patients with a major response was significantly greater than in those without a response or with a minor response. CONCLUSION: Major tumor downstaging can be provided by preoperative CRT in patients with resectable cephalic PDA. Survival appears to be significantly improved in selected patients.

Adult↗
PubMedDate not supplied

Preoperative locoregional re-evaluation by endoscopic ultrasound in pancreatic ductal adenocarcinoma after neoadjuvant chemoradiation.

INTRODUCTION: The accuracy of endoscopic ultrasound (EUS) for the diagnosis and staging of pancreatic ductal adenocarcinoma (PDA) has been confirmed. Chemo-radiotherpay (CRT) induces tumor changes which can limit the accuracy of EUS. The aim of our study was to analyze the efficacy of EUS following neoadjuvant CRT comparing findings with the pathology results. PATIENTS AND METHODS: From November 1996 to October 2003, 45 patients with histologically proven and EUS-staged PDA were treated with neo-adjuvant CRT and radical surgery. All were restaged before surgery using both EUS and computed tomography. Fifteen patients were found to have developed distant metastases. Thirty patients finally underwent pancreaticoduodenectomy (N=24) or distal pancreatectomy (N=6). RESULTS: Following CRT, tumor stage was correctly assessed in 12 patients (40%). The most frequent misinterpretation was overestimation of tumor size (N=13, 43.3%). Locoregional vascular invasion of veins was suspected by EUS in 13 patients (43.3%) but surgical findings and the histological examination were both negative. Node status was correctly assessed in 27 patients (90%) but nodal involvement was found on the histological specimen in only 3 patients. CONCLUSION: Preoperative EUS after neoadjuvant CRT for PDA does not enable reliable definitive selection of patients for surgery, probably due to radiation-induced pancreatic changes.

Adenocarcinoma↗
PubMedDate not supplied

Treatment of esophagojejunostomic leakage by cervical stapling and loop jejunostomy.

Reestablishment of digestive continuity after radical surgery for severe esophagojejunostomic leakage is a major challenge associated with high morbidity and uncertain feasibility. In this case report we describe a conservative double exclusion technique involving cervical stapling and loop jejunostomy. This technique greatly simplifies subsequent reconstruction and is suitable in most cases.

Adenocarcinoma↗