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Biomedical subjects

P Cubertafond

Publications and source records attributed to P Cubertafond.

52 records · Page 3Linked to original sources
PubMedDate not supplied

Radical surgery for gallbladder cancer. Results of the French Surgical Association Survey.

BACKGROUND/AIMS: Gallbladder carcinoma is a highly lethal disease. The advantages of radical surgery remain controversial. The authors' objective was to evaluate the effectiveness of an aggressive approach to gallbladder carcinoma on long-term survival. METHODOLOGY: A questionnaire was sent to 73 institutions in France, Europe, and overseas. Data, from 724 patients treated between 1980 and 1989, were analyzed for patient sex and age, associated hepatobiliary diseases, symptoms and signs, diagnostic tests, operative management, pathology reports and survival. Seventy-eight percent of the patients were women, and 22% were men. Gallstones were present in 86% of the cases. Four percent of the patients had Tis lesions, 11% had T1 to T2 lesions, and 85% had T3 to T4 lesions. RESULTS: Twenty-three percent of the patients underwent curative operations, and 77% had a palliative treatment (25% of the patients underwent exploratory laparotomy). Exploratory laparotomy was followed by the highest mortality rate (66%), and older patients (>70 years) had a higher operative risk. The overall median survival was 3 months, and long-term survival correlated with cancer stage: Tis >60 months, T1 to T2 >22 months, and T3 to T4 2 to 8 months. Projected five-year survival for cancers limited to the gallbladder and treated by simple cholecystectomy was 93%, 18% and 10% for Tis, T1 and T2 respectively. For T3 to T4, no difference was observed among the different surgical procedures adopted--hepatic resection, trans-tumoral stenting or biliary-enteric anastomosis. CONCLUSIONS: In conclusion, a simple cholecystectomy is effective only for Tis cancer. An extended cholecystectomy for invasive cancer should be performed, but only if there is limited involvement of the immediately adjacent hepatic parenchyma. There is now a need to evaluate more effective adjuvant therapy in the form of radiotherapy or newer chemotherapeutic agents.

Adult↗
PubMedDate not supplied

[The primary neoplasm of the gall-bladder. Report of 55 cases (author's transl)].

The authors report 55 cases of primary neoplasms of the bladder which represent 5,2 per cent of cholecystectomies, their study prove its very important deadly character. They insist on the necessity of the immediatly systematic examination. This examination permit a knowledge of the in situ stades and permit to make adapted surgical treatment. This treatment may be a cholecystectomy if it's a in situ type adenocarcinoma but it must be an enlarged cholecystectomy in all the other cases.

Adenocarcinoma↗
PubMedDate not supplied

Prevention of postoperative wound dehiscence in high risk patients. A randomized comparison of internally applied resorbable polyglactin 910 mesh and externally applied polyamide fiber mesh.

This randomized prospective study was undertaken to compare the effectiveness of two methods used to prevent post-operative wound dehiscence in 100 high risk patients. Fifty patients were treated with a polyamide fiber mesh applied externally to the skin using a topical glue, while the other 50 patients were treated with a resorbable intraperitoneal mesh of polyglactin 910. Each patient had at least one of the following risk factors for wound dehiscence: undernutrition, malignancy, ascites, peritoneal infection, immunodepression, abdominal irradiation, repetitive surgical procedures through the same incision, or pulmonary disease. Judging criteria consisted of the development or absence of dehiscence and the frequency of abdominal wall complications. The percentage of wound dehiscence was significantly increased in patients with externally applied polyamide fiber mesh as compared to those with intraperitoneal polyglactin 910 mesh (p less than 0.01). Abdominal wall complications and the duration of healing did not vary significantly in frequency between the two groups. The intraperitoneal placement of a polyglactin mesh was more effective and better tolerated than external application of a polyamide fiber mesh.

Adult↗
PubMedDate not supplied

[Lymph node involvement and prognosis in medullary cancers of the thyroid gland].

Involvement of regional lymph nodes is extremely common in medullary carcinoma of the thyroid gland (MTC). The aim of the present study was to determinate the prognostic of MTC correlated with the regional lymph node involvement. From 1975 to 1994, 23 MTC patients were treated. The surgical protocol included a total thyroidectomy with bilateral dissection of the jugulocarotid chain and of the paratracheal groove. We have distinguished two groups: group N+ (histological lymph nodes involvement) and group N- (absence of histological lymph nodes involvement). In each group we have evaluated the prognostic significance of age, sex, palpable lymph nodes, histological capsular effraction and presence of distant metastasis. The data were analyzed with the exact Fisher test and comparisons by Student t test. Significance was defined as p > 0.05. Survical curves were based on the method of Kaplan Meier. In Group N+ (n = 15), 9/15 patients died: they had palpable lymph nodes, histological capsular effraction and distant synchronous or metachronous metastasis. The median survival was 8 months, when patients have distant metastasis. Six patients are alive, 2 with an elevated thyrocalcitonin level without metastasis, and 3 with resection of metastatic MCT to regional lymph nodes. In groupe N- (n = 8), all patients are alive: 2/8 patients had palpable lymph nodes, 1/8 had histological capsular effraction, but none had distant metastasis. 2 patients underwent resection of regional lymph metastasis and one of pulmonary metachronous metastasis. Gender did not appear to affect the lymph involvement. Factors significantly associated in the group N+ included the following: age (p = 0.003), palpable lymph nodes (p = 0.015), capsular effraction (p > 0.00025), distant synchronous metastasis (p < 0.013). The regional lymph node metastasis had significant influence on the 5-year survival, 48% vs 100% (p = 0.006), and on disease free survival, 16.6% vs 62.5% (p = 0.018). The median time from resection of the primary tumor to the development of metastasis disease was 37 months for patients N+ vs 169 months for patients N-. Involvement lymph node did not affect the metastasis disease, regional involvement or distant metastasis (p > 0.05).

Adult↗