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Biomedical subjects

P Lasser

Publications and source records attributed to P Lasser.

At least 109 records · Page 6Linked to original sources
PubMed1994

Preoperative chemotherapy of locally advanced gastric cancer.

Gastric adenocarcinomas, even in the absence of distant metastases, have a poor prognosis which is particularly dismal when tumors are located in the cardia, in the event of locoregional lymph node involvement and/or bulky tumors. Postoperative adjuvant chemotherapy has never clearly demonstrated its efficacy on survival. Besides ongoing trials using new and more active regimens, preoperative chemotherapy has been used for unresectable cancer due to loco-regional extension and when locally advanced cancer is potentially resectable but with poor prognosis such as bulkiness, when tumors are located in the cardia and when there is tumor in the coeliac area at CAT-scan with suspected metastatic lymph nodes. In case of unresectable tumor at initial surgery five publications have reported the ability of chemotherapy to reduce the tumor volume and to allow subsequent resection of the gastric tumor in 40% to 60% of the cases. In these cases there is a clear survival advantage as the median survival reported in 2 of these studies was 12 and 18 months compared to the 4 to 6 months median survival reported in historical studies in case of unresectable cancer [17, 18]. In case of locally advanced gastric tumors some Japanese case reports have demonstrated the ability of preoperative chemotherapy to concentrate in the tumor tissue and to downstage the tumors. Four North American and European studies have demonstrated that preoperative chemotherapy is feasible, and will probably increase the resection rate. J. Ajani has reported 2 studies in which tolerance was acceptable: a major response (R) observed in 24% and 31%, the resectability rates were 72% and 77% and the median survival 15 and 16 months, respectively. Our experience is based on 30 patients treated with a combination of continuous i.v. 5-FU and CDDP. Fifteen had a tumor of the cardia, 15/30 had enlarged lymph nodes and 7/30 a linitis plastica (diffuse type). After a mean number of 3 cycles, 27/30 patients were evaluable for response. One patient achieved a CR and 14 a PR (OR rate 56%, 95% CI: 38% to 74%) but only one of those with linitis plastica responded. Twenty-eight patients underwent surgery and 23 had a macroscopically complete resection (82%). Resectability rate was higher after OR (13/15) than in nonresponding patients (4/12). Toxicity was acceptable, however grade 4 leucopenia in 5 patients and one toxicity-related death were observed. There was no increase in postoperative complications. Nine patients received postoperative chemotherapy and 3 patients with positive margins received postoperative external radiotherapy.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenocarcinoma↗
PubMed1994

[Intra-arterial hepatic chemotherapy. Experience of 200 cases].

OBJECTIVES: This retrospective study had three aims: a) to investigate whether one catheter, whatever the number of hepatic arteries, associated with miscellaneous arterial ligations, produced the same results as the implantation of multiple catheters, b) to study the survival rate after intra-arterial chemotherapy, and c) based on a multifactorial study of prognostic factors, to define the best indications of this treatment in the future. METHODS: Two hundred catheters were surgically implanted to perform intrahepatic arterial chemotherapy in patients with multiple unresectable isolated liver tumors. The origins of these tumours were colorectal cancer in 152 cases, neuroendocrine tumour in 13 cases, hepatocellular carcinoma in 9 cases, and miscellaneous tumours in 22 cases. The hepatic arteries were ligated in 32% of the cases. Resection of the primary or local recurrence was performed at the same time in respectively 41% and 16% of the cases. RESULTS: The use of only one catheter was always possible, and the ligations of miscellaneous accessory hepatic arteries did not modify the therapeutic results. There were no postoperative deaths. Numerous complications occurred during local chemotherapy, mainly digestive and hepatobiliary complications (38.5% of the cases). Early discontinuation of local chemotherapy was due to the occurrence of thrombosis of the hepatic artery in 23% of the cases (after a mean delay of 5.2 months) and to the occurrence of digestive or hepato-biliary complications in 11% of the cases. The rate of objective response was 44%, with 22 complete and 62 partial responses on morphologic examination. The crude survival rates were 65 +/- 3% at 1 year, 33 +/- 4% at 2 years and 5 +/- 2% at 5 years, with a median survival of 16 months. The median survival was different according to the primary tumour (34 months for neuroendocrine tumours, 17 months for colorectal tumours and 12 months for hepatocellular and miscellaneous carcinomas). For the 152 colorectal cancers, a multifactorial study identified 2 main independent adverse prognostic factors: an involvement of the liver greater than 50% (P = 0.006) and circulating carcinoembryonic antigen > 100 ng/L (P = 0.001).

Adult↗
PubMed1994

[Intraperitoneal hyperthermic chemotherapy (IPHC), a promising treatment of peritoneal carcinomatosis].

Intraperitoneal hyperthermic chemotherapy (IPHC) appears to be a promising treatment of peritoneal carcinomatosis. This paper reports the physio-pathological background of IPHC and the various studies which have been published in the literature. It points out the heterogeneity of these series and discuss the most critical points as surgical indications, choice of the antineoplastic drugs, their doses, temperatures of the IPHC, extend of the cytoreductive surgery, morbidity and mortality. Finally, several options are proposed for those points which are not yet standardized.

Animals↗
PubMed1994

Treatment of peritoneal carcinomatosis by intraperitoneal chemo-hyperthermia: reliable and unreliable concepts.

Intraoperative peritoneal chemo-hyperthermia (IPCH) is a promising treatment of peritoneal carcinomatosis arising from digestive tumors. After presenting the rationale for the use of IPCH, this review reports the results published to date by different groups. Unfortunately, data with respect to technical aspects, indications and results are unclear, inhomogeneous and questionable. The discussion presents reliable and unreliable points, mainly concerning the technical aspects of IPCH: what is the maximal desirable tumor thickness before initiating treatment? What is the ideal temperature? Is central hyperthermia beneficial? What is the ideal duration? What is the most effective antimitotic drug? A new classification of peritoneal seeding before cytoreductive surgery and before the initiation of IPCH, is proposed, and a suggestion concerning the reporting of drug concentrations made. Numerous prospective studies need to be conducted to test different technical modalities and to evaluate the results of IPCH.

Animals↗
PubMed1994

[Contributions and limitations of transcutaneous ultrasonography in the preoperative evaluation for hepatic resections].

From October 1990 to January 1992, 36 patients were operated in order to perform an hepatectomy for hepatic metastases (n = 33) or primary malignant tumors (= 3). The authors evaluated the reliability of preoperative ultrasonography (US) by comparing US data to intraoperative findings without consideration of others preoperative examinations. Preoperative US detected 65 out the 78 nodules founded intra-operatively; 13 nodules (4 to 30 mm) and a micronodular dissemination were not detected (sensitivity 82% for the whole lesions). Probable causes of false negative cases (size, location and echogenicity of the nodules) are discussed. Sixty three out of the 65 nodules detected were correctly located in the hepatic segmentation by preoperative US. Hepatectomy was performed in 30 of the 36 patients (84%). The resection previously planned by preoperative US was realized in 24 patients, 5 hepatic resections (14%) had to be enlarged and one completed by a lymphadenectomy; in 6 cases (16.5%) the hepatectomy was not possible because of intraoperative findings of lesions previously not detected by preoperative examinations including US (3 with not removable hepatic nodules, 3 with lymph nodes metastases). This study confirms the reliability of US for anatomical location of hepatic lesions. US sensitivity for the detection is satisfactory. However the number of nodules was underestimated in one third of the patients. The hepatic resection previously planned was effectively realized in only 67% of the cases, in one case out of 6, the resection had to be enlarged and in one case out of 6, the resection was not possible.

Adult↗
PubMed1993

[Resectable liver metastases and synchronous extra-hepatic sites of colorectal origin. Surgical indications].

Twenty-two patients with liver metastases and synchronous extra-hepatic localizations or colorectal cancer underwent complete resection of all their cancerous lesion. Their survival was not significantly different from that of 87 patients in whom single or multiple metastases involving only the liver had been resected. Analysis of our 22 patients showed that they fell into two subgroups: those with lung metastases (n = 5) and those with pediculate colonic nodes (n = 6), who benefited from the double resection since their disease-free survival rate at 5 years was 35 percent. In contrast, patients who had a few peritoneal nodules (n = 8) relapsed during the first 13 postoperative months. The presence of one or a few extra-hepatic lesions does not necessarily preclude resection of the liver metastases, provided they can be resected during the same operation in case of intra-abdominal lesions and during a later operation in case of lung metastases. A single peritoneal nodule may be the first manifestation of peritoneal dissemination and contra-indicates the resection of liver metastases.

Adult↗
PubMed1993

Repeat hepatectomy for cancer.

In a series of 279 hepatectomies performed for cancer between June 1984 and March 1992, 46 were repeat operations, for metastases in 41 patients. The primary tumour was in the colon and rectum (28 patients), APUDoma (five) and miscellaneous (eight). Repeat hepatectomies were performed in 26 per cent of patients who had recurrence after the first liver resection and in 40 per cent of those who had liver recurrence. An unsuspected extrahepatic recurrence was discovered and resected in eight instances and in two other cases a known extrahepatic recurrence was resected during the second hepatectomy. The hospital mortality rate was 2 per cent (one patient); the death was from nosocomial pneumonia. The total morbidity rate including minor complications was 32 per cent, with a higher frequency of haemorrhagic problems after secondary liver resection (12 per cent) than after primary hepatectomy (5 per cent). The rate of postoperative complications after repeat hepatectomy was related significantly to operative blood loss greater than 1500 ml (P = 0.04). The technical problems of repeat hepatectomy were: (1) re-exposure of the liver, considered to be difficult in 67 per cent of second liver resections and 80 per cent of third procedures; (2) the liver parenchyma, which often had histological modifications between first and second resections and was more difficult to 'work' as shown by the mean duration of clamping of the hepatic pedicle (54 min for secondary versus 36 min for primary liver resection); and (3) modification of the intraparenchymal vasculobiliary anatomy following liver regeneration after major hepatectomy. Intraoperative ultrasonography was of great benefit. Rates of crude and recurrence-free survival were relatively encouraging at 47 and 33 per cent 3 years after the second liver resection for the whole group. These values were lower for colorectal cancer (37 and 21 per cent 3 years after the second hepatectomy). These figures do not, however, convey the complete picture of the outcome for these patients. During the same follow-up period, 143 recurrences were detected and a mean of 2.9 resections per patient were performed. The indications for repeat hepatectomy are still to be clarified, although the surgical technique is safe.

Adult↗
PubMed1993

Potential contribution of 131I-labelled monoclonal anti-CEA antibodies in the treatment of liver metastases from colorectal carcinomas: pretherapeutic study with dose recovery in resected tissues.

20 patients with liver metastases from colorectal carcinoma undergoing laparotomy received 15-60 mg intravenously, either intact or fragments of, anti-carcinoembryonic antigen (anti-CEA) monoclonal antibodies labelled with 0.55-1.48 GBq (15-40 mCi) of 131I, 3-8 days prior to operation. The uptake measured per gram of metastases ranged from 0.33 to 6.6 x 10(-3%) of injected dose. Tumour to liver uptake ratios ranged from 2 to 33. The radiation dose, estimated in 6 patients (3 of each group), for an extrapolated dose of 3.7 GBq (100 mCi) of 131I ranged from 0.3 to 0.8 Gy in normal liver or spleen (an acceptable estimate for bone marrow radiation dose) and from 3.4 to 8.2 Gy to the hepatic metastases, indicating that probably other therapeutic modalities should be associated with radioimmunotherapy.

Antibodies, Monoclonal↗
PubMed1993

Postoperative pulmonary complications. Epidural analgesia using bupivacaine and opioids versus parenteral opioids.

BACKGROUND: Different types of analgesia have been proposed for the prevention of postoperative respiratory complications. The aim of this prospective, double-blind randomized study was to compare the impact of epidural bupivacaine and opioids versus parenteral opioids on respiratory complications in patients who had undergone major abdominal surgery. METHODS: One hundred fifty-three patients undergoing abdominal surgery for cancer were randomly allocated to receive either general anesthesia with intravenous fentanyl and postoperative analgesia with subcutaneous morphine (SC group) or general anesthesia combined with epidural bupivacaine and epidural bupivacaine plus morphine for postoperative pain relief (EP group). Analgesia was tested on a visual analog pain scale. Pulmonary complications were evaluated according to clinical complications, chest radiographs, arterial blood gas analysis, and pulmonary function tests. The evaluation was carried out on the day before the operation and on the first 5 postoperative days. Particular attention also was paid to the episodes of arterial hypotension and hemoglobin oxygen desaturation during the 1st postoperative night. RESULTS: Pain relief was significantly better in the EP group than in the SC group (P < 0.05) especially during recovery and on the 1st and 2nd postoperative days. In the EP group, vital capacity decreased less on the 1st postoperative day (P < 0.05) and arterial oxygen tension was greater in the recovery room (P < 0.05). However, no statistically significant difference was observed between the SC and EP groups in the incidence of clinical pulmonary complications (31% and 27%, respectively) and radiographic chest abnormalities (52% and 46%, respectively). The EP group recovered intestinal function earlier (P < 0.05), but significantly more patients in this group had episodes of systolic hypotension (21% vs. 8%; P < 0.05) during the 1st postoperative night. The length of the hospital stay was similar in both groups of treatment. CONCLUSIONS: Epidural analgesia with a combination of local anesthetic and opioid improves patient comfort. However, this type of analgesia does not decrease the incidence of postoperative pulmonary complications, does not reduce the length of the hospital stay, and carries the risk of complications from episodic systemic hypotension.

Abdomen↗
PubMed1993

Transcatheter chemoembolization of progressive carcinoid liver metastasis.

PURPOSE: The authors report their experience treating progressive liver metastases from carcinoid tumor with doxorubicin, iodized oil, and gelatin sponge embolization. MATERIALS AND METHODS: Of 23 patients, 18 had carcinoid syndrome and 19 had elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) levels. Relief of symptoms, changes in 5-HIAA levels, and changes in tumor size could be evaluated in 10, 11, and 17 patients, respectively. RESULTS: Symptomatic response was complete (average duration, 29 months) in 70% and partial in 30% of evaluated patients. Biologic response was complete (average duration, 21 months) in 73%, partial in 18%, and minor in 9% of evaluated patients. Morphologic response was complete in 11%, partial in 24%, and minor in 24% of evaluated patients. Survival after diagnosis of primary tumor, diagnosis of hepatic metastases, and first chemoembolization was 81, 47, and 24 months, respectively. Eight patients were alive at the end of the study. No mortality was related to chemoembolization. CONCLUSION: Chemoembolization is safe and effective for palliation of carcinoid liver metastases.

Adult↗
PubMed1993

[Triple hepatectomy for cancer].

The resection of the metastases from digestive malignant lesions are always the most efficient treatment, if it is complete. However it must be performed without major operative risk. According to this point of view, it is logical to examine the feasibility of three successive hepatectomies for metastases. We report in this study our experience with five cases of triple hepatectomies performed for 4 colic cancers and 1 carcinoid cancer. Two major hepatectomies were performed during this third resection. The re-exposure of the liver was very difficult in 4 cases, and the texture of the liver parenchyma was flabby and abnormal in 5 cases (confirmed with the histologic study). The mean duration of the surgery was 307 minutes, the mean duration of the intermittent pedicle clamping was 59 minutes, and the mean blood loss was 1710 ml. No post-operative death occurred, and the morbidity was low. This 5 third hepatectomies have been compared, for the feasability, to the 41 second hepatectomies and to the 234 first hepatectomies which we have performed. In proportion as hepatectomies are carried out, the difficulties to expose the liver increase, the texture of the liver parenchyma gets spoiled and the duration of the operation increases. In conclusion, the third hepatectomies are technically difficult to perform, but they are feasable. However it is too early to be able to define their indications.

Adenocarcinoma↗
PubMed1993

[Pseudo-continent perineal colostomies after amputation of the rectum for cancer].

From February 1989 to February 1982, 23 pseudocontinent perineal colostomies (PC), performed after abdominoperineal excision for rectal carcinoma, were evaluated. Perineal colostomy was performed using a free autotransplant of smooth muscle, according to Schmidt, associated with colonic irrigations. This procedure was proposed to the younger and more alert patients without advanced rectal carcinoma. These 23 cases represented 35% of the rectal extirpations performed during the same period. Four patients did not accept a PC and preferred, after being fully informed about both types of colostomies, to have a classical iliac colostomy which they thought to be safer. The advantages of this procedure were mainly psychological, as the body scheme and corporeal image were not disturbed. Continence was evaluated in only 21 cases, because two patients had non-specific complications (necrosis of the colonic extremity, and colonic perforation due to enema material). Ten patients were incontinent to flatus, but did not have to wear a sanitary towel, while 11 patients had occasional, minor soiling, requiring the use of a sanitary towel. None of the patients had major incontinence requiring a secondary iliac colostomy. When asked what they thought of results, none said that they were dissatisfied. The degree of satisfaction was subjective and was not correlated with the quality of functional results as seven patients declared themselves satisfied although they had minor soiling, and conversely, two patients were not completely satisfied, even though they had no soiling. Six months after operation, the muscular transplanted ring had disappeared in half of the patients, but this did not seem to have any repercussion of the quality of functional results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1993

[Desmoid tumors or intra-abdominal fibromatoses].

Intraabdominal desmoid tumour or fibromatosis, recurrent but non-metastatic, invasive, fibroblastic proliferations, are rare tumours. From 1968 to 1989, 16 patients were treated at Gustave Roussy Institute. They were associated with familial adenomatous polyposis in 10% of cases. These tumours, observed mainly in young women (70 to 85% of cases), are aggravated by pregnancy, and spontaneous regression can occur at menopause, proving their hormonal dependence. Although histologically benign, they are serious lesions due to their invasive character; their excision is complete in only 50% of cases. They recur in 30% to 75% of cases and cause death of the patient in 30% of cases. Treatment is surgical but due to their often very slow course, and their spontaneous stabilisation in some cases, a mutilating surgical treatment (extensive small intestine resection) does not seem to be justified. Radiotherapy is effective only at doses incompatible with the site of these tumours (35 to 60 Gy). Chemotherapy has never been shown to be effective.

Adult↗
PubMed1993

[A multivariate prospective study of prognostic factors in 200 operated epidermoid cancers of the esophagus. Definition of patients for whom surgical resection was of benefit].

From 1982 to 1991, 200 patients with squamous-cell esophageal cancers underwent operation. Sixteen prognostic parameters were prospectively collected and analyzed. The main aim of this study was to define the best preoperative criteria for selection for curative surgery and which patients would benefit most from radical resection. Squamous-cell head and neck carcinoma was associated in 43.5% of cases. Of these, 24% preceded the esophageal carcinoma while 19.5% were synchronous. Resection was curative (i.e. grossly complete) in 144 cases, palliative (leaving gross tumor behind) in 25 cases, and judged impossible in 31 cases. Twenty-one patients died during their hospitalization. Five-year survival, according to the Kaplan-Meier method, was 18 +/- 3.6% for all patients, and 27 +/- 4.8% for patients undergoing curative resection (including postoperative mortality). Palliative resections or invasion of adjacent organs, but not resection with positive lymph nodes, was thought to be synonymous with incurability. Multivariate analysis showed that the two principal statistically significant characteristics were the stage as determined by roentgenological and endoscopic evaluation (P = 0.003) (clearly assessable during initial work-up) and type of resection (complete or not) (P = 0.04). Tumor diameter, as determined on CT-scan (< or > than 30 mm), was at the limit of statistical significance (P = 0.09). A second multivariate analysis of prognostic factors was conducted in 128 patients undergoing resection with curative intent and who survived the initial postoperative period. Roentgenologic/endoscopic staging alone emerged as being statistically significant (P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Single and multifactorial prognostic study of 400 operated rectal adenocarcinomas].

From 1976 to 1988, 496 patients with rectal adenocarcinoma have been treated at Gustave-Roussy Institute. There were 258 men (52%) and 238 women (48) with a median age of 61 years. Sixty pts (12%) had local treatment (contact-therapy or electro-resection). Thirty six pts (8.25%) had a simple exploration with colostomy. Four hundred pts had a resection: 202 abdomino-perineal resection, 7 perineal resection, 167 anterior resection, and 24 Hartmann's technique. Post-operative mortality was 1% (4 pts). Among these 400 pts, 208 had no complementary treatment, 134 had pre +/- post-operative radiotherapy and 58 had post-operative radiotherapy. Sixty one pts had palliative resection. The actuarial survival of the 400 pts at 3, 5 and 10 years are respectively 65%, 51% and 37.5%. The number of lost to follow-up patients was 11 (2.5%) at 5 years and 24 (5.5%) at 10 years. A retrospective uni and multifactorial analysis of the clinical, biological and histopathological data of the 400 pts was done, 18 factors were studied. Our judgement criterion was 5 year survival. The uni-factorial analysis showed 7 variables which had great influence on survival: age > 60 (p = 0.001), signs of severe illness (p < 0.0001), curative or palliative criterion of the surgery (p = 0.0001), depth of invasion (p = 0.0001), lymph node invasion (p = 0.0001), neural invasion (p = 0.0001) and positive emboli (p = 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗