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P Lasser

Publications and source records attributed to P Lasser.

At least 145 records · Page 8Linked to original sources
PubMed1990

[150 hepatic resections of malignant tumors. Technical aspects].

One hundred and fifty hepatic resections for liver tumors have been performed in 130 patients during the last six years. The origin of the tumors was miscellaneous, but 76 resections were made for liver metastases from colo-rectal cancers, and all the types of hepatic resections were performed. The post-operative mortality and morbidity were respectively 2% and 26%. After such an experience, we think that hepatic resections for tumors are currently safe surgical operations. This security comes from two technical ameliorations: the practice of intraoperative ultrasonography and the systematic use of repetitive pedicular clampings. A detailed account is done about the different operative technics concerning intraoperative ultrasonography, pedicle clamping and different types of systematized or atypical hepatectomies.

Colorectal Neoplasms↗
PubMed1990

[Combination radiotherapy and chemotherapy in the treatment of locally advanced adenocarcinoma of the pancreas. Experiences of the Gustave Roussy Institute].

Non-resectable pancreatic adenocarcinomas (PA) are of poor prognosis with median survival of 4-6 months. Radiotherapy (RT) and chemotherapy (CT) association are potential palliative treatments recently investigated. We have tested such an association in a pilot study. Twelve patients (pts) with non-resectable PA and localized tumors were treated by 2 cycles of CT (5-FU + adriamycin + cisplatinum) and then 2 or 3 split courses of RT (20 Gy/12 days and 8 fractions with a 16 day interval). CT was reintroduced, if initially active, for 3 cycles. Results were: 3 CR (11+, 13+, 16 months) for a response rate of 25%, 1 MR (4 months) and 5 stabilizations longer than 6 months. The 1 year survival was 56 +/- 15% with no patient surviving longer than 2 years. Tolerance was acceptable for RT and toxicity with CT was digestive (grade II) for all pts, leucopenia grade III for 3 pts and thrombopenia grade II for 2 pts. Two pts experienced digestive hemorrhage for anastomatic ulceration, responsible for death in one case. This pilot study confirms the transient efficacy of RT + CT association for non-resectable PA. However, the toxicity and treatment duration lead us to recommend other studies of less toxic association before initiation of randomized trials.

Actuarial Analysis↗
PubMed1989

Prognostic factors in primary gastrointestinal non-Hodgkin's lymphoma. A multivariate analysis, report of 106 cases, and review of the literature.

The authors have reviewed 106 cases of primary gastrointestinal non-Hodgkin's lymphoma (GI-NHL) treated at the Institut Gustave-Roussy (IGR), France, between 1975 and 1986. The occurrence was 55 in the stomach, 26 in the small intestine, ten ileocecal, seven in the large intestine, and eight patients had multiple involvement. Patients were clinically staged according to the Ann Arbor staging system using the modification of Musshoff for Stage IIE. All histologic material of the 106 patients were reviewed and graded according to the Working Formulation (WF) and the Kiel classifications. Most patients received combination chemotherapy as part or all of their primary treatment program (95 patients, 90%). Seventy five patients (71%) had a multimodality treatment. The overall 5-year survival rate was 60%. Sixteen variables were tested by univariate analyses for prognostic influence on survival. Of these, only clinical stage (P less than 0.001), the achievement of initial complete remission (CR) (P less than 0.001), erythrocyte sedimentation rate (ESR) (P = 0.01), mesenteric involvement (P = 0.03), and serosal infiltration (P = 0.05) were significant prognostic factors. Important variables were tested by a multivariate analysis using the Cox model taking into account different treatment modalities. Only three variables entered the regression analysis at a significant level: clinical stage (P = 0.02), surgical resection (P = 0.03), and histologic grade (Kiel) (P = 0.04). When the achievement of initial CR was introduced into the model, it was the most significant variable (P less than 0.001) whereas all other variables became nonsignificant except for the histologic grade (Kiel) (P = 0.004). Based on results of the multivariate analyses we propose two prognostic classifications of patients: one at the initial evaluation depending on clinical stage, surgical resectability, and histologic grade (Kiel); the other at the end of primary treatment depending on the achievement or not of CR and the histologic grade.

Adolescent↗
PubMed1989

Intra-arterial hepatic chemotherapy for metastatic liver from colo-rectal carcinoma origin.

Loco-regional intra-arterial chemotherapy of hepatic metastases from colo-rectal cancer is one of the most effective non-surgical treatments in this clinical situation. In our experience of 58 cases treated during 3 years, in a non randomized study by either: 1) discontinuous perfusion of 5FU (using a subcutaneous access) or 2) by continuous infusion of FUDR (using an implantable pump), we observed an objective response rate of 52% and 53% with a 1 year survival of 73% and 90%, respectively. This technique, however, is limited in its application by loco-regional complications and in its long term efficacy by the development of extrahepatic metastases. The proof of its efficacy in terms of survival prolongation, is being studied within the framework of a prospective randomized trial with a control group.

Adenocarcinoma↗
PubMed1989

[Neoadjuvant chemotherapy in locally advanced gastric adenocarcinoma. Preliminary results].

Gastric adenocarcinoma locally advanced or located at the cardia, or of large size or with local lymphadenopathies are of bad prognosis. To improve the surgical results we have tested the feasibility and tumoral efficacity of pre-operative (neoadjuvant) chemotherapy. Twenty patients have been included between 6/87 and 12/88. Median age was 63 years (36-74); all patients were in good general condition (OMS 0-1). The tumors were located at the cardia in 50%. The tumor median size was 10 cm (6-19), pathological lymph nodes were seem at CAT. Scan in 10/20. The neoadjuvant chemotherapy was continuous IV, 5 FU 1 g/m2/day for 5 days + CDDP 100 mg/m2, day 1. The cycles were repeated every 4 weeks. The median number of cycles prior surgery was 2 (1-4) and depended of tolerance and efficacy. We have observed (WHO criteria). 1 CR, 12 PR (Responsible rate: 65%). 6 MR or S. One patient was non evaluable because coronary insufficiency complicating the first cycle. The neoadjuvant chemotherapy toxicity was mainly hematological. The surgical procedure was curative in 15/20 patients; palliative 4 and non feasible for progression 1. Normal rate of post-operative complications was encountered: 2 subphrenic abscess, 1 pneumopathy, 1 stercoral peritonitis. At this date 3/20 patients died (17 patients are still alive, among them 14 are NED (the overall median survival is more than 10 months). This study demonstrated the feasibility and high response rate of neoadjuvant chemotherapy in patients with locally advanced gastric carcinomas. A randomized trial is warranted to demonstrate the survival benefit.

Adenocarcinoma↗
PubMed1989

[Anatomo-pathologic study of hepatic toxicity in intra-arterial hepatic chemotherapy].

Intra-arterial hepatic chemotherapy is effective in the treatment of colorectal or endocrine carcinomas liver metastasis. However it is potentially toxic for the healthy liver. To check this, we studied non tumoral liver specimens in 14 patients treated by intra-arterial chemotherapy with 5 fluorouracil, 5 fluoro-2 deoxyuridine and an association of 5 fluorouracil and streptozotocin. The main hepatic lesions observed were: sclerosing cholangitis, central vein (dilatation and fibrosis) and moderate hepatocellular necrosis or cholestasis in the centrolobular area. Thus intra-arterial hepatic chemotherapy has important toxic effects on healthy liver, even if clinical and biological liver disturbances are minimal in most cases. Caution must be exercised in using this method.

Adult↗
PubMed1989

[Gastroduodenal complications of hepatic intra-arterial chemotherapy of hepatic metastases of colorectal origin].

Fifty-eight patients with colorectal liver metastases were treated by intra-arterial hepatic chemotherapy (IAHC) containing 5 FU (n = 42) or FUDR (n = 16). Twenty-three patients (39.6 p. 100) complained of abdominal pain. In three of these patients, the course was complicated by digestive hemorrhage. Endoscopic explorations and angioscintigraphy were normal in 4, showed oesophagitis in 3, superficial gastritis or duodenitis in 8 (34.7 p. 100) and gastric (2) or duodenal ulceration (6) in 8 (34.7 p. 100). The duodenal ulceration was extensive and considered to be cause of hemorrhage in two cases. Duodenal perforation due to the catheter was discovered in two other cases, one of which was secondary to tumoral extension revealed by forceps biopsy. This patient died 3 months later. Surgical treatment was mandatory in the other case due to digestive hemorrhage but did not prevent death. Angioscintigraphy performed in 15 patients with gastroduodenal inflammation or ulceration was normal in 7 patients, revealed arterial thrombosis in 5 and an extra-hepatic perfusion in the gastroduodenal area in 3 : this was related to a small pyloric artery which was occluded secondarily. IAHC was continued there after. This experience underlines the importance of exploring patients with digestive symptoms during IAHC so that it may be temporarily discontinued while an inadequately positioned infusion catheter may be corrected should gastroduodenal ulceration occur.

Antineoplastic Agents↗
PubMed1989

[Epidermoid cancer of the esophagus: is the combination of chemotherapy then surgery beneficial?].

Ninety-two patients with carcinoma of the esophagus were treated with pre-operative chemotherapy (2 courses) before undergoing surgery. Chemotherapy and/or radiation were carried out after surgery depending on the tumor response to chemotherapy and extent of the tumor found at surgery. Tumor response before surgery (according to OMS criteria) was determined in 84 patients. Forty-four percent of patients showed a tumor regression of over 50%. Curative surgery was more frequently performed in patients with good tumor regression (greater than 50%) than in patients with less satisfactory tumor regression (less than 50%) (76 versus 57.5% respectively) (P = 0.08). Patients who underwent curative surgery had a lower pathologic staging when tumor regression was over 50%. However, the number of patients is too limited for any definite conclusions to be made. Survival rate at 3 years was similar in both groups of patients with curative surgery. Survival was not influenced by the extent of tumor regression before surgery. This study also suggests that the pre-operative chemotherapy did not increase the survival rate of patients who underwent curative surgery. Therefore it does not seem advisable to undertake a phase III randomized study on pre-operative chemotherapy patients.

Antineoplastic Agents↗
PubMed1989

[Technics of extensive lymph node curettage in cancer of the esophagus].

During esophagectomy for cancer traditional lymph node curettage is performed extensively in the lower region but is practically nonexistent towards the upper zone, which fails to correspond to a satisfactory anatomic and oncologic exeresis. An operative technique has been adopted to extend lymph gland curettage, particularly in the anterior and superior mediastinum in the region of the recurrent and cervical chains. An analysis is performed of the advantages (increased survival) and inconveniences (increased postoperative morbidity) inherent in these extensive lymph node curettages.

Abdomen↗
PubMed1988

[Epidermoid cancers of the esophagus: combined chemotherapy, surgery and radiotherapy. Preliminary results in 50 cases].

Fifty operable epidermoid esophageal carcinomas were treated by combined chemotherapy, surgery and radiotherapy. The post-operative mortality was 5.4% and the severe post-operative morbidity was 29%. The vindesine-5FU-platinum association and the vindesine-endoxan-platinum association gave respectively 55% and 35% objective responses (OR) after two preoperative courses without increasing the operative mortality. The patients who showed an OR had a less important tumoral extension. Thus, an objective response to the pre-operative chemotherapy is in fact a new prognostic factor. Survival without recurrence seems to be increased when chemotherapy is efficient in the curative resection group. These findings incite to promote prospective randomized studies with this kind of combined therapy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Postoperative pulmonary complications: general anesthesia with postoperative parenteral morphine compared with epidural analgesia.

In a prospective study, patients undergoing abdominal cancer surgery were randomly allocated to receive either general anesthesia with fentanyl intravenously and postoperative analgesia with parenteral morphine (GA group) or general anesthesia combined with epidural bupivacaine and epidural morphine for postoperative pain relief (EP group). Analgesia was tested on a visual pain scale. Pulmonary complications were evaluated by clinical complications, blood gas analysis, x-ray film changes, and pulmonary volumes (vital capacity, forced expiratory volume in 1 second). Measurements were performed on the day before the operation and on the first 5 postoperative days. In the EP group the pain relief was significantly better on the first day (p less than 0.03). Whatever the criteria used, the rates of pulmonary complications were similar in the two groups: clinical complications 21% versus 26%, radiologic complications 50% versus 64% for GA and EP groups, respectively. Postoperative PaO2 and spirometric values were similar in the two groups. Postoperative epidural analgesia may improve the patient's comfort but does not decrease the incidence of pulmonary complications.

Abdomen↗
PubMed1987

[Anastomotic fistula after gastrectomy. Diagnostic value of radiologic monitoring. Retrospective study of 123 gastrectomies].

In order to determine the usefulness of systematic radiological exploration after gastrectomy, 123 gastrectomies (39 total, 84 subtotal) performed over a 10-year period were reviewed. Control radiology had been carried out in 51% of the cases. Retrospectively, except for the lower percentage of total gastrectomies the two groups (with and without control radiology) were comparable. The overall incidence of fistula (9%) was similar to that found in the literature, bearing in mind that 90% of gastrectomies in this series were performed for cancer. The only two factors predictive of fistula were the presence of fever or of post-operative focal infection (P less than 0.001). It would appear that control radiology after gastrectomy is indicated only when post-operative fever is present. If this were done the number of useless examinations would be reduced and the cost-effectiveness ratio of radiology would be improved.

Female↗
PubMed1987

[Locoregional chemotherapy of hepatic metastases of colorectal cancer].

Locoregional, intra-arterial chemotherapy of liver metastases secondary to colo-rectal cancers is the least damaging among non-surgical treatments. In our experience of 58 cases treated during three years either with intermittent perfusions of 5 FU, or with continuous perfusion of FUDR (by pump), we observed 52% and 53% of objective responses with a survival rate at one year, of 73% and 90% respectively. However, this technique is limited because of locoregional complications and less effective, due to the development of extra-hepatic metastases. The proof of its effectiveness, in terms of survival, is currently being studied in the scope of a prospective and randomized trial with control group.

Adenocarcinoma↗
PubMed1987

[Conservative treatment in cancer of the breast].

Conservative treatment combining breast saving surgical procedures and radiotherapy, is considered as the best treatment for small breast cancers. The purpose of the study is to define the most appropriate surgical technique in order to reach both the complete resection of the primary and the best cosmetic result. Terms corresponding to the type of resection will be define in order to facilitate the comparison between the different studies on tumorectomies for breast cancer. Technical problems will be analyzed in the light of our experience of the conservative treatment especially in what concerns the cosmetic results.

Axilla↗