Background
The benefit of repetitive PIPAC specifically in CPM patients has yet to be demonstrated in terms of oncological and functional outcomes.
Objective
The aim of this study was to evaluate the ...outcome of patients with non-resectable colorectal peritoneal metastases (CPM) treated with pressurized intraperitoneal aerosol chemotherapy (PIPAC).
Methods
We conducted an analysis of a prospective single-center database of all CPM patients who underwent PIPAC with oxaliplatin 92 mg/m
2
body surface (PIPAC-Ox). The outcome criteria were adverse events (Common Terminology Criteria for Adverse Events version 4.0), Peritoneal Regression Grading Score (PRGS), and survival.
Results
Overall, 102 patients with a median age of 64 years (33–88) were scheduled for PIPAC-Ox. Access to the abdominal cavity for the first application failed in 22/102 (21.6%) patients. A total of 185 PIPACs were performed, with 26/102 (25.5%), 20/102 (19.6%), 17/102 (16.7%), and 17/102 (16.7%) patients undergoing one, two, three, and four or more PIPACs, respectively. Perioperative overall morbidity/mortality Grade I–V occurred in 14 (7.6%), 29 (15.8%), 6 (3.2%), 1 (0.5%), and 1 (0.5%) patient without significant differences between each cycle. Of 27 patients who underwent three or more PIPACs, 20/102 (19.6%) had major/complete CPM regression (PRGS 1–2). In a multivariate analysis, independent predictive factors for > 12 months’ survival following the first PIPAC-Ox administration were three or more PIPACs (odds ratio OR 4.5, 95% confidence interval CI 1.35–15.2;
p
= 0.014) and younger patient age (OR 1.058, 95% CI 1.00–1.12;
p
= 0.039).
Conclusions
Repetitive PIPAC-Ox for CPM patients, alone or combined with perioperative systemic chemotherapy, is feasible. Our data suggest that three or more consecutive PIPAC-Ox cycles for advanced CPM can improve survival.
Intraoperative hemodynamic instability is a major challenge during adrenalectomy for pheochromocytoma. Typically, pheochromocytoma is performed laparoscopically either through the retroperitoneal or ...transperitoneal approach. We aimed to determine if the operative approach affects intraoperative hemodynamic instability during surgery for pheochromocytoma in a large multicenter multicenter cohort.
Retrospective, multicenter analysis of consecutive patients with pheochromocytoma who underwent total unilateral laparoscopic adrenalectomy without conversion were included. Statistical analysis was performed using established intraoperative criteria for intraoperative hemodynamic instability: 1) systolic blood pressure >160 mm Hg; 2) systolic blood pressure > 200 mm Hg; 3) mean arterial pressure <60 mm Hg; 4) systolic blood pressure >160 mm Hg + mean arterial pressure <60 mm Hg; and 5) systolic blood pressure >200 mm Hg + mean arterial pressure <60 mm Hg; and 6) intravenous vasopressor + vasodilator.
In total, 341 patients met the inclusion criteria, 101 (29.6%) underwent retroperitoneal adrenalectomy and 240 (70.4%) transperitoneal adrenalectomy. Multivariate analysis showed that retroperitoneal adrenalectomy carries greater risk for mean arterial pressure <60 mm Hg (odds ratio 6.255, confidence interval 1.134–34.235, P = .035) compared with transperitoneal adrenalectomy. Overall and cardiovascular morbidity rates were comparable between the 2 approaches. The medical center was a significant independent influencing factor for all 6 intraoperative hemodynamic instability definitions.
Variability in institutional management of pheochromocytoma intraoperatively has significant impact on all 6 intraoperative hemodynamic instability definitions. Standardization of anesthesia should be considered to reduce this variability.
•SOS is a likely side effect of colorectal liver metastases chemotherapy.•Clinical diagnosis is not enabled by actual knowledges.•This study aimed at establishing preoperative features of SOS on ...CT-scan.•Peripheral hepatic heterogeneity, clover-like sign, increase in spleen size were independent predictors.
Sinusoidal obstruction syndrome (SOS) is a likely side effect of colorectal liver metastases (CRLM) chemotherapy. This study aimed to assess computed tomography scan (CT-scan) performance for SOS diagnosis for patients receiving neoadjuvant chemotherapy (NC) prior to CRLM surgery, comparing obtained results with pathological gold standard.
Preoperative CT-scans of 67 patients who had received a NC prior to liver resection for CRLM from 2011 to 2016 were retrospectively analysed. Positive diagnosis and severity of SOS were established after consensual review of the slides by three pathologists. Preoperative CT-scans were separately interpreted by two radiologists and evocative signs of SOS were sought, defined according to a literature review and operators experience. In order to identify SOS predictors, univariate analysis and multivariate logistic regression were used to study CT-scan signs and pathological results correlation.
Twenty-nine patient (43%) had an SOS, 22 (33%) were low-grade and 7 (10%) were high-grade. All patient had received a median of 6 cures (3–27) containing Oxaliplatin for 53 (79%) of them. In univariate analysis, hepatic heterogeneity (p<0.001), puddle-like or micronodular appearance (p<0.001), peripheral distribution of heterogeneity (p=0.085), clover-like sign (p=0.02), splenomegaly (p=0.0026), spleen volume increase ≥30% (p=0.04) or splenic length increase ≥15% (p=0.04), as well as the subjective impression of the observer (P<0.001) were significantly associated with SOS diagnosis. In multivariate analysis, clover-like sign (OR 1.87, 95% CI 1.18–2.95, p=0.0081), increase in spleen volume ≥30% (OR 1.29, 95% CI 1.01–1.64, p=0.04), and the peripheral distribution of heterogeneity (OR 1.53, 95% CI 1.21–1.94, p<0.001) were independent SOS predictors. The area under the ROC curve was 0.804. The inter-observer agreement for SOS diagnosis was moderate (Kappa=0.546).
CT-scan can detect suggestive signs of SOS in patients receiving chemotherapy for CRLM. By integrating clinical and biological information into CT-scan data, it may be fruitful to create a positive diagnostic and severity score for chemotherapy-induced SOS.
Background. Adhesive small bowel obstruction (SBO) represents a heavy burden in healthcare systems worldwide and is associated with significant morbidity and mortality. Although conservative ...treatment alone can lead to SBO resolution in most cases, its optimal duration is still a matter of debate. The aim of this study was to analyze different SBO evolution patterns in order to further determine when to switch to surgical treatment. Study Design. All patients who were admitted for adhesive SBO between 2011 and 2016 were reviewed. Patients who had immediate surgery (IS), a successful medical treatment (SMT), and a failed medical treatment (FMT) were compared in terms of overall morbidity, mortality, and SBO recurrence. Results. Overall 154 patients were identified, including 23 (14.9%) in IS, 27 (17.5%) in FMT, and 104 (67.6%) in SMT groups. In terms of comorbidities, patients were similar in all groups. Overall morbidity rates were highest in IS and FMT groups (30% and 33%, respectively, vs. 4% in the SMT group, p<0.001) whereas mortality rate was highest in the FMT group (22% vs. 0% and 0% in IS and SMT groups, respectively, p<0.001). SBO recurrence rate was highest in the SMT group (22% vs. 4% and 7% in IS and FMT groups, respectively, p=0.042). Conclusion. FMT seems to be associated with similar overall morbidity compared with IS but with increased postoperative mortality. Patient frailty seems to be worsened by prolonged inefficient medical treatment.
During the six years of experiments, the DEPHY EXPE Mediterranean belt network has designed,experimented, and assessed two innovative prototypes of grapevine farming systems with low pesticideinputs. ...The first one IPM-50%, based on integrated protection management, and the second oneInnoBio, using biocontrol solutions, have been tested in seven experimental stations of AgriculturalChambers and INRA/SupAgro Montpellier. Innovative decision rules were designed for the control ofpowdery mildew and downy mildew (main grapevine diseases leading to the part of 75% of theTreatment Frequency Index). The results indicate that the TFI (calculated without biocontrol applications) decrease of 37% is possible with IPM-50% strategy, and a decrease of 60% with InnoBiostrategy. The performances of the systems have been also assessed on agronomic and socio-economiccriteria. The IPM-50% strategy has each year a high score of overall sustainability. For the InnoBiostrategy, the TFI decrease is matching with the performances expected by the French Ecophyto plan.But, the production and the profitability objectives are not achieved every years. The InnoBio farmingsystem needs re-adjustments to validate promising results using biocontrol levers in grapevine farmingsystems.
Les six années d’essais du réseau DEPHY EXPE Arc méditerranéen ont permis de concevoir,expérimenter et évaluer deux prototypes innovants de systèmes viticoles à bas intrants phytosanitaires.Le premier IPM-50%, basé sur la protection intégrée et le second InnoBio, mettant en avant lebiocontrôle, ont été testés sur sept sites appartenant aux groupes des Chambres d’Agriculture et del’INRA/SupAgro de Montpellier. Des règles de décision innovantes ont été construites pour le contrôledu mildiou et de l’oïdium (bioagresseurs principaux de la vigne responsables de 75% des IFT). Lesrésultats montrent qu’il est possible de réduire de 37% l’IFT hors biocontrôle pour la stratégie IPM-50%et de 60% avec InnoBio. Les performances des systèmes ont également été évaluées sur d’autrescritères agronomiques et socio-économiques. La majorité des systèmes IPM-50% montrent unedurabilité satisfaisante tous les ans. Pour la stratégie InnoBio, bien que la baisse d’IFT corresponde auxattentes du plan Ecophyto, les objectifs de production et de rentabilité ne sont pas atteints chaqueannée, et nécessitent des réajustements pour valider des résultats prometteurs utilisant les leviers debiocontrôle.
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