Background This study evaluated the association between oral gastrografin administration and the need for operative intervention in patients with presumed adhesive small bowel obstruction. Methods ...Between October 2006 and August 2009, 242 patients with uncomplicated acute adhesive small bowel obstruction were included in a randomized, controlled trial (the Adhesive Small Bowel Obstruction Study, NCT00389116 ) and allocated to a gastrografin arm or a saline solution arm. The primary end point was the need for operative intervention within 48 hours of randomization. The secondary end points were the resection rate, the time interval between the initial computed tomography and operative intervention, the time interval between oral refeeding and discharge, risk factors for the failure of nonoperative management, in-hospital mortality, duration of stay, and recurrence or death after discharge. We performed a systematic review of the literature in order to evaluate the relationship between use of gastrografin as a diagnostic/therapeutic measure, the need for operative intervention, and the duration of stay. Results In the gastrografin and saline solution arms, the rate of operative intervention was 24% and 20%, respectively, the bowel resection rate was 8% and 4%, the time interval between the initial computed tomography and operative intervention, and the time interval between oral refeeding and discharge were similar in the 2 arms. Only age was identified as a potential risk factor for the failure of nonoperative management. The in-hospital mortality was 2.5%, the duration of stay was 3.8 days for patients in the gastrografin arm and 3.5 days for those in the saline solution arm ( P = .19), and the recurrence rate of adhesive small bowel obstruction was 7%. These results and those of 10 published studies suggest that gastrografin did not decrease either the rate of operative intervention (21% in the saline solution arm vs 26% in the gastrografin arm) or the number of days from the initial computed tomography to discharge (3.5 vs 3.5; P = NS for both). Conclusion The results of the present study and those of our systematic review suggest that gastrografin administration is of no benefit in patients with adhesive small bowel obstruction.
Background Ischemia and necrosis are complications of small bowel obstruction (SBO) and require rapid surgical treatment. At present, there are no sufficiently accurate preoperative biomarkers of ...ischemia or necrosis. The objective of the current study was to evaluate the value of serum procalcitonin levels for predicting conservative management failure and the presence of intraoperatively observed bowel ischemia (reversible or not) in patients with SBO. Study Design One hundred and sixty-six participants of 242 in a randomized controlled trial focusing on the management of SBO (Acute Bowel Obstruction Diagnostic study ABOD, NCT00389116 ) had available data on procalcitonin and were included in the study. The primary study objective was to determine whether serum procalcitonin could identify patients in whom conservative management (CM) failed (the surgical management SM group) and the subset of SM patients with intraoperatively observed ischemia (reversible or not). For the analysis, the patients were divided into subgroups according to the success or failure of CM and (for surgically managed patients) the presence or absence of intraoperative ischemia (reversible or not). Results Procalcitonin levels were higher in the SM group (n = 35) than in the CM group (n = 131) (0.53 vs 0.14 ng/mL; p = 0.031) and higher in the group managed surgically with ischemia (n = 12) than patients managed surgically without intraoperative ischemia (n = 23) (1.16 vs 0.21 ng/mL, respectively; p < 0.001). A multiple logistic regression showed that procalcitonin is a risk factor for CM failure (odds ratio = 3.5; 95% CI, 1.4–8.5; p = 0.006) and for ischemia (reversible or not) (odds ratio = 46.9; 95% CI, 4.0–547.3; p < 0.001). Conclusions Procalcitonin can help predict CM failure and occurrence of bowel ischemia (reversible or not) in SBO patients, but additional studies are needed.
Aim
Neoadjuvant chemotherapy has proven valuable in locally advanced resectable colon cancer (CC) but its effect on oncological outcomes is uncertain. The aim of the present paper was to report ...3‐year oncological outcomes, representing the secondary endpoints of the PRODIGE 22 trial.
Method
PRODIGE 22 was a randomized multicentre phase II trial in high‐risk T3, T4 and/or N2 CC patients on CT scan. Patients were randomized between 6 months of adjuvant FOLFOX (upfront surgery) or perioperative FOLFOX (four cycles before surgery and eight cycles after; FOLFOX perioperative). In wild‐type RAS patients, a third arm testing perioperative FOLFOX‐cetuximab was added. The primary endpoint was the tumour regression grade. Secondary endpoints were 3‐year overall survival (OS), disease‐free survival (DFS), recurrence‐free survival (RFS) and time to recurrence (TTR).
Results
Overall, 120 patients were enrolled. At interim analysis, the FOLFOX‐cetuximab arm was stopped for futility. The remaining 104 patients represented our intention‐to‐treat population. In the perioperative group, 96% received the scheduled four neoadjuvant cycles and all but one had adjuvant FOLFOX for eight cycles. In the control arm, 38 (73%) patients received adjuvant FOLFOX. The median follow‐up was 54.3 months. Three‐year OS was 90.4% in both arms hazard ratio (HR) = 0.85, 3‐year DFS, RFS and TTR were, respectively, 76.8% and 69.2% (HR=0.94), 73% and 69.2% (HR = 0.86) and 82% and 72% (HR = 0.67) in the perioperative and control arms, respectively. Forest plots did not show any subgroup with significant difference for survival outcomes. No benefit from adding cetuximab was observed.
Conclusion
Perioperative FOLFOX has no detrimental effect on long‐term oncological outcomes and may be an option for some patients with locally advanced CC.
Background
Avoiding the use of nasogastric tubes (NGTs) is recommended after colorectal surgery but there is no consensus on intraoperative gastric decompression using NGTs during colorectal surgery. ...The objective was to assess the effect of avoiding insertion of NGTs during colorectal surgery for the recovery of gastrointestinal (GI) functions.
Method
1561 patients undergoing colorectal surgery, for whom information on NGT use was available, were included in this retrospective analysis and propensity score analysis of the prospective GRACE Audit database. Patients who did and did not have an NGT during surgery were compared.
Results
Among the study population of 1561 patients, 696 patients were matched to correct baseline differences between groups. The no-NGT group significantly improved GI motility impairment (e.g., less postoperative nausea OR = 0.59; CI 95%: 0.42–0.84 and a better tolerance of early feeding OR = 2.07; CI 95%: 1.33–3.22). Such an association was also highlighted for reduced postoperative morbidity OR = 0.60; CI 95%: 0.43–0.83, and especially pulmonary complications OR = 0.08; CI 95%: 0.01–0.59, or parietal complications OR = 0.29; CI 95%: 0.09–0.87. The risk of postoperative ileus was not significantly reduced in the no-NGT group OR = 0.67; CI 95%: 0.43–1.06.
Conclusion
No NGT insertion during colorectal surgery is safe and could improve postoperative GI function recovery.
Background
The purposes of this study were to describe the characteristics of a prospective multicenter series of patients with salivary duct carcinoma and to investigate prognostic factors.
Methods
...Patients included for salivary duct carcinoma between 2009 and 2016 in the Réseau d'Expertise Français des Cancers ORL Rares (REFCOR) database were selected. Immunohistochemical analyses were performed.
Results
Sixty‐one patients were included in this study. The primary site was the parotid gland in 90% of the cases. Fifty‐seven percent of the tumors were stage IV, 65% of patients had lymph node involvement, and 10% had metastases. Tumors showed androgen receptor (89%) and human epidermal growth factor receptor 2 (HER2)/neu (36%). Ninety‐four percent of patients underwent surgery and 86% had postoperative radiotherapy. Six patients were treated with targeted therapies. The 3‐year overall survival (OS) was 74% and the 3‐year disease‐free survival (DFS) was 44%. Tumor stages III to IV reduced DFS (hazard ratio HR 4.3; P = .04). The N2/3 class reduced distant metastasis‐free survival (HR 7.3; P = .007).
Conclusion
Salivary duct carcinoma prognosis is poor and is correlated with tumor stage and lymph node classification. Androgen receptor and HER2/neu should be tested as they offer the possibility of targeted therapies.
Background: No study on bioclinical criteria predicting a biliary origin for acute pancreatitis has included endosonography as a reference examination. Re-examination of bioclinical parameters ...deserves consideration in the era where other causes are known (e.g. hereditary, autoimmune). Aim and Methods: To determine the performance of bioclinical markers in predicting a biliary origin of acute pancreatitis where the diagnosis of biliary lithiasis was established or ruled out using endosonography. Only patients with a first acute episode of pancreatitis were included. Results: 213 patients (male: 55%; median age: 56 years) were prospectively included in 14 centres. Causes of acute pancreatitis were: biliary (62%), alcoholic (25%), other (13%). Delay between symptom-onset and admission was <48 h in 80%. Endosonography was the sole method establishing the diagnosis of biliary pancreatitis in 15% of patients. At univariate analysis, age, female sex, declared alcohol consumption, elevated aspartate and alanine transaminases on admission, gammaglutamyl transferase, alkaline phosphatase, total bilirubin, lipase, mean corpuscular volume were predictive of a biliary origin. Only age (p < 0.0001), sex (p < 0.0008) and alanine transaminase (p < 0.0004) remained significant at multivariate analysis. At age 50, the respective sensitivity and specificity were 73 and 65%. With an elevated alanine transaminase at 2 times the upper limit of normal range, the respective sensitivity and specificity were 74 and 84%. The probability of a biliary origin of acute pancreatitis could be estimated by the following formula: = 1/1 + exp(4.6967 − 0.0656 × age + 1.1208 × sex − 0.6909 × alanine transaminase). Conclusion: When endosonography is performed to confirm or exclude a biliary origin of acute pancreatitis, age, sex and alanine transaminase at admission are the only factors predictive of a biliary cause.
