Targetable kinase fusions are extremely rare (<1%) in colorectal cancers (CRCs), making their diagnosis challenging and often underinvestigated. They have been shown particularly frequently among ...MSI-High, BRAF/KRAS/NRAS wild-type CRCs with MLH1 loss (MLH1loss MSI-High wild-type).
We searched for NTRK1, NTRK2, NTRK3, ALK, ROS1, BRAF, RET, and NRG1 kinase fusions in CRCs using methods easy-to-implement in pathology laboratories: immunohistochemistry (IHC), fluorescent in situ hybridization (FISH), and fully automated real-time PCR targeted analyses. RNA-sequencing analyses were used for confirmation.
Among 84 selected MLH1 deficient (IHC) CRCs cases, MLH1loss MSI-High wild-type CRCs consisted first in 19 cases after Idylla™ analyses and finally in 18 cases (21%) after RNA-sequencing (detection of one additional KRASG12D mutation). FISH (and when relevant, IHC) analyses concluded in 5 NTRK1, 3 NTRK3, 1 ALK, 2 BRAF, and 2 RET FISH positive tumors. ALK and NTRK1 rearranged tumors were IHC positive, but pan-TRK IHC was negative in the 3 NTRK3 FISH positive tumors. RNA-sequencing analyses confirmed 12 of 13 fusions with only one false positive RET FISH result. Finally, 12/18 (67%) of MLH1loss MSI-High wild-type CRCs contained targetable kinase fusions.
Our study demonstrates the feasibility, but also the cost-effectiveness, of a multistep but rapid diagnostic strategy based on nonsequencing methods to identify rare and targetable kinase fusions in patients with advanced CRCs, as well as the high prevalence of these kinase fusions in MLH1loss MSI-High wild-type CRCs. Nevertheless, confirmatory RNA-sequencing analyses are necessary in case of low FISH positive nuclei percentage to rule out FISH false-positive results.
•Gene fusions are very rare (<1%) in colorectal cancers (CRCs) but more frequent in MSI-High RAS-BRAF wild-type CRCs.•Among 84 CRCs with MLH1 loss, including 18 RAS-BRAF wild-type cases, we diagnosed 12 (66.7%) gene fusions.•Tumors with MLH1 loss, microsatellite instability and no RAS-BRAF mutation must be tested for targetable gene fusions.•NTRK1, NTRK3, ALK, RET, and BRAF gene fusions diagnosis is attainable in CRCs using fluorescent in situ hybridization (FISH).•Low percentage FISH results must be confirmed using RNA-sequencing analyses.
Background
Only a few series have demonstrated the safety of laparoscopic resection for hepatocellular carcinoma (HCC) and the benefits of this approach. Moreover, these studies reported mostly minor ...and nonanatomic hepatic resections. This report describes the results of a pair-matched comparative study between open and laparoscopic liver resections for HCC in a series of essentially anatomic resections.
Methods
Patients were retrospectively matched in pairs for the following criteria: sex, age, American Society of Anesthesiology (ASA) score, severity of liver disease, tumor size, and type of resection. A total of 42 patients undergoing laparoscopy were compared with patients undergoing laparotomy during the same period. Surgeons from the authors’ department not trained in laparoscopy performed open resections. Operative, postoperative, and oncologic outcomes were compared.
Results
The mean duration of surgery was similar in the two groups. Significantly less bleeding was observed in the laparoscopic group (364.3 vs. 723.7 ml;
p
< 0.0001). Transfusion was required for four patients (9.5%) in the laparoscopic group and seven patients (16.7%) in the open surgery group (
p
= 0.51). Postoperative ascites was less frequent after laparoscopic resections (7.1 vs. 26.1%;
p
= 0.03). General morbidity was similar in the two groups (9.5 vs. 11.9%;
p
= 1.00). The mean hospital stay was significantly shorter for the patients undergoing laparoscopy (6.7 vs. 9.6 days;
p
< 0.0001). The surgical margin and local recurrence adjacent to the liver stump were not affected by laparoscopy. The overall postoperative survival rates in the laparoscopic group were 93.1% at 1 year, 74.4% at 3 years, and 59.5% at 5 years and, respectively, 81.8, 73, and 47.4% in the open surgery group (
p
= 0.25). The postoperative disease-free survival rates in the laparoscopic group were at 81.6% at 1 year, 60.9% at 3 years, and 45.6% at 5 years, respectively, 70.2, 54.3, and 37.2% in the open surgery group (
p
= 0.29).
Conclusions
Laparoscopic resection of HCC for selected patients gave a better postoperative outcome without oncologic consequences. Prospective trials are required to confirm these results.
Sigmoidal diverticulitis is the inflammation or infection of a diverticulum. It may be simple or complicate into an abscess, perforation, stenosis or fistula. These complications are referred to as ...diverticular disease. Surgical treatment may be required as an emergency measure in the event of serious signs, or at a later stage if disabling symptoms persist. The aim of this study was to assess the 90-day post-operative morbidity and mortality of complicated sigmoidal diverticulitis managed in emergency.
We retrospectively included all patients (n = 62) with complicated sigmoidal diverticulitis who underwent surgery between 2010 and 2019. 90-day mortality was assessed for each patient. Overall morbidity was assessed using the Dindo-Clavien classification, with major morbidity corresponding to stages ≥III. Factors predictive of overall and major morbidity were analyzed.
Postoperative mortality at 90 days was nil. Overall morbidity at 90 days according to the Dindo-Clavien classification was 80,7 %, with major morbidity at 27,4 %. Multivariate logistic regression analysis retained male gender (OR=6.771,40; 32.74, p = 0.02), BMI over 25 (OR=58.823.95; 876.95, p = 0.01) and smoking (OR=8.770.84; 91.13, p = 0.07) as independent predictors of the occurrence of overall morbidity at 90 days. Likewise, only an ASA score ≥ III was highlighted as an independent predictive factor (OR=5.001.51; 16.51, p = 0.01) of major morbidity at 90 days (Dindo-Clavien ≥ III).
In our study, mortality was nil, the overall morbidity rate was 80.7 % and 27.4 % for major morbidity. Nevertheless, the choice of surgical technique remains open to debate, given the absence of any difference in morbidity and mortality from anastomotic resection during emergency surgery, and the less morbid and easier restoration of digestive continuity afterwards in selected patients.
Aim
The aim of this work was to investigate the association between early postoperative anastomotic leakage or pelvic abscess (AL/PA) and symptomatic anastomotic stenosis (SAS) in patients after ...surgery for left colonic diverticulitis.
Method
This is a retrospective study based on a national cohort of diverticulitis surgery patients carried out by the Association Française de Chirurgie. The assessment was performed using path analyses. The database included 7053 patients operated on for colonic diverticulitis, with surgery performed electively or in an emergency, by open access or laparoscopically. Patients were excluded from the study analysis where there was (i) right‐sided diverticulitis (the initial database included all consecutive patients operated on for colonic diverticulitis), (ii) no anastomosis was performed during the first procedure or (iii) missing information about stenosis, postoperative abscess or anastomotic leakage.
Results
Of the 4441 patients who were included in the final analysis, AL/PA occurred in 327 (4.6%) and SAS occurred in 82 (1.8%). AL/PA was a significant independent factor associated with a risk for occurrence of SAS (OR = 3.41, 95% CI = 1.75–6.66), as was the case for diverting stoma for ≥100 days (OR = 2.77, 95% CI = 1.32–5.82), while central vessel ligation proximal to the inferior mesenteric artery was associated with a reduced risk (OR = 0.41; 95% CI = 0.19–0.88). Diverting stoma created for <100 days or ≥100 days was also a factor associated with a risk for AL/PA (OR = 3.08, 95% CI = 2–4.75 and OR = 12.95, 95% CI = 9.11–18.50). Interestingly, no significant association between radiological drainage or surgical management of AL/PA and SAS could be highlighted.
Conclusion
AL/PA was an independent factor associated with the risk for SAS. The treatment of AL/PA was not associated with the occurrence of anastomotic stenosis. Diverting stoma was associated with an increased risk of both AL/PA and SAS, especially if it was left for ≥100 days. Physicians must be aware of this information in order to decide on the best course of action when creating a stoma during elective or emergency surgery.
•Avoiding splenic flexure mobilization during left colectomy for sigmoid diverticulitis does not increase significantly severe postoperative complications at day 90.•The prevalence of anastomotic ...leakage, hemorrhage, and the need to return to the operating theatre was similar between the patients with and without splenic flexure mobilization.•This is the first study using propensity score matching that included almost 1000 patients who were operated on for sigmoid diverticulitis.
We report the first description of portal and mesenteric vein thrombosis associated with suppurative mesenteric adenitis in a 71-year-old woman. The bacterium detected in mesenteric lymph nodes was ...Fusobacterium nucleatum, an anaerobic Gram-negative bacillus. Our patient had a clinical syndrome of pharyngitis and fever preceding portal vein thrombosis. Abdominal symptoms improved with antibiotics and anticoagulant therapy. This location of F. nucleatum in mesenteric lymph nodes provides an interesting insight into the occurrence of septic thrombosis in the portal vein following pharyngo-tonsillar infection.
Isolated duodenal injury in blunt abdominal trauma is unusual. Diagnosis requires a complete exploration of the abdominal cavity. The authors present a rare case of disruption and necrosis of the ...second duodenum with periampullary duodenal detachment.
Because of their rarity, chemical burns of rectum and colon have been poorly studied. This clinical report studies the epidemiologic, diagnostic, and therapeutic features of rectal and colonic burns ...after enema with caustics.
This is a retrospective clinical report of a personal series of 21 patients admitted in our hospital from January 1990 to January 2000 for an acute chemical colitis after enema.
Inpatient prevalence: 0.04%. Mean age: 29.7 ± 12 years (range 17 to 19). Sex ratio: 16 female and 5 male. Circumstances: suicide (n = 14), abortion (n = 3), murder (n = 3), mistake (n = 1). Responsible caustic: sulphuric acid (n = 12), chlorhydric acid (n = 5), potash (n = 2), unknown acid (n = 1), plant decoction (n = 1). Injected quantity: 50 to 250 mL. Ten patients suffered light damage and had an early favorable course under medical treatment, 8 of them had a secondary rectal-sigmoid stenosis. Eleven patients presented with severe necrotic damage, of difficult and often delayed diagnosis based on an enduring symptomatology without clear peritoneal syndrome. Upon surgery, necrotic damage spread on rectum and sigmoid colon (n = 2), up to the transverse colon (n = 4), to the right colonic angle (n = 3), to the right colon (n = 2); once a 10 cm long necrosis of the ileum was associated (n = 1); only 1 patient had a colonic perforation. Performed surgery: 11 resections of necrotic colon and proximal colostomy (Hartman operation). Mortality: 6 patients. Morbidity: 3 of 5 patients.
Chemical burns of rectum and colon produced by strong acid or basic products are necrotizing lesions whose gravity is often hidden by the absence of peritoneal inflammation signs, thus mortality is high. Only early surgery is likely to improve the poor prognosis of severe chemical damage of the rectum and colon.
Primary hepatic leiomyoma is a very rare tumor secondary to benign smooth muscle proliferation. The primary location in the liver is usually found in adult women. A 36-year-old woman with right upper ...quadrant abdominal pain had primary hepatic leiomyoma. The presenting features of primary leiomyoma and the diagnostic approach for these lesions are discussed, in particular the role of immunohistochemistry.
Le léiomyome hépatique primitif est une tumeur exceptionnelle liée à une prolifération musculaire lisse bénigne. La localisation hépatique primitive est plus fréquemment observée chez la femme à ...l’âge adulte. Nous rapportons l’observation d’une femme âgée de 36 ans se plaignant de douleurs de l’hypocondre droit dues à une tumeur hépatique. Elle était opérée et le diagnostic était un léiomyome primitif. La présentation clinique et la démarche diagnostique sont discutées, tout particulièrement le rôle de l’étude immunohistochimique.
Primary hepatic leiomyoma is a very rare tumor secondary to benign smooth muscle proliferation. The primary location in the liver is usually found in adult women. A 36-year-old woman with right upper quadrant abdominal pain had primary hepatic leiomyoma. The presenting features of primary leiomyoma and the diagnostic approach for these lesions are discussed, in particular the role of immunohistochemistry.
