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Article ; Online: Safety and Feasibility of High-Pressure/High-Dose Pressurized Intraperitoneal Aerosol Chemotherapy (HP/HD-PIPAC) for Primary and Metastatic Peritoneal Surface Malignancies.

Ramos Arias, Gabriel / Sindayigaya, Rémy / Ouaissi, Mehdi / Buggisch, Jonathan R / Schmeding, Maximilian / Giger-Pabst, Urs / Zieren, Jürgen

Annals of surgical oncology

2022 Volume 30, Issue 4, Page(s) 2497–2505

Abstract: Objective: The aim of this study was to evaluate the feasibility and perioperative safety of high-pressure/high-dose pressurized intraperitoneal aerosol chemotherapy (HP/HD-PIPAC) to manage peritoneal surface malignancies (PSM).: Methods: ... ...

Abstract	Objective: The aim of this study was to evaluate the feasibility and perioperative safety of high-pressure/high-dose pressurized intraperitoneal aerosol chemotherapy (HP/HD-PIPAC) to manage peritoneal surface malignancies (PSM). Methods: Retrospective analysis of a prospective database of about 130 consecutive patients scheduled for HP/HD-PIPACs for PSM. Doxorubicin plus cisplatin (PIPAC-C/D) or oxaliplatin (PIPAC-Ox) were nebulized into a constant capnoperitoneum of 20 mmHg at doses of 6, 30, or 120 mg/m Results: The median age of patients was 62 years (range 9-82), and the primary tumor site was of colorectal (CRC), upper gastrointestinal tract (UGI), unknown primary (CUP), malignant epithelioid mesothelioma of the peritoneum (MPM), hepato-pancreatic-biliary tract (HPB), and other origin in 30 (23.1%), 27 (20.8%), 16 (12.3%), 16 (12.3%), 6 (4.6%), and 35 (26.9%) patients, respectively. Abdominal access failed for a first, second, third, and fourth or more HP/HD-PIPAC in 12/130 (9.2%), 4/64 (6.3%), 6/40 (15.0%), and 2/33 (6.1%) patients. A total of 243 procedures were performed in 118 patients. No intraoperative complications related to increased capnoperitoneal pressure occurred, but an intraoperative bleeding complication was observed in 1/243 (0.4%) patients. The overall rate of postoperative procedure-related complications was 19.3% (47/243), while 15.3% (37/243), 1.6% (6/243), 1.6% (1/243), 0.4% (1/243), and 0.4% (1/243) were Grade I, II, III, IV, and V complications, respectively. Conclusions: Perioperative complications of HP/HD-PIPAC are comparable with standard pressure/dose PIPAC treatment protocols. Prospective studies are warranted to examine potential improvement in therapy outcomes.
MeSH term(s)	Humans ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Peritoneal Neoplasms/drug therapy ; Peritoneal Neoplasms/secondary ; Retrospective Studies ; Feasibility Studies ; Respiratory Aerosols and Droplets ; Mesothelioma, Malignant
Language	English
Publishing date	2022-11-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-12698-4
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Article ; Online: Outcomes and Side Effects of Preoperative Chemoradiotherapy for Locally Advanced Upper Rectal Cancer.

Chomicki, Sandra / Chapet, Sophie / Drifa, Moussata / Ouaissi, Mehdi / Bourlier, Pascal / Debbi, Kamel / Loganadane, Gokoulakrichenane / Calais, Gilles

Anticancer research

2022 Volume 42, Issue 10, Page(s) 4833–4840

Abstract: Background/aim: The benefit of neoadjuvant (chemo) radiotherapy for locally advanced upper rectal tumors remains controversial. Thus, we aimed to evaluate the outcome of patients with stage II or-III upper rectal cancer undergoing neoadjuvant (chemo) ... ...

Abstract	Background/aim: The benefit of neoadjuvant (chemo) radiotherapy for locally advanced upper rectal tumors remains controversial. Thus, we aimed to evaluate the outcome of patients with stage II or-III upper rectal cancer undergoing neoadjuvant (chemo) radiotherapy followed by total mesorectal excision in our institution. Patients and methods: From April 2004 to October 2019, all patients with stage II or III upper rectal cancer treated with neoadjuvant (chemo) radiotherapy followed by total mesorectal excision were identified from our database. Overall survival, progression-free survival, and local recurrence were assessed using the Kaplan-Meier method. Acute and late treatment-related toxicities were recorded according to the CTCAE-5 version. Results: The study group consisted of 106 patients. Respectively, 36% and 61% of patients had stage II and stage III upper rectal cancer. The median follow-up period was 4.4 ± 3.4 years. Five-year overall survival and progression-free survival were respectively 78% [95% confidence interval (CI)=69.2-88] and 76.8% (95%CI=68.4-86.2). The rate of local recurrence at 5 years was 3.78% (95%CI=0-7.98). Forty-two percent of patients presented early toxicities and 27.4% of patients experienced early surgical complications. Late toxicities and surgical complications occurred in 24.5% and 9.4% of patients, respectively. Conclusion: Neoadjuvant (chemo) radiotherapy followed by total mesorectal excision of stage II-III upper rectal cancer is effective and safe.
MeSH term(s)	Chemoradiotherapy/adverse effects ; Chemoradiotherapy/methods ; Disease-Free Survival ; Humans ; Neoadjuvant Therapy/adverse effects ; Neoplasm Recurrence, Local/pathology ; Neoplasm Staging ; Rectal Neoplasms/drug therapy ; Rectal Neoplasms/surgery ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-10-03
Publishing country	Greece
Document type	Journal Article
ZDB-ID	604549-2
ISSN	1791-7530 ; 0250-7005
ISSN (online)	1791-7530
ISSN	0250-7005
DOI	10.21873/anticanres.15988
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Article ; Online: What Is the Optimal Elective Colectomy for Splenic Flexure Cancer: End of the Debate? A Multicenter Study From the GRECCAR Group With a Propensity Score Analysis.

Manceau, Gilles / Alves, Arnaud / Meillat, Hélène / Benhaïm, Léonor / Ouaïssi, Mehdi / Panis, Yves H / Tuech, Jean-Jacques / Dousset, Bertrand / Brigand, Cécile / Cotte, Eddy / Lakkis, Zaher / Badic, Bogdan / Marchal, Frédéric / Sabbagh, Charles / Diouf, Momar / Karoui, Mehdi

Diseases of the colon and rectum

2022 Volume 65, Issue 1, Page(s) 55–65

Abstract: Background: The optimal elective colectomy in patients with splenic flexure tumor is debated.: Objective: This study aimed to compare splenic flexure colectomy, left hemicolectomy, and subtotal colectomy for perioperative, histological, and survival ... ...

Abstract	Background: The optimal elective colectomy in patients with splenic flexure tumor is debated. Objective: This study aimed to compare splenic flexure colectomy, left hemicolectomy, and subtotal colectomy for perioperative, histological, and survival outcomes in this setting. Design: This is a multicenter retrospective cohort study. Setting: Patients diagnosed with nonmetastatic splenic flexure tumor who underwent elective colectomy were included. Patients: Between 2006 and 2014, 313 consecutive patients were operated on in 15 French Research Group of Rectal Cancer Surgery centers. Interventions: Propensity score weighting was performed to compare short- and long-term outcomes. Main outcome measures: The primary end point was disease-free survival. Secondary end points included overall survival, quality of surgical resection, overall postoperative morbidity, surgical postoperative morbidity, and rate of anastomotic leakage. Results: The most performed surgery was splenic flexure colectomy (59%), followed by subtotal colectomy (23%) and left hemicolectomy (18%). Subtotal colectomy was more often performed by laparotomy compared with splenic flexure colectomy and left hemicolectomy (93% vs 61% vs 56%, p < 0.0001), and was associated with a longer operative time (260 minutes (120-460) vs 180 minutes (68-440) vs 217 minutes (149-480), p < 0.0001). Postoperative morbidity was similar between the 3 groups, but the median length of hospital stay was significantly longer after subtotal colectomy (13 days (5-56) vs 10 (4-175) vs 9 (4-55), p = 0.0007). The median number of harvested lymph nodes was significantly higher after subtotal colectomy compared with splenic flexure colectomy and left hemicolectomy (24 (8-90) vs 15 (1-81) vs 16 (3-52), p < 0.0001). The rate of stage III disease and the number of patients treated by adjuvant chemotherapy were similar between the 3 groups. There was no difference in terms of disease-free survival and overall survival between the 3 procedures. Limitations: The study was limited by its retrospective design. Conclusions: In the elective setting, splenic flexure colectomy is safe and oncologically adequate for patients with nonmetastatic splenic flexure tumor. However, given the oncological clearance after splenic flexure colectomy, it seems that the debate is not completely closed. See Video Abstract at http://links.lww.com/DCR/B703. Cul es la colectoma electiva ptima para el cncer de ngulo esplnico fin del debate un estudio multicntrico del grupo greccar con un anlisis de puntaje de propensin: ANTECEDENTES:La colectomía electiva óptima en pacientes con tumores del ángulo esplénico continua en debate.OBJETIVO:Comparar la colectomía de ángulo esplénico, hemicolectomía izquierda y colectomía subtotal para los resultados perioperatorios, histológicos y de supervivencia en este escenario.DISEÑO:Estudio de cohorte retrospectivo multicéntrico.ESCENARIO:Se incluyeron pacientes diagnosticados de tumores del ángulo esplénico no metastásicos que se sometieron a colectomía electiva.PACIENTES:Entre 2006 y 2014, 313 pacientes consecutivos fueron intervenidos en 15 centros GRECCAR.INTERVENCIONES:Se realizó una ponderación del puntaje de propensión para comparar los resultados a corto y largo plazo.PRINCIPALES MEDIDAS DE RESULTADO:El criterio de valoración principal fue la supervivencia libre de enfermedad. Los criterios de valoración secundarios incluyeron la supervivencia general, la calidad de la resección quirúrgica, la morbilidad posoperatoria general, la morbilidad posoperatoria quirúrgica y la tasa de fuga anastomótica.RESULTADOS:La cirugía más realizada fue la colectomía del ángulo esplénico (59%), seguida de la colectomía subtotal (23%) y la hemicolectomía izquierda (18%). La colectomía subtotal se realizó con mayor frecuencia mediante laparotomía en comparación con la colectomía de ángulo esplénico y la hemicolectomía izquierda (93% frente a 61% frente a 56%, p <0.0001), y se asoció con un tiempo quirúrgico más prolongado (260 min [120-460] frente a 180 min [68-440] frente a 217 min [149-480], p <0.0001). La morbilidad posoperatoria fue similar entre los tres grupos, pero la duración media de la estancia hospitalaria fue significativamente más prolongada después de la colectomía subtotal (13 días [5-56] frente a 10 [4-175] frente a 9 [4-55], p = 0.0007). La mediana del número de ganglios linfáticos extraídos fue significativamente mayor después de la colectomía subtotal en comparación con la colectomía del ángulo esplénico y la hemicolectomía izquierda (24 [8-90] frente a 15 [1-81] frente a 16 [3-52], p <0.0001). La tasa de enfermedad en estadio III y el número de pacientes tratados con quimioterapia adyuvante fueron similares entre los 3 grupos. No hubo diferencias en términos de supervivencia libre de enfermedad y supervivencia general entre los 3 procedimientos.LIMITACIONES:El estudio estuvo limitado por su diseño retrospectivo.CONCLUSIONES:En un escenario electivo, la colectomía del ángulo esplénico es segura y oncológicamente adecuada para pacientes con tumores del ángulo esplénico no metastásicos. Sin embargo, dado el aclaramiento oncológico tras la colectomía del ángulo esplénico, parece que el debate no está completamente cerrado. Consulte Video Resumen en http://links.lww.com/DCR/B703.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Anastomotic Leak/epidemiology ; Case-Control Studies ; Chemotherapy, Adjuvant/methods ; Chemotherapy, Adjuvant/statistics & numerical data ; Colectomy/statistics & numerical data ; Colectomy/trends ; Colon, Transverse/pathology ; Colonic Neoplasms/diagnosis ; Colonic Neoplasms/mortality ; Colonic Neoplasms/surgery ; Disease-Free Survival ; Elective Surgical Procedures/methods ; Female ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Morbidity/trends ; Operative Time ; Outcome Assessment, Health Care ; Perioperative Period/mortality ; Postoperative Complications/mortality ; Postoperative Complications/pathology ; Propensity Score ; Retrospective Studies ; Survival Analysis
Language	English
Publishing date	2022-09-12
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Webcast
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000001937
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Article ; Online: Emergency reversal of gastric bypass for missed diagnosis of internal hernia and bowel ischemia in a pregnant woman.

Guilbaud, Théophile / Bouayed, Amine / Ouaissi, Mehdi

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

2016 Volume 12, Issue 8, Page(s) e68–e71

MeSH term(s)	Abdominal Pain/etiology ; Adult ; Delayed Diagnosis ; Emergency Treatment ; Female ; Gastric Bypass/adverse effects ; Hernia, Abdominal/diagnosis ; Hernia, Abdominal/surgery ; Humans ; Intestinal Obstruction/diagnosis ; Intestinal Obstruction/surgery ; Intestine, Small/blood supply ; Intestine, Small/surgery ; Ischemia/diagnosis ; Ischemia/surgery ; Obesity, Morbid/surgery ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Pregnancy ; Pregnancy Complications/etiology ; Pregnancy Complications/surgery ; Recurrence ; Reoperation ; Therapeutics
Language	English
Publishing date	2016-09
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2274243-8
ISSN	1878-7533 ; 1550-7289
ISSN (online)	1878-7533
ISSN	1550-7289
DOI	10.1016/j.soard.2016.08.022
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Article ; Online: Available prediction scores of conversion for laparoscopic rectal cancer surgery seem to be unsuitable for nowadays rectal cancer management.

Sekkat, Hamza / Souadka, Amine / Courtot, Lise / Rafik, Ali / Amrani, Laila / Benkabbou, Amine / Peyrafort, Pierre / Giger-Pabst, Urs / Karam, Elias / Mohsine, Raouf / Majbar, Anass M / Ouaissi, Mehdi

BMC surgery

2022 Volume 22, Issue 1, Page(s) 162

Abstract: Introduction: This study aimed to externally evaluate the accuracy of four predictive scores for conversion to open surgery after rectal laparoscopic resection. None of the four scores achieved external validation previously.: Methods: This was a ... ...

Abstract	Introduction: This study aimed to externally evaluate the accuracy of four predictive scores for conversion to open surgery after rectal laparoscopic resection. None of the four scores achieved external validation previously. Methods: This was a retrospective analysis of two prospectively maintained databases from two academic centers in France and Morocco. All consecutive patients who underwent laparoscopic resection for rectal adenocarcinoma between 2005 and 2020 were included. Logistic regression was used to assess the association between the factors present in the four scores and conversion. The accuracy of each score was assessed using the area under the curve (AUC). Observed and predicted conversion rates were compared for each score using the Chi-square goodness-of-fit test. Results: Four hundred patients were included. There were 264 men (66%) with a mean age of 65.95 years (standard deviation 12.2). The median tumor height was 7 cm (quartiles 4-11) and 29% of patients had low rectal tumors. Conversion rate was 21.75%. The accuracy to predict conversion was low with an AUC lower than 0,62 for the four models. The observed conversion rates were significantly different from the predicted rates, except for one score. Conclusions: The four models had low accuracy in predicting the conversion to open surgery for laparoscopic rectal resection. There is a need for new well-designed studies, analyzing more specific variables, in a multicentric design to ensure generalizability of the results for daily surgical practice.
MeSH term(s)	Aged ; Conversion to Open Surgery ; Female ; Humans ; Laparoscopy ; Logistic Models ; Male ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-05-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2050442-1
ISSN	1471-2482 ; 1471-2482
ISSN (online)	1471-2482
ISSN	1471-2482
DOI	10.1186/s12893-022-01617-9
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Article ; Online: Impact of Modern Management Strategies on the Clinical Outcome of Patients With Low Rectal Cancer - A Retrospective, Monocentric Cohort Study.

Karam, Elias / Sindayigaya, Remy / Giger-Pabst, Urs / Gabriel, Michel / Michot, Nicolas / Courtot, Lise / Tabchouri, Nicolas / Moussata, Driffa / Lecomte, Thierry / Chapet, Sophie / Calais, Gilles / Bourlier, Pascal / Salamé, Ephrem / Ouaissi, Mehdi

Anticancer research

2022 Volume 42, Issue 4, Page(s) 1949–1963

Abstract: Background: The aim of this study was to retrospectively investigate the impact of intersphincteric resection (ISR) and Enhanced Recovery After Surgery (ERAS) protocols for rectal cancer.: Patients and methods: Since we implemented rectal ERAS ... ...

Abstract	Background: The aim of this study was to retrospectively investigate the impact of intersphincteric resection (ISR) and Enhanced Recovery After Surgery (ERAS) protocols for rectal cancer. Patients and methods: Since we implemented rectal ERAS protocol and ISR in 2016, we retrospectively assessed and compared clinical, pathological and survival outcomes of two groups of patients: group 1, treated 2000-2015 (n=242); and group 2, treated 2016-2020 (n=108). Propensity score matching using nearest-neighbor method was used to match each patient of group 1 to a patient of group 2. Results: Before and after matching, the American Society of Anesthesiology score for patients in group 1 was significantly lower than in group 2 (score of 3: 9.9% vs. 25.9%, p<0.0001) as were grade I-II complications (27.7% vs. 45.4% p<0.001). Before and after matching, the quality of the mesorectum excision was significantly lower in group 1 (complete in 31% vs. 59.2% p<0.0001). After matching, 3-year overall survival for groups 1 and 2 were similar (88.2% vs. 92.6%; p=0.988). Conclusion: ERAS and ISR had no negative impact on the oncological outcome of our patients and increased the preservation of bowel continuity.
MeSH term(s)	Cohort Studies ; Humans ; Neoplasm Grading ; Rectal Neoplasms/surgery ; Rectum/surgery ; Retrospective Studies
Language	English
Publishing date	2022-03-28
Publishing country	Greece
Document type	Journal Article
ZDB-ID	604549-2
ISSN	1791-7530 ; 0250-7005
ISSN (online)	1791-7530
ISSN	0250-7005
DOI	10.21873/anticanres.15673
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Article ; Online: Simultaneous or staged resection for synchronous liver metastasis and primary rectal cancer: a propensity score matching analysis.

Karam, Elias / Bucur, Petru / Gil, Camille / Sindayigaya, Remy / Tabchouri, Nicolas / Barbier, Louise / Pabst-Giger, Urs / Bourlier, Pascal / Lecomte, Thierry / Moussata, Driffa / Chapet, Sophie / Calais, Gilles / Ouaissi, Mehdi / Salamé, Ephrem

BMC gastroenterology

2022 Volume 22, Issue 1, Page(s) 201

Abstract: Background: Colorectal cancer is the third most common cancer in France and by the time of the diagnosis, 15-25% of patients will suffer from synchronous liver metastases. Surgery associated to neoadjuvant treatment can cure these patients, but few ... ...

Abstract	Background: Colorectal cancer is the third most common cancer in France and by the time of the diagnosis, 15-25% of patients will suffer from synchronous liver metastases. Surgery associated to neoadjuvant treatment can cure these patients, but few studies focus only on rectal cancer. This study was meant to compare the outcomes of patients who underwent a simultaneous resection to those who underwent a staged resection (rectum first or liver first) in the University Hospital of Tours, France. Methods: We assessed retrospectively a prospective maintained data base about the clinical, pathological and survival outcomes of patients who underwent a simultaneous or a staged resection in our center between 2010 and 2018. A propensity score matching was used, considering the initial characteristics of our groups. Results: There were 70 patients (55/15 males, female respectively) with median age 60 (54-68) years. After matching 48 (69%) of them underwent a staged approach and 22 (31%) a simultaneous approach were compared. After PSM, there were 22 patients in each group. No differences were found in terms of morbidity (p = 0.210), overall survival (p = 0.517) and disease-free survival (p = 0.691) at 3 years after matching. There were significantly less recurrences in the simultaneous group (50% vs 81.8%, p = 0.026). Conclusions: Simultaneous resection of the rectal primary cancer and synchronous liver metastases is safe and feasible with no difference in terms of survival.
MeSH term(s)	Colorectal Neoplasms/pathology ; Female ; Hepatectomy/adverse effects ; Humans ; Liver Neoplasms ; Male ; Middle Aged ; Propensity Score ; Prospective Studies ; Rectal Neoplasms/surgery ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2022-04-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2041351-8
ISSN	1471-230X ; 1471-230X
ISSN (online)	1471-230X
ISSN	1471-230X
DOI	10.1186/s12876-022-02250-9
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Article ; Online: Development and technical validation of an ultrasound nebulizer to deliver intraperitoneal pressurized aerosols in a rat colon cancer peritoneal metastases model.

Buggisch, Jonathan R / Göhler, Daniel / Sobilo, Julien / Lerondel, Stéphanie / Rezniczek, Günther A / Stintz, Michael / Rudolph, Andreas / Tabchouri, Nicolas / Roger, Sébastien / Ouaissi, Mehdi / Giger-Pabst, Urs

BMC cancer

2022 Volume 22, Issue 1, Page(s) 570

Abstract: Background/aim: To develop and validate a nebulizer device for anti-cancer research on pressurized intraperitoneal aerosol supply in a preclinical peritoneal metastases (PM) rat model.: Material and methods: For aerosol generation, an ultrasonic ... ...

Abstract	Background/aim: To develop and validate a nebulizer device for anti-cancer research on pressurized intraperitoneal aerosol supply in a preclinical peritoneal metastases (PM) rat model. Material and methods: For aerosol generation, an ultrasonic nebulizer (USN) was modified. Aerosol analyses were performed ex-vivo by laser diffraction spectrometry (LDS). Intraperitoneal (IP) Results: The USN was able to establish a stable and reproducible capnoperitoneum at a pressure of 8 to 10 mmHg. LDS showed that the USN provides a polydisperse and monomodal aerosol with a volume-weighted diameter of 2.6 μm. At a CO Conclusions: The USN together with the PM rat model are suitable for robust and species-specific preclinical pharmacological studies regarding intraperitoneal delivery of pressurized aerosolized drugs and cancer research.
MeSH term(s)	Aerosols ; Animals ; Colonic Neoplasms/diagnostic imaging ; Colonic Neoplasms/drug therapy ; Fluorodeoxyglucose F18 ; Humans ; Nebulizers and Vaporizers ; Peritoneal Neoplasms/diagnostic imaging ; Peritoneal Neoplasms/secondary ; Rats
Chemical Substances	Aerosols ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2022-05-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2041352-X
ISSN	1471-2407 ; 1471-2407
ISSN (online)	1471-2407
ISSN	1471-2407
DOI	10.1186/s12885-022-09668-0
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Article ; Online: Role of protective stoma after primary anastomosis for generalized peritonitis due to perforated diverticulitis-DIVERTI 2 (a prospective multicenter randomized trial): rationale and design (nct04604730).

Pinson, Jean / Tuech, Jean-Jacques / Ouaissi, Mehdi / Mathonnet, Murielle / Mauvais, François / Houivet, Estelle / Lacroix, Elie / Rondeaux, Julie / Sabbagh, Charles / Bridoux, Valérie

BMC surgery

2022 Volume 22, Issue 1, Page(s) 191

Abstract: Background: Traditionally, patients with peritonitis Hinchey III and IV due to perforated diverticulitis were treated with Hartmann's procedure. In the past decade, resection and primary anastomosis have gained popularity over Hartmann's procedure and ... ...

Abstract	Background: Traditionally, patients with peritonitis Hinchey III and IV due to perforated diverticulitis were treated with Hartmann's procedure. In the past decade, resection and primary anastomosis have gained popularity over Hartmann's procedure and recent guidelines recommend Hartmann's procedure in two situations only: critically ill patients and in selected patients with multiple comorbidity (at high risk of complications). The protective stoma (PS) is recommended after resection with primary anastomosis, however its interest has never been studied. The aim of this trial is to define the role of systematic PS after resection and primary anastomosis for peritonitis Hinchey III and IV due to perforated diverticulitis. Methods/design: This DIVERTI 2 trial is a multicenter, randomized, controlled, superiority trial comparing resection and primary anastomosis with (control group) or without (experimental group) PS in patients with peritonitis Hinchey III and IV due to perforated diverticulitis. Primary endpoint is the overall 1 year morbidity according to the Clavien-Dindo classification of surgical complications. All complications occurring during hospitalization will be collected. Late complications occurring after hospitalization will be collected during follow-up. In order to obtain 80% power for a difference given by respective main probabilities of 67% and 47% in the protective stoma and no protective stoma groups respectively, with a two-sided type I error of 5%, 96 patients will have to be included in each group, hence 192 patients overall. Expecting a 5% rate of patients not assessable for the primary end point (lost to follow-up), 204 patients will be enrolled. Secondary endpoints are postoperative mortality, unplanned reinterventions, incisional surgical site infection (SSI), organ/space SSI, wound disruption, anastomotic leak, operating time, length of hospital stay, stoma at 1 year after initial surgery, quality of life, costs and quality-adjusted life years (QALYs). Discussion: The DIVERTI 2 trial is a prospective, multicenter, randomized, study to define the best strategy between PS and no PS in resection and primary anastomosis for patients presenting with peritonitis due to perforated diverticulitis. Trial registration: ClinicalTrial.gov: NCT04604730 date of registration October 27, 2020. https://clinicaltrials.gov/ct2/show/NCT04604730?recrs=a&cond=Diverticulitis&draw=2&rank=12 .
MeSH term(s)	Anastomosis, Surgical/adverse effects ; Colostomy/adverse effects ; Diverticulitis/complications ; Diverticulitis/surgery ; Diverticulitis, Colonic/complications ; Diverticulitis, Colonic/surgery ; Humans ; Intestinal Perforation/complications ; Intestinal Perforation/surgery ; Peritonitis/complications ; Peritonitis/surgery ; Prospective Studies ; Quality of Life ; Treatment Outcome
Language	English
Publishing date	2022-05-16
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	2050442-1
ISSN	1471-2482 ; 1471-2482
ISSN (online)	1471-2482
ISSN	1471-2482
DOI	10.1186/s12893-022-01589-w
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Article ; Online: Pectoralis major muscle atrophy is associated with mitochondrial energy wasting in cachectic patients with gastrointestinal cancer.

Dolly, Adeline / Lecomte, Thierry / Tabchouri, Nicolas / Caulet, Morgane / Michot, Nicolas / Anon, Benjamin / Chautard, Romain / Desvignes, Yoann / Ouaissi, Mehdi / Fromont-Hankard, Gaëlle / Dumas, Jean-François / Servais, Stéphane

Journal of cachexia, sarcopenia and muscle

2022 Volume 13, Issue 3, Page(s) 1837–1849

Abstract: Background: Cancer cachexia is a multifactorial syndrome characterized by involuntary and pathological weight loss, mainly due to skeletal muscle wasting, resulting in a decrease in patients' quality of life, response to cancer treatments, and survival. ...

Abstract	Background: Cancer cachexia is a multifactorial syndrome characterized by involuntary and pathological weight loss, mainly due to skeletal muscle wasting, resulting in a decrease in patients' quality of life, response to cancer treatments, and survival. Our objective was to investigate skeletal muscle alterations in cachectic cancer patients. Methods: This is a prospective study of patients managed for pancreatic or colorectal cancer with an indication for systemic chemotherapy (METERMUCADIG - NCT02573974). One lumbar CT image was used to determine body composition. Patients were divided into three groups [8 noncachectic (NC), 18 with mild cachexia (MC), and 19 with severe cachexia (SC)] based on the severity of weight loss and muscle mass. For each patient, a pectoralis major muscle biopsy was collected at the time of implantable chamber placement. We used high-resolution oxygraphy to measure mitochondrial muscle oxygen consumption on permeabilized muscle fibres. We also performed optical and electron microscopy analyses, as well as gene and protein expression analyses. Results: Forty-five patients were included. Patients were 67% male, aged 67 years (interquartile range, 59-77). Twenty-three (51%) and 22 (49%) patients were managed for pancreatic and colorectal cancer, respectively. Our results show a positive correlation between median myofibres area and skeletal muscle index (P = 0.0007). Cancer cachexia was associated with a decrease in MAFbx protein expression (P < 0.01), a marker of proteolysis through the ubiquitin-proteasome pathway. Mitochondrial oxygen consumption related to energy wasting was significantly increased (SC vs. NC, P = 0.028) and mitochondrial area tended to increase (SC vs. MC, P = 0.056) in SC patients. On the contrary, mitochondria content and networks remain unaltered in cachectic cancer patients. Finally, our results show no dysfunction in lipid storage and endoplasmic reticulum homeostasis. Conclusions: This clinical protocol brings unique data that provide new insight to mechanisms underlying muscle wasting in cancer cachexia. We report for the first time an increase in mitochondrial energy wasting in the skeletal muscle of severe cachectic cancer patients. Additional clinical studies are essential to further the exploring and understanding of these alterations.
MeSH term(s)	Aged ; Cachexia/pathology ; Colorectal Neoplasms/pathology ; Female ; Gastrointestinal Neoplasms/complications ; Humans ; Male ; Middle Aged ; Mitochondria/metabolism ; Muscular Atrophy/metabolism ; Pectoralis Muscles/metabolism ; Pectoralis Muscles/pathology ; Prospective Studies ; Quality of Life ; Weight Loss
Language	English
Publishing date	2022-03-22
Publishing country	Germany
Document type	Clinical Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2586864-0
ISSN	2190-6009 ; 2190-5991
ISSN (online)	2190-6009
ISSN	2190-5991
DOI	10.1002/jcsm.12984
Database	MEDical Literature Analysis and Retrieval System OnLINE

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