Venous resection for pancreatic cancer, a safe and feasible option? A systematic review and meta-analysis.

BACKGROUND: In pancreatic ductal adenocarcinoma patients with suspected venous infiltration, a R0 resection is most of the time not possible without venous resection (VR). To investigate this special kind of patients, this meta-analysis was conducted to compare mortality, morbidity and long-term survival of pancreatic resections with (VR+) and without venous resection (VR-). METHODS: A systematic search was performed in Embase, Pubmed and Web of Science. Studies which compared over twenty patients with VR + to VR-for PDAC with ≥1 year follow up were included. Articles including arterial resections were excluded. Statistical analysis was performed with the random effect Mantel-Haenszel test and inversed variance method. Individual patient data was compared with the log-rank test. RESULTS: Following a review of 6403 papers by title and abstract and 166 by full text, a meta-analysis was conducted of 32 studies describing 2216 VR+ and 5380 VR-. There was significantly more post-pancreatectomy hemorrhage (6.5% vs. 5.6%), R1 resections (36.7% vs. 28.6%), N1 resections (70.3% vs. 66.8%) and tumors were significantly larger (34.6 mm vs. 32.8 mm) in patients with VR+. Of all VR + patients, 64.6% had true pathological venous infiltration. The 90-day mortality, individual patient data for overall survival and pooled multivariate hazard ratio for overall survival were similar. CONCLUSION: VR is a safe and feasible option in patients with pancreatic cancer and suspicion of venous involvement, since VR during pancreatic surgery has comparable overall survival and complication rates.

Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study.

BACKGROUND: Whether patients who undergo resection of ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently unknown. The aim of this study was to compare survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma in a propensity score-matched analysis. METHODS: An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma between 2006 and 2017, in 13 centres in six countries. Propensity scores were used to match patients who received adjuvant chemotherapy with those who did not, in the entire cohort and in two subgroups (pancreatobiliary/mixed and intestinal subtypes). Survival was assessed using the Kaplan-Meier method and Cox regression analyses. RESULTS: Overall, 1163 patients underwent pancreatoduodenectomy for ampullary adenocarcinoma. After excluding 187 patients, median survival in the remaining 976 patients was 67 (95 per cent c.i. 56 to 78) months. A total of 520 patients (53·3 per cent) received adjuvant chemotherapy. In a propensity score-matched cohort (194 patients in each group), survival was better among patients who received adjuvant chemotherapy than in those who did not (median survival not reached versus 60 months respectively; P = 0·051). A survival benefit was seen in patients with the pancreatobiliary/mixed subtype; median survival was not reached in patients receiving adjuvant chemotherapy and 32 months in the group without chemotherapy (P = 0·020). Patients with the intestinal subtype did not show any survival benefit from adjuvant chemotherapy. CONCLUSION: Patients with resected ampullary adenocarcinoma may benefit from gemcitabine-based adjuvant chemotherapy, but this effect may be reserved for those with the pancreatobiliary and/or mixed subtype.

ANTECEDENTES: Actualmente se desconoce si la quimioterapia adyuvante ofrece un beneficio en la supervivencia de los pacientes que se someten a resección de un adenocarcinoma ampular. El objetivo de este estudio fue comparar la supervivencia mediante la concordancia estimada por emparejamiento por puntaje de propensión, entre pacientes con y sin quimioterapia adyuvante después de la resección de un adenocarcinoma ampular. MÉTODOS: Se realizó un estudio internacional de cohortes multicéntrico, que incluyó a los pacientes que se sometieron a una duodenopancreatectomía por adenocarcinoma ampular (2006-2017) en 13 centros de seis países. Los puntajes de propensión se usaron para emparejar a los pacientes que recibieron quimioterapia adyuvante con los que no; tanto en la cohorte completa como en dos subgrupos (subtipo pancreaticobiliar / mixto e intestinal). La supervivencia se evaluó utilizando el método de Kaplan-Meier y las regresiones de Cox. RESULTADOS: En total, 1.163 pacientes fueron sometidos a una duodenopancreatectomía por adenocarcinoma ampular. Después de excluir a 179 pacientes, la mediana de supervivencia de los 976 pacientes restantes fue de 67 meses (i.c. del 95%, 56-78), de los cuales un total de 520 pacientes (53%) recibieron quimioterapia adyuvante. En una cohorte de emparejamiento por puntaje de propensión (194 versus 194 pacientes), la mediana de supervivencia fue mejor en los pacientes tratados con quimioterapia adyuvante en comparación con aquellos sin quimioterapia adyuvante (no se alcanzó la mediana de supervivencia versus 60 meses, respectivamente; P = 0,051). En el subtipo pancreaticobiliar/mixto se observó un beneficio en la supervivencia; no se alcanzó la mediana de supervivencia en pacientes que recibieron quimioterapia adyuvante versus 32 meses en el grupo sin quimioterapia, P = 0,020. El subtipo intestinal no mostró beneficio en la supervivencia de la quimioterapia adyuvante. CONCLUSIÓN: Los pacientes con adenocarcinoma ampular resecado pueden beneficiarse de la quimioterapia adyuvante basada en gemcitabina, pero este efecto podría reservarse para aquellos pacientes con subtipo de tumor pancreaticobiliar y/o mixto.

In the Era of the Leeds Protocol: A Systematic Review and A Meta-Analysis on the Effect of Resection Margins on Survival Among Pancreatic Ductal Adenocarcinoma Patients.

BACKGROUND AND AIMS: A positive resection margin is considered to be a factor associated with poor prognosis after pancreatic ductal adenocarcinoma resection. However, analysis of the resection margin is dependent on the pathological slicing technique. The aim of this systematic review and meta-analysis was to study the impact of resection margin on the survival of pancreatic ductal adenocarcinoma patients whose specimens were analyzed using the axial slicing technique. MATERIAL AND METHODS: A systematic search in the PubMed, Cochrane, and Embase datasets covering the time period from November 2006 to January 2019 was performed. Only studies with axial slicing technique (Leeds Pathology Protocol or Royal College of Pathology Protocol) were included in the final database. Meta-analysis between the marginal distance and survival was performed with the Inverse Variance Method in RevMan. RESULTS: The systematic search resulted in nine studies meeting the inclusion criteria. The median survival for a resection margin 0 mm ranged from 12.3 to 23.4 months, for resection margin <0.5 mm 16 months, for resection margin <1 mm ranged from 11 to 27.5 months, for resection margin <1.5 mm ranged from 16.9 to 21.2 months, and for resection margin >2 mm ranged from 53.9 to 63.1 months. Five studies were eligible for meta-analysis. The pooled multivariable hazard ratio favored resection margin ⩾1 mm (hazard ratio: 1.32 and 95% confidence interval: 1.03-1.68, p = 0.03). CONCLUSION: Resection margins ⩾1 mm seem to lead to better survival in pancreatic ductal adenocarcinoma patients than resection margin <1 mm. However, there is not enough data to evaluate the effect of oncologic therapy or to analyze the impact of other resection margin distances on survival.

Percutaneous treatment of extrahepatic recurrence of hepatocellular carcinoma.

PURPOSE: The goal of this study was to retrospectively evaluate the results of imaging-guided percutaneous ablation in patients with controlled intrahepatic hepatocellular carcinoma (HCC) with limited extrahepatic disease. MATERIALS AND METHODS: Eleven patients with limited extrahepatic disease and/or potential short-term clinical manifestations with controlled primary intrahepatic HCC were included into the study. There were nine men and two women, with a mean age of 67.4 years±10.2 (SD) (range: 54-85 years). All patients had extrahepatic disease treated by either radiofrequency ablation or electroporation. Extrahepatic disease consisted of lymph node metastases (5 patients), tumor seeding along a needle tract (3 patients), adrenal gland metastasis, bone metastasis and pulmonary metastasis (one patient each). RESULTS: Response to treatment was complete in 7/11 patients (64%). The mean survival time after treatment was 18.8±12.7 (SD) months (median, 16 months; range: 4-42 months). No severe complications associated with percutaneous treatment were observed. CONCLUSION: Our results suggest that imaging-guided percutaneous ablation techniques should be considered as a useful option for the treatment of extrahepatic disease in patients with HCC. Further studies are needed, however to fully determine the potential role of these techniques in this elective application.

[Comparative study of measurement of posterior tooth crowding between the dental panoramic xray and dental scanner]. / Etude comparative des mesures d'encombrement postérieur entre la radiographie panoramique dentaire et le scanner dentaire.

The purpose of this work was to compare measurements of the posterior crowding in the mandibular arcade between two types of radiographic examinations: the dental panoramic one and the dental scanner. Our sample is composed of 12 patients before treatment orthodontic, with an average age of 16 + 4 years. These patients presented an posterior crowding on dental panoramic radiography accepted the catch of a dental scanner to re-examine this crowding. To make this study, we measured on dental panoramic radiographies and the dental scanners of each patient posterior available space and posterior necessary space according to the technique of Merrifield and we calculated the posterior crowding for each case. The comparison of the two variables was carried out by using the Test T of Student. The results our study shows that: Dental panoramic radiography raises the posterior dental crowding when this compared to the dental scanner (Student, p < 0.05). The percentage of enlarging of this crowding varies enormously between 18 % and 73% with an average of 48.58 % +/- 15, 90.

[A comparative study of the transverse dimensions of the dental arches between Class I dental occlusion and Class II1 and Class II2 malocclusions]. / Etude comparative des dimensions transversales des arcades entre la classe I occlusale et les malocclusions de classe II1 et classe II2.

The purpose of this work was to compare transverse dimensions of the maxillary and mandibular arches in the canine and molar region between three groups of patients: the first group had an occlusion in class II division 1, the second one a dental class II division 2 and the third one, a class I bite. Our sample is composed of 94 patients, with an average age of 20 +/- 3 years: 31 patients presented a class I occlusion, 33 a class III1 and 30 cases presented a dental class II2. For this study, we measured, on the maxillary and mandibular dental casts of each patient, the intercanine and intermolar canine (central inter fossa). Comparison of variables was conducted using the variance analysis ANOVA; the selected post-hoc test is the Bonferrroni test. On the basis of our study, we can get the following results: Maxillary intercanine distance is narrower in class II1 compared to class II2 of 2 mm "p < 0.05". Mandibular intercanine distance is narrower in class III1 compared to class II2 of 1, 3 mm "p < 0.05". Maxillary intermolar distance (inter fossa) is narrower in class II1 compared to class I of 2, 2 mm "p < 0.05".

[Open bite and and therapeutic strategy]. / Béance antérieure et attitude thérapeutique.

Anterior open bites can be divided into two categories: skeletal and dento-alveolar. The etiology, basically affecting dento-alveolar structures, is functional or mechanical such as the rotation of the first higher molars, the exaggerated curve of Spee and the incisor supraclusion and the simple orthodontic treatment can bring a therapeutic success but functional rehabilitation remains the guaranty of such a stability of our treatment. The purpose of this work is to make a teaching article which puts the point on the interest of the elements of the diagnosis and the orthodontic treatment indicated in certain clinical situations of anterior open-bite; this by detailing biomechanics of correction of this anomaly requiring various therapeutic strategies. Functional rehabilitation remains always the guaranty of such a therapeutic stability. For the teaching aspect, we want to attach stereotypic forms and also to present clinical cases treated in the service of consultation and dental treatment in order to answer such a request.

[Influence of premolar extraction on the dimensions of the lower dental arch: clinical study of 30 cases]. / Influence des extractions des prémolaires sur la dimension de l'arcade mandibulaire: etude clinique auprès de 30 cas.

The purpose of this work is to study the form's and transversal dimensions changes of dental arches during the orthodontical treatment within the first premolars extractions. Our sample is composed of thirty treated casts in Edgewise technique in the orthodontic service in Center of Consultation and Dental Treatment (C.C.D.T.) of Rabat. In order to realise this study, we have used in the treatment's beginning and final of each case mandibular moulding. On our results base, it brings out that the intercanine distance increases whereas the intermolar distance decrease during the orthodontical treatment, and that the only found dismorphism is linked to the treatment's options (extraction- non extraction) only for intermolar distance.

[What measures can be taken to reduce the number of smoking adolescents and young women?]. / Quelles sont les mesures susceptibles de réduire le nombre d'adolescentes et de femmes fumeuses?

A proper understanding of the factors exposing adolescents and young women to the risk of smoking dependence is necessary to develop effective preventive measures. These measures will be different depending on whether they are designed for adolescents and young women in general or for the context of pregnancy. For adolescents, efforts should be continued to provide information about smoking and the dangers of tobacco as well as about the social manipulation involved. The image of a natural, active woman, free of tobacco and capable of making her own decisions should be promoted. Health education and communication professionals should make use of different media with an audience among the young. Messages should be validated with a target population before diffusion. A better coherence between the adult and young populations concerning legal obligations and mutual respect is significantly useful. Educational structures (schools and universities) should participate in long-term community projects implicating peer groups and trained professionals. Values which should be reinforced include self-esteem, affirmation of personal competence and difference, self-respect and respect of others. Early identification of factors favoring psychosocial vulnerability at this age is indispensable to facilitate referral to professional support and care centers, the number of which remains insufficient to date. Support when ceasing smoking, based on individual and group assistance, should take into account the individual's phase of maturation, and must be proposed and operated by trained professionals working in a network. During pregnancy, it is crucial to recognize that the woman's specific physical and psychological situation is a unique opportunity to propose a new approach to smoking, taking into consideration the fragile context during this period of maturation and its impact on the woman's general life. Beyond sociopolitical measures and a philosophical debate on the position of women, men, and the family in the 21st century, propositions can be put forward for actions before, during and after the maternity period. It is important to continue the educational aspect without creating a guilt feeling. Messages should be elaborated with women. Healthcare professionals should be trained about smoking and smoking dependence. They should repeat minimal advice and continuously propose stopping smoking, taking into consideration the woman's stage of maturation and her motivation. Carbon monoxide monitoring should become a routine practice. Prognostic factors and possible difficulties should be identified early, if possible before pregnancy or at least during pregnancy, in order to propose adapted multidisciplinary support. The health booklet for the mother and the infant should be improved. Midwives should play an important role in prevention. A multidisciplinary effort will have the greatest impact: smoke-free environment in maternities, professional clinics, and the real-life territory of the pregnant woman. Individual care and support are more appropriate than group support. The partner should be implicated. For very dependent women, basically psychological support of smoking cessation should be completed with nicotine substitution therapy using protocols which should be redefined with more extensive studies. All these measures should be continued for six months after birth whether the woman has stopped smoking during pregnancy or not.