Resected colorectal cancer liver metastases : Prognostic study about 110 patients.

INTRODUCTION: The prognosis of hepatic metastases in colorectal cancers is constantly being improved at the cost of multidisciplinary care, allowing each patient to have an adapted strategy. The prognostic factors make it possible to recognize patients needing further treatment after resection and closer monitoring. OBJECTIVE: The aim of our study was to conduct a prognostic study to identify factors influencing survival at 5 years for patients operated of colorectal liver metastases. METHODS: This is a retrospective study conducted over a period of 10 years (2005-2015). All patients operated for liver metastasis of colorectal cancers were included. The primary endpoint was overall survival. Secondary endpoints were recurrence-free survival and operative morbidity and mortality. The proportions were compared by the Chi 2 test. The survival curves were established according to the Kaplan-Meier method and the comparison of the curves according to the Logrank test. A univariate and then multivariate Cox model was used to determine prognostic factors. The significance level was set at 0.05. RESULTS: Overall survival of our patients at 3 and 5 years was 49% and 32% respectively. Recurrence-free survival was 21% at 3 years and 15% at 5 years. In multivariate analysis, the hepatic resection margin <1 mm and the number of hepatic metastases ≥3 were independent factors correlated with survival. CONCLUSIONS: colorectal liver metastases surgery improves patient survival. Some factors need to be sought to adapt care strategies.

Open liver trauma causing hepatico caval fistula successfully treated by embolization.

INTRODUCTION: Traumatic arteriovenous fistula results from a breach of vascular integrity between a vein and an adjacent artery. Hepato caval fistula is a rare entity. Open surgical approaches have increasingly given way to radiological embolization techniques in the treatment of these arteriovenous fistulae, especially in intrahepatic locations. CASE REPORT: We report the case of a patient diagnosed with a fistula, from the right branch of the liver artery to the right hepatic vein, developed following an open liver trauma. Successful embolization through the transarterial route was achieved with simple outcomes. CONCLUSION: The interventional radiology for endovascular management has revolutionized the treatment of hepatic liver traumas. The conservative treatment is henceforth the common approach even if hepatic artery or hepatic veins are involved in case of arteriovenous fistula.

[The POSSUM: a good scoring system for predicting mortality in elderly patients undergoing emergency surgery?] / Le POSSUM: un bon score pour prédire la mortalité du sujet âgé opéré en urgence?

INTRODUCTION: POSSUM (Physiologic and Operative Severity Score for the enumeration of Mortality and morbidity) is a scoring system for predicting mortality which is largely used in elective aortic and abdominal surgery. The aim of our study was to validate POSSUM with regards to elderly patients (> 70 years) undergoing digestive emergency surgery. We wanted to determine the optimal threshold for POSSUM, consisting of a physiological score and of an operative score for predicting mortality in this population. METHODS: This is a case-control analytic retrospective study of 291 patients aged ≥70 years undergoing digestive emergency surgery. These patients were divided into two groups each comprising 50 patients. Group "DC": patients died in the immediate postoperative period and Control group "SURV" chosen by lot. We analyzed the reliability of POSSUM in predicting mortality and morbidity. Subsequently, we created ROC curve to find the thresholds with the best sensitivity/specificity couple. RESULTS: The physiological score, operative score and mortality and morbidity rates predicted by POSSUM and mortality predicted by P-POSSUM are predictors of mortality (P < 0.0001). The threshold values for the physiological and operative score with the best sensitivity/specificity couple were 23 and 15 respectively. CONCLUSION: Predicting mortality in patients allows to target care management programs and to inform the patient and his family of the risks.

[Laparoscopic colectomy versus colectomy performed via laparotomy in the treatment of non-metastatic colic adenocarcinomas]. / Colectomie laparoscopique versus colectomie par laparotomie dans le traitement des adénocarcinomes coliques non métastatiques.

INTRODUCTION: Laparoscopic colectomy is considered with increasing frequency the gold standard treatment for colorectal cancer. Our study aims to show that short-term results and the oncological safety of laparoscopy are at least equivalent to those of laparotomy in the treatment of non-metastatic colic adenocarcinomas. We also highlight the impact of the learning curve on outcomes after laparoscopy in patients with these cancers. METHODS: We conducted a retrospective study of all patients undergoing surgery for resectable colic adenocarcinomas over a period of 6 years. The study population was divided into 2 groups based on the surgical procedure used initially. The group "OC" included 35 patients who underwent midline laparotomy and the group "LAC" included 30 patients who underwent laparoscopy. All data were analyzed using SPSS software version 19.0. RESULTS: Our study showed that there was no significant difference in short-term outcomes between the 2 groups, namely intraoperative morbidity, hospital stay, intensive care unit stay as well as postoperative morbidity and mortality. Regarding the long-term outcomes, there was also no significant difference in the incidence of late complications, type of recurrence, overall survival and disease-free survival. Oncological safety based on the limits of resection and the number of lymph nodes removed was not significantly different between the two groups. Operative time was significantly longer in the laparoscopic group (p <0.001). Convertion rate was 33%. It went from 67% in the first 2 years of the study to 13% in the last 2 years. The conversion from laparoscopy to laparotomy had no significant impact neither on early postoperative outcomes nor on overall survival and disease-free survival. CONCLUSION: Laparoscopy is a surgical procedure resulting in at least equivalent short and long term outcomes as laparotomy. The learning curve representing a "prerequisite" has no negative impact on the outcomes of laparoscopic treatment of non-metastatic colic cancers.

[Strangled rectal prolapse in young adults: about a case and review of the literature]. / Prolapsus rectal étranglé de l'adulte jeune: à propos d'un cas et revue de la littérature.

Rectal prolapse is a rectal static disorder which involves rectal wall intussusception inducing its externalization through the anus. It usually affects children and the elderly. Its occurrence in young adults is rare. Strangulated rectal prolapse is also a rare complication. We report the case of a 30-year old patient who underwent emergency surgery for strangulated rectal prolapse. Emergency perineal rectosigmoidectomy (Altemeier repair) was performed with simple outcome.