[Peroperative rescue procedure after failure of oesophagojejunostomy following total gastrectomy]. / Technique de sauvetage peropératoire d'une anastomose oesojéjunale après gastrectomie.

Leakage of oesophagojejunostomy is a severe complication of total gastrectomy. We present a technique allowing preoperative preservation of a defective oesophagojejunostomy: this technique involves closure of the cervical esophagus with stapler, double-lumen transanastomotic tube, mediastinal drainage and feeding jejunostomy.

Prevention of radiation enteritis by intrapelvic breast prosthesis.

Pelvic malignancies frequently require post-operative radiation therapy that may induce small bowel damage at an incidence of 5-25%. Various surgical techniques have been reported to prevent acute and chronic radiation enteritis. This article describes the technical aspects of pelvic exclusion by an intrapelvic silicone breast prosthesis.

Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus.

BACKGROUND: We conducted a multicenter, randomized trial to compare preoperative chemoradiotherapy followed by surgery with surgery alone in patients with stage I and II squamous-cell cancer of the esophagus. METHODS: The preoperative combined therapy consisted of two one-week courses; each involved radiotherapy, in a dose of 18.5 Gy delivered in five fractions of 3.7 Gy each, and 80 mg of cisplatin per square meter of body-surface area, administered 0 to 2 days before the first day of radiotherapy. The surgical plan included one-stage en bloc esophagectomy and proximal gastrectomy by the abdominal and right thoracic routes, to be performed immediately after randomization in the group assigned to surgery alone and two to four weeks after the completion of preoperative chemoradiotherapy in the group assigned to combined therapy. RESULTS: A total of 297 patients entered the study; 11 were found to be ineligible, and 4 were lost to follow-up. Of the remaining 282, 139 were assigned to surgery alone and 143 to combined therapy. After a median follow-up of 55.2 months, no significant difference in overall survival was observed; the median survival was 18.6 months for both groups. As compared with the group treated with surgery alone, the group treated preoperatively had longer disease-free survival (P=0.003), a longer interval free of local disease (P=0.01), a lower rate of cancer-related deaths (P=0.002), and a higher frequency of curative resection (P=0.017). However, there were more postoperative deaths (P=0.012) in the group treated preoperatively with chemoradiotherapy. Three prognostic factors were found to influence survival in a multivariate analysis: the disease stage, based on computed tomography; the location of the tumor; and whether the surgical resection was curative. CONCLUSIONS: In patients with squamous-cell esophageal cancer, preoperative chemoradiotherapy did not improve overall survival, but it did prolong disease-free survival and survival free of local disease.

[Cystic dystrophy on an aberrant duodenal pancreas. Apropos of a case]. / Dystrophie kystique sur pancréas aberrant duodénal. A propos d'une observation.

Cystic dystrophy of the aberrant pancreas is a rare poorly understood condition which is difficult to diagnose and treat. The primary clinical signs are epigastralgia associated with poor general health and complications due to stenosis of the duodenum. Endoscopy gives the most information on tissue lesions and cystic formations in the duodenal mucosa. Although the condition is benign, and due to the lack of sufficient history in endoscopically treated cases, cystic dystrophy of the aberrant duodenal pancreas appears to require duodenopancreatectomy.

[Predictive factors of recurrence in surgically treated rectal villous tumors. Therapeutic approach based on 184 cases]. / Les facteurs prédictifs de récidive des tumeurs villeuses rectales opérées. Attitude thérapeutique à propos de 184 cas.

The aim of this retrospective study on 184 operated cases was to propose a therapeutic management scheme for villous tumours of the rectum. Among the 184 operated patients, 167 (90,7%), mean age 65 years, were seen after a follow-up of 2 to 20 years. The tumour was most often localized in the rectal ampoula (141 cases) and was benign in 65 p. 100. Endoanal surgery was performed in 76 patients among whom recurrence was observed in 29.7%. Posterior exeresis (Kraske method) was performed in 52 cases with a recurrence rate of 31.9%). Finally, abdominoperineal amputation was performed 20 times, essentially for advanced stage tumours. Based on the statistical analysis of the recurrence factors for these different techniques, we have concluded that endoanal surgery predominates for benign tumours smaller than 5 cm situated at least 8 cm from the anus. Above the size of 5 cm, due to the major risk of tumourectomy, we believe rectal exeresis is the most rational treatment.

[Disseminated peritoneal leiomyomatosis: an exceptionally misleading disease. A case report]. / La léiomyomatose péritonéale disséminée. Une affection exceptionnelle trompeuse. A propos d'un cas.

Peritoneal leiomyomatosis disseminata is an exceptional benign disease with characteristic multifocal subperitoneal smooth muscle cell growth. We report and exceptional case associating pelvic endometriosis and mimicking cancer of the ovary. Surgery was performed and was found a posteriori to be excessive in light of the good prognosis of this disease. Positive hormone receptor assays on the surgical specimen favoured ovarian steroid hormone involvement in the aetiopathology of this strange disease.

Pancreatic localization of a Castleman's tumour.

Castleman's tumour is a rare anatomo-clinical entity. Most cases of Castleman's tumour occur in the mediastinum. The histopathology demonstrates benign angiofollicular lymph node hyperplasia. The pancreatic localization is uncommon and has only been reported once. We describe a new case with literature review.

[Proctocolectomy with ileo-anal anastomosis performed with mechanical suture without mucosectomy and without protective ileostomy]. / Coloproctectomie avec anastomose iléo-anale effectuée par suture mécanique sans mucosectomie et sans iléostomie de protection.

Abdominal proctocolectomy with formation of an ileal reservoir anastomosed onto the anal canal using a stapler device is described. This technique avoids also stripping the mucosa from the anal canal which is time consuming and often difficult and incomplete. The avoidance of a temporary ileostomy did not lead to an increase in post operative complications. Seventeen patients have undergone this procedure for ulcerative colitis and the advantages and disadvantages of it are discussed.

[Colorectal cancer in patients over the age of 80 years]. / Le cancer colo-rectal chez les sujets de plus de 80 ans.

Between January 1, 1973 and December 31, 1986, 1.734 patients underwent colorectal resections for carcinoma. The patients were divided into two groups: group I included 163 patients > 80 years on first presentation; group II comprised 1.571 patients < 80 years. The total perioperative mortality rates of the elderly and younger group were 15.3 percent and 5 percent respectively (p < 0.001). The surgical mortality rates in group I were 7.4 percent after elective operations versus 4.5 percent in group II and were not statistically different. Emergency surgery was associated with a significantly higher incidence of perioperative deaths at any age (p < 0.001). In the elderly group, most deaths (88%) resulted from complications of coexisting medical disorders or thrombo-embolic complications. The 5 year survival for the young and elderly groups were 46.2 percent and 35 percent respectively (p < 0.05). However, excluding patients dying from nonmalignant disease, the 5 year survival rate did not differ significantly between the two groups of patients (49.5 percent versus 42.2 percent).

[Local recurrence after surgery for cancer of the rectum]. / Récidives loco-régionales après cancer du rectum opéré.

Local tumor recurrence rates after curative rectal cancer surgery are reportedly high and herald a poor diagnosis. Extramural recurrence is most common and is due to the failure to remove all of the tumor during the initial operation. In the rarer anastomotic recurrence, the implantation of exfoliated malignant cells is possible, but histochemical changes in the mucosa surrounding a tumor may be considered as an alternative cause of local recurrence. Local recurrence rates did not improve when the distal margins were extended over 2 cm, but microscopic lateral tumor extension appears to be the major determinant of recurrence. Early diagnosis is based on frequent CEA assays, history, physical examination, endoscopy, endoluminal ultrasound and pelvic CT scan. Aggressive treatment involving a combination of field irradiation, surgical debulking and intra-operative radiation can result in local control and long-term survival in 10 to 25% of patients.