[Surgical interventions for erroneous diagnoses of liver metastases]. / Interventions chirurgicales pour diagnostics erronés de métastases hépatiques.

Among 635 laparotomies carried out for liver metastases (LM) between June 1983 and December 1992, twenty three operations (with 6 hepatectomies) were performed for a false positive diagnosis of LM. They represented 3.6% of the whole population, but only 2.8% if the 5 patients operated for persistent diagnostic doubt are excluded. The 6 hepatectomies represented 2.2% of the 276 hepatectomies carried out for LM. The 23 false positive diagnosis of LM could be classified as follows: 14 complete errors (operation for the diagnosis of LM), 4 partial errors (the operation was also indicated for a concomitant disease), and 5 cases of real diagnostic doubt. Two groups of patients were differentiated according to the survey: one group had a regular survey and had a modification of their initial morphologic examinations of the liver, and one group had no reference morphologic examinations of the liver. The errors were more frequent in the first group. Atypical angiomas were the most frequent lesion (n = 10), followed by atypical cysts (n = 4), and nodular focal hyperplasia (n = 4): they represented 78% of all false positive diagnosis of LM. These false positive lesions were mainly detected in three carcinomas: colorectal carcinomas (n = 10), breast cancers (n = 5) and melanomas (n = 3): they represented 78% of the incorrect diagnosis. The relative frequency was high for melanomas (36%) and breast cancers (14%), but low for colorectal cancers (2%). The retrospective study of these cases shows that some errors could be eliminated by a more extensive imaging and systematic radio-clinical confrontation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidermoid cancer of the esophagus. Does the efficacy of chemoradiotherapy justify surgical abstention?]. / Cancers épidermoïdes de l'oesophage. L'efficacité des traitements chimio-radiothérapiques autorise-t-elle l'abstention chirurgicale?

Nine inoperable patients with squamous esophageal cancer were selected from 112 patients treated with combination chemo-radiotherapy. The criteria of selection were: 1) localized cancer (T1 or T2 of the TNM classification), 2) complete response after neoadjuvant chemotherapy suggesting the possibility of a good survival, 3) and 65 Gy-irradiation in the previous tumor bed. Eight of these 9 carcinomas recurred locally after a median delay of 12.6 months after the end of the treatment (extremes: 2 and 30 months). Only one patient is free of disease 24 months after the end of the treatment. These results point out that this chemo-radiotherapeutic association is disappointing in the long term in terms of loco-regional tumoral control and survival, but appeared to be good palliative treatment. This is an argument against the attitude of physicians who currently recommended a non-surgical strategy and deny the value of surgery. The carcinologic surgical excision of esophageal cancers is still the best treatment today. It must be performed whenever it is feasible, possibly associated with complementary treatments (evaluated in prospective studies).