Bevacizumab efficacy in metastatic colorectal cancer is dependent on primary tumor resection.
Purpose Bevacizumab plus fluoropyrimidine-based chemotherapy is standard treatment for first-line and second-line metastatic colorectal cancer (mCRC). However, to date, there is no current biomarker predictive for the benefit of bevacizumab use for these patients. Preclinical data suggest that the presence of the primary tumor could be involved in less efficient antitumor activity of antiangiogenic agents, but no clinical data currently support this hypothesis. Methods We performed a retrospective analysis of factors associated with overall survival (OS) in a study cohort of 409 mCRC patients. Univariate and multivariate Cox proportional hazard regression models were used to assess the infl…
Should CT scan be performed when CRP is elevated after colorectal surgery? Results from the inflammatory markers after colorectal surgery study.
Summary Introduction Serum concentration of C-reactive protein (CRP) that exceeds a pre-defined threshold between the 3rd and 5th postoperative day is a reliable marker of infectious complications after colorectal surgery. However, the optimal strategy to follow when a high CRP is found has not been defined. The aim of this study was to analyze the usefulness of computed tomography (CT) scan in this situation in a prospective cohort of patients following colorectal surgery. Methods Between November 2011 and April 2015, patients at two surgical centers who had undergone elective colorectal resection with anastomosis and who had a CRP > 12.5 mg/dL on the 4th postoperative day (POD) were prosp…
Indicaciones de la cirugía antirreflujo en pacientes con esófago de Barrett
Using A Heating Cable Within The Abdomen To Make Hyperthermic Intraperitoneal Chemotherapy Easier: Feasibility And Safety Study In The Swine
International audience; BACKGROUND: Hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex, expensive and time-consuming procedure. Despite its good results in the treatment of peritoneal carcinomatosis, these factors have precluded the wider use of this procedure around the world. We hypothesized that HIPEC could be performed by heating the liquid within the abdomen and thus avoiding the need for an external heating circuit and a pump. The aim of this study was to assess the feasibility and safety of an internal heating device for hyperthermic intraperitoneal chemotherapy in an experimental model. METHODS: Four large-white pigs underwent one-hour open intraperitoneal hyperthermia w…
Incidence and survival in late liver metastases of colorectal cancer
Background and Aims Data concerning the risk of long-term liver metastasis following surgery of colorectal cancer in the general population are scarce. The 10-year incidence and prognosis of metachronous liver metastases remain unknown. Methods Among 4584 patients resected for cure for colorectal cancer recorded in two French digestive population-based cancer registries between 1985 and 2000, 602 presented metastases including liver metastases. Results The cumulated incidence of liver metastasis was 15% at 5 years and 17% at 10 years, and was mainly related to stage at diagnosis. The 10-year cumulative incidence was 6% for stage I and 30% for stage III. The hazard ratio was 3.2 [2.4–4.3] fo…
Altered distribution and function of splenic innate lymphoid cells in adult chronic immune thrombocytopenia
IF 7.607; International audience; Innate lymphoid cells (ILCs) have been characterized as innate immune cells capable to modulate the immune response in the mucosae. Human ILCs have been rarely described in secondary lymphoid organs except in tonsils. Moreover, their function and phenotype in human secondary lymphoid organs during autoimmune diseases have never been studied. We took advantage of splenectomy as a treatment of immune thrombocytopenia (ITP) to describe and compare splenic ILC from 18 ITP patients to 11 controls. We first confirmed that ILC3 represented the most abundant ILC subset in human non-inflamed spleens, accounting for 90% of total ILC, and that they were mostly constit…
Marqueurs inflammatoires pour le diagnostic précoce d’infection postopératoire : le même seuil pour la chirurgie rectale et colique ?
Resume Introduction La fistule anastomotique est la complication redoutee apres chirurgie colorectale. De nombreux travaux ont montre l’interet du dosage de la CRP en postoperatoire comme marqueur diagnostic precoce. Le seuil critique des marqueurs biologiques de l’inflammation doit-il rester le meme que la resection soit colique ou rectale ? Patients et methode Il s’agit d’une etude basee sur une cohorte constituee entre 2011 et 2014, incluant 497 patients avec une resection colorectale programmee. La proteine C-reactive et la pro-calcitonine ont ete mesurees tous les jours entre la veille et le 4e jour. Toutes les complications postoperatoires intra-abdominales ont ete considerees comme u…
Hepatic arterial infusion of gemcitabine-oxaliplatin in a large metastasis from colon cancer
International audience; Hepatic arterial infusion (HAI) of chemotherapy can be performed in cases of liver-confined metastatic disease, resulting in increased local drug concentrations. Here we report the case of a 61-year-old man who presented with an isolated large unresectable liver metastasis of colon cancer after failure of surgery and multiple administration of systemic chemotherapy. The patient was treated with a combination of gemcitabine and oxaliplatin using HAI. The tolerance was excellent and a radiological complete response was obtained after 8 cycles of HAI. The rationale for the use of gemcitabine and oxaliplatin as well as that for the combination of the 2 drugs is discussed…
Are Adiponectin and Leptin Good Predictors of Surgical Infection after Colorectal Surgery? A Prospective Study
Infections are the most frequent complication after colorectal surgery. It has been suggested that adipose tissue metabolism could be related to the risk of post-operative infection, but this could be partially related to the body-mass index. The aim of this study was to look for a relation between adipocytokine levels and the risk of post-operative infection and its type.This prospective cohort study was conducted between March 2013 and March 2014 in two French teaching hospitals. Pre-operative plasma levels of adiponectin and leptin were measured in consecutive patients undergoing elective colorectal surgery. All infections in the 30 d following surgery were recorded.Among the 142 patient…
Faut-il réaliser un scanner quand la protéine C réactive est élevée après chirurgie colorectale ? Résultats de la cohorte IMACORS
Resume Introduction Les concentrations seriques de proteine C reactive (CRP) en deca d’un seuil predefini entre le 3e et le 5e jour postoperatoire sont un marqueur fiable de l’absence de complication infectieuse apres chirurgie colorectale. Cependant, la strategie a mettre en place en cas de CRP elevee n’est pas codifiee. Le but de ce travail etait d’analyser l’utilite du scanner dans cette situation au sein d’une cohorte prospective de chirurgie colorectale reglee. Methodes Entre novembre 2011 et avril 2015, les patients ayant une CRP > 125 mg/L au 4e jour postoperatoire d’une resection colorectale reglee dans l’un des 2 centres participants ont ete inclus prospectivement dans une base. To…
Preferential splenic CD8+ T-cell activation in rituximab-nonresponder patients with immune thrombocytopenia
The pathogenic role of B cells in immune thrombocytopenia (ITP) has justified the therapeutic use of anti-CD20 antibodies such as rituximab (RTX). However, 60% of ITP patients do not respond to RTX. To decipher the mechanisms implicated in the failure of RTX, and because the spleen plays a well-recognized role in ITP pathogenesis, 12 spleens from ITP patients who had been nonresponders to RTX therapy were compared with 11 spleens from RTX-untreated ITP patients and 9 controls. We here demonstrate that in RTX-nonresponder ITP patients, preferential Th1 and Tc1 T lymphocyte polarizations occur, associated with an increase in splenic effector memory CD8(+) T-cell frequency. Moreover, in the RT…
The caregiver/patient relationship at the heart of health : A qualitative study
National audience