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Messager M(1), Lefevre JH, Pichot-Delahaye V, Souadka A, Piessen G, Mariette C; FREGAT working group – FRENCH.


Collaborators: Arnaud JP, Balon JM, Bonnetain F, Borie F, Brachet D, Brigand C, Carrere N, D’Journo XB, Dechelotte P, Delpero JR, Dhari A, Fabre S, Fernandez M,  Flamein R, Gillet B, Glaise A, Glehen O, Goéré D, Guilbert M, Guiramand J, Hebbar M, Huten N, Kraft K, Leteurtre E, Louis D, Mabrut JY, Mathieu B, Meunier B, Michalak S, Michot F, Millat B, Paye F, Peschaud F, Pezet D, Pocard M, Poisson A, Prudhomme M, Regimbeau JM, Thiébot T, Thomas PA, Tsilividis B, Vandois F.


Author information:

(1)Department of Digestive Surgery, Angers University Hospital, Angers, France.


OBJECTIVE: The aim of this retrospective study was to evaluate the survival impact of perioperative chemotherapy (PCT) in patients with gastric signet ring cell (SRC) adenocarcinoma.

BACKGROUND: PCT is a standard treatment for advanced resectable gastric adenocarcinoma (GA). SRC has a worse prognosis compared to non-SRC and the chemosensitivity of SRC is uncertain.

METHODS: Among 3010 patients registered in 19 French centers between January 1997 and January 2010, 1050 (34.9%) were diagnosed with SRC. Of those treated with curative intent (n = 924), 171 (18.5%) received PCT with surgery (PCT group), whereas 753 (81.5%) were treated with primary surgery (S group). PCT was based mainly on a fluorouracil-platinum doublet or triplet regimen.

RESULTS: The groups were comparable regarding age, gender, American Society of Anesthesiologists (ASA) score, malnutrition, tumor location and cTNM stage. 60 patients did not undergo resection because of tumor progression (10) or metastases (50) found at operation. The R0 resection rates were 65.9% and 62.3% in the S and PCT groups, respectively (P = 0.308). Fewer patients received adjuvant chemotherapy in the S group than in the PCT group (35.2% vs. 66.5%, P <  0.001). At a median follow-up of 31.5 months, the median survival was shorter in  the PCT group (12.8 vs. 14.0 months, P = 0.043). On multivariate analysis, PCT was found to be an independent predictor of poor survival (HR = 1.4, 95% CI 1.1-1.9, P = 0.042).

CONCLUSIONS: PCT provides no survival benefit in patients with gastric SRC. Clinical record: ADCI001, Clinical identifier NCT01249859.


DOI: 10.1097/SLA.0b013e3182352647

PMID: 22005144  [Indexed for MEDLINE]


Ann Surg. 2011 Nov;254(5):684-93; discussion 693. doi: 10.1097/SLA.0b013e3182352647.

Honoré C(1), Goéré D, Messager M, Souadka A, Dumont F, Piessen G, Elias D, Mariette C; FREGAT Working Group – FRENCH.

Collaborators: Arnaud J, Balon J, Borie F, Brachet D, Brigand C, Carrere N, D’Journo X, Dechelotte P, Delpero JR, Dhari A, Fabre S, Fernandez M, Flamein R, Gillet B, Glaise A, Glehen O, Guilbert M, Guiramand J, Huten N, Kraft K, Lefevre  JH, Leteurtre E, Louis D, Mabrut J, Mathieu B, Meunier B, Michalak S, Michot F, Millat B, Paye F, Pichot- Delahaye V, Peschaud F, Pezet D, Pocard M, Poisson A, Prudhomme M, Regimbeau J, Thiébot T, Thomas PA, Tsilividis B, Vandois F.

Author information:

(1)Department of Surgical Oncology, Institut Gustave Roussy, Cancer Center, 114,  rue Edouard Vaillant, 94805 Villejuif, Cedex, France.

Comment in Chirurg. 2013 May;84(5):434.

INTRODUCTION: The poor prognosis of signet ring cell (SRC) eso-gastric adenocarcinoma (EGA) might be explained by its great affinity for the peritoneum. The aim of this study was to identify predictors of peritoneal carcinomatosis recurrence (PCR) after curative surgery and hence identify high risk patients.

METHODS: A retrospective national survey was conducted over 19 French surgical centers between 1997 and 2010. Patients with non-metastatic disease who benefited from curative surgery without postoperative death were included. Event-free patients who did not reach the time point of 24 months were excluded.

RESULTS: In a cohort of 3010 patients, 1050 were SRC EGA and 424 patients met the selection criteria. The tumor location was mainly gastric (68.9%) and a total gastrectomy was performed in 218 patients (51.4%). Chemoradiotherapy or chemotherapy alone was given preoperatively to 71 (16.7%) and postoperatively to  150 (35.4%) patients. After a median follow-up of 54 months, recurrence was diagnosed in 214 patients (50.5%) within a mean delay of 17 ± 10.7 months. PCR was diagnosed in 81 patients (19.1%). In multivariable analysis, four factors were identified as predictors of PCR: linitis plastica (p < 0.001; OR = 4.83), tumor invasion of/or through the peritoneal serosa (p = 0.022; OR = 1.58), lymph  node involvement (p = 0.005; OR = 1.7) and tumors of gastric origin (p = 0.026; OR = 2.36), with PCR rates of 55%, 26%, 23% and 22%, respectively.

CONCLUSION: Identification of strong predictors for PCR among this large series of SRC EGA patients helps to identify subgroups of patients that may benefit from specific therapeutic strategies such as prophylactic hyperthermic intraperitoneal chemotherapy.

Copyright © 2012 Elsevier Ltd. All rights reserved.

DOI: 10.1016/j.ejso.2012.12.013

PMID: 23313257  [Indexed for MEDLINE]

Eur J Surg Oncol. 2013 Mar;39(3):235-41. doi: 10.1016/j.ejso.2012.12.013. Epub 2013 Jan 11.

Hamid M(1), Tbouda M(2), Majbar AM(3), Raiss M(4), Ahallat M(5).


Author information:

(1)Department of Surgery «C», Ibn Sina Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Morocco.

Electronic address:

(2)Department of Anatomopathology, Ibn Sina Hospital, Mohammed V University of Rabat, Faculty of Medicine and Pharmacy, Morocco.

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(3)Department of Surgery «C», Ibn Sina Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Morocco.

Electronic address:

(4)Department of Surgery «C», Ibn Sina Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Morocco.

Electronic address:

(5)Department of Surgery «C», Ibn Sina Hospital, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Morocco.

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Solid serous cystadenoma is an uncommon benign pancreatic tumor, with only, including this case, 21 cases published so far. It is often misdiagnosis with other malignant pancreatic tumors. Below we report a new case of a solid serous cystadenoma of the pancreas treated by laparoscopic distal pancreatectomy in 53-year-old female who presented with epigastric pain. Histological and immunohistochemical examination revealed a solid serous cystadenoma of the pancreas.

Preoperative diagnosis of this subtype of serous cystadenoma is difficult, and, due to its benign nature, conservative resection of the tumor is the recommended treatment. After analyzing the literature, including this case from our department, we discuss clinical presentation, imaging characteristics and histopathological findings, considering in particular difficulties in preoperative diagnosis, feasibility of laparoscopic resection.

Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.


DOI: 10.1016/j.ijscr.2017.09.014

PMCID: PMC5633824

PMID: 28965087


Int J Surg Case Rep. 2017;40:97-101. doi: 10.1016/j.ijscr.2017.09.014. Epub 2017  Sep 23.

El Bacha H(1)(2), Salihoun M(3)(4), Kabbaj N(3)(4), Benkabbou A(3)(5).


Author information:

(1)Faculté de médecine et de pharmacie de Rabat, Mohammed V University, Rabat, Morocco.

(2)Explorations Fonctionnelles Digestives, Ibn Sina Hospital, Rabat, Morocco.

(3)Faculté de médecine et de pharmacie de Rabat, Mohammed V University, Rabat, Morocco.

(4)Explorations Fonctionnelles Digestives, Ibn Sina Hospital, Rabat, Morocco.

(5)Surgical Department A, Ibn Sina Hospital, Rabat, Morocco.


BACKGROUND: Hepatocellular carcinoma has a poor prognosis; few patients can undergo surgical curative treatment according to Barcelona Clinic Liver Cancer guidelines. Progress in surgical techniques has led to operations for more patients outside these guidelines. Our case shows a patient with intermediate stage hepatocellular carcinoma presenting a good outcome after curative treatment.

CASE PRESENTATION: We report the case of an 80-year-old Moroccan man, who was positive for hepatitis c virus, presenting an intermediate stage epatocellular carcinoma (three lesions between 20 and 60 mm). He presented a complete tumor necrosis after portal vein embolization and achieved 24-month disease-free survival after surgery.

CONCLUSIONS: Perioperative care in liver surgery and multidisciplinary discussion can help to extend indications for liver resection for hepatocellular carcinoma outside European Association for the Study of the Liver/American Association for  the Study of Liver Diseases recommendations and offer a curative approach to selected patients with intermediate and advanced stage hepatocellular carcinoma.


DOI: 10.1186/s13256-016-1160-8

PMCID: PMC5210282

PMID: 28049508  [Indexed for MEDLINE]


J Med Case Rep. 2017 Jan 4;11(1):7. doi: 10.1186/s13256-016-1160-8.

Souadka A(1), Naya MS(1), Serji B(1), El Malki HO(1), Mohsine R(1), Ifrine L(1),  Belkouchi A(1), Benkabbou A(1).


Author information:

(1)Surgical Department A, Ibn Sina Hospital, Faculty of Medicine, Mohammed V University in Rabat, Morocco.


INTRODUCTION: Resident participation in laparoscopic cholecystectomy (LC) is one of the first steps of laparoscopic training. The impact of this training is not well-defined, especially in developing countries. However, this training is of critical importance to monitor surgical teaching programmes.

OBJECTIVE: The aim of this study was to determine the impact of seniority on operative time and short-term outcome of LC.

DESIGNS AND SETTINGS: We performed a retrospective study of all consecutive laparoscopic cholecystectomies for gallbladder lithiasis performed over 2 academic years in an academic Surgical Department in Morocco.

PARTICIPANTS: These operations were performed by junior residents (post-graduate year [PGY] 4-5) or senior residents (PGY 6), or attending surgeons assisted by junior residents, none of whom had any advanced training in laparoscopy. All data concerning demographics (American Society of Anesthesiologists, body mass index and indications), surgeons, operative time (from skin incision to closure), conversion rate and operative complications (Clavien-Dindo classification) were recorded and analysed.

One-way analysis of variance, Student’s t-test and Chi-square tests were used as appropriate with statistical significance attributed to P < 0.05.

RESULTS: One hundred thirty-eight LC were performed. No differences were found on univariate analysis between groups in demographics or diagnosis category. The overall rate of operative complications or conversions and hospital stay were not significantly different between the three groups. However, mean operative time was significantly longer for junior residents (n = 27; 115 ± 24 min) compared to  senior residents (n = 37; 77 ± 35 min) and attending surgeons (n = 66; 55 ± 17 min) (P < 0.001).

CONCLUSION: LC performed by residents appears to be safe without a significant

difference in complication rate; however, seniority influences operative time.

This information supports early resident involvement in laparoscopic procedures and also the need to develop cost-effective laboratory training programmes.


DOI: 10.4103/0972-9941.186687

PMCID: PMC5363119

PMID: 28281477


J Minim Access Surg. 2017 Apr-Jun;13(2):131-134. doi10.4103/0972-9941.186687.

Hrora A(1)(2), Majbar AM(1)(2), Elalaoui M(1)(2), Raiss M(1)(2), Sabbah F(1)(2), Ahallat M(1)(2).


Author information:

(1)Clinique Chirurgicale C., Ibn Sina University Hospital, Rabat, Morocco.

(2)Research Group in Colorectal Cancer, Faculty of Medicine, Mohamed V University, Rabat, Morocco.


The aim of this study was to determine the predictable factors for conversion during laparoscopic proctectomies, and for postoperative morbidity, in order to assist in defining the best candidates of patients for initial experience in laparoscopic proctectomies for rectal adenocarcinoma. A retrospective analysis of consecutive patients who underwent laparoscopic rectal resection for rectal adenocarcinoma operated by a single surgeon, between 2005 and 2012, were performed. Predictive factors for conversion and for postoperative morbidity were analyzed using univariate and multivariate analysis. Sixty-nine patients were included.

There were 35 (50.7 %) men with a median age of 53 years. Forty-seven patients had tumors located below 8 cm from the anal verge, and sphincter-preserving surgery was performed in 52 (75.4 %) patients. Thirty-four patients were operated in the early period (before 2009). Conversion rate was 17.4 %. In multivariate analysis, the independent predictive factors for conversion were time period (before 2009) (p = 0.007, Exp. 19.9; CI (95 %) 2.2-177.4) and tumors located 8 cm above the anal verge (p = 0.028, Exp. 5.23, CI (95 %) 1.2-22.8). Twenty-two patients (31.9 %) had a complicated postoperative course. Only male gender was associated with postoperative complications (p = 0.01, CI (95 %) 1.3-11.8).

Our study showed that conversion rate is influenced by surgeon’s experience, and height of the tumor and that male gender  is a predisposing factor for a higher morbidity rate. These results suggest that women with low rectal tumors requiring colo-anal anastomosis or abdomino-perineal resection would be the best candidates for early surgeons’ experience in laparoscopic proctectomies for rectal adenocarcinoma.

DOI: 10.1007/s12262-015-1426-1

PMCID: PMC5386931

PMID: 28442832

Indian J Surg. 2017 Apr;79(2):90-95. doi: 10.1007/s12262-015-1426-1. Epub 2016 Jan 11.

Hamid M(1), Majbar AM(2), Hrora A(2), Ahallat M(2).


Author information:

(1)Faculty of Medicine and Pharmacy of Rabat, Department of Surgery, Ibn Sina Hospital, Mohammed V University of Rabat, Rabat, Morocco.

(2)Faculty of Medicine and Pharmacy of Rabat, Department of Surgery, Ibn Sina Hospital, Mohammed V University of Rabat, Rabat, Morocco.


BACKGROUND: Local recurrence of colorectal cancer is a major cause of morbidity and mortality that usually implies a worse prognosis. Its etiopathogenesis is still a subject of debate. Recurrence on the perineal wound caused by anal retractor device is rarely reported.

CASE PRESENTATION: We present the case of a 75-year-old woman with perineal skin  recurrence on the site of Lone Star Retractor™ from rectal adenocarcinoma. The patient underwent a curative proctectomy followed by a hand-sewn coloanal anastomosis using Lone Star Retractor™ 2 years ago for a tumor of the lower rectum. The recurrence was most likely caused by the seeding of exfoliated tumor  cells into the perianal skin which was abraded by the retractor.

CONCLUSION: This case is the fourth case reported in the literature and

highlights the importance of the use of less traumatic endoanal retractors to prevent such perianal recurrence. Recurrence on the perineal wound caused by anal retractor device is rare but possible. Further studies are needed to define preventive measures able to reduce cutaneous implants.

DOI: 10.1186/s40792-017-0405-0

PMCID: PMC5745204

PMID: 29282589

Surg Case Rep. 2017 Dec 28;3(1):130. doi: 10.1186/s40792-017-0405-0.

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