Background. Recent studies suggested substantial differences between primary tumors and metastases for EGFR expression in colorectal cancer (CRC). The aim of the study was to correlate the expression of a panel of molecular markers between primary CRC samples and metastases. Methods. Expressions of EGFR, pEGFR, VEGF, pVEGF, PTEN, pAKT and p21 were analyzed in 28 primary tumors and 32 liver metastases by immunohistochemistry performed on formalin-fixed, paraffin-embedded sections from 46 CRC patients. The molecular profiles were evaluated by tissue micro-array. The correlation between tumor and metastasis biomarker expressions was tested. Results. Among 60 CRC samples, 25% were EGFR positive, 38% were pEGFR positive, 38% were VEGF positive, 48% were pVEGF positive, 70% were pAKT positive and 51% were p21 positive. PTEN was deleted in 39% of cases and absence of p21 expression was found in 49% of cases. A significant correlation was observed between primary tumors and metastases for pAKT (p = 0.037) and pEGFR (p = 0.0002) status. In patients treated with cetuximab-based therapy (n = 18), p21 appeared as a significant predictive factor of response (p = 0.036). Conclusion. Biomarkers status may change between primary and metastatic sites in CRC, with potential implications for the identification of patients who are likely to respond to anti-EGFR treatment.triangle

Objective. -The use of ultrasonography is widespread for both the diagnosis and treatment of liver tumors. However, the measurement of liver volume by ultrasonography is not commonty done. We report an original method of liver volumetry using ultrasonography and an investigation into the usefulness of ultrasonography in this context.Methods. -The data for 50 patients undergoing various types of major hepatectomy were collected. We preoperatively measured liver volume using ultrasonography, dividing the liver into three main compartments according to precise anatomical landmarks, and then made comparisons with the volume of the actual specimen after hepatectomy, for all of the study participants.Results. -Total volume correlation between the two groups was good (r = 0.916, P < 0.001). However, the correlation was weaker in cases of right hepatectomy compared with other types of hepatectomy.Conclusion. -This study demonstrates the possibility of doing liver volumetry using an ultrasound device. Further investigation to establish the reliability of this easily available and noninvasive approach is needed. (C) 2008 Elsevier Masson SAS. All rights reserved.

Technical advances that has been achieved during the past two decades have not dramatically improved the 35% five-year survival rate observed in patients with colorectal cancer. these tumours remain one of the most challenging problems in public health policies in western countries. Screening applies to some subgroups of high-risk individuals and the general population aged over 50. In order to improve their efficacy, such screening programs imply large-scale information campaigns and a strong cooperation with the general physicians. any recent modification of bowel habits and by rectal bleeding. It has to be confirmed by rectal examination and by colonoscopy which allows sampling of the tumour. Loco-regional and distant metastatic tumour spread must be assessed precisely before any therapeutic strategy is decided. Surgery, which resects the tumour en bloc with the corresponding lymphatic territories, is the only treatment that can achieve long term cure. In localized tumours, surgery alone can provide patients with 5-years survival rates close to 95%. On the other hand, surgery alone is not sufficient to cure patients with advanced cancers. In recent years, several adjuvant therapeutic modalities have been shown to improve the results of surgery in these cases (rectal cancer: pre-operative radiotherapy or post-operative radio-chemotherapy, colon cancer with nodal metastases: post-operative chemotherapy). There is a hope that a better use of our diagnostic and therapeutic armementarium would be able to avoid or to cure up to 75% of the colorectal cancers we are dealing with.

The emergence of interventional endoscopy and of laparoscopic surgery has radically modified the therapeutic options when dealing with biliary lithiasis. The clinical diagnosis of acute cholecystitis is often confirmed by ultrasonography. The cholecystectomy, which has to be performed within a few hours after the diagnosis, can be conducted laparoscopically in some selected patients and by skilled surgeons. Clinical examination, abnormalities of liver function tests and imaging techniques allow the diagnosis of acute cholangitis with a good reliability. The choice between the different therapeutic options depends on the severity of the patient's condition and his age. In patients with severe acute cholangitis, there is an urgent need to drain the common bile duct and, if possible, to clear it from stones. In young patients with a low operative risk, the complete treatment of both bladder and common bile duct lithiasis is usually achieved through an open laparotomy. In aged and high-risk patients, the endoscopic sphincterotomy is able to achieve these goals and has become the method of choice since it reduces drastically mortality and morbidity rates. The common bile duct can be cleared endoscopically from stones at first intent or after insertion of a nasobiliary drainage allowing decompression of the biliary tree and washouts with antibiotics. The endoscopic route is particularly indicated in patients with residual bile duct stones after cholecystectomy. in the other ones, the way to treat the gallbladder stones has to be discussed. The crucial preoperative diagnosis of associated bile duct stones is usually suspected clinically, biologically and by imaging techniques before cholecystectomy. It can be made preoperatively by retrograde cholangiography or endoscopic ultrasonography. In case of demonstrated stones, their endoscopic treatment followed by a laparoscopic cholecystectomy a few days later is currently being assessed. This diagnosis can also be made during cholecystectomy by routine cholangiography, and is followed by the treatment in the same session. At present, the full laparoscopic treatment of both gallbladder and bile duct stones has not been assessed.

The extent of an hepatectomy is limited by the degree of liver insufficiency induced by the resection of a certain amount of functional parenchyma and by the ability of the remnant liver to regenerate which is considerably diminished in cirrhotic liver. Mortality and morbidity rates after liver resections are related to the amount of intra- and post-operative blood loss, to the complexity of the resection, and to the volume and the function of the remnant liver. As resectional techniques and those used to reduce blood loss are now well-known, the surgeon has to spare the largest amount of nontumoral parenchyma provided the carcinologic rules are fulfilled. The preoperative assessment of the remnant volume of liver after resection can be predicted with reliability but no relationship has been established with the functional aspect. The liver function Child-Pugh scoring system and the clearance of indocyanin green are still the best factors that can be used to predict the risk of post-operative liver failure. Each of these factors which is not fully reliable by itself has to be associated one with the others. There is a need for search and assessment of known and new factors that can be able to predict liver failure after hepatectomy.