PURPOSE:Standard adjuvant treatment for stage III colorectal cancer (CRC) combines intravenous oxaliplatin with a fluoropyrimidine, either with intravenous 5-fluorouracil with folinic acid oxaliplatin, capecitabine (CAPOX). This study aims to describe the toxicity of these two regimens in patients with a diverting stoma. METHODS:We conducted a retrospective, single-center study of patients with stage III CRC who had a diverting stoma and received adjuvant treatment with either FOLFOX or CAPOX between January 2016 and July 2023. Clinical characteristics and treatment details were extracted from electronic health records. The primary end point was the rate of hospitalization during adjuvant chemotherapy. Secondary end points included treatment compliance and toxicity. RESULTS:A total of 87 patients with CRC and a diverting stoma received treatment with either CAPOX (n = 37) or modified FOLFOX regimen: oxaliplatin, 5-fluorouracil, folinic acid (mFOLFOX6)  (n = 50). No patient had dihydropyrimidine dehydrogenase deficiency. Baseline clinical characteristics were similar between groups. The hospitalization rate was 35% with CAPOX and 18% with FOLFOX (P = .07). Most hospitalizations occurred during the first cycles of adjuvant treatment and were primarily related to digestive toxicities. Higher hospitalization rates with CAPOX were observed across all subgroups, regardless of sex, age, performance status, or renal function. CONCLUSION:Patients with a diverting stoma who receive adjuvant chemotherapy with fluoropyrimidines and oxaliplatin are at higher risk of severe digestive toxicities when treated with the CAPOX regimen. The mFOLFOX6 regimen appears to be safer alternative in this population.

Introduction La majorité des récidives après œsophagectomie surviennent dans les deux premières années. En France, la surveillance postopératoire est habituellement conduite pendant cinq ans. Cependant, des rechutes plus tardives ont été rapportées, soulevant la question de la pertinence d’un suivi prolongé. Méthodes Une étude rétrospective bicentrique a été menée au CHU de Lille et à l’hôpital Saint-Antoine. Ont été inclus les patients opérés d’un cancer de l’œsophage à visée curative entre 2009 et 2015, vivants et indemnes de récidive à cinq ans. Les récidives tardives (≥5 ans) et les seconds cancers primitifs ont été recensés et leurs facteurs associés analysés. Résultats Parmi 664 patients opérés, 229 remplissaient les critères d’inclusion. Douze patients (5,2 %) ont présenté une récidive tardive, dont 50 % métastatiques, survenant jusqu’à 107 mois après la chirurgie. En analyse multivariée, cinq variables étaient indépendamment associées à une diminution de la survie sans récidive : le sexe masculin (OR=6,09 ; p=0,001), les antécédents néoplasiques (OR=2,28 ; p=0,048), la radiochimiothérapie néoadjuvante (OR=3,18 ; p=0,002), le carcinome épidermoïde (OR=2,22 ; p=0,022) et les marges de résection non saines (OR=56,32 ; p=0,001). Seize patients (6,9 %) ont développé un second cancer primitif, principalement ORL ou pulmonaire. La radiochimiothérapie néoadjuvante était associée à un risque accru de seconde localisation (OR=2,64 ; p=0,011). Conclusion Un risque évolutif persiste au-delà de cinq ans après œsophagectomie curative, sous forme de récidives tardives (5 %) et de seconds cancers primitifs (6,9 %). Ces résultats remettent en question l’arrêt systématique du suivi à cinq ans et plaident pour une surveillance prolongée et individualisée.

INTRODUCTION:The majority of recurrences after esophagectomy occur within the first two years. In France, postoperative follow-up usually continues for five years. However, later relapses have been reported, raising the question of whether prolonged follow-up is indicated. METHODS:A retrospective, two-center study was conducted at the University Hospital of Lille and Saint-Antoine Hospital in Paris. The study included patients who had undergone curative esophageal cancer surgery between 2009 and 2015, and were alive and free of recurrence at five years. Late recurrences (≥5 years) and second primary cancers were identified and their associated factors analyzed. RESULTS:Of 664 patients who underwent resection of esophageal cancer, 229 met the inclusion criteria. Twelve of these patients (5.2%) experienced a late recurrence, 50% of which were metastatic, occurring up to 107 months after surgery. In multivariable analysis, five variables were independently associated with decreased recurrence-free survival: male sex (OR=6.09; P=0.001), prior cancer history (OR=2.28; P=0.048), neoadjuvant chemoradiotherapy (OR=3.18; P=0.002), squamous cell carcinoma (OR=2.22; P=0.022), and positive-margin resections (OR=56.32; P=0.001). Sixteen patients (6.9%) developed a second primary cancer, mainly head and neck or lung cancer. Neoadjuvant chemoradiotherapy was associated with an increased risk of a second cancer site (OR=2.64; P=0.011). CONCLUSION:A residual risk of disease progression persists beyond five years after curative esophagectomy, in the form of late recurrences (5%) and second primary cancers (6.9%). These findings challenge the systematic discontinuation of follow-up at five years and support a prolonged and individualized surveillance strategy.

Background:In locally advanced esophagogastric adenocarcinoma (EGA), perioperative chemotherapy is the standard of care and can result in complete/major pathological response. In this setting, real-world data on the impact of postoperative chemotherapy are scarce. Objective:The primary objective was to assess the impact of postoperative chemotherapy on overall survival (OS) in cases of complete/major pathological response and/or no serosal involvement. Secondary endpoints were disease-free survival (DFS) and the identification of predictive factors associated with OS. Design:A retrospective comparative multicentric study was conducted using the nationwide, prospectively collected FREGAT (FRench EsoGAstric Tumor) database. Methods:Patients with EGA treated with perioperative chemotherapy registered in the FREGAT database who had a complete/major pathological response and/or no serosal involvement (ypT0-2 or ypT3 Mandard TRG 2, ypN0, R0) were included. Results:Among 1870 patients with EGA treated with perioperative chemotherapy identified in the FREGAT database, 345 met the inclusion criteria, and 218 (63.2%) received postoperative chemotherapy. Postoperative chemotherapy was associated with OS improvement regardless of the regimen used (median OS: not achieved vs 65.7 months; p < 0.0001). Similarly, DFS was improved with postoperative chemotherapy (median DFS: not achieved vs 65.7 months; p < 0.0001). In multivariable analysis, age, primary tumor location, postoperative complications, and no postoperative chemotherapy were associated with poorer survival outcomes. Conclusion:Postoperative chemotherapy after resection of EGA with complete/major pathological response and/or tumors without serosal involvement remains the standard of care, improves survival outcomes, and should be recommended when the patient's condition allows it.

Importance Antibiotic-only management (AOM) for uncomplicated acute appendicitis is increasingly adopted, raising concern about missed appendiceal neoplasms. Objective To assess the prevalence, histologic spectrum, and predictors of incidental appendiceal tumors after appendectomy for acute appendicitis. Design, Setting, and Participants This single-center retrospective cohort study was conducted from January 1, 2013, to December 31, 2021, at the tertiary surgical emergency center at Saint-Antoine Hospital in Paris, France. All consecutive adult patients undergoing appendectomy for acute appendicitis were eligible for inclusion. Data were analyzed in June 2025. Exposure Standard surgical management with appendectomy (no AOM); preoperative clinical variables, laboratory values, and imaging findings were assessed as potential predictors of appendiceal tumors. Main Outcome and Measures Prevalence and histopathological classification of incidental appendiceal neoplasms identified after appendectomy for acute appendicitis and preoperative clinical and radiologic factors associated with aggressive tumors. Results Among the cohort, median (IQR) age was 32 years (25-43), and 999 patients (44%) were female. Among 2293 appendectomies, 37 (1.6%) had malignant or premalignant lesions and 8 (0.3%) had benign nondysplastic lesions. Neuroendocrine tumors (NETs) (n = 22) predominated; all were grade 1 (G1) and smaller than 2 cm, with 19 (86%) measuring 1 cm or less without recurrence after 34 months of follow-up. Other lesions included low-grade appendiceal mucinous neoplasms (n = 5), metastatic tumors (n = 3), goblet cell carcinomas (n = 2), mucinous adenocarcinoma (n = 1), and low-grade dysplastic polyps (n = 4). Compared with nonneoplastic appendicitis, aggressive tumors (putting aside G1 NETs <2 cm and low-grade dysplasia) occurred more often in older patients (median [IQR] age, no malignant lesions: 32 years [25.0-43.0] vs malignant lesions: 45.0 years [37.8-57.2]; P = .03), with longer median symptom duration (no malignant lesions: 2 days vs malignant lesions: 1 day; P < .001), larger median (IQR) appendiceal diameter (no malignant lesions: 11.0 mm [9.0-13.0] vs malignant lesions: 18.0 mm [14.0-25.5]; P < .001), and radiologic suspicion of complicated appendicitis (no malignant lesions: 287 of 2234 [13%] vs malignant lesions: 6 of 11 [55%]; P = .001). In dedicated univariate analysis, NETs could not be distinguished from nonneoplastic appendicitis by any clinical or radiological variables tested. Using eligibility criteria for AOM derived from the univariate analysis (abdominal pain duration <14 days; age <60 years; and on imaging: uncomplicated appendicitis, appendiceal diameter <15 mm, and absence of suspicious appendiceal, peritoneal, hepatic, or bone lesions), none of the patients with aggressive tumors met the entirety of these criteria. However, 17 of 22 small G1 NETs (77%) and 1 of 4 low-grade dysplastic polyps (25%) fulfilled these criteria. By grouping all these selection criteria, 74% of the cohort met eligibility criteria for potential AOM; within the subgroup with uncomplicated appendicitis, 85% would have been eligible. Conclusions and Relevance In this single-center cohort study, incidental appendiceal tumors were mostly small and low-grade NETs; aggressive malignancies were exceptional and occurred in identifiable high-risk profiles. Applied assembled preoperative selection criteria reliably excluded patients with aggressive tumors, thereby supporting the oncologic safety of AOM in rigorously selected individuals.

OBJECTIVE:Evaluate the feasibility of early radical enterocutaneous fistula (ECF) surgery. BACKGROUND:After failure of medical treatment for ECF, the optimal timing of surgical reintervention remains debated. METHODS:Patients undergoing radical ECF surgery to treat postoperative small bowel- ECFs and/or colon-ECFs (2005-2024) were retrospectively included. Success was defined as no remnant ECF or ECF-related stoma at the most recent follow-up and absence of 90-day postoperative mortality. Early ECF surgery was defined as planned surgery (urgent procedures excluded) occurring within 4 months of the last abdominal procedure. RESULTS:Among 200 patients (median 62 years; 43% female; 40% American Society of Anesthesiologists ≥ 3), 77% had small bowel-ECF only, 12% colon-ECF only and 11%. both. Eighty-two percent were referred, with a median delay of 48 days [interquartile range (IQR): 8-200] after ECF diagnosis. Referral center management lasted 34 days (IQR: 3-90), with 10% exceeding 120 days. After excluding 22 emergency procedures, early ECF surgery was performed in 39% (70/178). Early-surgery patients had fewer respiratory comorbidities (9% vs 21%; P = 0.036) and shorter ECF diagnosis-to-transfer interval (16 days vs 145; P = 0.001). Early surgery did not impact operative time ( P = 0.312), mortality ( P = 0.091), severe morbidity ( P = 0.867), and reoperations ( P = 0.511). After a median follow-up of 12 months, the success rate was 74% (permanent stomas = 11%; recurrence = 17%). American Society of Anesthesiologists ≥ 3 ( P = 0.012) and malignancies ( P = 0.010) were independently associated with failure on multivariate analysis, whereas ECF-origin ( P = 0.924) and surgical timing ( P = 0.438) were not. CONCLUSIONS:For postoperative small bowel/colon ECF, the success rate of radical surgery is 74%. Early surgery seems feasible (39%) and does not compromise success. Further prospective studies are needed.

OBJECTIVE:To evaluate the necessity of postoperative antibiotics following appendectomy for acute appendicitis, particularly in patients with intra-abdominal fluid, and to identify factors associated with postoperative infections. BACKGROUND:Postoperative antibiotic use after appendectomy remains controversial, especially in the presence of intra-abdominal fluid. While some surgeons prescribe antibiotics empirically, there is no consensus on whether they reduce the risk of postoperative infections in patients with intra-abdominal fluid accumulation. METHODS:A retrospective study was conducted at Saint Antoine Hospital (2013-2020) analyzing 1,539 patients with acute appendicitis (abscess and peritonitis were excluded). The presence of intra-abdominal fluid, antibiotic use, and postoperative outcomes were recorded. Risk factors for infections were identified through univariate and multivariate analysis. RESULTS:Intra-abdominal fluid was present in 880 patients(57.2%), with 474 exhibiting sero-sanguinous intra-abdominal fluid and 406 presenting purulent intra-abdominal fluid. Postoperative antibiotics were administered to 18.1% of patients, yet no significant difference in infection rates was found between patients with and without peritoneal intra-abdominal fluid . The study identified three independent risk factors for postoperative infection: ASA score (HR=5.129,P=0.004), symptom duration>2 days (HR=2.290,P=0.029), and the presence of appendicolith (HR=2.204,P=0.042). Postoperative antibiotic use did not significantly prevent infections, but inadequate antibiotic therapy was associated with higher rates of readmission and infectious outcomes. CONCLUSION:Routine use of postoperative antibiotics for acute appendicitis, even with intra-abdominal fluid may not be necessary. Further research is needed to determine whether a targeted antibiotic approach based on risk factors for postoperative infections can improve outcomes without exacerbating antibiotic resistance.

Objective:Evaluate the feasibility of early radical enterocutaneous fistula (ECF) surgery.Background:After failure of medical treatment for ECF, the optimal timing of surgical reintervention remains debated.Methods:Patients undergoing radical ECF surgery to treat postoperative small bowel- ECFs and/or colon-ECFs (2005-2024) were retrospectively included. Success was defined as no remnant ECF or ECF-related stoma at the most recent follow-up and absence of 90-day postoperative mortality. Early ECF surgery was defined as planned surgery (urgent procedures excluded) occurring within 4 months of the last abdominal procedure.Results:Among 200 patients (median 62 years; 43% female; 40% American Society of Anesthesiologists >= 3), 77% had small bowel-ECF only, 12% colon-ECF only and 11%. both. Eighty-two percent were referred, with a median delay of 48 days [interquartile range (IQR): 8-200] after ECF diagnosis. Referral center management lasted 34 days (IQR: 3-90), with 10% exceeding 120 days. After excluding 22 emergency procedures, early ECF surgery was performed in 39% (70/178). Early-surgery patients had fewer respiratory comorbidities (9% vs 21%; P = 0.036) and shorter ECF diagnosis-to-transfer interval (16 days vs 145; P = 0.001). Early surgery did not impact operative time (P = 0.312), mortality (P = 0.091), severe morbidity (P = 0.867), and reoperations (P = 0.511). After a median follow-up of 12 months, the success rate was 74% (permanent stomas = 11%; recurrence = 17%). American Society of Anesthesiologists >= 3 (P = 0.012) and malignancies (P = 0.010) were independently associated with failure on multivariate analysis, whereas ECF-origin (P = 0.924) and surgical timing (P = 0.438) were not.Conclusions:For postoperative small bowel/colon ECF, the success rate of radical surgery is 74%. Early surgery seems feasible (39%) and does not compromise success. Further prospective studies are needed.

BACKGROUND:Smoking is a major risk factor for esophageal squamous cell carcinoma (ESCC) and is linked to increased postoperative morbidity. However, its impact on long-term survival remains unclear. This study evaluated the influence of preoperative smoking status on postoperative complications and survival following esophagectomy for ESCC in a high-volume center. METHODS:Patients who underwent surgery for ESCC between 1996 and 2019 were retrospectively categorized as smokers (S-group) or non-smokers (NS-group). A subgroup analysis was performed to compare active and former smokers. Primary outcomes included major postoperative complications (Clavien-Dindo ≥ III), pulmonary complications, and postoperative mortality at 30 and 90 days. Long-term outcomes included overall survival (OS) and recurrence-free survival (RFS). RESULTS:Among 694 patients, 97 (14%) were in the NS-group and 597 (86%) in the S-group. Smokers had significantly higher major morbidity rates (37% vs 23%, P = .002), including major pulmonary complications (29% vs 21%, P = .03). Active smoking was associated with increased 30-day mortality (P = .006) and higher rates of acute respiratory distress syndrome (P = .012) compared to former smokers. OS and RFS did not differ significantly between groups. The absence of post-operative smoking data limits long-term outcome interpretation. CONCLUSION:Smoking was associated with increased perioperative morbidity, particularly pulmonary complications, but its effect on long-term survival remains uncertain. Structured smoking cessation programs should be integrated into perioperative care. Future studies should incorporate postoperative smoking status to better assess its impact on survival.

BACKGROUND:The efficacy of the laparoscopic approach for total gastrectomy (TG) in Western countries remains under discussion. Recently, textbook outcome (TO) has gained recognition as a comprehensive measure of quality of care in upper gastrointestinal surgery. Although predictive factors for TO after TG are well documented, the influence of the surgical approach requires further analysis. This study aimed to compare the TO completion rate after TG for gastric cancer between the open (OTG) and laparoscopic TG (LTG) approaches. METHODS:TO was defined by 10 criteria: (1) absence of intraoperative complications, (2) macroscopically complete resection, (3) R0 margin, (4) retrieval of ≥15 lymph nodes, (5) absence of postoperative complications with Clavien-Dindo grade ≥ 2, (6) no surgical reintervention within 30 days, (7) no unplanned intensive care unit admission within 30 days, (8) no mortality within 30 days, (9) length of stay ≤ 21 days, and (10) no readmission within 30 days. Propensity score matching was used to adjust for potential selection bias. Predictive factors associated with TO were identified through univariate and multivariate analyses. RESULTS:Among the 188 patients, 34 underwent LTG. TO was achieved in 46.8% of cases, with no significant difference between OTG and LTG (45.5% vs 52.9%; P =.43). After propensity score matching, similar outcomes were observed (44.1% vs 52.9%; P =.47). However, LTG was associated with fewer postoperative complications of Clavien-Dindo grade ≥ 2 (P =.049), particularly pulmonary complications (P =.041). CONCLUSION:This study confirms the feasibility and safety of LTG for cancer. The laparoscopic approach yields a TO completion rate comparable with that of the open approach while reducing postoperative complications.

BACKGROUND:Oesophageal cancer is metastatic at diagnosis in 40 % of cases, with liver metastasis (LM) being the second most frequent site. In oligometastatic patients, the survival benefit of ablative therapy over chemotherapy remains unclear. This study aims to evaluate the impact of liver resection on overall and progression-free survival in patients with limited LM from Oesophageal Adenocarcinoma (OA) or Siewert I-II Oeso-Gastric Junction Adenocarcinoma (OGJA). METHODS:This retrospective, multicenter national study included patients treated between 2000 and 2015 in 17 centers. Eligible patients had OA or OGJA, WHO performance status ≤2, and ≤3 resectable, isolated LM. Patients were assigned to two groups: LM ablation with systemic chemotherapy (ablation group) or systemic chemotherapy alone (control group). Exclusion criteria included age >75, extrahepatic disease, non-operable patients, or those who cannot be included in a chemo(radio)therapy-based treatment strategy. RESULTS:Fifty-four patients were included: 31 in the ablation group (57 %) and 23 in the control group (43 %). Both groups were comparable in terms of demographic characteristics, OA, cTNM stage, LM number (p = 0.166) and size (p = 0.622), and timing of metastasis. Postoperative mortality at 90 days was 3.2 %, and severe complications (Clavien-Dindo ≥3) occurred in 12.9 %. Median follow-up was 72 months. Median overall survival and progression-free survival were significantly longer in the ablation group: 36.7 vs. 14.9 months, and 17.7 vs. 9.0 months respectively. LM ablation and pN + status were independently associated with OS. In the ablation group, pN + remained a significant prognostic factor. CONCLUSION:Liver resection for isolated LM in OA and OGJA improved overall and progression-free survival compared to chemotherapy alone. A curative-intent approach is feasible in selected patients.

Abstract Background International guidelines for locally advanced esophageal squamous cell carcinoma (ESCC) recommend both neoadjuvant chemoradiotherapy (nCRT) followed by planned surgery (P-surg) or definitive chemoradiotherapy (dCRT) with salvage surgery (S-surg). However, the optimal treatment remains unknown, and the ongoing pragmatic NEEDS randomized trial is assessing the efficacy of an organ-preserving strategy after dCRT (Nilsson, Front Oncol 2022). Real-world data on the management of non-metastatic ESCC is limited. This study aims to describe the treatment strategies and prognosis of patients with non-metastatic ESCC in a real-world setting. Methods We conducted a retrospective cohort study of patient treated for non-metastatic ESCC between 2014 and 2022. Data were extracted from the FREGAT database. For the entire population, different treatment strategies were described. We compared patients who received nCRT with those who received dCRT under real-life conditions (“Real-life” population) and according to the NEEDS randomized trial criteria (“NEEDS-like” population). Five-year overall survival (OS) and relapse-free survival (RFS) were compared between nCRT and dCRT patients using a Cox proportional hazard model adjusting for major confounders. In operated patients, the impact of surgery on OS and RFS was assessed using a time-dependent Cox proportional hazard model. Postoperative outcomes were compared between P-surg and S-surg using Fisher’s exact test. Results From 971 patients diagnosed with non-metastatic ESCC, 867 (89.3%) received a curative treatment including dCRT (41.0%), nCRT (28.0%), primary esophagectomy (9.8%), neoadjuvant chemotherapy (3.4%), or endoscopic resection (1.0%). Fifty-nine patients (6,1%) received supportive care or chemotherapy alone. Forty-five patients (4.6%) died during or before treatment. In the “real-life” population (n=659), 269 patients received nCRT and 390 patients received dCRT. A total of 229 patients (93.5%) in nCRT group underwent P-surg and S-surg was performed in 44 patients (11.3%) in dCRT group. After adjustment, dCRT was associated with a significantly poorer 5-year OS and RFS (respectively HR=1.83, 95%CI 1.44-2.33; HR=1.98, 95%CI 1.57-2.49). A complete clinical response (cCR) was observed in 21.6% and 29.5% of the nCRT and dCRT groups, respectively. Among cCR undergoing resection, 35.8% had residual disease on pathological specimen. Time between CRT and surgery was 58 days (IQR44-72) vs. 109 days (IQR71-278) for P-surge and S-Surg respectively. The 90-day mortality, major morbidity (Clavien-Dindo III/IV) and pulmonary complication rates were similar in both groups, except for a higher risk of anastomotic leakage after S-surg (p=0.05). In the “NEEDS-like” population (n=598), findings were consistent and comparable to those observed in the “real-life” population. Conclusion Among non-mestastatic ESCC included in the FREGAT database, 10.6% had a non-curative approach or died prematurely. Most patients underwent dCRT, with S-surg rate of only 11.3%. Neoadjuvant CRT followed by P-surg was associated with the best outcome in terms of OS and RFS in both “rela life” and “Needs-like” populations. In operated patients, postoperative outcomes were similar after nCRT and dCRT, except for a higher incidence of anastomotic leakage after S-surg. This study highlighted the therapeutic strategies used and their results in real-life conditions for non-metastatic ESCC inside the FREGAT database. The treatment option of nCRT followed by P-surg appears to remain the optimal curative treatment regimen.

Despite our increased understanding of the biological and molecular aspects of gastro-oesophageal tumourigenesis, the identification of prognostic or predictive factors remains challenging. Patients with resectable gastric and oesophageal adenocarcinoma are often treated similarly after surgical resection, regardless of their tumour biology, clinical characteristics, and histological treatment response. Substantial progress has been made in the past 5 years in managing patients with gastric or oesophageal adenocarcinoma, including the use of immune checkpoint inhibitors and new targeted therapies, leading to substantial improvements in clinical outcomes. These advancements have primarily been established in advanced and metastatic disease, while the management framework for local and locoregional disease is just beginning to shift. We provide an overview of existing data on biomarkers and tumour-related and host-related factors that are relevant to stratify patients into low-risk and high-risk recurrence groups, both before and after surgery, paving the way for more personalised treatment approaches.

Some patients with inflammatory bowel disease (IBD) require subtotal colectomy (STC) with ileostomy. The recent literature reports a significant number of patients who do not undergo subsequent surgery and are resigned to living with a definitive stoma. The aim of this work was to analyse the rate of definitive stoma and the cumulative incidence of secondary reconstructive surgery after STC for IBD in a large national cohort study. A national retrospective study (2013–2021) was conducted on prospectively collected data from the French Medical Information System Database (PMSI). All patients undergoing STC in France were included. The association between definitive stoma and potential risk factors was studied using univariate and multivariate analyses. A total of 1860 patients were included (age 45 ± 9 years; median follow-up 30 months). Of these, 77% ( n  = 1442) presented with ulcerative colitis. Mortality and morbidity at 90 days after STC were 5% ( n  = 100) and 47% ( n  = 868), respectively. Reconstructive surgery was identified in 1255 patients (67%) at a mean interval of 7 months from STC. Seveny-four per cent ( n  = 932) underwent a completion proctectomy with ileal pouch anal anastomosis and 26% ( n  = 323) an ileorectal anastomosis. Six hundred and five (33%) patients with a definitive stoma had an abdominoperineal resection ( n  = 114; 19%) or did not have any further surgical procedure ( n  = 491; 81%). Independent risk factors for definitive stoma identified in multivariate analysis were older age, Crohn's disease, colorectal neoplasia, postoperative complication after STC, laparotomy and a low-volume hospital. We found that 33% of patients undergoing STC with ileostomy for IBD had definitive stoma. Modifiable risk factors for definitive stoma were laparotomy and a low-volume hospital.

A floppy Nissen fundoplication with valve calibration (FNF-VC) performed by laparotomy has been described, to reduce postoperative dysphagia and gas bloating after 360°-fundoplication. As laparoscopy is the gold standard for fundoplication, this study reports the first results of a modified FNF-VC adapted for laparoscopy (LFNF). Seventy-two consecutive patients, who underwent LFNF for refractory GERD between 2012 and 2021, were included. Postoperative outcomes and quality of life (QoL) by GERSS, GERD-HRQL, and GIQLI scores before and after surgery were assessed. The main symptoms were pyrosis (81

Introduction The impact of overweight and obesity on pathological outcomes, complications, and oncologic outcomes following surgery for gastric adenocarcinoma has been poorly reported in Western populations. This study aimed to better understand the impact of overweight and obesity on both surgical and oncological outcomes in patients who underwent surgery for gastric cancer. Methods Data were retrospectively collected from a multi-institutional European database. 1589 patients underwent surgery for gastric adenocarcinoma between 2007 and 2017. Patients were divided into three groups according to their body mass index (BMI): 722 normoponderal patients (45.4%), 585 overweight patients (36.8%), and 282 obese patients (17.7%). Results The tumor stage, administration of perioperative chemotherapy, number of harvested lymph nodes, and reoperation rates were similar. Tumor location differed between the groups, with more distal locations in normoponderal patients than in overweight patients (51.4% vs. 44.1%, p = 0.04). Surgical complications were more frequent in obese patients than in normoponderal patients (34.8% vs. 24.2%, p= 0.005), and severe postoperative complications too. The medical complication rate was higher in overweight and obese patients (31.5% and 32.6% vs. 24.1%, p= 0.003). There was no difference in the overall survival. Conclusions Obesity was not related to tumor stage, pre- or intraoperative strategies, or survival in patients undergoing surgery for gastric adenocarcinoma. However, postoperative morbidity increases in patients with obesity. Surgery for gastric adenocarcinoma should be proposed for all patients and should be performed as usual, regardless of their BMI. However, obese patients should be counseled regarding the higher risk of postoperative complications.

AIM:Diverting ileostomy (DS) after restorative proctocolectomy (RPC) can be omitted in selected patients. Its omission could improve functional outcomes and quality of life (QoL), as has been demonstrated in patients after proctectomy. The aim of this study was to report the impact of diverting ileostomy on functional outcomes and QoL after ileal pouch-anal anastomosis (IPAA). METHODS:This was a retrospective study including all patients operated (2015-2020) for RPC with IPAA. Functional outcome was evaluated by validated scores (LARS, Wexner, Öresland, pouch functional score [PFS] and the ileoanal pouch syndrome severity [IPSS] score). Global health-related QoL was evaluated with the SF-36. We also analysed demographic characteristics, morbidity, correlation between functional outcomes and QoL. RESULTS:Among 179 eligible patients, 150 responded (84%): S- (no stoma = 78; 52%) and S+ (had stoma = 72; 48%). Overall morbidity and anastomotic leak rates were 46% and 9.3%, respectively without difference between the groups. Medians for the functional scores were comparable between the S- and S+ group, respectively: 18 [12.5-31] versus 18 [11-31], p = 0.48 for LARS; 9 [7-11] versus 9 [7-12], p = 0.23 for Wexner's score; 6 [3-13] versus 8 [5-11], p = 0.22 for Öresland's score, 6 [3-13] versus 6.8 [4-12], p = 0.174 for PFS score, and 40 [35-45] versus 46 [42-51], p = 0.045 for IPSS score. The SF-36 summary score was comparable between the two groups without any difference in eight specific health dimensions. After propensity score matching, results were still comparable between the two groups for all scores. Linear regression found a significant correlation between all QoL domains and all functional scores (p < 0.001). CONCLUSION:DS for IPAA does not alter either functional outcomes or QoL and can be omitted in selected patients.

BACKGROUND:Data in the literature suggest that obstruction is an independent predictor of poor prognosis in colon cancer. Of all possible sites of recurrence, peritoneal metastases are associated with worse survival. Our aim was to report the incidence of metachronous peritoneal metastases from a cohort of patients undergoing resection of obstructive colon cancer with curative intent and to identify predictive factors for metachronous peritoneal metastases. METHODS:From 2000 to 2015, a total of 2,325 patients were treated for obstructive colon cancer in French surgical centers, members of the French National Surgical Association (AFC). Patients with palliative management, synchronous metastatic disease, and with postoperative mortality were excluded. A multivariate analysis was performed to determine independent predictive factors of metachronous peritoneal metastases. RESULTS:The cohort included 1,085 patients. The median follow-up was 21.5 months. Metachronous peritoneal metastases occurred in 12% of patients and were diagnosed after a median interval of 13.5 months. The cumulative 3-year metachronous peritoneal metastasis rate was 10.9%. Three-year overall survival was 85% for patients who did not develop recurrence, 71% for those who develop recurrence without peritoneal metastases, and 56% for those with metachronous peritoneal metastases (P < .0001). In multivariate analysis, 3 variables were identified as independent risk factors for metachronous peritoneal metastases: pT4 stage (odds ratio: 1.98; 95% confidence interval: 1.17-3.36; P = .011), pN2 stage (odds ratio: 2.57; 95% confidence interval: 1.89-4.45; P = .0007), and fewer than 12 lymph nodes examined (odds ratio: 2.01; 95% confidence interval: 1.08-3.74; P = .028). CONCLUSION:This study showed a significant risk of metachronous peritoneal metastases after curative-intent resection of obstructive colon cancer. The awareness of factors predisposing to metachronous peritoneal metastases could improve the treatment strategy of these patients.

AIM:Some patients with inflammatory bowel disease (IBD) require subtotal colectomy (STC) with ileostomy. The recent literature reports a significant number of patients who do not undergo subsequent surgery and are resigned to living with a definitive stoma. The aim of this work was to analyse the rate of definitive stoma and the cumulative incidence of secondary reconstructive surgery after STC for IBD in a large national cohort study. METHOD:A national retrospective study (2013-2021) was conducted on prospectively collected data from the French Medical Information System Database (PMSI). All patients undergoing STC in France were included. The association between definitive stoma and potential risk factors was studied using univariate and multivariate analyses. RESULTS:A total of 1860 patients were included (age 45 ± 9 years; median follow-up 30 months). Of these, 77% (n = 1442) presented with ulcerative colitis. Mortality and morbidity at 90 days after STC were 5% (n = 100) and 47% (n = 868), respectively. Reconstructive surgery was identified in 1255 patients (67%) at a mean interval of 7 months from STC. Seveny-four per cent (n = 932) underwent a completion proctectomy with ileal pouch anal anastomosis and 26% (n = 323) an ileorectal anastomosis. Six hundred and five (33%) patients with a definitive stoma had an abdominoperineal resection (n = 114; 19%) or did not have any further surgical procedure (n = 491; 81%). Independent risk factors for definitive stoma identified in multivariate analysis were older age, Crohn's disease, colorectal neoplasia, postoperative complication after STC, laparotomy and a low-volume hospital. CONCLUSION:We found that 33% of patients undergoing STC with ileostomy for IBD had definitive stoma. Modifiable risk factors for definitive stoma were laparotomy and a low-volume hospital.

A 62-year-old man with a past history of sleep apnea syndrome, umbilical and left inguinal hernia repairs, was referred to the emergency room for acute respiratory distress. He had underwent a screening colonoscopy 12 h earlier for a family history of colonic adenoma. This colonoscopy was complete, normal, and uneventful. A plain chest X-ray showed a distended colon extending to the upper third of the right side of the chest (Fig. 1). Further anamnesis helped the patient to remember a right diaphragmatic hernia, well-documented by CT-scan years ago. He had not previously mentioned this condition, when evaluated for colon screening. The patient was admitted to the surgical intensive care unit. A CT-scan confirmed a right diaphragmatic hernia with terminal ileum and ascending colon content, no sign of mesenteric ischemia, and massive pulmonary collapse. Conservative treatment with nasogastric suction quickly improved the patient's condition. He was discharged at day-6. Diaphragmatic hernia repair was scheduled 10 weeks later. Laparoscopy showed a complete agenesis of the right diaphragmatic dome (Fig. 2; Fig. 3), and was therefore converted into laparotomy for complete surgical repair. Postoperative course was unremarkable. Patient was discharged on day-6. Follow-up at 1 month was uneventful. Congenital diaphragmatic hernias are rare and usually diagnosed in the pre- natal period or in neonates with respiratory distress, calling for emergency neonatal repair [1,2]. In underdiagnosed or neglecting adults, the condition can be life-threatening, as seen in our patient [3,4]. Surgical repair is therefore strongly recommended, even in asymptomatic patients [5]. Recurrences are exceptional.