Papers by Reza Kianmanesh
American Journal of Roentgenology, 2001
OBJECTIVE. Differences of attenuation and enhancement patterns in focal nodular hyperplasia and h... more OBJECTIVE. Differences of attenuation and enhancement patterns in focal nodular hyperplasia and hepatocellular adenoma were evaluated and quantified using triphasic singleslice helical CT. MATERIALS AND METHODS. Forty-five histologically proven focal nodular hyperplasias in 27 patients and 18 hepatocellular adenomas in six patients were examined with helical CT. Quantitative evaluation included the following: attenuation of lesions, scar, and liver parenchyma during unenhanced, arterial (20 sec after injection), and portal venous phases (70 sec after injection); relative enhancement of lesions and liver (the ratio between attenuation in arterial phase and portal venous phase, respectively, and attenuation in unenhanced phase); and the prevalence of scar and its central vessel in focal nodular hyperplasia. RESULTS. The study showed no significant difference between mean attenuation values of focal nodular hyperplasia (mean ± SD, 51.2 ± 5.9 H) and hepatocellular adenoma (mean ± SD, 56.3 ± 7.8 H) in the unenhanced phase. In the arterial phase attenuation values were significantly higher in focal nodular hyperplasia (mean ± SD, 117.9 ± 15.1 H) than in hepatocellular adenoma (mean ± SD, 80.1 ± 10.5 H). In the portal venous phase no significant differences in attenuation values were detected between focal nodular hyperplasia (mean ± SD, 112.1 ± 20.4 H) and hepatocellular adenoma (mean ± SD, 110.2 ± 12.9 H). For enhancement parameter thresholds separating focal nodular hyperplasia from hepatocellular adenoma, the following were found: the relative enhancement was higher in 100% of the focal nodular hyperplasias and lower than or equal to 1.6 (accuracy, 96%) in 87% of the hepatocellular adenomas. CONCLUSION. Triphasic helical CT combined with quantitative evaluation of liver lesions offers the possibility of detecting differences in liver lesions that are visually similar on CT. The attenuation and relative enhancement in the arterial phase show significant differences that make accurate differentiation between focal nodular hyperplasia and hepatocellular adenoma possible.
Journal de Radiologie, 2007
Édité par Elsevier Masson SAS. Tous droits réservés formation médicale continue le point sur… Ana... more Édité par Elsevier Masson SAS. Tous droits réservés formation médicale continue le point sur… Anatomie du foie : ce qu'il faut savoir M Lafortune (2), A Denys (1), A Sauvanet (3) et S Schmidt (1)
Neuroendocrinology, 2012
come correlated with histopathological data. The terminology of the new WHO classification (NET G... more come correlated with histopathological data. The terminology of the new WHO classification (NET G1/G2; neuroendocrine carcinoma (NEC) G3) [4] is utilized in this article in concert with the former appellation (welldifferentiated endocrine tumor/carcinoma; poorly differentiated endocrine carcinoma). Of note, this does not imply that grading has been assessed in the cited studies. This reflects the difficulty that until recently grading was neither routine method nor a requirement for clinical studies, and both, differentiation status and grading, are not necessarily the same. Therapeutic approaches for management of metastatic disease include surgical, medical, radiological and nuclear medicine strategies. More recently, novel molecular targeted drugs have been introduced into the NET treatment armamentarium. Each of the management strategies exhibit potential therapeutic benefits and the indications for their usage as well as the outcomes are discussed in detail.
Cancers, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Neuroendocrinology, 2017
Neuroendocrine tumors of the small intestine are the most common causes of the carcinoid syndrome... more Neuroendocrine tumors of the small intestine are the most common causes of the carcinoid syndrome. Carcinoid heart disease occurs in more than half of the patients with the carcinoid syndrome. Patients with carcinoid heart disease who need to undergo surgery should also undergo preoperative evaluation by an expert cardiologist. Treatment with long-acting somatostatin analogs aims at controlling the excessive hormonal output and symptoms related to the carcinoid syndrome and at preventing a carcinoid crisis during interventions. Patients with a gastrinoma require pre- and postoperative treatment with high doses of proton pump inhibitors. Patients with a glucagonoma require somatostatin analog treatment and nutritional supplementation. Patients with a VIPoma also require somatostatin analog treatment and intravenous fluid and electrolyte therapy. Insulinoma patients generally require intravenous glucose infusion prior to operation. In patients with localized operable insulinoma, somat...
Surgical Endoscopy
Background The aim of this study was to analyze risk factors of local recurrence (LR) after exclu... more Background The aim of this study was to analyze risk factors of local recurrence (LR) after exclusive laparoscopic thermo-ablation (TA) with or without associated liver resection. Methods Between 2012 and 2017, among 385 patients who underwent 820 TA in our department, 65 (17%) patients (HCC = 11, LM = 54) had exclusive laparoscopic TA representing 112 lesions (HCC = 17, LM = 95). TA was associated with other procedures in 57% of cases (liver resection 81%). All TA were done without liver clamping. Median tumor size was 1.8 cm [ranges from 0.3 to 4.5], 18% of the lesions were larger than 3 cm in size and 11% close to major liver vessels. Tumors locations were 77.5% in right liver, 36% in S7&S8, and 46% in S7&S8&S4a. Results Mortality was nil and morbidity rate 15.4% including Dindo–Clavien > II grade 3%. The median follow-up was 24 months [0.77–75]. Per lesion LR rate after TA was 18% ( n = 19 patients) with a mean time of 7.6 months. Among patients with LR, 18 (95%) could have been re-treated successfully (new resection = 11, re-TA = 7). Multivariate analyses revealed that tumor location in S7 alone, S7&S8 and/or S7, S8, or S4a were independent risk factors of LR after TA. Conclusions Exclusive laparoscopic TA is a safe and an effective tool to treat liver malignancies with or without liver resection. Other than classical risk factors, tumor location in upper segments of the liver, are independent risk factors for LR.
World journal of surgery, Apr 1, 2018
Limited pancreatic resections are increasingly performed, but the rate of postoperative fistula i... more Limited pancreatic resections are increasingly performed, but the rate of postoperative fistula is higher than after classical resections. Pancreatic segmentation, anatomically and radiologically identifiable, may theoretically help the surgeon removing selected anatomical portions with their own segmental pancreatic duct and thus might decrease the postoperative fistula rate. We aimed at systematically and comprehensively reviewing the previously proposed pancreatic segmentations and discuss their relevance and limitations. PubMed database was searched for articles investigating pancreatic segmentation, including human or animal anatomy, and cadaveric or surgical studies. Overall, 47/99 articles were selected and grouped into 4 main hypotheses of pancreatic segmentation methodology: anatomic, vascular, embryologic and lymphatic. The head, body and tail segments are gross description without distinct borders. The arterial territories defined vascular segments and isolate an isthmic ...
Surgery
The surgical treatment of giant incisional hernias with loss of domain is challenging due to the ... more The surgical treatment of giant incisional hernias with loss of domain is challenging due to the possibility of intra-abdominal hypertension after the herniated content is returned to the peritoneal cavity. Progressive preoperative pneumoperitoneum has been described before repair of the hernia, although its efficacy has not been demonstrated clearly. Our aim was to evaluate the efficacy of preoperative progressive pneumoperitoneum in expanding the volume of the peritoneal cavity and the outcomes after surgical treatment of incisional hernias with loss of domain. All consecutive patients with incisional hernias with loss of domain undergoing preoperative progressive pneumoperitoneum and operative repair were included in a prospective observational study. All patients had pre- and postoperative progressive pneumoperitoneum computed tomography of the abdomen. Open incisional hernias with loss of domain repair consisted of anatomic reconstruction of the abdominal wall by complete closure of the defect and reinforcement with a sublay synthetic mesh, whenever possible. The cohort was composed of 45 patients (mean age, 60.5 years). Before the preoperative progressive pneumoperitoneum, the mean volume of the herniated content was 38% of the total peritoneal volume. The mean abdominal volume increased by 53% after the preoperative progressive pneumoperitoneum. One patient died during preoperative progressive pneumoperitoneum, but the postoperative mortality was zero, giving a mortality rate of 2% to the treatment using preoperative progressive pneumoperitoneum. Complete reduction of the herniated content intraperitoneally with primary closure of the fascia was achieved in 42 out of 45 patients (94%). Reinforcement by a synthetic mesh was possible in 37 patients (84%). Overall, surgical complications related directly to the operative procedure occured in 48% of cases. The rates of overall and severe morbidity were 75 and 34%, respectively. At a mean follow-up of 18.6 months, the recurrence rate was 8% (3 out of 37 patients) with non-absorbable meshes and 57% (4 out of 7 patients) with absorbable mesh. Preoperative progressive pneumoperitoneum increased the volume of the abdominal cavity in patients with incisional hernias with loss of domain, allowing complete reduction of the herniated content and primary fascial closure in 94% of patients, with acceptable overall morbidity.
HepatoBiliary Surgery and Nutrition
Neuroendocrinology
Computed tomography scan is the current standard cross-sectional imaging modality for neuroendocr... more Computed tomography scan is the current standard cross-sectional imaging modality for neuroendocrine tumor (NET) workup. Diffusion-weighted magnetic resonance imaging (DW-MRI) has proven to be more sensitive than standard sequences to diagnose liver metastases; whole-body DW-MRI may be more sensitive than whole-body MRI. Clinical implications have not yet been assessed. Thus, we evaluated radiological and clinical contributions of liver and whole-body DW-MRI to manage NETs. Twenty-five abnormal liver and 22 abnormal whole-body standard MRIs were first analyzed retrospectively. MR images were then reanalyzed after adding DW sequences. The standard of reference for metastasis confirmation was a combination of radiological follow-up and histological proof. Clinical impact was defined as MRI changes of liver invasion (unilobar to bilobar and/or <50 to >50% of liver) or therapeutic management changes made during a dedicated multidisciplinary meeting after whole-body MRI. Thirty-two patients with mainly small intestine NETs (24/32) were studied. Adding DW to standard liver MRI yielded additional findings for 45% of the patients with 1.78 times more new lesions, mainly infracentimetric; it induced a management change for 18% of the patients. DW sequences added to whole-body MRI yielded additional findings for 71% of the patients, with 1.72 times more lesions, mainly infracentimetric, and induced a change in management for 19% of the patients. Adding DW sequences to standard MRI revealed additional metastases and led to modifications of patient management. Prospective studies are needed to confirm these results.
Journal of Plastic, Reconstructive & Aesthetic Surgery
The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for ... more The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for autologous microsurgical breast reconstruction. Several recipient vessels sites for microvascular anastomosis have been described such as the internal thoracic vessels, the thoracodorsal vessels, and the circumflex scapular vessels. Nonetheless, the choice of the recipient site depends mainly on individual operator's experience and preferences, and currently the best recipient vessel site is under debate. This anatomical observational study aimed to determine whether anatomy could address this dilemma by determining the best vessel diameter to match the donor with these three recipient sites. Our series reports 80 dissections of the three anatomical regions of interest. Forty formalin-preserved female cadavers were dissected bilaterally. Internal vessels diameter measurements were recorded with a vascular gauge ranging from 1.0 to 5.0 mm with successive half-millimeter graduations. The median diameter of the deep inferior epigastric (DIEA), internal thoracic (ITA), circumflex scapular (CSA), and thoracodorsal arteries (TDA) were: 2.0, 2.5, 2.5, and 1.5 mm, respectively. The median diameter of the deep inferior epigastric, internal thoracic, circumflex scapular, and thoracodorsal veins were: 3.0, 3.0, 3.0, and 2.5 mm, respectively. At the individual level, the perfect match between DIEA and ITA was significantly more frequent than between DIEA and TDA (p = 0.002), and it was more frequent between DIEA and CSA than between DIEA and TDA (p = 0.009). This study supports the use of the internal thoracic pedicle as the first recipient vessel choice, which should be considered, at least anatomically, as the best one with the closest diameter matching with the donor pedicle.
World Journal of Surgery
Suprapubic incisional hernias (SIH) are a rare wall defect, whose surgical management is challeng... more Suprapubic incisional hernias (SIH) are a rare wall defect, whose surgical management is challenging because of limited literature. The proximity of the hernia to bone, vascular, nerve, and urinary structures, and the absence of posterior rectus sheath in this location imply adequate technique of surgical repair. We aimed to describe a cohort of female patients operated on for SIH after gynecological surgery using a homogeneous surgical technique and to report surgical outcomes. The records of all consecutive patients operated on for SIH in a specialized surgical center between January 2009 and January 2015 were retrospectively reviewed. The same open technique was performed, i.e., using a mesh placed inferiorly in the preperitoneal space of Retzius, with large overlap, and fixed on the Cooper's ligaments, through the muscles superiorly and laterally with strong tension, in a sublay or underlay position. The cohort included 71 female patients. SIH were recurrent in 31% of patients and was related to cesarean in 32 patients (45.1%) and to gynecologic surgery in 39 patients (54.9%). The mesh was totally extraperitoneal in 76.1% of patients. The postoperative mortality rate was null. The rate of specific surgical complications was 29.6%. After a median follow-up of 30.3 months, the recurrence rate was 7%. The open approach for SIH repair was safe and efficient. Due to the paucity of adequate scientific studies, this reproducible open method could help moving toward a standardization of SIH surgical management.
International Journal of Surgery, 2017
Pre-existing chronic liver diseases and the complexity of the transplant surgery procedures lead ... more Pre-existing chronic liver diseases and the complexity of the transplant surgery procedures lead to a greater risk of further surgery in transplanted patients compared to the general population. The aim of this monocentric retrospective cohort study was to assess the epidemiology of surgical complications in liver transplanted patients who require further surgical procedures and to characterize their post-operative risk of complications to enhance their medical care. From January 1997 to December 2011, 1211 patients underwent orthotropic liver transplantation in our center. A retrospective analysis of prospectively collected data was performed considering patients who underwent surgical procedures more than three months after transplantation. We recorded liver transplantation technique, type of surgery, post-operative complications, time since the liver transplant and immunosuppressive regimens. Among these, 161 patients (15%) underwent a further 183 surgical procedures for conditions both related and unrelated to the transplant. The most common surgical procedure was for an incisional hernia repair (n = 101), followed by bilioenteric anastomosis (n = 44), intestinal surgery (n = 23), liver surgery (n = 8) and other surgical procedures (n = 7). Emergency surgery was required in 19 procedures (10%), while 162 procedures (90%) were performed electively. Post-operative mortality and morbidity were 1% and 30%, respectively. According to the Dindo-Clavien classification, the most common grade of morbidity was grade III (46%), followed by grade II (40%). Surgical procedures on liver transplanted patients are associated with a significantly high risk of complications, irrespective of the time elapsed since transplantation.
Annals of surgical oncology, Jan 6, 2016
This study was designed to identify factors associated with morbidity and mortality in patients o... more This study was designed to identify factors associated with morbidity and mortality in patients older than 70 years who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC). Major surgery is associated with higher morbidity and mortality in elderly patients. For PC, CRS and HIPEC is the only current potential curative therapy, but the risks inherent to this patient population have called its benefits into question. We retrospectively analyzed a multi-center database from 1989 to 2015. All patients who underwent CRS and HIPEC for PC were selected and patients older than 70 years were matched 1:4 with a younger cohort according to cancer origin, peritoneal cancer index (PCI), and completeness of cytoreduction. Major morbidity and mortality were analyzed. Of 2328 patients, 188 patients older than aged 70 years were matched with 704 younger patients. Patients older than aged 70 years demonstrated a higher American...
HepatoBiliary Surgery and Nutrition, 2016
Laparoscopic liver resection (LLR) is technically possible with new devices which allow a relativ... more Laparoscopic liver resection (LLR) is technically possible with new devices which allow a relatively bloodless liver parenchymal transection. Despite, the main concern remains intraoperative hemorrhage. Currently, perioperative excessive blood loss during LLR is difficult to control with necessity of laparotomy conversion. Moreover, major blood loss requires transfusion and increases postoperative morbidity and mortality. When inflow is limited by the hepatic pedicle clamping, it reduces intraoperative blood loss. The Pringle maneuver, first described in 1908, is the simplest method of inflow occlusion and currently can be achieved during LLR. The purpose of this note was to describe two different modalities of Pringle maneuver used by two different teams during LLR.
HPB, 2016
Objective: The aim of this study is to evaluate whether a parenchymal-sparing strategy provides s... more Objective: The aim of this study is to evaluate whether a parenchymal-sparing strategy provides similar results in terms of morbidity, mortality, and oncological outcome of non-PSH hepatectomies in a propensity score matched population (PSMP) in case of multiple (>3) bilobar colorectal liver metastases (CLM). Background: The surgical treatment of bilobar liver metastasis is challenging due to the necessity to achieve complete resection margins and a sufficient future remnant liver. Two approaches are adaptable as follows: parenchymal-sparing hepatectomies (PSH) and extended hepatectomies (NON-PSH). Methods: A total of 3036 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were matched in a 1:1 propensity score analysis in order to compare PSH versus NON-PSH resections. Results: PSH was associated with a lower number of complications (1) (25% vs. 34%, p = 0.04) and a lower grade of Dindo-Clavien III and IV (10 vs. 16%, p = 0.03). Liver failure was less present in PSH (2 vs. 7%, p = 0.006), with a shorter ICU stay (0 day vs. 1 day, p = 0.004). No differences were demonstrated in overall and disease-free survival. Conclusion: In conclusion, PSH resection for bilobar multiple CLMs represents a valid alternative to NON-PSH resection in selected patients with a reduced morbidity and comparable oncological results.
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Papers by Reza Kianmanesh