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Recipient Prize
D. Martin
Thursday, Feb. 29, 2024 · 4 p.m. · 23m 44s
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you know the press a manual in the surgery department into shoes or who actually a
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challenge a little bit the boundary of a raise action happen to select casino which is uh
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longer discussion mostly coming from is yeah but i was very pleased to see that's a
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yeah also some data from europe things so you weren't so ah we we'll uh we'll
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why on your form ah you already did me that he than
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the amount of the price and we have a pitcher that we can
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yeah we're not so now you have the chance to show last summer the
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new results thank you very much and go recognition again for your price thing too
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thank you uh very much for this kinda introduction
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to yeah uh president here uh participant's uh it's
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a great pleasure and honour um to present today
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this project which was um selected for the yearly
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price price sorry we listen to many uh speakers
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well known and prestige you speakers how ever i
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guess not many people in the room uh you know who i am so please let me introduce myself
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in a few words um i i attended medical
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university in lausanne switzerland and five book implies gal
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germany i got my uh mm mm doctorate in madison in two thousand a seventeen
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then i was a board certified in general surgery in two thousand
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nineteen and i was awarded private doesn't at the university of frozen into
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talent i worked in several a hospital but many at issue even less than
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and at the yet she mortgage which is a small a hospital
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just next to design a beautiful place just next to the lake
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i went through a different surgical specialities but mainly
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general surgery h. p. b. surgery and transplant
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surgery i uh just recently completed a fifteen
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months a fellowship at the royal infirmary net and randy you kate uh in transplant surgery
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including will jog and ritual across all over the country was uh
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very great experience enriching experience a lot of whiskey hockey's and it's
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a great pleasure uh so you probably know a that a manual
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it's made with this one of my bus one of my a mentor hissed a medical
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ad director of to a live in progress a centre which was built approximately two years
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ago he's very involved on a institution level but also
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on a national level and international level he's involved in the
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u. h. p. b. uh society he's experience skewed in
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many well in basically ramping critics surgery and has that
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research interest in either a pancreatic oncology and
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uh the rest which is enhanced recovery after um
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surgery so uh and not about us that was a bit to the
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boring part for you let's talk about the project so as previously discussed
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the management of h. e. c. must be a multi disciplinary
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does that a lot of key players in the management including
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right eulogy is either a intervention all a diagnostic pathologies to have but
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uh just of course oncologist surgeons and it's uh of course we all
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work together in order to improve a patient outcome but it's maybe one
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of the issues in the uh that's too but the case is that every
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a member of the team has become highly uh specialise in its
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own uh fields there are many ways of treating patients from intentional point
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of view there are a lot of difference a systemic treatment we saw
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it in the previous presentation uh we need information from the apologies so
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everything has become more and more a complex ants um one of the question
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is what is the role of the of the surgeons in h. e. c. management
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so it's talk a a bit more about these aspects because in fact as you know
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the b. c. c. guidelines which where uh develop them published in the late nineties were um
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developed by have pathologist ends at the time they were published
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the uh rule of a surgical rejection was not a very important and only
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considered for very early stage orally um stage b. c. l. c. um patience
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white pace was suggested for for intermediate stage however
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couldn't we reject more of these uh these yes should be patient so intermediate
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stage and could we spend their uh could tear yep so it is very interesting
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paper a publishing and out of habit energy into those and a sixteen
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and it really the focus of the the fall of the burn a team
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only twenty nine of person of the p. c. s. t. b. patients were treated according to the other
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it which is very very low and meaning that the vast majority of the patients are not treated um
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correctly according to the to the algorithm so our group in
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design we uh did this uh i met analysis including seven
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trials more than one thousand seven hundred patients seven hundred fifty
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have protected me is at nine hundred tapes and we show
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actually that the survival after have protected me was significantly trees
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fifty three months of verses twenty eight amounts for four days
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so we we challenged it's this this um other it and even
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the two thousand twenty to update uh i didn't improve much um
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from the surgical point of view and there's no line uh going to the intermediate stage
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uh here to the of lever is action
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so this is the um project which received a price this year to my
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burden patients with early any intermediate stage h. t. c. undergoing leave it was action
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it was a rich respective study a mighty sentry can't
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things to that on the news net work we were
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able to uh collaborate with the mount sinai hospital in
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new york levitate beaches but separate here in in paris france
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and the uh the pretended well your from the hospice either you
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so just a aim was to assess clinical outcomes and overall survival of p. c. s. c. a. n. b. patients
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that's underwent leaders action in to compare these two groups using except classification to melbourne score
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um so this is our methods retrospective uh as say before
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all consecutive patient that underwent events action uh
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between twenty ten and twenty twenty in these four
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raffle centres and experience in a cheesy management where included by definition b.
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j. c. stage a patients work signal uh h. c. c. including single
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large which are sometimes put in a b. c. c. b. stitch in
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in studies so we include it's single large as well in the stage
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o. r. h. e. c. less or equal the three no dues all the so
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called in three uh centimetres while the the city stage be where where only regional dealer
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including pretty yeah we're at right logical diagnosis of h. t. c.s no that's great invasion
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please you have the the function and that performance s. is you got off zero
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the tuner buttons core t. b. s. has been uh original described for the
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uh management of colour rectal lever my test as is and it's um included
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the number of the of the tuner subdivisions ends to size usually have to be used um
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lesion and the group of of timit to politics from the us they
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use it for h. e. c. and the publish it the first time in in
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two thousand and twenty in the b. g. s. and stay a separate it's the patients
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three stages slow tedious medium t. b. s. and how to be as depending on the
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two minute a burden so this is our uh uh courts six hundred twelve patients overall
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five hundred sixty two b. c. c. a. a only unfortunately fifty patients indivisible be group
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they were beats a younger a significantly however there was no difference in terms of sex
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b. m. i. as a score um alcohol
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can conceptions smoking a co morbidity stay betters
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interestingly approximately a third of the patients hat uh see
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roses but no difference between the two groups no difference
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in terms of uh h. u. h. t. v. air infections and of course the vast majority of the patient had
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child have a a great almost a hundred percent actually
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logically that patients into b. c. s. c. p. group heights a higher number of
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lesions and a higher size of the biggest
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lesions and therefore logically as well a higher
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two more borden score they also had a higher and number of three uh
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operative case procedures because uh approximately a
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half of them had had days before rejection
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this is a a surgical um and clinical outcome so it's
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in that patients ways uh intermediate stage uh h. u. c.
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uh and they went more complex surgery because they
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underwent more had protect i mean a a less minimally
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invasive surgery only sixteen percent operative time was longer more
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bought loss and a more of a a blood transfusion
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interestingly there was no difference in overall complication
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um even if they have significantly more major complication but overall rate was not statistically different
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and snow difference as well in terms of mortality approximately one
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two percent which is a comparable to the the church or
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and in terms of a specific complications to lever surgery there
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was no difference in pa stop societies by the cage or
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even faded however to had a a slightly uh increased
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overall uh things of stay searching the verses ten days
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it's a format pathological point of you know difference at
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yeah and in differing change grades uh info basket invasion
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and sorry ants are zero margin in it which was a between eight four ninety percent
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um let's talk about the interesting port overall survival so of course if we
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compare a busy i see a patient there's just b. c. s. e. b. altogether
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this is evasion had a statistically significant uh increased
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survival you was even and define because it interest of fifty person line
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a and b. c. c. b. patient hadn't were also whatever fifty seven months
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if we compare them now in terms of t. b. yes so tomb brenda score
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uh these yes yeah a patient purses be with
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location again here to b. c. c. patient had increased
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so variable however didn't have much uh patients in this group but it's this is important
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now if we take the b. c. s. shape patient versus b. but with medium
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and high t. b. s. then um the
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survivor was not statistically a different so uh
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and and same for disease free survival again if we take the b. c. i see
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a patient a a significantly a high year
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for a eleven months verses five point nine months
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uh this is for survival same as before if we compare according to the low
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t. b. s. there was a an increased survival for that a patient but again
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for the medium t. b. s. if we compare a. b. medium and a. b.
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hi t. b. s. there was no uh increased and no statistic
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difference in terms of um survivor so this is an important but i think we'll discuss it after
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uh we did also a nutty very cox regression
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isaiah is the analysis with i can put it to
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integrate one um but it's if we talked a statistically
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significant can generate input in this model the only factor
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that's a remained a that prick picture of
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of over survival was major possibilities complication for
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the a group and it's um may sex for to be group so overall into court to
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t. b. s. core had no influence if we and as it like uh this mystery cox regression
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it's interesting question as well i seems uh what is that
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correlation between that pathological humid written score
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uh and the red logical to melbourne score
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because uh if we think about the b. c. s. jaeger in almost
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every decision is based on you may gene and and we asked tests
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and compare this to the uh apology guises and actually it's very very good
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the collisions very strong reason are quite efficient
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of zero point uh it turned fifty three beaches
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very good so imaging exert rial will uh and tooling
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we should use it in in a a treatment based decision
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of course there are a lot of limitation of this
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thirty two trees retrospective design and it uses selection bias
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taste before surgery well we can assess tomorrow viability on a imaging
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what about preserved lever function um almost all of our patient had that
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preserve liver function but we should assess each in future in the other patients wheeze wheeze uh
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'tis deeper function which is not preserved when assets several important factors a f. p. uh eventually
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i'm pretty systemic therapies and it's uh we didn't
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have a control group let's say yes standard control
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group to challenge the surgical cohorts i'm
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against tastes or even um your transportation
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our does our conclusion a cheesy patient with medium and high humour brenda score
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t. b. s. had that comparable survival after surgery irrespective of decency stage
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t. b. s. could be a recommended for progress to
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predication and management we quit imagine using eighteen to melbourne
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uh ensure board sorry uh or even in future trial so we think that a refinement of p. c. s.
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c. a stage might be required in order to uh
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locates best treatment and select patients who might benefit from surgery
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and at the time of the paper focus so before they even recommended that burn
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clinically are cancer where if you watch much more interesting for surgeons because we uh who
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uh rejects and suggest was actions for uh intermediate stage patients so that's it thank you
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very much for you um attention and again thank you very much capacity for for you kind
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invitation and at this price it's a hundred things to tell mabel fall he's report
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he was the leader of this uh project and he wasn't a funny adventure thank you
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the traditions day well presented do we have any questions you have a certain hum
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oh sorry i
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thank you very much my name is on yeah and ah my from than i have a couple of questions actually
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i'm very importance today i agree totally agree it's too rigid the p. c. and v. and it's important to yeah
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may cross section more important and i think that what's
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retrospective that fifty patients that were p. c. l. c. b.
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and where where they know to be peace l. c. b. before them essential what that
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occurrence identifying where there were so they were operated beyond features secret or that was interesting
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point and nice in almost every respect study uh included in the mountain rises yeah my
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second question would be a interns that indication for transplantation because i think the most important yeah
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uh_huh and the way to go for sections to get more information about the
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two married to be able to find the right patients for transplantation did teal
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analysts they do we think we have micro vascular invasion for
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example in creating and how that impacted your indication for transportation
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uh no so the witness as a debt you know then we're not a liver transplant
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centre but we work closely with chain around we discussed this kind of uh of course
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of course liver transplant has a a huge role to play in
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this kind of position and see if we think intermediate stage um
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most of them and the work and the go um to sprint to the bit in several centres in
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a lot of different countries cases you there's a breach to transplant surgery where the on the waiting list
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so this is something of course we need to assess that criteria
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i don't know if per news that a man should therefore for
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yeah in the u. k. for example where worked so even
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these criteria it out much more um favour before surgery because
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the uh the size of the trimmer bigger and a number of the size allowed to undergo divergence from a much higher
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um so i think there's a lot of work to do from this point of
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view but that's the main uh intuition of just to do weaknesses lever transplant at all
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and uh probably a few patients especially from the new york
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teen that under one sale h. transparent after a breeze action yet
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witnesses that and did you look at the degree of portal hypertension how many patients had invasive measurements of
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uh we did try to get that that that that it was not very successful
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and um i guess not many people
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especially in france had is a systematic meter
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before it's uh do you do this routinely before the surgery if we go for
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for surgery for niches you'd be of course we'd we'd systematically routine in those and
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if i may one ask one final question and i i really i thought you had ten thirteen days of half
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does which is quite long in particular with the the resin
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minds that is that what is your typical length of stay
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ah well if we think four and h. e. c.
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b. major have protect them yeah i would say between it
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we just ten days is something a standard of
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course if we uh speak about uh which procedure
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or what they do when not much minimally invasive i'm here in this case icing alright approximately
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is around twenty twenty five percent of of a prescriptive prosody wasn't the same in the other centres
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but i would say minimally invasive forward per student in should be three
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four days maximum so probably a manual has a something to it is for
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but the rest is working very well for years action i know i agree we
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should the the the low speed test is a bit longer but we start to the
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the guidance see the stout uh wasn't the first gayness will either
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went to doesn't sixteen and we have patient before so two thousand sixteen
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and probably also for security patient the current guidelines have
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to be updated force you to patients so that's probably one
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also the should uh i think we can do it in three four days we can look at it together yeah
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how is you uh sorry if i may ask you a question my turn
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as experience and and what are the results with this lever a transplant for
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your your patients and i don't know if you have any that down on
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intermediate stage underwent lever transportation because if if we think about that a new
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included for the the transplants on techniques plants analysis of delivered is usually much more
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lesions that what was present on on preamp imaging e. v. even if we show
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that equation was cool on the whole explained start usually much more so they wear
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the yawns young creature i've precinct yeah i mean in the end we
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if we stay within me done we have like a ten percent and
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recurrence rate i know the data from the f. t. c. s. the
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recurrence made for h. t. c. after liver transplantation we have eleven percent
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yeah i it's it's very obvious as soon as we expand the criteria
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yeah yeah no matter in what way the recurrence rate goes up to sell
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it's a very difficult thing we do a lot of down staging a budget we have the long
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waiting time and again these are the patients that have more occurrences if they were aggressively down staged
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okay thank you
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i thank you very much thank you for your presentation in for the
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interesting discussion thank you so we move now to our next a speaker
00:21:53
who is also basin californian we have that great pleasure to have with us
00:21:58
apart as a major thing with american colleges you guessed want to e. g.
00:22:03
is a basin you see only as you can see nice weather had a chat
00:22:10
and um he's a principal investigators on many
00:22:13
uh important to tia trials in the field
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ah has published extensively on hypnotist that i can see no man hath in these uh
00:22:22
really the best to speak ill could indicators on a face to ongoing
00:22:28
and try as inhabit is i guess human face to thank you very much which are to be with us today
00:22:36
but are you very we hear you know raw
00:22:39
very nice introduction raw my background is break but rather is
00:22:44
very nice ra ra ra who or where there where you are
00:22:48
but that that's another or if you're not sure appreciate
00:22:51
are we not sure it's cruel well you know now or
00:22:56
will it be with you to a although ah extra
00:23:02
rules could we pursue you know our ground or on the
00:23:07
topic a little bit uh on drugs and this is
00:23:12
a huge topic ah i do see er lu era concerts
00:23:19
or what's going on uh working just great work you know
00:23:22
sir no it's it's just great ah was an orphan disease
00:23:27
or your when i start it on a regular drawbridge oh
00:23:30
sure you know you re really was nothing going on oh
00:23:35
here you know do we agree answers around where did you
