Abstract Chapter 1 explores how the footprint left by Rabelais’s fictional giants still pervades France’s modern culinary identity. Through reinvigorated bacchic myth, the giants illustrate Rabelais’s broader humanistic vision, foregrounding the tension that has historically been a part of the French use of food and territory to frame people. Along with regional wine representations in Rabelais, the Renaissance saw the rise of a naturalistic trend toward terroir in the group of contemporaneous poets know as the Pléiade. The evolution and establishment of terroir in the French imagination at this point occurred foremost not in respect to wine, but rather in respect to regional pride, fictional representations in Rabelais, and the construction of a national poetry.
Purpose: It is unclear whether the principles of open complete mesocolic excision (CME) can be safely applied to laparoscopic surgery. Furthermore, definitions vary over how radical optimal CME surgery should be. We report morbidity and oncological outcomes for laparoscopic CME without routine gastro-pancreatico-colic trunk (GPCT) dissection. Materials and Methods: An observational study with consecutive data for patients with Union for International Cancer Control (UICC) stage I–III colon adenocarcinoma who underwent elective laparoscopic resection between 2006 and 2015. Data were retrieved for demographics, tumor characteristics, treatment, and histology from prospectively maintained databases. Standardized, routinely video recorded, laparoscopic resections were performed in two United Kingdom centers from The National Training Programme for Laparoscopic Colorectal Surgery. Overall survival and disease-free survival (DFS) were reported using Kaplan–Meier curves and Cox regression. Results: Laparoscopic CME was performed in 567 patients, 52.7% (288/546) women, median (interquartile range [IQR]) age 73 (65–80) years. Median (IQR) length of stay was 4 (3–5) days with 4.0 (2.2–5.7)-year follow-up. Significant DFS predictors (hazard ratio [HR]) by multivariable Cox regression were age >80 years (1.9), American Society of Anesthesiologists (ASA) 3 and 4 (HR = 1.1), right colon cancer (1.7), UICC stage III (3.4), and intramesocolic grade (2.2). Overall 4-year DFS (95% confidence interval) was 81.3% (77–85). Four-year DFS by UICC grades I, II, and III was 94.6% (89–99), 83.4% (77–88), and 72.2% (66–78), respectively (log-rank P = .001). Morbidity by Clavien–Dindo grade was III 18 (3.2%), IV 4 (0.7%) and V 7 (1.2%). Conclusion: This large series suggests standardized laparoscopic CME without routine GPCT dissection has a low morbidity and achieves equivalent outcomes to the most radical open CME techniques.
