Centre Hospitalier Universitaire de Rennes

Robot-assisted partial nephrectomy (RAPN) represents the preferred minimally-invasive approach for localized renal tumors. Increasing attention has focused on optimizing parenchymal preservation, with enucleation proposed as a potentially advantageous strategy. This study aimed to compare perioperative and functional outcomes of enucleation versus enucleoresection in a large, contemporary multicenter RAPN cohort. Data were extracted from the multicentric and multicontinental European Association of Urology Young Academic Urologists (EAU-YAU) Renal Cancer Working Party database. Patients undergoing RAPN between 2015 and 2024 with clearly documented resection technique (enucleation vs enucleoresection) were included. The resection technique was chosen based on the surgeon's preference. Perioperative, pathological, and renal functional outcomes were evaluated. Acute kidney injury (AKI - defined according to the AKIN classification) and chronic kidney disease (CKD) worsening served as primary endpoints. Logistic regression and Cox proportional hazards models were used to assess the association between surgical technique and the risk of AKI and CKD progression; Kaplan-Meier curves were used to depict time-to-event and functional outcomes, while longitudinal eGFR analyses were performed to evaluate renal function trends over time. Among 1260 patients, 527 (42%) underwent enucleation and 733 (58%) enucleoresection. Adoption of both techniques remained stable over time. Baseline characteristics were comparable. Enucleoresection was associated with longer ischemia time, higher intraoperative complication rates, and a lower positive surgical margin rate (5.2% vs 8.3%, p=0.003). Postoperative AKI occurred more frequently after enucleoresection (18% vs 3%, p<0.001), although eGFR recovery was similar at a median follow-up of 12 vs 25 months. In the overall cohort and among patients with baseline CKD stages 1-2, enucleation was associated with a lower risk of CKD progression (p<0.001). Enucleation during RAPN offers a parenchyma-sparing approach with potential functional advantages, particularly in patients with preserved baseline renal function. This benefit must be balanced against a slightly higher risk of positive margins, reinforcing the necessity of thoughtful case selection and standardized surgical technique.

A significant proportion of patients presenting a primary sclerosing cholangitis (PSC) will require liver transplantation (LT). The present study aimed to investigate graft loss and patient death in a large cohort of patients. We conducted a nationwide multicenter retrospective study including all adult patients transplanted for PSC in France From 1985 to 2019. Were included 571 patients; median follow-up after LT was 89.0 months (IQR, 43.0-151.0). Patient survival at 5, 10 and 20 years after LT was 88.2%, 81.2% and 62.6%. After exclusion of patients who died during the first month after LT, 37 patients (6.6%) died during the first 2 years and the main cause was malignancies (n = 15, 40.5%, including 12 cases of recurrent cholangiocellular carcinoma). After 2 years, 90 patients (17.2%) died; the two main causes were malignancies (n = 36, 40.0%, including 13 cases of colorectal cancer) and sepsis (n = 23, 25.6%, of which 7 were related to recurrent PSC). Graft survival at 5, 10 and 20 years was 89.5%,78.7% and 62.7%. Independent factors associated with late patient death (after 2 years) were an older age at LT, a bilio-digestive anastomosis and the use of preventive UDCA; independent factors associated with late graft loss were recurrent PSC, cellular rejection, a younger age at LT, and the use of tacrolimus (protective). Our results emphasise that the prognosis after LT for PSC could be improved by better detection of cholangiocellular carcinoma before LT, and colorectal cancer after LT.

Postoperative pain management typically relies on numerical (NRS) or analogue rating scales. However, exclusive focus on nociception may overlook broader aspects of patient experience, especially under regional anaesthesia (RA). This post hoc analysis of the COMFORT trial (NCT05234216) examined whether replacing the NRS with a comfort-focused scale affects patient-reported experience, opioid use, and related outcomes. We analysed data from a cluster-randomised trial in 29 French centres. Adults undergoing elective non-cardiac surgery managed in the post-anaesthesia care unit (PACU) were included. The intervention (comfort scale) and comparator (pain NRS) were applied in the PACU. Patient-reported experience was measured with the EVAN-G/LR scales, self-completed on the ward/day-care unit ≥4 h postoperatively. Participants were divided into RA and general anaesthesia subgroups. Of 885 randomised patients, 786 had evaluable EVAN data. After regional anaesthesia (RA; n = 305), comfort‑focused assessment was associated with higher EVAN Pain (median 88 [IQR 75-94] vs. 75 [69-88]; p = 0.034), Waiting (100 [75-100] vs. 75 [50-100]; p = 0.012), and Global Index (81 [72-91] vs. 77 [68-90]; p = 0.044). After general anaesthesia (GA; n = 481), EVAN scores were similar between groups. Nefopam use was lower with the comfort approach in RA (7% vs. 18%; p = 0.005). Antiemetic use was lower with the comfort approach in GA. Replacing the NRS with a comfort-focused approach did not improve global patient experience after surgery. In patients receiving regional anaesthesia, however, using a comfort scale was associated with better patient-reported experience in the EVAN "Pain" dimension, while no benefit was observed after general anaesthesia.

International audience

Long-gap esophageal atresia (LGEA) represents a surgical challenge. Despite the increasing use of thoracoscopy over the past decades, its application in LGEAs remains limited. This study aimed to evaluate the morbidity and mortality rates of LGEA thoracoscopic repair in the early and mid-term in France over the study period. After institutional ethical approval (#23.76), we conducted a multicenter, retrospective analysis of all patients who underwent a thoracoscopic repair for LGEA in France from 2010 to 2022. LGEA was defined following ERNICA 2021 consensus. We collected data related to the initial treatment and up to 1-year follow-up. Postoperative complications were categorized into early (<30 days) and late (>30 days) and were classified according to the Clavien-Dindo classification. Fifty patients were included: 24 Delayed Primary Anastomosis (DPA) and 26 tractions. The overall rate of post-operative complication was 82%. The primary early complications included anastomotic leaks 56%, prolonged drainage 40%, pneumothorax 20%, pneumonia 20% and stricture 16% with no difference between DPA and traction. The traction method had a longer postoperative length of stay (69 vs. 31 days, p < 0,002). The nutritional evolution of tractions was poorer, with 30,8% exclusive oral nutrition at one year (vs. 66,7% DPA, p = 0.018). This is the largest cohort of patients who underwent thoracoscopic surgery for LGEA. Although thoracoscopic management of LGEAs is associated with a high complication rate, DPA management was associated with a shorter postoperative hospital stay and better mid-term nutritional outcomes. We believe that LGEAs remain a surgical challenge and thoracoscopy should be reserved for expert surgeons.

<h3>Background and Importance</h3> Our university hospital has been involved as a sponsor since the early stages of CAR-T clinical trial development, allowing us to put our experience into perspective and illustrate the central role we play in this therapeutic innovation. CAR-T cell therapy is a major breakthrough in the management of haematologic malignancies, but its use is associated with severe adverse events requiring specific management. One of the most frequent and potentially serious complications is cytokine release syndrome (CRS). CRS results from massive immune activation following CAR-T cell infusion, leading to excessive cytokine release, particularly interleukin-6 (IL-6). This inflammatory reaction can rapidly progress to severe multiorgan failure, requiring urgent treatment. <h3>Aim and Objectives</h3> To compare the incidence, severity, and management of CRS after CAR-T infusion in clinical trials versus standard-of-care patients at our university hospital. <h3>Material and Methods</h3> We retrospectively reviewed all patients who received CAR-T therapy between 1 January 2020 and 1 July 2025, distinguishing participants in clinical trials (n = 40) from real-life patients (n = 361). Demographics, indications, the occurrence of adverse events (CRS, ICANS), and their management (tocilizumab, corticosteroids) were analysed. <h3>Results</h3> CRS occurred in 50% (20/40) of trial patients and 83.9% (303/361) of real-life patients. The mean onset was earlier in clinical trials (1.55 days) than in real life (2.64 days). Duration was shorter in trials (3.67 days) than in routine care (6.65 days) (p = 0.0001). Grade ≥ 3 CRS was uncommon in both groups (10% in trials vs 1% in real life). Tocilizumab was administered in all trial cases (20/20) versus 66% (200/303) in routine care, with a longer delay to the first dose in clinical trials (3.7 vs 2 days). Five patients died in the real-life group whereas none in clinical trials. The number of tocilizumab doses differed significantly (2.5 per patient in trials vs 1.9 in routine care; p = 0.0031) with a similar dosage (555.2 mg vs 581.3 mg). <h3>Conclusion and Relevance</h3> CRS incidence and severity after CAR-T therapy were broadly comparable between clinical trials and real-life practice, but supportive measures were implemented later outside <h3>Conflict of Interest</h3> No conflict of interest