Centre Hospitalier Universitaire de Rouen

Lecanemab, the first anti-amyloid therapy approved by the European Medicines Agency, has demonstrated a statistically and clinically significant but moderate slowing of decline in early Alzheimer's disease (AD). In contrast, its long-term impact on the disease course is not formally established. Any benefit, therefore, needs to be carefully weighed against its adverse effects and practical constraints, which must be discussed with patients and caregivers within a shared decision-making process (SMD). However, applying SDM in this context is challenging due to treatment complexity, cognitive impairment and the involvement of care partners. Supported decision-making, which aims to assist individuals with decisional limitations in participating in important choices, has been promoted as a relevant approach. In this bicentric study conducted in France, we evaluated a simulated supported decision-making process in 25 patients with early AD who were eligible for lecanemab and faced the decision to choose anti-amyloid immunotherapy. We created a written decision aid using a consensus-based method to provide clear, accurate, and scientifically validated information to patients and care partners. After a one-week reflection period, both patients and care partners demonstrated a good overall understanding of the information provided, though care partners showed higher levels of comprehension and retention. The treatment was considered acceptable by most patients and their care partners. While patients ultimately remain the decision-makers, these findings highlight the central role of care partners in strengthening supported decision-making, notably through frameworks such as the French "trusted person" model.

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.