University Hospital of Lausanne

Oxaliplatin (Ox) is one of the recommended agents in Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) that benefitted of several phase I trials. Based on these data, the dose of 120mg/m2 was suggested by an expert consensus for fit patients with peritoneal metastases (PM) of gastrointestinal cancers. The aim of the current study is to determine the real-life feasibility and safety profile of this regimen. This retrospective study included all patients treated with PIPAC-Ox 120mg/m2 in six referral centers specialized in PM. The patients were assessed for all potential toxicities associated to high dose oxaliplatin. Adverse events were expressed with the use of CTCAE for medical complications and Clavien-Dindo for surgical complications. Logistic regression and multivariate analysis were performed. 259 PIPAC procedures were performed in 91 patients (53 male) diagnosed with unresectable PM of various origins; most patients (n=62) having colorectal PM. Concomitant IV 5FU was performed in 70 patients. All patients underwent the first PIPAC-Ox 120mg/m2, and 44 patients (48.3%) had ≥3 PIPAC. Abdominal pain was the most frequent grade III toxicity at the first PIPAC-Ox (n=34) while 30 patients routinely received continuous IV opioids. Nausea-vomiting and ascites infection were the others grade III toxicity observed at PIPAC 1, one in each case respectively. After PIPAC 3, RECIST partial/stable response in 68.2%; PRGS 1-2 in 77.3% and negative cytology in 50% of patients. High-dose PIPAC-Ox is feasible and safe. Local and histological response are well identified. However abdominal pain remains a main concern and continuous IV protocols should be considered routinely.

Streaming the intubation procedure performed with a videolaryngoscope (VL) to operating room monitors has been rendered possible through technical improvements. This study explored the impact of streaming McGRATH MAC+™ VL live intubations to operating room monitors on team dynamics, situational awareness and evaluated overall perceptions of the device in daily practice. This cross-sectional, observational study was conducted between February and November 2025 at the Lausanne university hospital (CHUV) in Switzerland. Operating room professionals with exposure to McGRATH MAC+™ streaming completed a paper-based questionnaire assessing perceived changes in awareness, participation, communication, and device performance. Retrospective within-subject comparisons (before vs after streaming ratings) were analysed. We enrolled 50 participants (37 anaesthesia, 13 operative). After the introduction of VL streaming, awareness of the intubation process was perceived to have improved by the anaesthesia staff (p < 0.001) and the operative staff (p = 0.005). The participants didn’t perceive a significant change in their participation to the intubation with VL streaming. Secondary outcomes highlighted facilitated intra-team communication within anaesthesia teams and modestly improved inter-team coordination. No meaningful changes were reported regarding perceived intubation time or complication rates. In addition, VL was considered highly effective for training and improved operator confidence. Streaming videolaryngoscope live intubations to operating room monitors resulted in higher retrospectively perceived situational awareness and the device was viewed as an educational asset. Selective use in difficult or teaching cases may offer a high-yield strategy for enhancing team coordination during airway management. clinicaltrials.gov : NCT06453525

Segmentectomy is increasingly used and is emerging as a key treatment option for early-stage non-small cell lung cancer (NSCLC). However, questions remain regarding the adequacy of lymph node evaluation, particularly differences in N1 versus N2 dissection, and the implications for staging accuracy and adjuvant therapy. This narrative review synthesizes evidence from studies published between 2019 and 2025 comparing nodal upstaging, survival outcomes, and the role of completion lobectomy following segmentectomy versus lobectomy. Twelve studies, including more than 175,000 patients, were analyzed. Lobectomy was associated with a significantly higher overall nodal upstaging rate (14.5% vs. 6.6%, p < 0.001), driven primarily by increased detection of N1 disease (13.3% vs. 3.7%, p < 0.001), while N2 upstaging rates were similar between procedures (5.5% vs. 3.2%, p = 0.07). Despite lower N1 detection, adjusted analyses reported comparable survival outcomes among patients with occult pathologic N1 (pN1) or N2 (pN2) disease who received adjuvant therapy. Segmentectomy provided outcomes comparable to lobectomy, whereas wedge resection was associated with inferior survival (HR 1.23, p = 0.042). Completion lobectomy has not demonstrated a consistent survival benefit and was associated with substantial morbidity in limited retrospective series, including high rates of thoracotomy conversion and major complications. When performed with systematic nodal dissection, adequate surgical margins, and appropriate adjuvant therapy, segmentectomy appears to provide survival outcomes comparable to lobectomy in selected patients with early-stage NSCLC. Completion lobectomy may not be routinely required and should be considered on a case-by-case basis within a multidisciplinary context. These findings support the use of segmentectomy in carefully selected patients when high-quality surgical staging and integrated oncologic care are ensured, while highlighting the need for prospective studies addressing occult nodal disease in the modern treatment era.

Although sleeve gastrectomy is a commonly performed bariatric procedure, it is well recognized as being associated with an increased risk of gastroesophageal reflux disease. This multifactorial phenomenon involves anatomical, functional, and hormonal alterations that can compromise the antireflux barrier. A thorough preoperative assessment is crucial for identifying at-risk patients and minimizing postoperative complications. Initial management relies on lifestyle and dietary modifications combined with medical therapy. However, refractory cases often require surgical revision. Conversion to Roux-en-Y gastric bypass, performed in Switzerland exclusively in specialized reference centers, remains the most effective strategy to control symptoms while maintaining the metabolic benefits of bariatric surgery.

The hypothalamic-pituitary-gonadal axis (HPG) controls pubertal development, sexual maturation, and fertility. We identified a role of hypothalamic microglia in controlling the HPG axis through receptor activator of nuclear factor κβ (Rank) signaling. Whole-body and microglia Rank depletion led to hypogonadotropic hypogonadism (HH) resulting from an alteration in gonadotropin-releasing hormone (GnRH) neuron function. In addition, we identified rare gene variants of RANK in patients with HH. Transcriptional profiling upon Rank loss revealed defective microglia activation and morphological alterations in the median eminence, decreasing the contacts and engulfment of GnRH terminal projections and impairing GnRH neuronal responses to kisspeptin. Overall, our data uncover the microglia as regulator of GnRH neuronal function through Rank signaling, with potential implications for reproductive maturation and fertility.