Comparison of open and robotic-assisted partial nephrectomy approaches using multicentric data (UroCCR-47 study).

We compared the outcomes of robotic-assisted partial nephrectomy (RPN) and open partial nephrectomy (OPN) using contemporary data to respond to unmet clinical needs. Data from patients included in the registry who underwent partial nephrectomy between January 01, 2014 and June 30, 2017 within 20 centres of the French Network for Research on Kidney Cancer UroCCR were collected (NCT03293563). Statistical methods included adjusted multivariable analyses. Rates of peri- and post-operative transfusion, and of surgical revision, were lower in the RPN (n = 1434) than the OPN (n = 571) group (2.9% vs. 6.0%, p = 0.0012; 3.8% vs. 11.5%, p < 0.0001; 2.4% vs. 6.7%, p < 0.0001, respectively). In multivariable analyses, RPN was independently associated with fewer early post-operative complications than OPN (overall: odds-ratio [95% confidence interval, CI] = 0.48 [0.35-0.66]; severe: 0.29 [0.16-0.54], p < 0.0001 for both) and shorter hospital stays (34% [30%; 37%], p < 0.0001). RPN was also a significantly associated with a decresedrisk of post-operative acute renal failure, and new-onset chronic kidney disease at 3 and 12 months post-surgery. There were no between-group differences in oncological outcomes. In comparison with OPN, RPN was associated with improved peri- and post-operative morbidity, better functional outcomes, and shorter hospital stays. Our results support the use of RPN, even for large and complex tumours.

Radical prostatectomy for locally advanced and high-risk prostate cancer: A systematic review of the literature.

CONTEXT: The role of radical prostatectomy (RP) in high-risk prostate cancer (PCa) is increasing. PURPOSE: To review the existing literature and determine the value of RP in high-risk and locally advanced PCa. DOCUMENTARY SOURCE: MEDLINE, Embase and the Cochrane Central Register of Controlled Trials were searched from 01/2000 through 05/2016 according to the PRISMA guidelines. SELECTION OF STUDIES: Forty-two studies describing outcomes of RP among 52,546 patients with high-risk and locally advanced PCa. RESULTS: Mortality was approximately 0-1% and Clavien≥3 complications ranged from 1.8% to 12%. Biochemical recurrence-free and metastasis-free survival ranged from 40 to 94% and 90 to 96.1% at 5 years and from 27 to 68% and 64.4 to 85.1% at 10 years, respectively. Overall and cancer specific survival ranged from 55.2 to 98.6% and 89.8 to 100% at 5 years and from 58 to 84% and 65 to 96% at 10 years, respectively. The 12-mo continence rates ranged from 32% to 96.2% and the erectile function recovery ranged from 60% to 64%. LIMITS: Studies were heterogeneous especially regarding the definition of high-risk disease and the use of adjuvant treatments. CONCLUSIONS: The utilization of RP in high-risk and locally advanced PCa is increasing. Existing data support the advantages of RP in this group of patients. However, uniformity in definitions and indications are a prerequisite in order to establish its role as an important therapeutic arm in a multimodality management strategy.

[Salvage radical prostatectomy for recurrent prostate cancer. Morbidity, oncological and functional results]. / Prostatectomie totale de rattrapage après échec de traitement local pour cancer de prostate : morbidité, résultats oncologiques et fonctionnels.

INTRODUCTION: Salvage radical prostatectomy (sRP) for radiorecurrent prostate cancer (PCa) is a challenging procedure. To report our experience with sRP for selected patients with local recurrence after primary treatment for localised PCa. METHODS: From 2005 to 2015, 24 patients underwent sRP for recurrent PCa in our center and were included in this retrospective study. Local recurrence was suspected by PSA increase>nadir+2ng/mL and was confirmed by biopsy. Perioperative complications according to Clavien-Dindo classification, oncological and functional results were analysed. RESULTS: Overall, 24 patients with a median age of 59 years (IQR: 55-60) were included. Median follow-up was 25 months (IQR: 9-26). Procedures were performed with open-retropubic approach in 50 % and robot-assisted laparoscopic approach in 50 %. Overall, 5 (21 %) and 2 (8 %) patients experienced grade≤IIIa and grade≥IIIb postoperative complication, respectively. Surgical margins were positive in 46 % of cases. Three out of 4 patients with postoperatively detectable PSA (>0.2ng/mL) had positive surgical margins. Seven patients experienced biochemical recurrence in a median delay of 19 months (9-62). Seventy-one percent (5) of these patients experienced clinical recurrence in a median delay of 24 months (10-113). Severe urinary incontinence (≥3 pads/day) and erectile dysfunction were reported in 25 % and 63 %, respectively. CONCLUSION: sRP for patients is a feasible procedure with encouraging local control rate and acceptable morbidity. This technique should be discussed as a treatment option for locally recurrent PCa in well-selected patients. LEVEL OF EVIDENCE: 4.

[Factors influencing the choice of nondonor families in a French organ-harvesting center]. / Analyse des raisons motivant le refus du don d'organes par les familles de patients en état de mort encéphalique dans un centre régional de prélèvement.

OBJECTIVES: Report the reasons that lead families to refuse organ donation during their close solicitation by hospital coordination. MATERIAL AND METHODS: A retrospective study was conducted between 2012 and 2015, including 148 (34%) refusal of organ donation among 426 patients identified in a state of brain death. A questionnaire of the family was completed for each interview. Collected data concerned patient characteristics, cause of death, description of the interview and reasons for refusal. A descriptive statistical analysis was performed. RESULTS: The median age of patients was 50 years with a sex ratio of 1.4 men to 1 woman. The most common reason for non-donor family was the desire to maintain the integrity of the body of the patient (28%) followed by a religious order pattern (11%), brutality and suddenness of death (9%), the denial of death (6%) and early age of the donor (5%). In 39% of cases, the family said that the donor had expressed a written or oral refusal in his lifetime. CONCLUSION: A better understanding of the reasons leading to the refusal of non-donor family could provide assistance to the medical team on actions to general public with the aim to reduce the refusal rate. LEVEL OF EVIDENCE: 4.