Imad Bentellis

Objectives: The objective is to compare the learning curves between two pioneer and three second‐generation surgeons for RAPN in terms of WIT, CD and positive surgical margins.Materials and methods: The charts of consecutive RAPNs of three centres were reviewed from the UroCCR prospective database. The experience was assessed by a regression model for each group. There was a univariate analysis on three consecutive sequences of 15 procedures. The learning speed for WIT was explored graphically by polynomial regression after cubic splines. Finally, CUSUM charts were obtained.Results: There were 1203 RAPN in the pioneer group and 119 performed by second‐generation surgeons. There was a significant difference in the distribution of tumour size (p < 0.001) and the RENAL score (p < 0.001). The operative time was longer in the first group (p > 0.001). Independent factors for a higher WIT were the second group (p < 0.001), higher experience (p < 0.001) the collinearity between the group and experience (p < 0.001), the RENAL score (p < 0.001) and blood loss (p < 0.001). Adjusted Loess regressions showed a plateau of WIT at 400 procedures for the pioneers and a significant decrease at 20 procedures for the second generation. CUSUM chart analysis showed a ‘staircase’ pattern of the learning process, with three major steps at 150, 200 and 300 procedures. The major limitation is the difference in sample size between the two arms.Conclusions: Learning curve patterns would reflect a transfer of knowledge to the second‐generation, as opposed to the establishment of standards by the pioneers.

Background: Over the past thirty years, there has been a major shift in the management of liver trauma. Contained hepatic vascular injuries (CHVI), including pseudoaneurysms and arteriovenous fistulas, are often feared because of the risk of secondary hemorrhage. However, little is known about CHVI. There are no guidelines for their management. Our aim was to validate the risk factors for CHVI, to identify the associated morbidities, and to establish a management protocol. Materials and Methods: A retrospective study of 318 liver trauma cases from a level 1 trauma center over the past 15 years, comparing the presence or absence of CHVI. Univariable and multivariable analyses were conducted. Treatment used to manage CHVI was also compared. Results: Liver trauma with the following characteristics, A.A.S.T. grade ≥III, bilateral injuries, and laceration-type lesions, were associated with a higher risk of CHVI. Grade A.A.S.T. ≥III and bilateral injuries were confirmed in a multivariable study with odds ratios as high as 4.0 and 3.5, respectively. CHVI was associated with significantly more delayed bleeding and controlled computed tomography. After analyzing the non-interventional management of CHVI less than two centimeters, a management algorithm is proposed. Conclusions: This retrospective unicentric study and literature review provide additional insight into the patient profile at risk for developing CHVI, its associated morbidity, and its management. Export

Purpose: This study was performed to assess the risk factors for artificial urinary sphincter (AUS) explantation in a large multicenter cohort.Methods: We retrospectively reviewed the medical records for all 1,233 implantations of the AMS-800 AUS device in male nonneurological patients from 2005 to 2020 across 13 French centers. Patients with neurological conditions were excluded from the study. To identify factors associated with explantation-free survival, survival analysis was performed. Explantation was defined as the complete removal of the device, whereas revision referred to the replacement of the device or its components.Results: The study included 1,107 patients, of whom 281 underwent AUS explantation. The median survival without explantation was 83 months. The leading causes of explantation were infection and erosion. Univariate analysis revealed several significant risk factors for explantation: age above 75 years (34.6% in the explanted group vs. 25.8% in the nonexplanted group, P=0.007), history of radiotherapy (43.5% vs. 31.3%, P=0.001), and anticoagulant use (15% vs. 8.6%, P<0.001). In logistic regression analysis, the only significant risk factor was previous radiotherapy (odds ratio [OR], 2.05; P<0.05). Cox proportional hazards analysis revealed 2 factors associated with earlier explantation: transcorporal cuff implantation (hazard ratio [HR], 2.67; P=0.01) and the annual caseload of the center (HR, 1.08; P=0.02). When specifically examining explantation due to erosion, radiotherapy was the sole factor significantly associated with the risk of erosion (OR, 2.47; P<0.05) as well as earlier erosion (HR, 1.90; P=0.039).Conclusions: In this series, conducted in a real-world setting across multiple centers with different volumes and levels of expertise, the median survival without AUS explantation was 83 months. This study confirms that radiotherapy represents the primary independent risk factor for AUS erosion in male nonneurological patients.

Background: The results of 12 h nighttime Cheneau–Toulouse–Munster (CTM) brace wear on adolescent idiopathic scoliosis are poorly described. Objective: The main objective was to analyze the efficiency of 12 h nighttime CTM brace wear on adolescent idiopathic scoliosis. The secondary objective was to identify the factors influencing good results. Methods: One hundred and fifty consecutive patients treated between 2006 and 2017 were retrospectively analyzed with subgroup analysis for the main curve pattern (main thoracic or main lumbar). The inclusion criteria were evolutive scoliosis, 12 h nighttime CTM brace wear, Risser stages 0-1-2 at the time of the prescription, and Cobb angle below 45 degrees. Success was defined as no surgery, and the main curve Cobb angle (CA) progression ≤5°. The overcurve was defined as the proximal thoracic curve above the main thoracic and mid-thoracic above the main lumbar curves. A logistic regression model was built to assess the predictors of success. RESULTS: Overall success was 70%: 60% for main thoracic (MT) and 84% for main lumbar scoliosis (ML) (p = 0.003). Efficacy was 62% at Risser stage 0 and 78% at Risser stage 1–2 (p = 0.054). For MT, failure was associated with high in-brace sagittal C7 tilt (Odds Ratio = 0.72, p = 0.014) and low initial overcurve CA (Odds Ratio = 0.42, p = 0.044). For ML, a high standing height was associated with success (OR = 1.42, p = 0.035), and frontal unbalanced C7 tilt was associated with failure (OR = 0.43, p = 0.02). Conclusion: Twelve-hour nighttime CTM brace wear provided good results for main lumbar curves with balanced frontal C7 tilt. For MT, this treatment is indicated if the in-brace sagittal C7 tilt is well balanced from Risser stage 2.

Aim The aim of the study was to determine the preoperative predictive factors of overall survival, relapse-free survival, and peritoneal carcinomatosis in obstructive colorectal cancer. Methods Data from patients undergoing emergency surgery for obstructive colorectal cancer at our center between 2004 and 2016 were extracted retrospectively from our health records. Several preoperative parameters were used to predict survival and peritoneal carcinomatosis using univariate and multivariate analysis, and ROC curves. Results A total of 107 patients with obstructive colorectal cancer were included. Five-year relapse-free and overall survival rates were 14% and 28%, respectively, with 15% peritoneal carcinomatosis. Univariate analysis showed that age ≥ 83 years old, preoperative ASA score ≥ 3, initial hemodynamic instability, and CRP > 18.3 mg/L was significantly associated with worse relapse-free and overall survival. In a multivariate analysis, only age > 83 years (HR = 1.75; HR = 2.16, for relapse-free and overall survival status, respectively) and hemodynamic instability (HR = 7.29; HR = 6.55) were confirmed in the multivariate model. Global peritoneal carcinomatosis was significantly associated with synchronous liver metastases in the multivariate model (OR = 4.56), and synchronous peritoneal carcinomatosis only was significantly associated with platelet to lymphocyte ratio (PLR) > 269 and synchronous liver metastases in the multivariate model (OR = 0.003; OR = 7.26). Conclusion Synchronous liver metastases are prognostic risk factor for global and synchronous peritoneal carcinomatosis whereas PLR > 269 was a significant protective factor for synchronous peritoneal carcinomatosis only for obstructive colorectal cancer. Age > 83 years and initial hemodynamic instability were key preoperative prognostic risk factors for worse relapse-free and overall survival. Prognostic usefulness of blood cell ratios for mortality and peritoneal carcinomatosis warrants further investigation.