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Current histoprognostic parameters and prognostic scores used in paragangliomas and pheochromocytomas do not adequately predict the risk of metastastic progression and survival. Here, using a series of 147 cases of paraganglioma and pheochromocytoma, we designed and evaluated the potential of a new score, the COPPS (COmposite Pheochromocytoma/paraganglioma Prognostic Score), by taking into consideration three clinico-pathological features (including tumor size, necrosis, and vascular invasion), and the losses of PS100 and SDHB immunostain to predict the risk of metastasis. We compared also the performance of the COPPS with several presently used histoprognostic parameters in risk assessment of these tumors. A PASS score (Pheochromocytoma of the Adrenal gland Scaled Score) ≥ 6 was significantly associated with the occurrence of metastases (P

Objective This study is to determine the impact of complications after total thyroidectomy on health-related quality of life (HR-QoL) and to identify significant predictive factors of HR-QoL changes. HR-QoL is usually impaired in patients with thyroid diseases compared to the general population. Thyroidectomy is largely performed in the case of benign thyroid benign and can be associated with long-term complications (vocal cord palsy, hypoparathyroidism). Design The prospective ThyrQoL multicenter trial (NCT02167529) included 800 patients who underwent total thyroidectomy for benign or malignant non-extensive disease in seven French referral hospitals between 2014 and 2016. Methods HR-QoL was assessed using the MOS 36-item short form health survey (SF-36) self-questionnaire with a 6-month follow-up. Results We observed a significant improvement of HR-QoL 6 months after surgery (P Conclusion We observed a significant improvement of HR-QoL 6 months after total thyroid surgery for benign thyroid disease.

Adrenocortical carcinoma is a rare neoplasm with a high rate of recurrence. We studied the impact of surgery on the survival in recurrent adrenocortical carcinoma patients.We performed a retrospective review of patients with recurrent adrenocortical carcinoma, managed in 5 French University Hospitals between 1980 and 2014. We compared surgery and medical management for ACC recurrence.Fifty-nine patients were included, 46 of whom had an initial R0 resection. Twenty-nine patients underwent reoperation for recurrence, while 30 had nonoperative treatments. Operated patients had a greater median overall survival after recurrence than nonoperated patients (91 vs 15 months; P.001). Patients operated on for local or distant recurrence had similar overall survival (110 vs 91 months; P = .81). In nonoperated patients, types of medical managements did not impact survival. Surgery for recurrence (P = .037) and a disease-free interval between initial resection and recurrence12 months (P = .059) were both prognostic factors for improved survival, whereas age, stage, and tumor size (P ≥ .2 each) were not. A Ki6725% tended to be associated with better overall survival (P = .051).Both surgery for recurrence and disease-free interval between the initial resection of an adrenocortical carcinoma and recurrence12 months are associated with better overall survival.

Please cite this article in press as: Sessa L, et al. Right robotic adrenalectomy for a 8 cm pheochromocytoma (with video). Journal of Visceral Surgery (2015), http://dx.doi.org/10.1016/j.jviscsurg.2015.06.010 Pheochromocytoma; Robotic surgery; Minimally invasive surgery; Robotics CT scan showed a 10 cm right adrenal tumor compatible with a pheochromocytoma. MIBG scintigraphy confirmed a right adrenal tumor single uptake. Routine biomolecular evaluation (SDHx and VHL genes) was negative for a familial disease. A totally robotic lateral transperitoneal right adrenalectomy was performed. The patient was placed in left lateral strict decubitus and flexed at the waist. An ‘‘open’’ right subcostal access was used to introduce a 12 mm optical trocar. Under laparoscopic vision (0◦ scope), 4 other trocars were introduced: two 8 mm right subcostal trocars, one 12 mm and one 10 mm trocars for the first-assistant’s left and right (liver retractor) hand, respectively. The robotic cart (da Vinci® Si Surgical System, Intuitive Surgical) was placed above the patient’s right shoulder and was docked. Intra-abdominal exploration confirmed the presence of a large retroperitoneal mass that completely modified the right suprarenal region. The right triangular ligament was divided and the liver was medially retracted. The right aspect of the vena cava was not initially accessible because of the large adrenal mass volume. Consequently, the tumor was first dissected, en bloc with the periadrenal fat, from the upper pole of the kidney and from lateral attachments to obtain an adequate mobilization of the adrenal mass allowing its rotation to better approach the right lateral and posterior aspects of the vena cava. Then, dissection was carried out progressively upward along the inferior vena cava on the medial margin of the tumor. Four large adrenal veins were consecutively dissected, clipped using nonabsorbable self-locking clips (Hem-o-lok®, Weck-Telefex Europe Ltd.), and divided. The adrenal mass was completely dissected and mobilized from its posterior aspect (iliopsoas muscle). Overall operative time was 90 minutes. No post-operative complication was observed hospitalization duration was 3 days. Pathology confirmed an adrenal pheochromocytoma, 8 cm in diameter with a PASS score 1 with R0 resection without capsular effraction.

Introduction L’hyperaldosteronisme primaire est une cause frequente d’HTA secondaire. La surrenalectomie ne guerit que 35% des patients. L’ARS est valide aux USA comme un score predictif de guerison. L’objectif de cette etude est de valider ce score en France. Methode Cette etude retrospective a collige les donnees des patients operes pour Adenome de Conn (AC) dans 4 CHU de 2002 a 2014. Le score ARS est note sur 5 points (femme=1, IMC inf ou = a 25 kg/m2 = 1, duree d’HTA Resultats 150 patients ont ete operes pour AC. Les donnees concernant le score ARS et le suivi a 6 mois ont ete etablies pour 120 patients. L’âge moyen etait de 51,7 ± 10,7 ans, 50,3% etaient des femmes. La duree moyenne de l’HTA avant chirurgie etait de 6,7 ± 6,6 ans avec 2,4 ± 1,2 antiHTA. 38,1% ont normalise leur TA sans ttt, 12,9% n’avaient pas normalise leur TA, 49% ont normalise leur TA mais requierent un ttt antiHTA. La morbidite etait de 5%, la mortalite nulle. Les femmes etait gueries dans 53,8% des cas contre 29,6% des hommes (p = 0,004). Les patients non gueris de leur HTA avaient en moyenne 1,6 antiHTA 6 mois apres la chirurgie versus 2,8 antiHTA avant la chirurgie. La guerison de l’HTA pour les patients avec un ARS de 0-1 a ete obtenue chez 18,8%, 29,8% pour un ARS de 2-3, 73,2% pour un ARS de 4-5 (p=0,0001). Conclusion Le score ARS est predictif de guerison de L’HTA en France. Declaration d’interet Les auteurs n’ont pas transmis de conflits d’interets.

La surrenalectomie pour adenome de Conn (AC) guerit 35 % des patients. L’ARS est valide aux Etats-Unis comme un score predictif de guerison. L’objectif est de valider ce score en France. Cette etude retrospective a collige les donnees des patients operes pour AC dans 4 CHU de 2002 a 2014. Le score ARS est note sur 5 points (femme = 1, IMC ≤ 25 = 1, duree d’HTA Cent cinquante patients ont ete operes pour AC, 98 % par cœlioscopie, 2 conversions. Une laparotomie d’emblee. Les donnees concernant le score ARS et le suivi a 6 mois ont ete etablies pour 120 patients. L’âge moyen etait de 51,7 ± 10,7 ans. La duree moyenne de l’HTA avant chirurgie etait de 6,7 ± 6,6 ans avec en moyenne 2,4 ± 1,2 antiHTA ; 38,1 % ont normalise leur TA sans ttt, 12,9 % n’avaient pas normalise leur TA, 49 % ont normalise leur TA mais requierent un ttt antiHTA. La morbidite etait de 5 %, la mortalite nulle. Les femmes etaient gueries dans 53,8 % des cas contre 29,6 % des hommes (p = 0,004). Les patients non gueris de leur HTA avaient en moyenne 1,6 antiHTA 6 mois apres la chirurgie versus 2,8 antiHTA avant la chirurgie. La guerison de l’HTA pour les patients avec un ARS de 0–1 est de 18,8 %, 29,8 % pour un ARS de 2–3, 73,2 % pour un ARS de 4–5 (p = 0,0001). Le score ARS est predictif de guerison de l’HTA en France.