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Background: Neoadjuvant immunotherapy emerges as a promising strategy for patients with localized colon cancer (CC) harboring microsatellite instability/mismatch repair deficiency (MSI/dMMR). The aim of this study is to evaluate the concordance between clinical cTN stage assessed by preoperative computed tomography (CT) scan and pTN stage of MSI/dMMR CC., Patients and Methods: Consecutive patients diagnosed for localized MSI/dMMR CC and treated with upfront surgery between 2013 and 2022 in two French centers were eligible. Two independent radiologists, blinded to pathological findings, reviewed all preoperative CT scans and assessed cTN stage, with a third radiologist reviewing discordant cases. Radiological predictive diagnostic accuracy for pT4 and pN+ (N+ = N1 or N2) were calculated., Results: One hundred and thirteen patients were included (right CCs = 79%). CT scan diagnostic performances for pT4 were sensitivity (Se) = 33.3%; specificity (Sp) = 94.0%; positive predictive value (PPV) = 66.7%; and negative predictive value (NPV) = 79.6% and for pN+ were Se = 70.3%; Sp = 59.2%; PPV = 45.6%; and NPV = 80.4%. When pT-pN were combined, 37.5% of tumors identified as cT4 and/or cN+ were actually pT1-3 and pN0, and 23.1% of the pT4 and pN+ population was not identified as such radiologically., Conclusion: The ability of preoperative CT scan to predict pT and pN stages is limited for localized MSI/dMMR CCs. Reassessing neoadjuvant strategies' benefit-risk balance in this population is needed., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

A major advance has been made in the management of rectal cancer, with the emergence in 2021 of total neoadjuvant treatment. The main publications from the RAPIDO and PRODIGE-23 trials reported a significant improvement in progression-free survival and the pathological complete response rate. The aim of this review is to synthesize recent data on neoadjuvant treatment of rectal cancer, to explain the long-term results of the RAPIDO and PRODIGE-23 trials, and to put them into perspective, considering current advances in de-escalation strategies. The update of the 5-year survival data from the RAPIDO trial highlights an increased risk of loco-regional relapse, with 11.7% of relapses in the experimental group and 8.1% in the control group, while the update of the PRODIGE-23 trial confirms the benefits of this treatment regimen, with a significant improvement in overall survival. In addition, the results of the OPRA and PROPSPECT trials confirm the benefit of total neoadjuvant treatment with induction chemotherapy, as well as the possibility of surgical de-escalation in the OPRA trial and radiotherapy in the PROSPECT trial. The challenge for the future is to identify patients who require total neoadjuvant treatment with the aim of curative surgery to obtain a cure without local or distant relapse, and those for whom therapeutic de-escalation can be envisaged., (Copyright © 2024 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Background: Laparoscopy for gastric cancer has not been as popular compared with other digestive surgeries, with conflicting reports on outcomes. The aim of this study focuses on the surgical techniques comparing open and laparoscopy by assessing the morbi-mortality and long-term complications after gastrectomy., Methods: A retrospective study (2013-2018) was performed on a prospective national cohort (PMSI). All patients undergoing resection for gastric cancer with a partial gastrectomy (PG) or total gastrectomy (TG) were included. Overall morbidity at 90 post-operative days and long-term results were the main outcomes. The groups (open and laparoscopy) were compared using a propensity score and volume activity matching after stratification on resection type (TG or PG)., Results: A total of 10,343 patients were included. The overall 90-day mortality and morbidity were 7% and 45%, with reintervention required in 9.1%. High centre volume was associated with improved outcomes. There was no difference in population characteristics between groups after matching. An overall benefit for a laparoscopic approach after PG was found for morbidity (Open = 39.4% vs. Laparoscopy = 32.6%, p = 0.01), length of stay (Open = 14[10-21] vs. Laparoscopy = 11[8-17] days, p<0.0001). For TG, increased reintervention rate (Open = 10.8% vs. Laparoscopy = 14.5%, p = 0.04) and increased oesophageal stricture rate (HR = 2.54[1.67-3.85], p<0.001) were encountered after a laparoscopic approach. No benefit on mortality was found for laparoscopic approach in both type of resections after adjusted analysis., Conclusions: Laparoscopy is feasible for PG with a substantial benefit on morbidity and length of stay, however, laparoscopic TG should be performed with caution, with of higher rates of reintervention and oesophageal stricture., Competing Interests: Declaration of competing interest We certify that the authors have no conflict of interest to report., (Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Objectives: We aimed to investigate possible differences in the aggregated hospital fatality rate from coronavirus disease 2019 (COVID-19) in France at the early phase of the outbreak and to determine whether factors related to population or healthcare supply before the pandemic could be associated with outcome differences., Study Design: This is a nationwide observational study including all French hospitals from January 24, 2020, to April 11, 2020., Methods: We analyzed the aggregated hospital fatality rate. A Poisson regression was performed to investigate associations between characteristics pertaining to populational health, socio-economic context and local healthcare supply at baseline, and the chosen outcome., Results: On April 11, 2020, a total number of 30,960 patients were hospitalized among the 3046 French healthcare facilities, including 6832 patients in the intensive care unit (ICU). A total of 8581 deaths due to COVID-19 had been recorded, with a median mortality rate per 10,000 people per department of 0.53 (interquartile range: 0.29-1.90). There were significant variations between the 95 French departments even after adjusting for outbreak inception (P < 0.001). After multivariable analysis, four factors were independently associated with a significantly higher aggregated hospital fatality rate: a higher ICU capacity at baseline (estimate = 1.47; P = 0.00791), a lower density of general practitioners (estimate = 0.95; P = 0.0205), a lower fraction of activity from the for-profit private sector (estimate = 0.99; P < 0.001), and the ratio of people older than 75 years (estimate = 0.91; P = 0.0023)., Conclusions: The aggregated hospital fatality rate from COVID-19 in France seems to vary among geographic areas, with some factors pertaining to local healthcare supply being associated with the outcome., (Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

On the same principle than total mesorectal excision in rectal cancer, the effect of complete mesocolic excision on short and long-term outcomes is actually evaluated for colonic adenocarcinoma. This method, usually performed for left colectomy, offers a surgical specimen of higher quality, with a larger number of lymph nodes harvested. For right colectomy, surgical specifications make it less common complete mesocolic excision and conventional surgery offer comparable outcomes, as regards to postoperative morbidity and mortality rates. No differences are identified between laparoscopic and open surgery. On oncologic outcomes, only two studies report a higher free-disease survival after complete mesocolic excision. Then, there is evidence that complete mesocolic excision offers a higher rate of specimen with extensive lymph node resection, without increased morbidity rate. However, there is limited evidence that it leads to improve long-term oncological outcomes., (Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: To analyze the results of the bibliometric system (SIGAPS score) of scientific publications in the Assistance publique-Hôpitaux de Paris (AP-HP) and to compare the scientific production among the various medical and surgical specialties of the academic hospitals of Paris., Methods: All the publications imported from Pubmed between 2006 and 2008 were included. The following data were taken into account and analysed: the hospital department of origin, the number of articles published, the number of full-time physicians, the SIGAPS score., Results: Thirty-eight thousand, seven hundred and nine publications were included. The departments were consisted of 747 full-time practitioners 5719 (1895 Professors [33.1%], 2772 Assistant Professors [48.4%] and 1052 fellows [18.4%]). The average number of full-time practitioner by department was 7.7±6.7 (range 1-69). The average total number of articles published in a department was 51.8±49.4 (range 1-453). The average SIGAPS score was more important in medicine than in surgery (621.2±670.1 vs. 401±382.2; P=0.01) but not the average number of article per practitioner (8.1±8.3 vs. 6.6±6.2; P=0.0797). The mean number of publication by full-time practitioner was 7.9±7.8 (1-45), or an average of 2.7±2.6 for each full-time practitioner each year., Conclusion: Academic hospitals in Paris have a reasonably scientific output but with a mean of 2.7 articles per full-time practitioner per year. No major differences between medical and surgical disciplines were observed., (Copyright © 2012 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Introduction: Total proctocolectomy, ensuring eradication of all diseased colorectal mucosa is the treatment of choice for ulcerative colitis, familial adenomatous polyposis. Before the era of ileal pouch anal anastomosis, definitive ileostomy was required. The aim of this study is to define both early and late morbidity and the functional result of continent ileostomy., Methods: All patients' chart who had a continent ileostomy in our department were reviewed. The functional result was evaluated in 43 patients., Results: Forty-nine patients (34 women) with a mean age of 42 years (range: 17-69) underwent a continent ileostomy, 32 following a restorative proctocolectomy. The mean follow-up was 20.5 (range: 3-34) years. Seventeen patients (35%) experienced an early postoperative complication requiring reintervention in two patients. There was no mortality, and conversion to an end ileostomy was not required. Twenty-two patients developed late complications requiring 50 reoperations. The mean number of catheterisations per 24h was 4.4. The SF36 questionnaire showed values close to those of the general population., Conclusion: Continent ileostomy carries a significant risk of non-severe complications. In selected patients, it represents a valuable alternative to an end ileostomy, in particular when restorative proctocolectomy has failed., (Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Purpose: The objective of this study was to analyze, during a transversal study, the predictive sociodemographic and individual factors to be ranked within the first 500 medical students in the 2009 French national ranking exam (NRE)., Methods: In September 2009, 5570 medical students have chosen their subspecialty. They were invited to fill-up a questionnaire that included sociodemographics and educational items. Logistic regression was used to identify factors that were associated with being ranked within the first 500 medical students., Results: A total of 4712 students (two third of women) responded to the questionnaire (92.3% response rate). The mean age of respondents was 24.7 years (±1.79). In the multivariate analysis, independent factors associated with being ranked within the first 500 medical students at the NRE were: being less than 25-year-old (odds ratio [OR]: 1.8; 95%CI: 1.3-2.5; P<0.001), region of origin (Île de France) (OR: 3.7; 95%CI: 2.3-5.8; P<0.0001), to succeed at the first medical year examination for the first time (OR: 1.7; 95%CI: 1.2-2.4; P<0.001), being in the first 20% of the medical students during externship (P<0.0001), critical reading test (CRT) teaching by graduate doctors (OR: 1.5; 95%CI: 1.05-2.1; P<0.001), and to participate in a national practicing ranking exam with a CRT (OR: 1.96; 95%CI: 1.3-3.03; P=0.002)., Conclusion: Our study identified six factors independently associated with being ranked within the first 500 medical students in the French NRE. Education and training of the CRT, newly introduced test in 2009, seem to play an important role., (Copyright © 2011 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)