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In the current setting of organ shortage, brain-dead liver donors with recent liver trauma (RLT) represent a potential pool of donors. Yet, data on feasibility and safety of liver transplantation (LT) using grafts with RLT are lacking.All liver grafts from brain-dead donors with RLT proposed for LT between 2010 and 2018 were identified from the nationwide CRISTAL registry of the Biomedicine Agency. The current study aimed at evaluating 1-y survival as the primary endpoint.Among 11 073 LTs, 142 LTs (1.3%) using grafts with RLT were performed. These 142 LTs, including 23 split LTs, were performed from 131 donors (46.1%) of 284 donors with RLT proposed for LT. Transplanted grafts were procured from donors with lower liver enzymes levels (P 0.001) and less advanced liver trauma according to the American Association for the Surgery of Trauma liver grading system (P 0.001) compared with not transplanted grafts. Before allocation procedures, 20 (7%) of 284 donors underwent damage control intervention. During transplantation, specific liver trauma management was needed in 19 patients (13%), consisting of local hemostatic control (n = 15), partial hepatic resection on back-table (n = 3), or perihepatic packing (n = 1). Ninety-day mortality and severe morbidity rates were 8.5% (n = 12) and 29.5% (n = 42), respectively. One-year overall and graft survival rates were 85% and 81%, and corresponding 5-y rates were 77% and 72%, respectively.Using liver grafts from donors with RLT seems safe with acceptable long-term outcomes. All brain-dead patients with multiorgan trauma, including liver injury, should be considered for organ allocation.

Background: Several medicinal treatments for avoiding post-operative ileus (POI) after abdominal surgery have been evaluated in randomised controlled trials. This network meta-analysis aimed to explore the relative effectiveness of these different treatments on ileus outcome measures. Methods: A systematic literature review was performed to identify randomised controlled trials (RCTs) comparing treatments for post-operative ileus following abdominal surgery. A Bayesian network meta-analysis was performed. Direct and indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analysis. Results: A total of 38 randomised controlled trials were included in this network meta-analysis reporting on 6371 patients. Our network meta-analysis shows that prokinetics significantly reduce the duration of first gas (Mean difference (MD) (hours) – 16; credible interval - 30, - 3.1; surface under the cumulative ranking curve (SUCRA) 0.418), duration of first bowel movements (Mean difference (MD) (hours) -25; credible interval - 39, - 11; SUCRA 0.25) and duration of post-operative hospitalisation (Mean difference (MD) (hours) – 1.9; credible interval – 3.8, - 0.040; SUCRA 0.34). Opioid antagonists are the only treatment that significantly improve the duration of food recovery (Mean difference (MD) (hours) - 19; credible interval - 26, - 14; SUCRA 0.163). Conclusion: Based on our meta-analysis, the two most consistent pharmacological treatments able to effectively reduce POI after abdominal surgery are prokinetics and opioid antagonists. The absence of clear superiority of one treatment over another highlights the limits of the pharmacological principles available.

Background The Mayo protocol for liver transplantation in patients with unresectable perihilar cholangiocarcinoma is based on strict selection and neoadjuvant chemoradiotherapy. The role of neoadjuvant chemoradiotherapy in this scenario remains unclear. The aim of this study was to compare outcomes after transplantation for perihilar cholangiocarcinoma using strict selection criteria, either with or without neoadjuvant chemoradiotherapy. Methods This was an international, multicentre, retrospective cohort study of patients who underwent transplantation between 2011 and 2020 for unresectable perihilar cholangiocarcinoma using the Mayo selection criteria and receiving neoadjuvant chemoradiotherapy or not receiving neoadjuvant chemoradiotherapy. Endpoints were post-transplant survival, post-transplant morbidity rate, and time to recurrence. Results Of 49 patients who underwent liver transplantation for perihilar cholangiocarcinoma, 27 received neoadjuvant chemoradiotherapy and 22 did not. Overall 1-, 3-, and 5-year post-transplantation survival rates were 65 per cent, 51 per cent and 41 per cent respectively in the group receiving neoadjuvant chemoradiotherapy and 91 per cent, 68 per cent and 53 per cent respectively in the group not receiving neoadjuvant chemoradiotherapy (1-year hazards ratio (HR) 4.55 (95 per cent c.i. 0.98 to 21.13), P = 0.053; 3-year HR 2.07 (95 per cent c.i. 0.78 to 5.54), P = 0.146; 5-year HR 1.71 (95 per cent c.i. 0.71 to 4.09), P = 0.229). Hepatic vascular complications were more frequent in the group receiving neoadjuvant chemoradiotherapy compared with the group not receiving neoadjuvant chemoradiotherapy (nine of 27 versus two of 22, P = 0.045). In multivariable analysis, tumour recurrence occurred less frequently in the group receiving neoadjuvant chemoradiotherapy (HR 0.30 (95 per cent c.i. 0.09 to 0.97), P = 0.044). Conclusion In selected patients undergoing liver transplantation for perihilar cholangiocarcinoma, neoadjuvant chemoradiotherapy resulted in a lower risk of tumour recurrence, but was associated with a higher rate of early hepatic vascular complications. Adjustments in neoadjuvant chemoradiotherapy reducing the risk of hepatic vascular complications, such as omitting radiotherapy, may further improve the outcome in patients undergoing liver transplantation for perihilar cholangiocarcinoma.

The ABO blood group system may influence tumorigenesis, but its prognostic value in liver transplantation (LT) for hepatocellular carcinoma (HCC) has never been assessed.All consecutive patients who underwent LT for HCC between 2013 and 2017 at 9 centers were analyzed. Predictors of tumor recurrence were identified using multivariable analysis, while comparison between group A and non-A recipients was performed after propensity score matching.Among 925 LT recipients, 406 were blood group A, 94 group B, 380 group O, and 45 group AB. On multivariable analysis, group A was associated with tumor recurrence (hazard ratio [HR] = 1.574 [95% confidence interval; 95% CI = 1.034-2.394] P = 0.034). After propensity score matching, 1- and 5-y recurrence rates were 7.4% and 20.1% in group A recipients versus 3.3% and 13.2% in non-A recipients (HR = 1.66 [95% CI = 1.12-2.45], P = 0.011). One and 5-y recurrence-free survivals were 85.2% and 66.8% in group A recipients versus 88.5% and 71.3% in non-A recipients (HR = 1.38 [95% CI = 1.01-1.90], P = 0.045). Among recipients within Milan criteria (n = 604), 1- and 5-y recurrence rates were 5.8% and 12.7% in group A recipients versus 3.1% and 12.2% in non-A recipients (HR = 1.197 [95% CI = 0.721-1.987], P = 0.485). Among recipients outside Milan criteria (n = 182), 1- and 5-y recurrence rates were 12.1% and 43.8% in group A recipients versus 3.9% and 15.6% in non-A recipients (HR = 3.175 [95% CI = 1.526-6.608], P = 0.002).ABO blood system influences the oncological outcome of recipients undergoing LT for HCC. Its incorporation in the prognostication model of LT for HCC may allow improving the management of LT candidates.

One-third of patients with cirrhosis present kidney failure (AKI and CKD). It has multifactorial causes and a harmful effect on morbidity and mortality before and after liver transplantation. Kidney function does not improve in all patients after liver transplantation, and liver transplant recipients are at a high risk of developing chronic kidney disease. The causes of renal dysfunction can be divided into three groups: pre-operative, perioperative and post-operative factors. To date, there is no consensus on the modality to evaluate the risk of chronic kidney disease after liver transplantation, or for its prevention. In this narrative review, we describe the outcome of kidney function after liver transplantation, and the prognostic factors of chronic kidney disease in order to establish a risk categorization for each patient. Furthermore, we discuss therapeutic options to prevent kidney dysfunction in this context, and highlight the indications of combined liver–kidney transplantation.

Summary Aim To study morbi-mortality, survival after hepatectomy in elderly patients, and influence on their short-term autonomy. Patients and methods This is a retrospective study conducted between 2002 and 2017 comparing patients less than 65 years old (controls) to those more than 65 years old (cases) from a prospective database, with retrospective collection of geriatric data. Cases were divided into three sub-groups (65–70 years, 70–80 years and > 80 years). Results Four hundred and eighty-two patients were included. There was no age difference in number of major hepatectomies (P = 0.5506), length of stay (P = 0.3215), mortality at 90 days (P = 0.3915), and surgical complications (P = 0.1467). There were more Grade 1 Clavien medical complications among the patients aged over 65 years (P = 0.1737). There was no difference in overall survival (P = 0.460) or disease-free survival (P = 0.108) according to age after adjustment for type of disease and hepatectomy. One-third of patients had geriatric complications. The “home discharge” rate decreased significantly with age from 92% to 68% (P = 0.0001). Early loss of autonomy after hospitalization increased with age, 16% between 65 and 70 years, 23% between 70 and 80 years and 36% after 80 years (P = 0.10). We identified four independent predictors of loss of autonomy: age > 70 years, cholangiocarcinoma, length of stay > 10 days, and metachronous colorectal cancer. Conclusions Elderly patients had the same management as young patients, with no difference in surgery or survival, but with an increase in early loss of autonomy.

Resume Objectif Etudier la morbi-mortalite, la survie des hepatectomies chez le sujet âge, ainsi que l’influence sur l’autonomie a court terme. Patient et methode Il s’agit d’une etude retrospective realisee de 2002 a 2017 comparant les patients de moins de 65 ans (temoins) aux plus de 65 ans (cas) a partir d’une base de donnees prospective avec recueil retrospectif des donnees geriatriques. Les cas etaient repartis en trois sous-groupes (65–70 ans, 70–80 ans et > 80 ans). Resultats Au total, 482 patients ont ete inclus. Il n’y avait pas de difference en fonction de l’âge sur le nombre d’hepatectomies majeures (p = 0,5506), la duree de sejour (p = 0,3215), la mortalite a 90 j (p = 0,3915) et les complications chirurgicales (p = 0,1467). Il y avait plus de complications medicales Clavien 1 parmi les patients de plus de 65 ans (p = 0,1737). Il n’y avait pas de difference de survie globale (p = 0,460) et sans recidive (p = 0,108) en fonction de l’âge apres ajustement sur le type de maladie et d’hepatectomie. Un tiers des malades avaient des complications geriatriques. Le taux de « sortie a domicile » diminuait significativement avec l’âge de 92 a 68 % (p = 0,0001). La perte d’autonomie precoce a la sortie augmentait avec l’âge, elle etait de 16 % entre 65 et 70 ans, de 23 % entre 70 et 80 et de 36 % apres 80 ans (p = 0,10). Nous avons identifie quatre facteurs predictifs independants de perte d’autonomie : un âge > 70 ans, le cholangiocarcinome, une duree de sejour > 10 jours, et le caractere metastatique metachrone de cancer colorectal. Conclusions Les patients âges avaient la meme prise en charge que les patients jeunes, sans difference sur les suites operatoires ou la survie, mais avec une augmentation de la perte d’autonomie precoce.

Resume Objectifs Evaluation de la valeur du PET scanner au 18F-FDG dans la differenciation des formes benignes et malignes des tumeurs intracanalaires papillaire et mucineuse du pancreas. Introduction Les TIPMP malignes ou de haut risque necessitent une resection chirurgicale mais cette chirurgie devrait etre evitee en cas de TIPMP a faible risque de malignite. Le PET scanner au 18F-FDG a ete etudie dans de nombreuses series retrospectives monocentriques. Methode Il s’agit d’une etude multicentrique francaise prospective non comparative. L’objectif principal de cette etude etait d’analyser la specificite du PET scanner au 18F-FDG pour l’identification des formes malignes des TIPMP (carcinome invasif ou in situ). Le diagnostic final etait obtenu sur l’analyse anatomopathologique de la piece d’exerese. Resultat Sur 120 patients analyses, 99 presentaient une confirmation de TIPMP, incluant 24 lesions malignes, 9 carcinomes in situ et 15 cancers invasifs. Le PET scanner au 18F-FDG etait positif dans 44 et 31 cas respectivement dans l’ensemble de la serie et sur la population de TIPMP. Chez les 99 patients presentant une TIPMP les resultats du PET scanner retrouvaient 13 vrais positifs, 18 faux positif, 57 vrais negatifs et 11 faux negatifs. La sensibilite, specificite, valeur predictive negative et valeur predictive positive etait respectivement de 54,2 %, 76 %, 83,8 % et 41,9 %. Nous n’avons pu identifier une valeur de cut-off de SUVmax permettant la distinction entre une lesion benigne maligne. Les imageries conventionnelles comportaient un scanner abdominal, une imagerie par resonance magnetique nucleaire et une echo-endoscopie. Dans le groupe des patients presentant une TIPMP qui avaient recu les trois techniques d’imagerie, la sensibilite, specificite, valeur predictive positive et negative etaient respectivement de 66,7 %, 84,4 %, 84,4 %, et 66,7 %. Conclusion Dans cette etude, le PET scanner au 18F-FDG n’ameliorait pas la distinction entre les formes benignes et malignes des TIPMP par rapport aux examens d’imagerie conventionnelle.

Resume But de l’etude Quatorze a 17 % des patients sont porteurs de metastases hepatiques synchrones (MHsCCR) au moment du diagnostic. Trois strategies de prise en charge curative des MHsCCR sont possibles : « classique », « combinee » et « foie premier ». Le but de cette etude est d’analyser les resultats des 3 strategies sur la morbi-mortalite postoperatoire et la survie globale et sans recidive. Patients et methodes Tous les patients pris en charge pour MHsCCR entre 2000 et 2015 au CHU de Toulouse Rangueil ont ete inclus. Trois groupes ont ete definis : (1) « classique » : chirurgie du primitif, puis chirurgie des MHsCCR ; (2) « combine » : chirurgie du primitif et chirurgie des MHsCCR en meme temps ; (3) « foie premier » : chirurgie des MHsCCR puis chirurgie du primitif. Resultats Cent soixante-dix patients qui ont eu 209 hepatectomies ont ete inclus (149 « classiques», 34 « combines » et 26 « foie premier »). Le taux de complications severes etait plus eleve dans le groupe « combine » que dans le groupe « classique » (35 % vs 12 %, p = 0,03), et que dans le groupe « foie premier » (35 % vs 19 %, p = 0,25), alors que les gestes de resections hepatiques etaient plus simples. La survie globale a 5 ans etait de 46 % sans difference significative entre les 3 groupes, avec une mediane de survie de 54 mois. La survie sans recidive etait de 24 % a 5 ans, avec une mediane de survie sans recidive de 14 mois, sans difference significative. Conclusion Les trois strategies etaient realisables et il n’existait pas de differences en termes de survies globales et sans recidive entre les trois approches. Il existait plus de complications severes dans le groupe « combine », sans meilleurs resultats oncologiques malgre une maladie hepatique moins importante et des gestes de resection hepatique plus limites.

Summary Aim of the study Fourteen to seventeen percent of patients suffering from colorectal cancer have synchronous liver metastases (sCRLM) at the time of diagnosis. There are currently three possible strategies for curative management of sCRLM: “classic”, “combined”, and “liver-first”. The aim of our research was to analyze the effects of the three surgical management strategies for sCRLM on postoperative morbidity and mortality and overall and recurrence-free survival. Patients and Methods Patients treated for sCRLM between October 2000 and May 2015 were included. We defined three groups: (1) “classic”: surgery of primary tumor and then surgery of sCRLM; (2) “combined”: combined surgery of primary tumor and sCRLM: and (3) “liver-first”: surgery of sCRLM and then surgery of primary tumor. Results During this period, 170 patients who underwent 209 hepatectomies were included (“classic”: 149, “combined”: 34, “liver-first”: 26). The rate of severe complications was higher in the “combined” group compared to the “classic” group (35% vs. 12%, P = 0.03), and the “liver-first” group (35% vs. 19%, P = 0.25), while there were significantly fewer liver resections. Overall survival at 5 years in our cohort was 46%, without significant differences between the groups, and a median survival of 54 months. Recurrence-free survival of the patients in our cohort was 24% at 5 years, with a median survival time without recurrence of 14 months, without significant differences between the groups. Conclusion All three strategies were feasible and there were no differences regarding overall and recurrence-free survivals between the three approaches. The “combined” strategy group had significantly more severe complications and did not provide better oncological results, despite less aggressive liver disease and more limited liver resections.

International audience; Background: Spontaneous rupture of hepatocellular carcinoma (HCC) remains a life-threatening complication, with a reported mortality rate of between 16 and 30% and an incidence rate of approximately 3% in Europe. Survival data and risk factors after ruptured HCC are lacking, especially for peritoneal metastasis (PM).Objectives: The aims of this study were to evaluate the pattern of recurrence and mortality after hepatectomy for ruptured HCC, and to focus on PM.Methods: We retrospectively reviewed the files of patients admitted to 14 French surgical centers for spontaneous rupture of HCC between May 2000 and May 2012.Results: Overall, 135 patients were included in this study. The median disease-free survival and overall survival (OS) rates were 16.1 (11.0-21.1) and 28.7 (26.0-31.5) months, respectively, and the median follow-up period was 29 months. At last follow-up, recurrences were observed in 65.1% of patients (n = 88). The overall rate of PM following ruptured HCC was 12% (n = 16). Surgical management of PM was performed for six patients, with a median OS of 36.6 months. An α-fetoprotein level > 30 ng/mL (p = 0.0009), tumor size at rupture > 70 mm (p = 0.0009), and vascular involvement (p < 0.0001) were found to be independently associated with an increased likelihood of recurrence. No risk factor for PM was observed.Conclusion: This large-cohort French study confirmed that 12% of patients had PM after ruptured HCC. A curative approach may be an option for highly selected patients with exclusive PD because of the survival benefit it could provide.

Purpose To evaluate the impact of blended learning using a combination of educational resources (flipped classroom and short videos) on medical students’ (MSs) for radiology learning. Material and methods A cohort of 353 MSs from 2015 to 2018 was prospectively evaluated. MSs were assigned to four groups (high, high-intermediate, low-intermediate, and low achievers) based on their results to a 20-MCQs performance evaluation referred to as the pretest. MSs had then free access to a self-paced course totalizing 61 videos based on abdominal imaging over a period of 3 months. Performance was evaluated using the change between posttest (the same 20 MCQs as pretest) and pretest results. Satisfaction was measured using a satisfaction survey with directed and spontaneous feedbacks. Engagement was graded according to audience retention and attendance on a web content management system. Results Performance change between pre and posttest was significantly different between the four categories (ANOVA, P = 10−9): low pretest achievers demonstrated the highest improvement (mean ± SD, + 11.3 ± 22.8 points) while high pretest achievers showed a decrease in their posttest score (mean ± SD, − 3.6 ± 19 points). Directed feedback collected from 73.3% of participants showed a 99% of overall satisfaction. Spontaneous feedback showed that the concept of “pleasure in learning” was the most cited advantage, followed by “flexibility.” Engagement increased over years and the number of views increased of 2.47-fold in 2 years. Conclusion Learning formats including new pedagogical concepts as blended learning, and current technologies allow improvement in medical student’s performance, satisfaction, and engagement.

Biliary fistula is one of the most common complications after hepatectomy. This study evaluated the effect of transcystic biliary drainage during hepatectomy on the occurrence of postoperative biliary fistula.This multicentre RCT was carried out from 2009 to 2016 in nine centres. Patients were randomized to transcystic biliary drainage or no transcystic drainage (control). Patients underwent hepatectomy (more than 2 segments) of non-cirrhotic livers. The primary endpoint was the occurrence of biliary fistula after surgery. Secondary endpoints were morbidity, postoperative mortality, duration of hospital stay, reoperation, readmission to hospital, and complications caused by catheters. Intention-to-treat and per-protocol analyses were performed.A total of 310 patients were randomized. In intention-to-treat analysis, there were 158 patients in the transcystic group and 149 in the control group. Seven patients were removed from the per-protocol analysis owing to protocol deviations. The biliary fistula rate was 5·9 per cent in intention-to-treat and 6·0 per cent in per-protocol analyses. The rate was similar in the transcystic and control groups (5·7 versus 6·0 per cent; P = 1·000). There were no differences in terms of morbidity (49·4 versus 46·3 per cent; P = 0·731), mortality (2·5 versus 4·7 per cent; P = 0·367) and reoperations (4·4 versus 10·1 per cent; P = 1·000). Median duration of hospital stay was longer in the transcystic group (11 versus 10 days; P = 0·042). The biliary fistula risk was associated with the width and length of the hepatic cut surface.This randomized trial did not demonstrate superiority of transcystic drainage during hepatectomy in preventing biliary fistula. The use of transcystic drainage during hepatectomy to prevent postoperative biliary fistula is not recommended. Registration number: NCT01469442 ( http://www.clinicaltrials.gov).La fístula biliar es una de las complicaciones más comunes después de la hepatectomía. Este estudio evalúa el efecto del drenaje biliar transcístico durante la hepatectomía en la aparición de una fístula biliar postoperatoria. MÉTODOS: Este ensayo prospectivo aleatorizado y multicéntrico (Clinical Trial NCT01469442) con dos grupos de estudio (grupo transcístico versus grupo control) se llevó a cabo de 2009 a 2016 en 9 centros. Los pacientes fueron sometidos a una hepatectomía (≥ 2 segmentos) en hígados no cirróticos. El resultado principal fue la aparición de una fístula biliar después de la cirugía. Los resultados secundarios fueron la morbilidad, la mortalidad postoperatoria, la duración de la estancia hospitalaria, la reintervención, la necesidad de reingreso y las complicaciones causadas por los catéteres. Se realizaron análisis por intención de tratamiento y por protocolo.Un total de 310 pacientes fueron randomizados. Por intención de tratamiento, 158 pacientes fueron aleatorizados al grupo transcístico y 149 al grupo control. Siete pacientes fueron excluidos del análisis por protocolo por desviaciones del protocolo. La tasa de fístula biliar fue del 5,9% en el análisis por intención de tratamiento y del 6,0% en el análisis por protocolo. Esta tasa fue similar para el grupo transcístico y para el grupo control: 5,7% versus 6,0% (P = 1). No hubo diferencias en términos de morbilidad (49,4% versus 46,9%, P = 0,731), mortalidad (2,5% versus 4,7%, P = 0,367) y reintervenciones (4,4% versus 10,1%, P = 1). La mediana de la duración de la estancia hospitalaria fue mayor para el grupo transcístico (11 versus 10 días, P = 0,042). El riesgo de fístula biliar se correlacionó con el grosor y la longitud de la transección hepática. CONCLUSIÓN: Este ensayo aleatorizado no demuestra la superioridad del drenaje transcístico durante la hepatectomía para prevenir la fístula biliar. No se recomienda el uso de drenaje transcístico durante la hepatectomía para prevenir la fístula biliar postoperatoria.

International audience; OBJECTIVE: To compare two techniques of remnant liver hypertrophy in candidates for extended hepatectomy: radiological simultaneous portal vein (PVE) and hepatic vein embolization (HVE); namely liver venous deprivation (LVD), and ALPPS. SUMMARY BACKGROUND DATA: Recent advances in chemotherapy and surgical techniques have widened indications for extended hepatectomy, before which remnant liver augmentation is mandatory. ALPPS and LVD typically show higher hypertrophy rates than PVE, but their respective places in patient management remain unclear. METHODS: All consecutive ALPPS and LVD procedures performed in eight French centers between 2011 and 2020 were included. The main endpoint was the successful resection rate (resection rate without 90-day mortality) analyzed according to an intention-to-treat principle. Secondary endpoints were hypertrophy rates, intra- and post-operative outcomes. RESULTS: Among 209 patients, 124 had LVD 37 [13,1015] days before surgery, while 85 underwent ALPPS with an inter-stages period of 10 [6, 69] days. ALPPS was mostly-performed for colorectal liver metastases (CRLM), LVD for CRLM and perihilar cholangiocarcinoma. Hypertrophy was faster for ALPPS. Successful resection rates were 72.6% for LVD ± rescue ALPPS (n=6) versus 90.6% for ALPPS (p

BACKGROUND Colorectal cancer is the third most common cancer in men and the second most common in women worldwide. Almost a third of the patients has or will develop liver metastases. Neoadjuvant chemotherapy (NAC) has recently become nearly systematic prior to surgery of colorectal livers metastases (CRLMs). The response to NAC is evaluated by radiological imaging according to morphological criteria. More recently, the response to NAC has been evaluated based on histological criteria of the resected specimen. The most often used score is the tumor regression grade (TRG), which considers the necrosis, fibrosis, and number of viable tumor cells. AIM To analyze the predictive factors of the histological response, according to the TRG, on CRLM surgery performed after NAC. METHODS From January 2006 to December 2013, 150 patients who had underwent surgery for CRLMs after NAC were included. The patients were separated into two groups based on their histological response, according to Rubbia-Brandt TRG. Based on their TRG, each patient was either assigned to the responder (R) group (TRG 1, 2, and 3) or to the non-responder (NR) group (TRG 4 and 5). All of the histology slides were re-evaluated in a blind manner by the same specialized pathologist. Univariate and multivariate analyses were performed. RESULTS Seventy-four patients were classified as responders and 76 as non-responders. The postoperative mortality rate was 0.7%, with a complication rate of 38%. Multivariate analysis identified five predictive factors of histological response. Three were predictive of non-response: More than seven NAC sessions, the absence of a radiological response after NAC, and a repeat hepatectomy (P < 0.005). Two were predictive of a good response: A rectal origin of the primary tumor and a liver-first strategy (P < 0.005). The overall survival was 57% at 3 yr and 36% at 5 yr. The disease-free survival rates were 14% at 3 yr and 11% at 5 yr. The factors contributing to a poor prognosis for disease-free survival were: No histological response after NAC, largest metastasis > 3 cm, more than three preoperative metastases, R1 resection, and the use of a targeted therapy with NAC (P < 0.005). CONCLUSION A non-radiological response and a number of NAC sessions > 7 are the two most pertinent predictive factors of non-histological response (TRG 4 or 5).

Contexte : Tant l’enseignement du savoir-faire que celui du savoir-être, en particulier la communication médecin-patient peuvent être améliorés. Objectifs : Décrire et documenter l’intérêt des étudiants pour des dispositifs de formation à la communication et à la relation médecin-patient associant l’art dramatique et la simulation. Méthodes : Trente-trois étudiants en médecine (diplôme de formation approfondie en sciences médicales 1 et 2) ont participé à des ateliers de communication associant successivement une approche théâtrale comportant plusieurs exercices et une mise en situation professionnelle de communication en situation de consultation avec un patient simulé. Résultats : La grande majorité (92 %) des étudiants ayant participé à ces ateliers ont estimé que l’expérience leur a été bénéfique tant sur le plan du savoir-faire que du savoir-être et 94 % ont validé l’intérêt de ces ateliers pour leur pratique ultérieure. Les exercices théâtraux les plus plébiscités étaient l’histoire en cercle, l’histoire à plusieurs et l’histoire avec contrainte. Conclusion : L’association d’outils pédagogiques contextualisants, comme l’expérience théâtrale, le recours aux patients simulés en situation de problématiques cliniques fréquentes ou complexes, à des étudiants observateurs, le recours à la vidéo, et le débriefing entre les différents acteurs, recueille une très forte adhésion et détermine un grand bénéfice ressenti auprès des apprenants. Les résultats très positifs de cette expérience nous encouragent à étendre cette approche pédagogique intégrative à l’ensemble des étudiants du deuxième cycle des études médicales.

Highlights • Solitary gastric metastasis of RCC are scarce. • When feasible, surgical or endoscopic treatment of gastric metastasis should be performed. • Risk of metastatic recurrence is significant and must be taken into consideration in the therapeutic strategy., Introduction Renal cell carcinoma (RCC) represents above 3 % of all cancers. At diagnosis, above 25 % of patients with RCC present an advanced disease. Gastric metastasis of RCC is associated with poor outcome. We report the case of a patient treated for a gastric metastasis of RCC and we conducted a systematic review of the literature to report all published cases of RCC patients with gastric metastasis. Case presentation In December 2010, a 61-year-old man was treated by open partial nephrectomy for a localized right clear cell RCC. In September 2018, a metachronous gastric metastasis was found on CT scan. The lesion was located on the lesser curvature of the stomach, measuring 4.5 cm long axis. No other secondary lesions were identified. A laparoscopic wedge resection, converted to laparotomy was performed. Two years later, in September 2020, a CT scan was performed, revealing a 17 mm adenopathy behind the hepatic hilum and a surgical management was performed, including a lymph node dissection of the hepatic hilum and the hepatic artery. Actually, he remains healthy. Clinical discussion and conclusion Our systematic review suggests that solitary gastric metastasis of RCC are scarce. In comparison of patients with multiple metastatic sites, the median survival of patients with solitary gastric metastasis is longer.

Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients where surgical resection is possible, outcome is influenced by perioperative morbidity and lymph node status. Laparoscopic liver resection is associated with improved clinical and oncological outcomes in primary and metastatic liver cancer compared with open liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient. The primary aim of this study was to compare overall survival for a large series of patients treated for intrahepatic cholangiocarcinoma by open or laparoscopic approach. Secondary objectives were to compare disease-free survival, predictors of death, and recurrence.Patients treated with laparoscopic or open liver resection for intrahepatic cholangiocarcinoma from 2000 to 2018 from 3 large international databases were analyzed retrospectively. Each patient in the laparoscopic resection group (case) was matched with 1 open resection control (1:1 ratio), through a propensity score calculated on clinically relevant preoperative covariates. Overall and disease-free survival were compared between the matched groups. Predictors of mortality and recurrence were analyzed with Cox regression, and the Textbook Outcomes were described.During the study period, 855 patients met the inclusion criteria (open liver resection = 709, 82.9%; laparoscopic liver resection = 146, 17.1%). Two groups of 89 patients each were analyzed after propensity score matching, with no significant difference regarding pre- and postoperative variables. Overall survival at 1, 3, and 5 years was 92%, 75%, and 63% in the laparoscopic liver resection group versus 92%, 58%, and 49% in the open liver resection group (P = .0043). Adjusted Cox regression revealed severe postoperative complications (hazard ratio: 10.5, 95% confidence interval [1.01-109] P = .049) and steatosis (hazard ratio: 13.8, 95% confidence interval [1.23-154] P = .033) as predictors of death, and transfusion (hazard ratio: 19.2, 95% confidence interval [4.04-91.4] P.001) and severe postoperative complications (hazard ratio: 4.07, 95% confidence interval [1.15-14.4] P = .030) as predictors of recurrence.The survival advantage of laparoscopic liver resection over open liver resection for intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data.