Robotic versus laparoscopic partial mesorectal excision for cancer of the high rectum: a single-center study with propensity score match analysis

Background: The role of robotic surgery for partial mesorectal excision (PME) in patients with high rectal cancer (RC) remains unexplored. This study aimed to compare the operative and postoperative outcomes of robotic (R-PME) versus laparoscopic (L-PME) PME for high RC. Methods: This was a single-center propensity score cohort study of consecutive patients diagnosed with RC in the high rectum (>10 to 15 cm from the anal verge) who underwent surgery between September 2012 and May 2019. Results: Of 131 selected patients (50 R-PME and 81 L-PME), 88 were matched using propensity score (44 per group). Operative and postoperative variables were similar between R-PME and L-PME patients, except for operative time (220 min and 190 min, respectively; p < 0.0001). No conversion was needed. Overall morbidity was 15.9%; 4 patients (4.5%) developed anastomotic leakage. The mean hospital stay was 7.25 days for R-PME vs. 7.64 days for L-PME (p = 0.597). R0 resection was achieved in 100% of R-PME and 90.9% of L-PME (p = 0.116). Only 3 patients (1 R-PME, 2 L-PME) received a permanent stoma (p = 1). No group differences were observed for overall or disease-free survival rates at 5 years. The costs of R-PME were significantly higher than those of L-PME. Conclusion: Minimally invasive surgery can be performed safely for PME in high RC. No difference can be detected between R-PME and L-PME for both short- and long-term outcomes, leaving the choice of the surgical approach to the surgeon’s experience. Specific health economic studies are needed to evaluate the cost-effectiveness of robotic surgery for RC

Neuropsychiatric Symptoms in Elderly Inpatients: A Multicenter Cross-Sectional Study

Background/Aims: We determined the prevalence of neuropsychiatric symptoms in geriatric rehabilitation patients to compare neuropsychiatric symptoms between patients with and without dementia, and to evaluate associations linking severity of cognitive impairment and neuropsychiatric symptoms. Methods: In February 2009, we studied patients aged 75 years or older who had been admitted to four geriatric rehabilitation units in the Paris area. The twelve Neuropsychiatric Inventory items and four neuropsychiatric subsyndromes defined by the European Alzheimer's Disease Consortium were evaluated. Results: Of the 194 patients, 149 (76.8%) had dementia, and 154 (79.4%) had exhibited at least one neuropsychiatric symptom during the past week. Agitation was the most common neuropsychiatric symptom in the group with dementia (36.9%) and depression in the group without dementia (35.6%). The dementia group had significantly higher prevalences of hyperactivity (p < 0.001) and delusions (p = 0.01) than the non-dementia group. In the dementia group, severity of cognitive impairment was associated with hyperactivity (p = 0.01) and psychosis (p = 0.02). Conclusion: The prevalence of neuropsychiatric symptoms among geriatric rehabilitation patients was high but not higher than in elderly outpatients

Effets d’une complémentation de 3 semaines par la citrulline (Cit) sur le turn over protéique chez des patients âgés dénutris

National audienceIntroduction et but de l’étude : La prise en charge nutritionnelle de la sarcopénie et de la dénutrition est souvent peu efficace chez la personne âgée, notamment à cause de la résistance à l’anabolisme protéique postprandial. La Cit stimule la synthèse protéique musculaire chez le rat âgé et chez l’homme jeune. Le but de cette étude est de mesurer si la Cit est efficace sur le turn over protéique des patients âgés dénutris (PAD) hospitalisés. Matériel et méthodes : Cette étude prospective (PHRC National 2007, ClinicalTrials.gov Identifier: NCT00714675), randomisée et multicentrique a inclus 29 PAD hospitalisés en soins de suite gériatrique. Ils recevaient tous, pendant 20 jours, par voie orale, soit 10 g de Cit soit un mélange iso-azoté de 6 acides aminés (AAs) non essentiels (AANE). Le turn over protéique corps entier, la vitesse de synthèse fractionnaire de l’albumine (VSFA) et la séquestration splanchnique ont été mesurés le 21ème jour par une technique de dilution isotopique utilisant la 13C-Leucine et la 3D-Leucine, chez des patients à jeun depuis 12 heures et en situation postprandiale. Résultats et Analyse statistique : 24 patients ont terminé l’étude. Il n’y a pas de modification du turn over protéique et de la synthèse protéique corps entier (NOLD). La VSFA n’est pas modifiée. En revanche, il existe une tendance à la diminution de l’extraction splanchnique des AAs chez les patients traités par la Cit (Cit : 45.2 [26.2;58.4], AANE : 60.3 [48.3 ;69.7] en %/j, p<0.09, Test de Wilcoson). On observe une augmentation de la différence de l’aire sous la courbe des AAs totaux dans le sang périphérique, entre l’état de jeune et postprandial, chez les patients ayant reçu la Cit (1804 [1224;2091] μmol.h/l) comparé aux témoins (821 [657;1140] μmol.h/l; p< 0.01, Test de Wilcoxon) après soustraction des AANE placebo.(médiane;quartiles [Q1;Q3]). Conclusion : Cette étude montre que la Cit n’a d’effet ni sur la synthèse protéique corps entier ni sur la vitesse de synthèse fractionnaire de l’albumine. En revanche, elle tend à diminuer la séquestration splanchnique des AAs et augmente leur biodisponibilité en périphérie. Ce processus étant une des clés de la synthèse protéique, la Cit pourrait être un adjuvant nutritionnel intéressant, en présence d’une prise en charge hypercalorique-hyperprotéique, chez les personnes âgées dénutrie

Renal transplantation in patients with AA amyloidosis nephropathy: results from a French multicenter study.

International audienceAlthough end-stage renal disease related to AA amyloidosis nephropathy is well characterized, there are limited data concerning patient and graft outcome after renal transplantation. We performed a multicentric retrospective survey to assess the graft and patient survival in 59 renal recipients with AA amyloidosis. The recurrence rate of AA amyloidosis nephropathy was estimated at 14%. The overall, 5- and 10-year patient survival was significantly lower for the AA amyloidosis patients than for a control group of 177 renal transplant recipients (p = 0.0001, 0.028 and 0.013, respectively). In contrast, we did not observe any statistical differences in the 5- and 10- year graft survival censored for death between two groups. AA amyloidosis-transplanted patients exhibited a high proportion of infectious complications after transplantation (73.2%). Causes of death included both acute cardiovascular events and fatal septic complications. Multivariate analysis demonstrated that the recurrence of AA amyloidosis on the graft (adjusted OR = 14.4, p = 0.01) and older recipient age (adjusted OR for a 1-year increase = 1.06, p = 0.03) were significantly associated with risk of death. Finally, patients with AA amyloidosis nephropathy are eligible for renal transplantation but require careful management of both cardiovascular and infectious complications to reduce the high risk of mortality