Robot-assisted versus laparoscopic pancreatoduodenectomy:a pan-European multicenter propensity-matched study

Background: The use of robot-assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort. Methods: An international multicenter retrospective study including patients after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009–2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien–Dindo ≥III). Results: Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot-assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/in-hospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot-assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P &lt; .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P &lt; .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P &lt; .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P &lt; .001), and a higher R0-resection rate (73.2% vs 84.4%; P &lt; .001). Conclusion: This European multicenter study found no differences in overall major morbidity and 30-day/in-hospital mortality after robot-assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot-assisted pancreatoduodenectomy. In contrast, robot-assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy.</p

Robot-assisted versus laparoscopic pancreatoduodenectomy:a pan-European multicenter propensity-matched study

Background: The use of robot-assisted and laparoscopic pancreatoduodenectomy is increasing, yet large adjusted analyses that can be generalized internationally are lacking. This study aimed to compare outcomes after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy in a pan-European cohort. Methods: An international multicenter retrospective study including patients after robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy from 50 centers in 12 European countries (2009–2020). Propensity score matching was performed in a 1:1 ratio. The primary outcome was major morbidity (Clavien–Dindo ≥III). Results: Among 2,082 patients undergoing minimally invasive pancreatoduodenectomy, 1,006 underwent robot-assisted pancreatoduodenectomy and 1,076 laparoscopic pancreatoduodenectomy. After matching 812 versus 812 patients, the rates of major morbidity (31.9% vs 29.6%; P = .347) and 30-day/in-hospital mortality (4.3% vs 4.6%; P = .904) did not differ significantly between robot-assisted pancreatoduodenectomy and laparoscopic pancreatoduodenectomy, respectively. Robot-assisted pancreatoduodenectomy was associated with a lower conversion rate (6.7% vs 18.0%; P &lt; .001) and higher lymph node retrieval (16 vs 14; P = .003). Laparoscopic pancreatoduodenectomy was associated with shorter operation time (446 minutes versus 400 minutes; P &lt; .001), and lower rates of postoperative pancreatic fistula grade B/C (19.0% vs 11.7%; P &lt; .001), delayed gastric emptying grade B/C (21.4% vs 7.4%; P &lt; .001), and a higher R0-resection rate (73.2% vs 84.4%; P &lt; .001). Conclusion: This European multicenter study found no differences in overall major morbidity and 30-day/in-hospital mortality after robot-assisted pancreatoduodenectomy compared with laparoscopic pancreatoduodenectomy. Further, laparoscopic pancreatoduodenectomy was associated with a lower rate of postoperative pancreatic fistula, delayed gastric emptying, wound infection, shorter length of stay, and a higher R0 resection rate than robot-assisted pancreatoduodenectomy. In contrast, robot-assisted pancreatoduodenectomy was associated with a lower conversion rate and a higher number of retrieved lymph nodes as compared with laparoscopic pancreatoduodenectomy.</p

Quels modes de gestion de la santé animale dans le cadre One Health?

Chapitre 12International audienc

Formula for the estimation of urine osmolality in healthy cats

International audienceA simple and intuitive formula for the estimation of urine osmolality (Uosm) using the measured concentrations of major active urine osmolytes over a wide range of urine dilutions was proposed in healthy cats. Sixty-three urine samples were retrieved using ultrasound-guided cystocentesis from sixteen healthy cats under 5 years of age receiving intravenous infusion over a period of 24 h. Samples were collected at baseline (T0), T2, T6, T12, and T24. Urine osmolality was measured using a freezing-point osmometer, and the concentrations of osmolytes (urea, sodium, glucose, and potassium) were evaluated. A simple linear regression model for a clinical use was selected, and the agreement between the calculated and actual urine osmolalities was assessed. Urinary concentrations of urea, sodium and glucose were the three variables included in the model with the lowest AICC. Urine osmolality can be predicted accurately and precisely using urine urea, sodium and glucose with the following equation: Uosm = 1.25 × urea (mmol/l) or 20.87 × urea (g/l) + 1.1 × sodium (mmol/l) + 67 × glucose (mmol/l) or 3.72 × glucose (mg/dl). The concordance correlation coefficient for repeated measures between the actual and the calculated urine osmolality was extremely close to 1, which supported a high agreement: 0.996 (CI 95%: [0.993; 0.998]). In a population of healthy cats, urine osmolality can be predicted accurately and precisely using urinary urea, sodium and glucose concentrations. Similar formulae could potentially be established to help the clinician in pathological situation

The inferior mesoiliacal shunt: A novel shunt for refractory rectal variceal bleeding due to splanchnic thrombosis.

Surgical shunt therapy may be required when pharmacologic, endoscopic, and radiologic treatment of chronic splanchnic vein thrombosis have failed. In this case report, we present a new interposition shunt for the treatment of refractory rectal variceal bleeding: the inferior mesoiliacal shunt between the inferior mesenteric vein and the left common iliac vein using a cryopreserved iliac venous graft. The postoperative course was complicated by shunt thrombosis at day 2, probably owing to inadvertent interruption of anticoagulation and a decrease in the shunt flow rate. Surgical thrombectomy was performed successfully. The patient presented no relapse of rectal bleeding and was asymptomatic and well at the 12-month follow-up.status: Published onlin

Vers une histoire décentrée de la danse (vol. 1)

International audienceComment l’histoire de la danse est-elle reconfigurée, bousculée et stimulée par la recherche actuelle ? Suite à la sortie de l’ouvrage collectif Nouvelle Histoire de la danse en Occident aux Éditions du Seuil en septembre 2020, sous la direction de Laura Cappelle, auquel nous avons participé comme autrices, nous avons souhaité développer les questionnements que la rédaction de l’ouvrage avait suscités. Une des évolutions majeures des dernières décennies est la prise de conscience que l’histoire de la danse, telle une étoile double, s’était organisée en deux centres autour desquels gravitaient l’essentiel des recherches et les enseignements universitaires : l’institution, d’une part, l’Occident, d’autre part. Si des danses non occidentales ont suscité attrait et fascination en Occident, elles ont longtemps été perçues comme sans histoire ; or, elles souffrent elles-mêmes d’une réelle exclusion des catégories d’art moderne et contemporaine, problème encore récurrent dans la programmation des institutions théâtrales en Europe et dans les livres d’histoire. En s’appuyant sur des débats récents en histoire globale (entendue ici comme une approche attentive aux connections et entrelacements entre des régions spécifiques) cet ouvrage sur le décentrement propose d’inscrire la danse en tant qu’événement artistique, social, ou corporel dans un rapport indiciel avec l’histoire politique, économique, religieuse, sociale et de décentrer le regard de l’historien.ne afin d’explorer la complexité des circulations des pratiques de danse dans leur pluralité. Il s’agit d’une approche qui examine les danses de l’hors-scène, l’hors-les-murs, l’hors-champs, ainsi que les transferts culturels, les pratiques transnationales et/ou non-occidentales