Defining benchmark outcomes for ALPPS

OBJECTIVE: The aim of this study was to use the concept of benchmarking to establish robust and standardized outcome references after the procedure ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy). BACKGROUND AND AIMS: The recently developed ALPPS procedure, aiming at removing primarily unresectable liver tumors, has been criticized for safety issues with high variations in the reported morbidity/mortality rates depending on patient, disease, technical characteristics, and center experience. No reference values for relevant outcome parameters are available. METHODS: Among 1036 patients registered in the international ALPPS registry, 120 (12%) were benchmark cases fulfilling 4 criteria: patients ≤67 years of age, with colorectal metastases, without simultaneous abdominal procedures, and centers having performed ≥30 cases. Benchmark values, defined as the 75th percentile of the median outcome parameters of the centers, were established for 10 clinically relevant domains. RESULTS: The benchmark values were completion of stage 2: ≥96%, postoperative liver failure (ISGLS-criteria) after stage 2: ≤5%, ICU stay after ALPPS stages 1 and 2: ≤1 and ≤2 days, respectively, interstage interval: ≤16 days, hospital stay after ALPPS stage 2: ≤10 days, rates of overall morbidity in combining both stage 1 and 2: ≤65% and for major complications (grade ≥3a): ≤38%, 90-day comprehensive complication index was ≤22, the 30-, 90-day, and 6-month mortality was ≤4%, ≤5%, and 6%, respectively, the overall 1-year, recurrence-free, liver-tumor-free, and extrahepatic disease-free survival was ≥86%, ≥50%, ≥57%, and ≥65%, respectively. CONCLUSIONS: This benchmark analysis sets key reference values for ALPPS, indicating similar outcome as other types of major hepatectomies. Benchmark cutoffs offer valid tools not only for comparisons with other procedures, but also to assess higher risk groups of patients or different indications than colorectal metastases

Fabrique de la déclamation antique

Née dans un cadre scolaire, conçue à l’origine comme un instrument de formation et d’instruction de la jeunesse, la déclamation, qui n’était d’abord qu’un moyen, suscita un tel engouement qu'elle devint aussi très vite une fin en soi : si l’on déclamait au départ pour apprendre à parler, on déclamera bientôt pour le plaisir de déclamer ; le genre oscille donc entre instruction et distraction des élites. Par les jeux intertextuels et génériques qu'elle instaure avec d’autres productions littéraires, par les liens qu'elle tisse avec son contexte juridique, politique et social, la déclamation a été un élément essentiel de la vie culturelle antique, fonctionnant parfois comme une sorte de laboratoire des idées et des formes. Les textes ici réunis prennent en compte la déclamation antique, aussi bien grecque que latine, de Sénèque le Père jusqu’aux déclamateurs de la Troisième Sophistique, et au-delà, dans une perspective croisée permettant de mieux comprendre comment la déclamation a pu être – et rester – pendant près de deux millénaires la norme de toute culture supérieure, concourant à la transmission des valeurs, esthétiques, éthiques, juridiques, politiques, et à la fabrique des élites.Born in the shadow of schools and conceived as a teaching instrument to instruct young people, declamation which was at first a means to an end, quickly became a popular end in itself. Whereas declamation was, at the beginning, a way to learn how to speak, declamation for declamations sake was soon the rule: therefore it fluctuates between instruction and entertainment of the elite. Through intertextual and generic links with other literary productions and its relationship with the juridical, political and social context, declamation was an essential element in the cultural life of Antiquity and could sometimes play the role of an experimental field for new forms and ideas. In this collection of articles, we look into Greek and Latin declamation, from Seneca the Elder to the declamators of the Third Sophistic and beyond, through a crossed perspective, to better understand how declamation could be – and stay – for two millenia, the norm for any superior culture, contributing to the transmission of aestethical, ethical, juridical and political values and the fabrication of elites