Patient selection for laparoscopic excision of adrenal metastases: a multicenter cohort study

International audienceIntroduction The use of laparoscopy for the excision of adrenal metastasis remains controversial. We aimed to report oncological and perioperative outcomes of laparoscopic excision of adrenal metastases and to seek for predictive factors of unfavourable oncological outcomes. Methods A retrospective chart review was conducted and all consecutive patients who underwent laparoscopic adrenalectomy (LA) in the setting of metastatic cancer in two academic urology departments from November 2006 through January 2014 were included. Primary tumors were categorized as pulmonary, renal or “other primary” tumors to allow statistical comparison. Unfavourable surgical outcomes were defined as the occurrence of either postoperative complications and/or positive surgical margins. Results Forty-three patients who underwent a total of 45 LA were included for analysis. There were 8 complications (17.8%). Positive surgical margins were found in 12 specimens (26.7%). After a median follow-up of 37 months, estimated overall survival rates were 89.5% and 51.5% at 1 year and 5 years, respectively. In multivariable analysis the only predictor of unfavourable surgical outcomes was a tumor size > 5 cm (OR= 20.5; p=0.001). In multivariate analysis the pulmonary (OR=0.3; p=0.008) or “other” (OR= 0.1; p=0.0006) origin of the primary tumor was the only prognostic factor of shorter cancer specific survival. Conclusion Laparoscopic resection of adrenal metastasis can be safely performed in most patients but is associated with an increased risk of positive surgical margins and postoperative complications in larger tumors (>5 cm). Adrenalectomy provides better oncological outcomes in metastases from renal cell carcinoma compared to other primary tumors

23. Payen (Pascal), Les îles nomades : conquérir et résister dans l'Enquête d'Hérodote

Nouhaud Michel. 23. Payen (Pascal), Les îles nomades : conquérir et résister dans l'Enquête d'Hérodote. In: Revue des Études Grecques, tome 110, Juillet-décembre 1997. pp. 671-673

Sur une allusion d'Eschine (Ambassade, 75) au stratège athénien Tolmidès

Nouhaud Michel. Sur une allusion d'Eschine (Ambassade, 75) au stratège athénien Tolmidès. In: Revue des Études Grecques, tome 99, fascicule 472-474, Juillet-décembre 1986. pp. 342-346

23. Payen (Pascal), Les îles nomades : conquérir et résister dans l'Enquête d'Hérodote

Nouhaud Michel. 23. Payen (Pascal), Les îles nomades : conquérir et résister dans l'Enquête d'Hérodote. In: Revue des Études Grecques, tome 110, Juillet-décembre 1997. pp. 671-673

Nouveau Monde et renouveau de l’histoire naturelle. Volume II

Le Vieux Monde a beaucoup écrit sur le Nouveau. Il ne s'est pas privé de le juger, et de le juger mal. Dès le départ, le continent et ses habitants ont été affublés d'un nom erroné. Plus tard, le "Siècle des Lumières" a énoncé d'incroyables contre-vérités. L'ethnocentrisme européen était triomphant. En outre, les préjugés anti-espagnols venaient déformer un peu plus les images fantasmatiques. Aujourd'hui, les sciences mesurent mieux leurs limites ; nous savons que l'Amérique n'est pas encore découverte. À chaque étape, l'Histoire Naturelle aura été un élément-clé du débat. Jamais les savants n'auront été des hommes de cabinet qui s'imaginent travailler loin des contingences : le patriotisme, l'idéologie, la politique ou tout simplement le bonheur esthétique étaient au rendez-vous. L'ambition personnelle ne pouvait pas être toujours absente ; en revanche, l'abnégation et l'enthousiasme sont souvent venus à bout de difficultés matérielles de tout ordre. Vaille que vaille, les créoles eux-mêmes prirent peu à peu la mesure de leurs richesses. Tout cela explique qu'une équipe d'hispanistes spécialisés dans l'Amérique Hispanique ait voulu apporter sa pierre sur un pareil chantier. Les textes que nous publions ont été présentés et discutés à la Sorbonne en séminaire. Un volume est déjà paru en 1986

Recommandations du comité de cancérologie de l'Association Française d'Urologie - actualisation 2022-2024: prise en charge du cancer du rein

International audienceAim: To update the recommendations for the management of kidney cancers. Methods: A systematic review of the literature was conducted from 2015 to 2022. The most relevant articles on the diagnosis, classification, surgical treatment, medical treatment and follow-up of kidney cancer were selected and incorporated into the recommendations. Therefore, the recommendations were updated while specifying the level of evidence (high or low). Results: The gold standard for the diagnosis and evaluation of kidney cancer is contrast-enhanced chest and abdominal CT. MRI and contrast-enhanced ultrasound are indicated in special cases. Percutaneous biopsy is recommended in situations where the results will influence the therapeutic decision. Renal tumours should be classified according to the pTNM 2017 classification, the WHO 2022 classification and the ISUP nucleolar grade. Metastatic kidney cancer should be classified according to the IMDC criteria. Partial nephrectomy is the gold standard treatment for T1a tumours and can be performed by an open approach, by laparoscopy or by robot-guidance. Active surveillance of tumours less than 2 cm in size can be considered regardless of the patient's age. Ablative therapies and active surveillance are options in elderly patients with comorbidity. T1b tumours should be treated by partial or radical nephrectomy depending on the complexity of the tumour. Radical nephrectomy is the first-line treatment for locally advanced cancers. Adjuvant treatment with pembrolizumab should be considered in patients at intermediate and high risk for recurrence after nephrectomy. In metastatic patients: Immediate cytoreductive nephrectomy may be offered to oligometastatic patients in combination with local treatment of metastases if this can be complete and delayed cytoreductive nephrectomy can be proposed for patients with a complete response or a significant partial response. Medical treatment should be proposed as first-line therapy for patients with a poor or intermediate prognosis. Surgical or local treatment of metastases can be proposed in case of single or oligo-metastases. The recommended first-line drugs for metastatic patients with clear cell renal carcinoma are the combinations axitinib/pembrolizumab, nivolumab/ipililumab, nivolumab/cabozantinib and lenvatinib/pembrolizumab. Cabozantinib is the recommended first-line treatment for patients with metastatic papillary carcinoma. Cystic tumours should be classified according to the Bosniak classification. Surgical removal should be proposed as a priority for Bosniak III and IV lesions. It is recommended that patient monitoring be adapted to the aggressiveness of the tumour. Conclusion: These updated recommendations are a reference that will allow French and French-speaking practitioners to improve kidney cancer management

La realidad y el deseo

Avec La realidad y el deseo. Toponymie du découvreur en Amérique espagnole (1492-1520), un des derniers travaux de Carmen Val Julián, disparue en 2004, s’affirme une recherche pionnière, originale et minutieuse, sur la toponymie, l’acte de nomination et ce monde qui fut déclaré Nouveau. L’héritage riche et fécond de celle qui contribua activement au renouveau des études hispaniques tout en enseignant pendant quinze ans à l’ENS de Fontenay / Saint-Cloud et à l’École polytechnique apparaît dans la seconde partie de ce volume, grâce à une vingtaine d’auteurs qui furent proches d’elle et s’inscrivent dans les lignes de recherche qu’elle a développées : écrire l’histoire, réécrire les histoires, nommer l’espace, mesurer le pouvoir des mots. Mais cet ouvrage mémoriel n’aurait pas été complet si des voix plus personnelles n’avaient évoqué, sous toutes ses facettes, la personnalité chaleureuse d’une traductrice, d’une enseignante, d’une chercheuse. Ce volume d’études sur l’Amérique latine et plus largement sur le monde hispanique témoigne de son rayonnement.La realidad y el deseo. Toponymie du découvreur en Amérique espagnole (1492-1520), one of the last works of Carmen Val Julián, who died in 2004, provides pioneering, original and meticulous research on toponymy, the act of naming and what came to be known as the New World. The rich and fertile heritage of this author who played an active role in the revival of Hispanic studies during her fifteen years spent teaching at the Ecole Nationale Supérieure in Fontenay/Saint Cloud and the Ecole Polytechnique features in the second part of this volume. It includes contributions from twenty or so authors who knew her well and who follow the lines of research which she developed: writing history, rewriting histories, naming and measuring the power of words. But this tribute would not be complete without more personal evocations of all aspects of the warm personality of this translator, teacher and researcher. This volume of studies on Latin America and the Spanish-speaking world in general demonstrates the region’s influence

Oncologic outcomes and survival in pT0 tumors after radical cystectomy in patients without neoadjuvant chemotherapy: results from a large multicentre collaborative study.

International audiencePURPOSE: To assess the postsurgical survival of patients with urothelial carcinoma of the bladder with pT0 tumor at pathologic examination of cystectomy specimens. METHODS: A multi-institutional, retrospective database was analyzed with data from 4758 radical cystectomy (RC) patients who underwent RC without neoadjuvant chemotherapy and who were diagnosed with pT0 on the basis of the pathologic specimen. Survival curves were estimated. A multivariate Cox model was used to evaluate the association between prognosis factors and disease recurrence or survival. RESULTS: Overall, 258 patients (5.4%) were included in the study. The median age was 64 years. At last resection, 171 tumors were invasive (at least pT2), and 87 were not. Median follow-up was 51 months. At multivariate analysis, initial location of the tumor and absence of lymphadenectomy were associated with tumor recurrence (P = 0.03 and P = 0.005, respectively) and specific mortality (P = 0.005 and 0.001, respectively). The main limitation of the study is its retrospective design, which is due to the rarity of this situation. Cancer-specific and recurrence-free survival rates were 89 and 85%, respectively, at 5 years and 82 and 80%, respectively, at 10 years. CONCLUSIONS: Despite acceptable oncological outcomes, patients with a pT0 tumor at the time of RC are still at risk of recurrence and progression and should not be considered to be entirely cured. In this population, stringent follow-up according to current recommendations should be effective

The subclassification of papillary renal cell carcinoma does not affect oncological outcomes after nephron sparing surgery

International audienceObjectives To evaluate the oncological outcomes of papillary renal cell carcinoma (pRCC) following nephron sparing surgery (NSS) and to determine whether the subclassification type of pRCC could be a prognostic factor for recurrence, progression, and specific death. Materials and methods An international multicentre retrospective study involving 19 institutions and the French network for research on kidney cancer was conducted after IRB approval. We analyzed data of all patients with pRCC who were treated by NSS between 2004 and 2014. Results We included 486 patients. Tumors were type 1 pRCC in 369 (76 %) cases and type 2 pRCC in 117 (24 %) cases. After a mean follow-up of 35 (1–120) months, 8 (1.6 %) patients experienced a local recurrence, 12 (1.5 %) had a metastatic progression, 24 (4.9 %) died, and 7 (1.4 %) died from cancer. Patients with type I pRCC had more grade II (66.3 vs. 46.1 %; p \textless 0.001) and less grade III (20 vs. 41 %; p \textless 0.001) tumors. Three-year estimated cancer-free survival (CFS) rate for type 1 pRCC was 96.5 % and for type 2 pRCC was 95.1 % (p = 0.894), respectively. Three-year estimated cancer-specific survival rate for type 1 pRCC was 98.4 % and for type 2 pRCC was 97.3 % (p = 0.947), respectively. Tumor stage superior to pT1 was the only prognostic factor for CFS (HR 3.5; p = 0.03). Conclusion Histological subtyping of pRCC has no impact on oncologic outcomes after nephron sparing surgery. In this selected population of pRCC tumors, we found that tumor stage is the only prognostic factor for cancer-free surviva