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Branger N, Doumerc N, Waeckel T, Bigot P, Surlemont L, Knipper S, Pignot G, Audenet F, Bruyère F, Fontenil A, Parier B, Champy C, Rouprêt M, Patard JJ, Henon F, Fiard G, Guillotreau J, Beauval JB, Michel C, Bernardeau S, Taha F, Mallet R, Panthier F, Guy L, Vignot L, Khene ZE, Bernhard JC. Preparing for the Worst: Management and Predictive Factors of Open Conversion During Minimally Invasive Renal Tumor Surgery (UroCCR-135 Study). EUR UROL SUPPL 2024; 63:89-95. [PMID: 38585592 PMCID: PMC10997889 DOI: 10.1016/j.euros.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
Background and objective Data regarding open conversion (OC) during minimally invasive surgery (MIS) for renal tumors are reported from big databases, without precise description of the reason and management of OC. The objective of this study was to describe the rate, reasons, and perioperative outcomes of OC in a cohort of patients who underwent MIS for renal tumor initially. The secondary objective was to find the factors associated with OC. Methods Between 2008 and 2022, of the 8566 patients included in the UroCCR project prospective database (NCT03293563), who underwent laparoscopic or robot-assisted minimally invasive partial (MIPN) or radical (MIRN) nephrectomy, 163 experienced OC. Each center was contacted to enlighten the context of OC: "emergency OC" implied an immediate life-threatening situation not reasonably manageable with MIS, otherwise "elective OC". To evaluate the predictive factors of OC, a 2:1 paired cohort on the UroCCR database was used. Key findings and limitations The incidence rate of OC was 1.9% for all cases of MIS, 2.9% for MIRN, and 1.4% for MIPN. OC procedures were mostly elective (82.2%). The main reason for OC was a failure to progress due to anatomical difficulties (42.9%). Five patients (3.1%) died within 90 d after surgery. Increased body mass index (BMI; odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.09, p = 0.009) and cT stage (OR: 2.22, 95% CI: 1.24-4.25, p = 0.008) were independent predictive factors of OC. Conclusions and clinical implications In MIS for renal tumors, OC was a rare event (1.9%), caused by various situations, leading to impaired perioperative outcomes. Emergency OC occurred once every 300 procedures. Increased BMI and cT stage were independent predictive factors of OC. Patient summary The incidence rate of open conversion (OC) in minimally invasive surgery for renal tumors is low. Only 20% of OC procedures occur in case of emergency, and others are caused by various situations. Increased body mass index and cT stage were independent predictive factors of OC.
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Affiliation(s)
- Nicolas Branger
- Department of Urology, Institut Paoli Calmettes, Marseille, France
| | | | | | - Pierre Bigot
- Department of Urology, CHU Angers, Angers, France
| | | | - Sophie Knipper
- Department of Urology, Institut Paoli Calmettes, Marseille, France
| | - Géraldine Pignot
- Department of Urology, Institut Paoli Calmettes, Marseille, France
| | - François Audenet
- Department of Urology, Hopital européen Georges Pompidou, Paris, France
| | | | | | | | - Cécile Champy
- Department of Urology, Hopital Henri Mondor, Créteil, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | | | | | - Gaëlle Fiard
- Department of Urology, CHU Grenoble, Grenoble, France
| | | | | | | | | | - Fayek Taha
- Department of Urology, CHU Reims, Reims, France
| | - Richard Mallet
- Department of Urology, Polyclinique Francheville, Périgueux, France
| | | | - Laurent Guy
- Department of Urology, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Fleury R, Bertail T, Bensalah K, Bernhard JC, Audenet F, Waeckel T, Parier B, Champy C, Olivier J, Doumerc N, Tricard T, Branger N, Bruyere F, Neuville P, Surlemont L, Alexandre Long J, Fontenil A, Vallee M, Roupret M, Boissier R, Jacques Patard J, Durand M, Ouzaid I, Rouget B, Durand X, Joncour C, Belas O, Denise Gomez F, Bigot P, Khene ZE. The Impact of Histological Variants on Oncological Outcomes After Surgical Resection of a Nonmetastatic Renal Cell Carcinoma with Tumor Thrombus: A Multi-institutional Study. EUR UROL SUPPL 2024; 62:123-130. [PMID: 38496822 PMCID: PMC10940768 DOI: 10.1016/j.euros.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Background There is no definitive evidence of the prognosis impact of histological variants (HVs) in patients who undergo surgical resection of a nonmetastatic renal cell carcinoma (nm-RCC) with venous tumor thrombus (TT). Objective To investigate the impact of HVs on the prognosis of patients with nm-RCC with TT after radical surgery. Design setting and participants Patients who underwent radical nephrectomy with the removal of the venous TT for an nm-RCC were included in a retrospective study. Outcome measurements and statistical analysis Three groups were identified: clear cell (ccRCC), papillary (pRCC), and chromophobe (chRCC) RCC. The primary outcome measures (disease-free and overall survival [OS]) were assessed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate Cox proportional hazard models were used to study the impact of HVs on survival. Results and limitations A total of 873 patients were included. The histological subtypes were distributed as follows: ccRCC in 780 cases, pRCC in 58 cases, and chRCC in 35 cases. At the time of data analysis, 612 patients were recurrence free and 228 had died. A survival analysis revealed significant differences in both OS and recurrence-free survival across histological subtypes, with the poorest outcomes observed in pRCC patients (p < 0.05). In a multivariable analysis, pRCC was independently associated with worse disease-free survival and OS (hazard ratio [HR]: 1.71; p = 0.01 and HR: 1.24; p = 0.04), while chRCC was associated with more favorable outcomes than ccRCC (HR: 0.05; p < 0.001 and HR: 0.02; p < 0.001). A limitation of the study is its retrospective nature. Conclusions In this multicentric series, HVs appeared to impact the medium-term oncological prognosis of kidney cancer with TT. Patient summary This study investigated the differences in oncological outcomes among histological variants (clear cell, papillary, and chromophobe) in a cohort of nonmetastatic renal cell carcinoma patients with venous tumor thrombus extension. We observed that these histological variants within this specific subgroup exhibit distinct outcomes, with papillary renal cell carcinoma being associated with the worst prognosis.
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Affiliation(s)
- Raphael Fleury
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Théophile Bertail
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Karim Bensalah
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
- LTSI, Inserm U1099, Université de Rennes 1, Rennes, France
| | | | - Francois Audenet
- Department of Urology, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Thibaut Waeckel
- Department of Urology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Bastien Parier
- Department of Urology, Hôpital Bicêtre, APHP, Paris, France
| | - Cécile Champy
- Department of Urology, Centre Hospitalier Henri Mondor, APHP, Créteil, France
| | - Jonathan Olivier
- Department of urology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Nicolas Doumerc
- Department of Urology, Centre Hospitalier Universitaire Rangueil, Toulouse, France
| | - Thibault Tricard
- Department of Urology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Nicolas Branger
- Department of Urology, Institut Paoli Calmettes de Marseille, Marseille, France
| | - Franck Bruyere
- Department of Urology, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Paul Neuville
- Department of Urology, Hospices Civils de Lyon, Lyon, France
| | - Louis Surlemont
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Jean Alexandre Long
- Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Alexis Fontenil
- Department of Urology, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Maxime Vallee
- Department of Urology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Morgan Roupret
- Department of Urology, Hôpital de la Pitié Salpêtrière, APHP, Paris, France
| | - Romain Boissier
- Department of Urology, Hôpital de la Conception, APHM, Marseille, France
| | - Jean Jacques Patard
- Department of Urology, Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France
| | - Mathieu Durand
- Department of Urology, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Idir Ouzaid
- Department of Urology, Hôpital Bichat, APHP, Paris, France
| | - Benjamin Rouget
- Department of Urology, Centre Hospitalier de Libourne, Libourne, France
| | - Xavier Durand
- Department of Urology, Hôpital Privé Saint Joseph, Paris, France
| | - Charlotte Joncour
- Department of Urology, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Olivier Belas
- Department of Urology, Pôle Santé Sud au Mans, Le Mans, France
| | | | - Pierre Bigot
- Department of Urology, Centre Hospitalier Universitaire d’Angers, d’Angers, France
| | - Zine-Eddine Khene
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
- LTSI, Inserm U1099, Université de Rennes 1, Rennes, France
| | - members of the French Committee of Urologic Oncology CCAFU
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
- LTSI, Inserm U1099, Université de Rennes 1, Rennes, France
- Department of Urology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Department of Urology, Hôpital Européen Georges Pompidou, APHP, Paris, France
- Department of Urology, Centre Hospitalier Universitaire de Caen, Caen, France
- Department of Urology, Hôpital Bicêtre, APHP, Paris, France
- Department of Urology, Centre Hospitalier Henri Mondor, APHP, Créteil, France
- Department of urology, Centre Hospitalier Universitaire de Lille, Lille, France
- Department of Urology, Centre Hospitalier Universitaire Rangueil, Toulouse, France
- Department of Urology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
- Department of Urology, Institut Paoli Calmettes de Marseille, Marseille, France
- Department of Urology, Centre Hospitalier Universitaire de Tours, Tours, France
- Department of Urology, Hospices Civils de Lyon, Lyon, France
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France
- Department of Urology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
- Department of Urology, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
- Department of Urology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Department of Urology, Hôpital de la Pitié Salpêtrière, APHP, Paris, France
- Department of Urology, Hôpital de la Conception, APHM, Marseille, France
- Department of Urology, Centre Hospitalier de Mont-de-Marsan, Mont-de-Marsan, France
- Department of Urology, Centre Hospitalier Universitaire de Nice, Nice, France
- Department of Urology, Hôpital Bichat, APHP, Paris, France
- Department of Urology, Centre Hospitalier de Libourne, Libourne, France
- Department of Urology, Hôpital Privé Saint Joseph, Paris, France
- Department of Urology, Centre Hospitalier Universitaire de Reims, Reims, France
- Department of Urology, Pôle Santé Sud au Mans, Le Mans, France
- Department of Urology, Hôpital Tenon, APHP, Paris, France
- Department of Urology, Centre Hospitalier Universitaire d’Angers, d’Angers, France
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Lehrer R, Cornelis F, Bernhard JC, Bigot P, Champy C, Bruyère F, Rouprêt M, Doumerc N, Bensalah CK, Olivier J, Audenet F, Tricard T, Parier B, Durand X, Durand M, Charles T, Branger N, Surlemont L, Xylinas E, Beauval JB, Barral M. Minimally invasive nephron-sparing treatments for T1 renal cell cancer in patients over 75 years: a comparison of outcomes after robot-assisted partial nephrectomy and percutaneous ablation. Eur Radiol 2023; 33:8426-8435. [PMID: 37466710 DOI: 10.1007/s00330-023-09975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To compare the oncological and perioperative outcomes of robot-assisted partial nephrectomy (RPN) and percutaneous thermal ablation (PTA) for treatment of T1 renal cell cancer (RCC) in patients older than 75 years. MATERIALS AND METHODS Retrospective national multicenter study included all patients older than 75 years treated for a T1 RCC by RPN or PTA between January 2010 and January 2021. Patients' characteristics, tumor data, and perioperative and oncological outcomes were compared. RESULTS A total of 205 patients for 209 procedures (143 RPN and 66 PTA) were included. In the PTA group, patients were older (80.4 ± 3.7 vs. 79 ± 3.7 years (p = 0.01)); frailer (ASA score (2.43 ± 0.6 vs. 2.17 ± 0.6 (p < 0.01)); and more frequently had a history of kidney surgery (16.7% [11/66] vs. 5.6% [8/143] (p = 0.01)) than in the RPN group. Tumors were larger in the RPN group (2.7 ± 0.7 vs. 3.2 ± 0.9 cm (p < 0.01)). Operation time, length of hospital stay, and increase of creatinine serum level were higher in RPN (respectively 92.1 ± 42.7 vs. 150.7 ± 61.3 min (p < 0.01); 1.7 ± 1.4 vs. 4.2 ± 3.4 days (p < 0.01); 1.9 ± 19.3% vs. 10.1 ± 23.7 (p = 0.03)). Disease-free survival and time to progression were similar (respectively, HR 2.2; 95% CI 0.88-5.5; p = 0.09; HR 2.1; 95% CI 0.86-5.2; p = 0.1). Overall survival was shorter for PTA that disappeared after Cox adjusting model (HR 3.3; 95% CI 0.87-12.72; p = 0.08). CONCLUSION Similar oncological outcomes are observed after PTA and RPN for T1 RCC in elderly patients. CLINICAL RELEVANCE STATEMENT Robot-assisted partial nephrectomy and percutaneous thermal ablation have similar oncological outcomes for T1a kidney cancer in patients over 75 years; however, operative time, decrease in renal function, and length of hospital stay were lower with ablation. KEY POINTS • After adjusting model for age and ASA score, similar oncological outcomes are observed after percutaneous thermal ablation and robot-assisted partial nephrectomy for T1 renal cell cancer in elderly patients. • Operation time, length of hospital stay, and increase of creatinine serum level were higher in the robot-assisted partial nephrectomy group.
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Affiliation(s)
- Raphaël Lehrer
- Department of Radiology, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France
- Department of Interventional Radiology, Sorbonne Université, Paris, France
| | - Francois Cornelis
- Radiology Department, Memorial Sloan Kettering Cancer Center, New York, USA
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
| | - Jean-Christophe Bernhard
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Hôpital Pellegrin, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Bigot
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Angers University Hospital, Angers, France
| | - Cécile Champy
- Department of Urology, University Hospital Henri Mondor, AP-HP, Créteil, France
- INSERM, U1430, Henri Mondor University Hospital, AP-HP, 94000, Creteil, France
| | - Franck Bruyère
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Tours University Hospital, Tours, France
| | - Morgan Rouprêt
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Pitié-Salpêtrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Nicolas Doumerc
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, University Hospital Rangueil, Toulouse, France
| | - Charles-Karim Bensalah
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | - François Audenet
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | | | - Bastien Parier
- Department of Urology, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Xavier Durand
- Department of Urology, Paris Saint-Joseph Hospital, Paris, France
| | - Matthieu Durand
- Department of Urology, Hôpital Pasteur 2, Nice, France
- INSERM U1081 - CNRS, UMR 7284, Université de Nice Côte d'Azur, Nice, France
| | - Thomas Charles
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Poitiers University Hospital, Poitiers, France
| | - Nicolas Branger
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Louis Surlemont
- Department of Urology, Rouen University Hospital, Rouen, France
| | - Evanguelos Xylinas
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Jean-Baptiste Beauval
- French Research Network on Kidney Cancer UroCCR, Bordeaux, France
- Department of Urology, Grenoble University Hospital, Grenoble, France
| | - Matthias Barral
- Department of Radiology, Sorbonne Université, AP-HP, Hôpital Tenon, Paris, France.
- Department of Interventional Radiology, Sorbonne Université, Paris, France.
- Service d'Imagerie Radiologiques et Interventionnelles Spécialisées, Hôpital Tenon, Sorbonne Université, AP-HP, 4 rue de la chine, 75020, Paris, France.
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Klein C, Margue G, Champy C, Parier B, Waeckel T, Bensalah K, Olivier J, Doumerc N, Audenet F, Branger N, Roupret M, Surlemont L, Bruyere F, Durand X, Durand M, Long JA, Gaillard V, Xylinas E, Vallee M, Rouget B, Bigot P, Bernhard JC. Can Simplified PADUA Renal (SPARE) Nephrometry scoring system help predict renal function outcomes after robot-assisted partial nephrectomy? (UroCCR study 93). Minerva Urol Nephrol 2023; 75:569-576. [PMID: 37728493 DOI: 10.23736/s2724-6051.23.05324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND The SPARE Nephrometry Score (NS) is described as easier to implement than the RENAL and PADUA NSs, currently more widely used. Our objective was to compare the accuracy of SPARE NS in predicting renal function outcomes following RAPN. METHODS A multicentric retrospective study was conducted using French kidney cancer network (UroCCR, NCT03293563) database. All patients included had RAPN for cT1 renal tumors between May 2010 and March 2021. SPARE was compared to RENAL, PADUA and Tumor Size to predict postoperative acute kidney injury (AKI), chronic kidney disease (CKD) upstaging, de novo CKD at 3-6 months follow-up and Trifecta failure. The ability of the different NSs and tumor size to predict renal function outcomes was evaluated using uni- and multivariate logistic regression models. RESULTS According to our study criteria, 1171 patients were included. Mean preoperative tumor size and estimated glomerular filtration rate (eGFR) were 3.4±1.4 cm and 85.8 mL/min/1.73 m2. In total, 266 (22.7%), 87 (7.4%), 94 (8%), and 624 (53.3%) patients had AKI, de novo CKD, CKD upstaging, and Trifecta failure, respectively. In multivariate analysis, all three NSs and tumor size were independent predictors of AKI, CKD de novo, CKD upgrade and Trifecta failure. There was no significant difference between all three NS and tumor sizes in predicting renal function outcomes. CONCLUSIONS SPARE Score seems to be a valid alternative to predict renal function outcomes after RAPN. Nevertheless, in our study, tumor size was as accurate as NSs in predicting postoperative outcomes and, therefore, seems to be the logical choice for surgical decisions.
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Affiliation(s)
- Clément Klein
- Department of Urology, University Hospital of Bordeaux, Bordeaux, France -
| | - Gaelle Margue
- Department of Urology, University Hospital of Bordeaux, Bordeaux, France
| | - Cécile Champy
- Department of Urology, Henri Mondor Hospital, Paris, France
| | - Bastien Parier
- Department of Urology, Kremlin Bicêtre Hospital, Paris, France
| | - Thibaut Waeckel
- Department of Urology, Caen University Hospital, Caen, France
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Jonathan Olivier
- Department of Urology, University Hospital of Lille, Lille, France
| | - Nicolas Doumerc
- Department of Urology, University Hospital of Toulouse, Toulouse, France
- Comité de Cancérologie de l'Association Française d'Urologie (CCAFU), Groupe Rein, Paris, France
| | - François Audenet
- Department of Urology, European Georges Pompidou Hospital, Paris, France
| | - Nicolas Branger
- Department of Urology, Paoli Calmettes Institute, Marseille, France
| | - Morgan Roupret
- Comité de Cancérologie de l'Association Française d'Urologie (CCAFU), Groupe Rein, Paris, France
- Department of Urology, La Pitié Salpêtrière Hospital, Paris, France
| | - Louis Surlemont
- Department of Urology, University Hospital of Rouen, Rouen, France
| | - Franck Bruyere
- Department of Urology, University Hospital of Tours, Tours, France
| | - Xavier Durand
- Department of Urology, Saint Joseph Hospital, Paris, France
| | - Mathieu Durand
- Department of Urology, University Hospital of Nice, Nice, France
| | | | - Victor Gaillard
- Department of Urology, University Hospital of Strasbourg, Strasbourg, France
| | | | - Maxime Vallee
- Department of Urology, University Hospital of Poitiers, Poitiers, France
| | - Benjamin Rouget
- Department of Urology, Hospital of Libourne, Libourne, France
| | - Pierre Bigot
- Comité de Cancérologie de l'Association Française d'Urologie (CCAFU), Groupe Rein, Paris, France
- Department of Urology, University Hospital of Angers, Angers, France
| | - Jean-Christophe Bernhard
- Department of Urology, University Hospital of Bordeaux, Bordeaux, France
- Comité de Cancérologie de l'Association Française d'Urologie (CCAFU), Groupe Rein, Paris, France
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5
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Brument M, Defortescu G, Bugel H, Sibert L, Duflot T, Dupuis H, Surlemont L, Pfister C, Cornu JN. Differential impact of COVID-19 on urological surgeries in public and private institutions between 2019 and 2021 in France. Prog Urol 2023:S1166-7087(23)00109-4. [PMID: 37328317 PMCID: PMC10239898 DOI: 10.1016/j.purol.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The COVID-19 pandemic disrupted all routine health care services in 2020. To date, data regarding adjustment and coverage of surgical backlog in the post-COVID era actually remains scarce. The aim of this study was to compare the number of urological procedures coded between 2019 and 2021 in public and private institutions to (i) quantify the variation in surgical activity linked to the shutdown in 2020 and (ii) study the adjustment of procedures over the year 2021. MATERIALS AND METHODS This is a comprehensive retrospective analysis of all urological surgeries coded between January 1, 2019 and December 31, 2021 in France. Data were extracted from the open access dataset of the national Technical Agency for Information on Hospital Care (ATIH) website. In total, 453 urological procedures were retained and allocated in 8 categories. Primary outcome was the impact of COVID-19 analyzed by the 2020/2019 variation. The secondary outcome was the post-COVID catch-up analyzed by the 2021/2019 variation. RESULTS Surgical activity in public hospitals dropped by 13.2% in 2020 compared to 7.6% in the private sector. The most impacted areas were functional urology, stones and BPH. Incontinence surgery did not recover at all in 2021. BPH and stone surgeries were far less impacted in the private sector, with even explosive activity in 2021, post-COVID period. Onco-urology procedures were roughly maintained with a compensation in 2021 in both sectors. CONCLUSION The recovery of surgical backlog was much more efficient in the private sector in 2021. The pressure on the health system associated to the multiple COVID-19 waves may generate a gap between public and private surgical activity in the future. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- M Brument
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France.
| | - G Defortescu
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - H Bugel
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - L Sibert
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - T Duflot
- Service d'urologie, centre hospitalier de Tourcoing, 115, rue du Président-Coty, 59200 Tourcoing, France
| | - H Dupuis
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - L Surlemont
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - C Pfister
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - J-N Cornu
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
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Klein C, Bensalah K, Champy C, Bensalah K, Champy C, Olivier J, Doumerc N, Audenet F, Branger N, Roupret M, Surlemont L, Bruyere F, Durand X, Parier B, Durand M, Waeckel T, Rouget B, Gaillard V, Xylinas E, Vallee M, Long J, Bernhard J. Does Simplified PADUA Renal (SPARE) Nephrometry scoring system can help predicting renal function outcomes after Robot-Assisted Partial Nephrectomy (RAPN) (UroCCR study 93)? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Brument M, Dupuis H, Duflot T, Surlemont L, Defortescu G, Sibert L, Pfister C, Cornu J. Impact du COVID-19 sur l’activité chirurgicale urologique dans les établissements de santé publics et privés sur le territoire national français entre 2019 et 2021. Progrès en Urologie - FMC 2022. [PMCID: PMC9617165 DOI: 10.1016/j.fpurol.2022.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectifs La pandémie de COVID-19 a perturbé fortement l’organisation des soins. Notre objectif était de rapporter le nombre de codages de tous les actes chirurgicaux urologiques dans les établissements de santé publics et privés français en 2019, 2020 et 2021 afin de (i) quantifier la variation d’activité chirurgicale liée à la crise en 2020 et (ii) étudier le rattrapage éventuel des actes sur l’année 2021. Méthodes Pour chaque acte chirurgical classant Classification commune des actes médicaux (CCAM) relatif au domaine de l’urologie, le nombre de codages réalisés en 2019, en 2020 et en 2021 en établissement public et privé a été extrait de la base de données en libre accès de l’Agence technique de l’information sur l’hospitalisation (ATIH). Les 453 actes chirurgicaux ont été répartis en 9 catégories : cancérologie, lithiase, organes génitaux externes, haut appareil, vessie, hypertrophie bénigne de prostate (HBP), traumatologie, urologie fonctionnelle (pelvi-périnéologie/neuro-urologie/incontinence), et transplantation. L’impact du COVID a été analysé par la variation 2020/2019 (année de référence), et le rattrapage post-COVID par la variation 2021/2019. Résultats Les établissements publics ont subi une baisse d’activité de 13,2 % en 2020, contre 7,5 % dans le privé, variable selon les thématiques (Tableau 1). La pelvi-périnéologie et les chirurgies bénignes furent sévèrement impactées, la cancérologie restant relativement préservée, en accord avec les recommandations. La chirurgie de l’HBP et de la lithiase furent beaucoup moins impactées dans le secteur privé notamment pour l’urétéroscopie. L’analyse des données 2021 montre un rattrapage d’activité supérieur dans le secteur privé dans quasiment tous les domaines, notamment en onco-urologie, à l’exception notable des cystectomies carcinologiques. La chirurgie du prolapsus et de l’incontinence, impactés par ailleurs par les arrêtés ministériels d’encadrement des pratiques, restait réduite en 2021 sans aucun rattrapage. L’activité de transplantation restait aussi significativement réduite. Conclusion La diminution d’activité chirurgicale urologique fut beaucoup plus importante dans le secteur public en 2020, avec une préservation de la cancérologie. Les données 2021 montrent un rattrapage d’activité notablement plus élevé dans les établissements privés, à l’exception notable de la chirurgie de l’incontinence et du prolapsus, également impactés durant cette période par des mesures d’encadrement restrictives.
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Affiliation(s)
- M. Brument
- CHU de Rouen, Rouen, France,Auteur correspondant
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Dupuis H, Khene ZE, Surlemont L, Saout K, Bakayoko A, Ducousso H, Bugel H, Pfister C, Cornu JN. Preoperative risk factors for complications after flexible and rigid ureteroscopy for stone disease: A French multicentric study. Prog Urol 2022; 32:593-600. [DOI: 10.1016/j.purol.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
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Surlemont L, Bernhard JC, Bensalah CK, Audenet F, Bigot P, Doumerc N, De La Taille A, Roupret M, Olivier J, Bruyère F, Parier B, Lang H, Brenier M, Waeckel T, Long JA, Durand M, Branger N, Tambwe R, Cussenot O, Boissier R, Charles T, Nouhaud FX. Impact of obesity in the management of kidney cancer, study URO-CCR n°87. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Surlemont L, Bernarhd J, Bensalah K, Bigot P, Doumerc N, De la taille A, Rouprêt M, Villers A, Bruyere F, Lebacle C, Lang H, Durand X, Tillou X, Long J, Rouget B, Durand M, Pignot G, Larre S, Cussenot O, Nouhaud F. Impact de l’obésité dans la prise en charge du cancer du rein, étude URO-CCR N°87. Prog Urol 2021. [DOI: 10.1016/j.purol.2021.08.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dupuis HGA, Chebbi A, Surlemont L, Rigal O, Di Fiore F, Pfister C, Nouhaud FX. Efficacy and safety of anti-vascular endothelial growth factor therapies in older patients for first line treatment of metastatic renal cell carcinoma. Transl Androl Urol 2021; 10:2418-2426. [PMID: 34295728 PMCID: PMC8261413 DOI: 10.21037/tau-20-1481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/17/2021] [Indexed: 12/09/2022] Open
Abstract
Background immunotherapy became the first line treatment of metastatic renal cell carcinoma (mRCC). Nevertheless, a better understanding of the specificities of targeted therapies (TT) in the elderly population could be helpful in order to improve the management of mRCC in this population. The aim of this retrospective study was to assess efficacy and safety of sunitinib and sorafenib used as first-line TT in 70 years older patients compared to younger patients. Methods Data were retrospectively collected for all consecutive mRCC patients receiving first line TT treatment by sunitinib or sorafenib for mRCC from January 2006 to November 2017. Patients were divided into two groups according to the age using a cut-off at 70 years old. Median progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier method and compared using log-rank test. Results In total, 147 patients were included; 94 (63.9%) were <70 and 53 (36.1%) were 70 years old or more. First line TT used was sunitinib in 123 (83.7%) patients or sorafenib in 24 (16.3%) patients. Median PFS was 8 months for elderly patients vs. 6 in younger group (P=0.68). Median OS were 26 vs. 36 months (P=0.08). Severe induced toxicity was more frequent among elderly patients: 34 (64.2%) vs. 46 patients (48.9%) (P=0.07). Rate of treatment discontinuation due to toxicity was 22 patients (23.4%) in younger group vs. 28 patients (52.8%) in the elderly group (P=0.0005). Results were similar in the 2 groups regarding the type of toxicities. Conclusions Our results suggest similar efficacy of anti-vascular endothelial growth factor (VEGF) agents as first-line treatment for mRCC among younger and older patients with an age cut-off of 70 years. Safety results suggest that these drugs can be safely used for older patients with a need of caution regarding toxicity prevention.
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Affiliation(s)
| | - Ala Chebbi
- Urology Department, Rouen University Hospital, Rouen, France
| | - Louis Surlemont
- Urology Department, Rouen University Hospital, Rouen, France
| | - Olivier Rigal
- Medical Oncology Unit, Henri Becquerel Center, Rouen, France
| | | | - Christian Pfister
- Urology Department, Rouen University Hospital, Rouen, France.,Clinical Investigation Center, Inserm 1404, Onco Urology, Rouen, France
| | - François-Xavier Nouhaud
- Urology Department, Rouen University Hospital, Rouen, France.,Clinical Investigation Center, Inserm 1404, Onco Urology, Rouen, France
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Surlemont L, Nouhaud FX, Dupuis H, Delcourt C, Defortescu G, Cornu JN, Pfister C. [BCG strain shortage from 2012 to 2014: Evaluation of its impact on the management of patients with high-risk NMIBC]. Prog Urol 2021; 31:324-331. [PMID: 33516609 DOI: 10.1016/j.purol.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION BCG instillations are the gold-standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC) with a decreased risk of tumor recurrence and muscle infiltration. From 2012 to 2014, a stock shortage of the Connaught strain has led to the cessation of supply for immucyst in France. The objective of this study was to evaluate the potential impact of BCG shortage on the management of patients with NMIBC. PATIENTS AND METHODS We conducted a retrospective single-center study including patients followed from May 2005 to May 2015 with a high-risk NMIBC (primo-diagnosis). Patients were separated into two groups: not impacted by the shortage (NISG: 56 patients) and impacted by the shortage (ISG: 53 patients). Data on tumour recurrence (RFS), muscle progression (PFS) and overall and specific survival (OS and SS) were also analysed. RESULTS The BCG induction schedule could not be carried out in 20.8% of cases in the ISG compared to only 5.3% of cases in NISG (P=0.02). Similarly, the maintenance treatment was incomplete for 56.6% of cases versus 37.5% in NISG (P=0.047). Nevertheless, it should be underlined that very high-risk NMIBC received a complete induction BCG schedule. The ISG seems to have benefited with the evolution of the guidelines with the use of diagnosis bladder fluorescence but without significant difference on the rate of second look bladder trans-uretral resection. The cystectomy rate was higher in ISG. No significant difference in RFS, PFS, OS, and SS between the two groups. CONCLUSION In our experience, RFS, PFS, OS or SS were not impacted by the BCG shortage. These data may be explained by a better selection of very high-risk patients including the recommended BCG schedule and more frequently the use of diagnosis bladder fluorescence. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- L Surlemont
- Service urologie, CHU de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - F-X Nouhaud
- Service urologie, CHU de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - H Dupuis
- Service urologie, CHU de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Delcourt
- Service urologie, CHU de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Defortescu
- Service urologie, CHU de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - J-N Cornu
- Service urologie, CHU de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Pfister
- Service urologie, CHU de Rouen, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
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Auble A, Baron M, Chebbi A, Surlemont L, Leroi A, Cornu J. Sacral neuromodulation and non-obstructive retention: Monocentric retrospective study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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