Centre Hospitalier Universitaire de Rouen

Epilepsy is a common and disabling neurological disorder. To significantly improve the quality of life of patients, the primary goal is to achieve seizure freedom. Unfortunately, 30 % of epilepsies are drug-resistant and seizure freedom is not acheived. Cenobamate is a new anti-seizure medication (ASM) used as a treatment for focal epilepsy in adults whose seizures have not been able to be controlled by two prior ASM. Two previous pivotal studies have showed an unusual seizure-free rate at 21 % and 28 %. A retrospective observational study was conducted to determine the effectiveness, safety and retention of cenobamate in 87 patients with highly focal drug-resistant epilepsy. The responder rate was 48 % with a seizure-free rate of 18 % at the last follow-up, with a mean dose of cenobamate at 216 mg. Adverse events were reported in 74 % patients, the most frequent being somnolence/fatigue and dizziness. No cases of DRESS or death were reported during the study. Cenobamate was discontinued in 34 % of patients, for a lack of efficacy despite an adequate dosage (≥ 200 mg) in 30 %, a poor tolerance in 27 %, for both insufficient efficacy and poor tolerance in 40 %, or for pregnancy plans in 3 %. Cenobamate is an effective and well-tolerated ASM in drug-resistant focal epilepsy and should be tried for highly drug-resistant epilepsy, even if many previous ASM have failed. Moreover, the impressive seizure-free rate leads to introducing cenobamate to all patients before or during the evaluation for surgical candidacy, and in any case before any resective surgery.

The primary objective was to evaluate an association between obesity and histological type of RCC. The secondary objective was to assess if there was an effect of obesity on tumor characteristics.

A multicenter comparative descriptive study was carried out in nearly 30 French hospitals. Histological features of operated RCC of patients included between 2007 and 2020 were compared according to their BMI. Obesity was defined as a BMI≥30kg/m², with a P<0.05.

In total, 6749 RCC were analyzed, including 1687 (25%) from obese patients. This population was more frequently diabetic (61% versus 41%, P<0.001) and hypertensive (27% versus 11%, P<0.001). Regarding histological evaluation, the obese group presented clearer cell carcinoma. Other types presented odd ratios below 1 on multivariate analysis, P<0.01 except for type II papillary RCC. Tumor size (pT) and nuclear ISUP grade were both lower when BMI was above 30kg/m²: 72.4% of size pT 1-2 versus 68.5% (P=0.026) and 50% of nuclear ISUP grade 1-2 versus 43.3% for the non-obese group (P<0.0001). There was no difference in survival due to an insufficient number of events.

In this large cohort study, we report novel data on a positive association between obesity and histological type of RCC, in particular clear cell RCC.

Despite improvements in perioperative pain management protocols, severe postoperative pain is still a burden for many patients. To improve the prevention and treatment of postoperative pain, it must be accurately assessed for each procedure type. However, there is little data available assessing the pain levels after robot-assisted urological surgeries. This cohort study aimed to estimate the pain scores that can be expected after various types of robotic-assisted urologic procedures.

This was a prospective, multicentre, observational trial in 44 centers in Europe that included patients scheduled for robotic-assisted urological surgery. The primary outcome was pain scores on the first day after surgery assessed using the numeric rating scale (NRS). Secondary outcomes included pain score on the second day after surgery, morphine equivalent consumption in mg 48 h after the surgery, postoperative nausea and vomiting (PONV), and surgical complications.

A total of 965 patients were recruited between November 2022 and June 2023. Median pain score on postoperative day 1 was 2 at rest (IQR, 0-4) (n = 963) and 3 with movement (IQR, 1-5) (n = 921). Morphine equivalent consumption 48 h after the surgery was 4 mg (IQR 0-20 mg). PONV was experienced by 16 % of the patients (153/963).

This large cohort study demonstrates that patients experience low pain scores and require low opioids after robotic-assisted urological surgery when commonly used multimodal analgesia protocols are administered.

clinicaltrials.gov No. NCT05575284.