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Collin-Bund V, Viviani V, Meyer N, Goetsch T, Boisramé T, Faller E, Lecointre L, Gabriele V, Akladios C, Garbin O, Host A. Study of the feasibility of outpatient sacrocolpopexy by laparoscopy. J Gynecol Obstet Hum Reprod 2024; 53:102792. [PMID: 38663686 DOI: 10.1016/j.jogoh.2024.102792] [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: 01/01/2024] [Revised: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Laparoscopic sacrocolpopexy (LSCP) is currently the gold standard surgical technique for treating pelvic prolapse. This study aimed to evaluate the feasibility of laparoscopic sacrocolpopexy in ambulatory care. PATIENTS AND METHODS This prospective study was conducted to evaluate the feasibility of LSCP in women who visited the outpatient department of obstetrics and gynecology at the University Hospital of Strasbourg between July 2018 and December 2021. All women with indications for laparoscopic sacrocolpopexy for prolapse treatment who were willing to be treated as outpatients were included. The main criterion of the study was to evaluate the rate of re-hospitalization between discharge from the outpatient department after LSCP and postoperative follow-up consultations. RESULTS Among the whole population (57/200, 28.5 %) included, 4 (7 %) were hospitalized. The quality of life was not altered with a preserved EuroQol (EQ-5D) quality of life score with a mean score of 73±18.4 standard deviation (SD) 95 % confidence interval (CI) (67.9; 78.1) on postoperative day 3 (D3) and 91.2 ± 16.3 SD 95 % CI (86.2-96) on D30. On D1, D2, D3, and D7, the anxiety rate evaluated by State-Trait Anxiety Inventory score (STAI Y-A) remained low, with mean scores of 24.8 ± 9.6 SD 95 % [23.4-26.5] on D30. All patients were satisfied or very satisfied with the procedure and outpatient management, with an average score of 9.6/10 (range: 8-10). CONCLUSION This prospective, monocentric study evaluating the feasibility of outpatient LSCP reported demonstrated low rates of complications and re-hospitalization after outpatient management. Furthermore, the patients' quality of life was not altered, and they patients were satisfied with this type of management.
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Affiliation(s)
- V Collin-Bund
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - V Viviani
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - N Meyer
- Department of Public Health, Biostatistic laboratory, Université de Strasbourg, 67081 Strasbourg, France
| | - T Goetsch
- Department of Public Health, Biostatistic laboratory, Université de Strasbourg, 67081 Strasbourg, France
| | - T Boisramé
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - E Faller
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - L Lecointre
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France; I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, 67081 Strasbourg, France; Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, France
| | - V Gabriele
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - C Akladios
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - O Garbin
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - A Host
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
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Gaultier V, Mounien D, Faller E, Boisramé T, Gabriele V, Lecointre L, Martel C, Akladios C. [How i do… laparotomy omentosplenectomy during complete cytoreductive surgery?]. Gynecol Obstet Fertil Senol 2022; 50:689-692. [PMID: 36028185 DOI: 10.1016/j.gofs.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/13/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Affiliation(s)
- V Gaultier
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France.
| | - D Mounien
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - E Faller
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - T Boisramé
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - V Gabriele
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - L Lecointre
- IHU-Strasbourg (institut hospitalo-universitaire), institut de chirurgie guidée par image, Strasbourg, France; ICube UMR 7357 - laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, CNRS, université de Strasbourg, Strasbourg, France
| | - C Martel
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - C Akladios
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
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Akladios C, Daraï É, Golfier F, Lecuru F, Collinet P, Uzan C, Lavoué V, Guyon F, Ferron G, Querleu D. [A curriculum based certification of competence in gynaecologic surgical oncology]. ACTA ACUST UNITED AC 2021; 50:26-32. [PMID: 34774853 DOI: 10.1016/j.gofs.2021.07.003] [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: 04/08/2021] [Accepted: 07/04/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies, the SFOG, the CNGOF, the SFCO and the SCGP, supported by the CNU of Obstetrics &Gynaecology- and UNICANCER, agreed to materialize this course and attest it by a certification awarded by a national jury. MATERIAL AND METHODS The national committee of certification in gynaecological oncology made up of 10 members, representing the 6 concerned organizations, set itself 5 objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification. RESULTS Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including 20 advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including 4 parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021. CONCLUSION The optimisation of the surgical management of patients treated for gynaecological cancer is achieved through the identification of a training course and the certification, by a national jury, of the skills of surgeons who have completed it.
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Affiliation(s)
- C Akladios
- Hôpitaux universitaires de Strasbourg, CHU de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - É Daraï
- Hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Golfier
- Centre hospitalier Lyon Sud CHEM Grand Revoyet, hôpital Lyon Sud-Lyon, 69310 Pierre-Bénite, France
| | - F Lecuru
- Institut Curie-Paris, institut Curie Ensemble hospitalier - site de Paris, 26, rue d'Ulm, 75005 Paris, France
| | - P Collinet
- Hôpital Jeanne-de-Flandre-Lille, avenue Eugene-Avinée, 59000 Lille, France
| | - C Uzan
- Hôpital de la Pitié Salpêtrière, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - V Lavoué
- Centre Eugène-Marquis, hôpital Sud, CHU de Rennes, avenue Bataille Flandres-Dunkerque C S 44229, 35042 Rennes, France
| | - F Guyon
- Institut Bergonié, centre de lutte contre le cancer (CLCC) de la région Nouvelle-Aquitaine, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - G Ferron
- Institut universitaire du cancer de Toulouse ONCOPOLE Iuct O, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - D Querleu
- Société européenne d'oncologie gynécologique, 7, allée du Niger, 31000 Toulouse, France
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Touboul C, Legendre G, Agostini A, Akladios C, Bendifallah S, Bolze PA, Bouet PE, Chauvet P, Collinet P, Dabi Y, Delotte J, Deffieux X, Dion L, Gauthier T, Kerbage Y, Koskas M, Millet P, Narducci F, Ouldamer L, Ploteau S, Santulli P, Golfier F. [Guidelines for Clinical Practice of the French College of Obstetricians and Gynecologists 2021: Prophylactic procedures associated with gynecologic surgery]. ACTA ACUST UNITED AC 2021; 49:805-815. [PMID: 34520857 DOI: 10.1016/j.gofs.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To draw up recommendations on the use of prophylactic gynecologic procedures during surgery for other indications. DESIGN A consensus panel of 19 experts was convened. A formal conflict of interest policy was established at the onset of the process and applied throughout. The entire study was performed independently without funding from pharmaceutical companies or medical device manufacturers. The panel applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the quality of evidence on which the recommendations were based. The authors were advised against making strong recommendations in the presence of low-quality evidence. Some recommendations were ungraded. METHODS The panel studied 22 key questions on seven prophylactic procedures: 1) salpingectomy, 2) fimbriectomy, 3) salpingo-oophorectomy, 4) ablation of peritoneal endometriosis, 5) adhesiolysis, 6) endometrial excision or ablation, and 7) cervical ablation. RESULTS The literature search and application of the GRADE system resulted in 34 recommendations. Six were supported by high-quality evidence (GRADE 1+/-) and 28 by low-quality evidence (GRADE 2+/-). Recommendations on two questions were left ungraded due to a lack of evidence in the literature. CONCLUSIONS A high level of consensus was achieved among the experts regarding the use of prophylactic gynecologic procedures. The ensuing recommendations should result in improved current practice.
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Affiliation(s)
- C Touboul
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France.
| | - G Legendre
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Agostini
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de la Conception (AP-HM), Marseille, France
| | - C Akladios
- Service de Gynécologie Obstétrique et Médecine de la Reproduction des hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - S Bendifallah
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - P A Bolze
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P E Bouet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - P Chauvet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
| | - P Collinet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - Y Dabi
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - J Delotte
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - X Deffieux
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital A.-Béclêre (AP-HP), 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - L Dion
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du Centre Hospitalier Universitaire de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - T Gauthier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Y Kerbage
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - M Koskas
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de de l'hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - P Millet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - F Narducci
- Département de Cancérologie Gynécologique, Centre de Lutte Contre le Cancer Oscar-Lambret, Lille, France
| | - L Ouldamer
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - S Ploteau
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Nantes, 38 bd Jean-Monnet, 44093 Nantes cedex 1, France
| | - P Santulli
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Cochin (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - F Golfier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Wehr M, Lecointre L, Schneider H, Schwartz L, Faller E, Boisramé T, Baldauf JJ, Akladios C. [Outpatient laparoscopic hysterectomy in France: A monocentric randomized trial]. ACTA ACUST UNITED AC 2021; 50:33-39. [PMID: 34509670 DOI: 10.1016/j.gofs.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of outpatient laparoscopic hysterectomy using the assessment of post-operative quality of life. METHODS A prospective randomized single-center trial was performed in France between 2013 and 2016. A total of 42 patients needed laparoscopic hysterectomy was included. Postoperative quality of life was assessed using the standardized Euroquol questionnaire. Patients filled the score before the operation and then on the 3rd and 30th postoperative day. Secondary outcomes were assessment of postoperative pain, overall quality of life, analgesic use, and anxiety. The patients were randomized into two groups, group A with a conventional hospital stay of 2 to 3 days and group B with a short stay and a discharge the day after the intervention. RESULTS Twenty-one patients were randomized to group A as well as group B. We did not find any significant differences between the two groups in our study either on our primary outcome or in the seconds ones. On day 3, the average of Euroquol score was 0.68 for group A against 0.50 for group B (P=0.05). Likewise, the scores for postoperative pain were similar with 70.6 in group A and 61.8 in group B (P=0.21). The trend was the same for quality of life score or anxiety. CONCLUSION Our study shows the possibility and the safety of outpatient laparoscopic hysterectomy.
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Affiliation(s)
- M Wehr
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - L Lecointre
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France; I-Cube UMR 7357 laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, université de Strasbourg, 67081 Strasbourg, France; Institut hospitalo-universitaire (IHU) Institute for Minimally Invasive Hybrid Image-Guided Surgery, université de Strasbourg, 67081 Strasbourg, France.
| | - H Schneider
- Centre hospitalier de Saverne, Saverne et Haguenau, France.
| | - L Schwartz
- Centre hospitalier de Haguenau, Saverne et Haguenau, France.
| | - E Faller
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - T Boisramé
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - J-J Baldauf
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - C Akladios
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
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Lucot JP, Cosson M, Verdun S, Debodinance P, Bader G, Campagne-Loiseau S, Salet-Lizee D, Akladios C, Ferry P, De Tayrac R, Delporte P, Curinier S, Deffieux X, Blanc S, Capmas P, Duhamel A, Fritel X, Fauconnier A. Long-term outcomes of primary cystocele repair by transvaginal mesh surgery versus laparoscopic mesh sacropexy: extended follow up of the PROSPERE multicentre randomised trial. BJOG 2021; 129:127-137. [PMID: 34264001 DOI: 10.1111/1471-0528.16847] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/11/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effectiveness and safety of laparoscopic sacropexy (LS) and transvaginal mesh (TVM) at 4 years. DESIGN Extended follow up of a randomised trial. SETTING Eleven centres. POPULATION Women with cystocele stage ≥2 (pelvic organ prolapse quantification [POP-Q], aged 45-75 years without previous prolapse surgery. METHODS Synthetic non-absorbable mesh placed in the vesicovaginal space and sutured to the promontory (LS) or maintained by arms through pelvic ligaments and/or muscles (TVM). MAIN OUTCOME MEASURES Functional outcomes (pelvic floor distress inventory [PFDI-20] as primary outcome); anatomical assessment (POP-Q), composite outcome of success; re-interventions for complications. RESULTS A total of 220 out of 262 randomised patients have been followed at 4 years. PFDI-20 significantly improved in both groups and was better (but below the minimal clinically important difference) after LS (mean difference -7.2 points; 95% CI -14.0 to -0.05; P = 0.029). The improvement in quality of life and the success rate (LS 70%, 61-81% versus TVM 71%, 62-81%; hazard ratio 0.92, 95% CI 0.55-1.54; P = 0.75) were similar. POP-Q measurements did not differ, except for point C (LS -57 mm versus TVM -48 mm, P = 0.0093). The grade III or higher complication rate was lower after LS (2%, 0-4.7%) than after TVM (8.7%, 3.4-13.7%; hazard ratio 4.6, 95% CI 1.007-21.0, P = 0.049)). CONCLUSIONS Both techniques provided improvement and similar success rates. LS had a better benefit-harm balance with fewer re-interventions due to complications. TVM remains an option when LS is not feasible. TWEETABLE ABSTRACT At 4 years, Laparoscopic Sacropexy (LS) had a better benefit-harm balance with fewer re-interventions due to complications than Trans-Vaginal Mesh (TVM).
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Affiliation(s)
- J-P Lucot
- Service de gynécologie-obstétrique, Hôpital Saint Vincent de Paul, Groupe des Hôpitaux de l'Institut Catholique de Lille (GHICL), Lille, France
| | - M Cosson
- Service de Gynécologie médico chirurgicale Pôle Femme, mère, nouveau-né, Hôpital Jeanne de Flandre, CHRU de Lille, France
| | - S Verdun
- Biostatistics Department-Delegation for Clinical Research and Innovation, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | | | - G Bader
- Service de gynécologie-obstétrique CHI Poissy-St-Germain, Université Versailles Saint-Quentin, Poissy, France
| | | | - D Salet-Lizee
- Groupe Hospitalier Diaconesses Croix St-Simon, Paris, France
| | | | - P Ferry
- Service de Gynécologie Obstétrique, Centre Hospitalier, La Rochelle, France
| | - R De Tayrac
- Hôpital Carémeau CHU de Nîmes, Nîmes, France
| | - P Delporte
- Centre Hospitalier de Dunkerque, Dunkerque, France
| | | | - X Deffieux
- Hôpital Antoine Béclère, Clamart, France
| | - S Blanc
- Service de Gynécologie, Centre Hospitalier de la Région d'Annecy, Pringy, France
| | - P Capmas
- Service de Gynécologie Obstétrique Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - A Duhamel
- Univ Lille, CHU Lille, ULR 2694 METRICS, Lille, France
| | - X Fritel
- Université de Poitiers, INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | - A Fauconnier
- Centre Hospitalier de Dunkerque, Dunkerque, France.,Unité de recherche EA 7285, Université Versailles St-Quentin, Montigny-le-Bretonneux, France
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7
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Zilliox M, Lecointre L, Azais H, Ballester M, Bendifallah S, Bolze PA, Bourdel N, Bricou A, Canlorbe G, Carcopino X, Chauvet P, Collinet P, Coutant C, Dabi Y, Dion L, Gauthier T, Graesslin O, Huchon C, Koskas M, Lavoue V, Mezzadri M, Mimoun C, Ouldamer L, Raimond E, Touboul C, Lapointe M, Akladios C. Management of borderline ovarian tumours during pregnancy: Results of a French multi-centre study. Eur J Obstet Gynecol Reprod Biol 2020; 256:412-418. [PMID: 33296755 DOI: 10.1016/j.ejogrb.2020.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/24/2020] [Revised: 10/05/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices. MATERIALS AND METHODS A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility. RESULTS The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population. CONCLUSION BOTs remain rare, but this study - despite its small sample size - supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.
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Affiliation(s)
- M Zilliox
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France.
| | - L Lecointre
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France; I-Cube UMR 7357 Science Laboratory, Strasbourg, France; IHU: Institute for Minimally Invasive Hybrid Image Guided Surgery, Strasbourg, France
| | - H Azais
- Department of Gynaecology, Pitié Salpetriere Hospital, Paris, France
| | - M Ballester
- Department of Gynaecology, Diaconesses Croix Saint Simon, Paris, France
| | - S Bendifallah
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - P A Bolze
- Department of Gynaecology, University Hospital South Lyon, Pierre-Bénite, France
| | - N Bourdel
- Department of Gynaecology, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - A Bricou
- Department of Gynaecology, Diaconesses Croix Saint Simon, Paris, France
| | - G Canlorbe
- Department of Gynaecology, Pitié Salpetriere Hospital, Paris, France
| | - X Carcopino
- Department of Gynaecology, La Timone Hospital, Marseille, France
| | - P Chauvet
- Department of Gynaecology, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - P Collinet
- Department of Gynaecology, Jeanne de Flandres Hospital, Lille, France
| | - C Coutant
- Centre de Lutte Contre le Cancer, Dijon, France
| | - Y Dabi
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - L Dion
- Department of Gynaecology, University South Hospital, Rennes, France
| | - T Gauthier
- Department of Gynaecology, University Hospital, Limoges, France
| | - O Graesslin
- Department of Gynaecology, University Hospital, Reims, France
| | - C Huchon
- Department of Gynaecology, Intercommunal Hospital of Poissy, Poissy, France
| | - M Koskas
- Department of Gynaecology, Bichat Hospital, Paris, France
| | - V Lavoue
- Department of Gynaecology, University South Hospital, Rennes, France
| | - M Mezzadri
- Department of Gynaecology, Lariboisière Hospital, Paris, France
| | - C Mimoun
- Department of Gynaecology, Lariboisière Hospital, Paris, France
| | - L Ouldamer
- Department of Gynaecology, University Hospital of Tours, Tours, France
| | - E Raimond
- Department of Gynaecology, University Hospital, Reims, France
| | - C Touboul
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - M Lapointe
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France
| | - C Akladios
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France
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Vermel M, Lecointre L, Faller É, Boisramé T, Akladios C. [Care management and elective carcinological surgery place during the COVID-19 pandemic: A case report]. ACTA ACUST UNITED AC 2020; 48:774-776. [PMID: 32417400 PMCID: PMC7224657 DOI: 10.1016/j.gofs.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 12/15/2022]
Affiliation(s)
- M Vermel
- Service de chirurgie gynécologique, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | - L Lecointre
- Service de chirurgie gynécologique, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - É Faller
- Service de chirurgie gynécologique, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - T Boisramé
- Service de chirurgie gynécologique, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - C Akladios
- Service de chirurgie gynécologique, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
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9
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Minella C, Simeu B, Rohr S, Akladios C, Lecointre L. [Perineal vaginal evisceration of the hail through a fistulized elythrocele due to negligence of a pessary with ulceration: A case report]. Gynecol Obstet Fertil Senol 2020; 48:464-465. [PMID: 31991175 DOI: 10.1016/j.gofs.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Indexed: 06/10/2023]
Affiliation(s)
- C Minella
- Service de Gynécologie, Hôpital universitaire de Strasbourg-hôpital d'Hautepierre, 1, avenue Molière, 67098 Strasbourg, France.
| | - B Simeu
- Service de chirurgie digestive, Hôpital Universitaire de Strasbourg, 1, avenue Moliere, 67098, Strasbourg, France
| | - S Rohr
- Service de chirurgie digestive, Hôpital Universitaire de Strasbourg, 1, avenue Moliere, 67098, Strasbourg, France
| | - C Akladios
- Service de Gynécologie, Hôpital universitaire de Strasbourg - hôpital d'Hautepierre, 1, avenue Molière, 67098 Strasbourg, France
| | - L Lecointre
- Service de Gynécologie, Hôpital universitaire de Strasbourg - hôpital d'Hautepierre, 1, avenue Molière, 67098 Strasbourg, France
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10
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Vincent L, Jankowski C, Ouldamer L, Ballester M, Bendifallah S, Bolze PA, Akladios C, Costaz H, Lavoué V, Canlorbe G, Collinet P, Touboul C, Huchon C, Bricou A, Dridi S, Padéano MM, Bengrine L, Arnould L, Coutant C. Prognostic factors of overall survival for patients with FIGO stage IIIc or IVa ovarian cancer treated with neo-adjuvant chemotherapy followed by interval debulking surgery: A multicenter cohort analysis from the FRANCOGYN study group. Eur J Surg Oncol 2020; 46:1689-1696. [PMID: 32417154 DOI: 10.1016/j.ejso.2020.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/31/2020] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The aim of this study was to identify prognostic factors of overall survival in patients with FIGO stage IIIc or IVa ovarian cancer (OC) treated by neo-adjuvant chemotherapy (NAC) followed by interval debulking surgery. MATERIALS AND METHODS Data from 483 patients with ovarian cancer were retrospectively collected, from January 1, 2000 to December 31, 2016, from the FRANCOGYN database, regrouping data from 11 centers specialized in ovarian cancer treatment. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analysis were performed to define prognostic factors of overall survival. RESULTS The median overall survival was 52 after a median follow up of 30 months. After univariate analysis, factors significantly associated with decreased overall survival were; no pelvic and/or para-aortic lymphadenectomy (p = 0.002), residual disease (CC1/CC2/CC3) after surgery (p < 0.001), positive cytology after NAC (p < 0.001), omental disease after NAC (p = 0.002), no pathologic complete response (pCR) (p = 0.002). In multivariate analysis, factors significantly associated with decreased overall survival were; residual disease after surgery (HR = 1.93; CI95% (1.16-3.21), p = 0.01) and positive cytology after NAC (HR = 1.59; CI95% (1.01-2.55), p = 0.05). Patients with no residual disease after surgery had a median overall survival of 64 months versus 35 months for patients with residual disease. Patients with negative cytology after NAC had a median overall survival of 71 months versus 43 months for patients with positive cytology after NAC. CONCLUSION In this first and largest French based retrospective study, complete cytoreductive surgery in ovarian cancer remains the main prognostic factor of overall survival.
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Affiliation(s)
- L Vincent
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France; University of Burgundy, 7 Jeanne d'Arc boulevard, 21000, Dijon, France.
| | - C Jankowski
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - L Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, 2 Tonnelé boulevard, 37000, Tours, France; INSERM U1069 Université François-Rabelais, 10 Tonnelé boulevard, 37000, Tours, France
| | - M Ballester
- Department of Gynecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Avron Street, 75020, Paris, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 4 Chine street, 75020, Paris, France
| | - P A Bolze
- Gynecological Surgery Service, CHU Lyon-Sud, 165 Grand Revoyet Road, 69495, Pierre-Bénite, France
| | - C Akladios
- Department of Surgical Gynecology, University Hospital of Strasbourg, Molière Avenue, 67200, Strasbourg, France
| | - H Costaz
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - V Lavoué
- Department of Gynecological Surgery, Rennes University Hospital, 16 Bulgarie boulevard, 35200, Rennes, France
| | - G Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Hopital boulevard, 75013, Paris, France; INSERM,UMR S 938, Sorbonne University, 75005, Paris, France
| | - P Collinet
- Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Eugéne Avinée Avenue, 59000, Lille, France
| | - C Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, 40 Verdun Avenue, 94010, Créteil, France
| | - C Huchon
- Department of Gynecology, Centre Hospitalier de Poissy, 10 Champ Gaillard Street, 78300, Poissy, France
| | - A Bricou
- Department of Gynaecology, Bobigny University, AP-HP, Hôpital Jean-Verdier, 14 Juillet Avenue, 93140, Bondy, France
| | - S Dridi
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France; University of Burgundy, 7 Jeanne d'Arc boulevard, 21000, Dijon, France
| | - M M Padéano
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - L Bengrine
- Department of Medical Oncology, Georges-Francois Leclerc Cancer Center, Dijon, 1 Professeur Marion Street, 21000, France
| | - L Arnould
- Department of Anatomopathology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - C Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France; University of Burgundy, 7 Jeanne d'Arc boulevard, 21000, Dijon, France
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11
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Akladios C, Azais H, Ballester M, Bendifallah S, Bolze PA, Bourdel N, Bricou A, Canlorbe G, Carcopino X, Chauvet P, Collinet P, Coutant C, Dabi Y, Dion L, Gauthier T, Graesslin O, Huchon C, Koskas M, Kridelka F, Lavoue V, Lecointre L, Mezzadri M, Mimoun C, Ouldamer L, Raimond E, Touboul C. [Guidelines for surgical management of gynaecological cancer during pandemic COVID-19 period - FRANCOGYN group for the CNGOF]. ACTA ACUST UNITED AC 2020; 48:444-447. [PMID: 32222433 PMCID: PMC7103920 DOI: 10.1016/j.gofs.2020.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period. MATERIAL AND METHOD Recommendations based on the consensus conference model. RESULTS In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies. CONCLUSION During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.
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Affiliation(s)
- C Akladios
- Service de gynécologie, CHU de Hautepierre, 67000 Strasbourg, France
| | - H Azais
- Service de gynécologie, hôpital la Pitié-Salpêtrière, 75013 Paris, France
| | - M Ballester
- Service de gynécologie, Dioconessess Croix Saint Simon, 75012 Paris, France
| | - S Bendifallah
- Service de gynécologie obstétrique, hôpital Tenon, 75020 Paris, France
| | - P-A Bolze
- Service de gynécologie obstétrique, CHU Lyon Sud, 69000 Lyon, France
| | - N Bourdel
- Service de gynécologie obstétrique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - A Bricou
- Service de gynécologie, Dioconessess Croix Saint Simon, 75012 Paris, France
| | - G Canlorbe
- Service de gynécologie, hôpital la Pitié-Salpêtrière, 75013 Paris, France
| | - X Carcopino
- Service de gyécologie, La Timone, 13000 Marseille, France
| | - P Chauvet
- Service de gynécologie obstétrique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - P Collinet
- Service de gynécologie, hôpital Jeanne de Flandres, 59000 Lille, France
| | - C Coutant
- Centre de lutte contre le cancer, 21000 Dijon, France
| | - Y Dabi
- Service de gynécologie obstétrique, hôpital Tenon, 75020 Paris, France
| | - L Dion
- Service de gynécologie, CHU hôpital Sud, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - T Gauthier
- Service de gynécologie obstétrique, CHU, 87000 Limoges, France
| | - O Graesslin
- Service de gynécologie obstétrique, CHU, 51000 Reims, France
| | - C Huchon
- Service de gynécologie obstétrique, CHI Poissy, 78300 Poissy, France
| | - M Koskas
- Service de gynécologie obstétrique, hôpital Bichat, 75018 Paris, France
| | - F Kridelka
- Service de chirurgie oncologique, CHU, Liège, Belgique
| | - V Lavoue
- Service de gynécologie, CHU hôpital Sud, 16, boulevard de Bulgarie, 35000 Rennes, France.
| | - L Lecointre
- Service de gynécologie obstétrique, hôpital Tenon, 75020 Paris, France
| | - M Mezzadri
- Service de gynécologie, hôpital Lariboisière, 75010 Paris, France
| | - C Mimoun
- Service de gynécologie, hôpital Lariboisière, 75010 Paris, France
| | - L Ouldamer
- Service de gynécologie, CHU Tours, 37000 Tours, France
| | - E Raimond
- Service de gynécologie obstétrique, CHU, 51000 Reims, France
| | - C Touboul
- Service de chirurgie oncologique, CHU, Liège, Belgique
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12
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Lecointre L, Velten M, Akladios C. Impact sur la survie du nombre de cycles de chimiothérapie néo-adjuvante dans les cancers de l’ovaire de stade avancé – Étude multicentrique FRANCOGYN. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2019.11.013] [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] Open
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13
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Pontvianne M, Riss J, Goillot V, Aubry G, Lecointre L, Akladios C. [Ambulatory minimally invasive hysterectomy: Limiting factors related to health professionals]. ACTA ACUST UNITED AC 2019; 47:831-835. [PMID: 31614229 DOI: 10.1016/j.gofs.2019.10.003] [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: 02/13/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The feasibility of minimally invasive hysterectomy for ambulatory benign pathology has been demonstrated in many international studies. France has a considerable delay of multifactorial origin in this field. The objective of this study is to identify the limiting factors related to health professionals to the realization of minimally invasive ambulatory hysterectomy and to determine possible strategies to increase its rate. METHODS This is a cross-sectional survey conducted over 2 months using a self-administered questionnaire sent by email to 180 gynecological surgeons in 2 French regions (Grand Est and Bourgogne-Franche Comté). RESULTS A total of 22% of health professionals responded to the survey. The vast majority of practitioners (60%) said they did not carry out ambulatory care by habit. The apprehension of the reaction of the patients (47.5%), the fear of delayed diagnosis of complications (12.5%), the management of pain in the postoperative period (42.5%) also participated in brake of the promotion of ambulatory care. DISCUSSION Improvement of the organisation of city and hospital management allowing a better continuity of care (70%), the economic valuation (37.5%) and the increase in the hourly amplitude of the ambulatory surgery unit (5%) would improve the rate of ambulatory care of minimally invasive hysterectomies, according to the gynecologist surgeons surveyed. In addition, a prospective study evaluating the quality of life of patients after ambulatory care of minimally invasive hysterectomy would allow better adherence of health professionals and patients to the ambulatory care project in 70% of cases. CONCLUSION The change of mentality of health professionals remains a priority for the promotion of ambulatory surgery in gynecology. Information and communication are therefore essential to the expansion of the ambulatory.
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Affiliation(s)
- M Pontvianne
- Pole de gynécologie Obstétrique Hôpitaux, Universitaires de Strasbourg, CHU Hautepierre, 67000 Strasbourg, France.
| | - J Riss
- Pole de gynécologie Obstétrique Hôpitaux, Universitaires de Strasbourg, CHU Hautepierre, 67000 Strasbourg, France
| | - V Goillot
- Pole de gynécologie Obstétrique Hôpitaux, Universitaires de Strasbourg, CHU Hautepierre, 67000 Strasbourg, France
| | - G Aubry
- Service de chirurgie gynécologique, CHU Hautepierre, Strasbourg, France
| | - L Lecointre
- Service de chirurgie gynécologique, CHU Hautepierre, Strasbourg, France
| | - C Akladios
- Service de chirurgie gynécologique, CHU Hautepierre, Strasbourg, France
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14
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Goillot V, Paté M, Delaitre A, Akladios C, Baldauf JJ, Lecointre L. [Use of HPV virologic test for atypical glandular cells in Alsace between 2014 and 2016]. ACTA ACUST UNITED AC 2019; 47:802-807. [PMID: 31336187 DOI: 10.1016/j.gofs.2019.07.005] [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: 05/12/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The new recommendations by the National Institute of Cancer (January 2017) recommend the use of a complementary human papillomavirus (HPV) virologic test during the diagnosis of atypical glandular cells in pap smear. The aim of this study was the performance analysis of the HPV virologic test for the detection of significant histological cervical abnormalities (CIN2 or more) in case of atypical glandular cells before the new recommendations were published. METHODS We performed a descriptive and retrospective cohort study in Alsace between January 2014 and December 2016. We have included, from the EVE-association database, the patients with atypical glandular cells in pap smear. RESULTS In total, 1074 patients had a pap smear with atypical glandular cells ; 0.18% of total pap smears. This study included 152 patients who had a HPV test. We observed 6 cases of CIN2 (3.9%) and 12 cases of CIN3 (7.9%). No in situ adenocarcinoma nor invasive carcinoma were detected. The sensitivity of the HPV test was 88.9% (95% CI: [0.65; 0.99]), the specificity was 65.9% (95% CI: [0.55; 0.76]), the positive predictive value was 34% (95% CI: [0.21; 0.49]) and the negative predictive value was 96.8% (95% CI: [0.89; 0.99]). CONCLUSION The detection of HPV in atypical glandular cells seems to be powerful with an excellent negative predictive value but, because of moderate sensitivity and due to the risk of histologic lesion progression, the current recommendations should to be applied with care.
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Affiliation(s)
- V Goillot
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - M Paté
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France.
| | - A Delaitre
- Département de médecine générale, 4, rue Kirschleger, 67058 Strasbourg cedex, France
| | - C Akladios
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - J-J Baldauf
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - L Lecointre
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
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Lavoue V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze P, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la motte rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lecuru F, Lefrere-Belda M, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Senechal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. Management of epithelial cancer of the ovary, fallopian tube, primary peritoneum. Long text of the joint French clinical practice guidelines issued by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY, endorsed by INCa. (Part 2: systemic, intraperitoneal treatment, elderly patients, fertility preservation, follow-up). J Gynecol Obstet Hum Reprod 2019; 48:379-386. [DOI: 10.1016/j.jogoh.2019.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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16
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Lavoue V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lecuru F, Lefrere-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Senechal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Long text of the Joint French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Part 1: Diagnostic exploration and staging, surgery, perioperative care, and pathology. J Gynecol Obstet Hum Reprod 2019; 48:369-378. [PMID: 30936027 DOI: 10.1016/j.jogoh.2019.03.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 03/03/2019] [Accepted: 03/19/2019] [Indexed: 11/27/2022]
Abstract
An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed: an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). For FIGO stages III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B).
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Affiliation(s)
- V Lavoue
- Service de gynécologie, CHU de Rennes, Hôpital sud, 16 Bd de Bulgarie, 35000 Rennes, France; INSERM 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, Rue Bataille Flandres-Dunkerques, Rennes, France.
| | - C Huchon
- Service de Gynécologie, CHI Poissy, France
| | - C Akladios
- Service de Gynécologie, Hôpital Hautepierre, CHU Strasbourg, France
| | - P Alfonsi
- Service d'Anesthésie, Hôpital Saint Joseph, Paris, France
| | - N Bakrin
- Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, Lyon, France
| | - M Ballester
- Service de gynécologie, GH Diaconesses Croix Saint Simon, Paris, France
| | - S Bendifallah
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
| | - P A Bolze
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France
| | - F Bonnet
- Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France
| | - C Bourgin
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France
| | - N Chabbert-Buffet
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
| | - P Collinet
- Service de Chirurgie Gynécologique, Hôpital Jeanne de Flandres, CHRU, Lille, France
| | - B Courbiere
- Pôle Femmes-Parents-Enfants - Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147 bd Baille, 13005 Marseille/Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397 Marseille, France
| | | | | | - C Falandry
- Service d'oncogériatrie, Hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, Lyon, France
| | - G Ferron
- Service d'oncologie chirurgicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France
| | - L Fournier
- Service de radiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - L Gladieff
- Service d'oncologie médicale, Institut Claudius Regaud, IUCT Oncopole, Toulouse, France
| | - F Golfier
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre Bénite, Lyon, France
| | - S Gouy
- Service de chirurgie, Institut Gustave Roussy, Villejuif, France
| | - F Guyon
- Service de chirurgie, Institut Bergonié, Bordeaux, France
| | - E Lambaudie
- Service de chirurgie, Institut Paoli Calmette, Marseille, France
| | - A Leary
- Service d'oncologie médicale, Institut Gustave Roussy, Villejuif, France
| | - F Lecuru
- Service de chirurgie gynécologique et oncologique, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - M A Lefrere-Belda
- Service d'anatomo-pathologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - E Leblanc
- Service de chirurgie, Centre Oscar Lambret, Lille, France
| | - A Lemoine
- Service d'anesthésie, Hôpital Tenon, AP-HP, Paris, France
| | - F Narducci
- Service de chirurgie, Centre Oscar Lambret, Lille, France
| | - L Ouldamer
- Service de chirurgie gynécologique, CHU de Tours, France
| | - P Pautier
- Service d'oncologie médicale, Institut Gustave Roussy, Villejuif, France
| | - F Planchamp
- Service de méthodologie, Institut Bergonié, Bordeaux, France
| | - N Pouget
- Service de chirurgie, Curie (site Saint Cloud), Paris, France
| | - I Ray-Coquard
- Service d'oncologie médicale, Centre Léon Bérard, Lyon, France
| | | | | | - C Touboul
- Service de chirurgie gynécologique, CHI de Créteil, Créteil, France
| | | | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, Hôpital Pitié Salpêtrière, Institut Universitaire de Cancérologie, Sorbonne Université, INSERM U938, France
| | - B You
- Service d'oncologie médicale, Institut de cancérologie des Hospices Civils de Lyon, Pierre-Bénite, Lyon, Paris, France
| | - E Daraï
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de La Chine, APHP, Institut Universitaire de Cancérologie Sorbonne Université, UMRS-938, France
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17
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Lavoué V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lécuru F, Lefrère-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Sénéchal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. [Part II drafted from the short text of the French guidelines entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa. (Systemic and intraperitoneal treatment, elderly, fertility preservation, follow-up)]. ACTA ACUST UNITED AC 2019; 47:111-119. [PMID: 30704955 DOI: 10.1016/j.gofs.2018.12.011] [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: 12/28/2018] [Indexed: 10/27/2022]
Abstract
Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO III stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A). For BRCA mutated patient, Olaparib is recommended (grade B).
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Affiliation(s)
- V Lavoué
- Service de gynécologie, hôpital sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Inserm 1242, chemistry, oncogenesis, stress and signaling, centre Eugène-Marquis, rue Bataille-Flandres-Dunkerques, 35000 Rennes, France.
| | - C Huchon
- Service de gynécologie, CHI Poissy, 78000 Poissy, France
| | - C Akladios
- Service de gynécologie, hôpital Hautepierre, CHU de Strasbourg, 67000 Strasbourg, France
| | - P Alfonsi
- Service d'anesthésie, hôpital Saint-Joseph, 75014 Paris, France
| | - N Bakrin
- Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - M Ballester
- Service de gynécologie, groupe hospitalier Diaconesses-Croix-Saint-Simon, 75020 Paris, France
| | - S Bendifallah
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, UMRS-938, Sorbonne université, 75000 Paris, France
| | - P A Bolze
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - F Bonnet
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Bourgin
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandres, CHRU de Lille, 59000 Lille, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, UMRS-938, Sorbonne université, 75000 Paris, France
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandres, CHRU de Lille, 59000 Lille, France
| | - B Courbiere
- Pôle Femmes-Parents-Enfants, centre clinico-biologique d'AMP, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; CNRS, IRD, IMBE UMR 7263, Avignon université, Aix Marseille université, 13397 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Service d'anatomo-pathologie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - C Falandry
- Service d'oncogériatrie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - G Ferron
- Service d'oncologie chirurgicale, institut Claudius-Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - L Fournier
- Service de radiologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - L Gladieff
- Service d'oncologie médicale, institut Claudius-Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - F Golfier
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - S Gouy
- Service de chirurgie, institut Gustave-Roussy, 94000 Villejuif, France
| | - F Guyon
- Service de chirurgie, institut Bergonié, 33000 Bordeaux, France
| | - E Lambaudie
- Service de chirurgie, institut Paoli-Calmette, 13000 Marseille, France
| | - A Leary
- Service d'oncologie médicale, institut Gustave-Roussy, 94000 Villejuif, France
| | - F Lécuru
- Service de chirurgie gynécologique et oncologique, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - M A Lefrère-Belda
- Service d'anatomo-pathologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - E Leblanc
- Service de chirurgie, centre Oscar-Lambret, 59000 Lille, France
| | - A Lemoine
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Narducci
- Service de chirurgie, centre Oscar-Lambret, 59000 Lille, France
| | - L Ouldamer
- Service de chirurgie gynécologique, CHU de Tours, 37000 Tours, France
| | - P Pautier
- Service d'oncologie médicale, institut Gustave-Roussy, 94000 Villejuif, France
| | - F Planchamp
- Service de méthodologie, institut Bergonié, 33000 Bordeaux, France
| | - N Pouget
- Service de chirurgie, Curie (site Saint-Cloud), 75000 Paris, France
| | - I Ray-Coquard
- Service d'oncologie médicale, centre Léon-Bérard, 69000 Lyon, France
| | | | | | - C Touboul
- Service de chirurgie gynécologique, CHI de Créteil, 94000 Créteil, France
| | | | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, 75013 Paris, France; Inserm U938, institut universitaire de cancérologie, Sorbonne université, 75000 Paris, France
| | - B You
- Service d'oncologie médicale, institut de cancérologie, hospices civils de Lyon, Pierre-Bénite, 69000 Lyon, France
| | - E Daraï
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Institut universitaire de cancérologie, UMRS-938, Sorbonne université, 75000 Paris, France
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18
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Lavoué V, Huchon C, Akladios C, Alfonsi P, Bakrin N, Ballester M, Bendifallah S, Bolze PA, Bonnet F, Bourgin C, Chabbert-Buffet N, Collinet P, Courbiere B, De la Motte Rouge T, Devouassoux-Shisheboran M, Falandry C, Ferron G, Fournier L, Gladieff L, Golfier F, Gouy S, Guyon F, Lambaudie E, Leary A, Lécuru F, Lefrère-Belda MA, Leblanc E, Lemoine A, Narducci F, Ouldamer L, Pautier P, Planchamp F, Pouget N, Ray-Coquard I, Rousset-Jablonski C, Sénéchal-Davin C, Touboul C, Thomassin-Naggara I, Uzan C, You B, Daraï E. [Part I drafted from the short text of the French Guidelines entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY and endorsed by INCa. (Diagnosis management, surgery, perioperative care, and pathological analysis)]. ACTA ACUST UNITED AC 2019; 47:100-110. [PMID: 30686724 DOI: 10.1016/j.gofs.2018.12.010] [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: 12/28/2018] [Indexed: 10/27/2022]
Abstract
Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B).
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Affiliation(s)
- V Lavoué
- Service de gynécologie, hôpital sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France; Inserm 1242, Chemistry, Oncogenesis, Stress and Signaling, Centre Eugène Marquis, rue Bataille Flandres-Dunkerques, 35000 Rennes, France.
| | - C Huchon
- Service de gynécologie, CHI Poissy, 78000 Poissy, France
| | - C Akladios
- Service de gynécologie, hôpital Hautepierre, CHU Strasbourg, 67000 Strasbourg, France
| | - P Alfonsi
- Service d'anesthésie, hôpital Saint-Joseph, 75014 Paris, France
| | - N Bakrin
- Service de chirurgie digestive, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - M Ballester
- Service de gynécologie, groupe hospitalier Diaconesses Croix Saint Simon, 75020 Paris, France
| | - S Bendifallah
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, institut universitaire de cancérologie Sorbonne université, 75000 Paris, France
| | - P A Bolze
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - F Bonnet
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - C Bourgin
- Service de chirurgie gynécologique, hôpital Jeanne de Flandres, CHRU, 59000 Lille, France
| | - N Chabbert-Buffet
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, institut universitaire de cancérologie Sorbonne université, 75000 Paris, France
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne de Flandres, CHRU, 59000 Lille, France
| | - B Courbiere
- Pôle Femmes-Parents-Enfants-Centre Clinico-Biologique d'AMP, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; IMBE UMR 7263, Aix-Marseille université, CNRS, IRD, Avignon université, 13397 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Service d'anatomopathologie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - C Falandry
- Service d'oncogériatrie, hospices civiles de Lyon, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - G Ferron
- Service d'oncologie chirurgicale, institut Claudius Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - L Fournier
- Service de radiologie, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - L Gladieff
- Service d'oncologie médicale, institut Claudius Regaud, IUCT Oncopole, 31000 Toulouse, France
| | - F Golfier
- Service de chirurgie gynécologique, CHU Lyon-Sud, Pierre-Bénite, 69000 Lyon, France
| | - S Gouy
- Service de chirurgie, institut Gustave Roussy, 94000 Villejuif, France
| | - F Guyon
- Service de chirurgie, institut Bergonié, 33000 Bordeaux, France
| | - E Lambaudie
- Service de chirurgie, institut Paoli Calmette, 13000 Marseille, France
| | - A Leary
- Service d'oncologie médicale, institut Gustave Roussy, 94000 Villejuif, France
| | - F Lécuru
- Service de chirurgie gynécologique et oncologique, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - M A Lefrère-Belda
- Service d'anatomopathologie, hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - E Leblanc
- Service de chirurgie, Centre Oscar Lambret, 59000 Lille, France
| | - A Lemoine
- Service d'anesthésie, hôpital Tenon, AP-HP, 75020 Paris, France
| | - F Narducci
- Service de chirurgie, Centre Oscar Lambret, 59000 Lille, France
| | - L Ouldamer
- Service de chirurgie gynécologique, CHU de Tours, 37000 Tours, France
| | - P Pautier
- Service d'oncologie médicale, institut Gustave Roussy, 94000 Villejuif, France
| | - F Planchamp
- Service de méthodologie, institut Bergonié, 33000 Bordeaux, France
| | - N Pouget
- Service de chirurgie, Curie (site Saint Cloud), 75000 Paris, France
| | - I Ray-Coquard
- Service d'oncologie médicale, Centre Léon Bérard, 69000 Lyon, France
| | | | | | - C Touboul
- Service de chirurgie gynécologique, CHI de Créteil, 94000 Créteil, France
| | | | - C Uzan
- Service de chirurgie et cancérologie gynécologique et mammaire, hôpital Pitié-Salpêtrière, 75013 Paris, France; Inserm U938, institut universitaire de cancérologie, Sorbonne université, 75000 Paris, France
| | - B You
- Service d'oncologie médicale, institut de cancérologie des hospices Civils de Lyon, Pierre-Bénite, 69000 Lyon Paris, France
| | - E Daraï
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; UMRS-938, institut universitaire de cancérologie Sorbonne université, 75000 Paris, France
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Sénéchal C, Akladios C, Bendifallah S, Ouldamer L, Lecuru F, Rousset-Jablonski C. [Follow-up of patients treated for an epithelial ovarian cancer, place of hormone replacement therapy and of contraception: Article drafted from the French Guidelines in oncology entitled "Initial management of patients with epithelial ovarian cancer" developed by FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY under the aegis of CNGOF and endorsed by INCa]. ACTA ACUST UNITED AC 2019; 47:250-262. [PMID: 30685388 DOI: 10.1016/j.gofs.2018.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To define follow-up modalities after an epithelial ovarian, tubal or primitive peritoneal cancer. To define possibilities of hormone replacement therapy (HRT) and contraceptive use after treatment. METHODS Systematic review of the literature in French and English langage conducted on Pubmed/Medline and the Cochrane Library. RESULTS After the treatment of an epithelial ovarian, tubal or primitive peritoneal cancer, symptoms evaluation for follow-up is recommended at 3 months, 6 months, 12 months, 18 months, 24 months, and then yearly (Grade B). Only patients with an initial complete surgery (CC0, without any macroscopic signs of disease), and with a good general condition (ECOG 0) should be followed with paraclinic tests, with a serum HE4 or CA125 concentration measurement, from 6 months after the end of treatments (GradeC). Systematic follow-up with CT of the chest, abdomen, and pelvis is not recommended (GradeC). Imaging test is recommended in case of an increased serum concentration of HE4 or CA125 (Grade B). An HRT should be proposed to women younger than 45 after a non-conservative treatment for a high grade serous (GradeC) or for a mucinous (GradeC) ovarian, tubal or primitive peritoneal adenocarcinoma. HRT is not contra-indicated in women older than 45 presenting a climacteric syndrome after the treatment of a high grade serous (Grade B) or of a mucinous (GradeC) ovarian, tubal or primitive peritoneal adenocarcinoma.
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Affiliation(s)
- C Sénéchal
- Institut Bergonié, 33000 Bordeaux, France.
| | - C Akladios
- CHU de Hautepierre, 67000 Strasbourg, France
| | | | | | - F Lecuru
- Hôpital européen Georges Pompidou, AP-HP, 75015 Paris, France
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Pinton A, Lecointre L, Hummel M, Metten MA, Rodriguez M, Bryand A, Baldauf JJ, Garbin O, Akladios C. Laparoscopic pelvic lymphadenectomy in patients with intermediate-risk endometrial cancer: Is it worth it? J Gynecol Obstet Hum Reprod 2017; 47:51-55. [PMID: 29196157 DOI: 10.1016/j.jogoh.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/08/2017] [Revised: 11/13/2017] [Accepted: 11/23/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The main aim of this study is to evaluate operative and postoperative morbidity of laparoscopic pelvic lymphadenectomy as well as its potential impact on the postoperative management in patients with an intermediate-risk of endometrial cancer. METHODS We did a retrospective study between January 2009 and December 2013. We included all patients operated by laparoscopy for endometrial cancer presumed to have an intermediate-risk of recurrence. Pelvic lymphadenectomy in this group of patients was performed at the discretion of operating surgeons. Patients were consequently divided into two groups according to whether or not pelvic lymphadenectomy was performed. We made a comparative analysis between these two groups. RESULTS Overall, 116 patients were managed for endometrial cancer presumed to be intermediate-risk. Among these, 93 received treatment with laparoscopy and were included in the study. Patients' characteristics did not differ between the two groups. The mean duration of surgery was significantly longer when pelvic lymphadenectomy was performed. The average number of retrieved lymph nodes was 13 and we had seven patients with positive lymph nodes (10%). CONCLUSION Pelvic lymphadenectomy allows a better postoperative classification for some patients without more complication.
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Affiliation(s)
- A Pinton
- Department of Obstetrics and Gynaecology, Strasbourg University, Hôpital de Hautepierre, avenue Molière, 67091 Strasbourg, France
| | - L Lecointre
- Department of Obstetrics and Gynaecology, Strasbourg University, Hôpital de Hautepierre, avenue Molière, 67091 Strasbourg, France
| | - M Hummel
- Department of Obstetrics and Gynaecology, Hôpital du CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - M-A Metten
- Department of Biostatistics, Strasbourg University, Strasbourg, France
| | - M Rodriguez
- Department of Obstetrics and Gynaecology, Strasbourg University, Hôpital de Hautepierre, avenue Molière, 67091 Strasbourg, France
| | - A Bryand
- Department of Obstetrics and Gynaecology, Strasbourg University, Hôpital de Hautepierre, avenue Molière, 67091 Strasbourg, France; Department of Obstetrics and Gynaecology, Hôpital du CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - J-J Baldauf
- Department of Obstetrics and Gynaecology, Strasbourg University, Hôpital de Hautepierre, avenue Molière, 67091 Strasbourg, France
| | - O Garbin
- Department of Obstetrics and Gynaecology, Hôpital du CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - C Akladios
- Department of Obstetrics and Gynaecology, Hôpital du CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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Tissot M, Lecointre L, Faller E, Afors K, Akladios C, Audebert A. Clinical presentation of endometriosis identified at interval laparoscopic tubal sterilization: Prospective series of 465 cases. J Gynecol Obstet Hum Reprod 2017; 46:647-650. [DOI: 10.1016/j.jogoh.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/01/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
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Lecointre L, Sananès N, Weingertner AS, Gaudineau A, Akladios C, Cavillon V, Langer B, Favre R. [Fetoscopic laser coagulation in 200 consecutive monochorionic pregnancies with twin-twin transfusion syndrome]. J Gynecol Obstet Hum Reprod 2017; 46:175-181. [PMID: 28403975 DOI: 10.1016/j.jogoh.2016.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/08/2016] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To report preoperative data, surgical characteristics, complications and perinatal outcome of twin-twin transfusion syndrome (TTTS) managed with laser ablation surgery, to analyze predictors of neonatal survival and to compare the 100 most recent cases with the older 100. MATERIALS AND METHODS Observational cohort moncentric study of 200 cases of TTTS consecutively treated with fetoscopic laser coagulation between January 2004 and December 2014. RESULTS There were 49 stage I, 88 stage II, 55 stage III and eight stage IV. Median gestation at time of laser was 20.1±3.0 weeks' gestation (WG) whereas median gestation at delivery was 31.6±5.4 WG. Overall perinatal survival rate was 68.0% and 84.0% have one or more surviving twins. Preterm premature rupture of membranes occurred in 39 cases with and the median gestational age for this complication was 28.8±4.6 SA. Predictive factors to have at least one living birth were Quintero stage and gestational age at delivery. In the most recent period, there were significantly more TTTS Quintero stage I treated with laser, more coagulation by the Solomon technique and a larger number of coagulated vessels. CONCLUSION The neonatal survival of TTTS is improved by fetoscopic laser coagulation, preferely by using Solomon tecnhique. The use of active management of stage I is currently on research.
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Affiliation(s)
- L Lecointre
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - N Sananès
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Inserm, UMR-S 1121, « Biomatériaux et Bioingénierie », 11, rue Humann, 67085 Strasbourg cedex, France
| | - A S Weingertner
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France
| | - A Gaudineau
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - C Akladios
- Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - V Cavillon
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France
| | - B Langer
- Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - R Favre
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France
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Gabriele V, Gapp-Born E, Ohl J, Akladios C, Mathelin C. [Infertility and breast cancer: Is there a link? Updated review of the literature and meta-analysis]. ACTA ACUST UNITED AC 2016; 44:113-20. [PMID: 26850280 DOI: 10.1016/j.gyobfe.2015.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/31/2015] [Accepted: 12/04/2015] [Indexed: 12/31/2022]
Abstract
UNLABELLED The objective of this review was to assess the level of risk of breast cancer of patients consulting for infertility. METHODS Studies of cohorts and case-control were extracted from the Pubmed database from January 2000 until May 2015 through the following keywords: "infertility"; "endometriosis"; "polycystic ovary syndrome"; "breast cancer", "cancer risk". Eleven publications were finally selected after exclusion of publications dealing with infertility after breast cancer. Our meta-analysis, involving 10 of these publications, was performed using Review Manager software, Cochrane Collaboration, 2014. The results were calculated by etiology of infertility, polycystic ovary syndrome (PCOS) and endometriosis, as well as globally. RESULTS The analysis of these published epidemiological studies confirms that infertility is not a breast cancer risk factor, but the results are contradictory. Three studies have shown a significantly increased risk of breast cancer in a population of infertile women, while 7 others have not found this risk. These contradictions are due to the heterogeneity of the studies, the included populations, the follow-up periods and confounding factors. Our meta-analysis of the selected studies has not identified a significant association between infertility and breast cancer risk (1.05; 95% CI [0.96-1.16]). A subgroup analysis on endometriosis and PCOS showed no significant association either, with an OR of 1.02 (95% CI [0.87-1.19]) and 1.19 (95% CI [0.93-1.51]), respectively. CONCLUSION Infertility is not an identified risk factor for breast cancer. A message reassuring about a possible risk of infertility-related breast cancer should be given to these patients. Infertility is therefore not an indication of increased breast surveillance.
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Affiliation(s)
- V Gabriele
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France.
| | - E Gapp-Born
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - J Ohl
- Centre médico-chirurgical et obstétrical (CMCO), 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - C Akladios
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - C Mathelin
- Unité de sénologie, hôpital de Hautepierre, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
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Schrot-Sanyan S, Brandt A, Minstedt K, Akladios C. Does prophylactic bilateral salpingectomy during pelviscopic hysterectomy increase perioperative morbidity? EUR J GYNAECOL ONCOL 2016; 37:771-774. [PMID: 29943918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED Purpose ofinvestigation: To compare the safety of additional salpingectomies in patients undergoing laparoscopic hysterectomies for benign indication. MATERIALS AND METHODS The study was conducted in the Ortenau Klinikum Offenburg (Baden-Wirttemberg, Germany). Classical laparoscopic hysterectomies were performed between 2010 and 2011 and a prophylactic salpingectomy was added thereafter. The authors analysed the postoperative complications until 2013 according to the Clavien-Dindo scale in performing a logistic regression model adjusted on potential confounders. They also analysed other surgery outcomes such as operative time, duration of the hospital stay, and the blood loss during the surgery. RESULTS Over 301 patients were retrieved from the records. Postoperative complication rates were not different between the two groups (13.8% versus 14.2 % patients, OR = 0.93 [0.47 - 1.84], p = 0.84). Other outcomes were also not different. CONCLUSION Prophylactic salpingectomy performed during a laparoscopic hysterectomy for benign conditions seems to be' safe and recommended. Prospective studies especially with respect to the magnitude of the prophylactic effect are needed.
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Bryand A, Hamidou Z, Paget-Bailly S, Bonnetain F, Mathelin C, Baldauf JJ, Akladios C. [Health-related quality of life in patients treated for ovarian cancer: tools and issues]. ACTA ACUST UNITED AC 2015; 43:151-7. [PMID: 25596884 DOI: 10.1016/j.gyobfe.2014.12.011] [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: 06/22/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Abstract
Health-related quality of life (QoL) in patients treated for ovarian cancer is directly and heavily impacted by the natural history of cancer, its evolution and its therapeutic modalities. The evaluation and consideration of various parameters of QoL seems to be a major issue. Indeed, on the one hand, it is essential to take into account the opinion of patients in the choice of therapeutic strategies for this cancer with a poor prognosis and, on the other hand, more and more studies show that QoL is an independent prognostic factor in ovarian cancer. Improvement in this case, in addition to being an endpoint by itself, would potentially improve the overall survival of patients. To date there are several tools to assess QOL of patients with ovarian cancer. The 2 questionnaires most commonly used are: FACT-O and the EORTC QLQ-OV28. The aim of our study was to evaluate from a review of the literature, the reciprocal effects of ovarian cancer on QoL and QoL on ovarian cancer survival, as well as specificities of each of the 2 questionnaires most commonly used in assessing the QoL.
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Affiliation(s)
- A Bryand
- CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - Z Hamidou
- Service de santé publique, faculté de médecine, 27, boulevard Jean-Moulin, 13385 Marseille cedex, France
| | - S Paget-Bailly
- CHRU de Besançon, 2, place Saint-Jacques, 25000 Besançon, France
| | - F Bonnetain
- CHRU de Besançon, 2, place Saint-Jacques, 25000 Besançon, France
| | - C Mathelin
- CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - J-J Baldauf
- CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - C Akladios
- CHU Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
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