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Brun JL, Plu-Bureau G, Huchon C, Ah-Kit X, Barral M, Chauvet P, Cornelis F, Cortet M, Crochet P, Delporte V, Dubernard G, Giraudet G, Gosset A, Graesslin O, Hugon-Rodin J, Lecointre L, Legendre G, Maitrot-Mantelet L, Marcellin L, Miquel L, Le Mitouard M, Proust C, Roquette A, Rousset P, Sangnier E, Sapoval M, Thubert T, Torre A, Trémollières F, Vernhet-Kovacsik H, Vidal F, Marret H. Management of women with abnormal uterine bleeding: Clinical practice guidelines of the French National College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2023; 288:90-107. [PMID: 37499278 DOI: 10.1016/j.ejogrb.2023.07.001] [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: 03/09/2023] [Revised: 06/25/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To provide French guidelines for the management of women with abnormal uterine bleeding (AUB). DESIGN A consensus committee of 26 experts was formed. A formal conflict-of-interest policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding (i.e. pharmaceutical or medical device companies). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The last guidelines from the Collège National des Gynécologues et Obstétriciens Français on the management of women with AUB were published in 2008. The literature seems now sufficient for an update. The committee studied questions within 7 fields (diagnosis; adolescents; idiopathic AUB; endometrial hyperplasia and polyps; type 0-2 fibroids; type 3 or higher fibroids; and adenomyosis). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and evidence profiles were compiled. The GRADE® methodology was applied to the literature review and the formulation of recommendations. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 36 recommendations. Among the formalized recommendations, 19 are strong and 17 weak. No response was found in the literature for 14 questions. We chose to abstain from recommendations rather than providing advice based solely on expert clinical experience. CONCLUSIONS The 36 recommendations make it possible to specify the diagnostic and therapeutic strategies for various clinical situations practitioners encounter, from the simplest to the most complex.
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Affiliation(s)
- J L Brun
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France.
| | - G Plu-Bureau
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - C Huchon
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | - X Ah-Kit
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - M Barral
- Service de radiologie interventionnelle, hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - P Chauvet
- Service de chirurgie gynécologique, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63000 Clermont-Ferrand, France
| | - F Cornelis
- Service de radiologie interventionnelle, hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - M Cortet
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - P Crochet
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147 boulevard Baille, 13005 Marseille, France
| | - V Delporte
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49 rue de Valmy, 59000 Lille, France
| | - G Dubernard
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - G Giraudet
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49 rue de Valmy, 59000 Lille, France
| | - A Gosset
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - O Graesslin
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45 rue Cognac-Jay, 51092 Reims, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Lecointre
- Service de chirurgie gynécologique, CHU Strasbourg, 1 avenue Molière, 67200 Strasbourg, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU Angers, 4 rue Larrey, 49933 Angers, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Marcellin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Miquel
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147 boulevard Baille, 13005 Marseille, France
| | - M Le Mitouard
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Proust
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37044 Tours, France
| | - A Roquette
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - P Rousset
- Service de radiologie, hôpital Sud, CHU Lyon, 165 chemin du Grand Revoyet, 69495 Pierre-Benite, France
| | - E Sangnier
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45 rue Cognac-Jay, 51092 Reims, France
| | - M Sapoval
- Service de radiologie interventionnelle, hôpital europeen Georges-Pompidou, APHP, 20 rue Leblanc, 75015 Paris, France
| | - T Thubert
- Service de gynécologie-obstétrique, Hotel Dieu, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - A Torre
- Centre de procréation médicalement assistée, centre hospitalier Sud Francilien, 40 avenue Serge Dassault, 91106 Corbeil-Essonnes, France
| | - F Trémollières
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Vernhet-Kovacsik
- Service d'imagerie thoracique et vasculaire, hôpital Arnaud-de-Villeneuve, CHU Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - F Vidal
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37044 Tours, France
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Trémollieres FA, Chabbert-Buffet N, Plu-Bureau G, Rousset-Jablonski C, Lecerf JM, Duclos M, Pouilles JM, Gosset A, Boutet G, Hocke C, Maris E, Hugon-Rodin J, Maitrot-Mantelet L, Robin G, André G, Hamdaoui N, Mathelin C, Lopes P, Graesslin O, Fritel X. Management of postmenopausal women: Collège National des Gynécologues et Obstétriciens Français (CNGOF) and Groupe d'Etude sur la Ménopause et le Vieillissement (GEMVi) Clinical Practice Guidelines. Maturitas 2022; 163:62-81. [PMID: 35717745 DOI: 10.1016/j.maturitas.2022.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/23/2022] [Accepted: 05/17/2022] [Indexed: 12/26/2022]
Abstract
AIM The aim of these recommendations is to set forth an individualized approach to the management of early postmenopausal women (i.e., within the first 10 years after natural menopause) covering all aspects of lifestyle and therapeutic management, with or without menopause hormone therapy (MHT). MATERIALS AND METHODS Literature review and consensus of French expert opinion. Recommendations were graded according to the HAS methodology and levels of evidence derived from the international literature, except when there was no good-quality evidence. SUMMARY RECOMMENDATIONS The beginning of menopause is an ideal time for each woman to evaluate her health status by assessing her bone, cardiovascular, and cancer-related risk factors that may be amplified by postmenopausal estrogen deficiency and by reviewing her lifestyle habits. Improving lifestyle, including nutrition and physical activity, and avoiding risk factors (notably smoking), should be recommended to all women. MHT remains the most effective treatment for vasomotor symptoms but it could be also recommended as first-line treatment for the prevention of osteoporosis in early postmenopausal women at low to moderate risk for fracture. The risks of MHT differ depending on its type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used. There is reasonable evidence that using transdermal estradiol in association with micronized progesterone or dydrogesterone may limit both the venous thromboembolic risk associated with oral estrogens and the risk of breast cancer associated with synthetic progestins. Treatment should be individualized to each woman, by using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of its benefit-risk balance. For bothersome genitourinary syndrome of menopause (GSM) symptoms, vaginal treatment with lubricants and moisturizers is recommended as first-line treatment together with low-dose vaginal estrogen therapy, depending on the clinical course. No recommendation of an optimal duration of MHT can be made, but it must take into consideration the initial indication for MHT as well as each woman's benefit-risk balance. Management of gynecological side-effects of MHT is also examined. These recommendations are endorsed by the Groupe d'Etude sur la Ménopause et le Vieillissement hormonal (GEMVI) and the Collège National des Gynécologues-Obstétriciens Français (CNGOF).
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Affiliation(s)
- F A Trémollieres
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France; Inserm U1048-I2MC-Equipe 9, Université Toulouse III Paul-Sabatier, 1, avenue du Professeur-Jean-Poulhes, BP 84225, 31432 Toulouse cedex 4, France.
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique, médecine de la reproduction, APHP Sorbonne Universitaire, Site Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Plu-Bureau
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France; Université de Paris, Paris, France; Inserm U1153 Equipe EPOPEE, Paris, France
| | - C Rousset-Jablonski
- Département de chirurgie oncologique, Centre Léon Bérard, 28, Promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France; Département d'obstétrique et gynécologie, Hospices Civils de Lyon, CHU Lyon Sud, 165, Chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université Lyon, EA 7425 HESPER-Health Services and Performance Research, 8, avenue Rockefeller, 69003 Lyon, France
| | - J M Lecerf
- Service de nutrition et activité physique, Institut Pasteur de Lille, 1, rue du Professeur-Calmette, 59019 Lille cedex, France; Service de médecine interne, CHRU Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - M Duclos
- Service de médecine du sport et des explorations fonctionnelles, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, UFR Médecine, BP 10448, 63000 Clermont-Ferrand, France; INRAE, UMR 1019, UNH, CRNH Auvergne, 63000 Clermont-Ferrand, France
| | - J M Pouilles
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - A Gosset
- Centre de Ménopause et Maladies Osseuses Métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - G Boutet
- AGREGA, Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33000 Bordeaux, France
| | - C Hocke
- Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - E Maris
- Département d'obstétrique et gynécologie, CHU Montpellier, Université Montpellier, Montpellier, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France
| | - G Robin
- Service de gynécologie médicale, orthogénie et sexologie, UF de gynécologie endocrinienne, Hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - G André
- 15, boulevard Ohmacht, 67000 Strasbourg, France
| | - N Hamdaoui
- Centre Hospitalier Universitaire Nord, Assistance publique-Hôpitaux de Marseille, Chemin des Bourrely, 13015 Marseille, France
| | - C Mathelin
- Institut de cancérologie Strasbourg Europe, 17, rue Albert-Calmette, 67200 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200 Strasbourg, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS UMR7104 Inserm U964, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
| | - P Lopes
- Nantes, France Polyclinique de l'Atlantique Saint Herblain, 44819 St Herblain, France; Université ́de Nantes, 44093 Nantes cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, Institut Mère-Enfant Alix de Champagne, Centre Hospitalier Universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
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Brun JL, Plu-Bureau G, Huchon C, Ah-Kit X, Barral M, Chauvet P, Cornelis F, Cortet M, Crochet P, Delporte V, Dubernard G, Giraudet G, Gosset A, Graesslin O, Hugon-Rodin J, Lecointre L, Legendre G, Maitrot-Mantelet L, Marcellin L, Miquel L, Le Mitouard M, Proust C, Roquette A, Rousset P, Sangnier E, Sapoval M, Thubert T, Torre A, Trémollières F, Vernhet-Kovacsik H, Vidal F, Marret H. [Management of women with abnormal uterine bleeding: Clinical practice guidelines of the French National College of Gynecologists and Obstetricians (CNGOF)]. Gynecol Obstet Fertil Senol 2022; 50:345-373. [PMID: 35248756 DOI: 10.1016/j.gofs.2022.02.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To provide French guidelines for the management of women with abnormal uterine bleeding (AUB). DESIGN A consensus committee of 26 experts was formed. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, or medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The last guidelines from the Collège national des gynécologues et obstétriciens français (CNGOF) on the management of women with AUB was published in 2008. The literature seems now sufficient for an update. The committee studied questions within 7 fields (diagnosis; adolescent; idiopathic AUB; endometrial hyperplasia and polyps; fibroids type 0 to 2; fibroids type 3 and more; adenomyosis). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 36 recommendations. Among the formalized recommendations, 19 present a strong agreement and 17 a weak agreement. Fourteen questions did not find any response in the literature. We preferred to abstain from recommending instead of providing expert advice. CONCLUSIONS The 36 recommendations made it possible to specify the diagnostic and therapeutic strategies of various clinical situations managed by the practitioner, from the simplest to the most complex.
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Affiliation(s)
- J-L Brun
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - G Plu-Bureau
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - C Huchon
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - X Ah-Kit
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - M Barral
- Service de radiologie interventionnelle, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - P Chauvet
- Service de chirurgie gynécologique, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
| | - F Cornelis
- Service de radiologie interventionnelle, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - M Cortet
- Service de gynécologie, hôpital Croix-Rousse, CHU Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - P Crochet
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147, boulevard Baille, 13005 Marseille, France
| | - V Delporte
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49, rue de Valmy, 59000 Lille, France
| | - G Dubernard
- Service de gynécologie, hôpital Croix-Rousse, CHU Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - G Giraudet
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49, rue de Valmy, 59000 Lille, France
| | - A Gosset
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - O Graesslin
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45, rue Cognac-Jay, 51092 Reims, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Lecointre
- Service de chirurgie gynécologique, CHU Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49933 Angers, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Marcellin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Miquel
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147, boulevard Baille, 13005 Marseille, France
| | - M Le Mitouard
- Service de gynécologie, hôpital Croix-Rousse, CHU Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Proust
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - A Roquette
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Rousset
- Service de radiologie, hôpital Sud, CHU Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - E Sangnier
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45, rue Cognac-Jay, 51092 Reims, France
| | - M Sapoval
- Service de radiologie interventionnelle, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - T Thubert
- Service de gynécologie-obstétrique, Hôtel-Dieu, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - A Torre
- Centre de procréation médicalement assistée, centre hospitalier Sud Francilien, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - F Trémollières
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Vernhet-Kovacsik
- Service d'imagerie thoracique et vasculaire, hôpital Arnaud-de-Villeneuve, CHU Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - F Vidal
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2, boulevard Tonnellé, 37044 Tours, France
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Sangnier E, Ouldamer L, Bendifallah S, Huchon C, Collinet P, Bricou A, Mimoun C, Lecointre L, Graesslin O, Raimond E, Creton de Limerville H. 258. Risk factors for recurrence of borderline ovarian tumors in France: A multicenter retrospective study by the francogyn group. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.147] [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: 11/16/2022]
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David C, Djelouah M, Dumange M, Sanchez S, Chrusciel J, Bonneau S, Gabriel R, Hoeffel C, Graesslin O, Raimond E. 260 Magnetic resonnance imaging evaluation of cervical length by the women[StQuote]s age: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.271] [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: 11/27/2022]
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Chene G, Graesslin O. [Essure® implants: What's news in the management of symptomatic patients?]. Gynecol Obstet Fertil Senol 2022; 50:105-106. [PMID: 34700032 DOI: 10.1016/j.gofs.2021.10.008] [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: 10/04/2021] [Indexed: 06/13/2023]
Affiliation(s)
- G Chene
- Département de gynécologie, université de Lyon, hôpital Femme-Mère-Enfant, HFME, 59, boulevard Pinel, 69000 Lyon, France; Université Claude Bernard Lyon 1, EMR 3738, 69000 Lyon, France.
| | - O Graesslin
- Département de gynécologie, centre hospitalier de Reims, institut Mère Enfant Alix de Champagne, 45, rue Cognac-Jay, 51092 Reims, France
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Chene G, Cerruto E, Merviel P, Agostini A, Crochet P, Giraudet G, Capmas P, Fernandez H, Graesslin O. Surgical techniques for the removal of Essure ® microinserts: a literature review on current practice. EUR J CONTRACEP REPR 2021; 26:404-412. [PMID: 34096440 DOI: 10.1080/13625187.2021.1925883] [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] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the different techniques for Essure® microinserts removal and to assess the risk of fracture of the device and the intra- and post-operative complications in relation to surgical technique variants. METHODS Electronic search in Medline, Scopus and Embase databases using the following keywords: Essure; Essure removal; Essure surgical technique. RESULTS Out of 95 articles in the initial database, 17 studies were eligible for inclusion in our literature review. Several surgical techniques have been described in which the most frequent were laparoscopic salpingectomy (LS), laparoscopic cornuectomy (LC), laparoscopic or vaginal hysterectomy (LH, VH) with en-bloc salpingectomy. There were more fractures of the device with the LS procedure (6.25%) followed by the LC technique (2.77%), while there was no fracture with hysterectomy. However, peri-and post-operative complications were more severe and frequent with hysterectomy in comparison with the LC and LS procedures (respectively 8.1% Clavien Dindo grade 3 for the hysterectomy group, 1.11% for the LC procedure and 0.69% for the LS technique). CONCLUSION Due to the lack of standardised surgical treatment guidelines, a system of care networks for symptomatic patients with adverse effects related to Essure® headed by specialised centres may offer a suitable and high-quality management with the appropriate removal techniques within two objectives: limiting the risk of fracture (with an en-bloc removal of the Essure® microinserts) and avoiding intra- and post-operative complications.
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Affiliation(s)
- G Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France.,Claude Bernard university of Lyon 1, Lyon, France
| | - E Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, HFME, University of Lyon, Lyon, France
| | - P Merviel
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Hospital of Brest, Brest, France
| | - A Agostini
- Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Marseille, La Conception Hospital, Aix Marseille Université, Marseille, France
| | - P Crochet
- Department of Obstetrics and Gynecology, Hospital Arnaud de Villeneuve, University of Montpellier, Montpellier, France
| | - G Giraudet
- Department of Gynecology, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France
| | - P Capmas
- Department of Gynecology, Bicetre Hospital, GHU Sud, AP-HP, Le Kremlin Bicetre, France
| | - H Fernandez
- Department of Gynecology, Bicetre Hospital, GHU Sud, AP-HP, Le Kremlin Bicetre, France
| | - O Graesslin
- Department of Gynecology, Institut Mère Enfant Alix de Champagne, University hospital of Reims, Reims, France
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8
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Trémollieres F, Chabbert-Buffet N, Plu-Bureau G, Rousset-Jablonski C, Lecerf JM, Duclos M, Pouilles JM, Gosset A, Boutet G, Hocke C, Maris E, Hugon-Rodin J, Maitrot-Mantelet L, Robin G, André G, Hamdaoui N, Mathelin C, Lopes P, Graesslin O, Fritel X. [Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines (Short version)]. Gynecol Obstet Fertil Senol 2021; 49:305-317. [PMID: 33863697 DOI: 10.1016/j.gofs.2021.03.010] [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] [Indexed: 10/21/2022]
Affiliation(s)
- F Trémollieres
- Centre de ménopause et maladies osseuses métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France; Inserm U1048-I2MC-Équipe 9, Université Toulouse III Paul-Sabatier, 1, avenue du Professeur-Jean-Poulhès, BP 84225, 31432 Toulouse cedex 4, France.
| | - N Chabbert-Buffet
- Service de gynécologie obstétrique, médecine de la reproduction, APHP Sorbonne Universitaire, Site Tenon, 4, rue de la Chine, 75020 Paris, France
| | - G Plu-Bureau
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France; Université de Paris, Paris, France; Inserm U1153 Equipe EPOPEE, Paris, France
| | - C Rousset-Jablonski
- Département de chirurgie oncologique, Centre Léon Bérard, 28, Prom.-Léa-et-Napoléon-Bullukian, 69008 Lyon, France; Département d'obstétrique et gynécologie, Hospices Civils de Lyon, CHU Lyon Sud, 165, Chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Université Lyon, EA 7425 HESPER-Health Services and Performance Research, 8, avenue Rockefeller, 69003 Lyon, France
| | - J-M Lecerf
- Service de nutrition et activité physique, Institut Pasteur de Lille, 1, rue du Professeur-Calmette, 59019 Lille cedex, France; Service de médecine interne, CHRU Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - M Duclos
- Service de médecine du sport et des explorations fonctionnelles, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France; Clermont Université, Université d'Auvergne, UFR Médecine, BP 10448, 63000 Clermont-Ferrand, France; INRAE, UMR 1019, UNH, CRNH Auvergne, 63000 Clermont-Ferrand, France
| | - J-M Pouilles
- Centre de ménopause et maladies osseuses métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - A Gosset
- Centre de ménopause et maladies osseuses métaboliques, Hôpital Paule-de-Viguier, CHU Toulouse, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse, France
| | - G Boutet
- AGREGA, Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33000 Bordeaux, France
| | - C Hocke
- Service de chirurgie gynécologique et médecine de la reproduction, Centre Aliénor d'Aquitaine, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - E Maris
- Département d'obstétrique et gynécologie, CHU Montpellier, Université Montpellier, Montpellier, France
| | - J Hugon-Rodin
- Service de Gynécologie, Groupe hospitalier Paris Saint Joseph, Inserm, U1153, epidémiologie obstétricale, périnatale et pédiatrique, Centre de recherche en épidémiologie et statistiques, Paris, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, Hôpital Port-Royal, 123 boulevard de Port-Royal, 75014 Paris, France
| | - G Robin
- Service de gynécologie médicale, orthogénie et sexologie, UF de gynécologie endocrinienne, Hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - G André
- 15, boulevard Ohmacht, 67000 Strasbourg, France
| | - N Hamdaoui
- Centre Hospitalier Universitaire Nord, Assistance publique-Hôpitaux de Marseille, Chemin des Bourrely, 13015 Marseille, France
| | - C Mathelin
- Institut de cancérologie Strasbourg Europe, 17, rue Albert-Calmette, 67200 Strasbourg, France; Hôpitaux Universitaires de Strasbourg, 1 avenue Molière, 67200 Strasbourg, France; Institut de génétique et de biologie moléculaire et cellulaire (IGBMC), CNRS UMR7104 Inserm U964, 1, rue Laurent-Fries, 67400 Illkirch-Graffenstaden, France
| | - P Lopes
- Nantes, France Polyclinique de l'Atlantique Saint Herblain, 44819 St Herblain, France; Université de Nantes, 44093 Nantes cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, Institut Mère-Enfant Alix de Champagne, Centre Hospitalier Universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
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Wehbe K, Duminil L, François C, Pelissier A, Graesslin O, Raimond E. [Interest of Negative Pressure Therapy in the management of breast surgery disunions and infections: About two cases]. ACTA ACUST UNITED AC 2021; 49:561-563. [PMID: 33434752 DOI: 10.1016/j.gofs.2021.01.006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 10/22/2022]
Affiliation(s)
- K Wehbe
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, 45, rue Cognacq-Jay, 51092 Reims, France.
| | - L Duminil
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, 45, rue Cognacq-Jay, 51092 Reims, France
| | - C François
- Department of plastic and reconstructive surgery, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - A Pelissier
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, 45, rue Cognacq-Jay, 51092 Reims, France
| | - O Graesslin
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, 45, rue Cognacq-Jay, 51092 Reims, France
| | - E Raimond
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, 45, rue Cognacq-Jay, 51092 Reims, France.
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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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11
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Sangnier E, Ouldamer L, Bendifallah S, Huchon C, Collinet P, Bricou A, Mimoun C, Lecointre L, Graesslin O, Raimond E. Risk factors for recurrence of borderline ovarian tumors in France: A multicenter retrospective study by the FRANCOGYN group. J Gynecol Obstet Hum Reprod 2020; 50:101961. [PMID: 33127559 DOI: 10.1016/j.jogoh.2020.101961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Borderline ovarian tumors (BOTs) although rare, have shown an increase in the incidence worldwide. Although the survival rate is high, the recurrence rate is estimated to be between 5% and 34%. The objective of this study was to identify risk factors for recurrence of BOTs. METHODS This retrospective multicenter study included 493 patients treated surgically for BOT between January 2001 and December 2018. RESULTS Thirty-seven patients showed recurrence (group R, 7.5%), while 456 did not (group NR, 92.5%). With an average follow-up of 30.5 months (1-276), the overall recurrence rate was 7.5%. Recurrence rates for the BOT and invasive types were 5.7% (n = 28) and 1.4% (n = 7), respectively. The mean time to recurrence was 44.1 (3-251) months. Univariate analysis showed that age at diagnosis, type of surgical procedure, histological type, and FIGO stage were factors influencing recurrence. Multivariate analysis showed that the risk factors for recurrence of BOT were conservative treatment (OR = 7 [95% CI 3.01-16.23]; p < 0.05) and advanced FIGO stage (OR = 5.86 [95% CI 2.21-15.5]; p < 0.05). DISCUSSION To the best of our knowledge, this multicenter study was one of the largest studies on the risk factors for BOT recurrence. Conservative treatment and advanced FIGO stage were identified as risk factors for BOT recurrence. These results reinforce the need for restaging of patients who did not have an optimal initial surgical staging so as not to avoid missing a tumor in the advanced stage. Referral to a surgical oncology center is suggested to optimize overall patient management.
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Affiliation(s)
- E Sangnier
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes university, Reims, France
| | - L Ouldamer
- Department of Obstetrics and Gynaecology, Regional University Hospital Center of Tours, Bretonneau Hospital, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France
| | - S Bendifallah
- Department of Obstetrics and Gynaecology, Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - C Huchon
- Department of Obstetrics and Gynaecology, Intercommunal Hospital Center of Poissy, Poissy, France
| | - P Collinet
- Department of Obstetrics and Gynaecology, Regional University Hospital Center of Lille, Lille, France
| | - A Bricou
- Department of Obstetrics and Gynaecology, Jean Verdier Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - C Mimoun
- Department of Obstetrics and Gynaecology, Lariboisière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris 7, Paris, France
| | - L Lecointre
- Department of Obstetrics and Gynaecology, University Hospital Center, Strasbourg, France
| | - O Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes university, Reims, France
| | - E Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes university, Reims, France.
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Birene B, Ishaque U, Chrusciel J, Bonneau S, Gabriel R, Graesslin O. Influence of the external cephalic version attempt on the Cesarean section rate: experience of a type 3 maternity hospital in France. Arch Gynecol Obstet 2020; 303:443-454. [PMID: 32895742 DOI: 10.1007/s00404-020-05765-2] [Citation(s) in RCA: 3] [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: 03/14/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To define the effects of attempted external cephalic version (ECV) in a low-risk population for breech delivery in a maternity hospital where breech vaginal delivery is widely practiced. MATERIALS AND METHODS Retrospective exposed-unexposed study including 204 patients presented with a live singleton fetus breech presentation on third-trimester ultrasound and who delivered at Reims University Hospital between January 1st, 2013 and July 1st, 2018. RESULTS 121 patients received ECV. Cesarean section rate was lower (OR with no adjustment 0.42 [0.24-0.76] p = 0.004) but without significant difference in the exposed patients after adjustment. This difference was significant between exposed and unexposed patients in the subgroup of 51 primiparous (OR = 0.14 [0.04-0.52] p = 0.002) and 51 multiparous (OR = 0.26 [0.08-0.89] p = 0.028) but not in the subgroup of 102 nulliparous. There was no difference in fetal impact other than neonatal management in the delivery room, which is less needed in exposed primiparous women. Attempted ECV significantly decreased the breech rate (72.5 vs 100%, p < 0.001). There were 7 (5.79%) complications. Three factors favored success: high uterine height (p = 0.011), a non-elevated BMI (p = 0.006) and an earlier term at ECV (p = 0.003). CONCLUSION The attempt of ECV in the Reims University Hospital does not significantly reduce the Cesarean section rate and has no effect on neonatal status.
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Affiliation(s)
- Benjamin Birene
- Department of Obstetrics and Gynecology, Reims University Hospital, Reims, France.
| | - U Ishaque
- Department of Obstetrics and Gynecology, Reims University Hospital, Reims, France
| | - J Chrusciel
- Department of Research and Public Health, Reims University Hospital, Reims, France
| | - S Bonneau
- Department of Obstetrics and Gynecology, Reims University Hospital, Reims, France
| | - R Gabriel
- Department of Obstetrics and Gynecology, Reims University Hospital, Reims, France
| | - O Graesslin
- Department of Obstetrics and Gynecology, Reims University Hospital, Reims, France
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13
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Gaudet Chardonnet A, Azaïs H, Ballester M, Raimond E, Bendifallah S, Ouldamer L, Coutant C, Graesslin O, Touboul C, Collinet P, Bricou A, Huchon C, Daraï E, Lavoue V, Koskas M, Uzan C, Canlorbe G. Prognostic Value and Risk Factors of Peritoneal Carcinomatosis Recurrence for Patients with Endometrial Cancer: A Multicenter Study from the FRANCOGYN Group. Ann Surg Oncol 2020; 28:212-221. [PMID: 32648177 DOI: 10.1245/s10434-020-08812-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prognosis for patients with endometrial cancer (EC) peritoneal carcinomatosis (PC) recurrence has received little study. This study aimed to determine specific risk factors and prognosis of EC with PC recurrence (PCR) versus no PC recurrence (NPCR). METHODS Data of all patients with EC who received primary surgical treatment between January 2000 and February 2017 were abstracted from the French FRANCOGYN Research Group database. Clinical and pathologic variables were compared between the two groups (PCR vs. NPCR). Multivariate analysis was performed to define prognostic factors for peritoneal recurrence. Overall survivals (OS) of patients after recurrence were compared using the Kaplan-Meier method. RESULTS The study analyzed 1466 patients, and 257 of these patients (17.5%) had recurrence. At presentation, 63 of these patients had PC. International Federation of Gynecology and Obstetrics (FIGO) stages 3 and 4 disease were significantly associated with PCR versus NPCR (odds ratio 2.24; 95% confidence interval 1.23-4.07; p = 0.008). The death rate for the patients with PC was 47.6%, with a median survival of 12 months after diagnosis of recurrence. According to the histologic subtype, OS was 29 months (Q1-Q3, 13-NA) for endometrioid carcinomas, 7.5 months (Q1-Q3, 4-15) for serous carcinomas, and 10 months (Q1-Q3, 5-15) for clear cell carcinomas. Chemotherapy for treatment of PCR was associated with improved OS after recurrence (OSAR; p = 0.0025). CONCLUSION An initial advanced stage of EC is a risk factor for PCR. For women with PCR, a diagnosis of type 1 EC recurrence more than 12 months after the initial treatment and management of PCR with chemotherapy is associated with improved OSAR. Prospective studies are needed to determine the precise optimal management required in this clinical situation and to assess the relevance of biomarkers to predict the risk of PCR for EC patients.
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Affiliation(s)
- A Gaudet Chardonnet
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | - H Azaïs
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France
| | - M Ballester
- Service de Chirurgie Gynécologique et Mammaire, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France
| | - E Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - S Bendifallah
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology and Obstetrics, Tenon University Hospital, Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics," Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France.,Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France
| | - L Ouldamer
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - C Coutant
- Center de Lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - O Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - C Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - P Collinet
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France.,Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - A Bricou
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology and Obstetrics, Jean Verdier University Hospital, Bondy, France
| | - C Huchon
- Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal, Poissy, France
| | - E Daraï
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology and Obstetrics, Tenon University Hospital, Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics," Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France.,Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France
| | - V Lavoue
- Service de Gynécologie, INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Université de Rennes 1, Hopital Sud, CHU de Rennes, Rennes, France
| | - M Koskas
- Service de Chirurgie et Oncologie Gynécologique et Mammaire, APHP, Université Paris Diderot Hôpital Bichat, Paris, France
| | - C Uzan
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France.,INSERM UMR_S_938, "Cancer Biology and Therapeutics," Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France.,Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France
| | - G Canlorbe
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France. .,INSERM UMR_S_938, "Cancer Biology and Therapeutics," Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, Paris, France. .,Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France.
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14
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Canard C, Diaz E, Gusdorf L, Loget J, Durlach A, Graesslin O, Cadiot G, Viguier M. [Isolated Crohn's disease of the vulva with rapid clinical response to infliximab and azathioprine]. Ann Dermatol Venereol 2020; 147:569-571. [PMID: 32505375 DOI: 10.1016/j.annder.2020.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/15/2020] [Accepted: 04/22/2020] [Indexed: 11/15/2022]
Affiliation(s)
- C Canard
- Service de dermatologie-vénérologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - E Diaz
- Service de dermatologie-vénérologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - L Gusdorf
- Service de dermatologie-vénérologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - J Loget
- Service de dermatologie-vénérologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - A Durlach
- Service de biopathologie, hôpital Maison-Blanche, 51092 Reims, France
| | - O Graesslin
- Service de gynécologie obstétrique, hôpital Maison-Blanche, 51092 Reims, France
| | - G Cadiot
- Service d'hépato-gastroentérologie et de cancérologie digestive, hôpital Robert-Debré, 51092 Reims, France
| | - M Viguier
- Service de dermatologie-vénérologie, hôpital Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France.
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15
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Serre E, Diguisto C, Body G, Raimond E, Bendifallah S, Touboul C, Graesslin O, Carcopino X, Ballester M, Daraï E, Ouldamer L. [Prognostic significance of groin lymph node ratio in vulvar squamous cell carcinoma]. ACTA ACUST UNITED AC 2020; 48:729-735. [PMID: 32339764 DOI: 10.1016/j.gofs.2020.04.011] [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: 06/10/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim was to review the clinical impact of lymph node ratio (LNR) of groin metastatic nodal disease in women with vulvar squamous cell carcinoma. MATERIAL AND METHODS Cohort study of women with vulvar squamous cell carcinoma, managed between January 2005 and December 2015, in five institutions in France with prospectively maintained databases (French multicenter tertiary care centers). POPULATION In total, 636 women managed for VSCC of whom 508 (79.9%) underwent surgical groin nodal staging. MAIN OUTCOME MEASURES Comparison of overall and recurrence free survival between women according to LNR. RESULTS In total, 176 women (34.6%) had at least one positive lymph node (LN). There was a significant differences for the 5-year overall survival and recurrence free survival rates between women with LNR>0.2 and women with LNR<0.2. CONCLUSION LNR seems to be a significant prognostic factor in women with vulvar squamous cell carcinoma.
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Affiliation(s)
- E Serre
- Department of Gynecology, CHU de Tours, Tours, France; Inserm U1069, Université François-Rabelais, Tours, France
| | - C Diguisto
- Department of Gynecology, CHU de Tours, Tours, France
| | - G Body
- Department of Gynecology, CHU de Tours, Tours, France; Inserm U1069, Université François-Rabelais, Tours, France
| | - E Raimond
- Department of Obstetrics and Gynecology, Institute Alix-de-Champagne, University Hospital, Reims, France
| | - S Bendifallah
- Department of Obstetrics and Gynecology, GRC-6 UPMC, Hôpital Tenon, Université Pierre et Marie-Curie, AP-HP, Paris 6, France; UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie-Curie, Paris, France
| | - C Touboul
- Department of Obstetrics and Gynecology, centre hospitalier intercommunal, Créteil, France
| | - O Graesslin
- Department of Obstetrics and Gynecology, Institute Alix-de-Champagne, University Hospital, Reims, France
| | - X Carcopino
- Department of Gynecological surgery, AP-HP, Marseille, France
| | - M Ballester
- Department of Obstetrics and Gynecology, Institute Alix-de-Champagne, University Hospital, Reims, France; Inserm UMR S 938, Université Pierre et Marie-Curie, Paris, France
| | - E Daraï
- Department of Obstetrics and Gynecology, GRC-6 UPMC, Hôpital Tenon, Université Pierre et Marie-Curie, AP-HP, Paris 6, France; Inserm UMR S 938, Université Pierre et Marie-Curie, Paris, France
| | - L Ouldamer
- Department of Gynecology, CHU de Tours, Tours, France; Inserm U1069, Université François-Rabelais, Tours, France.
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16
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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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17
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Maurel J, Faivre AC, Graesslin O, Raimond É. [Pelvic cellulitis on pyogenic streptococcal bartholinitis: Case report]. ACTA ACUST UNITED AC 2020; 48:529-531. [PMID: 32112861 DOI: 10.1016/j.gofs.2020.02.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Indexed: 11/15/2022]
Affiliation(s)
- J Maurel
- Service de gynécologie-obstétrique, hôpital Maison-Blanche, université Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51100 Reims, France.
| | - A C Faivre
- Service de gynécologie-obstétrique, hôpital Maison-Blanche, université Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51100 Reims, France
| | - O Graesslin
- Service de gynécologie-obstétrique, hôpital Maison-Blanche, université Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51100 Reims, France
| | - É Raimond
- Service de gynécologie-obstétrique, hôpital Maison-Blanche, université Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51100 Reims, France
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18
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Gac MM, Duminil L, Bonneau S, Gabriel R, Graesslin O, Raimond E. Gynecology-obstetric resident surgery training: a national evaluation. Arch Gynecol Obstet 2019; 300:1353-1366. [PMID: 31531778 DOI: 10.1007/s00404-019-05284-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/03/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The main objective of this study was to evaluate surgery training and evaluation of French gynecology-obstetrics residents. The second objective was to evaluate using simulation during residency. STUDY DESIGN This national descriptive study, utilized a questionnaire to survey all interns in French gynecology and obstetrics. At the end of a study, 129 responses of residents were analyzed. RESULTS The participation rate was 12%. The majority of residents were women (84%) and the highest response rate was from the Ile-de-France region (36%). The lowest rate was from the Southern region. The majority of residents were in the eighth semester (20%). Residents reported surgical and obstetric orientations in 53% (n = 68) and 44% (n = 57) of cases, respectively. Registration for cancer oncology was reported by 22% (n = 28) of respondents. Evaluation of oncologic surgery training was mostly considered "good" by the surgical group and "passable" by the obstetrics group. Access to simulators was usually restricted and most often utilized the pelvitrainer. Sessions were typically not mandatory and numbered between zero and five per semester. Three types of simulators were accessible in the Ile-de-France, North-West, West and Rhône-Alpes. The North-East did not have access to animal models, and the South-West did not have access to corpses. Surgical classes were more common in the Rhône-Alpes, North-East, Ile-de-France and North-West regions. To improve their training in oncological surgery, 64% (n = 18) of residents planned to do an inter-university exchange and 54% had completed additional specialized training. Measures that were most expected to improve training were increased training in surgery (96% of respondents, n = 27) and more intensive coaching (96%, n = 27). CONCLUSIONS Companionship is a pillar of residents training, but its effectiveness is variable. One solution could be to implement better use of simulation methods.
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Affiliation(s)
- M M Gac
- Département de Gynécologie-Obstétrique, Hôpital Maison Blanche, 45 rue Cognacq Jay, 51092, Reims Cedex, France.,Université de Reims-Champagne-Ardennes, Reims, France
| | - L Duminil
- Département de Gynécologie-Obstétrique, Hôpital Maison Blanche, 45 rue Cognacq Jay, 51092, Reims Cedex, France.,Université de Reims-Champagne-Ardennes, Reims, France
| | - S Bonneau
- Département de Gynécologie-Obstétrique, Hôpital Maison Blanche, 45 rue Cognacq Jay, 51092, Reims Cedex, France.,Université de Reims-Champagne-Ardennes, Reims, France
| | - R Gabriel
- Département de Gynécologie-Obstétrique, Hôpital Maison Blanche, 45 rue Cognacq Jay, 51092, Reims Cedex, France.,Université de Reims-Champagne-Ardennes, Reims, France
| | - O Graesslin
- Département de Gynécologie-Obstétrique, Hôpital Maison Blanche, 45 rue Cognacq Jay, 51092, Reims Cedex, France.,Université de Reims-Champagne-Ardennes, Reims, France
| | - Emilie Raimond
- Département de Gynécologie-Obstétrique, Hôpital Maison Blanche, 45 rue Cognacq Jay, 51092, Reims Cedex, France. .,Université de Reims-Champagne-Ardennes, Reims, France.
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19
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Raimond E, Delorme C, Ouldamer L, Carcopino X, Bendifallah S, Touboul C, Daraï E, Ballester M, Graesslin O. Surgical treatment of vulvar cancer: Impact of tumor-free margin distance on recurrence and survival. A multicentre cohort analysis from the francogyn study group. Eur J Surg Oncol 2019; 45:2109-2114. [PMID: 31285094 DOI: 10.1016/j.ejso.2019.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 03/24/2019] [Revised: 06/24/2019] [Accepted: 07/02/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE In vulvar cancer, it is admitted that tumor-free margin distance is one of the most important element for locoregional control. It is currently recommended to surgically remove the tumor with at least an 8 mm tumor-free margin. The aim of this study was to evaluate the impact of tumor-free margin distance on recurrence and survival in vulvar cancer. MATERIAL AND METHODS From 2005 to 2016, 112 patients surgically treated for a vulvar squamous cell cancer were included in a retrospective multicenter study. Overall, disease-free and metastasis-free survivals were analyzed according to tumor-free margin distance. RESULTS Patients were divided into three groups: group 1 (margin <3 mm, n = 47); group 2 (margin ≥3 mm to < 8 mm, n = 48) and group 3 (margin ≥8 mm, n = 17). During the study, 26,8% patients developed recurrence (n = 30) after a median of 8 months (1-69). Analysis of 5-year overall survival, as well as disease-free and metastasis-free survivals, did not reveal a difference between groups. We performed a subgroup analysis in patients with a tumor-free margin <8 mm (group 1 and 2). It showed that histological lesions observed closest to the edge of the specimen were more often invasive or in situ carcinoma lesions in group 1 than in group 2, in which VIN lesions were mainly observed at this location. After re-excision, no patients in group 1 and 50% (n = 2) patients in group 2 developed recurrence. CONCLUSION This study did not reveal a significant impact of tumor-free margin distance on recurrence and survival in vulvar cancer. Moreover, the benefit of re-excision seems stronger when tumor-free margins are positive or very close (<3 mm), cases in which invasive or in situ lesions are often present closest to the edge of the specimen.
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Affiliation(s)
- E Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France.
| | - C Delorme
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - L Ouldamer
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France
| | - X Carcopino
- Department of Obstetrics and Gynecology, Hopital Nord, APHM, Marseilles, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - C Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France; Faculté de Médecine de Créteil UPEC, Paris XII, France
| | - E Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - M Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - O Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
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20
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Amaro P, Duminil L, Bonneau S, Piardi T, Cousson J, Gabriel R, Graesslin O, Raimond E. Hemorrhagic pancreatic cyst during third trimester of pregnancy: A case-report. Eur J Obstet Gynecol Reprod Biol 2019; 237:137-138. [PMID: 31039487 DOI: 10.1016/j.ejogrb.2019.04.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 04/17/2019] [Indexed: 11/18/2022]
Affiliation(s)
- P Amaro
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - L Duminil
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - S Bonneau
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - T Piardi
- Department of General Surgery, Robert Debré Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - J Cousson
- Department of Reanimation, Robert Debre Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - R Gabriel
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - O Graesslin
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - E Raimond
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France.
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21
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Graesslin O, Verdon R, Raimond E, Koskas M, Garbin O. [Management of tubo-ovarian abscesses and complicated pelvic inflammatory disease: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. ACTA ACUST UNITED AC 2019; 47:431-441. [PMID: 30880246 DOI: 10.1016/j.gofs.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/10/2019] [Indexed: 01/09/2023]
Abstract
A tubo-ovarian abscess (ATO) should be suspected in a context of pelvic inflammatory disease (PID) in case of severe pain associated with the presence of general signs and palpation of an adnexal mass at pelvic examination. Imaging allows most often a rapid diagnosis, by ultrasound or CT, the latter being irradiant but also allowing to consider the differential diagnoses (digestive or urinary diseases) in case of pelvic pain. MRI, non-irradiating examination, whenever it is feasible, provides relevant information, more efficient, guiding quickly the diagnosis. The diagnosis of tubo-ovarian abscess should lead to the hospitalization of the patient, the collection of bacteriological samples, the initiation of a probabilistic antibiotherapy associated with drainage of the purulent collection. In severe septic forms (generalized peritonitis, septic shock), surgery (laparoscopy or laparotomy) keeps its place. In other situations, ultrasound-guided trans-vaginal puncture in the absence of major hemostasis disorders or severe sepsis is a less morbid alternative to surgery and provides high rates of cure. Today, ultrasound-guided trans-vaginal puncture has been satisfactory evaluated in the literature and is part of a logic of therapeutic de-escalation. Randomized trials evaluating laparoscopic drainage versus radiological drainage should be able to answer, in the coming years, questions that are still outstanding (impact on chronic pelvic pain, fertility). The recommendations for the management of ATO published in 2012 by the CNGOF remain valid, legitimizing the place of radiological drainage associated with antibiotic therapy.
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Affiliation(s)
- O Graesslin
- Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, CHU, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - R Verdon
- Service de maladies infectieuses et tropicales, CHRU de Caen, 14000 Caen, France
| | - E Raimond
- Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, CHU, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - M Koskas
- Service de gynécologie-obstétrique, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris, France
| | - O Garbin
- Service de gynécologie, CMCO, pôle de gynécologie des hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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22
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Brun JL, Castan B, de Barbeyrac B, Cazanave C, Charvériat A, Faure K, Mignot S, Verdon R, Fritel X, Graesslin O. [Pelvic Inflammatory Diseases: Updated Guidelines for Clinical Practice - Short version]. ACTA ACUST UNITED AC 2019; 47:398-403. [PMID: 30880245 DOI: 10.1016/j.gofs.2019.03.012] [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: 03/10/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To provide up-to-date guidelines on management of pelvic inflammatory disease (PID). METHODS An initial search of the Cochrane database, PubMed, and Embase was performed using keywords related to PID to identify reports in any language published between January 1990 and January 2012, with an update in 2018. All identified reports published in French and English relevant to the areas of focus were included. A level of evidence based on the quality of the data available was applied for each area of focus and used for the guidelines. RESULTS PID must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to exclude tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1g, once, by intra-muscular (IM) or intra-venous (IV) route, doxycycline 100mg×2/d, and metronidazole 500mg×2/d oral (PO) for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1 to 2g/d until clinical improvement, doxycycline 100mg×2/d, IV or PO, and metronidazole 500mg×3/d, IV or PO for 14days (grade B). Drainage of TOA is indicated if the collection measures more than 3cm (grade B). Follow-up is required in women with sexually transmitted infections (STI) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3 to 6months after PID (grade C), before the insertion of an intra-uterine device (grade B), before elective termination of pregnancy or hysterosalpingography. Targeted antibiotics on identified bacteria are better than systematic antibioprophylaxis in those conditions. CONCLUSIONS Current management of PID requires easily reproducible investigations and antibiotics adapted to STI and vaginal microbiota.
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Affiliation(s)
- J-L Brun
- Service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - B Castan
- Unité fonctionnelle d'infectiologie régionale, centre hospitalier d'Ajaccio, 27, avenue Impératrice-Eugénie, 20303 Ajaccio, France
| | - B de Barbeyrac
- Centre national de référence des infections sexuellement transmissibles bactériennes, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - C Cazanave
- Centre national de référence des infections sexuellement transmissibles bactériennes, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - A Charvériat
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - K Faure
- Service des maladies infectieuses, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France
| | - S Mignot
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - R Verdon
- Service de maladies infectieuses et tropicales, CHRU de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - X Fritel
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - O Graesslin
- Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, 45, rue Cognacq-Jay, 51092 Reims, France
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Ah-Kit X, Hoarau L, Graesslin O, Brun JL. [Follow-up and counselling after pelvic inflammatory disease: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. ACTA ACUST UNITED AC 2019; 47:458-464. [PMID: 30878686 DOI: 10.1016/j.gofs.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine the procedures for follow-up and counselling of patients after pelvic inflammatory disease (PID). METHODS A search in the Cochrane database, PubMed, and Google was performed using keywords related to follow-up and PID to identify reports published between 1990 and 2018. All studies published in French and English relevant to the areas of focus were included. A level of evidence (LE) based on the quality of the data available was applied for each area of focus and used for the guidelines. RESULTS The rate of recurrent PID is 15 to 21%. They are related to a recurrent sexually transmitted infection (STI) in 20 to 34% of cases. Recurrence PID increase the risk of infertility and chronic pelvic pain (LE2). Follow-up is recommended after PID (grade C). The rate of patients lost to follow-up is around 40%. Follow-up is improved by personalized text message reminders (grade B). Vaginal sampling for detection of N. gonorrhoeae, C. trachomatis, (and M. genitalium) by nucleic acid amplification techniques is recommended 3 to 6 months after treatment of PID associated with STI to rule out possible reinfections (grade C). The use of condoms after PID associated with STI is recommended to reduce the risk of recurrences (grade C). The systematic use of contraceptive pills after PID is not recommended to prevent subsequent infertility and chronic pelvic pain. Vaginal sampling for microbiological diagnosis is recommended before the insertion of an intrauterine device (grade B). The risk of ectopic pregnancy is high in these women and must be kept in mind. CONCLUSION Patient counselling and microbiological testing after PID decrease the risk of STI and thus the recurrence of PID.
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Affiliation(s)
- X Ah-Kit
- Pôle d'obstétrique - reproduction - gynécologie, centre Aliénor d'Aquitaine, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - L Hoarau
- Pôle d'obstétrique - reproduction - gynécologie, centre Aliénor d'Aquitaine, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - O Graesslin
- Service de gynécologie-obstétrique, institut Mère-Enfant Alix-de-Champagne, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - J-L Brun
- Pôle d'obstétrique - reproduction - gynécologie, centre Aliénor d'Aquitaine, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; UMR 5234, microbiologie fondamentale & pathogénicité, université de Bordeaux, 33076 Bordeaux, France.
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Golfier F, Chanavaz-Lacheray I, Descamps P, Agostini A, Poilblanc M, Rousset P, Bolze PA, Panel P, Collinet P, Hebert T, Graesslin O, Martigny H, Brun JL, Déchaud H, de Malartic CM, Piechon L, Wattiez A, Chapron C, Daraï E. The definition of Endometriosis Expert Centres. J Gynecol Obstet Hum Reprod 2018; 47:179-181. [PMID: 29510272 DOI: 10.1016/j.jogoh.2018.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 02/01/2018] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Abstract
Endometriosis is a common condition that causes pain and infertility. It can lead to absenteeism and also to multiple surgeries with a consequent risk of impaired fertility, and constitutes a major public health cost. Despite the existence of numerous national and international guidelines, the management of endometriosis remains suboptimal. To address this issue, the French College of Gynaecologists and Obstetricians (CNGOF) and the Society of Gynaecological and Pelvic Surgery (SCGP) convened a committee of experts tasked with defining the criteria for establishing a system of care networks, headed by Expert Centres, covering all of mainland France and its overseas territories. This document sets out the criteria for the designation of Expert Centres. It will serve as a guide for the authorities concerned, to ensure that the means are provided to adequately manage patients with endometriosis.
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Affiliation(s)
- F Golfier
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France; Société de Chirurgie Gynécologique et Pelvienne (SCGP), France.
| | | | - P Descamps
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France; Société de Chirurgie Gynécologique et Pelvienne (SCGP), France
| | - A Agostini
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France; Société de Chirurgie Gynécologique et Pelvienne (SCGP), France
| | - M Poilblanc
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France
| | - P Rousset
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France
| | - P-A Bolze
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France
| | - P Panel
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France; Société de Chirurgie Gynécologique et Pelvienne (SCGP), France
| | - P Collinet
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France; Société de Chirurgie Gynécologique et Pelvienne (SCGP), France
| | - T Hebert
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France; Société de Chirurgie Gynécologique et Pelvienne (SCGP), France
| | - O Graesslin
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France; Société de Chirurgie Gynécologique et Pelvienne (SCGP), France
| | - H Martigny
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France
| | - J-L Brun
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France; Société de Chirurgie Gynécologique et Pelvienne (SCGP), France
| | - H Déchaud
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France; Société de Chirurgie Gynécologique et Pelvienne (SCGP), France
| | - C M de Malartic
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France
| | - L Piechon
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France
| | - A Wattiez
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France
| | - C Chapron
- Société de Chirurgie Gynécologique et Pelvienne (SCGP), France
| | - E Daraï
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), France; Société de Chirurgie Gynécologique et Pelvienne (SCGP), France
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Chanavaz-Lacheray I, Darai E, Descamps P, Agostini A, Poilblanc M, Rousset P, Bolze PA, Panel P, Collinet P, Hebert T, Graesslin O, Martigny H, Brun JL, Dechaud H, Mezan De Malartic C, Piechon L, Wattiez A, Chapron C, Golfier F. [Definition of endometriosis expert centres]. ACTA ACUST UNITED AC 2018; 46:376-382. [PMID: 29490889 DOI: 10.1016/j.gofs.2018.01.009] [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: 01/01/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The Collège national des gynécologues obstétriciens français (CNGOF), in agreement with the Société de chirurgie gynécologique et pelvienne (SCGP), has set up a commission in 2017 to define endometriosis expert centres, with the aim of optimizing endometriosis care in France. METHODS The committee included members from university and general hospitals as well as private facilities, representing medical, surgical and radiological aspects of endometriosis care. Opinion of endometriosis patients' associations was obtained prior to writing this work. The final text was presented and unanimously validated by the members of the CNGOF Board of Directors at its meeting of October 13, 2017. RESULTS Based on analysis of current management of endometriosis and the last ten years opportunities in France, the committee has been able to define the contours of endometriosis expert centres. The objectives, production specifications, mode of operation, missions and funding for these centres were described. The following missions have been specifically defined: territorial organization, global and referral care, communication and teaching as well as research and evaluation. CONCLUSION Because of its daily impact for women and its economic burden in France, endometriosis justifies launching of expert centres throughout the country with formal accreditation by health authorities, ideally as part of the National Health Plan.
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Affiliation(s)
- I Chanavaz-Lacheray
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France
| | - E Darai
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - P Descamps
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - A Agostini
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - M Poilblanc
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France
| | - P Rousset
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France
| | - P-A Bolze
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France
| | - P Panel
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - P Collinet
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - T Hebert
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - O Graesslin
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - H Martigny
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France
| | - J-L Brun
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - H Dechaud
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - C Mezan De Malartic
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France
| | - L Piechon
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France
| | - A Wattiez
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France
| | - C Chapron
- Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - F Golfier
- Collège national des gynécologues et obstétriciens français (CNGOF), 91, boulevard de Sébastopol, 75002 Paris, France; Société de chirurgie gynécologique et pelvienne (SCGP), hôpital Cochin, bâtiment Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France.
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Gac MM, Raimond E, Orquevaux P, Pelissier A, Graesslin O. [Anemia due to vitamin deficiencies in obese pregnant women]. ACTA ACUST UNITED AC 2017; 45:573-575. [PMID: 28967598 DOI: 10.1016/j.gofs.2017.08.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
Affiliation(s)
- M M Gac
- Département de gynécologie-obstétrique, hôpital Maison Blanche, université de Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - E Raimond
- Département de gynécologie-obstétrique, hôpital Maison Blanche, université de Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - P Orquevaux
- Département de médecine interne, hôpital Robert-Debré, université de Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - A Pelissier
- Département de gynécologie-obstétrique, hôpital Maison Blanche, université de Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, hôpital Maison Blanche, université de Reims-Champagne-Ardenne, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Rousselin A, Bendifallah S, Nyangoh Timoh K, Ouldamer L, Canlorbe G, Raimond E, Hudry N, Coutant C, Graesslin O, Touboul C, Collinet P, Bricou A, Huchon C, Daraï E, Ballester M, Levêque J, Lavoue V. Patterns of care and the survival of elderly patients with high-risk endometrial cancer: A case-control study from the FRANCOGYN group. Eur J Surg Oncol 2017; 43:2135-2142. [PMID: 28888799 DOI: 10.1016/j.ejso.2017.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/23/2017] [Accepted: 07/27/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The standard of care of endometrial cancer involves complex procedures such as pelvic and para-aortic lymphadenectomy and omentectomy, particularly for high-risk endometrial cancer. Few data are available about these complex surgical procedures and adjuvant therapy in elderly women. We aim to examine treatment and survival of elderly women diagnosed with high-risk endometrial cancer. STUDY DESIGN We performed a case-control study of women diagnosed between 2001 and 2013 with high-risk endometrial cancers. Women older than 70 years (n = 198) were compared with patients <70 years (n = 198) after matching on high-risk for recurrence and LVSI status. RESULTS Elderly patients had lymphadenectomies less frequently compared with younger patients (76% vs 96%, p < 0.001) and no adjuvant treatment more frequently (17% vs 8%, p = 0.005) due to less chemotherapy being administered (23% vs 46%, p < 0.001). The 3-year DFS, CSS and OS of patients ≥70 years was 52% (43-61), 81% (74-88) and 61% (53-70), respectively. These were significantly lower than the 3-year DFS, CSS, and OS of younger patients, which was 75% (68-82) (p < 0.001), 92% (87-96) (p < 0.008) and 75% (69-82) (p = 0.018), respectively. Cox proportional hazard models found that elderly women had 57% increased risk of recurrence (hazard ratio 1.57, 95% CI 1.04-2.39) compared with younger patients. CONCLUSION Although we found an independently significant lower DFS in elderly patients with high-risk endometrial cancer when compared with young patients, elderly women are less likely to be treated with lymphadenectomy and chemotherapy. Specific guidelines for management of elderly patients with high-risk endometrial cancer are required to improve their prognosis.
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Affiliation(s)
- A Rousselin
- CHU de Rennes, Service de Gynécologie, Hopital Sud, 16 Bd de Bulgarie, 35000 Rennes, France; Université de Rennes 1, France; INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Rennes, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_707, "Epidemiology, Information Systems, Modeling", University Pierre and Marie Curie, Paris 6, France
| | - K Nyangoh Timoh
- CHU de Rennes, Service de Gynécologie, Hopital Sud, 16 Bd de Bulgarie, 35000 Rennes, France; Université de Rennes 1, France; INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Rennes, France
| | - L Ouldamer
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France
| | - G Canlorbe
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France
| | - E Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - N Hudry
- Center de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - C Coutant
- Center de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - O Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - C Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - P Collinet
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - A Bricou
- Department of Gynaecology and Obstetrics, Jean Verdier University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris 13, France
| | - C Huchon
- Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal, Poissy, France
| | - E Daraï
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France
| | - M Ballester
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France
| | - J Levêque
- CHU de Rennes, Service de Gynécologie, Hopital Sud, 16 Bd de Bulgarie, 35000 Rennes, France; Université de Rennes 1, France; INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Rennes, France
| | - V Lavoue
- CHU de Rennes, Service de Gynécologie, Hopital Sud, 16 Bd de Bulgarie, 35000 Rennes, France; Université de Rennes 1, France; INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Rennes, France.
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Bourrellier L, Bensalem R, Bersot Y, Bertrand A, Duminil L, Malinovsky JM, Bonneau S, Graesslin O, Raimond E. Disseminated intravascular coagulation syndrome two months after conservative management of placenta accreta. About two patients. Eur J Obstet Gynecol Reprod Biol 2017; 215:266-267. [PMID: 28689576 DOI: 10.1016/j.ejogrb.2017.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 11/29/2022]
Affiliation(s)
- L Bourrellier
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - R Bensalem
- Department of Anesthesiology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Y Bersot
- Department of Anesthesiology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - A Bertrand
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - L Duminil
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - J M Malinovsky
- Department of Anesthesiology,, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - S Bonneau
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - O Graesslin
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Emilie Raimond
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France.
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Cattin A, De Baene A, Achon E, Bersot Y, Destoop Q, Pelissier A, Bonneau S, Malinovsky JM, Graesslin O, Raimond E. Évaluation de la mise en place d’un protocole de réhabilitation précoce postcésarienne. ACTA ACUST UNITED AC 2017; 45:202-209. [DOI: 10.1016/j.gofs.2017.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/30/2017] [Indexed: 01/01/2023]
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Raimond E, Pelissier A, Etienette Emeriau M, François C, Graesslin O. Use of negative pressure wound therapy after vulvar carcinoma: case studies. J Wound Care 2017; 26:72-74. [DOI: 10.12968/jowc.2017.26.2.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- E. Raimond
- Fellowship, Department of Obstetrics and Gynaecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - A. Pelissier
- Fellowship, Department of Obstetrics and Gynaecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - M. Etienette Emeriau
- Hospital Practitioner, Department of Obstetrics and Gynaecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - C. François
- Head of Department, Department of Plastic and Reconstructive Surgery, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - O. Graesslin
- Head of Department, Department of Obstetrics and Gynaecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
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Ouldamer L, Bendifallah S, Body G, Canlorbe G, Touboul C, Graesslin O, Raimond E, Collinet P, Coutant C, Lavoué V, Lévêque J, Daraï E, Ballester M. Call for Surgical Nodal Staging in Women with ESMO/ESGO/ESTRO High–Intermediate Risk Endometrial Cancer: A Multicentre Cohort Analysis from the FRANCOGYN Study Group. Ann Surg Oncol 2017; 24:1660-1666. [DOI: 10.1245/s10434-016-5731-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Indexed: 01/25/2023]
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Saunier C, Raimond E, Dupont A, Pelissier A, Bonneau S, Gabriel R, Graesslin O. [French residents' training in instrumental deliveries: A national survey]. ACTA ACUST UNITED AC 2016; 45:1186-1193. [PMID: 27312098 DOI: 10.1016/j.jgyn.2016.05.003] [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: 02/24/2016] [Revised: 04/17/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate French residents in Obstetrics and Gynaecology's training in instrumental deliveries in 2015. PATIENTS AND METHODS We conducted a national descriptive survey among 758 residents between December 2014 and January 2015. Respondents were invited by email to specify their University Hospital, their current university term, the number of instrumental deliveries performed by vacuum extractor, forceps or spatulas, and whether they made systematic ultrasound exams before performing the extraction. RESULTS Response rate was 34.7 % (n=263). There were important differences between regions in terms of type of instruments used. Vacuum extractor was the most commonly used instrument for instrumental deliveries by French residents (56.9 %), more than forceps (25.2 %) and spatulas (17.9 %). At the end of the residency, all the residents had been trained in instrumental deliveries with at least two instruments. CONCLUSION The training of difficult techniques as well as their perfect control is required for instrumental deliveries. Yet, we are forced to note that there are substantial differences in the French residents' training in instrumental deliveries depending on their region. So, teaching at least two techniques seems essential as well as improving the training capacities and standardizing practices. A greater systematization of the teaching of the mechanics and obstetric techniques might be a solution to be considered too.
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Affiliation(s)
- C Saunier
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - E Raimond
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - A Dupont
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - A Pelissier
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - S Bonneau
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - R Gabriel
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Ousmen A, Conroy T, Guillemin F, Velten M, Jolly D, Mercier M, Causeret S, Cuisenier J, Graesslin O, Hamidou Z, Bonnetain F, Anota A. Impact de l’occurrence de l’effet response shift sur la détermination de la différence minimale cliniquement importante d’un score de qualité de vie. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.03.030] [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: 11/29/2022] Open
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Alnot-Burette J, Nakib I, Lipere A, Delemer B, Graesslin O. [Thyroid function for infertile women during ovarian hyperstimulation as part of IVF]. ACTA ACUST UNITED AC 2016; 44:156-62. [PMID: 26966034 DOI: 10.1016/j.gyobfe.2016.01.007] [Citation(s) in RCA: 2] [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: 09/24/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Optimal thyroid function is necessary for an effective fertility. Many authors have suggested that thyroid function has an impact on IVF outcome. Conversely, IVF has been suggested to induce changes in thyroid function. The aim of this study was to determine the nature and the timing of alterations in thyroid function, throughout controlled ovarian hyperstimulation, from the beginning of therapy to the day of triggering ovulation. And make a clarification of the current recommendations of the thyroid function during hormonal stimulation. METHODS Subjects were recruited from March 2013 to July 2013 at the Hospital of the University of Reims. The studied population consisted of 50 infertile patients who had undergone IVF/ICSI cycles. Thyroid axis exploration was realized before therapy and at every hormonal dosage during ovarian monitorage. RESULTS Prematuary fluctuations were observed without impact on pregnancy rate. We could detect potential hypothyroid women thanks to this dosage and define a connection between pregnancy rate and TSH with a threshold closer to 1mUI/L than 2,5mUI/L defined by the endocrine society. CONCLUSIONS The link between thyroid function, forecast of conception and pregnancy is well documented. Currently, there is no recommendation on the rate of TSH targets for the patients in medical assisted procreation.
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Affiliation(s)
- J Alnot-Burette
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - I Nakib
- Service de biologie de la reproduction-CECOS, centre hospitalo-universitaire de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - A Lipere
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - B Delemer
- Service endocrinologie, centre hospitalo-universitaire de Reims, rue du Général-Koenig, 51092 Reims cedex, France
| | - O Graesslin
- Service de gynécologie-obstétrique, centre hospitalo-universitaire de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Raimond E, Duminil L, Pelissier A, Destoop Q, Aknin S, Bednarek N, Graesslin O. Maternal cardiac arrest at 26 weeks gestation: birth of a child to term without neurological sequelae. Eur J Obstet Gynecol Reprod Biol 2016; 199:213-4. [PMID: 26898749 DOI: 10.1016/j.ejogrb.2016.01.028] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- E Raimond
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France.
| | - L Duminil
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - A Pelissier
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - Q Destoop
- Department of Anesthesiology, Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - S Aknin
- Department of Anesthesiology, Intensive Care Unit, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - N Bednarek
- Department of Pediatric, Pediatric Intensive Care, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
| | - O Graesslin
- Department of Obstetrics and Gynecology, Maison Blanche Hospital, Reims-Champagne-Ardennes University, Reims, France
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Raimond E, Delorme C, Pelissier A, Bonneau S, Graesslin O. [Training achieves an internal version and a total breech extraction at birth of second twin]. ACTA ACUST UNITED AC 2015; 43:646-51. [PMID: 26411390 DOI: 10.1016/j.gyobfe.2015.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/29/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate French residents in obstetrics and gynaecology's training to internal version and breech extraction during vaginal delivery of the second twin. METHODS A national descriptive survey conducted among 1064 residents between July and October 2014. Respondents were invited by email to specify the type of theoretical and practical training they had received, their university hospital obstetrical practices and the number of vaginal internal version and breech extraction of the second twin they had seen and performed. RESULTS Response rate was 38.7% (n=412). Regarding the type of theoretical training, 39.8% of residents (n=164) had received the obstetrical mechanics and techniques degree; 47.6% (n=196) had got a teaching during special education classes and 29.4% (n=121) a training on mannequin. There were important differences between regions. At the end of residency, 45.6% of residents (n=36) had practiced more than five vaginal internal version and breech extraction of the second twin. CONCLUSION Internal version and breech extraction are difficult but essential maneuvers for the management of twin delivery. The French residents in obstetrics and gynaecology's training for these maneuvers seems to be insufficient. It is necessary to improve their teaching, this teaching must also be equivalent between regions.
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Affiliation(s)
- E Raimond
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - C Delorme
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - A Pelissier
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - S Bonneau
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, hôpital Maison-Blanche, université de Reims-Champagne-Ardennes, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Hocedez C, Pelissier A, Mosbah R, Raimond E, Gabriel R, Graesslin O. Arthrite septique de la symphyse pubienne au cours de la grossesse. ACTA ACUST UNITED AC 2015; 43:472-3. [DOI: 10.1016/j.gyobfe.2015.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
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Mosbah R, Raimond E, Pelissier A, Hocedez C, Graesslin O. [Relevance of the sentinel lymph node biopsy in breast multifocal and multicentric cancer]. ACTA ACUST UNITED AC 2015; 43:375-82. [PMID: 25921507 DOI: 10.1016/j.gyobfe.2015.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/26/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The sentinel lymph node biopsy is a gold standard in the management of breast cancer. Its role in multifocal or multicentric tumors is still evolving. The aim of this study is to assess the feasibility and pertinence of sentinel lymph node biopsy in multifocal and multicentric tumors based on a systematic review of literature. METHODS A systematic review was conducted searching in the following electronic databases PubMed using "sentinel lymph node biopsy", "breast cancer", "multifocal tumor", "multicentric tumor" and "multiple tumor" as keywords. We included original articles published between 2000 and 2014, both French and English, studying feasibility of sentinel lymph node biopsy in invasive breast cancer, multicentric and/or multifocal tumors. The first end point was success rate and false negative rate. RESULTS Twenty-six articles were included in this literature review, with 2212 cases (782 multifocal, 737 multicentric and 693 multiple tumors). Percentage of tumors whose stage was higher than stage T2 ranged from 0 to 86.3%. Success rate average was 83.1%. False negative average was 8.2%. False negative rate was less than 10% in 15 articles. Mean of sentinel lymph node biopsy was 2 (1-9). The average rate of sentinel lymph node positive was 50.6%. Axillary recurrence rate was 0.5%. CONCLUSION Despite the methodological biases of the studies included in this review of literature, the false negative rate of sentinel node biopsy in multifocal and multicentric breast cancers are less than 10% with a low rate of axillary recurrence. Despite the lack of randomized study, this procedure can be routinely performed in accordance with rigorous technical process.
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Affiliation(s)
- R Mosbah
- Département de gynécologie-obstétrique, hôpital Maison Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Université Reims - Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France
| | - E Raimond
- Département de gynécologie-obstétrique, hôpital Maison Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Université Reims - Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France.
| | - A Pelissier
- Département de gynécologie-obstétrique, hôpital Maison Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Université Reims - Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France
| | - C Hocedez
- Département de gynécologie-obstétrique, hôpital Maison Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Université Reims - Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France
| | - O Graesslin
- Département de gynécologie-obstétrique, hôpital Maison Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Université Reims - Champagne-Ardennes, 51, rue Cognacq-Jay, 51095 Reims cedex, France
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Bendifallah S, Canlorbe G, Collinet P, Arsène E, Huguet F, Coutant C, Hudry D, Graesslin O, Raimond E, Touboul C, Daraï E, Ballester M. Just how accurate are the major risk stratification systems for early-stage endometrial cancer? Br J Cancer 2015; 112:793-801. [PMID: 25675149 PMCID: PMC4453957 DOI: 10.1038/bjc.2015.35] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 01/06/2015] [Accepted: 01/12/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To compare the accuracy of five major risk stratification systems (RSS) in classifying the risk of recurrence and nodal metastases in early-stage endometrial cancer (EC). METHODS Data of 553 patients with early-stage EC were abstracted from a prospective multicentre database between January 2001 and December 2012. The following RSS were identified in a PubMed literature search and included the Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC-1), the Gynecologic Oncology Group (GOG)-99, the Survival effect of para-aortic lymphadenectomy (SEPAL), the ESMO and the ESMO-modified classifications. The accuracy of each RSS was evaluated in terms of recurrence-free survival (RFS) and nodal metastases according to discrimination. RESULTS Overall, the ESMO -modified RSS provided the highest discrimination for both RFS and for nodal metastases with a concordance index (C-index) of 0.73 (95% CI, 0.70-0.76) and an area under the curve (AUC) of 0.80 (0.78-0.72), respectively. The other RSS performed as follows: the PORTEC1, GOG-99, SEPAL, ESMO classifications gave a C-index of 0.68 (0.66-0.70), 0.65 (0.63-0.67), 0.66 (0.63-0.69), 0.71 (0.68-0.74), respectively, for RFS and an AUC of 0.69 (0.66-0.72), 0.69 (0.67-0.71), 0.68 (0.66-0.70), 0.70 (0.68-0.72), respectively, for node metastases. CONCLUSIONS None of the five major RSS showed high accuracy in stratifying the risk of recurrence or nodal metastases in patients with early-stage EC, although the ESMO-modified classification emerged as having the highest power of discrimination for both parameters. Therefore, there is a need to revisit existing RSS using additional tools such as biological markers to better stratify risk for these patients.
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Affiliation(s)
- S Bendifallah
- 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France [2] INSERM UMR S 707, 'Epidemiology, Information Systems, Modeling', University Pierre and Marie Curie, Paris 6, France
| | - G Canlorbe
- Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France
| | - P Collinet
- Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France
| | - E Arsène
- Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Lille, France
| | - F Huguet
- Department of Radiation Oncology, Tenon University Hospital, University Pierre and Marie Curie, Paris 6, France
| | - C Coutant
- Centre de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - D Hudry
- Centre de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - O Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - E Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - C Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - E Daraï
- 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France [2] INSERM UMR S 938, University Pierre et Marie Curie, Paris 6, France
| | - M Ballester
- 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Institut Universitaire de Cancérologie (IUC), Paris 6, France [2] INSERM UMR S 938, University Pierre et Marie Curie, Paris 6, France
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Mechiche Alami S, Velard F, Draux F, Siu Paredes F, Josse J, Lemaire F, Gangloff SC, Graesslin O, Laurent-Maquin D, Kerdjoudj H. Gene screening of Wharton's jelly derived stem cells. Biomed Mater Eng 2015; 24:53-61. [PMID: 24928918 DOI: 10.3233/bme-140974] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stem cells are the most powerful candidate for the treatment of various diseases. Suitable stem cell source should be harvested with minimal invasive procedure, found in great quantity, and transplanted with no risk of immune response and tumor formation. Fetal derived stem cells have been introduced as an excellent alternative to adult and embryonic stem cells use, but unfortunately, their degree of "stemness" and molecular characterization is still unclear. Several studies have been performed deciphering whether fetal stem cells meet the needs of regenerative medicine. We believe that a transcriptomic screening of Wharton's jelly stem cells will bring insights on cell population features.
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Affiliation(s)
- S Mechiche Alami
- EA 4691 «Biomatériaux et Inflammation en Site Osseux», Pôle Santé, SFR CAP-Santé (FED 4231), Université de Reims Champagne-Ardenne, Reims, France UFR D'odontologie, URCA, Reims, France
| | - F Velard
- EA 4691 «Biomatériaux et Inflammation en Site Osseux», Pôle Santé, SFR CAP-Santé (FED 4231), Université de Reims Champagne-Ardenne, Reims, France UFR D'odontologie, URCA, Reims, France
| | - F Draux
- EA 4691 «Biomatériaux et Inflammation en Site Osseux», Pôle Santé, SFR CAP-Santé (FED 4231), Université de Reims Champagne-Ardenne, Reims, France UFR D'odontologie, URCA, Reims, France
| | - F Siu Paredes
- EA 4691 «Biomatériaux et Inflammation en Site Osseux», Pôle Santé, SFR CAP-Santé (FED 4231), Université de Reims Champagne-Ardenne, Reims, France Centre de Biologie Moléculaire, Université d'Aréquipa, Aréquipa, Pérou
| | - J Josse
- EA 4691 «Biomatériaux et Inflammation en Site Osseux», Pôle Santé, SFR CAP-Santé (FED 4231), Université de Reims Champagne-Ardenne, Reims, France UFR de Pharmacie, URCA, Reims, France
| | - F Lemaire
- EA 4691 «Biomatériaux et Inflammation en Site Osseux», Pôle Santé, SFR CAP-Santé (FED 4231), Université de Reims Champagne-Ardenne, Reims, France UFR D'odontologie, URCA, Reims, France
| | - S C Gangloff
- EA 4691 «Biomatériaux et Inflammation en Site Osseux», Pôle Santé, SFR CAP-Santé (FED 4231), Université de Reims Champagne-Ardenne, Reims, France UFR de Pharmacie, URCA, Reims, France
| | - O Graesslin
- Département de Gynécologie CHU de Reims, Reims, France
| | - D Laurent-Maquin
- EA 4691 «Biomatériaux et Inflammation en Site Osseux», Pôle Santé, SFR CAP-Santé (FED 4231), Université de Reims Champagne-Ardenne, Reims, France UFR D'odontologie, URCA, Reims, France Département de Chirurgie Dentaire, CHU de Reims, Reims, France
| | - H Kerdjoudj
- EA 4691 «Biomatériaux et Inflammation en Site Osseux», Pôle Santé, SFR CAP-Santé (FED 4231), Université de Reims Champagne-Ardenne, Reims, France UFR D'odontologie, URCA, Reims, France
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Bendifallah S, Canlorbe G, Raimond E, Hudry D, Coutant C, Graesslin O, Touboul C, Huguet F, Cortez A, Daraï E, Ballester M. A clue towards improving the European Society of Medical Oncology risk group classification in apparent early stage endometrial cancer? Impact of lymphovascular space invasion. Br J Cancer 2014; 110:2640-6. [PMID: 24809776 PMCID: PMC4037837 DOI: 10.1038/bjc.2014.237] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/30/2014] [Accepted: 04/10/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Lymphovascular space invasion (LVSI) is one of the most important predictors of nodal involvement and recurrence in early stage endometrial cancer (EC). Despite its demonstrated prognostic value, LVSI has not been incorporated into the European Society of Medical Oncology (ESMO) classification. The aim of this prospective multicentre database study is to investigate whether it may improve the accuracy of the ESMO classification in predicting the recurrence risk. Methods: Data of 496 patients with apparent early-stage EC who received primary surgical treatment between January 2001 and December 2012 were abstracted from prospective multicentre database. A modified ESMO classification including six risk groups was created after inclusion of the LVSI status in the ESMO classification. The primary end point was the recurrence accuracy comparison between the ESMO and the modified ESMO classifications with respect to the area under the receiver operating characteristic curve (AUC). Results: The recurrence rate in the whole population was 16.1%. The median follow-up and recurrence time were 31 (range: 1–152) and 27 (range: 1–134) months, respectively. Considering the ESMO modified classification, the recurrence rates were 8.2% (8 out of 98), 23.1% (15 out of 65), 25.9% (15 out of 58), and 45.1% (28 out of 62) for intermediate risk/LVSI−, intermediate risk/LVSI+, high risk/LVSI−, and high risk/LVSI+, respectively (P<0.001). In the low risk group, LVSI status was not discriminant as only 7.0% (14 out of 213) had LVSI+. The staging accuracy according to AUC criteria for ESMO and ESMO modified classifications were of 0.71 (95% CI: 0.68–0.74) and 0.74 (95% CI: 0.71–0.77), respectively. Conclusions: The current modified classification could be helpful to better define indications for nodal staging and adjuvant therapy, especially for patients with intermediate risk EC.
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Affiliation(s)
- S Bendifallah
- 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France [2] INSERM UMR S 707, 'Epidemiology, Information Systems, Modeling', University Pierre and Marie Curie, Paris, France
| | - G Canlorbe
- Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France
| | - E Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - D Hudry
- Centre de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - C Coutant
- Centre de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - O Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - C Touboul
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - F Huguet
- Department of Radiation Oncology, Tenon University Hospital, University Pierre and Marie Curie, Paris, France
| | - A Cortez
- Department of Pathology, Tenon University Hospital, University Pierre and Marie Curie, Paris, France
| | - E Daraï
- 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France [2] INSERM UMR S 938, University Pierre et Marie Curie, Paris, France
| | - M Ballester
- 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), Paris, France [2] INSERM UMR S 938, University Pierre et Marie Curie, Paris, France
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Deffieux X, Sentilhes L, Savary D, Letouzey V, Marcelli M, Mares P, Pierre F, Brun JL, Boukerrou M, Daraï É, Fauconnier A, Fritel X, Herry M, Hocke C, Tardif D, Villefranque V, Cosson M, Debodinance P, Fernandez H, Ferry P, Graesslin O, Hermieu JF, Jacquetin B, Jourdain O, Lenormand L, Marpeau L, Michaud P, Rabischong B, Salet-Lizée D, Sergent F, de Tayrac R. Indications de la cure du prolapsus génital par voie vaginale avec prothèse : consensus d’experts du Collège national des gynécologues et obstétriciens français (CNGOF). ACTA ACUST UNITED AC 2013; 42:628-38. [DOI: 10.1016/j.jgyn.2013.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 08/23/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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Bendifallah S, Canlorbe G, Raimond E, Bazire L, Huguet F, Graesslin O, Rouzier R, Darai E, Ballester M. An external validation study of nomograms designed to predict isolated loco-regional and distant endometrial cancer recurrences: how applicable are they? Br J Cancer 2013; 109:1498-503. [PMID: 23989946 PMCID: PMC3777006 DOI: 10.1038/bjc.2013.500] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 07/28/2013] [Accepted: 07/30/2013] [Indexed: 11/09/2022] Open
Abstract
Background: To externally validate and assess the robustness of two nomograms to predict the recurrence risk of women with endometrial cancer (EC). Methods: Using an independent, multicentre external patient cohort we assessed the discrimination and calibration of two nomograms – the 3-year isolated loco-regional (ILRR) and distant (DR) recurrence nomograms – in women with surgically treated stage I–III EC. Results: Two hundred and seventy one eligible women were identified from two university hospital databases and the Senti-Endo trial. The median follow-up and initial recurrence time were 38.1 (range: 12–69) and 22.0 (range: 8.3–55) months, respectively. The overall recurrence rate was 13.8% (37 out of 271). Predictive accuracy according to the discrimination was 0.69 (95% CI, 0.58–0.79) and 0.66 (95% CI, 0.60–0.71) for the 3-year ILRR and DR nomograms, respectively. The correspondence between observed recurrence rate and the nomogram predictions suggests a moderate calibration of the nomograms in the validation cohort. Conclusion: The nomograms were externally validated and shown to be partly generalisable to a new and independent patient population. The tools need to be improved by including information on the lymph node status and adjuvant therapies.
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Affiliation(s)
- S Bendifallah
- 1] Department of Obstetrics and Gynaecology, Tenon University Hospital, University Pierre and Marie Curie, CHU Tenon, APHP, 4 Rue de la Chine, 75020 Paris, France [2] UMR S 707, 'Epidemiology, Information Systems, Modeling', University Pierre and Marie Curie, Paris, France
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Orquevaux P, Brabant-Viau A, Bory JP, Bernard P, Rieu P, Jaussaud R, Graesslin O, Pennaforte JL. Grossesses lupiques : à propos de 73 cas au CHU de Reims et au centre hospitalier d’Epernay entre 1990 et 2012. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pelissier-Komorek A, Lucereau-Barbier M, Diab J, Gavillon N, Graesslin O. [Acute non-puerperal uterine inversion the third degree]. Gynecol Obstet Fertil 2013; 41:130-2. [PMID: 23375988 DOI: 10.1016/j.gyobfe.2012.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/25/2012] [Indexed: 11/25/2022]
Abstract
The uterine inversion is a rare gynecologic complication. Usually, it is extremely serious obstetric complication exposing the young mother at the risk of postpartum haemorrhage. We report the case of a 57-year-old woman, hemodynamically unstable at admission, with an acute uterine inversion a complete fundic submucosal myoma. The surgical management was done by a double approach: laparoscopic and vaginal. Although rare and difficult diagnosis, the acute non-puerperal uterine inversion is a medical-surgical emergency caused by an intracavitary expansive process.
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Affiliation(s)
- A Pelissier-Komorek
- Service de gynécologie-obstétrique, maternité Alix de Champagne, hôpital Maison Blanche, centre hospitalier universitaire de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
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Clerson P, Graesslin O, Gater A, Taylor F, Rofail D, Filonenko A, Schellschmidt I, Rosen K. M134 EVAPIL-R SCALE: VALIDATION OF TOOL TO ASSESS TOLERABILITY OF DIFFERENT CONTRACEPTIVE METHODS IN LONGITUDINAL STUDIES. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dabakuyo TS, Guillemin F, Conroy T, Velten M, Jolly D, Mercier M, Causeret S, Cuisenier J, Graesslin O, Gauthier M, Bonnetain F. Response shift effects on measuring post-operative quality of life among breast cancer patients: a multicenter cohort study. Qual Life Res 2012; 22:1-11. [PMID: 22383104 DOI: 10.1007/s11136-012-0135-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To characterize response shift effects in patients with breast cancer (BC). METHODS The QLQ-C30, BR23, and EurQOL-EQ-5D were assessed at baseline and at the end of the first hospitalization. We used the then-test approach to characterize changes in internal standards by calculating the mean difference between the then-test (retrospective measure) and pre-test baseline QoL assessments. The Ideal Scale Approach was also used to assess changes in standards by comparing health and QoL expectancies between baseline and the end of the first hospitalization. Successive Comparison Approach was used to assess changes in values through the longitudinal assessment of the relative importance of EuroQOL dimensions. RESULTS The results of this study showed that recalibration RS effects occurred early after the first hospitalization for 6/15 dimensions of QLQ-C30 (emotional, cognitive, fatigue, insomnia, appetite loss, diarrhea) and 2/8 of BR-23 (future perspective, systemic therapy side effects). Moreover, health and QoL expectancies changed between the baseline and the end of the first hospitalization, and changes in values were seen for the self-care and usual activities dimensions of the EuroQOL-EQ-5D. CONCLUSIONS The occurrence of RS early after the first hospitalization suggests that it needs to be taken into account to interpret QoL changes in BC.
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Affiliation(s)
- T S Dabakuyo
- Biostatistics and Epidemiology Unit, Centre Georges François Leclerc, 1 rue Professeur Marion, 21000, Dijon, France.
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Bendifallah S, Defert S, Chabbert-Buffet N, Maurin N, Chopier J, Antoine M, Bezu C, Touche D, Uzan S, Graesslin O, Rouzier R. Scoring to predict the possibility of upgrades to malignancy in atypical ductal hyperplasia diagnosed by an 11-gauge vacuum-assisted biopsy device: An external validation study. Eur J Cancer 2012; 48:30-6. [DOI: 10.1016/j.ejca.2011.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 08/09/2011] [Accepted: 08/15/2011] [Indexed: 10/15/2022]
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Fauvet R, Brzakowski M, Morice P, Resch B, Marret H, Graesslin O, Daraï E. Borderline ovarian tumors diagnosed during pregnancy exhibit a high incidence of aggressive features: results of a French multicenter study. Ann Oncol 2011; 23:1481-7. [PMID: 22003244 DOI: 10.1093/annonc/mdr452] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The purpose of the current study was to evaluate the characteristics of borderline ovarian tumors (BOTs) diagnosed during pregnancy. PATIENTS AND METHODS We conducted a retrospective multicenter study of 40 patients with BOTs diagnosed during pregnancy between 1997 and 2009 at five tertiary universitary departments of Gynecology and Obstetrics and one French cancer center. The medical records were reviewed to determine surgical procedure, histology, restaging surgery and recurrence. RESULTS Mean patient age was 30.2 ± 5.4 years. Most BOTs were diagnosed during the first trimester of pregnancy (62%). Salpingo-oophorectomy (N = 24) was more frequently performed than cystectomy (N = 11) during pregnancy (P = 0.01). Only two patients had an initial complete staging. BOTs were mucinous, serous and mixed in 48%, 42% and 10% of patients, respectively. Twenty-one percent of mucinous BOTs exhibited intraepithelial carcinoma or microinvasion. Forty-seven percent of serous BOTs exhibited micropapillary features, noninvasive implants or microinvasion. Restaging surgery performed in 52% patients resulted in upstaging in 24% of cases. Recurrence rate in patients with serous BOT with micropapillary features or peritoneal implants was 7.5%. CONCLUSIONS BOTs diagnosed during pregnancy exhibit a high incidence of aggressive features and are rarely completely staged initially. Given this setting, up-front salpingo-oophorectomy should be considered and restaging planned.
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Affiliation(s)
- R Fauvet
- Department of Gynecology and Obstetrics, University Hospital of Amiens, Amiens, France.
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Lucereau-Barbier M, Graesslin O. Contraception et fertilité ultérieure. Contraception 2011. [DOI: 10.1016/b978-2-294-70921-0.00015-2] [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: 10/14/2022]
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