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Ruffolo AF, Lallemant M, Aurore D, Kerbage Y, Rubod C, Cosson M. Self-care of vaginal pessary for pelvic organ prolapse: a systematic review and meta-analysis. Arch Gynecol Obstet 2024:10.1007/s00404-024-07506-1. [PMID: 38634900 DOI: 10.1007/s00404-024-07506-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION There is no evidence about the efficacy of self-care of vaginal pessary in women with symptomatic pelvic organ prolapse (POP). The aim of this systematic review and meta-analysis is to assess the adherence to pessary treatment among women who engage in self-management of their pessary. METHODS We performed a systematic review and meta-analysis, according to PRISMA 2020 guidelines, and selected seven publications for inclusion in the analysis. RESULTS Pooled continuation rate of self-cared vaginal pessary was the 76% (95%CI: 66-85%) with a I2-test of 93.3% (p < 0.001). Pooled conversion to POP surgery was the 12% (95%CI: 1-23%) with a I2-test of 96% (p < 0.001). Continuation rate was not statistically different between women who were treated by self-care and non-self-care management of vaginal pessary (RR 1.11, 95%CI 0.96-1.27; p = 0.15), with a related I2-test of 37% (p = 0.21). CONCLUSION Self-care vaginal pessary management presented a high continuation rate in women affected by pelvic organ prolapse at a long follow-up. The rate of conversion to surgical management of POP was low. No significant difference in continuation rate were highlighted between women who adopted the self-care or the clinical-based management of pessary.
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Affiliation(s)
| | - Marine Lallemant
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Deseure Aurore
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Yohan Kerbage
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Chrystèle Rubod
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
| | - Michel Cosson
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000, Lille, France
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Rubod C, de Prémare C, Kerbage Y, Kyheng M, Plouvier P, Chossegros C, Robin G. Does surgery for colorectal endometriosis prior to IVF±ICSI have an impact on cumulative live birth rates? Reprod Biomed Online 2024; 48:103649. [PMID: 38335899 DOI: 10.1016/j.rbmo.2023.103649] [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: 07/02/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 02/12/2024]
Abstract
RESEARCH QUESTION Does colorectal endometriosis surgery prior to IVF ± intracytoplasmic sperm injection (ICSI) impact cumulative live birth rates? DESIGN This retrospective, monocentric study (Lille University Hospital) was conducted between 1 January 2007 and 31 December 2018. Two groups of patients from the JFIV database were included: a group undergoing IVF±ICSI alone (120 patients, 215 oocyte retrievals), and a group undergoing surgery and then IVF±ICSI (69 patients, 109 oocyte retrievals). The mode of management was decided after a multidisciplinary team meeting. Different criteria such as age (cut-off 35 years), anti-Müllerian hormone concentration (cut off 2 ng/ml), imaging results and the patient's symptomatology were considered: the most symptomatic patients underwent surgery prior to IVF±ICSI. The cumulative clinical pregnancy and live birth rates obtained after four IVF attempts were estimated and compared between the two groups using competing risk survival methods. RESULTS The cumulative live birth rates after four IVF attempts in the two groups were not statistically significantly different (50.8% in the IVF±ICSI group versus 52.2% in the surgery followed by IVF±ICSI group, P = 0.43). The results for the cumulative clinical pregnancy rates were the same (56.7% in the IVF±ICSI group versus 58% in the surgery followed by IVF±ICSI group, P = 0.47). CONCLUSION The study shows that cumulative live birth and pregnancy rates were similar in infertile patients with colorectal endometriosis who underwent IVF±ICSI either with or without prior colorectal endometriosis surgery.
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Affiliation(s)
- Chrystèle Rubod
- Service de chirurgie gynécologique, CHU Lille, Lille, France.; Univ. Lille, CHU Lille, Lille, France
| | | | - Yohan Kerbage
- Service de chirurgie gynécologique, CHU Lille, Lille, France
| | - Maeva Kyheng
- Service de Biostatistiques, CHU Lille, Lille, France
| | - Pauline Plouvier
- Service d'Assistance Médicale à la Procréation et Préservation de la Fertilité, CHU Lille, Lille, France
| | | | - Geoffroy Robin
- Univ. Lille, CHU Lille, Lille, France.; Service d'Assistance Médicale à la Procréation et Préservation de la Fertilité, CHU Lille, Lille, France
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Cathelain A, Phalippou J, Kerbage Y. [Robot-assisted laparoscopic orthotopic ovarian cortex autograft after ovarian tissue cryopreservation - with video]. Gynecol Obstet Fertil Senol 2024:S2468-7189(24)00091-6. [PMID: 38522748 DOI: 10.1016/j.gofs.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Alice Cathelain
- Département de médecine de la reproduction et préservation de la fertilité, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France; Département de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France.
| | - Jérome Phalippou
- Département de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHU de Lille, 59000 Lille, France
| | - Yohan Kerbage
- Service de chirurgie gynécologique, MCU PH, hôpital Jeanne-de-Flandre, CHU de Lille, université de Lille, 59000 Lille, France
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Lallemant M, Shimojyo AA, Mayeur O, Ramanah R, Rubod C, Kerbage Y, Cosson M. Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system. PLoS One 2024; 19:e0299012. [PMID: 38512958 PMCID: PMC10956756 DOI: 10.1371/journal.pone.0299012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/04/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION AND HYPOTHESIS In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the female pelvic system has been developed. In the literature, no study has currently evaluated apical prolapse repair by posterior sacrospinous ligament fixation using a generic model nor a patient-specific model that personalize the management of POP and predict surgical outcomes based on the patient's pre-operative Magnetic Resonance Imaging. The aim of our study was to analyze the influence of a right and/or left sacrospinous ligament fixation and the distance between the anchorage area and the ischial spine on the pelvic organ mobility using a generic and a patient-specific Finite Element model (FEM) of the female pelvic system during posterior sacrospinous ligament fixation (SSF). METHODS Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix's or the vaginal apex and Bp point for the anterior aspect of the anorectal junction. RESULTS Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively. CONCLUSION According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04551859.
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Affiliation(s)
- Marine Lallemant
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Andres Arteaga Shimojyo
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Olivier Mayeur
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
| | - Rajeev Ramanah
- Service de Gynécologie Obstétrique, Pôle Mère-Femme, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
- Laboratoire de Nanomédecine, Imagerie et Thérapeutiques, INSERM E4 4662, Université de Franche-Comté, Besançon, France
| | - Chrystèle Rubod
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Yohan Kerbage
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
| | - Michel Cosson
- Université Lille, CNRS, Centrale Lille, UMR 9013—LaMcube—Laboratoire de Mécanique, Multiphysique, Multiéchelle, F-59000, Lille, France
- CHU Lille, Service de Chirurgie Gynécologique, F-59000, Lille, France
- Faculté de médecine, Université Lille Nord de France, F-59000, Lille, France
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Lavoue V, Raimond E, Ballester M, Carcopino X, Azais H, Kerbage Y, Koskas M, Lecointre L, Huchon C, Touboul C, Ouldamer L. [FRANCOGYN group: A brief history]. Gynecol Obstet Fertil Senol 2024; 52:51-54. [PMID: 37839793 DOI: 10.1016/j.gofs.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Describing the constitution of the FRANCOGYN group (a national French research group in Oncological and Gynecological Surgery) and present its current and future development. METHODS Literature review using PUBMed database with the keyword "FRANCOGYN". OBJECTIVES Describing the constitution of the FRANCOGYN group (a national French research group in Oncological and Gynecological Surgery) and present its current and future development. RESULTS The FRANCOGYN group was formed in December 2015, bringing together over the years more than 17 gynecological and oncological surgical department in France. The group carries out clinical research on gynecological pelvic cancers by constituting retrospective cohorts. Its legitimacy allows it to lead or co-lead the drafting of recommendations for clinical practice in the field of gynecological cancers. It now offers prospective randomized research funded by national grants. CONCLUSION The FRANCOGYN network allows us to propose a national reflection on the surgical management of pelvic cancers in women, resulting in numerous international reference publications.
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Affiliation(s)
- Vincent Lavoue
- Service de gynécologie, Francen institut de recherche en santé, environnement et travail (Irset) - UMR_S 1085, site Hôpital Sud, CHU de Rennes, université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France.
| | - Emilie Raimond
- Service de gynécologie, CHU de Reims, université de Reims, Reims, France
| | - Marcos Ballester
- Service de gynécologie, Diaconesses, Croix Saint-Simon, Paris, France
| | - Xavier Carcopino
- Service de gynécologie, université de Marseille, AP-HM, Marseille, France
| | - Henri Azais
- Service de gynécologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Yohan Kerbage
- Service de gynécologie, université de Lille, Lille, France
| | - Martin Koskas
- Service de gynécologie, hôpital Bichat, AP-HP, Paris, France
| | - Lise Lecointre
- Service de gynécologie, CHU de Strasbourg, Strasbourg, France
| | - Cyrille Huchon
- Service de gynécologie, hôpital Lariboisière, AP-HP, Paris, France
| | - Cyril Touboul
- Service de gynécologie, hôpital Tenon (AP-HP.6) Paris, Sorbonne université, UMRS U938 : biologie et thérapie des cancers, Paris, France
| | - Lobna Ouldamer
- Service de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, université François-Rabelais, unité Inserm 1069, 2, boulevard Tonnelle, 37044 Tours, France
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Ouasti S, Ilic J, Mimoun C, Bendifallah S, Huchon C, Ouldamer L, Lorenzini J, Lavoué V, Raimond E, Dion L, Costaz H, Dupre PF, Graesslin O, Uzan J, Kerbage Y, Chauvet P, Canlorbe G, Touboul C, Dabi Y. Adherence to ESGO guidelines and impact on survival in obese patients with endometrial cancer: a multicentric retrospective study. Int J Gynecol Cancer 2023; 33:1950-1956. [PMID: 37788899 DOI: 10.1136/ijgc-2023-004642] [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] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES Obesity is known to be both a major risk factor for endometrial cancer and associated with surgical complexity. Therefore, the management of patients with obesity is a challenge for surgeons and oncologists. The aim of this study is to assess the adherence to European Society of Gynaecological Oncology (ESGO) guidelines in morbidly obese patients (body mass index (BMI) >40 kg/m2). The secondary objectives were the impact on overall survival and recurrence-free survival. METHODS All the patients who were treated for an endometrial cancer in the 11 cancer institutes of the FRANCOGYN group were included and classified into three weight groups: morbid (BMI >40 kg/m2), obese (BMI 30-40), and normal or overweight (BMI <30). Adherence to guidelines was evaluated for surgical management, lymph node staging, and adjuvant therapies. RESULTS In total, 2375 patients were included: 1330 in the normal or overweight group, 763 in the obese group, and 282 in the morbid group. The surgical management of the morbid group was in accordance with the guidelines in only 30% of cases, compared with 44% for the obese group and 48% for the normal or overweight group (p<0.001); this was largely because of a lack of lymph node staging. Morbid group patients were more likely to receive the recommended adjuvant therapy (61%) than the obese group (52%) or the normal or overweight group (46%) (p<0.001). Weight had no impact on overall survival (p=0.6) and morbid group patients had better recurrence-free survival (p=0.04). CONCLUSION Adherence to international guidelines for surgical management is significantly lower in morbid group patients, especially for lymph node staging. However, morbidly obese patients had more often the adequate adjuvant therapies. Morbid group patients had a better recurrence-free survival likely because of better prognosis tumors.
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Affiliation(s)
- Samia Ouasti
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Johanna Ilic
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Camille Mimoun
- Department of Gynaecology, Hospital Group Saint-Louis Lariboisiere and Fernand-Widal, Paris, France
| | - Sofiane Bendifallah
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Cyrille Huchon
- Department of Gynaecology, Hospital Group Saint-Louis Lariboisiere and Fernand-Widal, Paris, France
| | - Lobna Ouldamer
- Department of Gynaecology, Hôpital Bretonneau, Tours, France
| | | | - Vincent Lavoué
- Department og Gynecology and Obstetrics, Rennes 1 University, Rennes, France
| | - Emilie Raimond
- Department of Gyneacology and Obstetrics, Reims Champagne-Ardenne University, Reims, France
| | - Ludivine Dion
- Department of Gynecology and Obstetrics, Rennes 1 University, Rennes, France
| | - Hélène Costaz
- Departement of Oncology Surgery, Georges-François Leclerc Centre, Dijon, France
| | | | - Olivier Graesslin
- Department of Obstetrics and Gynecology, Université de Reims Champagne-Ardenne, Reims, France
| | - Jennifer Uzan
- Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal de Créteil (CHI Créteil), Créteil, France
| | | | - Pauline Chauvet
- Department of Gynaecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Cyril Touboul
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Yohann Dabi
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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Aissaoui O, Phalippou J, Cordoba A, Azais H, Ouldamer L, Bolze PA, Ballester M, Huchon C, Mimoun C, Akladios C, Lecointre L, Raimond E, Graesslin O, Carcopino X, Lavoué V, Bendifallah S, Touboul C, Dabi Y, Canlorbe G, Koskas M, Chauvet P, Collinet P, Kerbage Y. Brachytherapy and surgery versus surgery alone for IB2 (FIGO 2018) cervical cancers: A FRANCOGYN study. Eur J Obstet Gynecol Reprod Biol 2023; 290:128-134. [PMID: 37788511 DOI: 10.1016/j.ejogrb.2023.09.021] [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: 05/27/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Evaluation of the management by first brachytherapy followed by radical hysterectomy (Wertheim type) compared to radical hysterectomy alone (Wertheim type) for the treatment of IB2 cervical cancer. METHODS Data from women with histologically proven FIGO stage IB2 cervical cancer treated between April 1996 and December 2016 were retrospectively abstracted from twelve French institutions with prospectively maintained databases. RESULTS Of the 211 patients with FIGO stage IB2 cervical cancer without lymph node involvement included, 136 had surgical treatment only and 75 had pelvic lymph node staging and brachytherapy followed by surgery. The surgery-only group had significantly more adjuvant treatment (29 vs. 3; p = 0.0002). A complete response was identified in 61 patients (81%) in the brachytherapy group. Postoperative complications were comparable (63,2% vs. 72%, p = 0,19) and consisted mainly of urinary (36vs. 27) and digestive (31 vs 22) complications and lymphoceles (4 vs. 1). Brachytherapy had no benefit in terms of progression-free survival (p = 0.14) or overall survival (p = 0.59). However, for tumors of between 20 and 30 mm, preoperative brachytherapy improved recurrence-free survival (p = 0.0095) but not overall survival (p = 0.41). This difference was not observed for larger tumors in terms of either recurrence-free survival (p = 0.55) or overall survival (p = 0.95). CONCLUSION Our study found that preoperative brachytherapy had no benefit for stage IB2 cervical cancers in terms of recurrence-free survival or overall survival. For tumor sizes between 2 and 3 cm, brachytherapy improves progression-free survival mainly by reducing pelvic recurrences without improving overall survival.
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Affiliation(s)
- Othman Aissaoui
- CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.
| | - Jérôme Phalippou
- CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France.
| | - Abel Cordoba
- Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France.
| | - Henri Azais
- AP-HP.CUP, Service de chirurgie cancérologique gynécologique et du sein, Hôpital Européen Georges-Pompidou, Paris, France.
| | - Lobna Ouldamer
- Department of Gynaecology. CHRU de Tours. Hôpital Bretonneau. INSERM Unit, 1069, 2 boulevard Tonnellé 37044 TOURS, France.
| | - Pierre Adrien Bolze
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, France.
| | - Marcos Ballester
- Department of Gynaecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, 125 rue d'Avron, 75020 Paris, France.
| | - Cyrille Huchon
- APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.
| | - Camille Mimoun
- APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.
| | - Cherif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France.
| | - Vincent Lavoué
- Department of Gynaecology, CHU de Rennes, France; INSERM, 1242, COSS, Rennes, Université de Rennes 1, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France.
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France.
| | - Yohann Dabi
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Geoffroy Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP Paris, France.
| | - Martin Koskas
- Department of Gynaecology and Obstetrics, Hôpital Bichat, AP HP, France.
| | - Pauline Chauvet
- Department of Gynaecology and Obstetrics, CHU de Clermont Ferrand, France
| | - Pierre Collinet
- CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.
| | - Yohan Kerbage
- CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.
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Kheirbek N, Delporte V, El Hajj H, Martin C, Delplanque S, Kerbage Y, Rubod C, Cosson M, Giraudet G. Comparing vNOTES Hysterectomy with Laparoscopic Hysterectomy for Large Uteri. J Minim Invasive Gynecol 2023; 30:877-883. [PMID: 37422053 DOI: 10.1016/j.jmig.2023.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVE Our study aimed to compare conventional laparoscopic hysterectomies (LHs) with vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomies performed for patients with large uteri (weight >280 g) at our institution, which underwent a change in practice from conventional LH to vNOTES for large uteri. DESIGN Retrospective cohort. SETTING French tertiary university hospital. PATIENTS Two cohorts: the last 54 patients who underwent vNOTES hysterectomy and the last 52 patients who underwent conventional LH for large uteri. INTERVENTION Baseline characteristics and surgical outcomes were assessed, including uterine weight, mode of delivery for previous pregnancies, history of abdominal surgery, indication for hysterectomy, associated procedures, operative time (OT), complications, volume of intraoperative bleeding, and length of postoperative hospital stay. MEASUREMENTS AND MAIN RESULTS Both groups were comparable, with a mean uterine weight of 586.4 ± 289.2 g in the laparoscopy group compared with 686.7 ± 374.6 g in the vNOTES group. There was a significant decrease in the OT in the vNOTES group with a median of 99 minutes (66.5-138.5 minutes) compared with 171 minutes (131-208 minutes) in the laparoscopy group, p <.001. The length of hospital stay was also decreased in the vNOTES group with a median of 0.5 nights compared with 2 nights in the laparoscopy group, p <.001. More patients were managed in an ambulatory setting in the vNOTES group (50% vs 3.7%, p <.001). Our study did not find any significant difference in terms of bleeding or the number of conversions to another surgical approach. The frequency of intraoperative and postoperative complications was very low. CONCLUSION Compared with the laparoscopic approach, vNOTES hysterectomy for large uteri (>280 g) is associated with decreased OT, a shorter hospital stay, and increased performance in the ambulatory setting.
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Affiliation(s)
- Nour Kheirbek
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France.
| | - Victoire Delporte
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France
| | - Houssein El Hajj
- Department of Gynecologic Oncology and Senology, Curie Institute, Saint Cloud, France (Drs. El Hajj)
| | - Claire Martin
- Department of Biostatistics (Dr. Martin), Lille University and Lille University Hospital, ULR 2694 - METRICS: evaluation of health technologies and medical practices, Lille, France
| | - Sophie Delplanque
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France
| | - Yohan Kerbage
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France; University of Lille, Henri Warembourg, Lille, France (Drs. Kerbage, Rubod, and Cosson)
| | - Chrystèle Rubod
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France; University of Lille, Henri Warembourg, Lille, France (Drs. Kerbage, Rubod, and Cosson)
| | - Michel Cosson
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France; University of Lille, Henri Warembourg, Lille, France (Drs. Kerbage, Rubod, and Cosson)
| | - Geraldine Giraudet
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France
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9
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Wohrer H, Koual M, Bentivegna E, Benoit L, Metairie M, Bolze PA, Kerbage Y, Raimond E, Akladios C, Carcopino X, Canlorbe G, Uzan J, Lavoue V, Mimoun C, Huchon C, Koskas M, Costaz H, Margueritte F, Dabi Y, Touboul C, Bendifallah S, Ouldamer L, Delanoy N, Nguyen-Xuan HT, Bats AS, Azaïs H. Prognostic impact of cytoreductive surgery conducted with primary intent, versus cytoreductive surgery after neoadjuvant chemotherapy, in the management of patients with advanced epithelial ovarian cancers: a multicentre, propensity score-matched study from the FRANCOGYN group. BJOG 2023; 130:1511-1520. [PMID: 37165717 DOI: 10.1111/1471-0528.17524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To compare survival and morbidity rates between primary cytoreductive surgery (pCRS) and interval cytoreductive surgery (iCRS) for epithelial ovarian cancer (EOC), using a propensity score. DESIGN We conducted a propensity score-matched cohort study, using data from the FRANCOGYN cohort. SETTING Retrospective, multicentre study of data from patients followed in 15 French department specialized in the treatment of ovarian cancer. SAMPLE Patients included were those with International Federation of Gynaecology and Obstetrics (FIGO) stage III or IV EOC, with peritoneal carcinomatosis, having undergone CRS. METHODS The propensity score was designed using pre-therapeutic variables associated with both treatment allocation and overall survival (OS). MAIN OUTCOME MEASURES The primary outcome was OS. Secondary outcomes included recurrence-free survival (RFS), quality of CRS and other variables related to surgical morbidity. RESULTS A total of 513 patients were included. Among these, 334 could be matched, forming 167 pairs. No difference in OS was found (hazard ratio, HR = 0.8, p = 0.32). There was also no difference in RFS (median = 26 months in both groups) nor in the rate of CRS leaving no macroscopic residual disease (pCRS 85%, iCRS 81.4%, p = 0.76). The rates of gastrointestinal tract resections, stoma, postoperative complications and hospital stay were significantly higher in the pCRS group. CONCLUSIONS Analysis of groups of patients made comparable by propensity score matching showed no difference in survival, but lower postoperative morbidity in patients treated with iCRS.
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Affiliation(s)
- Henri Wohrer
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Meriem Koual
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saint-Père, Paris, France
| | - Enrica Bentivegna
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Louise Benoit
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saint-Père, Paris, France
| | - Marie Metairie
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Pierre-Adrien Bolze
- Department of Gynecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Yohan Kerbage
- CHU Lille, Service de Chirurgie Gynécologique, Université Lille, Lille, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Cherif Akladios
- Department of Gynaecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, Marseille, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital, Paris, France
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, Paris, France
- University Institute of Cancer, Sorbonne University, Paris, France
| | - Jennifer Uzan
- Department of Obstetrics Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Creteil, France
| | - Vincent Lavoue
- Service de Gynécologie, INSERM 1242, Oncogenesis, Stress and Signaling, CRLC Eugène Marquis, Université de Rennes 1, Hopital Sud, CHU de Rennes, Rennes, France
| | - Camille Mimoun
- Service de Chirurgie Gynécologique - Université de Paris, Hôpital Lariboisière, Paris, France
| | - Cyrille Huchon
- Service de Chirurgie Gynécologique - Université de Paris, Hôpital Lariboisière, Paris, France
| | - Martin Koskas
- Division of Gynaecologic Oncology, Bichat University Hospital, Paris, France
| | - Hélène Costaz
- Department of Surgical Oncology, Georges-Francois Leclerc Centre, Dijon, France
| | - François Margueritte
- Department of Gynaecology, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye Site Hospitalier de Poissy, Poissy, France
| | - Yohann Dabi
- Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Lobna Ouldamer
- Department of Gynaecology, Hôpital Universitaire de Tours, Tours, France
| | - Nicolas Delanoy
- Institut du Cancer Paris CARPEM, Université de Paris Cité, Paris, France
- Department of Medical Oncology, AP-HP Centre, Hopital Européen Georges Pompidou, Paris, France
| | - Huyen-Thu Nguyen-Xuan
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
| | - Anne-Sophie Bats
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- Institut du Cancer Paris CARPEM, Université de Paris Cité, Paris, France
- INSERM UMR-S 1147, Centre de Recherche des Cordeliers, University of Paris Cité, Paris, France
| | - Henri Azaïs
- Department of Gynaecological Oncological and Breast Surgery, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- Institut du Cancer Paris CARPEM, Université de Paris Cité, Paris, France
- INSERM UMR-S 1147, Centre de Recherche des Cordeliers, University of Paris Cité, Paris, France
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10
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Bartin R, Delangle R, Mergui JL, Azaïs H, Bolze PA, Philip CA, Kerbage Y, Raimond E, Lecointre L, Carcopino X, Castela M, Uzan C, Canlorbe G. Impact of cervical excisional dimensions on endocervical margins status in adenocarcinoma in situ of the uterine cervix: A multicenter study from the FRANCOGYN group. J Gynecol Obstet Hum Reprod 2023; 52:102622. [PMID: 37321399 DOI: 10.1016/j.jogoh.2023.102622] [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: 05/02/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Excisional procedures have a central role in the management of adenocarcinoma in situ of the cervix (AIS). We aimed to evaluate the relationship between the excisional specimen dimensions and the endocervical margin status. METHODS We conducted a multicentric retrospective study in seven French centers. All cases with proven AIS on a colposcopic biopsy and undergoing an excisional procedure afterwards were included in the analysis. We evaluated the impact of excision length, along with the lateral and anteroposterior diameters on the endocervical margin status. An additional subgroup analysis of the impact of maternal age on endocervical margin status was also conducted. RESULTS Of the 101 cases of AIS diagnosed on initial biopsy, 95 underwent a primary excisional procedure, among which 80% (n = 76/95) had uninvolved endocervical margins and 20% (n = 19/95) had positive endocervical margins. The excisional specimen length was not significantly related to the endocervical margin status. Conversely, both lateral and antero-posterior diameters were significantly correlated with the negative endocervical margins status: OR = 1,19, 95% CI [1.03, 1.40], p = 0.025, for the lateral diameter and OR = 1.34, 95% CI [1.14, 1.64], p = 0.001 for the antero-posterior diameter. The median lateral diameter was 20 mm, IQR (18, 24) in case of endocervical negative margins vs. 18 mm IQR (15, 24) in case of positive endocervical margins (p = 0.039), and the median anteroposterior diameter was 17 mm IQR (15, 20) in case of negative endocervical margins vs 14 mm IQR (11, 15) in case of positive endocervical margins (p = 0.004), respectively. Additionally, in patients over 45 years old, endocervical margin were more likely to be positive despite similar excisional dimensions (7/17 (41%) of positive endocercival margins before 45 years old vs 12/78 (15%) after, p = 0.039) CONCLUSIONS: Endocervical margin statues were significantly related to the transverse diameters (lateral and anteroposterior diameters), but not to the excision specimen length. Reducing the excised length may lead to fewer post-procedure complications but would still allow to obtain a large proportion of negative endocervical margins.
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Affiliation(s)
- Raphael Bartin
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France
| | - Romain Delangle
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France
| | - Jean-Luc Mergui
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France
| | - Henri Azaïs
- Gynecologic and Breast Oncologic Surgery Department, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75015 Paris, France
| | - Pierre-Adrien Bolze
- Department of Gynecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, France
| | - Charles-Andre Philip
- Department of Gynecologic and Oncologic Surgery and Obstetrics, CHU Lyon Croix-Rousse, Université Lyon 1, France
| | - Yohan Kerbage
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Lise Lecointre
- Department of Surgical Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Mathieu Castela
- Scarcell Therapeutics, 101 rue de Sèvres, 75006 Paris, France
| | - Catherine Uzan
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; University Institute of Cancer, Sorbonne University, 75013 Paris, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, 75013 Paris, France; Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France; University Institute of Cancer, Sorbonne University, 75013 Paris, France.
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11
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Jochum F, Angeles MA, Balaya V, Drouin L, Nikolova T, Mathevet P, Lécuru F, Azais H, Betrian S, Bolze PA, Dabi Y, Kerbage Y, Sanson C, Zaccarini F, Guyon F, Akladios C, Hsu A, Bendifallah S, Deluche E, Guani B. Management of patients with advanced epithelial ovarian cancer: a European survey. Arch Gynecol Obstet 2023; 308:535-549. [PMID: 36737552 DOI: 10.1007/s00404-023-06948-3] [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: 10/20/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of this study was to assess current European practices in the management of patients with advanced epithelial ovarian cancer in 2021. METHODS A 58-question electronic survey was distributed anonymously to the members of six European learned societies. Initial diagnostic workup and staging, pathological data, surgical data, treatments and follow-up strategies were assessed. RESULTS A total of 171 participants from 17 European countries responded to emailed surveys. Most participants were experienced practitioners (superior than 15 years of experience) specializing in gynecology-obstetrics (29.8%), surgical oncology (25.1%), and oncogynecology (21.6%). According to most (64.8%) participants, less than 50% of patients were eligible for primary debulking surgery. Variations in the rate of primary debulking surgery depending on the country of origin of the practitioners were observed in this study. The LION study criteria were applied in 70.4% of cases during PDS and 27.1% after chemotherapy. In cases of BRCA1-2 mutations, olaparib was given by 75.0-84.8% of respondents, whereas niraparib was given in cases of BRCA wild-type diseases. CONCLUSIONS This study sheds light on current practices and attitudes regarding the management of patients with advanced epithelial ovarian cancer in Europe in 2021.
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Affiliation(s)
- Floriane Jochum
- Department of Obstetrics and Gynecology, University Hospital, Strasbourg, France.
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France.
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France
| | - Vincent Balaya
- Department of Obstetrics and Gynecology, Foch Hospital, Suresnes, France
| | - Leonor Drouin
- Department of Gynecology, CHU de Limoges, Limoges, France
| | - Tanja Nikolova
- Academic Teaching Hospital of Heidelberg University, Baden-Baden, Germany
| | - Patrice Mathevet
- Women-Mother-Child Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Fabrice Lécuru
- Breast, Gynecology and Reconstructive Surgery Unit, Curie Institute, Paris, France
| | - Henri Azais
- Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, Paris, France
| | - Sarah Betrian
- Department of Medical Oncology, IUCT Oncopole, Toulouse, France
| | | | - Yohann Dabi
- Department of Gynecology, Tenon Hospital, AP-HP, Paris, France
| | - Yohan Kerbage
- Department of Gynecology, Jeanne de Flandre Hospital, Lille, France
| | - Claire Sanson
- Surgical Oncology Department, Gustave Roussy Institute, Villejuif, France
| | - François Zaccarini
- Surgical Oncology Department, Gustave Roussy Institute, Villejuif, France
| | - Fréderic Guyon
- Surgical Oncology Department, Bergonié Institute, Bordeaux, France
| | - Cherif Akladios
- Department of Obstetrics and Gynecology, University Hospital, Strasbourg, France
| | - Arthur Hsu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | | | - Elise Deluche
- Oncology Department, University Hospital, Limoges, France
| | - Benedetta Guani
- Department of Obstetrics and Gynecology, Fribourg Hospital, Fribourg, Switzerland
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12
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Métairie M, Benoit L, Koual M, Bentivegna E, Wohrer H, Bolze PA, Kerbage Y, Raimond E, Akladios C, Carcopino X, Canlorbe G, Uzan J, Lavoué V, Mimoun C, Huchon C, Koskas M, Costaz H, Margueritte F, Dabi Y, Touboul C, Bendifallah S, Ouldamer L, Delanoy N, Nguyen-Xuan HT, Bats AS, Azaïs H. A Suggested Modification to FIGO Stage IV Epithelial Ovarian Cancer. Cancers (Basel) 2023; 15:706. [PMID: 36765667 PMCID: PMC9913138 DOI: 10.3390/cancers15030706] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
International Federation of Gynecology and Obstetrics (FIGO) staging classification for stage IV epithelial ovarian cancer (EOC) separates stages IVA (pleural effusion) and IVB (parenchymal and/or extra-abdominal lymph node metastases). We aimed to evaluate its prognostic impact and to compare survival according to the initial metastatic location. We conducted a multicenter study between 2000 and 2020, including patients with a FIGO stage IV EOC. Primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS) and recurrence rates. We included 307 patients: 98 (32%) had FIGO stage IVA and 209 (68%) had FIGO stage IVB. The median OS and PFS of stage IVA patients were significantly lower than those of stage IVB patients (31 versus 45 months (p = 0.02) and 18 versus 25 months (p = 0.01), respectively). Recurrence rate was higher in stage IVA than IVB patients (65% versus 47% (p = 0.004)). Initial pleural involvement was a poor prognostic factor with a median OS of 35 months versus 49 months for patients without initial pleural involvement (p = 0.024). Patients with FIGO stage IVA had a worse prognosis than patients with FIGO stage IVB EOC. Pleural involvement appears to be relevant for predicting survival. We suggest a modification of the current FIGO staging classification.
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Affiliation(s)
- Marie Métairie
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Louise Benoit
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
- INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saints-Pères, 75006 Paris, France
| | - Meriem Koual
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
- INSERM UMR-S 1124, University of Paris Cité, Centre Universitaire des Saints-Pères, 75006 Paris, France
| | - Enrica Bentivegna
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Henri Wohrer
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Pierre-Adrien Bolze
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Lyon Sud University Hospital, Hospices Civils de Lyon, Université Lyon 1, 69002 Lyon, France
| | - Yohan Kerbage
- CHU Lille, Department of Gynaecologic Surgery, University Lille, 59000 Lille, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, 51100 Reims, France
| | - Cherif Akladios
- Department of Gynaecology, Hôpitaux Universitaires de Strasbourg, 67200 Strasbourg, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), University Avignon, CNRS, IRD, IMBE, UMR 7263, 13397 Marseille, France
| | - Geoffroy Canlorbe
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological and Breast Surgery and Oncology, Pitié-Salpêtrière, 75013 Paris, France
- Centre de Recherche Saint-Antoine (CRSA), INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, 75012 Paris, France
- University Institute of Cancer, Sorbonne University, 75013 Paris, France
| | - Jennifer Uzan
- Department of Obstetrics Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
| | - Vincent Lavoué
- Department of Gynaecological Surgery, INSERM U1085, équipe 8, CRLC Eugène Marquis, Université de Rennes 1, Hôpital Sud, CHU de Rennes, 35000 Rennes, France
| | - Camille Mimoun
- Department of Gynaecological Oncological and Breast Surgery—Université de Paris, Hôpital Lariboisière, 75010 Paris, France
| | - Cyrille Huchon
- Department of Gynaecological Oncological and Breast Surgery—Université de Paris, Hôpital Lariboisière, 75010 Paris, France
| | - Martin Koskas
- AP-HP (Assistance Publique des Hôpitaux de Paris), Division of Gynaecologic Oncology, Bichat University Hospital, 75018 Paris, France
| | - Hélène Costaz
- Department of Surgical Oncology, Georges-François Leclerc Centre, 21000 Dijon, France
| | - François Margueritte
- Department of Gynaecology, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-laye, Site Hospitalier de Poissy, 78498 Poissy, France
| | - Yohann Dabi
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology ans Obstetrics, Hôpital Tenon, 75020 Paris, France
| | - Cyril Touboul
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology ans Obstetrics, Hôpital Tenon, 75020 Paris, France
| | - Sofiane Bendifallah
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecology ans Obstetrics, Hôpital Tenon, 75020 Paris, France
| | - Lobna Ouldamer
- Department of Gynaecology, Hôpital Universitaire de Tours, 37000 Tours, France
| | - Nicolas Delanoy
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Medical Oncology, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Huyen-Thu Nguyen-Xuan
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
| | - Anne-Sophie Bats
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
- INSERM UMR-S 1147, University of Paris Cité, Centre de Recherche des Cordeliers, 75006 Paris, France
- Institut du Cancer Paris CARPEM, 75006 Paris, France
| | - Henri Azaïs
- AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynaecological Oncological and Breast Surgery, Hôpital Européen Georges-Pompidou, 75015 Paris, France
- INSERM UMR-S 1147, University of Paris Cité, Centre de Recherche des Cordeliers, 75006 Paris, France
- Institut du Cancer Paris CARPEM, 75006 Paris, France
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Martin FA, Dion L, Nyangoh Timoh K, Dupré PF, Azaïs H, Bendifallah S, Touboul C, Dabi Y, Graesslin O, Raimond E, Costaz H, Kerbage Y, Huchon C, Mimoun C, Koskas M, Akladios C, Lecointre L, Canlorbe G, Chauvet P, Ouldamer L, Levêque J, Lavoué V. Endometrial cancer of the very elderly: Management and survival in the Francogyn population. Eur J Surg Oncol 2023; 49:1023-1030. [PMID: 36707344 DOI: 10.1016/j.ejso.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
INTRODUCTION We aimed to describe management and survival of patients with endometrial cancer (EC) ≥80 years to identify poor prognosis criteria. METHODS We collected clinical, histologic, surgical and follow-up data for patients with EC ≥ 80 years included in a multicenter French cohort (FRANCOGYN) who underwent primary surgical treatment from 1999 to 2019. The outcomes were overall survival (OS) and disease-free survival (DFS). We performed a descriptive analysis then a survival time analysis and comparison using the Kaplan Meier method and log-rank test. RESULTS Of the 1647 patients with EC who received treatment during the study period, 184 (11.17%) were ≥80 years. The mean age was 84 years (±3.34). Thirty-three patients (25.4%) died during the follow-up period and 26 relapsed (18.4%). Forty-nine patients were lost to follow-up (27.37%). The median follow-up time was 15.3 months (4.9-28.8). The median OS and DFS was 16.4 months (6.3-24.9) and 13.6 months (4.5-26.6), respectively. Eighty-three patients received adjuvant therapy (45.11%), out of 95 who had a formal or relative indication. Four patients received adjuvant chemotherapy (2.6%), out of 61 who had a formal or relative indication. Inappropriate or underuse of chemotherapy was significantly associated with a lower median OS of 12.6 months [3.73-24] versus 17.3 months [7.93-41.77] when performed appropriately (HR = 4.14, CI 95% [1.62-10.56]), and a lower median DFS of 10.83 months [3.73-24] versus 17.3 months [7.93-28.5] (HR = 9.04, CI 95% [2.04-40.12]). CONCLUSION Our results suggest that very elderly patients with EC should receive adjuvant chemotherapy according to the standard care guidelines.
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Affiliation(s)
| | - Ludivine Dion
- Gynecology Department of Rennes Teaching Hospital, France
| | | | | | - Henri Azaïs
- Gynecology Department of Georges Pompidou European Teaching Hospital, AP-HP, France
| | - Sofiane Bendifallah
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
| | - Cyril Touboul
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
| | - Yohann Dabi
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
| | | | - Emilie Raimond
- Gynecology Department of Reims Teaching Hospital, AP-HP, France
| | - Hélène Costaz
- Department of Surgical Oncology, Centre Georges François Leclerc, Comprehensive Cancer Center of Dijon, France
| | - Yohan Kerbage
- Gynecology Department of Lille Teaching Hospital, France
| | - Cyrille Huchon
- Gynecology Department of Lariboisiere Teaching Hospital, AP-HP, France
| | - Camille Mimoun
- Gynecology Department of Lariboisiere Teaching Hospital, AP-HP, France
| | - Martin Koskas
- Gynecology Department of Bichat Teaching Hospital, AP-HP, France
| | - Cherif Akladios
- Gynecology Department of Strasbourg Teaching Hospital, France
| | - Lise Lecointre
- Gynecology Department of Strasbourg Teaching Hospital, France
| | - Geoffroy Canlorbe
- Gynecology Department of La Pitié Salpétrière Teaching Hospital, AP-HP, France
| | - Pauline Chauvet
- Gynecology Department of Clermont Ferrand Teaching Hospital, AP-HP, France
| | - Lobna Ouldamer
- Gynecology Department of Tours Teaching Hospital, AP-HP, France
| | - Jean Levêque
- Gynecology Department of Rennes Teaching Hospital, France
| | - Vincent Lavoué
- Gynecology Department of Rennes Teaching Hospital, France.
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14
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Lallemant M, Giraudet G, Delporte V, Behal H, Rubod C, Delplanque S, Kerbage Y, Cosson M. Long-Term Assessment of Pelvic Organ Prolapse Reoperation Risk in Obese Women: Vaginal and Laparoscopic Approaches. J Clin Med 2022; 11:jcm11226867. [PMID: 36431343 PMCID: PMC9695500 DOI: 10.3390/jcm11226867] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to compare reoperation risks after pelvic organ prolapse repair at 5-year follow-up between obese, overweight, and normal-weight women and to assess these risks accounting for the surgical procedure. We performed a retrospective chart review of all the women who underwent POP repair by transvaginal mesh surgery between January 2005 and January 2009 or laparoscopic sacrocolpopexy between January 2003 and December 2013 at the Gynecologic Surgery Department of the Lille University Hospital. During the study period, 744 women who underwent POP repair were divided into three groups: 382 (51%), 240 (32%), and 122 (16%) in the nonobese group (BMI < 25 kg/m²), overweight group (25 kg/m² ≤ BMI < 30 kg/m²), and obese group (BMI ≥ 30 kg/m²), respectively. The primary outcome was global reoperation. The median duration of follow-up was 87 months. The risks of global reoperation did not significantly differ between the three BMI groups (adjusted HR (95% CI): 1.12 (0.69 to 1.82) for overweight women and 0.90 (0.46 to 1.74) for obese women compared to normal-weight women, adjusted p = 0.80), nor among the women who underwent transvaginal mesh surgery or laparoscopic sacrocolpopexy. The risks of reoperation for POP recurrence, stress urinary incontinence, or mesh-related complications did not significantly differ between the three BMI groups in the overall population nor accounting for the surgical procedure. In conclusion, obesity does not seem to be a risk factor of reoperation for POP recurrence, SUI, or mesh-related complications in the long term regardless of the surgical approach.
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Affiliation(s)
- Marine Lallemant
- Department of Gynecologic Surgery, Jeanne de Flandre University Hospital, 59000 Lille, France
- Correspondence:
| | - Géraldine Giraudet
- Department of Gynecologic Surgery, Jeanne de Flandre University Hospital, 59000 Lille, France
| | - Victoire Delporte
- Department of Gynecologic Surgery, Jeanne de Flandre University Hospital, 59000 Lille, France
| | - Hélène Behal
- Santé Publique: Epidémiologie et Qualité des Soins, Unité de Biostatistiques, University of Lille, France CHU Lille, EA 2694, 59000 Lille, France
| | - Chrystele Rubod
- Department of Gynecologic Surgery, Jeanne de Flandre University Hospital, 59000 Lille, France
| | - Sophie Delplanque
- Department of Gynecologic Surgery, Jeanne de Flandre University Hospital, 59000 Lille, France
| | - Yohan Kerbage
- Department of Gynecologic Surgery, Jeanne de Flandre University Hospital, 59000 Lille, France
| | - Michel Cosson
- Department of Gynecologic Surgery, Jeanne de Flandre University Hospital, 59000 Lille, France
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Gauci PA, Deluche E, Azais H, Zaccarini F, Guani B, Balaya V, Kerbage Y, Jochum F, Sanson C, Guyon F, Akladios C, Bendifallah S, Dabi Y. Surgical management of patients with advanced ovarian cancer: Results of a French National Survey. J Gynecol Obstet Hum Reprod 2022; 51:102463. [DOI: 10.1016/j.jogoh.2022.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
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16
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Lallemant M, Clermont-Hama Y, Giraudet G, Rubod C, Delplanque S, Kerbage Y, Cosson M. Long-Term Outcomes after Pelvic Organ Prolapse Repair in Young Women. J Clin Med 2022; 11:jcm11206112. [PMID: 36294437 PMCID: PMC9605202 DOI: 10.3390/jcm11206112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to describe the long-term outcomes of Pelvis Organ Prolapse (POP) repair in women under 40 years old. A retrospective chart review of all POP repairs performed in women ≤40 years old between January 1997 and December 2015 in the Gynecologic Surgery Department of Lille University Hospital was performed. Inclusion criteria were all women ≤40 years old who underwent a POP repair with a stage ≥2 POP according to the Baden and Walker classification. The study population was separated into three groups: a sacrohysteropexy group, a vaginal native tissue repair (NTR) group, and a transvaginal mesh surgery (VMS) group. The primary outcome was reoperation procedures for a symptomatic recurrent POP. Secondary outcomes were other complications. During the study period, 43 women ≤ 40 years old who underwent a POP repair were included and separated into three groups: 28 patients (68%), 8 patients (19%), and 7 patients (16%) in the sacrohysteropexy, VMS, and NTR groups respectively. The mean followup time was 83 ± 52 months. POP recurrence, reoperated or not, was essentially diagnosed in the VMS group (87.5%) and the NTR group (50%). POP recurrence repairs were performed for nine patients (21%): 7%, 62.5%, and 25% in the sacrohysteropexy, VMS, and NTR groups, respectively. Global reoperation concerned 10 patients (23%) whatever the type of POP surgery, mainly patients from the VMS group (75%) and from the NTR group (25%). It occurred in only 7% of patients from the sacrohysteropexy group. Two patients (4%) presented a vaginal exposure of the mesh (in the VMS group). De novo stress urinary incontinence was encountered by nine patients (21%): 29% and 12.5% in the sacrohysteropexy and NTR groups, respectively. Despite the risk of recurrence, POP repair should be proposed to young women in order to restore their quality of life. Vaginal native tissue repair or sacrohysteropexy should be performed after explaining to women the advantages and disadvantages of each procedure.
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Simon O, Dion L, Nyangoh Timoh K, Dupré PF, Azaïs H, Bendifallah S, Touboul C, Dabi Y, Graesslin O, Raimond E, Costaz H, Kerbage Y, Huchon C, Mimoun C, Koskas M, Akladios C, Lecointre L, Canlorbe G, Chauvet P, Ouldamer L, Levêque J, Lavoué V. Impact of severe obesity in the management of patients with high-risk endometrial cancer: A FRANCOGYN study. J Gynecol Obstet Hum Reprod 2022; 51:102429. [DOI: 10.1016/j.jogoh.2022.102429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/29/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
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18
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Ozenne A, De Berti M, Body G, Carcopino X, Graesslin O, Kerbage Y, Akladios C, Huchon C, Bricou A, Mimoun C, Raimond E, Ouldamer L. Risk Factors for Recurrence of Borderline Ovarian Tumours after Conservative Surgery and Impact on Fertility: A Multicentre Study by the Francogyn Group. J Clin Med 2022; 11:jcm11133645. [PMID: 35806930 PMCID: PMC9267171 DOI: 10.3390/jcm11133645] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction: Borderline ovarian tumours (BOT) represent 10–20% of epithelial tumours of the ovary. Although their prognosis is excellent, the recurrence rate can be as high as 30%, and recurrence in the infiltrative form accounts for 3% to 5% of recurrences. Affecting, in one third of cases, women of childbearing age, the surgical strategy with ovarian conservation is now recommended despite a significant risk of recurrence. Few studies have focused exclusively on patients who have received ovarian conservative treatment in an attempt to identify factors predictive of recurrence and the impact on fertility. The objective of this study was to identify the risk factors for recurrence of BOT after conservative treatment and the impact on fertility. Material and methods: This was a retrospective, multicentre study of women who received conservative surgery for BOT between February 1997 and September 2020. We divided the patients into two groups, the “R group” with recurrence and the “NR group” without recurrence. Results: Of 175 patients included, 35 had a recurrence (R group, 20%) and 140 had no recurrence (NR group, 80%). With a mean follow-up of 30 months (IQ 8–62.5), the overall recurrence rate was 20%. Recurrence was BOT in 17.7% (31/175) and invasive in 2.3% (4/175). The mean time to recurrence was 29.5 months (IQ 16.5–52.5). Initial complete peritoneal staging (ICPS) was performed in 42.5% of patients (n = 75). In multivariate analysis, age at diagnosis, nulliparity, advanced FIGO stage, the presence of peritoneal implants, and the presence of a micropapillary component for serous tumours were factors influencing the occurrence of recurrence. The post-surgery fertility rate was 67%. Conclusion: This multicentre study is to date one of the largest studies analysing the risk factors for recurrence of BOT after conservative surgery. Five risk factors were found: age at diagnosis, nulliparity, advanced FIGO stage, the presence of implants, and a micropapillary component. Only 25% of the patients with recurrence underwent ICPS. These results reinforce the interest of initial peritoneal staging to avoid ignoring an advanced tumour stage.
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Affiliation(s)
- Adele Ozenne
- Department of Gynecology, Tours University Hospital, 37044 Tours, France; (A.O.); (M.D.B.); (G.B.)
| | - Marion De Berti
- Department of Gynecology, Tours University Hospital, 37044 Tours, France; (A.O.); (M.D.B.); (G.B.)
| | - Gilles Body
- Department of Gynecology, Tours University Hospital, 37044 Tours, France; (A.O.); (M.D.B.); (G.B.)
- INSERM U1069, Université François-Rabelais, 37044 Tours, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France;
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes University, 51100 Reims, France; (O.G.); (E.R.)
| | - Yohan Kerbage
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital, CHRU LILLE, Rue Eugene Avinée, 59037 Lille, France;
| | - Cherif Akladios
- Department of Surgical Gynecology, Strasbourg University Hospital, 67000 Strasbourg, France;
| | - Cyrille Huchon
- Department of Gynecology, CHI Poissy-St-Germain, EA 7285 Risques Cliniques et Sécurité en Santé des Femmes, Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France;
| | - Alexandre Bricou
- Department of Gynecology, Bobigny University, AP-HP, Jean-Verdier Hospital, 93140 Bondy, France;
| | - Camille Mimoun
- Department of Gynecology and Obstetrics, Lariboisiere Hospital, 750019 Paris, France;
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes University, 51100 Reims, France; (O.G.); (E.R.)
| | - Lobna Ouldamer
- Department of Gynecology, Tours University Hospital, 37044 Tours, France; (A.O.); (M.D.B.); (G.B.)
- INSERM U1069, Université François-Rabelais, 37044 Tours, France
- Correspondence: ; Tel.: +33-2-47-47-47-41; Fax: +33-2-47-47-92-73
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Kerbage Y, Dericquebourg S, Collinet P, Verpillat P, Giraudet G, Rubod C. Cystic adenomyoma surgery. J Gynecol Obstet Hum Reprod 2022; 51:102313. [PMID: 35031510 DOI: 10.1016/j.jogoh.2022.102313] [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: 08/06/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Cystic adenomyoma is a lesion located within the myometrium. It is lined with endometrium and has hemorrhagic content. This rare entity has been described as a focal form of adenomyosis. However, it is poorly understood, and the management of symptomatic patients is not codified. Our objective is to evaluate the effectiveness of treatment with planned surgery for cystic adenomyoma on symptoms and fertility in a retrospective series of patients. STUDY DESIGN This is a retrospective study between January 2011 and January 2018 in a university hospital of patients that had surgery for cystic adenomyoma with uterine preservation. RESULTS Pre-operative, per-operative, and post-operative data were recorded. Of the 18 patients included, 3 were lost to follow-up; 15 underwent laparoscopic surgery and 3 operative hysteroscopies. Complications during and after surgery were rare, involving only 3 patients, and of low severity. One patient saw no improvement in pain after surgery and 2 patients saw only partial improvement in their pain; 7 patients achieved at least one pregnancy with favorable outcome after surgery. CONCLUSION Based on this series, we argue that conservative surgical treatment for cystic adenomyoma generally improves pain and fertility without causing morbidity.
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Affiliation(s)
- Yohan Kerbage
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France; CHU Lille, University Lille, Lille F-59000, France.
| | - Sarah Dericquebourg
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France
| | - Pierre Collinet
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France; CHU Lille, University Lille, Lille F-59000, France
| | | | - Géraldine Giraudet
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France
| | - Chrystèle Rubod
- Service de Chirurgie Gynécologique, CHU Lille, 1 Avenue Oscar Lambret, Lille F-59000, France; CHU Lille, University Lille, Lille F-59000, France
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20
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Kerbage Y, Loridan A, Jean dit Gauthier E, Cosson M, Giraudet G, Rubod C. Evaluation of the contribution of a multimedia tool in the monitoring of low-risk pregnancy: Qualitative study carried out with general practitioners in France. J Gynecol Obstet Hum Reprod 2022; 51:102319. [DOI: 10.1016/j.jogoh.2022.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
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21
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Drouin L, Guani B, Balaya V, Azaïs H, Betrian S, Bolze PA, Dabi Y, Kerbage Y, Sanson C, Zaccarini F, Mathevet P, Lécuru F, Guyon F, Akladios C, Bendifallah S, Deluche E. Results of a 2021 French National Survey on Management of Patients with Advanced Stage Epithelial Ovarian Cancer. J Clin Med 2021; 10:4829. [PMID: 34768353 PMCID: PMC8585030 DOI: 10.3390/jcm10214829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to assess current French practices in the management of patients with advanced epithelial ovarian cancer. METHOD a 58-question electronic survey was distributed anonymously to the members of the SFOG (French Society of Gynaecological Oncology), GINECO-ARCAGY (National Investigators Group for Ovarian and Breast Cancer Studies in France) and FRANCOGYN (French research group in oncological and gynaecological surgery). Initial diagnostic workup and staging, pathological data, surgical data, treatments and follow-up strategies were assessed. RESULTS a total of 107 participants responded to emailed surveys. Most of the respondents were obstetrician-gynaecologists (37.4%), surgical oncologists (34.6%) and medical oncologists (17.8%). According to most (76.8%) participants, less than 50% of patients were eligible for primary debulking surgery (PDS). The LION study criteria were applied in 69.5% of cases during PDS and 39% after chemotherapy. The timing of BRCA testing was very heterogeneous and ranged from 1 to 6 months. The use of bevacizumab as an adjuvant schedule was lower in cases of no residual disease (for 54.5% of respondents) compared to cases of residual disease (for 63.6% of respondents). In cases of BRCA1-2 mutations, olaparib was given by 75.8-84.8% of respondents, whereas niraparib was given in cases of BRCA wild-type diseases. CONCLUSION this survey provides an extensive and a unique review of current French practices in the management of patients with advanced epithelial ovarian cancer in 2021.
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Affiliation(s)
- Leonor Drouin
- Department of Gynecology, CHU de Limoges, 87000 Limoges, France;
| | - Benedetta Guani
- Department of Gynecology and Obstetrics, 1700 Fribourg, Switzerland;
| | - Vincent Balaya
- Department of Gynecology, CHU Vaudois, 1011 Lausanne, Switzerland; (V.B.); (P.M.)
| | - Henri Azaïs
- Gynecologic and Breast Oncologic Surgery Department, Georges-Pompidou European Hospital, 75015 Paris, France;
| | - Sarah Betrian
- Department of Medical Oncology, IUCT Oncopole, 31100 Toulouse, France;
| | - Pierre-Adrien Bolze
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, 69100 Villeurbanne, France;
| | - Yohann Dabi
- Department of Gynecology, Sorbonnes University, Tenon Hospital, AP-HP, 75020 Paris, France; (Y.D.); (S.B.)
| | - Yohan Kerbage
- Department of Obstetrics and Gynecology, Lille University Hospital, 59000 Lille, France;
| | - Claire Sanson
- Surgical Oncology Department, Gustave Roussy Institute, 94805 Villejuif, France; (C.S.); (F.Z.)
| | - François Zaccarini
- Surgical Oncology Department, Gustave Roussy Institute, 94805 Villejuif, France; (C.S.); (F.Z.)
| | - Patrice Mathevet
- Department of Gynecology, CHU Vaudois, 1011 Lausanne, Switzerland; (V.B.); (P.M.)
| | - Fabrice Lécuru
- Breast, Gynecology and Reconstructive Surgery Unit, Curie Institute, 75005 Paris, France;
| | - Fréderic Guyon
- Surgical Oncology Department, Bergonié Institute, 33000 Bordeaux, France;
| | - Cherif Akladios
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, 67091 Strasbourg, France;
| | - Sofiane Bendifallah
- Department of Gynecology, Sorbonnes University, Tenon Hospital, AP-HP, 75020 Paris, France; (Y.D.); (S.B.)
| | - Elise Deluche
- Department of Medical Oncology, CHU de Limoges, 87000 Limoges, France
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22
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Mimoun C, Paoletti X, Gaillard T, Crestani A, Benifla JL, Mezzadri M, Bendifallah S, Touboul C, Bricou A, Dabi Y, Canlorbe G, Kerbage Y, Lavoué V, Ouldamer L, Lecointre L, Coutant C, Fauconnier A, Rouzier R, Huchon C. Using a new diagnostic tool to predict lymph node metastasis in advanced epithelial ovarian cancer leads to simple lymphadenectomy decision rules: A multicentre study from the FRANCOGYN group. PLoS One 2021; 16:e0258783. [PMID: 34665839 PMCID: PMC8525770 DOI: 10.1371/journal.pone.0258783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop a new diagnostic tool to predict lymph node metastasis (LNM) in patients with advanced epithelial ovarian cancer undergoing primary cytoreductive surgery. MATERIALS AND METHOD The FRANCOGYN group's multicenter retrospective ovarian cancer cohort furnished the patient population on which we developed a logistic regression model. The prediction model equation enabled us to create LNM risk groups with simple lymphadenectomy decision rules associated with a user-friendly free interactive web application called shinyLNM. RESULTS 277 patients from the FRANCOGYN cohort were included; 115 with no LNM and 162 with LNM. Three variables were independently and significantly (p<0.05) associated with LNM in multivariate analysis: pelvic and/or para-aortic LNM on CT and/or PET/CT (p<0.00), initial PCI ≥ 10 and/or diaphragmatic carcinosis (p = 0.02), and initial CA125 ≥ 500 (p = 0.02). The ROC-AUC of this prediction model after leave-one-out cross-validation was 0.72. There was no difference between the predicted and the observed probabilities of LNM (p = 0.09). Specificity for the group at high risk of LNM was 83.5%, the LR+ was 2.73, and the observed probability of LNM was 79.3%; sensitivity for the group at low-risk of LNM was 92.0%, the LR- was 0.24, and the observed probability of LNM was 25.0%. CONCLUSION This new tool may prove useful for improving surgical planning and provide useful information for patients.
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Affiliation(s)
- Camille Mimoun
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
- Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", UVSQ, Montigny-Le-Bretonneux, France
- Department of Surgical Oncology, Curie Institute, Saint-Cloud, France
- * E-mail:
| | | | - Thomas Gaillard
- Department of Surgical Oncology, Curie Institute, Saint-Cloud, France
| | - Adrien Crestani
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
| | - Jean-Louis Benifla
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
| | - Matthieu Mezzadri
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
| | - Sofiane Bendifallah
- Department of Gynecology and Obstetrics, Tenon University Hospital, AP-HP, Paris, France
| | - Cyril Touboul
- Department of Gynecology and Obstetrics, Tenon University Hospital, AP-HP, Paris, France
| | - Alexandre Bricou
- Department of Obstetrics, Gynecology and Reproductive Medicine, CH Jean Verdier, AP-HP, Bondy, France
| | - Yohann Dabi
- Department of Gynecology and Obstetrics, CHIC, Créteil, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Yohan Kerbage
- Department of Gynecologic Surgery, Jeanne de Flandre Hospital, CHU of Lille, Loos, France
| | | | - Lobna Ouldamer
- Department of Obstetrics and Gynecology, Bretonneau Hospital, CHU of Tours, Tours, France
| | - Lise Lecointre
- Department of Obstetrics and Gynecology, University Hospital Center, Strasbourg, France
| | - Charles Coutant
- Department of Surgical Oncology, Georges-François Leclerc Cancer Center, Dijon, France
| | - Arnaud Fauconnier
- Department of Obstetrics and Gynecology, Poissy-St Germain Hospital, Poissy, France
| | - Roman Rouzier
- Department of Surgical Oncology, Curie Institute, Saint-Cloud, France
- INSERM U900 STAMPM Team, Saint Cloud, France
| | - Cyrille Huchon
- Department of Gynecology and Obstetrics, Lariboisière University Hospital, AP-HP, Paris, France
- Research Unit EA 7285 "Risk and Safety in Clinical Medicine for Women and Perinatal Health", UVSQ, Montigny-Le-Bretonneux, France
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Touboul C, Legendre G, Agostini A, Akladios C, Bendifallah S, Bolze PA, Bouet PE, Chauvet P, Collinet P, Dabi Y, Delotte J, Deffieux X, Dion L, Gauthier T, Kerbage Y, Koskas M, Millet P, Narducci F, Ouldamer L, Ploteau S, Santulli P, Golfier F. [Guidelines for Clinical Practice of the French College of Obstetricians and Gynecologists 2021: Prophylactic procedures associated with gynecologic surgery]. ACTA ACUST UNITED AC 2021; 49:805-815. [PMID: 34520857 DOI: 10.1016/j.gofs.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To draw up recommendations on the use of prophylactic gynecologic procedures during surgery for other indications. DESIGN A consensus panel of 19 experts was convened. A formal conflict of interest policy was established at the onset of the process and applied throughout. The entire study was performed independently without funding from pharmaceutical companies or medical device manufacturers. The panel applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the quality of evidence on which the recommendations were based. The authors were advised against making strong recommendations in the presence of low-quality evidence. Some recommendations were ungraded. METHODS The panel studied 22 key questions on seven prophylactic procedures: 1) salpingectomy, 2) fimbriectomy, 3) salpingo-oophorectomy, 4) ablation of peritoneal endometriosis, 5) adhesiolysis, 6) endometrial excision or ablation, and 7) cervical ablation. RESULTS The literature search and application of the GRADE system resulted in 34 recommendations. Six were supported by high-quality evidence (GRADE 1+/-) and 28 by low-quality evidence (GRADE 2+/-). Recommendations on two questions were left ungraded due to a lack of evidence in the literature. CONCLUSIONS A high level of consensus was achieved among the experts regarding the use of prophylactic gynecologic procedures. The ensuing recommendations should result in improved current practice.
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Affiliation(s)
- C Touboul
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France.
| | - G Legendre
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Agostini
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de la Conception (AP-HM), Marseille, France
| | - C Akladios
- Service de Gynécologie Obstétrique et Médecine de la Reproduction des hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - S Bendifallah
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - P A Bolze
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - P E Bouet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Anger, 4, rue Larrey, 49933 Angers cedex 9, France
| | - P Chauvet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU Estaing, 1, place Lucie-Aubrac, 63000 Clermont-Ferrand, France
| | - P Collinet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - Y Dabi
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Tenon (AP-HP), Sorbonne Université, 4, rue de la Chine, 75020 Paris, France
| | - J Delotte
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - X Deffieux
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital A.-Béclêre (AP-HP), 157, rue de la Porte-de-Trivaux, 92140 Clamart, France
| | - L Dion
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du Centre Hospitalier Universitaire de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - T Gauthier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Limoges, 8, avenue Dominique-Larrey, 87000 Limoges, France
| | - Y Kerbage
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Jeanne-de-Flandre, avenue Eugène-Avinée, 59000 Lille, France
| | - M Koskas
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de de l'hôpital Bichat (AP-HP), 46, rue Henri-Huchard, 75018 Paris, France
| | - P Millet
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital de l'Archet 2, 151, route de Saint-Antoine, 06200 Nice, France
| | - F Narducci
- Département de Cancérologie Gynécologique, Centre de Lutte Contre le Cancer Oscar-Lambret, Lille, France
| | - L Ouldamer
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - S Ploteau
- Service de Gynécologie Obstétrique et Médecine de la Reproduction du CHU de Nantes, 38 bd Jean-Monnet, 44093 Nantes cedex 1, France
| | - P Santulli
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'Hôpital Cochin (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - F Golfier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction de l'hôpital Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
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Ouazana M, Kerbage Y, Chauvet P, Collinet P, Bouet PE, Touboul C, Legendre G, Golfier F, Ploteau S, Santulli P. Prophylactic procedures associated with gynecological surgery for the management of superficial endometriosis and adhesions. Clinical practice guidelines from the French College of Gynecologists and Obstetricians (CNGOF) ✰. J Gynecol Obstet Hum Reprod 2021; 50:102206. [PMID: 34391952 DOI: 10.1016/j.jogoh.2021.102206] [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: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To provide guidelines from the French College of Obstetricians and Gynecologists (CNGOF), based on the best currently available evidence, for the prophylactic procedures associated with gynecological surgery for benign disease such as superficial endometriosis lesions and adhesions. METHODS The CNGOF has decided to adopt the AGREE II and GRADE systems for grading scientific evidence. Each recommendation for practice was allocated a grade that reflects the quality of evidence (QE) (clinical practice guidelines). RESULTS Endometriosis and pelvic pain Superficial endometriosis can be entirely asymptomatic. Surgical treatment of asymptomatic superficial peritoneal endometriosis is not recommended in women of childbearing age for the prevention of pelvic pain, especially in case of proximity to noble organs (e.g., the ureters, rectum and sigmoid, and ovaries in nulligravida) as there is no evidence that the disease will progress to become symptomatic (low level of evidence). In case of accidental discovery of superficial endometriosis in women of childbearing age with pelvic pain, it is recommended that the lesions are excised, if surgically accessible. Removal of superficial endometriosis lesions in patients with painful symptoms improves quality of life and pain (low level of evidence). Endometriosis and infertility It appears that women with isolated superficial endometriosis diagnosed by laparoscopy with histological confirmation have a significantly higher incidence of primary infertility than patients without endometriosis. However, there is no data regarding the impact of treatment of these lesions on the fertility in these women or on the natural course of their disease (low level of evidence). It is recommended that excision is performed rather than monopolar coagulation of superficial endometriosis lesions in infertile women, as this results in a higher spontaneous pregnancy rate (low level of evidence). Adhesions and pelvic pain There is limited data in the literature regarding the benefit of performing systematic adhesiolysis during laparoscopy to prevent pelvic pain when incidental pelvic adhesions are discovered. For patients with pelvic pain, it is probably better not to perform adhesiolysis to prevent pelvic pain, although this can be decided on a case-by-case basis depending on the extent of the adhesions, the topography, and the type of surgery considered (low level of evidence). For asymptomatic patients, it is recommended not to perform adhesiolysis to prevent pelvic pain due to the lack of clear efficacy both short- or long-term and due to the increased risk of surgical injuries (low level of evidence). Adhesions and infertility There is limited data in the literature regarding the potential benefit of performing systematic adhesiolysis when there is an incidental discovery of pelvic adhesions during laparoscopy to prevent infertility. For infertile women, in the event of fortuitous discovery of adhesions at laparoscopy, it is probably better not to perform complex adhesiolysis. Only adhesiolysis of tubo-ovarian adhesions that are minimal or slight in terms of their extension and/or their nature may be useful to improve the chances of spontaneous pregnancy. However, it remains to be decided on a case-by-case basis depending on other potential causes of infertility (low level of evidence). For women without known infertility issues, it is probably better not to perform systematic adhesiolysis in order to improve their pregnancy chances, considering the balance between the unknown benefit and the risks of complications inherent to surgery (low level of evidence). CONCLUSION Further investigations are needed in order to increase the quality of management regarding associated interventions such as the treatment of superficial endometriosis or adhesions performed during a gynecologic surgical procedure and, thereby, bolster these recommendations.
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Affiliation(s)
- Marion Ouazana
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France
| | - Yohan Kerbage
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; University Lille, CHU Lille, F-59000 Lille, France
| | - Pauline Chauvet
- Department of Gynecological Surgery, Clermont-Ferrand University Hospital Estaing, Clermont-Ferrand, France; EnCoV, IP, UMR 6602 CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Pierre Collinet
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; University Lille, CHU Lille, F-59000 Lille, France
| | - Pierre Emmanuel Bouet
- Department of Reproductive Medicine, Angers University Hospital, Angers 49000, France
| | - Cyril Touboul
- APHP, GHU East, Tenon Hospital, Department of Obstetrics and Gynaecology, 4 rue de la Chine, F-75020, Paris, France
| | - Guillaume Legendre
- CHU Angers, Department of Obstetrics and Gynaecology, F-49000, Angers, France
| | - Francois Golfier
- CHU Lyon, Department of Obstetrics and Gynaecology, F-69000, Lyon, France
| | - Stéphane Ploteau
- Department of Gynecology and Obstetrics, Nantes University Hospital, Nantes, France
| | - Pietro Santulli
- Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France; Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France; Université de Paris, Department "Infection, Immunity, Inflammation", INSERM U1016, Institut Cochin, Paris, France.
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Nguyen-Xuan HT, Benoit L, Dabi Y, Touboul C, Raimond E, Ballester M, Bendifallah S, Collinet P, Kerbage Y, Ouldamer L, Bricou A, Lavoue V, Carcopino X, Huchon C. How to predict para-aortic node involvement in advanced cervical cancer? Development of a predictive score. A FRANCOGYN study. Eur J Surg Oncol 2021; 47:2900-2906. [PMID: 34274203 DOI: 10.1016/j.ejso.2021.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/12/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Node involvement is one of the main prognostic factors for cervical cancer. Para-aortic lymph node (PALN) assessment is crucial for treating advanced cervical cancer, to define irradiation fields. Objective of this study was to develop a score predicting para-aortic lymph node involvement in patients with advanced cervical cancer. PATIENTS AND METHOD We performed a multicenter, retrospective, study on 9 French centers from 2000 to 2015, including patients with advanced squamous cell cervix carcinoma who had PALN status assessed by imaging and/or by surgery. Factors associated with a risk of PALN involvement were determined by univariate and multivariate analysis using a logistic regression model. A score was then developed and validated. RESULTS A total of 1446 patients treated for cervical cancer were included. Of these, 498 had an advanced squamous cell cervical cancer. Ninety-one patients (18.3%) had positive PALN. After univariate and multivariate analysis, tumor size on pelvic MRI, initial SCC, and suspected pelvic node involvement on PET-CT were included in our score. This model allowed the population to be divided into 3 risk groups. Area under the ROC curve of the score was 0.81 (95%CI = 0.72-0.90). In the low-risk group, 9% (28/287) had PALN involvement, whereas in the high-risk group, 43% (22/51) had PALN involvement. CONCLUSION We developed a simple score predicting PALN involvement in advanced cervical cancers. Three risk groups can be defined, and patients considered to be at low risk may avoid para-aortic staging as well as extensive field irradiation.
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Affiliation(s)
- H T Nguyen-Xuan
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78300, Poissy, France; Department of Gynaecology and Obstetrics, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, France.
| | - L Benoit
- Department of Gynaecology and Obstetrics, Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, France; 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), Paris, France
| | - Y Dabi
- Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Créteil, France
| | - C Touboul
- 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), Paris, France
| | - E Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - M Ballester
- Department of Obstetrics and Gynecology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, 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), Paris, France
| | - P Collinet
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - Y Kerbage
- Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - L Ouldamer
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France
| | - A Bricou
- Department of Obstetrics and Gynecology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - V Lavoue
- CRLCC Eugène-Marquis, Service de Gynécologie, CHU de Rennes, Université de Rennes 1, Rennes, France
| | - X Carcopino
- Department of Obstetrics and Gynecology, Hopital Nord, APHM, Marseille, France
| | - C Huchon
- Department of Gynaecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, 78300, Poissy, France; EA 7285 Risques Cliniques et Sécurité en Santé des Femmes, University of Versailles-Saint-Quentin en Yvelines, France; Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Paris, Hôpital LARIBOISIERE, University of Paris, France
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Jouen T, Gauthier T, Azais H, Bendifallah S, Chauvet P, Fernandez H, Kerbage Y, Lavoue V, Lecointre L, Mimoun C, Ouldamer L, Seidler S, Siffert M, Vallin AL, Spiers A, Descamps P, Lacorre A, Legendre G. The impact of the COVID-19 coronavirus pandemic on the surgical management of gynecological cancers: Analysis of the multicenter database of the French SCGP and the FRANCOGYN group. J Gynecol Obstet Hum Reprod 2021; 50:102133. [PMID: 33789183 PMCID: PMC8004475 DOI: 10.1016/j.jogoh.2021.102133] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/19/2022]
Abstract
Introduction The coronavirus SARS-CoV-2 (COVID-19) pandemic has put tremendous pressure on the French healthcare system. Almost all hospital departments have had to profoundly modify their activity to cope with the crisis. In this context, the surgical management of cancers has been a topic of debate as care strategies were tailored to avoid any delay in treatment that could be detrimental to patient wellbeing while being careful not to overload intensive care units. The primary objective of this study was to observe changes in the surgical management of pelvic cancers during the COVID-19 pandemic in France. Material and Methods This study analyzed data from the prospective multi-center cohort study conducted by the French Society for Pelvic and Gynecological Surgery (SCGP) with methodological support from the French (FRANCOGYN) Group. All members of the SCGP received by e-mail a link allowing them to include patients who were scheduled to undergo gynecological carcinologic surgery between March 16th 2020 and May 11th 2020. Demographic data, the characteristics of cancers and the impact of the crisis in terms of changes to the usual recommended coarse of care were collected. Results A total of 181 patients with a median age 63 years were included in the cohort. In total, 31 patients had cervical cancer, 76 patients had endometrial cancer, 52 patients had ovarian or tubal cancer, 5 patients had a borderline tumor of the ovary, and 17 patients had vulvar cancer. During the study period, the care strategy was changed for 49 (27%) patients with postponed for 35 (19.3%) patients, and canceled for 7 (3.9%) patients. Surgical treatment was maintained for 139 (76.8%) patients. Management with neoadjuvant chemotherapy was offered to 19 (10,5%) patients and a change in surgical choice was made for 5 (2,8%) patients. In total, 8 (4,4%) patients tested positive for COVID-19. Data also shows a greater number of therapeutic changes in cases of ovarian cancer as well as a cancelation of a lumbo-aortic lymphadenectomy in one patient with cervical cancer. Hospital consultants estimated a direct detrimental impact of the COVID-19 pandemic for 39 patients, representing 22% of gynecological cancers. Conclusion This study provided observational data of the impact of the COVID-19 health crisis on the surgical management of gynecological cancers.
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Affiliation(s)
- Théo Jouen
- Departement of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Tristan Gauthier
- Departement of Obstetrics and Gynecology, Limoges University Hospital, Limoges, France
| | - Henri Azais
- Departement of Obstetrics and Gynecology, Georges-Pompidou European Hospital AP-HP, Paris, France
| | - Sofiane Bendifallah
- Departement of Obstetrics and Gynecology, Tenon Hospital AP-HP, Paris, France
| | - Pauline Chauvet
- Departement of Obstetrics and Gynecology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Herve Fernandez
- Departement of Obstetrics and Gynecology, Bicêtre Hospital AP-HP, Paris, France
| | - Yohan Kerbage
- Departement of Obstetrics and Gynecology, Lille University Hospital, Lille, France
| | - Vincent Lavoue
- Departement of Obstetrics and Gynecology, Rennes University Hospital, Rennes, France
| | - Lise Lecointre
- Departement of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Camille Mimoun
- Departement of Obstetrics and Gynecology, Lariboisière Hospital AP-HP, Paris, France
| | - Lobna Ouldamer
- Departement of Obstetrics and Gynecology, Tours University Hospital, Tours, France
| | - Stéphanie Seidler
- Departement of Obstetrics and Gynecology, Georges-Pompidou European Hospital AP-HP, Paris, France
| | - Marc Siffert
- Departement of Obstetrics and Gynecology, Bichat Hospital AP-HP, Paris, France
| | - Anne-Lyse Vallin
- Departement of Obstetrics and Gynecology, Creteil University Hospital, Créteil, France
| | - Andrew Spiers
- Departement of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Philippe Descamps
- Departement of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Aymeline Lacorre
- Departement of Obstetrics and Gynecology, Limoges University Hospital, Limoges, France
| | - Guillaume Legendre
- Departement of Obstetrics and Gynecology, Angers University Hospital, Angers, France; CESP-INSERM, U1018, Team 7, Reproductive and sexual health, Paris-Sud University, 94276 Villejuif, France.
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Kerbage Y, Rouillès J, Vignion AS, Delhem N, Thecua E, Deleporte P, Collinet P, Mordon S. Laser interstitial thermotherapy (LITT) for breast cancer: dosimetry optimization and numerical simulation. Lasers Med Sci 2021; 37:489-498. [PMID: 33713256 DOI: 10.1007/s10103-021-03286-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/04/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
Surgical treatment is standard for the treatment of small breast cancers. Due to the pain and esthetic sequelae that can follow surgery, minimally invasive treatments are under investigation. Our aim was to conduct a dosimetry study of laser interstitial thermotherapy. Turkey tissue was used as an ex vivo model, and mammary glands from ewes were used as in vivo models. We used two different wavelength lasers (805 nm and 980 nm). Two types of fiber from two different manufacturers were used: bare fibers with a diameter of 600 μm and diffusing fiber. The diffusing fibers were 5 mm and 10 mm in length. We also used a computerized model to predict thermal damage and to correlate with the ex vivo and in vivo procedures using a constant and variable coefficient. The mathematical model was based on the finite element method for solving light distribution, bio-heat, and thermal damage equations. Based on our ex vivo and in vivo experiments, we found that the optimal configuration for this treatment was the use of the 980-nm laser at 4 W with bare fibers for a minimum treatment time of 150 s. We also developed a predictive mathematical model that showed good predictability of necrosis in line with the experimental data. Laser treatment is a promising therapy for small breast lesions. However, further development of treatment guidance is necessary to support its use in clinical practice.
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Affiliation(s)
- Yohan Kerbage
- Univ. Lille, CHU Lille, U 1189, ONCO-THAI- Image Assisted Laser Therapy for Oncology, 1 avenue Oscar Lambret, F-59000, Lille, France. .,CHU Lille, Service de chirurgie gynécologique, F-59000, Lille, France.
| | - Julie Rouillès
- CHU Lille, Service de chirurgie gynécologique, F-59000, Lille, France
| | - Anne-Sophie Vignion
- Univ. Lille, CHU Lille, U 1189, ONCO-THAI- Image Assisted Laser Therapy for Oncology, 1 avenue Oscar Lambret, F-59000, Lille, France
| | - Nadira Delhem
- Univ. Lille, CHU Lille, U 1189, ONCO-THAI- Image Assisted Laser Therapy for Oncology, 1 avenue Oscar Lambret, F-59000, Lille, France.,CNRS, UMR8161, Institut de Biologie de Lille, Univ. Lille, Institut Pasteur de Lille, Lille, France
| | - Elise Thecua
- Univ. Lille, CHU Lille, U 1189, ONCO-THAI- Image Assisted Laser Therapy for Oncology, 1 avenue Oscar Lambret, F-59000, Lille, France
| | - Pascal Deleporte
- Univ. Lille, CHU Lille, U 1189, ONCO-THAI- Image Assisted Laser Therapy for Oncology, 1 avenue Oscar Lambret, F-59000, Lille, France
| | - Pierre Collinet
- Univ. Lille, CHU Lille, U 1189, ONCO-THAI- Image Assisted Laser Therapy for Oncology, 1 avenue Oscar Lambret, F-59000, Lille, France.,CHU Lille, Service de chirurgie gynécologique, F-59000, Lille, France
| | - Serge Mordon
- Univ. Lille, CHU Lille, U 1189, ONCO-THAI- Image Assisted Laser Therapy for Oncology, 1 avenue Oscar Lambret, F-59000, Lille, France
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Kerbage Y, Rouillès J, Estrade JP, Collinet P, Huchon C, Villefranque V, Rubod C. Surgical training through simulation dedicated to French Ob-gyn residents. Evaluation and satisfaction. J Gynecol Obstet Hum Reprod 2021; 50:102076. [PMID: 33515852 DOI: 10.1016/j.jogoh.2021.102076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In order to be able to develop surgical training of residents through simulation, we carried out a descriptive study, evaluating the satisfaction of participating residents and the benefit of the workshops offered during the 4 th Junior Master Class, free annual training organized in 2017 in Lille University Hospital. It is dedicated to ob-gyn residents in France, overseas departments and territories. MATERIAL AND METHODS During two days, plenary sessions and practical workshops on animal models or simulators were organized in laparoscopy, diagnostic and operative hysteroscopy, vaginal surgery and robotic surgery. A questionnaire was given anonymously to each student, collecting on the one hand their surgical curriculum, on the other hand, the evaluations of the theoretical contribution and the quality of the interventions and materials offered during the plenary sessions. The last part was subdivided into a questionnaire specific to each workshop. RESULTS The 48 residents who voluntarily followed this training were overwhelmingly satisfied with the quality of the training offered. The practical benefits outweighed the theoretical benefits. These workshops improved their practical skills from 63 % to 84 % depending on the workshops offered. In addition, 100 % of students would recommend this training to other residents and consider it useful for their future practice. CONCLUSION These very satisfactory results encourage us to organize new surgical training. Simulation is the key point for an appropriate surgical learning.
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Affiliation(s)
- Yohan Kerbage
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.
| | - Julie Rouillès
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France
| | - Jean Philippe Estrade
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France; Clinique Bouchard-Elsan, Chirurgie gynécologique, Marseille, France; Service de chirurgie gynécologique- Université de Paris, Hôpital Lariboisière, Paris, France; Maternité, Hôpital Simone Veil, 14 rue de Saint Prix, Eaubonne, France
| | - Pierre Collinet
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France
| | - Cyrille Huchon
- Service de chirurgie gynécologique- Université de Paris, Hôpital Lariboisière, Paris, France
| | | | - Chrystèle Rubod
- CHU Lille, Service de chirurgie gynécologique F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France
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de Foucher T, Hennebert C, Dabi Y, Ouldamer L, Lavoué V, Dion L, Canlorbe G, Bolze PA, Golfier F, Akladios C, Lecointre L, Kerbage Y, Collinet P, Bricou A, Carcopino X, Huchon C, Raimond E, Graesslin O, Owen C, Touboul C, Ballester M, Darai E, Bendifallah S. Recurrence Pattern of Cervical Cancer Based on the Platinum Sensitivity Concept: A Multi-Institutional Study from the FRANCOGYN Group. J Clin Med 2020; 9:E3646. [PMID: 33198384 PMCID: PMC7696862 DOI: 10.3390/jcm9113646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022] Open
Abstract
The standard of care for patients with advanced cervical cancer (ACC) includes platinum-based chemotherapy. The concept of platinum sensitivity is a major prognostic factor for patients with ovarian cancer. The aim of this study was to validate the applicability of the platinum sensitivity concept to ACC patients, and to estimate its prognostic interest in terms of overall survival (OS) and pattern of recurrence (location, timing). Data of women with histologically proven FIGO 2019 stages IB3-IV ACC, treated between May 2000 and November 2017 with platinum-based regimens, were retrospectively abstracted from 12 institutions from the FRANCOGYN Group. Respective 3-year OSs were 52% (95% CI: 40.8%-66.8%), 21.6% (95% CI: 12.6%-37.2%), and 14.6% (95% CI: 4.2%-50.2%), in case of recurrence <6 months, between 6 and 17 months, and ≥18 months (p < 0.001). Risk of metastatic or multisite recurrence was significantly higher in case of recurrence <6 months, and risk of local or isolated infradiaphragmatic nodal recurrence was significantly higher in case of recurrence >18 months (p < 0.001). In multivariate analysis, platinum sensitivity status was a strong prognostic factor for OS after recurrence, independent of histological grade, lympho-vascular space involvement, final lymph node status, and treatment. Platinum sensitivity status may help to classify patients in three prognostic subgroups for OS after recurrence, and appears to be a strong prognostic factor correlated to the pattern of recurrence.
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Affiliation(s)
- Tiphaine de Foucher
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
| | - Cecile Hennebert
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
| | - Yohan Dabi
- Departement of Obstetrics, Gynaecology and Reproductive Medecine, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France;
| | - Lobna Ouldamer
- Department of Gynaecology, CHRU de Tours, Hôpital Bretonneau, INSERM unit 1069, 2 boulevard Tonnelé, 37044 Tours, France;
| | - Vincent Lavoué
- Department of Gynaecology, CHU de Rennes, 35000 Rennes, France; (V.L.); (L.D.)
| | - Ludivine Dion
- Department of Gynaecology, CHU de Rennes, 35000 Rennes, France; (V.L.); (L.D.)
| | - Geoffroy Canlorbe
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, 75013 Paris, France;
| | - Pierre Adrien Bolze
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, 69000 Lyon, France; (P.A.B.); (F.G.)
| | - François Golfier
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, 69000 Lyon, France; (P.A.B.); (F.G.)
| | - Cherif Akladios
- Service de Gynécologie Obstétrique, CHU Hautepierre, 67000 Strasbourg, France; (C.A.); (L.L.)
| | - Lise Lecointre
- Service de Gynécologie Obstétrique, CHU Hautepierre, 67000 Strasbourg, France; (C.A.); (L.L.)
| | - Yohan Kerbage
- Department of Gynaecologic surgery, Hôpital Jeanne de Flandre, CHRU LILLE, Rue Eugene avinée, CEDEX, 59037 Lille, France; (Y.K.); (P.C.)
| | - Pierre Collinet
- Department of Gynaecologic surgery, Hôpital Jeanne de Flandre, CHRU LILLE, Rue Eugene avinée, CEDEX, 59037 Lille, France; (Y.K.); (P.C.)
| | - Alexandre Bricou
- Department of Obstetrics and Gynaecology, Jean-Verdier University Hospital, Assistance Publique des Hôpitaux de Paris, 93140 Bondy, France;
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France;
| | - Cyrille Huchon
- Department of Gynaecology, CHI Poissy-St-Germain, Université Versailles-Saint-Quentin en Yvelines, EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles-Saint-Quentin en Yvelines, 78000 Versailles, France;
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France; (E.R.); (O.G.)
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France; (E.R.); (O.G.)
| | - Clémentine Owen
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
| | - Cyril Touboul
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
| | - Marcos Ballester
- Department of Gynaecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, 125 rue d’Avron, 75020 Paris, France;
| | - Emile Darai
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 75020 Paris, France; (C.H.); (C.O.); (C.T.); (E.D.); (S.B.)
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Kerbage Y, Kakkos A, Kridelka F, Lambaudie E, Bats AS, Hébert T, Goffin F, Wallet J, Leblanc E, Hudry D, Narducci F. Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy? Ann Surg Oncol 2020; 27:3891-3897. [DOI: 10.1245/s10434-020-08471-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 11/18/2022]
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Knight S, Mancini J, Touboul C, Bolze PA, Bendifallah S, Ballester M, Collinet P, Kerbage Y, Ouldamer L, Atrous G, Lavoué V, Dion L, Dabi Y, Raimond E, Graesslin O, Huchon C, Mimouni M, Bricou A, Golfier F, Carcopino X. Prognostic value of posttreatment FEDG-PET imaging following combined chemoradiation therapy in locally advanced cervical cancer. J Gynecol Obstet Hum Reprod 2020; 49:101774. [PMID: 32330672 DOI: 10.1016/j.jogoh.2020.101774] [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] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the performances of posttreatment FEDG-PET to predict the prognosis of patients treated with concurrent chemoradiotherapy (CT/RT) for locally advanced cervical cancer. MATERIALS AND METHODS The medical records of 131 patients treated in 9 French academic institutions for IB2-IIB cervical cancer and for which a posttherapy FEDG-PET was performed were reviewed. All patients received CT/RT, possibly completed with vaginal brachytherapy (VBT) and completion surgery. Posttreatment FEDG-PET was performed within 3 months after completion of CT/RT or VBT. Incomplete metabolic response (IMR) was defined as the persistence of FEDG uptake. RESULTS An IMR was identified in 44 (33.6 %) cases. IMR was associated with higher risk of recurrence (aHR = 2.8; 95 %CI: 1.3-5.7; p = 0.006) and death (aHR = 4.5 ;95 %CI: 1.4-13.8; p = 0.009). Completion surgery was performed in 61 (46.9 %) patients with histologic cervical residual disease identified in 31 (50.8 %). FEDG-PET sensitivity and specificity in predicting cervical residual disease following CT/RT was 48.4 % (95 %CI: 30.8-66) and 80 % (95 %CI: 65.7-94.3), respectively. CONCLUSIONS In patients treated with CT/RT for locally advanced cervical cancer, despite limited performances to predict cervical residual disease, posttreatment FEDG-PET is predictive of patients' prognosis and long-term outcome.
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Affiliation(s)
- Sophie Knight
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, Hop Timone, BioSTIC, Marseille, 13385 France
| | - Cyril Touboul
- Departement of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Pierre Adrien Bolze
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France
| | - Marcos Ballester
- Department of Gynaecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, 125 rue d'Avron, 75020, Paris, France
| | - Pierre Collinet
- Department of Gynaecologic Surgery, Hôpital Jeanne de Flandre, CHRU LILLE, Rue Eugene avinée 59037 lille cedex, France
| | - Yohan Kerbage
- Department of Gynaecologic Surgery, Hôpital Jeanne de Flandre, CHRU LILLE, Rue Eugene avinée 59037 lille cedex, France
| | - Lobna Ouldamer
- Department of Gynecology, CHRU de Tours, Hôpital Bretonneau, INSERM Unit 1069, 2 Boulevard Tonnelé, 37044 TOURS, France
| | - Geoffroy Atrous
- Department of Gynecology, CHRU de Tours, Hôpital Bretonneau, INSERM Unit 1069, 2 Boulevard Tonnelé, 37044 TOURS, France
| | - Vincent Lavoué
- Department of Gynaecology, CHU de Rennes, France, INSERM 1242, COSS, Rennes, Université de Rennes 1, France
| | - Ludivine Dion
- Department of Gynaecology, CHU de Rennes, France, INSERM 1242, COSS, Rennes, Université de Rennes 1, France
| | - Yohann Dabi
- Departement of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France
| | - Cyrille Huchon
- Department of Gynecology, CHI Poissy-St-Germain, Université Versailles-Saint-Quentin en Yvelines, EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles-Saint-Quentin en Yvelines, Versailles, France
| | - Myriam Mimouni
- Department of Gynecology, CHI Poissy-St-Germain, Université Versailles-Saint-Quentin en Yvelines, EA 7285 Risques cliniques et sécurité en santé des femmes, Université Versailles-Saint-Quentin en Yvelines, Versailles, France
| | - Alexandre Bricou
- Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique des Hôpitaux de Paris, University Paris 13, France
| | - François Golfier
- Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397, Marseille, France.
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Kerbage Y, Senat MV, Drumez E, Subtil D, Vayssiere C, Deruelle P. Risk factors for failed induction of labor among pregnant women with Class III obesity. Acta Obstet Gynecol Scand 2019; 99:637-643. [PMID: 31863451 DOI: 10.1111/aogs.13794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/06/2019] [Revised: 11/28/2019] [Accepted: 11/28/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our aim was to identify risk factors for failed induction in morbidly obese patients undergoing the induction of labor at term. MATERIAL AND METHODS This was a retrospective multicenter study on a cohort of 235 patients with a body mass index greater than 40 kg/m2 and giving birth to a singleton in cephalic presentation, who had an induction of labor from 38 weeks of amenorrhea. Scheduled cesareans and spontaneous vaginal deliveries were excluded. Maternal, peri-partum and neonatal characteristics were analyzed according to the delivery route. RESULTS In all, 235 patients were included. Of these, 62.5% patients delivered vaginally and 37.5% by cesarean section. The frequency of nulliparity was greater in patients who had a cesarean section (56 [interquartile range, IQR, 38.1] vs 56 [IQR 63.6], P < .001). In multivariate analysis, nulliparity (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.58-4.97], P < .001), low Bishop's score (OR .794, 95% CI .70-.90, P < .001) and weight gain (OR 1.04, 95% CI 1.01-1.08, P = .033) were independent risk factors for failed induction. Umbilical cord pH at birth lower than 7 (0 vs 7 [IQR 8.0], P < .001) and lower than 7.20 (36 [IQR 24.5] vs 35 [IQR 39.8], P = .014) as well as the Apgar at 1 minute (14 [IQR 9.5] vs 17 [IQR 19.3], P = .032) was significantly higher in infants born by cesarean section. CONCLUSIONS In this cohort, 63% of women with Class III obesity had successful inductions of labor; risk factors for failed induction include nulliparity and unfavorable Bishop score.
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Affiliation(s)
- Yohan Kerbage
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
| | - Marie V Senat
- Gynecology-Obstetrics Service, Le Kremlin-Bicêtre Hospital, Public Hospital Assistance of Paris (APHP), Université Paris Sud, Orsay, France
| | - Elodie Drumez
- Department of Biostatistics, University of Lille, EA 2694 - Public Health: Epidemiology and Quality of Care, University Hospital of Lille (CHU), Lille, France
| | - Damien Subtil
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
| | - Christophe Vayssiere
- Women's-Maternity-Couple Center, Gynecology-Obstetrics Department, Paule de Viguier Hospital, University Hospital of Toulouse, Toulouse, France.,UMR 1027 INSERM, Université Paul-Sabatier Toulouse III, Toulouse, France
| | - Philippe Deruelle
- Department of Obstetrics, Jeanne de Flandre University Hospital (CHRU), Lille, France
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Kerbage Y, Rubod C, Hubert T, Bassil A, Ghesquière L, Garabedian C. Comment je fais… un modèle d’hystéroscopie à moindre coût. ACTA ACUST UNITED AC 2018; 46:664-666. [DOI: 10.1016/j.gofs.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Indexed: 11/25/2022]
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Kerbage Y, Canlorbe G, Estevez JP, Grabarz A, Mordon S, Uzan C, Collinet P, Azaïs H. [Microscopic peritoneal metastases of epithelial ovarian cancers. Clinical relevance, diagnostic and therapeutic tools]. ACTA ACUST UNITED AC 2018; 46:497-502. [PMID: 29656069 DOI: 10.1016/j.gofs.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Indexed: 10/17/2022]
Abstract
Understanding the biology and progression mechanisms of peritoneal metastases in ovarian epithelial cancers (EOC) is important because peritoneal carcinomatosis is present or will occur during surveillance of a majority of patients. Despite the clinical remission achieved after complete macroscopic cytoreductive surgery and platinum-based chemotherapy, 60% of patients will develop peritoneal recurrence. This suggests that microscopic lesions, which are not eradicated by surgery may be present and may participate in the mechanisms leading to peritoneal recurrence. This paper discusses current available data on microscopic peritoneal metastases, their diagnosis and their treatment. We reviewed all publications dealing with microscopic peritoneal metastases of EOC between 1980 and 2017. The most recent and most relevant publications dealing with the treatment modalities of these metastases were selected. Peritoneal and epiploic microscopic localizations would occur in 1.2 to 15.1% of cases at early-stage and are not treated during conventional surgery. They could represent a potential therapeutic target. Local treatments (intraperitoneal chemotherapy, photodynamic therapy, fluorescence-guided surgery) seem to be necessary in addition to surgery and chemotherapy and may help reduce the risk of peritoneal recurrence. The place of these treatments in the management of EOC remains to be defined by subsequent researches.
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Affiliation(s)
- Y Kerbage
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - J P Estevez
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France
| | - A Grabarz
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - S Mordon
- Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Collinet
- Service de chirurgie gynécologique, CHU de Lille, 59000 Lille, France; Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France
| | - H Azaïs
- Inserm, U1189, ONCO-THAI, thérapies laser assistées par l'imagerie, 59000 Lille, France; Service de chirurgie et oncologie gynécologique et mammaire, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Pitié-Salpêtrière, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France.
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Abstract
Image-guided surgery is a relevant way to reduce surgical morbidity and maximize cytoreductive surgery approach especially in ovarian cancer. Sentinel lymph node detection is a promising approach to avoid radical lymph node dissection and is slightly becoming standard in daily practice in endometrial and cervical cancer surgery even if it needs to be evaluated more precisely. Regarding carcinomatosis of ovarian origin, detection and treatment of microscopic disease could be appropriate to avoid local recurrences. Photodiagnosis and photodynamic therapy are innovative techniques that allow to precise limits of excision (fluorescence-guided surgery) and to treat microscopic disease. Further developments of those strategies are necessary to become standard diagnosis tools and treatment options.
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Affiliation(s)
- Henri Azaïs
- Department of Gynecological & Breast Surgery & Oncology, AP-HP, Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013 Paris, France; Pierre et Marie Curie University, Paris 6, France.,INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Geoffroy Canlorbe
- Department of Gynecological & Breast Surgery & Oncology, AP-HP, Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013 Paris, France; Pierre et Marie Curie University, Paris 6, France
| | - Yohan Kerbage
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.,Department of Gynecologic Surgery, CHU Lille, F-59000 Lille, France
| | - Anne Grabarz
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.,Department of Gynecologic Surgery, CHU Lille, F-59000 Lille, France
| | - Pierre Collinet
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.,Department of Gynecologic Surgery, CHU Lille, F-59000 Lille, France
| | - Serge Mordon
- INSERM, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
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Bassil A, Rubod C, Borghesi Y, Kerbage Y, Schreiber ES, Azaïs H, Garabedian C. Operative and diagnostic hysteroscopy: A novel learning model combining new animal models and virtual reality simulation. Eur J Obstet Gynecol Reprod Biol 2017; 211:42-47. [PMID: 28178577 DOI: 10.1016/j.ejogrb.2017.01.058] [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: 12/05/2016] [Revised: 01/17/2017] [Accepted: 01/30/2017] [Indexed: 11/16/2022]
Abstract
CONTEXT Hysteroscopy is one of the most common gynaecological procedure. Training for diagnostic and operative hysteroscopy can be achieved through numerous previously described models like animal models or virtual reality simulation. We present our novel combined model associating virtual reality and bovine uteruses and bladders. STUDY DESIGN End year residents in obstetrics and gynaecology attended a full day workshop. The workshop was divided in theoretical courses from senior surgeons and hands-on training in operative hysteroscopy and virtual reality Essure® procedures using the EssureSim™ and Pelvicsim™ simulators with multiple scenarios. Theoretical and operative knowledge was evaluated before and after the workshop and General Points Averages (GPAs) were calculated and compared using a Student's T test. RESULTS GPAs were significantly higher after the workshop was completed. The biggest difference was observed in operative knowledge (0,28 GPA before workshop versus 0,55 after workshop, p<0,05). All of the 25 residents having completed the workshop applauded the realism an efficiency of this type of training. The force feedback allowed by the cattle uteruses gives the residents the possibility to manage thickness of resection as in real time surgery. Furthermore, the two-horned bovine uteruses allowed to reproduce septa resection in conditions close to human surgery CONCLUSION: Teaching operative and diagnostic hysteroscopy is essential. Managing this training through a full day workshop using a combined animal model and virtual reality simulation is an efficient model not described before.
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Affiliation(s)
- Alfred Bassil
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France.
| | - Chrystèle Rubod
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France; University of Lille North of France, F-59000 Lille, France
| | - Yves Borghesi
- CH Valenciennes, Department of Gynaecology and Obstetrics, F-59300 Lille, France
| | - Yohan Kerbage
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France
| | | | - Henri Azaïs
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France; University of Lille North of France, F-59000 Lille, France
| | - Charles Garabedian
- CHRU Lille, Department of Gynaecology and Obstetrics, F-59000 Lille, France; University of Lille North of France, F-59000 Lille, France
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Azaïs H, Estevez JP, Foucher P, Kerbage Y, Mordon S, Collinet P. Dealing with microscopic peritoneal metastases of epithelial ovarian cancer. A surgical challenge. Surg Oncol 2017; 26:46-52. [PMID: 28317584 DOI: 10.1016/j.suronc.2017.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 08/22/2016] [Revised: 01/01/2017] [Accepted: 01/05/2017] [Indexed: 12/31/2022]
Abstract
Understanding biology and progression mechanisms of peritoneal metastases of epithelial ovarian cancer (EOC) is a cornerstone in the knowledge and the comprehensive management of the disease. Despite clinical remission after the association of complete cytoreductive surgery and platinum-based chemotherapy, peritoneal recurrence still occurs in 60% of patients. Eligible studies, published from 1980 to June 2016, were retrieved through ClinicalTrials.gov, MEDLINE, Cochrane databases and bibliography searches. We reviewed all publications that deals with microscopic peritoneal metastases of EOC in French and English. To discuss expected benefits of intraperitoneal (IP) chemotherapy, fluorescence-guided surgery or IP photodynamic therapy, we reviewed most recent and relevant studies. The final reference list was generated on the basis of originality and relevance to the broad scope of this review. Published data concerning early-stage ovarian cancer suggest that occult peritoneal or epiploic metastases are present in 1.2%-15.1% of cases. In the frequent case of advanced-stage disease, residual microscopic lesions are ignored by conventional surgery. We are convinced that microscopic peritoneal metastases are a relevant surgical therapeutic target. This article discusses existing data on microscopic peritoneal metastases, the treatment indications, the diagnostic and therapeutic surgical approaches to be developed and their expected benefits. A local therapeutic strategy to target microscopic lesions is needed in addition to complete macroscopic cytoreductive surgery to decrease the rate of peritoneal recurrence. Intraperitoneal chemotherapy, and targeted photodynamic therapy could play a role in this new paradigm. The roles of these different options must be defined by future researches.
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Affiliation(s)
- Henri Azaïs
- AP-HP, Pitié-Salpêtrière Hospital, Department of Gynecologic and Breast Surgery, F-75013 Paris, France; Univ. Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France.
| | | | - Périne Foucher
- CHU Lille, Department of Gynecology, F-59000 Lille, France
| | - Yohan Kerbage
- Univ. Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France; CHU Lille, Department of Gynecology, F-59000 Lille, France
| | - Serge Mordon
- Univ. Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
| | - Pierre Collinet
- Univ. Lille, U1189 - ONCO-THAI - Image Assisted Laser Therapy for Oncology, F-59000 Lille, France; CHU Lille, Department of Gynecology, F-59000 Lille, France
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Kerbage Y, Coulon C, Subtil D, Garabedian C. Locked twins: successful vaginal delivery of both twins after Zavanelli manoeuvre of Twin B. Eur J Obstet Gynecol Reprod Biol 2016; 207:236-237. [PMID: 27825768 DOI: 10.1016/j.ejogrb.2016.10.035] [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] [Received: 05/30/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Y Kerbage
- Université de Lille, Faculté de Médecine, Lille, France; Service de gynécologie-obstétrique, CHU Lille, Lille, France.
| | - C Coulon
- Service de gynécologie-obstétrique, CHU Lille, Lille, France
| | - D Subtil
- Université de Lille, Faculté de Médecine, Lille, France; Service de gynécologie-obstétrique, CHU Lille, Lille, France
| | - C Garabedian
- Université de Lille, Faculté de Médecine, Lille, France; Service de gynécologie-obstétrique, CHU Lille, Lille, France
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Kerbage Y, Azaïs H, Estevez JP, Merlot B, Collinet P. [Current controversies regarding power morcellation and future directions]. ACTA ACUST UNITED AC 2016; 44:417-23. [PMID: 27363612 DOI: 10.1016/j.gyobfe.2016.05.006] [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: 04/05/2016] [Accepted: 05/23/2016] [Indexed: 12/29/2022]
Abstract
Modern surgery tends to the improvement of minimally invasive strategies. Laparoscopy, rooted in practices for years, supplanted laparotomy in many directions. Regarding the extraction of large uterus, morcellation is currently the only way to externalize surgical specimens (myomas, uterine), without increasing the skin opening while allowing to reduce postoperative complications compared to laparotomy. However, in 2014, the Food and Drug Administration (FDA) discourages the use of uterine morcellation because of oncological risk. This recommendation has been challenged by a part of the profession. Our review has sought to identify the evidence for and against the use of morcellation. We also tried to quantify surgical risk and the current means of prevention. The incidence of uterine sarcomas is still poorly identified and preoperative diagnostic facilities remain inadequate. The small number of retrospective studies currently available could not enable any recommendation. The evaluation of morcellation devices and the improvement of preoperative diagnosis modalities (imaging, preoperative biopsy) are to continue to minimize the oncological risk.
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Affiliation(s)
- Y Kerbage
- Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France.
| | - H Azaïs
- Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France
| | - J P Estevez
- Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France
| | - B Merlot
- Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France
| | - P Collinet
- Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France
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40
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Kerbage Y, Collinet P, Rubod C, Merlot B, Cosson M. [Litigation in gynecological surgery: A retrospective study in the French university hospital of Lille between 1997 and 2015]. ACTA ACUST UNITED AC 2016; 44:196-9. [PMID: 27053035 DOI: 10.1016/j.gyobfe.2016.03.001] [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: 12/01/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Analysis of litigation in gynecological surgery in the French university hospital of Lille. METHODS It is a longitudinal and retrospective study. We collected all cases of complaints between November 1997 and August 2015 concerning the department of gynecological surgery, university hospital of Lille. Medical data were obtained using electronic medical record and hospital's legal unit gave data about the complaints. RESULTS Forty cases were identified during the reporting period. Thirty-three records concerned medical injuries and seven cases failing to provide information or lack of communication. Eleven complaints were reviewed by the French "commission de conciliation et d'indemnisation". Five cases were brought to administrative court. Finally, Lille high court examined two records. Most of complaints concerned perforation during endoscopic procedures, nosocomial infections and forgotten foreign bodies. It was not observed any increasing number of complaints during the whole period. It was noticed a decreasing number of legal action in favor of "commission de conciliation et d'indemnisation". CONCLUSION This study evaluated specifically litigation in gynecological surgery. It is necessary to conduct this type of study so as to improve medical care and to provide information for practitioner about consequences of their exercise.
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Affiliation(s)
- Y Kerbage
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, rue Eugène-Avinée, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France.
| | - P Collinet
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, rue Eugène-Avinée, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France
| | - C Rubod
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, rue Eugène-Avinée, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France
| | - B Merlot
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, rue Eugène-Avinée, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France
| | - M Cosson
- Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, CHRU de Lille, rue Eugène-Avinée, 59000 Lille, France; Faculté de médecine, université de Lille, 59000 Lille, France
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Kerbage Y, Debarge V, Lucot JP, Clouqueur E, Rubod C. Simulation training to teach postpartum hemorrhage surgery to residents. Eur J Obstet Gynecol Reprod Biol 2016; 201:27-30. [PMID: 27042768 DOI: 10.1016/j.ejogrb.2016.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Description of the aims, the framework and the results of a postpartum hemorrhage surgery workshop for residents. STUDY DESIGN This article is the first publication to describe a simulation workshop for the surgical management of maternal hemorrhage. Training was divided into both theoretical and practical workshops. Four obstetrician-gynecologists supervised residents who performed all the surgical procedures on a cadaver. This training course included the oldest residents at the Faculty of Medicine of Lille and was evaluated by participants using pre-test and post-test questionnaires. Medical knowledge was also evaluated. RESULTS The pre-test questionnaire showed that medical knowledge for the treatment of postpartum hemorrhage was acceptable but that real practice was lacking. Eighty-six percent of the residents responded that they were not able deal with the situation correctly and most considered it stressful. The post-test questionnaire showed that training greatly improved the participants' theoretical knowledge and technical skills as well as significantly improving self-confidence. CONCLUSIONS Based on these positive results this workshop will be included in the resident training program and also be extended to professionals as a part of the continuing medical education program.
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Affiliation(s)
- Y Kerbage
- Université de Lille - Faculté de Médecine, F-59000 Lille, France; Service de gynécologie-obstétrique - CHU Lille, F-59000 Lille, France
| | - V Debarge
- Université de Lille - Faculté de Médecine, F-59000 Lille, France; Service de gynécologie-obstétrique - CHU Lille, F-59000 Lille, France
| | - J P Lucot
- Service de gynécologie-obstétrique - CHU Lille, F-59000 Lille, France
| | - E Clouqueur
- Service de gynécologie-obstétrique - CHU Lille, F-59000 Lille, France
| | - C Rubod
- Université de Lille - Faculté de Médecine, F-59000 Lille, France; Service de gynécologie-obstétrique - CHU Lille, F-59000 Lille, France.
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