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Brun JL, Plu-Bureau G, Huchon C, Ah-Kit X, Barral M, Chauvet P, Cornelis F, Cortet M, Crochet P, Delporte V, Dubernard G, Giraudet G, Gosset A, Graesslin O, Hugon-Rodin J, Lecointre L, Legendre G, Maitrot-Mantelet L, Marcellin L, Miquel L, Le Mitouard M, Proust C, Roquette A, Rousset P, Sangnier E, Sapoval M, Thubert T, Torre A, Trémollières F, Vernhet-Kovacsik H, Vidal F, Marret H. Management of women with abnormal uterine bleeding: Clinical practice guidelines of the French National College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2023; 288:90-107. [PMID: 37499278 DOI: 10.1016/j.ejogrb.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/25/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To provide French guidelines for the management of women with abnormal uterine bleeding (AUB). DESIGN A consensus committee of 26 experts was formed. A formal conflict-of-interest policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding (i.e. pharmaceutical or medical device companies). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The last guidelines from the Collège National des Gynécologues et Obstétriciens Français on the management of women with AUB were published in 2008. The literature seems now sufficient for an update. The committee studied questions within 7 fields (diagnosis; adolescents; idiopathic AUB; endometrial hyperplasia and polyps; type 0-2 fibroids; type 3 or higher fibroids; and adenomyosis). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and evidence profiles were compiled. The GRADE® methodology was applied to the literature review and the formulation of recommendations. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 36 recommendations. Among the formalized recommendations, 19 are strong and 17 weak. No response was found in the literature for 14 questions. We chose to abstain from recommendations rather than providing advice based solely on expert clinical experience. CONCLUSIONS The 36 recommendations make it possible to specify the diagnostic and therapeutic strategies for various clinical situations practitioners encounter, from the simplest to the most complex.
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Affiliation(s)
- J L Brun
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France.
| | - G Plu-Bureau
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - C Huchon
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | - X Ah-Kit
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - M Barral
- Service de radiologie interventionnelle, hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - P Chauvet
- Service de chirurgie gynécologique, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63000 Clermont-Ferrand, France
| | - F Cornelis
- Service de radiologie interventionnelle, hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - M Cortet
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - P Crochet
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147 boulevard Baille, 13005 Marseille, France
| | - V Delporte
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49 rue de Valmy, 59000 Lille, France
| | - G Dubernard
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - G Giraudet
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49 rue de Valmy, 59000 Lille, France
| | - A Gosset
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - O Graesslin
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45 rue Cognac-Jay, 51092 Reims, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Lecointre
- Service de chirurgie gynécologique, CHU Strasbourg, 1 avenue Molière, 67200 Strasbourg, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU Angers, 4 rue Larrey, 49933 Angers, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Marcellin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Miquel
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147 boulevard Baille, 13005 Marseille, France
| | - M Le Mitouard
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Proust
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37044 Tours, France
| | - A Roquette
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - P Rousset
- Service de radiologie, hôpital Sud, CHU Lyon, 165 chemin du Grand Revoyet, 69495 Pierre-Benite, France
| | - E Sangnier
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45 rue Cognac-Jay, 51092 Reims, France
| | - M Sapoval
- Service de radiologie interventionnelle, hôpital europeen Georges-Pompidou, APHP, 20 rue Leblanc, 75015 Paris, France
| | - T Thubert
- Service de gynécologie-obstétrique, Hotel Dieu, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - A Torre
- Centre de procréation médicalement assistée, centre hospitalier Sud Francilien, 40 avenue Serge Dassault, 91106 Corbeil-Essonnes, France
| | - F Trémollières
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Vernhet-Kovacsik
- Service d'imagerie thoracique et vasculaire, hôpital Arnaud-de-Villeneuve, CHU Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - F Vidal
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37044 Tours, France
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Toutain T, Philip CA, Bollon L, Cros M, Fraissenon A, Dupont C, Gaucher L, Haesebaert J, Nohuz E, Cortet M. Surgical management of a loss of pregnancy in the first trimester: Patient experience and influencing factors, a prospective observational study. J Gynecol Obstet Hum Reprod 2023; 52:102602. [PMID: 37187317 DOI: 10.1016/j.jogoh.2023.102602] [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: 08/08/2022] [Revised: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Describe the "patient experience" regarding care provided during the surgical management of a loss of pregnancy in the first trimester and identify the factors influencing this experience. MATERIAL AND METHODS It is an observational prospective study conducted in two type III, academic, maternity wards in Lyon, France, carrying out 8,500 deliveries per year. Adult female patients, having undergone a suction curettage for a loss of pregnancy in the first trimester from 24 December 2020 to 13 June 2021 were inculded. The "patient experience" was assessed using the 15 questions of the Picker Patient Experience (PPE-15) questionnaire, and research was conducted on factors influencing the patient experience. The main outcome was the percentage of patients reporting a problem in response to at least one of the PPE-15 questions. RESULTS 58 out of 79 patients (73% CI [62-83]) reported at least one problem with their care. The largest proportion of problems was raised in question about "Opportunity for family/loved ones to talk to the doctor" (76% CI [61-87]). The lowest proportion of problems was raised in question about "Treated with respect and dignity" (8% CI [3-16]). No factors influencing the patient experience were identified. DISCUSSION Almost three out of four patients reported a problem in the experience as a patient. The main areas of improvement reported by patients were the participation of their family/relatives and the emotional support provided by the healthcare team. TWEETABLE ABSTRACT Better communication with patient families and emotional support could improve patient experience during the surgical management of a loss of pregnancy in the first trimester.
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Affiliation(s)
- T Toutain
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France
| | - C-A Philip
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France; LabTAU INSERM U1032, Université Lyon1, Lyon 69003, France
| | - L Bollon
- Faculty of Maieutic, Lyon, France
| | - M Cros
- Faculty of Maieutic, Lyon, France
| | - A Fraissenon
- Mother and Child Radiology Department, North University Hospital, Saint Etienne 42000, France; Paediatric Imaging Department, Woman-Mother-Child University Hospital, Hospices Civils de Lyon, Bron 69500, France
| | - C Dupont
- Research on Healthcare Performance (RESHAPE) INSERM U1290, Lyon 69003, France; AURORE Perinatal Network, Lyon 69004, France
| | - L Gaucher
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Midwifery Department, Geneva, Switzerland; Hospices Civils de Lyon, Public Healthcare Centre, Lyon F-69008, France
| | - J Haesebaert
- Research on Healthcare Performance (RESHAPE) INSERM U1290, Lyon 69003, France; Hospices Civils de Lyon, Public Healthcare Centre, Lyon F-69008, France
| | - E Nohuz
- Department of Obstetrics and Gynaecology, Woman-Mother-Child University Hospital, Hospices Civils de Lyon, Bron 69500, France
| | - M Cortet
- Department of Obstetrics and Gynaecology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon 69004, France; LabTAU INSERM U1032, Université Lyon1, Lyon 69003, France.
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Mathonnet A, Dabakuyo S, Philip CA, Jankowski C, Cortet M. [How is our practice of mastectomy? Analysis based on population data in a French department]. Gynecol Obstet Fertil Senol 2022; 50:770-776. [PMID: 36183985 DOI: 10.1016/j.gofs.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/22/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The objective of this research was to study the evolution of the mastectomy rate in patients with breast cancer between 1998 and 2015, based on population data from the Côte d'Or breast cancer registry of the FRANCIM network ("France cancer incidence and mortality"). METHODS In this study on population register we included patients who had presented a primary breast cancer (invasive cancer and/or carcinoma in situ [CIS]) between 1998 and 2015 in the Côte d'Or department. We estimated the annual proportions of mastectomies, then calculated their evolution trends over this period. RESULTS Between 1998 and 2015, 7093 patients were included. The overall proportion of mastectomies was stable at 28% and did not respond to a time trend (Sen's slope of 0.2% per year; P=0.289). There was an increase in the proportion of lobular carcinomas (slope at 0.3% per year; P <0.05), with a rising proportion of mastectomy for lobular carcinomas (slope at 0.6% per year; P<0.05) but decreasing for ductal (slope at -0.8% per year; P<0.05). The proportion of mastectomy was stable for plurifocal cancers but the proportion of plurifocal cancers increased over time (slope at 0.8% per year; P<0.05). CONCLUSION Therefore, mastectomy remained a stable practice over the 18 years of analysis in the Côte d'Or region. However, this overall stability is the result of variations in the profiles of diagnosed cancers and surgical practices.
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Affiliation(s)
- A Mathonnet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France.
| | - S Dabakuyo
- Registre des cancers du sein et des cancers gynécologiques de Côte d'Or, unité de recherche en epidémiologie et qualité de vie, Inserm U1231, Georges François Leclerc Centre-UNICANCER, Dijon, France
| | - C-A Philip
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France; Inserm U1032, LabTAU, université Lyon 1, Lyon, France
| | - C Jankowski
- Service de chirurgie oncologique, centre de lutte contre le cancer Georges-François Leclerc, Dijon, France
| | - M Cortet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, hospices civiles de Lyon, Lyon, France; Inserm U1032, LabTAU, université Lyon 1, Lyon, France
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Brun JL, Plu-Bureau G, Huchon C, Ah-Kit X, Barral M, Chauvet P, Cornelis F, Cortet M, Crochet P, Delporte V, Dubernard G, Giraudet G, Gosset A, Graesslin O, Hugon-Rodin J, Lecointre L, Legendre G, Maitrot-Mantelet L, Marcellin L, Miquel L, Le Mitouard M, Proust C, Roquette A, Rousset P, Sangnier E, Sapoval M, Thubert T, Torre A, Trémollières F, Vernhet-Kovacsik H, Vidal F, Marret H. [Management of women with abnormal uterine bleeding: Clinical practice guidelines of the French National College of Gynecologists and Obstetricians (CNGOF)]. Gynecol Obstet Fertil Senol 2022; 50:345-373. [PMID: 35248756 DOI: 10.1016/j.gofs.2022.02.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To provide French guidelines for the management of women with abnormal uterine bleeding (AUB). DESIGN A consensus committee of 26 experts was formed. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, or medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The last guidelines from the Collège national des gynécologues et obstétriciens français (CNGOF) on the management of women with AUB was published in 2008. The literature seems now sufficient for an update. The committee studied questions within 7 fields (diagnosis; adolescent; idiopathic AUB; endometrial hyperplasia and polyps; fibroids type 0 to 2; fibroids type 3 and more; adenomyosis). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 36 recommendations. Among the formalized recommendations, 19 present a strong agreement and 17 a weak agreement. Fourteen questions did not find any response in the literature. We preferred to abstain from recommending instead of providing expert advice. CONCLUSIONS The 36 recommendations made it possible to specify the diagnostic and therapeutic strategies of various clinical situations managed by the practitioner, from the simplest to the most complex.
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Affiliation(s)
- J-L Brun
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - G Plu-Bureau
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - C Huchon
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - X Ah-Kit
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - M Barral
- Service de radiologie interventionnelle, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - P Chauvet
- Service de chirurgie gynécologique, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
| | - F Cornelis
- Service de radiologie interventionnelle, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - M Cortet
- Service de gynécologie, hôpital Croix-Rousse, CHU Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - P Crochet
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147, boulevard Baille, 13005 Marseille, France
| | - V Delporte
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49, rue de Valmy, 59000 Lille, France
| | - G Dubernard
- Service de gynécologie, hôpital Croix-Rousse, CHU Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - G Giraudet
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49, rue de Valmy, 59000 Lille, France
| | - A Gosset
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - O Graesslin
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45, rue Cognac-Jay, 51092 Reims, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Lecointre
- Service de chirurgie gynécologique, CHU Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49933 Angers, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Marcellin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Miquel
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147, boulevard Baille, 13005 Marseille, France
| | - M Le Mitouard
- Service de gynécologie, hôpital Croix-Rousse, CHU Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Proust
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - A Roquette
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Rousset
- Service de radiologie, hôpital Sud, CHU Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - E Sangnier
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45, rue Cognac-Jay, 51092 Reims, France
| | - M Sapoval
- Service de radiologie interventionnelle, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - T Thubert
- Service de gynécologie-obstétrique, Hôtel-Dieu, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - A Torre
- Centre de procréation médicalement assistée, centre hospitalier Sud Francilien, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - F Trémollières
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Vernhet-Kovacsik
- Service d'imagerie thoracique et vasculaire, hôpital Arnaud-de-Villeneuve, CHU Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - F Vidal
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2, boulevard Tonnellé, 37044 Tours, France
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Lamblin G, Chene G, Leaune E, Philip CA, Moret S, Nohuz E, Golfier F, Cortet M. The psychological impact of therapeutic changes during the COVID-19-lockdown for gynaecological and breast cancer patients . J Gynecol Obstet Hum Reprod 2022; 51:102311. [PMID: 35007776 PMCID: PMC8739811 DOI: 10.1016/j.jogoh.2022.102311] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 12/05/2022]
Abstract
Objective The exceptional health situation related to the Coronavirus 2019 (COVID-19) pandemic has required an in-depth and immediate reorganisation of gynaecological cancer care. The main objective was to assess the psychological impact of such treatment modifications during the lockdown period for gynaecological and breast cancer patients. Patients and methods A multicentre prospective study was conducted in three university gynaecological cancer wards (Hospices Civils de Lyon, France) during the French first lockdown (16th March to 11th May 2020). All patients with non-metastatic breast cancer or gynaecological cancer were included. Data was collected regarding treatment modifications (delay, cancellation, change of therapeutic plan). The psychological impact of treatment modifications during and after the lockdown was assessed by validated questionnaires (SF-12, EORTC-QLQ-C30, HADS). Results A total of 205 consecutive patients were included, aged 60.5 ± 1.0 years. Seven patients (3.4%) presented a SARS-CoV-2 infection, and two patients died. Treatment was maintained for 122 (59.5%) patients, postponed for 72 (35.1%) and cancelled for 11 (5.4%). During the lockdown, 35/118 (29.7%) patients suffered from confirmed anxiety and the mean fatigue-EORTC score was 48.00 ± 2.51; it was 38.64 ± 2.33 (p = 0.02) after the lockdown. After the lockdown and compared to the lockdown period, the mental SF-12 score and overall health status EORTC score were significantly higher (45.03 ± 1.06 vs 41.71 ± 1.15, p = 0.02 and 64.58 ± 1.66 vs 57.44 ± 2.02, p = 0.0007, respectively). The number of confirmed-anxiety cases was significantly higher amongst patients for whom treatment was delayed or cancelled (40.5% vs 23.7%, p = 0.04). Conclusion This study quantified the treatment modifications of gynaecological cancer patients during the COVID-19 lockdown and revealed a poorer psychological state and quality of life during this period, even for patients whose treatment plan was not actually modified. Anxiety was more significant in patients with a delayed or cancelled treatment.
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Affiliation(s)
- G Lamblin
- Department of Obstetrics and Gynaecology Surgery, Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Bron, France; University of Lyon, Université Claude Bernard Lyon 1, Lyon, France.
| | - G Chene
- Department of Obstetrics and Gynaecology Surgery, Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Bron, France; University of Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - E Leaune
- Centre de Prévention du Suicide, Centre Hospitalier le Vinatier, 69500 Bron, France
| | - C A Philip
- Department of Obstetrics and Gynaecology Surgery, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - S Moret
- Department of Obstetrics and Gynaecology Surgery, Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Bron, France
| | - E Nohuz
- Department of Obstetrics and Gynaecology Surgery, Femme Mère Enfant University Hospital, Hospices Civils de Lyon, Bron, France; University of Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - F Golfier
- Department of Obstetrics and Gynaecology Surgery, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, 165 chemin du Grand Revoyet, 69310 Pierre Bénite, France
| | - M Cortet
- Department of Obstetrics and Gynaecology Surgery, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France; LabTAU, Unité INSERM U 1032, Université Claude Bernard Lyon 1, Lyon, France
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Favier A, Boinon D, Salviat F, Mazouni C, De Korvin B, Tunon C, Salomon AV, Doutriaux-Dumoulin I, Vaysse C, Marchal F, Boulanger L, Chabbert-Buffet N, Zilberman S, Coutant C, Espié M, Cortet M, Boussion V, Cohen M, Fermeaux V, Mathelin C, Michiels S, Delaloge S, Uzan C, Charles C. [Surgery or not on an atypical breast lesion? Taking anxiety into account in shared decision support from a prospective cohort of 300 patients]. ACTA ACUST UNITED AC 2021; 50:142-150. [PMID: 34562643 DOI: 10.1016/j.gofs.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Organized and individual breast screening have been accompanied by an increase in the detection of "atypical breast lesions (ABL)". Recently, the NOMAT multicenter study proposed a predictive model of the risk of developing breast cancer after detection of an ABL in order to avoid surgical removal of "low-risk" lesions. It also aimed to provide information on psychological experience, in particularly anxiety, to assist in the shared medical decision process. METHODS Three hundred women undergoing surgery for ABL were included between 2015 and 2018 at 18 French centers. Women completed questionnaires before and after surgery assessing their level of anxiety (STAI-State, STAI-Trait), their level of tolerance to uncertainty, their perceived risk of developing a breast cancer, and their satisfaction with the management care. RESULTS One hundred nighty nine patients completed the STAI-Status before and after surgery. Overall, a decrease in anxiety level (35.4 vs 42.7, P<0.001) was observed. Anxious temperament and greater intolerance to uncertainty were significantly associated swith decreased anxiety (33%), whereas younger age was associated with increased anxiety (8%). CONCLUSION Surgery for ABL seems to be associated with only a few cases with an increase in anxiety and seems to increase the perception of the risk of developing breast cancer. Taking into account the psychological dimension remains in all cases essential in the process of shared therapeutic decision.
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Affiliation(s)
- A Favier
- AP-HP (Assistance Publique des hôpitaux de Paris), department of gynecological and breast surgery and oncology, Pitié-Salpêtrière University Hospital, Paris, France.
| | - D Boinon
- Psycho-oncology unit, Gustave-Roussy, université Paris-Saclay, Villejuif, France; Université de Paris, LPPS, 92100 Boulogne Billancourt, France
| | - F Salviat
- Service de biostatistique et d'épidémiologie, Gustave-Roussy, Villejuif, France; CESP Inserm U1018, université Paris-Saclay, université Paris-Saclay, Villejuif, France
| | | | - B De Korvin
- Radiology center, centre Eugène-Marquis, CLCC, Rennes, France
| | - C Tunon
- Institut Bergonié, Bordeaux, France
| | - A-V Salomon
- Institut Curie, université Paris-Sciences Lettres, Inserm U934, département de médecine diagnostique et théranostique, Paris, France
| | | | - C Vaysse
- Département de chirurgie, CHU-Toulouse, institut universitaire du cancer de Toulouse-Oncopole, Toulouse, France
| | - F Marchal
- Institut de cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | | | | | - S Zilberman
- Hôpital Tenon, Sorbonne university, Paris, France
| | - C Coutant
- Centre Georges François Leclerc, Dijon, France
| | - M Espié
- University of Paris, Breast Unit, hôpital Saint-Louis, AP-HP, Paris, France
| | - M Cortet
- Service de gynécologie-obstétrique, hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - V Boussion
- Centre Jean-Perrin, Clermont-Ferrand, France
| | - M Cohen
- Institut Paoli Calmettes, Marseille, France
| | - V Fermeaux
- Service de pathologie, CHU Dupuytren, Limoges, France
| | - C Mathelin
- Les Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - S Michiels
- Service de biostatistique et d'épidémiologie, Gustave-Roussy, Villejuif, France; CESP Inserm U1018, université Paris-Saclay, université Paris-Saclay, Villejuif, France
| | | | - C Uzan
- AP-HP (Assistance Publique des hôpitaux de Paris), department of gynecological and breast surgery and oncology, Pitié-Salpêtrière University Hospital, Paris, France; Sorbonne University, Inserm UMR_S_938, "Cancer Biology and Therapeutics", centre de recherche Saint-Antoine (CRSA), Paris, France; Institut universitaire de cancérologie (IUC), Paris, France
| | - C Charles
- Université de Bordeaux, Bordeaux Population Health (U1219), équipe méthodes pour la recherche interventionnelle en santé des populations (MéRISP), Bordeaux, France
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Lamblin G, Golfier F, Peron J, Moret S, Chene G, Nohuz E, Lebon M, Dubernard G, Cortet M. [Impact of the COVID-19 Outbreak on the management of patients with gynecological cancers]. ACTA ACUST UNITED AC 2020; 48:777-783. [PMID: 33010487 PMCID: PMC7526595 DOI: 10.1016/j.gofs.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The exceptional health situation related to the SARS-Cov2 coronavirus pandemic (COVID-19) required a deep and very quickly adaptation of management practices in gynecological cancer. The main objective is to estimate the proportion of patients with treatment modifications. METHOD This is a multicenter prospective study conducted in 3 university gynecological cancer departments (HCLyon, France) during the period of confinement (March 16 to May 11, 2020). All patients with non-metastatic breast cancer or gynecological cancer were included. The planned treatment, postponement, delay and organizational modifications (RCP, teleconsultations) were studied. RESULTS Two hundred and five consecutive patients were included, average age 60.5±1.0. 7 patients (3.4%) had SARS-Cov-2 infection, 2 patients died. One hundred and twenty-two patients (59.5%) had a treatment maintained, 72 patients (35.1%) postponed, 11 patients (5.4%) cancelled. Of the 115 (56.1%) planned surgeries, 40 (34.8%) postponed, 7 cancelled (6.1%). 9 patients (7.8%) had a surgical modification. Of the 59 (28.8%) radiotherapy treatments scheduled, 24 (40.7%) postponed and 2 (3.4%) cancelled. Of the 56 (27.3%) chemotherapy treatment planned, 8 (14.3%) postponed and 2 (3.6%) cancelled. One hundred and forty-five patients (70.7%) have been discussed in multidisciplinary meeting. One hundred and fifty-eight patients (77%) had a teleconsultation system. CONCLUSION Our study assessed the impact of the COVID-19 pandemic on therapeutic management of patients with gynecological cancer during the period of confinement. This will probably improve our management of an eventual epidemic rebound or future health crisis.
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Affiliation(s)
- G Lamblin
- Service de chirurgie gynécologique, hôpital Femme Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France; Université Claude-Bernard Lyon 1, Lyon, France.
| | - F Golfier
- Service de chirurgie gynécologique, centre hospitalier Lyon Sud, hospices civils de Lyon, Pierre-Bénite, France
| | - J Peron
- Service d'oncologie médicale, centre hospitalier Lyon Sud, hospices civils de Lyon, Pierre-Bénite, France
| | - S Moret
- Service de chirurgie gynécologique, hôpital Femme Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - G Chene
- Service de chirurgie gynécologique, hôpital Femme Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - E Nohuz
- Service de chirurgie gynécologique, hôpital Femme Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France
| | - M Lebon
- Service de radiothérapie, centre hospitalier Lyon Sud, hospices civils de Lyon, Pierre-Bénite, France
| | - G Dubernard
- Service de chirurgie gynécologique, hôpital de la Croix Rousse, hospices civils de Lyon, Lyon, France
| | - M Cortet
- Service de chirurgie gynécologique, hôpital de la Croix Rousse, hospices civils de Lyon, Lyon, France
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Philouze P, Cortet M, Quattrone D, Céruse P, Aubrun F, Dubernard G, Mabrut JY, Delignette MC, Mohkam K. Surgical activity during the Covid-19 pandemic: Results for 112 patients in a French tertiary care center, a quality improvement study. Int J Surg 2020; 80:194-201. [PMID: 32693151 PMCID: PMC7368406 DOI: 10.1016/j.ijsu.2020.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 05/08/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND After the emergence of Covid-19 in China, Hubei Province, the epidemic quickly spread to Europe. France was quickly hit and our institution was one of the first French university to receive patients infected with Sars-COV2. The predicted massive influx of patients motivated the cancellation of all elective surgical procedures planned to free hospitalization beds and to free intensive care beds. Nevertheless, we should properly select patients who will be canceled to avoid life-threatening. The retained surgical indications are surgical emergencies, oncologic surgery, and organ transplantation. MATERIAL AND METHODS We describe the organization of our institution which allows the continuation of these surgical activities while limiting the exposure of our patients to the Sars Cov2. RESULTS After 4 weeks of implementation of intra-hospital protocols for the control of the Covid-19 epidemic, 112 patients were operated on (104 oncology or emergency surgeries and 8 liver transplants). Only one case of post-operative contamination was observed. No mortality related to Covid-19 was noted. No cases of contamination of surgical care personnel have been reported. CONCLUSION We found that the performance of oncological or emergency surgery is possible, safe for both patients and caregivers.
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Affiliation(s)
- P Philouze
- Head and Neck Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - M Cortet
- Gynecology and Obstetrics Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - D Quattrone
- Department of Anesthesiology and Critical Care, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - P Céruse
- Head and Neck Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - F Aubrun
- Department of Anesthesiology and Critical Care, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - G Dubernard
- Gynecology and Obstetrics Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - J Y Mabrut
- Department of General Surgery and Liver Transplantation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University, INSERM Unit 1052 / CNRS 5286 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - M C Delignette
- Department of Anesthesiology and Critical Care, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
| | - K Mohkam
- Department of General Surgery and Liver Transplantation, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon 1 University, INSERM Unit 1052 / CNRS 5286 103 Grande Rue de La Croix-Rousse, 69004, Lyon, France.
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Toubin C, Cortet M, Maisonnette-Escot Y, Coutant C, Riethmuller D. Interest of sentinel node before neoadjuvant chemotherapy in breast cancer: two-center study. Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Portha H, Jankowski C, Cortet M, Desmoulins I, Martin E, Lorgis V, Arnould L, Coutant C. [Non-metastatic triple-negative breast cancer in 2016: Definitions and management]. ACTA ACUST UNITED AC 2016; 44:492-504. [PMID: 27451066 DOI: 10.1016/j.gyobfe.2016.06.014] [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: 03/13/2016] [Accepted: 06/15/2016] [Indexed: 12/24/2022]
Abstract
Triple-negative breast cancer (TN), as defined by the triple negativity in immunohistochemistry: the absence of estrogen receptor, progesterone receptor and the absence of overexpression or amplification of HER2, corresponds to 15 % of invasive breast cancers. This is a very heterogeneous group of tumors both at the genomic and transcriptomic level and at morphological, clinical and prognostic level. Although there are some good prognosis forms, the majority of TN tumors is characterized by a poor prognosis with a greater frequency of visceral metastases and a maximum risk of relapse in the first two years after diagnosis. Systemic adjuvant treatment with chemotherapy is almost always indicated. The surgical treatment and radiotherapy treatment should be comparable to the other subtypes and obey the same rules of oncologic surgery. TN tumors are not associated with a higher risk of locoregional relapse after conservative treatment and adjuvant radiotherapy. Optimization of systemic therapies is currently and for the last decade a challenge. A number of targeted therapies and efficiency biomarkers identification of these targeted therapies is essential to allow significant progress in optimizing systemic therapy for these tumors.
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Affiliation(s)
- H Portha
- Département de chirurgie oncologique, centre de lutte contre le cancer Georges-François-Leclerc (CGFL), Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - C Jankowski
- Département de chirurgie oncologique, centre de lutte contre le cancer Georges-François-Leclerc (CGFL), Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France; UFR des sciences de santé, université de Bourgogne, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - M Cortet
- Département de chirurgie oncologique, centre de lutte contre le cancer Georges-François-Leclerc (CGFL), Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - I Desmoulins
- Département d'oncologie médicale, CGFL, Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - E Martin
- Département de radiothérapie, CGFL, Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - V Lorgis
- Département d'oncologie médicale, CGFL, Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - L Arnould
- Département de biologie et de pathologie des tumeurs, CGFL, Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - C Coutant
- Département de chirurgie oncologique, centre de lutte contre le cancer Georges-François-Leclerc (CGFL), Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France; UFR des sciences de santé, université de Bourgogne, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France.
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Jankowski C, Guiu S, Cortet M, Hudry D, Arnould L, Charon-Barra C, Desmoulins I, Rouzier R, Fumoleau P, Coudert B, Reyal F, Coutant C. Abstract P1-14-21: Predictive factors of pathologic complete response of HER2-positive breast cancer after preoperative chemotherapy with trastuzumab: Development of a specific predictor. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-14-21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: The aim of this study was to assess the M.D Anderson Cancer Center / Gustave Roussy Institute (MDACC/IGR) nomogram in predicting pathologic complete response (pCR) to preoperative chemotherapy in a cohort of HER2 tumors treated with preoperative chemotherapy with trastuzumab. Then, we combine clinical and pathological variable associated with pCR into a new nomogram specific of HER2 tumors treated by preoperative chemotherapy with trastuzumab.
Methods: Data from 270 patients treated with preoperative chemotherapy with trastuzumab at Curie Institute and at Georges Francois Leclerc Cancer Center were used to assess MDACC/IGR nomogram and then to develop a nomogram for pCR based on multivariate logistic regression. Model performance was quantified with respect to calibration and discrimination.
Results: The IGR/MDACC was not accurate to predicting pCR in HER2 tumors treated by preoperative chemotherapy with trastuzumab with poor discrimination (AUC=0,54, IC [0,51-0,58]) and poor calibration (p=0,01). After uni and multivariate analysis, the new pCR nomogram was based on T stage (TNM), hormonal receptor status, and ki67(%). The model had a good discrimination 0,74 (IC95% : [0,70-0,79]) and a good calibration (p=0,93).
Conclusion: To our knowledge, this is the first nomogram to predict pCR in HER2 tumors treated by preoperative chemotherapy with trastuzumab. To ensure exportability, the model need to be evaluate with a external validation set.
Citation Format: Jankowski C, Guiu S, Cortet M, Hudry D, Arnould L, Charon-Barra C, Desmoulins I, Rouzier R, Fumoleau P, Coudert B, Reyal F, Coutant C. Predictive factors of pathologic complete response of HER2-positive breast cancer after preoperative chemotherapy with trastuzumab: Development of a specific predictor. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-21.
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Affiliation(s)
- C Jankowski
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - S Guiu
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - M Cortet
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - D Hudry
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - L Arnould
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - C Charon-Barra
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - I Desmoulins
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - R Rouzier
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - P Fumoleau
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - B Coudert
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - F Reyal
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
| | - C Coutant
- Georges Francois Leclerc Cancer Center, Dijon, France; Institut Régional du Cancer, Montpellier, France; Institut Curie, Paris, France
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Misme H, Dupont C, Cortet M, Rudigoz RC, Huissoud C. Analyse descriptive du volume des pertes sanguines au cours de l’accouchement par voie basse et par césarienne. ACTA ACUST UNITED AC 2016; 45:71-9. [DOI: 10.1016/j.jgyn.2015.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/24/2014] [Accepted: 01/15/2015] [Indexed: 12/21/2022]
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Cortet M, Grimault A, Cheynel N, Lepage C, Bouvier AM, Faivre J. Patterns of recurrence of obstructing colon cancers after surgery for cure: a population-based study. Colorectal Dis 2013; 15:1100-6. [PMID: 23634749 DOI: 10.1111/codi.12268] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/02/2013] [Indexed: 12/16/2022]
Abstract
AIM Little is known about patterns of recurrence in obstructing colon cancer (OCC) at a population level. The aim of this study was to determine the risk of recurrence following potentially curative surgery in OCC compared with that in uncomplicated colon cancer (CC). METHOD Data were obtained from the population-based digestive cancer registry of Burgundy (France). Local and distant failure rates were calculated using actuarial methods. A multivariate analysis was performed using a Cox model. RESULTS Obstructing colon cancer represented 8.5% of all colon cancers resected with curative intent (n = 3375). The 5-year cumulative local recurrence rate was 14.2% for OCC and 7.6% for nonobstructing CC (P = 0.003). In the multivariate analysis, obstruction was an independent risk factor for local recurrence [hazard ratio 1.53 (1.01-2.34), P = 0.047]. The risk of local recurrence increased with advanced stage and age at diagnosis. The 5-year cumulative rate for distant metastases was also higher in OCC than in nonobstructing CC (36.1 vs 23.1%; P < 0.001). The relative risk of distant metastasis was borderline significant in the multivariate analysis [hazard ratio 1.25 (0.99-1.59), P = 0.057]. Stage at diagnosis, macroscopic type of growth, period of diagnosis and sex were also significant prognostic factors. Age and subsite were not significant in the multivariate analysis. CONCLUSION It is possible to conduct special surveys in population-based registries to determine the recurrence rate of CC. Recurrence remains a substantial problem and is more frequent in OCC than in nonobstructing CC. Efforts must be made to diagnose CC earlier. Mass screening is a promising approach.
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Affiliation(s)
- M Cortet
- Burgundy Digestive Cancer Registry, University of Burgundy, University Hospital Dijon, Dijon, France
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14
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Cortet M, Deneux-Tharaux C, Dupont C, Colin C, Rudigoz RC, Bouvier-Colle MH, Huissoud C. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth 2012; 108:984-9. [DOI: 10.1093/bja/aes096] [Citation(s) in RCA: 193] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dupont C, Deneux-Tharaux C, Cortet M, Colin C, Touzet S, Rabilloud M, Lansac J, Harvey T, Tessier V, Chauleur C, Pennehouat G, Morin X, Bouvier-Colle MH, Rudigoz RC. Prise en charge des hémorragies graves du post-partum après un accouchement par voie basse : étude en population dans 106 maternités françaises. ACTA ACUST UNITED AC 2012; 41:279-89. [DOI: 10.1016/j.jgyn.2012.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 02/04/2012] [Accepted: 02/17/2012] [Indexed: 11/29/2022]
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Salameh C, Canoui-Poitrine F, Cortet M, Lafon A, Rudigoz RC, Huissoud C. [Does persistent occiput posterior position increase the risk of severe perineal laceration?]. ACTA ACUST UNITED AC 2011; 39:545-8. [PMID: 21873097 DOI: 10.1016/j.gyobfe.2011.07.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 03/01/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the risk of severe perineal lacerations (III and IV degrees) during vaginal deliveries in occiput posterior position. PATIENTS AND METHODS We conducted a retrospective cohort study of 9097 vaginal deliveries in a teaching hospital's maternity between January 1st 2005 and December 31st 2008. Risk factors associated with tears of the 3rd or 4th degree were studied by a multivariate logistic regression. RESULTS Severe perineal lacerations occurred in 1.69% of cases (n=152) and did not significantly vary between 2005 and 2008. Parity was a protective factor (OR 0.42; P<0.001; IC(95%) 0.29-0.60) whereas instrumental extraction was associated with an increased risk: vacuum (OR 3.95; P<0.001, IC(95%) 2.23-7.00) and forceps (OR 3.55; P<0.001, IC(95%) 2.33-5.42). macrosomia. Risks were also increased in fetal macrosomia and episiotomy did not protect the mother (respectively OR 1.41 P<0.001, IC(95%) 1.19-1.68 and OR 1.73; P<0.001, IC(95%) 1.16-2.57). Persistent occiput posterior position was not significantly associated with an anal sphincter injury (OR=1.70 P=0.059; IC(95%) 0.98-2.94). DISCUSSION AND CONCLUSION In our series, occiput posterior position did not significantly impact the risk of severe perineal laceration. A manual rotation of the fetal head should be performed in case of associated risk factors.
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Affiliation(s)
- C Salameh
- Service de gynécologie-obstétrique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103 Grande-Rue-de-la-Croix-Rousse, Lyon cedex 04, France.
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Cortet M, Dupont C, Prunaret-Julien V, Fernandez MP, Peigne E, Huissoud C, Rudigoz RC. [Evolution of adherence to guidelines for prevention of group B streptococcal infections]. ACTA ACUST UNITED AC 2010; 39:569-74. [PMID: 20870364 DOI: 10.1016/j.jgyn.2010.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 06/28/2010] [Accepted: 07/27/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Assess the evolution in implementation of neonatal group B streptococcal infections prevention program in the Aurore network, between 2004 and 2009. PATIENTS AND METHODS A cross-sectional study was conducted during one week in the whole maternity units of the Aurore network about implementation of the neonatal streptococcal infection prevention program. Deliveries occurring after 37 weeks of gestation were included. Every stage required by the prevention program was registered for every delivery. Results obtained during this study were compared with those obtained in 2004. RESULTS Seven hundred and forty-four patients were included in 2004 and 618 in 2009. Vaginal swab rate was 96.3% in 2009 and 91.1% in 2004 (P<0.001), with a positive rate of 10.2 and 14.2%, respectively (P=0.041). Antibiotic infusion rates during delivery did not increase significantly. Clinical and biological surveillance of exposed newborns was significantly increased (P<0.001). No neonatal infection was observed during the study among newborns included in the program. CONCLUSION Sensitization of caregivers about neonatal streptococcal infection prevention seems to be efficient to increase the application of the prevention program written by the Aurore network.
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Affiliation(s)
- M Cortet
- Service de gynécologie-obstétrique, hospices civils de Lyon, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon cedex 04, France.
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