Identification of a group with high risk of postoperative complications after deep bowel endometriosis surgery: a retrospective study on 164 patients

PURPOSE

Identify a group with a high risk of postoperative complications after deep bowel endometriosis surgery.

METHODS

We conducted a retrospective study on patients treated from 2012 to 2018 in two departments of gynecological surgery at the Toulouse University Hospital, France. The postoperative complications were evaluated in relation to the surgical management, associated with or without non-digestive surgical procedures, initial disease and patient's characteristics.

RESULTS

164 patients were included. A postoperative complication occurred in 37.8% (n = 62) of the cases and required a secondary surgery in 18.3% (n = 30) of the cases. In the univariate analysis, the risk of postoperative complications increased significantly in the presence of segmental resection, disease progression, and associated urinary tract procedure or vaginal incision. In the multivariate analysis, the risk of overall postoperative complications was associated with the surgical management (p = 0.013 and 0.017) and particularly in the presence of segmental resection [Odds Ratio (OR): 20.87; CI 95% (1.96-221.79)]. The risk of rectovaginal fistula increased in the presence of segmental resection [OR: 22.71; CI 95% (2.74-188.01)] as well as in vaginal incision [OR: 19.67; CI 95% (2.43-159.18); p = 0.005].

CONCLUSION

The risk of overall postoperative complications and rectovaginal fistula in particular increases significantly in the presence of vaginal incision, segmental resection and urinary tract procedures after deep bowel endometriosis surgery.

[Lipofilling in breast reconstruction: is there any population with higher risk of local recurrence? Literature systematic review]

Safety of the autologous fat grafting (AFG) in the breast parenchyma remains a debated topic, particularly in reconstruction following breast cancer. This procedure still raises many questions, especially considering recent in vitro studies warning about the fact that lipofilling could promote tumor recurrence through increased neoangiogenesis, or facilitate metastasis. Through a systematic literature review on oncological risk and radiological follow-up, conducted from January 2010 to August 2014, we tried to identify populations at risk of recurrence after AFG. The study selection process was adapted from the Prisma statement. Out of the seven analysed patients cohorts, i.e. approximately 1500 AFG procedures, results on the risk of local recurrence appear reassuring after an average follow-up of 42 months. These results should be cautiously interpreted because of the heterogeneity of the studies. However, recurrences have been analysed based on the characteristics of the original tumor and many of them warn about population that seem more at risk of recurrence. Studies on radiological modifications after AFG emphasize the need for the radiologists to know the importance of radiological images induced by this procedure, however, AFG does not seem to interfere with radiological screening of local recurrence. In order to deliver clear information to patients receiving breast reconstruction by lipofilling, prospective studies focused on populations that seem to be most at risk of recurrence are required.

[Voluminous juvenile papillomatosis: Diagnostic, therapeutic and prognostic difficulties - a case report]

The juvenile papillomatosis is a rare entity. We shall systematically check for a cancer. A 20-year-old woman patient without any familial medical history of breast carcinoma, was presenting a voluminous nodule of the left breast. A core needle biopsy allowed to diagnose papilloma. A conservative surgical treatment was proposed and realized despite any possibility of complete resection. Histological examination of the surgical specimen concluded to a juvenile papillomatosis. A closed follow-up was proposed to the patient. This case illustrates the difficulty of a voluminous tumor surgery on a young woman. The main problem is to combine the cosmetic constraints with oncology risk.

Predictors of recurrence in high-grade cervical lesions and a plan of management

PRÉCIS: Positive endocervical margins are an important predictor of recurrence in high-grade cervical lesions, and though they do not always warrant retreatment, closer surveillance is recommended.

OBJECTIVE

To identify predictors of recurrence and persistence of high-grade cervical dysplasia and to determine appropriate follow-up.

DESIGN

prospective pilot study.

SETTING

Gynaecological surgical center.

POPULATION

Three hundred fifty-two patients were treated between 1999 and 2002 for high-grade lesions.

METHODS

According to the accessibility of the transformation zone and the degree of dysplasia, patients were treated either by conization or by loop electrosurgical excision procedure (LEEP). Follow-up comprised colposcopy and Pap-smear screening 4-6 months after treatment as well as high-risk human papillomavirus (HR-HPV) testing before and after treatment.

MAIN OUTCOME MEASURES

underscore predictors of recurrence and propose a treatment flowchart for both management and follow-up.

RESULTS

Of the 352 patients, 37 (10.5%) had true recurrence 6 months after initial surgical treatment and 6 patients (1.7%) had persistent lesions. Overall, 43 patients (12.2%) were considered as having recurrent disease. Patients were followed up for 5 years with a mean of 73 months. The most important predictor of recurrence was a positive HR-HPV test at 6 months postoperatively (odds ratio 38.8, 95% confidence interval 14.09, 107.05). The second significant predictor was positive endocervical margins and the third was positive pre-treatment HPV typing. A positive post-treatment HPV test had a more significant influence on risk than a positive test before treatment.

CONCLUSION

In agreement with recent findings, our study supports the usefulness of the HR-HPV test in the follow-up of treated high-grade lesions, especially when excision margins were positive.

[The adipose tissue transfer in the mammary parenchyma (part I): Review of the literature on modifications of the radiological images]

The adipose tissue transfer (ATT) in the mammary parenchyma is a subject of controversy and generates passionate debates in scientific meetings. So far, many phenomena remain unexplained. Among these phenomena, changes in mammogram images generated by the grafted adipose tissue and the interactions between the grafted adipose tissue and a clinically undetectable breast cancer are the most important. We will present a series of articles with a critical analysis of the scientific literature on each of these phenomena. This first article presents the review of the literature on modifications of the radiological images after ATT. Two types of images are most common in mammograms after ATT. These are oil cysts and microcalcifications. Regarding to the presented review of literature, there is not yet sufficient evidence to prove a similarity or not between these images generated by the ATT and those from a breast malignancy. Therefore, clinically, patients must be included in a prospective clinical trial and in terms of research, the first step should be an exhaustive description of radiological images after ATT and a comparison of these images to images of malignancy. So, it's important to include these patients in prospective protocols with close and long term follow-up.