[Epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas in Senegal]

AIM

To evaluate the epidemiological, etiological and evolutionary profile of vesico-vaginal fistulas (VVF) in university hospitals in Senegal.

PATIENTS AND METHOD

This is a retrospective, descriptive, single-center study, collecting the records of patients followed for VVF between January 2014 and December 2019 at the Urology and Andrology Department of the Centre hospitalier universitaire Aristide Le Dantec, Dakar, Senegal. The following parameters were studied: age, geographical origin, parity, and etiology of VVF. To assess the evolution of the epidemiological and etiological profile of VVF, we compared our results with those of series published by our structure.

RESULTS

Forty-five (45) VVFs were identified over a period of 6 years. This represents an annual average of 7.5 fistulas. The average age was 40±15.13 years with extremes of 13 years and 75 years; 17 patients (37.8%) were older than 45 years. The average parity was 3 with extremes from 0 to 12 children. Multiparous women represented 68.8% of the patients. Obstetric VVF (OVF) was more frequent (48.9%) followed by iatrogenic VVF (33.3%). The mean age was higher in the IVF group compared to the VVF group (32 years) (P = 0.0004). Thirty patients were from the Dakar region and its suburbs (66.6%). The etiology of VVF did not vary according to the geographical origin of the patients (P=NS). VVF was frequently associated with the management of cervical cancer in 42.2% of cases. Comparison of our current data with previous series shows a reduction in the annual incidence of VVF. VVFs, although they have decreased significantly, are still predominant. There is a constant increase in the number of IVF.

CONCLUSION

There is an evolution of the epidemiological and etiological profile marked by a decrease in the frequency of VVFs and an increase in that of IVFs. It is also worth noting the frequent association between cervical cancer and VVF.

LEVEL OF EVIDENCE

Level 4: retrospective study.

[A curriculum based certification of competence in gynaecologic surgical oncology]

OBJECTIVE

In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies, the SFOG, the CNGOF, the SFCO and the SCGP, supported by the CNU of Obstetrics &Gynaecology- and UNICANCER, agreed to materialize this course and attest it by a certification awarded by a national jury.

MATERIAL AND METHODS

The national committee of certification in gynaecological oncology made up of 10 members, representing the 6 concerned organizations, set itself 5 objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification.

RESULTS

Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including 20 advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including 4 parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021.

CONCLUSION

The optimisation of the surgical management of patients treated for gynaecological cancer is achieved through the identification of a training course and the certification, by a national jury, of the skills of surgeons who have completed it.

[National certification for gynecological cancer surgery]

OBJECTIVE

In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies: the SFOG, the CNGOF, the SFCO and the SCGP supported by the CNU of Obstetrics & Gynaecology, and UNICANCER agreed to materialize this course and attest it by a certification awarded by a national jury.

MATERIAL AND METHODS

The national committee of certification in gynaecological oncology made up of ten members, representing the 6 concerned organizations, set itself five objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification.

RESULTS

Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including twenty advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including four parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021.

[Impact of COVID-19 pandemic on breast and gynecologic cancers management. Experience of the Surgery Department in the Nice Anticancer Center]

Introduction

Durant la pandémie de COVID-19, les mesures de confinement et les recommandations des sociétés savantes de cancérologie ont pu impacter le recours aux soins des patients.

Méthodes

Cette étude rétrospective unicentrique comparaît le nombre et les caractéristiques des patientes reçues pour une première consultation pour une tumeur du sein ou gynécologique entre la période du confinement et une période contrôle, ainsi que les délais de prise en charge et les traitements proposés.

Résultats

Durant le confinement, 91 patientes ont été vues pour une demande de prise en charge, contre 159 durant la période contrôle, soit une baisse de 43,5 %. Les patientes étaient plus âgées (62,9 contre 60,9 ans), sans que cette différence soit significative (p = 0,339). Le stade tumoral n’était pas modifié. En sénologie, le délai entre la biopsie et la première consultation a été allongé de 5,5 jours (différence non significative). Parmi les 51 patientes ayant une indication opératoire durant le confinement, 16 (31,4 %) ont été reportées après la levée du confinement. Malgré tout, le délai entre la consultation et le début des traitements n’a pas été impacté. Nous n’avons pas non plus mis en évidence de modification statistiquement significative des pratiques.

Discussion

Au plus fort de la pandémie, les bénéfices et les risques du traitement du cancer ont dû être évalués en permanence, face au risque d’exposition au SARS-CoV-2. L’évaluation des pratiques en oncologie est essentielle pour comprendre le réel impact de cette pandémie, et se préparer à d’éventuelles crises futures.

[Impact of the COVID-19 Outbreak on the management of patients with gynecological cancers]

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.

[Guidelines for surgical management of gynaecological cancer during pandemic COVID-19 period - FRANCOGYN group for the CNGOF]

INTRODUCTION

Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period.

MATERIAL AND METHOD

Recommendations based on the consensus conference model.

RESULTS

In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies.

CONCLUSION

During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.

[A propensity score evaluation of single-port or multiport extraperitoneal para-aortic lymphadenectomy and the transperitoneal approach for gynecological cancers]

INTRODUCTION

Endoscopic para-aortic lymphadenectomy (PALN) is a crucial step in the management of gynecological cancers. However, some concerns exist on the completeness of PALN according to the route (transperitoneal vs. extraperitoneal single-port or multiport). We compared these three surgical techniques using a propensity score.

METHODS

We retrospectively reviewed all patients undergoing an endoscopic PALN for a gynecological cancer from May 2010 to Mars 2015. Fifty-one patients had a single-port extraperitoneal PALN, 16 a multiport extraperitoneal PALN and 62 a transperitoneal PALN. Factors independently related to technique performances were tested on a multivariate model adjusted for a propensity score.

RESULTS

The number of lymph nodes removed by transperitoneal route was 15 and extraperitoneal route single and multiport was 12. After adjustment for the propensity score of undergoing the extraperitoneal approach, no difference in the number of lymph node removed was noted (P=0.17). There was more lymphocyst after transperitoneal (17%) and multiport extraperitoneal PALN (19%) than after extraperitoneal PALN (2%) (P=0.04). Success rate of single-port extraperitoneal PALN was 94% (n=48). Four patients required a conversion to an open route due to vascular injury.

DISCUSSION

Using a propensity score, single-port extraperitoneal route offers similar efficacy to perform PALN than transperitoneal or multiport extraperitoneal route but with less lymphocysts.