Search

Objectives Description of fertility and prognosis of patients with borderline ovarian tumor (BOT) treated by fertility-sparing surgery through a longitudinal study from the French national cancer network. Methods All consecutive patients diagnosed with BOT from the French National Network dedicated to Ovarian Malignant Rare Tumors from 2010 and 2017 were selected. In 2018, an update was made by sending a questionnaire regarding recurrence and fertility to patients aged under 43 years at diagnosis and treated conservatively. We compared the characteristics of the patients with/without recurrence and with/without live birth. Results Fifty-two patients aged 18 to 42 years presented a desire of pregnancy. Thirty patients (58%) presented a FIGO IA tumor, and 20 patients were treated by bilateral cystectomies (38%). We observed at least one live birth for 33 patients (63%) and local recurrences in 20 patients (38%). Both recurrence and live birth in 17 patients (33%) were reported, with recurrence occurring before pregnancy, after a second fertility-sparing treatment, in half of the cases. No factors associated with recurrence or live birth in this study were identified. Moreover, in this population, both recurrence and live birth were independent of age, with a linear risk along time. Disease-free survival was worse for patients treated with bilateral cystectomy (n = 20, 38%), with no difference in terms of fertility. Conclusion Two third of the patients experienced life birth after conservation surgery. We did not highlight an age/time from surgery for which the risk of recurrence outweighs the chance of pregnancy and to radicalize surgery. Moreover, almost a quarter of the live birth occurred after recurrence, with no more further event to date in these patients. The results encourage to consider a second fertility-sparing surgery after local borderline recurrence in the case of pregnancy desire. All these decisions must be discussed in specialized multidisciplinary boards.

Resume La chirurgie de cytoreduction complete est la pierre angulaire du traitement des cancers avances de l’ovaire avec la chimiotherapie. La qualite de l’exerese chirurgicale est le facteur pronostique essentiel et une chirurgie complete doit donc etre realisee (grade A) dans un centre expert (grade B). La chirurgie des stades IV est possible et apporte un benefice en cas de chirurgie complete peritoneale abdominale (NP3). Il est recommande de realiser des lymphadenectomies lombo-aortiques et pelviennes en cas de suspicion clinique ou radiologique d’adenopathie metastatique (grade B). En l’absence d’adenopathie suspecte clinique ou radiologique et en cas de chirurgie peritoneale complete lors d’une chirurgie initiale, il est possible de ne pas realiser de lymphadenectomie parce que cela ne modifie pas le traitement medical ni la survie globale (grade B). La chimiotherapie neo-adjuvante pourra etre proposee en cas de : resection complete non envisageable en chirurgie premiere (grade B); alteration de l’etat general ou co-morbidites ou patiente âgee (diminution de la morbidite et amelioration de la qualite de vie) (grade B) ; stade IV notamment avec lesions intrahepatiques multiples ou metastases pulmonaires ou ascite importante avec miliaire (grade B). En cas de cancer de l’ovaire de stade FIGO III ou IV diagnostique par une biopsie lors d’une laparotomie prealable, une chimiotherapie neo-adjuvante et une chirurgie d’intervalle sont a privilegier (grade C). En cas de chirurgie palliative ou de constat peroperatoire de l’impossibilite de realiser une chirurgie a residu nul, il n’existe pas de donnees sur le type de geste chirurgical a effectuer ayant montre un impact sur la survie sans recidive ou sur la qualite de vie. Il est recommande de decrire la carcinose peritoneale avant toute exerese ainsi que les residus tumoraux en fin de chirurgie (taille, localisation et raison de la non-extirpabilite) (grade B). Il est recommande d’utiliser un score de carcinose peritoneal permettant d’evaluer de facon objective la charge tumorale comme le Peritoneal Carcinosis Index (PCI) (grade C). L’utilisation d’un compte rendu operatoire standardise est recommandee (grade C).

Sentinel lymph node biopsy has replaced axillary lymph node dissection in those patients with clinically node-negative axilla without compromising their oncologic outcomes. Indication of neoadjuvant chemotherapy has been extended to patients to evaluate the pathologic response and to offer more conservative breast surgery. Sentinel lymph node dissection after neoadjuvant chemotherapy is feasible and accurate in patients with clinically node-negative patients. The timing of the sentinel lymph node biopsy, before or after medical treatment has been studied with benefits for each procedure. Sentinel lymph node dissection has been explored in different randomized prospective studies in clinically positive axilla with the aim of reduce axillary lymph node dissection. However, several studies are necessary to more accurately identify residual axillary disease and the sentinel lymph node after neoadjuvant chemotherapy, to adjust the adjuvant radiotherapy protocols and to evaluate the impact on oncologic outcomes.

Resume Objectif L’Institut national du cancer a instaure depuis 2007 un seuil minimum de 20 patientes par an par centre traitant les patientes atteintes d’un cancer gynecologique. Cette revue a pour but d’evaluer si les donnees de la litterature valident cette demarche, et specifiquement pour le cancer de l’ovaire. Methodes Une recherche sur la base de donnees MEDLINE a ete conduite, afin de referencer tous les articles pertinents evaluant, d’une part, les liens entre la survie des patientes atteintes d’un cancer de l’ovaire et le volume moyen de patientes par centre ainsi que par operateur ; et d’autre part, les liens entre la qualite carcinologique de la chirurgie et ces memes volumes. Resultats Dix-neuf etudes repondaient a nos criteres d’inclusion ; dix-sept etaient retrospectives et 2 prospectives ; les echantillons de population variaient de 476 a 96 802 patientes. Les donnees les plus importantes, quantitativement et qualitativement, concernent l’evaluation de la survie en fonction du volume moyen par centre, avec 8 etudes sur 13 retrouvant une correlation statistiquement significative entre volume moyen par centre et survie. Les donnees concernant la qualite de la chirurgie sont moins abondantes et plus heterogenes, en fonction de la definition de la chirurgie « optimale » par les auteurs. Conclusion La mise en place de seuils par centre semble etre un moyen efficace d’ameliorer la survie dans le cancer de l’ovaire. Neanmoins, il faudrait que ces seuils soient specifiques au cancer de l’ovaire et pas elargis aux « cancers gynecologiques ».

Objective The aim of this study was to compare the feasibility and efficacy of robot-assisted laparoscopy with traditional laparotomy and conventional laparoscopy in a series of patients with locally advanced cervical cancer managed in our two institutions. Methods Twenty-two patients who underwent robot-assisted laparoscopy were compared with 20 patients who underwent adjuvant surgery by laparotomy and 16 who underwent conventional laparoscopy, before the arrival of the Da Vinci surgical system. Results There was no significant difference between the three groups in terms of body mass index, FIGO stage, or tumor histology. The complication rate was similar in the three groups of patients, although there was a trend towards more lymphatic complications in the robot-assisted subgroup managed medically. There was no significant difference in the recurrence rate between the robot-assisted laparoscopy, conventional laparoscopy and laparotomy groups (27.3%, 29.4% and 30%, respectively). Conclusion Robot-assisted laparoscopy is feasible after concurrent chemoradiation and brachytherapy in cases of locally advanced cervical cancer. This new surgical approach reduces hospital stay, and seems to result in less severe complications than conventional laparotomy without modifying the oncological outcome.