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Photodynamic therapy (PDT) has shown improvements in cancer treatment and in the induction of a proper anti-tumor immune response. However, current photosensitizers (PS) lack tumor specificity, resulting in reduced efficacy and side effects in patients with intraperitoneal ovarian cancer (OC). In order to target peritoneal metastases of OC, which overexpress folate receptor (FRα) in 80% of cases, we proposed a targeted PDT using a PS coupled with folic acid. Herein, we applied this targeted PDT in an in vivo mouse model of peritoneal ovarian carcinomatosis. The efficacy of the treatment was evaluated in mice without and with human peripheral blood mononuclear cell (PBMC) reconstitution. When mice were reconstituted, using a fractionized PDT protocol led to a significantly higher decrease in the tumor growth than that obtained in the non-reconstituted mice (p = 0.0469). Simultaneously, an immune response was reflected by an increase in NK cells, and both CD4+ and CD8+ T cells were activated. A promotion in cytokines IFNγ and TNFα and an inhibition in cytokines TGFβ, IL-8, and IL-10 was also noticed. Our work showed that a fractionized FRα-targeted PDT protocol is effective for the treatment of OC and goes beyond local induction of tumor cell death, with the promotion of a subsequent anti-tumor response.

During surgery for advanced epithelial ovarian cancer (EOC), the most important prognostic factor is the absence of residual tumor. Invisible microscopic peritoneal metastasis (mPM) are not removed during surgery and can be responsible of peritoneal recurrences. The aim of this current systematic review is to assess the role of fluorescence in evaluating mPM in EOC. We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov, Embase, Cochrane Library, and Web of Science databases. MeSH terms for fluorescence, EOC and peritoneal carcinomatosis were combined and not restricted to the English language. The final search was performed on September 1rst, 2021. The primary outcome was to determine the diagnostic accuracy of fluorescence. We also reviewed the different techniques used. Eighty-seven studies were identified. Of these, 10 were included for analysis. The sensitivity and specificity of fluorescence ranged between 66.7-100% and 54.2-100%, respectively. Most importantly, the negative predictive value (NPV) ranged from 90 to 100% Due to the heterogeneity of the studies, no consensus was reached concerning the optimal use of fluorescence in terms of type of dye, type and timing of injection and imager to use. No adverse event was reported. Fluorescence can safely be used in EOC to evaluate mPM with a high NPV. However, a randomized controlled trial is needed to homogenize current practice.

International audience; 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.

Resume De nouvelles approches therapeutiques moleculaires ont vu le jour ces dernieres annees pour les cancers gynecologiques avances parmi lesquels les inhibiteurs de poly-ADP-ribose-polymerases (PARPi). Ceux-ci ont demontre une efficacite dans les cancers sereux de haut grade ovarien chez les patientes porteuses de mutation du gene de predisposition aux cancers notamment du sein et de l’ovaire BRCA. Les donnees cliniques et pre cliniques suggerent que l’activite des inhibiteurs de PARPi ne serait pas limitee aux tumeurs mutees BRCA et mettraient en jeu la voie de recombinaison homologue. Ces donnees soulevent la question de l’efficacite des PARPi dans les cancers de l’endometre et du col de l’uterus a des stades avances pour lesquels les options therapeutiques sont aujourd’hui limitees. A l’heure actuelle, il existe peu de donnees disponibles quant a l’activite des PARPi dans les cancers de l’endometre et du col de l’uterus mais certains resultats semblent prometteurs. Nous proposons dans cette revue une synthese des etudes disponibles concernant les PARPi dans le cancer de l’endometre et le cancer du col de l’uterus.

The initial management of early-stage ovarian cancer consists of staging surgery including pelvic and para-aortic lymphadenectomy. The use of the sentinel lymph node (SLN) procedure in this setting may decrease the morbidity associated with this surgery. The objective of this review was to evaluate the feasibility of the SLN procedure in ovarian cancer diagnosed at an early stage by comparing the different techniques used and their accuracy. A systematic literature search was performed on PubMed and ClinicalTrials.gov for articles in English or French about the SLN technique in ovarian cancer. Ten studies were included in the analysis, with a total of 179 patients. The main tracers used were Technetium-99m, indocyanine green, and patent blue, and the most common site of injection was the proper ovarian and unfundibulopelvic ligaments. The overall detection rate was 87.7%. Of the small number of cases of lymph node metastasis reported, the SLN procedure had a sensitivity of 90.9% and a negative predictive value of 98.8%. The sentinel node procedure appears to be feasible and safe and could be reliable in determining the lymph node status of patients with early-stage ovarian cancer.

Background Lymphadenectomy is debated in patients with ovarian cancer. The aim of our study was to evaluate the impact of lymphadenectomy in patients with high-grade serous ovarian cancer receiving neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Methods A retrospective, unicentric study including all patients undergoing NACT and IDS was carried out from 2005 to 2018. Patients with and without lymphadenectomy were compared in terms of recurrence free survival (RFS), overall survival (OS), and complication rates. Results We included 203 patients. Of these, 133 had a lymphadenectomy (65.5%) and 77 had involved nodes (57.9%). Patients without a lymphadenectomy were older, had a more extensive disease and less complete CRS. No differences were noted between the lymphadenectomy and no lymphadenectomy group concerning 2-year RFS (47.4% and 48.6%, p = 0.87, respectively) and 5-year OS (63.2% versus 58.6%, p = 0.41, respectively). Post-operative complications tended to be more frequent in the lymphadenectomy group (18.57% versus 31.58%, p = 0.09). In patients with a lymphadenectomy, survival was significantly altered if the nodes were involved (positive nodes: 2-year RFS 42.5% and 5-year OS 49.4%, negative nodes: 2-year RFS 60.7% and 5-year OS 82.2%, p = 0.03 and p Conclusion Lymphadenectomy during IDS does not improve survival and increases post-operative complications.

International audience; 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.

Introduction Advanced epithelial ovarian cancer (EOC) is associated with high mortality and often managed first with neoadjuvant chemotherapy (NACT) followed by debulking surgery. Laparoscopic surgery with or without robotic assistance (Minimally Invasive Surgery (MIS)) may represent a beneficial option for these patients. The objective of this literature review is to clarify the place of MIS in the management of advanced EOC for selected patients. Method Pubmed, Cochrane and Clinicaltrials.gov online databases were used for this review, to select English or French published articles. Results We selected 11 original articles published between 2015 and 2020, 6 of which compared MIS and laparotomy. Among these 11 studies, 8 were retrospective cohorts, 2 were phase II trials, and one was a case-control study. In total, there were 3721 patients, of which 854 (23%) were treated with MIS. The robotic assistance was used with 224 patients (26%) of those MIS patients.Looking specifically at MIS patients, the laparoconversion rate was 9.5%, the rate of complete resection (CC-0) was 83.4%. Finally, the MIS complication rate was 1% intraoperatively and 12% postoperatively. The rate of complete resection, postoperative complication, as well as overall survival (OS) were comparable between patients treated with MIS or laparotomy. One study found an improved disease-free survival (DFS) in MIS versus laparotomy (18 months versus 12 months; p=0,027). Conclusion MIS seems feasible, effective, and reliable in comparison to laparotomy for the completion of cytoreductive surgery after NACT without compromising oncological safety. Prospective randomized controlled trials are needed to confirm the role of MIS in advanced EOC.

Introduction The benefit of a systematic lymphadenectomy is still debated in patients undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in ovarian cancer (OC). The objective of this study was to evaluate the predictive value of the pre-NACT and post-NACT CT in predicting definitive histological lymph node involvement. The prognostic value of a positive node on the CT was also assessed. Materiel and methods A retrospective, unicentric cohort study was performed including all patients with ovarian cancer who underwent NACT and IDS with a lymphadenectomy between 2005 and 2018. CT were analyzed blinded to pathology, and nodes with small axis ≥ 10 mm on CT were considered positive. Sensitivity (Se), specificity (Sp), and negative (NPV) and positive predictive values (PPV) and their CI95% were calculated. The 2-year recurrence free survival (RFS) and 5-year overall survival (OS) was compared. Results 158 patients were included, among which 92 (58%) had histologically positive lymph nodes. CT had a Se, Sp, NPV and PPV of 35%, 82%, 47% and 73% before NACT and 20%, 97%, 47% and 91% after NACT, respectively. Patients with nodes considered positive had a non-significant lower 2-year RFS and 5-year OS on the pre-NACT and post-NACT CT. Patients at ‘high risk’ (nodes stayed positive on the CT or became positive after NACT) also had a non-significant lower 2-year RFS and 5-year OS. Conclusion Presence of enlarged lymph nodes on CT is a weak indicator of lymph node involvement in patients with advanced ovarian cancer undergoing NACT. However, it could be used to assess prognosis.

Resume Les nouvelles recommandations europeennes concernant la prise en charge des patientes presentant un cancer de l’endometre ont ete publiees debut 2021. Ces recommandations sont conjointes aux trois societes savantes europeennes d’oncologie gynecologique (ESGO), de radiotherapie et d’oncologie (ESTRO) et d’anatomo-pathologie (ESP). Au nom de la Societe Francaise d’Oncologie Gynecologique (SFOG), nous souhaitons apporter a la connaissance du lectorat francophone les principales mesures pour la prise en charge des patientes qui representent une avancee par rapport aux recommandations de 2016. Les nouvelles recommandations europeennes concernant la prise en charge des patientes presentant un cancer de l’endometre insistent sur la generalisation de la recherche d’une instabilite des microsatellites (MSI) ou de l’analyse immunohistochimique des proteines du systeme MMR pour toutes les patientes. Aussi, la classification en 4 groupes a risque pronostic integre les donnees de l’analyse moleculaire (p53, MSI, POLE) pour guider la prise en charge chirurgicale initiale ainsi que les modalites du traitement adjuvant. La procedure du ganglion sentinelle au vert d’indocyanine est par ailleurs devenue la technique de reference pour la stadification ganglionnaire des stades FIGO I et II quel que soit le type histologique. On rappelle que la prise en charge doit etre assuree dans un etablissement specialise par une equipe specialisee dans la prise en charge des cancers gynecologiques, en particulier pour les patientes a haut risque et/ou presentant un cancer avance.

The latest European recommendations of the European Societies of Gynecological Oncology (ESGO), Radiotherapy and Oncology (ESTRO) and Anatomopathology (ESP) concerning the management of patients with endometrial cancer were published in 2021. On behalf of the French Society of Gynecologic Oncology (SFOG) and the SFOG campus, we wish to summarize for the French-speaking readership the main measures with a more specific application for France. We also incorporate data from a Delphi survey conducted with a panel of French and French-speaking Swiss experts. The data presented in this article relate to histo-molecular characteristics, radiological data of endometrial cancer, and management of low-risk, intermediate-risk, intermediate-high-risk, and metastatic cancers. The aim of this review article is to show the application of the latest international recommendations to clinicians and pathologists for the implementation of these recommendations.

In patients with persisting symptoms after uterine arteries embolization (UAE), ovarian arteries embolization (OAE) may play a role to improve symptoms and decrease subsequent surgery rates. In a retrospective cohort, we aimed to investigate the efficacy and safety of OAE in females with recurrent or persistent symptoms following UAE. We performed a retrospective analysis of prospectively collected cases at a single reference academic hospital; we identified patients who benefited from OAE for persisting symptoms following UAE from 2008 to 2021. Outcome variables included the rates of subsequent surgery, a quality-of-life questionnaire with the UFS-QOL tool, the MRI reduction in uterine and fibroids volumes and the fibroid devascularization rate. Among 1300 women treated with UAE during the study period, 18 eventually received OAE and were included (mean age 44 ± 4.3 SD). There was no OAE procedural complication. There was a decrease in uterine volume and a complete devascularization of the dominant fibroid in 10/11 (90.9%) patients who underwent 12 months MRI. Three women underwent subsequent hysterectomy. Among 10/18 patients who answered the quality-of-life questionnaire after a mean follow-up of 70 months, eight reported an improvement or stability of symptoms. OAE for persisting symptoms after UAE was associated with improvement or stability of quality-of-life in most study subjects and less than a fifth of the cohort underwent hysterectomy after OAE. This study highlights the role of OAE as an adjunct to UAE.

Introduction Sentinel lymph node biopsy (SLN) helps define lymph node status, a major prognostic factor in vulvar cancer. The aim of the current systematic review was to assess the use of indocyanine green (ICG) coupled with near-infrared (NIR) fluorescence imaging in SLN mapping in vulvar cancer in terms of technique used, feasibility and accuracy. Data sources We performed a systematic review using bibliographic citations from PubMed, Clinical Trials.gov , Embase, Cochrane Library, and Web of Science databases. MeSH terms for SLN, ICG and vulvar cancer were combined and restricted to the English language. The final search was performed on May 28, 2020. The primary outcome was to determine if the use of ICG alone in detecting SLN in women with vulvar cancer is as accurate as the gold standard dual labeling technique. Results Of the 34 studies initially identified, 13 were included for analysis. The SLN detection rate with ICG and NIR fluorescence ranged from 89.7 to 100%. No studies demonstrated the superiority of other detection techniques compared to ICG and NIR imaging. Lower SLN detection rates were found in studies with the most metastatic lymph nodes. No consensus was reached concerning the optimal use of ICG in terms of: injection timing or site; concentrations or volume of ICG; or use of human serum albumin or hybrid tracer. No adverse events were reported. Conclusion ICG for SLN mapping appears to be safe in women with vulvar cancer with a detection rate similar to the current techniques. A large prospective randomized controlled study with optimization of the technique is necessary to homogenize current practice and determine the true value of ICG in vulvar cancer. PROSPERO ID CRD42020178261.

Resumen El cancer de endometrio (CE) es el cancer ginecologico mas frecuente, tanto en Francia como en el resto de los paises occidentales. El diagnostico se suele establecer en un contexto de metrorragias posmenopausicas, despues de realizar una biopsia de endometrio. Despues de la menopausia, se debe investigar cualquier metrorragia o un grosor endometrial superior a 4 mm. La histologia, la exploracion fisica y las imagenes obtenidas por resonancia magnetica permiten determinar los grupos con riesgo de recidiva, asi como las modalidades del tratamiento inicial, a menudo quirurgico. La histerectomia con anexectomia bilateral es la intervencion de referencia, completada segun los casos por una exploracion ganglionar. El examen definitivo de las piezas operatorias permite redefinir los grupos en funcion del riesgo de recidiva, de acuerdo con los criterios establecidos en 2009 por la European Society for Medical Oncology, asi como la indicacion de los tratamientos adyuvantes (radioterapia, braquiterapia, quimioterapia). Es necesario saber identificar a las familias que presentan un riesgo genetico de CE (sindrome de Lynch) para adaptar su vigilancia, asi como a las pacientes aptas para una estrategia de preservacion de la fertilidad. la vigilancia es clinica. En la actualidad, son varias las lineas terapeuticas en desarrollo: antiangiogenicos, terapias dirigidas (via de senalizacion PI3K-AKT-mTOR), inmunoterapias (tumor con inestabilidad de los microsatelites). Con estas terapias, deberia mejorar el pronostico de las pacientes que presentan un CE.

Objective To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices. Materials and methods A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility. Results The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population. Conclusion BOTs remain rare, but this study – despite its small sample size – supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.

Resumen La linfadenectomia lumboaortica (LLA) o vaciamiento ganglionar lumboaortico es una tecnica dirigida a extirpar el tejido ganglionar a nivel laterocavo, precavo, interaortocavo, preaortico, lateroaortico supra e inframesenterico y del promontorio. En muchos casos, si las condiciones especificas de la paciente lo permiten, esta intervencion se puede efectuar por laparoscopia (reestadificacion del cancer de ovario en estadio precoz, estadificacion preterapeutica en el cancer de cuello de utero). Sin embargo, en caso de carcinomatosis, si la intervencion esta indicada, el estandar sigue siendo la laparotomia. En ginecologia, en ausencia de contraindicaciones debidas a caracteristicas propias de las pacientes, esta intervencion esta indicada en el cancer de ovario en estadio precoz (excepto en los tumores mucinosos) y avanzado, en la estadificacion del cancer de cuello de utero avanzado (por laparoscopia) y en algunos canceres de endometrio con riesgo de extension lumboaortica. Este tipo de cirugia requiere determinados conocimientos tecnicos, sobre todo en caso de adenopatias voluminosas o fijas, con un equipo sanitario y de anestesia entrenado para controlar los posibles riesgos vasculares.

International audience; BACKGROUND: This study compares morbidity and mortality associated with retroperitoneal and transperitoneal para-aortic lymphadenectomy (PAAL) for pretherapeutic nodal staging of locally advanced cervical cancers (FIGO IB3-IVA). METHODS: Pre-, per- and postoperative data of patients treated for locally advanced stage cervical cancer between 1999 and 2018 in 12 French referral centers (FRANCOGYN Study Group) were retrospectively collected. RESULTS: The study was conducted using a sample of 448 patients, of whom 223 (49,8%) underwent retroperitoneal (group 1) and 225 (50,2%) had transperitoneal PAAL (group 2). No differences were noted concerning clinical and histological characteristics between the two groups. Among these 448 patients, 23 (5,1%) had an intraoperative complication (9 (2,0%) in group 1 and 14 (3,1%) in group 2, p = 0.28) and 47 (10,5%) had a postoperative complication (22 (4,9%) in group 1 and 25 (5,6%) in group 2, p = 0.44), only one of which required revision surgery but the patient died. The length of hospital stay was significantly shorter in group 1 than in group 2 (3.97 versus 4.88 days, p

International audience; Prehabilitation is a multimodal approach to preoperative care based on physical exercise, dietary/nutritional interventions, smoking and alcohol cessation, and psychological care. The goal is to reduce stress and apprehension, encourage general well-being, and thus optimize the patient's state of health before surgery. Prehabilitation encompasses all the actions undertaken between the diagnosis of the disease and the initiation of surgery to reduce the morbidity attributable to the latter. Although there are few literature data on prehabilitation in gynecological surgery, the management of moderate-to-severe undernutrition prior to gynecological oncology surgery reduces the risk of postoperative complications and increases the overall survival rate.

The objective of the present study was to evaluate the implementation of Enhanced Recovery in Surgery (ERS) in French obstetrics and gynecology departments. To achieve this objective, we drafted an online questionnaire about ERS protocols for cesarian sections and hysterectomies with a benign indication and put a hyperlink on the 'French National College of Gynecologists and Obstetricians' (Collège National des Gynécologues et Obstétriciens Français) website. We obtained 112 analyzable responses. Respectively 66% and 34% of the surveyed departments had established ERS protocols for cesarean sections and for hysterectomies with a benign indication. However, not all of the key ERS items were sufficiently implemented: despite the establishment of written protocols, the degree of compliance with the guidelines issued by the French-Speaking Group for Enhanced Recovery After Surgery (Groupement Francophone de Réhabilitation Améliorée Après Chirurgie) was variable. There are few published data on the implementation of ERS in obstetrics and gynecology departments worldwide. In 2010, the Enhanced Recovery After Surgery® Society issued guidelines and a checklist for an ERS protocol. The literature data suggest that for most surgical disciplines, the main ERS criteria are not well known or not widely applied. ERS protocols are still not widespread in French gynecologic surgery departments. Moreover, the application of some of the major ERS items differs markedly from one ERS program to other, which is likely to reduce the level of effectiveness. It therefore appears to be essential to formalize and promote ERS protocols in gynecological surgery.

The current review explores the Enhanced Rehabilitation in Surgery (ERS) approach in the specific context of gynecological surgery. Implementation of an ERS protocol in gynecological surgery reduces postoperative complications and length of stay without increasing morbidity. An ERS approach is based on maintaining an adequate diet and hydration before the operation, according to the recommended time frame, to reduce the phenomenon of insulin resistance, and to optimize patient comfort. On the other hand, the use of anxiolytic treatment as premedication is not recommended. Systematic preoperative digestive preparation, a source of patient discomfort, is not associated with an improvement in the postoperative functional outcome or with a reduction in the rate of complications. A minimally invasive surgical approach is preferrable in the context of ERS. Prevention of surgical site infection includes measures such as optimized antibiotic prophylaxis, skin disinfection with alcoholic chlorhexidine, reduction in the use of drainage of the surgical site, and prevention of hypothermia. Early removal of the bladder catheter is associated with a reduction in the risk of urinary tract infection and a reduction in the length of hospital stay. Prevention of postoperative ileus is based on early refeeding, and prevention of postoperative nausea-vomiting in a multimodal strategy to be initiated during the intraoperative period. Intraoperative hydration should be aimed at achieving euvolemia. Pain control is based on a multimodal strategy to spare morphine use and may include locoregional analgesia. Medicines should be administered orally during the postoperative period to hasten the resumption of the patient's autonomy. The prevention of thromboembolic risk is based on a strategy combining drug prophylaxis, when indicated, and mechanical restraint, as well as early mobilization. However, the eclectic nature of the implementation of these measures as reported in the literature renders their interpretation difficult. Furthermore, beyond the application of one of these measures in isolation, the best benefit on the postoperative outcome is achieved by a combination of measures which then constitutes a global strategy allowing the objectives of the ERS to be met.

International audience; IntroductionIn France, participation in the organized breast cancer screening program remains insufficient. A personalized approach adapted to the risk factors for breast cancer (RBC) should make screening more efficient. A RBC evaluation consultation would therefore make it possible to personalize this screening. Here we report our initial experience.Material and methodThis is a prospective study on women who were seen at the RBC evaluation consultation and analyzing: their profile, their risk assessed according to Tyrer Cuzick model (TC) ± Mammorisk© (MMR), the existence of an indication of oncogenetic consultation (Eisinger and Manchester score), their satisfaction and the recommended monitoring.ResultsAmong the women who had had a TCS and/or MMR evaluation of SCR (n = 153), 76 (50%) had a high risk (n = 67) or a very high risk (n = 9). Almost half (47%) had a possible (15%) or certain (32%) indication to an oncogenetic consultation. Regarding this consultation, 98% of women were satisfied or very satisfied. In total, 60% of women had a change in screening methods.ConclusionThis RBC evaluation consultation satisfies women and for a majority of them, modifies their methods of breast cancer screening.; IntroductionL’adhésion en France au programme de dépistage organisé du cancer du sein demeure insuffisante. Une approche personnalisée adaptée aux facteurs de risque de cancer du sein (RCS) permettrait une meilleure efficience du dépistage. Une consultation d’évaluation du RCS permettrait donc de personnaliser ce dépistage. Nous rapportons ici notre expérience initiale.Matériel et méthodeIl s’agit d’une étude prospective portant sur les femmes ayant été vues à la consultation d’évaluation du RCS et analysant : leur profil, leur risque évalué selon les modèles de Tyrer Cuzick (TC) ± Mammorisk© (MMR), l’existence d’une indication de consultation d’oncogénétique (scores d’Eisinger et de Manchester), leur satisfaction et la surveillance préconisée.RésultatsParmi les femmes ayant eu une évaluation du RCS par le modèle TC et/ou MMR (n = 153), 76 (50 %) avaient un risque élevé (n = 67) ou très élevé (n = 9). Près de la moitié (47 %) avait une indication possible (15 %) ou certaine (32 %) à une consultation d’oncogénétique. Concernant cette consultation, 98 % des femmes étaient satisfaites ou très satisfaites. Au total, 60 % des femmes ont eu un changement des modalités de surveillance.ConclusionCette consultation d’évaluation du RCS satisfait les femmes et pour une majorité d’entre elles, modifie les modalités de leur surveillance mammaire.

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.

Resume Objectifs Editer, par le College national des gynecologues et obstetriciens francais (CNGOF), des recommandations fondees sur les preuves disponibles dans la litterature pour la prise en charge des tumeurs frontieres de l’ovaire (TFO) de stade precoce. Methodes Recherche bibliographique en langue francaise et anglaise effectuee par consultation des bases de donnees Pubmed, Cochrane, Embase et des recommandations internationales. Resultats Dans la prise en charge chirurgicale des TFO a un stade precoce, si une chirurgie sans risque de rupture tumorale avec extraction protegee des pieces operatoires est possible, la voie cœlioscopique est recommandee par rapport a la laparotomie (Grade C). Dans les TFO, il est recommande de prendre toutes les dispositions pour eviter la rupture tumorale, y compris la decision peroperatoire de laparoconversion (Grade C). Dans les TFO, une extraction de la piece operatoire a l’aide d’un sac endoscopique est recommandee (Grade C). En cas de TFO de stade precoce, uni- ou bilaterale, suspectee a l’imagerie preoperatoire chez une patiente menopausee et/ou sans de desir de preservation de fertilite et/ou de la fonction endocrine, il est recommande de realiser une annexectomie bilaterale (Grade B). En cas de TFO de stade precoce sereuse bilaterale avec desir de preservation de la fertilite et/ou de la fonction endocrine, il est recommande de realiser une kystectomie bilaterale dans la mesure du possible (Grade B). En cas de TFO de stade precoce mucineuse avec desir de preservation de la fertilite et/ou de la fonction endocrine, il est recommande de realiser une annexectomie unilaterale (Grade C). En cas de TFO de stade precoce endometrioide avec desir de preservation de la fertilite et/ou de la fonction endocrine, il n’est pas possible d’etablir une recommandation de choix de traitement entre kystectomie et annexectomie unilaterale. En cas de TFO de stade precoce mucineuse a l’analyse histologique definitive chez une femme ayant eu une kystectomie initiale, avec ou sans desir de preservation de la fertilite et/ou de la fonction endocrine, une reprise chirurgicale pour une annexectomie unilaterale est recommandee (Grade C). En cas de TFO de stade precoce sereuse a l’analyse histologique definitive chez une femme ayant eu une kystectomie initiale, avec desir de preservation de la fertilite et/ou de la fonction endocrine, il n’est pas recommande de reprise chirurgicale pour annexectomie en l’absence de lesion suspecte residuelle lors de la chirurgie et/ou a l’imagerie postoperatoire (echographie par referent ou IRM pelvienne) (Grade C). Une omentectomie est recommandee afin de realiser une stadification initiale chirurgicale complete lorsqu’une TFO est diagnostiquee a l’examen extemporane ou suspectee sur les elements radiologiques preoperatoires (Grade B). Il n’existe pas de donnees dans la litterature permettant de recommander le type d’omentectomie a realiser. Si une chirurgie de restadification est decidee pour une TFO a un stade presume precoce, une omentectomie est recommandee (Grade B). Des biopsies peritoneales multiples sont recommandees afin de realiser une stadification initiale chirurgicale complete lorsqu’une TFO est diagnostiquee a l’examen extemporane ou suspectee sur les elements radiologiques preoperatoires (Grade C). En cas de chirurgie de restadification pour une TFO a un stade presume precoce, l’exploration de la cavite abdominale doit etre complete et des biopsies peritoneales doivent etre realisees sur les zones suspectes ou de facon systematique (Grade C). Une cytologie peritoneale premiere est recommandee afin de realiser une stadification initiale chirurgicale complete lorsqu’une TFO est suspectee sur les elements radiologiques preoperatoires (Grade C). En cas de chirurgie de restadification pour une TFO a un stade presume precoce, une cytologie peritoneale premiere est recommandee (Grade C). Concernant les TFO sereuses ou mucineuses de stade precoce, il n’est pas recommande de realiser une hysterectomie a titre systematique (Grade C). Concernant les TFO de stade precoce de type endometrioide, et en l’absence de desir de conserver la fertilite, il est recommande de realiser une hysterectomie en chirurgie initiale ou si une chirurgie de restadification est indiquee (Grade C). Concernant les TFO de stade precoce de type endometrioide, en cas de desir de preservation de la fertilite, l’uterus peut etre conserve sous reserve d’une bonne evaluation de l’endometre par imagerie et prelevement endometrial (Grade C). Concernant les TFO de stade precoce, quel que soit le type histologique, il est recommande d’evaluer l’aspect macroscopique de l’appendice lors de la chirurgie (initiale ou de restadification si indiquee) (Grade B). Concernant les TFO de stade precoce, quel que soit le type histologique, il est recommande de ne realiser une appendicectomie qu’en cas d’aspect macroscopiquement pathologique de l’appendice (Grade C). Concernant les TFO de stade precoce, quel que soit le type histologique, la lymphadenectomie pelvienne et/ou lombo-aortique n’est pas recommandee dans le cadre d’une chirurgie initiale ou d’une chirurgie de restadification (Grade C). En cas de TFO diagnostiquee sur histologie definitive, l’indication de chirurgie de restadification doit etre discutee en Reunion de Concertation Pluridisciplinaire. Pour les TFO presumees de stade precoce, il est recommande de privilegier la voie cœlioscopique pour realiser une chirurgie de restadification (Grade C). Une chirurgie de restadification est recommandee en cas de TFO sereuse avec aspect micropapillaire et une inspection de la cavite abdominale non satisfaisante lors de la chirurgie initiale (Grade C). Une chirurgie de restadification est recommandee en cas de TFO mucineuse si seule une kystectomie a ete realisee ou que l’appendice n’a pas ete visualise, il sera alors realise une annexectomie unilaterale (Grade C). Si une chirurgie de restadification est decidee dans la prise en charge d’une TFO presumee de stade precoce, les gestes a realiser sont les suivants : une cytologie peritoneale (Grade C), une omentectomie (il n’existe pas de donnees dans la litterature permettant de recommander le type d’omentectomie a realiser) (Grade B), une exploration complete de la cavite abdominale avec biopsies peritoneales sur les zones suspectes ou de facon systematique (Grade C), la visualisation de l’appendice ± l’appendicectomie en cas d’aspect macroscopique pathologique (Grade C), une annexectomie unilaterale en cas de TFO mucineuse (Grade C).

Introduction/Background* The management of ovarian cancer has rapidly become more complex in recent years due to surgical and medical advances. The aim of this study was to assess French current practice in management of patients with advanced epithelial ovarian cancer. Methodology An anonymous survey was sent to the SFOG, GINECO-ARCAGY and FRANCOGYN members. The survey consisted of 58 items divided in five sections dealing with diagnostic staging, pathological and genetic data, surgical practice patterns, adjuvant/neoadjuvant treatment, and follow-up strategies. Result(s)* Overall, 107 answers were available. Most of participants were obstetrician-gynecologists (37.4%), surgical oncologists (34.6%), and medical oncologists (17.8%). Most of participants came from University Hospitals (40.2%) and Comprehensive Cancer Center (37.4%). For 76.8% of respondents, less than 50% of patients are eligible for primary debulking surgery. In case of neoadjuvant chemotherapy, surgical resecability is assessed after 3 cycles for 92.7% of respondents. LION study’s criteria were always applied during primary surgery for 69,5% of respondents. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is used as a first-line treatment for 41.4% of respondents (26.8% within clinical trial and 14.6% outside) and during interval surgery for 37.8% of respondents. According to the completeness of cytoreduction surgery and the BRCA mutation status, association of Paclitaxel-Carboplatin (every 3 weeks) is the most used combination as adjuvant chemotherapy for 69.7 to 84.8% of respondents and bevacizumab 15mg/kg is used in case of no residual disease for 52.9 to 61.7 of respondents. In case of BRCA1-2 mutations, Olaparib is given by 75.8% to 84.8% of respondents. The delay to obtain BRCA germline mutation results is less than 1 month for 26.5% of respondents and less than 3 months for 76.5% of respondents. An Homologous Recombination Repair Deficiency is searched for 73.5% of respondents and mainly by Myriad test (91.3%). Conclusion* In our study, the rate of HIPEC was high because 2 clinical trials are currently ongoing in France on HIPEC as 1st line treatment. Our results provide an interesting picture of current management in France in relation to International Guidelines. They provide a basis for further research and raise the question of updating guidelines for ovarian cancer management.

Introduction/Background* Recent findings have suggested that lymphadenectomy during primary cytoreductive surgery (CRS) in patients with ovarian cancer was not associated with an improve in survival, at the expense of a high morbidity. The aim of our study was to evaluate the impact of lymphadenectomy in patients with high-grade serous ovarian cancer benefitting from neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Methodology A retrospective, unicentric study including all patients undergoing NACT and IDS was carried out from 2005-2018. Patients with and without lymphadenectomy were compared in terms of recurrence free survival (RFS), overall survival (OS), and complication rates. Survival was assessed using a Cox regression model and Kaplan Meyer curves. Result(s)* We included 203 patients. Of these, 133 had a lymphadenectomy (65.5%) and 77 had involved nodes (57.9%). Patients who did not benefit from a lymphadenectomy were older with a more extensive disease and lesser rate of complete CRS. No differences were noted between the lymphadenectomy and no lymphadenectomy group concerning 2-year RFS (47.4% and 48.6%, p=0.87, respectively) and 5-year OS (63.2% versus 58.6%, p=0.41, respectively). Post-operative complications tended to be more frequent in the group with a lymphadenectomy (18.57 versus 31.58, p=0.09). In the group of patients with lymphadenectomy, survival was significantly altered in patients with involved nodes (positive lymph nodes: 2-year RFS 42.5% and 5-year OS 49.4%, negative nodes: 2-year RFS 60.7% and 5-year OS 82.2%, p= 0.03 and p Conclusion* Lymphadenectomy during IDS does not improve survival and increases post-operative complications.

Introduction/Background* The aim of this study was to investigate the current surgical and non-surgical therapeutic management of advanced epithelial ovarian cancer (AEOC) cases worldwide, using the data from an internationally launched survey. Methodology After the validation of a 58-item survey regarding diagnostic and pathological data, as well as surgical and chemotherapeutic strategies of AEOC in France, in the period between April and May 2021, the survey was launched among the members of the following gynecological cancer societies and study groups: IJGC Fellows, SENTICOL 3 study group, ARCAGY-GINECO, AGO, SFOG, SFOG Campus and FRANCOGYN. Result(s)* A total of 203 physicians completed the survey and majority of them, 171 (84.7%) were from Europe. Gynecological oncologists represented 49.2% of the respondents, surgical oncologists 25.1% and medical oncologists 13.7%. Most of the participants work in centers, managing more than 20 AEOC per year (91.5%). According to 66.7% of respondents, less than 50% of patients were eligible for primary debulking surgery (PDS). If neoadjuvant chemotherapy (NACT) was used, resectability was assessed after 3 cycles of NACT before interval debulking surgery (IDS) was performed. The most used peritoneal carcinomatosis index was Sugarbaker (69.8%), whereas Fagotti, modified Fagotti and Makar scores were used in 35.4%, 20.1% and 4.9%, respectively. After the initial staging, the decision between PDS and NADS-IDS was based on the number of the surgical procedures which had to be performed (82.9%), carcinosis index (61.6%), patient’s age (51.2%), global visual assessment (36.0%) and surgeon’s personal estimation (11.0%). During IDS, LION study’s criteria were always applied according to only 23.1% of the respondents. Hyperthermic intraperitoneal chemotherapy (HIPEC) was used as a first-line treatment from 16.0% of respondents within clinical trials and 14.1% out of clinical trials. Regardless of the surgical strategy (PDS or NACT-IDS) and the completeness of cytoreduction surgery, Olaparib was prescribed by 74.3% to 81.4% of the respondents and Niraparib by 8.6% to 12.9%. Bevacizumab was prescribed by 42.9% to 68.6% in case of no BRCA mutation. Conclusion* According to our study, the current management of ovarian cancer is in line with the ESGO guidelines. More participants are necessary for a more precise presentation.

Introduction/Background* The benefit of a systematic lymphadenectomy is still debated in patients undergoing neo-adjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in ovarian cancer (OC). The objective of this study was to evaluate the predictive value of the pre-NACT and post-NACT CT in predicting definitive histological lymph node involvement. The prognostic value of a positive node on the CT was also assessed. Methodology A retrospective, unicentric cohort study was performed including all patients with ovarian cancer who underwent NACT and IDS with a lymphadenectomy between 2005-2018. CT were analyzed blinded to pathology, and nodes with small axis ≥ 10 mm on CT were considered positive. Sensitivity (Se), specificity (Sp), and negative (NPV) and positive predictive values (PPV) and their CI95% were calculated. The 2-year recurrence free survival (RFS) and 5-year overall survival (OS) was compared. Result(s)* 158 patients were included, among which 92 (58%) had histologically positive lymph nodes. CT had a Se, Sp, NPV and PPV of 35%, 82%, 47% and 73% before NACT and 20%, 97%, 47% and 91% after NACT, respectively. Patients with nodes considered positive had a non-significant lower 2-year RFS and 5-year OS on the pre-NACT and post-NACT CT. Patients at ‘high risk’ (nodes stayed positive on the CT or became positive after NACT) also had a non-significant lower 2-year RFS and 5-year OS. Conclusion* Presence of enlarged lymph nodes on CT is a weak indicator of lymph node involvement in patients with advanced ovarian cancer undergoing NACT. However, it could be used to assess prognosis.

International audience; 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.

International audience; Objective: To assess the surgical management and survival of severely obese patients with high-risk endometrial cancer.Materials and methods: Data from 269 patients with high-risk endometrial cancer who were treated between 2001 and 2018 were collected from a multicenter database (11 centers). We classified the patients according to their BMI and compared outcomes in two groups: a normal weight group of women with a BMI < 25 kg/m2, and a severe obesity group of women with a BMI ≥ 35 kg/m2. The groups were compared for epidemiologic, pathologic, management, relapse-free survival (RFS) and overall survival (OS) elements.Results: Patients in the severe obesity group were younger (64 years vs. 68 years, p < 0.05) and had more comorbidities (hypertension, diabetes). They also had more locally advanced tumors and pelvic lymph node involvement (47% vs 24%, p < 0.05). The severely obese patients were less likely to undergo recommended surgical staging, with fewer lumbar aortic dissections than women of normal weight (23% vs 36%, p < 0.05) and fewer pelvic sentinel lymph node biopsies (26.5% vs 12.1%, p < 0.05). No difference in RFS or OS were observed between the two groups.Conclusion: Patients with severe obesity and high-risk endometrial cancer have more locally advanced tumors, and are less likely to be managed according to surgical recommendations. However, RFS and OS do not seem to be affected.