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Resume Les patientes porteuses d’une mutation du gene BReast Cancer 1 ou 2 (BRCA) ont une predisposition hereditaire aux cancers du sein et de l’ovaire. Ces mutations genetiques deleteres sont celles les plus couramment impliquees dans les cancers hereditaires du sein et de l’ovaire. La consultation d’oncogenetique joue un role cle dans l’identification des patientes a risque et la recherche et l’identification de la mutation chez la patiente et ses apparentes. La mise en evidence d’une mutation BRCA doit conduire a une surveillance rapprochee et peut justifier d’une chirurgie prophylactique mammaire et/ou annexielle dont les indications et les modalites sont detaillees par l’Institut national du cancer (INCa). Les inhibiteurs de poly-(ADN-riboses) polymerases (PARP), dont le plus connu est l’olaparib ont une efficacite majeure dans la prise en charge des cancers epitheliaux de l’ovaire chez les patientes porteuses d’une mutation BRCA et les nombreuses etudes en cours elargiront probablement les indications dans un futur proche.

Background: Breast cancer (BC) is a major public health concern with over 2 million new cases diagnosed and over 600,000 deaths in 2018 in women worldwide. When distant metastases are present at diagnosis, the 5-year survival rate is only 26%. Recent studies have suggested that persistent organic pollutants (POPs) that accumulate in adipose tissue (AT) can influence tumor phenotype and stimulate cellular processes important for metastasis such as invasion. We, therefore, tested the hypothesis that POP exposure is associated with BC metastasis. Methods: We conducted an exploratory case-control study in which the concentrations of 49 POPs were measured in both AT and serum samples from BC patients, with or without lymph node metastasis, who underwent partial or total mastectomies, lymph node biopsies and sampling of the adipocytic tumor microenvironment. Adjusted, unconditional logistic models were used to study the associations between the POP concentrations and the risk of metastasis and other hallmarks of cancer aggressiveness. Results: 2.3.7.8-TCDD concentrations in AT are positively associated with the risk of metastasis in 43 patients who have BMIs equal or higher than 25 kg/m2 (odds ratio: 4.48 (1.32–20.71)). Furthermore, the concentrations of 2.3.7.8-TCDD and two coplanar PCBs (77&169) in AT also were positively associated with the risk of lymph node metastasis and the tumor size. Conclusion: Our study suggests that 2.3.7.8-TCDD and some PCBs contribute to the development of tumor metastasis and other hallmarks of cancer aggressiveness. While these results should be considered with caution, this is the first study to identify such potential risk factors. Larger longitudinal studies are necessary to confirm our results.Clinical Trial Protocol Record: 2013-A00663-42. Keywords: Breast cancer, Environmental exposure, Adipose tissue, Serum, Organochlorine pesticides, Endocrine disrupting chemicals, Polychlorinated biphenyls, Perfluoroalkyl acid, Dioxins

El desarrollo de la cirugia minimamente invasiva, y mas particularmente de la laparoscopia desde la decada de 1980, ha permitido realizar un avance significativo en la cirugia ginecologica, tanto para enfermedades benignas como malignas. Las ventajas de la cirugia laparoscopica estan reconocidas desde hace muchos anos: disminucion de la hemorragia postoperatoria, reduccion del dolor postoperatorio, disminucion de la hospitalizacion, convalecencia mas rapida con reanudacion mas precoz de la actividad y ventajas esteticas. Sin embargo, el desarrollo de la laparoscopia no ha sido uniforme y esta tecnica se emplea demasiado poco en la actualidad en comparacion con la laparotomia, debido a su dificultad y a su curva de aprendizaje demasiado larga, quedando limitada a los centros y cirujanos con gran experiencia. La cirugia asistida por robot, que esta actualmente en pleno auge, esta en vias de convertirse en la alternativa a la laparoscopia y la laparotomia en el ambito de la cirugia ginecologica. Sus ventajas principales son la vision tridimensional, una exposicion controlada por el cirujano, una mayor ergonomia que permite disminuir la fatiga y aumentar la precision del cirujano, asi como una curva de aprendizaje mas corta que para la laparoscopia simple. Debido a que esta es una tecnica reciente, los datos de la literatura son numerosos, pero de calidad discutible por el momento, dada la falta de ensayos prospectivos y aleatorizados. Sin embargo, esta cirugia presenta varios inconvenientes: tamano y aparatosidad del robot, tiempo de instalacion, coste. Por tanto, esto implica la necesidad de sopesar bien las indicaciones de la laparoscopia asistida por robot, para equilibrar el balance beneficios/coste/organizacion. En este articulo, se analiza la aportacion de la cirugia asistida por robot en ginecologia, tanto en patologias benignas como malignas.

El cancer de endometrio es una patologia muy frecuente y de buen pronostico en un estadio precoz. Para el ginecologo o el medico general es fundamental establecer el diagnostico de forma precoz. Esto supone conocer los factores de riesgo y los signos de alarma, y efectuar la evaluacion complementaria adecuada que permita adoptar una conducta terapeutica rapida y adaptada. El proposito de este articulo es tratar todos los puntos importantes del diagnostico y de la evaluacion preterapeutica con el fin de obtener los elementos necesarios para un tratamiento optimo.

ObjectiveThe aim of our study was to report the technique, the feasibility, and perioperative results of robotic extraperitoneal paraaortic lymphadenectomy in gynecological cancers performed for isolated or combined procedures.MethodsThis is a retrospective study of 24 consecutive patients undergoing robotic extraperitoneal paraaortic lymphadenectomy using the Da Vinci Surgical system (Intuitive Inc, Sunnyvale, CA) (cervical cancer, n = 15; high-risk endometrial cancer, n = 8; and ovarian cancer, n = 2, including 1 synchronous tumor). Extraperitoneal paraaortic lymphadenectomy was performed using the surgical technique previously described by laparoscopy.ResultsOf the 24 included patients, 12 patients had isolated robotic extraperitoneal paraaortic lymphadenectomy, whereas the others underwent the following associated procedures: total hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and omentectomy (n = 7); pelvic transperitoneal lymphadenectomy (n = 3), laparotomic Bricker procedure (n = 1), and colpectomy (n = 1). The median age of patients was 55 (42–64) years, and body mass index was 24.1 kg/m2 (20.9–26.1). The operation was completed in all patients except three with associated procedures. Perioperative difficulties were encountered in 9 patients (gas leakage, n = 7; adhesions, n = 2; and dissection difficulties, n = 1). The number of removed paraaortic lymph nodes was 18 (14–25). The operating times were 180 (150–210) minutes for isolated extraperitoneal paraaortic lymphadenectomy and 240 (180–300) minutes in case of associated procedures. There were 2 intraoperative (pneumothorax and renal artery injury) and 5 postoperative (3 grades 1–2 and 2 grade 3) complications.ConclusionsIf robotic-assisted extraperitoneal paraaortic lymphadenectomy seems feasible in case of isolated procedure, further studies are required to prove its benefit compared with conventional laparoscopy.

Le cancer de l’ovaire est la premiere cause de mortalite par cancer gynecologique. La chirurgie est avec la chimiotherapie la base du traitement. La resection complete des lesions est l’objectif de la chirurgie qu’elle soit faite au debut du traitement ou apres quelques cycles de chimiotherapie. La selection des patientes entre chirurgie immediate ou differee est la seule question incompletement resolue. Les sites qui prennent en charge ces patientes et leur parcours de soins semblent au moins aussi importants que la qualite de l’acte chirurgical proprement dit.

Since the advent of sentinel node biopsy, which made it possible to reduce the morbidity of axillary surgery, axillary lymph node dissection has been constituting the treatment of reference in certain cases of breast cancer. One of the most frequent complications in the immediate postoperative period is the lymphocele or seroma, the frequency of which is independent of the axillary technique of surgery. Following an analysis of the literature, some risk factors were isolated such as a high body mass index, the high volume of the first three days drainage and arterial hypertension. Some techniques seem to show a benefit in the reduction of the lymphocele: sentinel node biopsy, padding of the axilla and the axillary drainage. The majority of other techniques such as the use of fibrin sealant, hemolymphostatic sponges, various techniques of axillary dissection, external axillary compression, differed mobilization from the upper limb, axillary dissection by lipo-aspiration and endoscopic axillary dissection, have too contradictory results at the present time to be recommended in clinical practice. No consensus is clearly established to decrease the incidence and the volume of the seroma after axillary dissection in breast cancer. Today, two techniques can be nevertheless distinguished: sentinel node biopsy and padding of the axilla.

Resume Objectifs Le but de l'etude etait de comparer la douleur postoperatoire des patientes ayant eu une hysterectomie par voie vaginale selon le procede d'hemostase, fils resorbables ou thermofusion. Patientes et methodes Etude retrospective realisee chez les 60 dernieres patientes ayant beneficie d'une hysterectomie par voie vaginale pour une pathologie benigne dans le service de chirurgie gynecologique du CHI de Poissy–Saint-Germain-en-Laye jusqu'en mars 2006. Parmi ces patientes, 32 avaient beneficie d'une hemostase par fils et 28 de la thermofusion. Les criteres etudies etaient la douleur postoperatoire, la consommation morphinique totale et les durees du traitement antalgique, de l'hospitalisation et du temps operatoire. Resultats La douleur postoperatoire des 24 premieres heures etait plus de deux fois inferieure avec l'utilisation de la thermofusion, que ce soit en periode postoperatoire immediate ou a 24 heures. Par ailleurs, la consommation morphinique totale etait aussi significativement inferieure par l'utilisation de la thermofusion. Discussion et conclusion Cette etude pilote temoigne que, en terme de douleur dans le postoperatoire immediat, la technique par thermofusion est seduisante. D'autres etudes prospectives et randomisees permettraient de le confirmer et de conclure egalement en terme de duree d'hospitalisation, de qualite de vie des patientes et de cout en terme de sante publique.

Study Objective To compare the rates of intraoperative and postoperative complications of robotic surgery and laparoscopy in the surgical treatment of endometrial cancer. Design Unicentric retrospective study (Canadian Task Force classification II-2). Setting Tertiary teaching hospital. Patients The study was performed from January 2002 to December 2011 and included patients with endometrial cancer who underwent laparoscopic or robotically assisted laparoscopic surgical treatment. Data collected included preoperative data, tumor characteristics, intraoperative data (route of surgery, surgical procedures, and complications), and postoperative data (early and late complications according to the Clavien-Dindo classification, and length of hospital stay). Morbidity was compared between the 2 groups. Measurements and Main Results The study included 146 patients, of whom 106 underwent laparoscopy and 40 underwent robotically assisted surgery. The 2 groups were comparable in terms of demographic and preoperative data. Intraoperative complications occurred in 9.4% of patients who underwent laparoscopy and in none who underwent robotically assisted surgery (p = .06). There was no difference between the 2 groups in terms of postoperative events. Conclusion Robotically assisted surgery is not associated with a significant difference in intraoperative and postoperative complications, even when there were no intraoperative complications of robotically assisted surgery.

Since the advent of sentinel node biopsy, which made it possible to reduce the morbidity of axillary surgery, axillary lymph node dissection has been constituting the treatment of reference in certain cases of breast cancer. One of the most frequent complications in the immediate postoperative period is the lymphocele or seroma, the frequency of which is independent of the axillary technique of surgery. Following an analysis of the literature, some risk factors were isolated such as a high body mass index, the high volume of the first three days drainage and arterial hypertension. Some techniques seem to show a benefit in the reduction of the lymphocele: sentinel node biopsy, padding of the axilla and the axillary drainage. The majority of other techniques such as the use of fibrin sealant, hemolymphostatic sponges, various techniques of axillary dissection, external axillary compression, differed mobilization from the upper limb, axillary dissection by lipo-aspiration and endoscopic axillary dissection, have too contradictory results at the present time to be recommended in clinical practice. No consensus is clearly established to decrease the incidence and the volume of the seroma after axillary dissection in breast cancer. Today, two techniques can be nevertheless distinguished: sentinel node biopsy and padding of the axilla.

The purpose of the study was to compare the postoperative pain of patients who had a hysterectomy through vaginal route according to the process of binding: wire or electrosurgical bipolar vessel sealing.Retrospective study carried out in the 60 last patients who underwent a hysterectomy by vaginal route for a benign pathology in the gynaecological service of surgery of the CHI Poissy-Saint-Germain-en-Laye until March 2006. Among these patients, 32 had profited from a binding by wire and 28 of the electrosurgical bipolar vessel sealing. The studied criteria were the post-operative pain, total morphine consumption and the durations of the analgesic treatment, the hospitalisation and intervention time.The postoperative pain in the first 24 hours was twice lower using thermofusion; it was valid in immediate post-operative period and after 24 hours. In addition, total morphine consumption was also significantly lower using thermofusion.This pilot study shows that the electrosurgical bipolar vessel sealing allows a reduction in the pain into the immediate postoperative period. Other prospective and randomised studies would allow it and conclude on the duration of hospitalisation, the quality of life from the patients and the cost in terms of public health.