•CT scanner or PET scanner are not sufficient to evaluate LNM in ovarian neoplasms.•Para-aortic LNM and colon involvement at imaging were the two variables of our score.•For a score ≥ 1, probability ...of LNM was 76%, specificity was 85.7%.
: Lymphadenectomy is part of cytoreductive surgery for patients with advanced epithelial ovarian cancer (AEOC) in case of abnormal lymph nodes before and during surgery. The aim of this study was to develop and validate a pre-operative radiological score to predict pelvic and/or para-aortic lymph node metastasis (LNM) in patients with AEOC undergoing cytoreductive surgery.
: We conducted a multicentre retrospective study. The construction sample was composed of 53 patients operated within two referral centers. The validation sample was composed of 39 patients operated in a third referral centre. The score was built with a logistic regression model with internal validation by bootstrap.
: Two variables were associated with the prediction of pelvic and/or para-aortic LNM at computerized tomography (CT) and/or positron emission tomography (PET/CT): “para-aortic lymph node involvement” (adjusted diagnostic odds ratio) (aDOR)=8.77 95CI 1.42-54.09, p=0.02) and “colon involvement” (aDOR=7.97 95CI 1.28-49.58, p=0.03). Bootstrap procedure showed that the model was stable. The 2-points LNM pre-operative radiological score was derived from these 2 radiological variables and a high-risk group was identified for a score ≥ 1: the probability of pelvic and/or para-aortic LNM was 76%, the specificity was 85.7% 95CI 67.3-96.0 and the positive likelihood ratio was 3.6 95CI 1.4-9.7. In the validation sample, a score ≥ 1 had a specificity of 78.3% and a LR+ of 1.2.
: LNM pre-operative radiological score could help the surgeon's decision to perform pelvic and para-aortic lymphadenectomy in patients with AEOC undergoing cytoreductive surgery.
: The research protocol was approved by the Ethics Committee for Research in Obstetrics and Gynecology (CEROG 2016-GYN 1003).
The aim of our study was to describe the bioinformatics approach to analyze miRNome with Next Generation Sequencing (NGS) of 200 plasma samples from patients with and without endometriosis. Patients ...were prospectively included in the ENDO-miRNA study that selected patients with pelvic pain suggestive of endometriosis. miRNA sequencing was performed using an Novaseq6000 sequencer (Illumina, San Diego, CA, USA). Small RNA-seq of 200 plasma samples yielded ~4228 M raw sequencing reads. A total of 2633 miRNAs were found differentially expressed. Among them, 8.6% (
= 229) were up- or downregulated. For these 229 miRNAs, the F1-score, sensitivity, specificity, and AUC ranged from 0-88.2%, 0-99.4%, 4.3-100%, and 41.5-68%, respectively. Utilizing the combined bioinformatic and NGS approach, a specific and broad panel of miRNAs was detected as being potentially suitable for building a blood signature of endometriosis.
To map the vascular anatomy of the obturator foramen using fixed anatomic landmarks.
Twenty obturator regions were dissected in 10 fresh female cadavers after vascular blue dye injection in five ...cadavers (50%). Furthermore, 104 obturator regions were reconstructed by angiotomodensitometry from 52 women under investigation for suspected arterial disease. The anatomy of the obturator region was mapped by measuring the distance of vascular structures from the middle of the two branches of the ischiopubic bone, which were used as fixed landmarks.
The bifurcation of the obturator artery was at a mean (SD) distance of 30.0 mm (4.5) from the middle of the ischiopubic branch (MISP). The anterior branch of the obturator vessels was 15.2 mm (10.1) from the MISP. The posterior branch of the obturator vessels was 5.5 mm (4.0) and 23.6 mm (8.7) from the middle of the outer edge of the obturator foramen (MOE) and the MISP, respectively. Using 5° and 95° percentiles of these measurements we defined a central avascular triangle.
Our data show that, beyond inter-individual variations, a central triangular avascular area can be identified in the obturator foramen between the posterior and anterior obturator artery using fixed landmarks.
Results from studies reporting the optimal stimulation duration of IVF-ICSI cycles are inconsistent. The aim of this study was to determine whether, in the presence of early ovulation-triggering ...criteria, prolonged ovarian stimulation modified the chances of a live birth. This cross-sectional study included 312 women presenting triggering criteria beginning from D8 of ovarian stimulation. Among the 312 women included in the study, 135 were triggered for ovulation before D9 (D ≤ nine group) and 177 after D9 (D > nine group). The issues of fresh +/− frozen embryo transfers were taken into consideration. Cumulative clinical pregnancy and live-birth rates after fresh +/− frozen embryo transfers were similar in both groups (37% versus 46.9%, p = 0.10 and 19.3% versus 28.2%, p = 0.09, respectively). No patient characteristics were found to be predictive of a live birth depending on the day of ovulation trigger. Postponing of ovulation trigger did not impact pregnancy or live-birth rates in early responders. A patient’s clinical characteristics should not influence the decision process of ovulation trigger day in early responders. Further prospective studies should be conducted to support these findings.
Our objective was to evaluate postoperative pain and opioid consumption in patients undergoing hysterectomy by low-impact laparoscopy and compare these parameters with conventional laparoscopy. We ...conducted a prospective study in two French gynecological surgery departments from May 2017 to January 2018. The primary endpoint was the intensity of postoperative pain evaluated by a validated numeric rating scale (NRS) and opioid consumption in the postoperative recovery unit on Day 0 and Day 1. Thirty-two patients underwent low-impact laparoscopy and 77 had conventional laparoscopy. Most of the patients (90.6%) who underwent low-impact laparoscopy were managed as outpatients. There was a significantly higher consumption of strong opioids in the conventional compared to the low-impact group on both Day 0 and Day 1: 26.0% and 36.4% vs. 3.1% and 12.5%, respectively (p = 0.02 and p < 0.01). Over two-thirds of the patients in the low-impact group did not require opioids postoperatively. Two factors were predictive of lower postoperative opioid consumption: low-impact laparoscopy (OR 1.38, 95%CI 1.13−1.69, p = 0.002) and a mean intraoperative peritoneum below 10 mmHg (OR 1.25, 95%CI 1.03−1.51). Total hysterectomy by low-impact laparoscopy is feasible in an outpatient setting and is associated with a marked decrease in opioid consumption compared to conventional laparoscopy.
To determine if the time-to-chemotherapy (TTC) after primary macroscopic complete cytoreductive surgery (CRS) influences recurrence-free survival (RFS) and overall survival (OS) in patients with ...epithelial ovarian cancer (EOC). We conducted an observational multicenter retrospective cohort analysis of women with EOC treated from September 2006 to November 2016 in nine institutions in France (FRANCOGYN research group) with maintained EOC databases. We included women with EOC (all FIGO stages) who underwent primary complete macroscopic CRS prior to platinum-based adjuvant chemotherapy. Two hundred thirty-three patients were included: 73 (31.3%) in the early-stage group (ESG) (FIGO I-II), and 160 (68.7%) in the advanced-stage group (ASG) (FIGO III-IV). Median TTC was 43 days (36-56). The median OS was 77.2 months (65.9-106.6). OS was lower in the ASG when TTC exceeded 8 weeks (70.5 vs. 59.3 months,
= 0.04). No impact on OS was found when TTC was below or above 6 weeks (78.5 and 66.8 months, respectively,
= 0.25). In the whole population, TTC had no impact on RFS or OS. None of the factors studied were associated with an increase in TTC. Chemotherapy should be initiated as soon as possible after CRS. A TTC greater than 8 weeks is associated with poorer OS in patients with advanced stage EOC.
Objective: The aim of the present study was to evaluate evolution and prognosis of mucinous ovarian carcinomas (mOC), with respect to the two invasive patterns: expansile and infiltrative invasion. ...Methods: This was a descriptive, retrospective, multicenter study conducted in 13 French centres from 1 January 2001 to 31 December 2019. All patients operated on for epithelial ovarian neoplasia of the mucinous type (infiltrative/expansile) were included, whether the surgery was performed immediately or after neoadjuvant chemotherapy. Results: A total of 94 women with mucinous carcinomas were included in the present study. Mucinous tumours were divided into 35 expansile (37%) and 59 infiltrative (63%) mOC. There was a statistically significant difference in early and late stages at initial diagnosis between expansile and infiltrative mOC. None of the expansile mOC showed metastatic lymph nodes, whereas almost a quarter of the infiltrative mOC were metastatic to the pelvic/para-aortic region. There was a clear difference in RFS, in favour of expansile mOC, with 90% survival at 5 years, compared with 60% for infiltrative mOC. Conclusions: Although infiltrative and expansile mOC belong to the same histological family, they present many distinctions in clinical presentation, histological invasion, and disease course.
Elderly and/or frail women with ovarian cancer are often undertreated. The aim of the study is to compare the effects of age and frailty on surgical approaches, postoperative complications, and ...prognosis in elderly women with ovarian cancer.
A retrospective multicenter study of women ≥70 years were treated for ovarian cancer at seven French university hospitals between 2007 and 2015.
Of the 1119 women treated for ovarian cancer during the study period, 147 were ≥70 years and had complete data. Of these women, 65 were aged 70-74 years, and 82 were aged ≥75 years. Overall, 77% of the younger women (49/65) received optimal treatment compared with 51% (40/82) of the older women (
= 0.018). Women ≥75 years underwent fewer bowel resections (32% vs. 67%,
< 0.001) and experienced fewer postoperative complications (22.6% vs. 38.9%,
< 0.001); 53.2% of the women in this age group were treated by primary surgery or surgery only. These women also received more chemotherapy with platinum only (15% 9/56 vs. 2% 1/57,
= 0.007) and less bevacizumab (9% 5/56 vs. 32% 18/57,
= 0.003). Patients with greater frailty (a modified Charlson Comorbidity Index mCCI score >3) had a five-year survival rate of 30% versus 62% for those with a score ≤3 (
< 0.001).
Surgeons modify their approach to treating ovarian cancer in women ≥75 years probably to reduce immediate postoperative complications. The prognosis is significantly worse in patients with greater frailty. Improvements to the sequence of treatments administered, with priority given to neoadjuvant chemotherapy in patients with greater frailty, could help increase the number of women who receive optimal treatment and improve their prognosis.
To evaluate urologic complications after colorectal resection for endometriosis.
Cohort study (Canadian Task Force classification II-2).
Tertiary referral university hospital and expert center in ...endometriosis.
One hundred sixty-six women with colorectal endometriosis proven by transvaginal sonography and magnetic resonance imaging.
Open or laparoscopic colorectal resection for endometriosis.
Forty-four patients (26.5%) experienced at least 1 urologic complication, including infection. Eight patients (4.8%) experienced postoperative symptomatic hydronephrosis requiring ureteral stent in 3 cases, a percutaneous nephrostomy in 1 case, and expectant management for the last 4. Urologic fistulas occurred in 5 patients (3%). Postoperative voiding dysfunction requiring self-catheterization was observed in 48 patients (28.9%). With univariate analysis, a relationship was found between voiding dysfunction and partial colpectomy (p = .001) and American Society of Reproductive Medicine total score (p = .02), and between the occurrence of urinary fistula and the use of prophylactic ureteral catheterization (p = .015) and parametrectomy (p = .02). A relationship was found between postoperative symptomatic hydronephrosis and the use of prophylactic ureteral catheterization (p = .003).
Colorectal resection for endometriosis can lead to urologic complications, particularly for patients requiring partial colpectomy, of which patients need to be informed.
Objective The objective of the study was to externally validate and assess the robustness of 2 nomograms designed to predict the probability of lymphatic dissemination (LD) for patients with ...early-stage endometrioid endometrial cancer. Study Design Using a prospective multicenter database, we assessed the discrimination, calibration, and clinical utility of 2 nomograms in patients with surgically treated early-stage endometrioid endometrial cancer. Results Among the 322 eligible patients identified, the overall LD rate was 9.9% (32 of 322). Predictive accuracy according to discrimination was 0.65 (95% confidence interval, 0.61–0.69) for the full nomogram and 0.71 (95% confidence interval, 0.68–0.74) for the alternative nomogram. The correspondence between observed recurrence rate and the nomogram predictions suggests a moderate calibration of the nomograms in the validation cohort. Conclusion The nomograms were externally validated and shown to be partly generalizable to a new and independent patient population. Although these tools provide a more individualized estimation of LD, additional parameters are needed to allow higher accuracy for counseling patients in clinical practice.
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