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Background: Breast reconstruction practices, predominantly implant-based, have evolved, with meshes aiding in overcoming traditional limitations. However, data comparing mesh-assisted prepectoral reconstruction with implants alone are lacking. This study aimed to assess whether synthetic meshes in prepectoral reconstruction impact postoperative complications., Material and Methods: We retrospectively studied 238 prepectoral immediate implant-based breast reconstructions (IBBR) in 211 patients from 2020 to 2022. Our primary endpoint was the 90-day revision surgery rate comparing mesh and non-mesh groups. Secondary endpoints included postoperative complications: seroma formation, skin necrosis, implant exposure, hematomas, surgical site infections, and implant loss. We conducted univariate and multivariate analyses to assess complications and risk factors for postoperative revision in the entire cohort., Results: There was a statistically significant higher rate of revision surgery in the mesh group (22 % vs. 9.0 %, p = 0.022) and more early complications in the mesh group, although there was no significant difference between the two groups. During the study period, the number of immediate IBBR significantly increased, reflecting expanded surgical indications that were no longer dependent on potential adjuvant treatments. and practices have changed. The multivariate analysis revealed no specific evidence of mesh use affecting surgical revision. However, it identified implant volume as a significant factor increasing the risk of revision surgery (p = 0.01)., Conclusion: This study underscores a significant practice shift: standardizing surgical techniques, particularly reducing mesh usage, did not lead to higher revision surgery rates. These findings suggest that the non-mesh assisted prepectoral approach is a valid technique., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Ovarian cancer is the first cause of death from gynecological malignancies mainly due to development of chemoresistance. Despite the emergence of PARP inhibitors, which have revolutionized the therapeutic management of some of these ovarian cancers, the 5-year overall survival rate remains around 45%. Therefore, it is crucial to develop new therapeutic strategies, to identify predictive biomarkers and to predict the response to treatments. In this context, functional assays based on patient-derived tumor models could constitute helpful and relevant tools for identifying efficient therapies or to guide clinical decision making., Method: The OVAREX study is a single-center non-interventional study which aims at investigating the feasibility of establishing in vivo and ex vivo models and testing ex vivo models to predict clinical response of ovarian cancer patients. Patient-Derived Xenografts (PDX) will be established from tumor fragments engrafted subcutaneously into immunocompromised mice. Explants will be generated by slicing tumor tissues and Ascites-Derived Spheroids (ADS) will be isolated following filtration of ascites. Patient-derived tumor organoids (PDTO) will be established after dissociation of tumor tissues or ADS, cell embedding into extracellular matrix and culture in specific medium. Molecular and histological characterizations will be performed to compare tumor of origin and paired models. Response of ex vivo tumor-derived models to conventional chemotherapy and PARP inhibitors will be assessed and compared to results of companion diagnostic test and/or to the patient's response to evaluate their predictive value., Discussion: This clinical study aims at generating PDX and ex vivo models (PDTO, ADS, and explants) from tumors or ascites of ovarian cancer patients who will undergo surgical procedure or paracentesis. We aim at demonstrating the predictive value of ex vivo models for their potential use in routine clinical practice as part of precision medicine, as well as establishing a collection of relevant ovarian cancer models that will be useful for the evaluation of future innovative therapies., Trial Registration: The clinical trial has been validated by local research ethic committee on January 25th 2019 and registered at ClinicalTrials.gov with the identifier NCT03831230 on January 28th 2019, last amendment v4 accepted on July 18, 2023., (© 2024. The Author(s).)

Based on results of clinical trials, completion ALND (cALND) is frequently not performed for patients with breast conservation therapy and one or two involved sentinel nodes (SN) by micro- or macro-metastases. However, there were limitations despite a conclusion of non-inferiority for cALND omission. No trial had included patients with SN macro-metastases and total mastectomy or with >2 SN macro-metastases. The aim of the study was too analyze treatment delivered and pathologic results of patients included in SERC trial. SERC trial is a multicenter randomized non-inferiority phase-3 trial comparing no cALND with cALND in cT0-1-2, cN0 patients with SN ITC (isolated tumor cells) or micro-metastases or macro-metastases, mastectomy or breast conservative surgery. We randomized 1855 patients, 929 to receive cALND and 926 SLNB alone. No significant differences in patient's and tumor characteristics, type of surgery, and adjuvant chemotherapy (AC) were observed between the two arms. Rates of involved SN nodes by ITC, micro-metastases, and macro-metastases were 5.91%, 28.12%, and 65.97%, respectively, without significant difference between two arms for all criteria. In multivariate analysis, two factors were associated with higher positive non-SN rate: no AC versus AC administered after ALND (OR = 3.32, p < 0.0001) and >2 involved SN versus ≤2 (OR = 3.45, p = 0.0258). Crude rates of positive NSN were 17.62% (74/420) and 26.45% (73/276) for patient's eligible and non-eligible to ACOSOG-Z0011 trial. No significant differences in patient's and tumor characteristics and treatment delivered were observed between the two arms. Higher positive-NSN rate was observed for patients with AC performed after ALND (17.65% for SN micro-metastases, 35.22% for SN macro-metastases) in comparison with AC administered before ALND., (© 2021. The Author(s).)

Background: Chemoradiotherapy (CRT) is the standard of care for patients diagnosed with locally advanced cervical cancer (LACC), a human papillomavirus (HPV)-related cancer that relapses in 30%-60% of patients. This study aimed to (i) design HPV droplet digital PCR (ddPCR) assays for blood detection (including rare genotypes) and (ii) monitor blood HPV circulating tumor DNA (HPV ctDNA) levels during CRT in patients with LACC., Methods: We analyzed blood and tumor samples from 55 patients with HPV-positive LACC treated by CRT in a retrospective cohort (n = 41) and a prospective cohort (n = 14). HPV-ctDNA detection was carried out by genotype-specific ddPCR., Results: HPV ctDNA was successfully detected in 69% of patients (n = 38/55) before CRT for LACC, including nine patients with a rare genotype. HPV-ctDNA level was correlated with HPV copy number in the tumor (r = 0.41, P < 0.001). HPV-ctDNA positivity for HPV18 (20%, n = 2/10) was significantly lower than for HPV16 (77%, n = 27/35) or other types (90%, n = 9/10, P = 0.002). HPV-ctDNA detection (positive versus negative) before CRT was associated with tumor stage (P = 0.037) and lymph node status (P = 0.02). Taking into account all samples from the end of CRT and during follow-up in the prospective cohort, positive HPV-ctDNA detection was associated with lower disease-free survival (DFS) (P = 0.048) and overall survival (OS) (P = 0.0013)., Conclusion: This is one of the largest studies to report HPV-ctDNA detection before CRT and showed clearance of HPV ctDNA at the end of treatment in most patients. Residual HPV ctDNA at the end of CRT or during follow-up could help to identify patients more likely to experience subsequent relapse., Competing Interests: Disclosure The authors have declared no conflicts of interest. Data sharing The data that support the findings of this study are available from Institut Curie but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Institut Curie., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) and complete surgical removal of the tumor, in relapsing patients may provide a clinical benefit. There is no consensus considering the place of HIPEC for patients who had first ovarian cancer relapse. To assess for possible efficacy of HIPEC on overall survival (OS) rates in this situation, we performed a multi-institutional study., Methods: The current study was a retrospective case control multi-institutional study comparing a group of patients treated with HIPEC to a group of patients treated without HIPEC. Inclusion criteria were first relapse of a serous ovarian carcinoma and >6 months after the end of initial treatment. Exclusion criteria were another pathological subtype of ovarian cancer, a relapse at <6 months after initial treatment, and a second relapse or more. We aimed to assess OS, morbidity, and mortality rates and prognostic factors., Results: From June 1997-July 2011, 42 patients were included, 23 in the HIPEC group and 19 in the control group. Each patient from the two groups had a complete secondary surgery at the time of the first relapse. At 4 years OS was 75.6 % in the HIPEC group and 19.4 % in the control group (p = 0.013). In a multivariate analysis, HIPEC and interval-free before the end of initial treatment were both independent prognostic factors., Conclusion: When compared to the control group, complete secondary surgery and HIPEC appear to afford a better OS rate than complete secondary surgery alone, in case of first ovarian cancer relapse. Further randomized trials are warranted to confirm these results.

Objectives: Endoscopy is a key tool in the diagnosis and management planning of peritoneal carcinomatosis. The aim of this study was to determine which type of endoscope is the most efficient for comprehensive staging of the upper abdomen peritoneal surface., Methods: From April 2010 to February 2011, endoscopies were performed on five human female fresh-frozen cadavers. Three endoscopes (rigid 0°, 30° and flexible) were used consecutively and compared., Results: The diaphragmatic areas explored with the flexible endoscope were significantly larger than those with the other two. On average, 135 (range 66-225), 168 (range 96-306), and 201 (range 128-399)cm(2) were observed using the 0°, 30°, and flexible laparoscopes, respectively. The p value obtained using the exact Wilcoxon test for paired data was 0.0019 between the 0° and 30° endoscopes and between the 30° and flexible endoscopes. The 30° endoscope was consistently better than the 0° endoscope for the observation of the diaphragm and spleen undersurface., Conclusion: Flexible endoscopy seemed to be the most efficient for the evaluation of peritoneal carcinomatosis. However, due to a poorer image, the need for considerable practice, and the high equipment and maintenance cost of the flexible endoscope, the rigid 30° endoscope seems to be the best compromise., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)