Search

To assess the prognostic factors of T1 and T2 infiltrating lobular breast cancers, and to investigate predictive factors of axillary lymph node involvement.This is a retrospective multicentric study, conducted from 1999 to 2008, among 13 french centers. All data concerning patients with breast cancer who underwent a primary surgical treatment including a sentinel lymph node procedure have been collected (tumors was stage T1 or T2). Patients underwent partial or radical mastectomy. Axillary lymph node dissection was done systematically (at the time of sentinel procedure evaluation), or in case of sentinel lymph node involvement. Among all the 8100 patients, 940 cases of lobular infiltrating tumors were extracted. Univariate analysis was done to identify significant prognosis factors, and then a Cox regression was applied. Analysis interested factors that improved disease free survival, overall survival and factors that influenced the chemotherapy indication. Different factors that may be related with lymph node involvement have been tested with univariate than multivariate analysis, to highlight predictive factors of axillary involvement.Median age was 60 years (27-89). Most of patients had tumours with a size superior to 10mm (n=676, 72%), with a minority of high SBR grade (n=38, 4%), and a majority of positive hormonal status (n = 880, 93, 6%). The median duration of follow-up was 59 months (1-131). Factors significantly associated with decreased disease free survival was histological grade 3 (hazard ratio [HR]: 3,85, IC 1,21-12,21), tumour size superior to 2cm (HR: 2,85, IC: 1,43-5,68) and macrometastatic lymph node status (HR: 3,11, IC: 1,47-6,58). Concerning overall survival, multivariate analysis demonstrated a significant impact of age less than 50 years (HR: 5,2, IC: 1,39-19,49), histological grade 3 (HR: 5,03, IC: 1,19-21,25), tumour size superior to 2cm (HR: 2,53, IC: 1,13-5,69). Analysis concerning macrometastatic lymph node status nearly reached significance (HR: 2,43, IC: 0,99-5,93). There was no detectable effect of chemotherapy regarding disease free survival (odds ratio [OR] 0,8, IC: 0,35-1,80) and overall survival (OR: 0,72, IC: 0,28-1,82). Disease free survival was similar between no axillary invasion (pN0) and isolated tumor cells (pNi+), or micrometastatic lymph nodes (pNmic). There were no difference neither between one or more than one macromatastatic lymph node. But disease free survival was statistically worse for pN1 compared to other lymph node status (pN0, pNi+ or pNmic). Factors associated with lymph node involvement after logistic regression was: age from 51 to 65 years (OR: 2,1, IC 1,45-3,04), age inferior to 50 years (OR 3,2, IC: 2,05-5,03), Tumour size superior to 2cm (OR 4,4, IC: 3,2-6,14), SBR grading 2 (OR 1,9, IC: 1,30-2,90) and SBR grade 3 (OR 3,5, IC: 1,61-7,75).The analysis of this series of 940 T1 and T2 lobular invasive breast carcinomas offers several information: factors associated with axillary lymph node involvement are age under 65 years, tumor size greater than 20mm, and a SBR grade 2 or 3. The same factors were significantly associated with the OS and DFS. The macrometastatic lymph node involvement has a significant impact on DFS and OS, which is not true for isolated cells and micrometastases, which seem to have the same prognosis as pN0.

This study evaluated the validity of endorectal ultrasonography in predicting rectal infiltration in patients with deep pelvic endometriosis.Patients were recruited consecutively in the Department of Surgical Gynecology of Diaconesses Hospital from April 1996 to July 2003. Inclusion criteria were the suspicion of deep pelvic endometriosis on the basis of outpatient history and/or clinical symptoms with a mass palpable on bimanual examination that might infiltrate the rectal wall. There were no exclusion criteria. Endorectal ultrasonography was performed by the same investigator with a 7.5-MHz to 10-MHz rigid probe, producing a 360 degrees view of the rectal wall and adjacent areas. We used surgical and histopathologic findings as the "gold standard" to evaluate the validity of endorectal ultrasonography.This study was based on 37 patients (mean age, 35.8 (range, 26-46) years) who underwent surgery. The time between endorectal ultrasonography and surgery ranged from 4 to 529 (mean, 88.7) days. Eight patients had endometriosis nodules penetrating the rectal wall. Endorectal ultrasonography showed sensitivity, specificity, a positive predictive value, and a negative predictive value of 87.5, 97, 87.5, and 97 percent, respectively, in the diagnosis of infiltration of the rectal wall by endometriosis.Endorectal ultrasonography is a reliable technique for visualizing rectal infiltration in patients with deep pelvic endometriosis. It should be more widely used by gynecologists because knowing about rectal infiltration before surgery is fundamental to defining the best possible surgical approach.

Resume Le syndrome du perinee descendant decrit en 1970 par Alan Parks reste d’interpretation physiopathologique et clinique difficile. A partir de la litterature, de 1966 a 2004, une revue generale sur le perinee descendant a ete effectuee. La symptomatologie observee est le plus souvent secondaire a des lesions associees. Les perinees descendants radiologiques n’ont pas toujours de traduction clinique. Le colpocystogramme montre la descente perineale et les troubles associes de la statique pelvienne, anterieurs et moyens, alors que la defecographie permet de mieux expliquer la dyschesie qui resulte en general d’un trouble posterieur associe (rectocele avec intussusception rectale). La prise en charge des perinees descendants repose sur le traitement medical et la reeducation. Il n’y a pas de consensus concernant le traitement chirurgical. La chirurgie traite en general les lesions associees. En cas d’effondrement complet du perinee, la voie abdominale avec soutien sous vesical, pre et retro-rectal, fixe sans tension au promontoire, pourrait etre interessante alors qu’une refection transanale du rectum a l’agrafeuse pourrait etre proposee lorsque le perinee descendant n’est associe qu’a une intussusception rectale ou a une rectocele.

Resume Contexte. – Depuis 1998, date de la parution des premieres recommandations, plus de 2500 references sur ce sujet ont ete publiees. Methodologie. – Un groupe d'experts reunis a la demande du ministere de la Sante a redige un premier document. Cinq autres experts ont par la suite analyse de maniere critique le premier document qui a ainsi beneficie de leurs remarques. Evolutions principales. – La part attribuable aux mutations deleteres constitutionnelles dans les cancers du sein et de l'ovaire est actuellement estimee a environ 5 %. L'efficacite du depistage par imagerie du cancer du sein est probable et pourrait a l'avenir beneficier de protocoles fondes sur l'IRM. L'impact du depistage du cancer de l'ovaire est plus discutable. L'efficacite de la chirurgie prophylactique a ete confirmee et quantifiee. La reduction probable de frequence de cancer du sein en cas d'ovariectomie pour les femmes BRCA1+ augmente encore l'impact de cette intervention. Ainsi, la chirurgie prophylactique sous reserve d'une qualite de vie post-intervention compatible avec le niveau de protection attendu peut etre medicalement recommandee en respectant une liste de criteres definis. Conclusions principales. – Du fait des limites methodologiques, d'effectifs parfois insuffisants observes dans les etudes et du manque de recul, ces positions ne peuvent neanmoins pretendre a une stabilite importante.

Resume Nous rapportons le cas d’un choriocarcinome uterin primitif, survenu en peri-menopause et associe a un adenocarcinome. Nous reprenons la litterature sur cette pathologie rare. L’histoire clinique et histologique sont rapportees. Une recherche de cas similaires dans la litterature est realisee avec l’aide de la base de donnees Medline . Le diagnostic de choriocarcinome a ete porte sur le dosage des βHCG puis sur l’analyse du curetage. Une polychimiotherapie a ete demarree devant l’aggravation clinique de la patiente. L’amelioration a ete spectaculaire et la patiente operee 5 mois plus tard par colpohysterectomie et lymphadenectomie pelvienne puis curietherapie vaginale. L’etude histologique n’a retrouve que des lesions d’adenocarcinome. Apres 18 mois de surveillance, elle est en remission complete. La revue de la litterature montre que les formes primitives sont exceptionnelles, leur etiologie mal connue et que le traitement repose sur une polychimiotherapie. Les choriocarcinomes uterins primitifs sont rares et toujours associes a une autre forme histologique. Nous rapportons un cas survenu en perimenopause et reprenons la revue de la litterature sur cette pathologie dont la polychimiotherapie a transforme le pronostic, autrefois catastrophique.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 42 - N° 5 - p. 499-501

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 33 - N° 7 - p. 577-588

Resume Objectif. – Proposer une attitude rationnelle dans la prise en charge des lesions infracliniques du sein a partir de l’analyse retrospective de 176 dossiers. Patientes et methode. – Cent soixante-seize patientes ont ete prises en charge durant l’annee 2000 pour une lesion infraclinique du sein. Les donnees epidemiologiques, mammographiques, les procedures diagnostiques effectuees et les resultats histologiques ont ete recueillis. Resultats. – Les patientes ont ete adressees pour une lesion ACR 2 dans 0,8 % des cas, ACR 3 : 34,8 %, ACR 4 : 43,2 % et ACR 5 : 21,2 %. Cent seize patientes ont beneficie d’une macrobiopsie stereotaxique : 55 Advanced Breast Biopsy Instrumentation (ABBI ® ), 61 Minimal Invasive Breast Biopsy (MIBB ® ). A l’histologie, 59,5 % correspondaient a une lesion benigne, 33,6 % a une lesion maligne, 2,6 % a une lesion frontiere et 4,3 % a un resultat suspect ou non contributif. Quarante-deux patientes ont eu une biopsie chirurgicale dont 56,1 % etaient benignes, 41,5 % malignes et 2,4 % frontiere. Dix-huit patientes ont ete surveillees par mammographie. On retrouve 90 % de lesions benignes en cas d’ACR 3 et 46 % de lesions malignes en cas d’ACR 4. En cas de resultat malin, frontiere ou suspect avec les macrobiospies stereotaxiques, la chirurgie a pu etre realisee en un temps dans 97 % des cas vs 55 % avec les biopsies chirurgicales ( p Discussion et conclusion. – Les lesions infracliniques du sein doivent etre classees radiologiquement selon la classification ACR. Les macrobiopsies stereotaxiques sont indiquees pour les lesions ACR 4 et ACR 5. En raison de leur fiabilite, leur pratique permet d’eviter un acte chirurgical a pres de 50 % des patientes car ces lesions sont benignes en cas d’ACR 4. Lorsque le resultat est malin, elles permettent le plus souvent une prise en charge chirurgicale en un temps.

Radical hysterectomy represents the treatment of choice for FIGO stage IA2-IIA cervical cancer. It is associated with several serious complications such as urinary and anorectal dysfunction due to surgical trauma to the autonomous nervous system. In order to determine those surgical steps involving the risk of nerve injury during both classical and nerve-sparing radical hysterectomy, we investigated the relationships between pelvic fascial, vascular and nervous structures in a large series of embalmed and fresh female cadavers. We showed that the extent of potential denervation after classical radical hysterectomy is directly correlated with the radicality of the operation. The surgical steps that carry a high risk of nerve injury are the resection of the uterosacral and vesicouterine ligaments and of the paracervix. A nerve-sparing approach to radical hysterectomy for cervical cancer is feasible if specific resection limits, such as the deep uterine vein, are carefully identified and respected. However, a nerve-sparing surgical effort should be balanced with the oncological priorities of removal of disease and all its potential routes of local spread.

Resume L’eventration perineale (ou hernie perineale postoperatoire) est une complication rare de l’amputation abdominoperineale du rectum. Nous en rapportons 4 cas illustrant la presentation clinique et les modalites de prise en charge de cette pathologie dont l’etiopathogenie reste discutee. Les modalites de l’amputation du rectum et de la technique de fermeture du perinee, la realisation d’une epiplooplastie, l’infection du site operatoire ont ete incriminees dans la survenue de cette complication. Lorsque l’âge et/ou le terrain autorisent une reparation, l’implantation d’une prothese par voie abdominale ouverte ou cœlioscopique represente l’option therapeutique adoptee dans ce travail, mais la voie perineale ou l’association des 2 abords peuvent avoir de l’interet pour corriger ce probleme toujours difficile a resoudre.

Background: Three randomized trials have concluded at non inferiority of omission of complementary axillary lymph node dissection (cALND) for patients with involved sentinel node (SN). However, we can outline strong limitations of these trials to validate this attitude with a high scientific level. We designed the SERC randomized trial to compare outcomes in patients with SN involvement treated with ALND or no further axillary treatment. The aim of this study was to analyze results of the first 1000 patients included. Patients and Methods: SERC trial is a multicenter non-inferiority phase 3 trial. Multivariate logistic regression analysis was used to identify independent factors associated with adjuvant chemotherapy administration and non-sentinel node (NSN) involvement. Results : Of the 963 patients included in the analysis set, 478 were randomized to receive cALND and 485 SLNB alone. All patient demographics and tumor characteristics were balanced between the two arms. SN ITC was present in 6.3% patients (57/903), micro metastases in 33.0% (298), macro metastases in 60.7% (548) and 289 (34.2%) were non eligible to Z0011 trial criteria. Whole breast or chest wall irradiation was delivered in 95.9% (896/934) of patients, adjuvant chemotherapy in 69.5% (644/926), endocrine therapy in 89.6% (673/751) and the proportions were similar in the two arms. The overall rate of positive NSN was 19% (84/442) for patients with cALND. Crude rates of positive NSN according to SN status were 4.5% for ITC (1/22), 9.5% for micro metastases (13/137), 23.9% for macro metastases (61/255) and were respectively 29.36% (64/218), 9.33% (7/75) and 7.94% (10/126) when chemotherapy was administered after cALND, before cALND and for patients without chemotherapy. Conclusion: The main objective of SERC trial is to demonstrate non inferiority of cALND omission. A strong interaction between timing of cALND and chemotherapy with positive NSN rate was observed. Citation Format: Houvenaeghel G, Cohen M, Raro P, De Troyer J, Tunon De Lara C, Guimbergues P, Gauthier T, Faure C, Vaini-Cowen V, Lantheaume S, Regis C, Darai E, Ceccato V, D'Halluin G, Del Piano F, Villet R, Jouve E, Beedassy B, Theret P, Gabelle P, Zinzindohoue C, Opinel P, Marsollier-Ferrer C, Dhainaut-Speyer C, Colombo P-E, Di Beo V, Lambaudie E, Tallet A, Boher J-M. Overview of the pathological results and treatment characteristics in the first 1000 patients randomized in the SERC trial: Axillary dissection versus no axillary dissection in patients with involved sentinel node [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-02.

La prise en charge uniciste des troubles de la statique pelvienne se justifie car ceux-ci interessent dans 18% des cas les trois etages du perinee qui sont interdependants. Il s’agit d’une chirurgie fonctionnelle et la fonction n’est pas toujours correlec a l’anatomie. Trois types de lesions elementaires sont observees: a) les incontinences: urinaire, la plus frequente, ou fecale; b) les dysfonctionnements: dysurie, dyspareunie, dyschesie; c) les ptoses. Chaque lesion doit etre traitee de facon elementaire mais la prise en charge uniciste doit tenir compte du geste effectue a l’etage adjacent pour eviter toute incompatibilite et interaction nefastes. Cet article detaille tous ces gestes elementaires et les replace dans le cadre d’une prise en charge globale. Il ressort que les techniques se soutenement sous-uretral de Prolene (ex: TVT) dominent dans le traitement de l’incontinence urinaire, que l’approche des prolapsus genito-urinaires peut se faire par voie abdominale laparotomique ou laparoscopique, avec apport de materiel et promontofixation, ou par voie vaginale par raphie et ligamentopexie, que deux types de prolapsus rectaux doivent etre distingues: celui du sujet jeune, veritable «maladie rectle», qui doit etre traite par voie abdominale (la encore laparotomique ou laparoscopique) et celui de la femme âgee, «maladie perineale», dont l’approche peut se faire par voie basse. Les choix entre des differentes associations possibles sont detailles. Ils necessistent une analyse semiologique rigoureuse, en s’aidant au besoin d’examens complementaires par imagerie. D’une facon generale, il ressort que l’apport de materiel augmente la longevite du montage et que dans certaines associations, il peut etre utile d’intervenir en deux temps.

We report a case of a pregnancy and follow the delivery of a young woman who previously underwent a laparoscopic sacral colpopexy (LSC) for pelvic organ prolapse (POP). A 38-year-old woman with POP desires pregnancy who after unsuccessful medical treatment with pessary underwent a laparoscopic uterine ventrosuspension (LUV). However, this procedure also failed and there was an immediate relapse. Thus, LSC was then performed. After which, she became pregnant culminating in elective caesarean delivery. The LUV failure was documented by a POP-Q classification and dynamic pelvic magnetic resonance (PMR) which was carried out 1 month after the surgery. When the same assessment was conducted after the LSC, it showed an optimal POP correction. The short-term post-delivery follow-up exhibited a small prolapse relapse, which remained stable 48 months after surgery as confirmed by a new PMR. Surgical correction of POP is possible in women with pregnancy desires. The result is variable and links to the POP stage and other surgical interventions.

Le perinee represente une unite embryologique, anatomique et fonctionnelle. Cette unite se retrouve dans les donnees epidemiologiques et physiopathologiques des troubles de la statique pelvienne. Les degradations survenant aux trois etages du perinee, urologique, gynecologique et ano-rectal, sont secon|daires a des atteintes conjonctives, musculaires et neurologiques mais dependent egalement de la qualite, de la situation et des rapports des organes pelviens. Ainsi, il semble logique de reunir pelvis et perinee d’une part et les differents etages du plancher pelvien d’autre part dans une meme discipline: la pelvi-perineologie. L’interet de ce nouveau concept n’est pas de creer une nouvelle specialite mais de sensibiliser et de reunir les differents specialistes concernes, pour qu’ils parlent le meme langage et surtout qu’ils prennent conscience que la prise en charge de l’un des etages risque de retentir sur un autre et qu’une approche globale des troubles de la statique pelvienne est donc necessaire.

To evaluate clinical effectiveness and complication rates at 5 years following the total Trans Vaginal Mesh (TVM) technique to treat pelvic organ prolapse. Prospective, observational, multi-centre study in patients with prolapse of stage II or higher. Of the 90 women enrolled in the study, 82 (91 %) were available for the 5-year follow-up period. At the 5-year endpoint, success, defined as no surgical prolapse reintervention and leading edge

Resume Contexte La cystocele constitue la forme clinique la plus frequente du prolapsus genital de la femme. Il s’agit d’une pathologie frequente et invalidante. Le traitement chirurgical de reference en est la promontofixation indirecte par prothese synthetique sous-vesicale par laparotomie. L’abord cœlioscopique tend a supplanter la laparotomie. L’utilisation de la voie d’abord vaginale pour la mise en place d’une prothese sous-vesicale pourrait presenter de nombreux interets : simplicite de realisation, duree operatoire moindre, convalescence plus courte, mais pourrait exposer a une morbidite accrue en ce qui concerne les complications liees aux protheses. La promontofixation indirecte cœlioscopique et la mise en place de protheses par voie vaginale sont couramment pratiquees en France bien que la HAS ait souligne l’absence d’evaluation suffisante de la securite et de la tolerance de la mise en place des protheses synthetiques par voie vaginale. Methode L’objectif principal de l’etude est de comparer la morbidite de la promontofixation cœlioscopique a la chirurgie par voie vaginale pour le traitement des cystoceles par prothese synthetique sous-vesicale. Le critere principal d’evaluation sera le taux de complications chirurgicales superieur ou egal au grade II de la classification de Clavien-Dindo survenant dans l’annee de suivi. Les objectifs secondaires sont de comparer les resultats fonctionnels a moyen terme (sexualite, signes fonctionnels urinaires et digestifs, douleurs), le retentissement sur la qualite de vie, ainsi que les resultats anatomiques. PROSPERE est une etude prospective randomisee multicentrique qui sera menee dans 12 centres hospitaliers francais. Deux cent soixante-deux patientes ayant une cystocele superieure ou egale au stade 2 POP-Q isolee ou non, âgees de 45 a 75 ans, seront inclues. Les patientes ne doivent pas avoir d’antecedent de chirurgie du prolapsus ou de conditions defavorables ou contre-indiquant l’une ou l’autre des voies d’abord. La realisation de cette etude devrait permettre de repondre a la problematique non resolue actuellement du choix de la voie d’abord pour la pose des renforts prothetiques sous-vesicaux. Cet essai permettrait de mieux determiner les indications respectives de l’une ou l’autre de ces voies d’abord, qui reposent actuellement sur des attitudes d’ecoles et des choix subjectifs.

Cystocele is a frequent and invalidating type of genital prolapse in woman. Sacropexy using synthetic mesh is considered the surgical gold standard, and the laparoscopic approach has supplanted the open abdominal route because it offers the same anatomical results with a lower morbidity. The use of mesh through the vaginal route may have many advantages: easiness to perform, shorter operative time and recovery, but may increase morbidity. In France, both laparoscopic sacropexy and vaginal mesh are commonly used to treat cystoceles. The French Haute Autorité de santé (HAS) has highlighted the lack of evaluation of safety assessment for vaginal meshes.The main objective of the study is to compare the morbidity of laparoscopic sacropexy with vaginal mesh for cystocele repair. The primary endpoint will be the rate of surgical complications greater or equal to grade 2 of the Clavien-Dindo classification at 1-year follow-up. The secondary aims are to compare the functional results in the medium term (sexuality, urinary and bowel symptoms, pain), the impact on quality of life as well as anatomical results. PROSPERE is a randomized controlled trial conducted in 12 participating French hospitals. 262 patients, aged 45 to 75years old, with cystocele greater or equal to stage 2 of the POP-Q classification (isolated or not) will be included. Exclusion criterias are a previous surgical POP repair, and inability or contra-indication to one or the other technique. We have designed this study to answer the question of the choice between laparoscopic sacropexy and vaginal mesh for the treatment of cystocele. The PROSPERE trial aims to help better determine the indications for one or the other of these techniques, which are currently based on subjective choices or school attitudes. This is the reason why competent authorities have asked for such studies.

Avec 53 000 nouveaux cas en France en 2011, le cancer du sein est le plus frequent chez la femme. Son traitement actuel repose sur l’association de la chirurgie, de la radiotherapie et d’un traitement medical.

Les troubles climateriques concernent plus de 50 % des femmes menopausees. Ce sont essentiellement les bouffees de chaleur, et les troubles genito-urinaires. Le traitement hormonal de la menopause (THM) qui est le traitement le plus efficace de ces troubles est contre-indique apres cancer du sein. Des alternatives therapeutiques non hormonales ont ete evaluees dans la litterature et peuvent etre proposees aux patientes dont la qualite de vie est alteree par ces troubles.

Le formaldehyde ayant ete classe carcinogene classe I par IARC, la suppression du formol au bloc operatoire dans une structure hospitaliere semi-privee a ete demandee. Ainsi, nous a ete propose un systeme de mise sous vide (TissueSAFE®) des prelevements a l’etat frais au bloc operatoire [1].

L’objectif de cet observatoire est de connaitre la situation de la reconstruction mammaire dans notre pays : qui se fait reconstruire, ou et par qui?

The standard management for advanced-stage epithelial ovarian cancer is optimum cytoreductive surgery followed by platinum based chemotherapy. However, retroperitoneal lymph node resection remains controversial. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of the disease and the histological type. Several published cohorts suggest the survival benefit of pelvic and para-aortic lymphadenectomy. A recent large randomized trial have demonstrated the potential benefit for surgical removal of bulky lymph nodes in term of progression-free survival but failed to show any overall survival benefit because of a critical methodology. Further randomised trials are needed to balance risks and benefits of systematic lymphadenectomy in advanced-stage disease. CARACO is a French ongoing trial, built to bring a reply to this important question. A huge effort for inclusion of the patients, and involving new teams, are mandatory.

To evaluate clinical outcomes at 3 years following total transvaginal mesh (TVM) technique to treat vaginal prolapse.Prospective, observational study in patients with prolapse ≥ stage II. Success was defined as POP-Q-stage 0-I and absence of surgical re-intervention for prolapse. Secondary outcome measures were: quality of life (QOL), prolapse-specific inventory (PSI), impact on sexual activity and complications.Ninety women underwent TVM repair, 72 a hysterectomy. Anatomical failure rate was 20.0% at 3 years. Three patients required re-intervention for prolapse. Improvements in QOL- and PSI-scores were observed at 1 and 3 years. Vaginal mesh extrusion occurred in 14.4% patients. After 3 years, 4.7% asymptomatic extrusions remained present. Of 61 sexually active women at baseline, a significant number of patients (41%) ceased sexual activity by 3 years; de novo dyspareunia was reported by 8.8%. One vesico-vaginal fistula resolved after surgery.Medium-term results demonstrate that the TVM technique provides a durable prolapse repair.

To evaluate the efficacy and complications of this new sub-urethral tape procedure with a follow up of 12 months.Prospective, multicenter study of 154 patients operated for stress urinary incontinence with the TVT Secur. Patients were operated between 24 July 2006 and 18 December 2007 and were all controlled at 2 months and 118 at 1 year. No associated surgical procedure was performed.One hundred five patients had pure stress incontinence with 12 of them presenting an intrinsic sphincter deficient. Forty-nine had a mixed urinary incontinence with 12 of them having ISD. Preoperatively, 69 patients complained of urgency and 12 of micturation disorder. Anaesthesia was local for 97 patients (63%). Per operative complications were five hemorrhages, one bladder injury, one vaginal wound, 21 patients had post-void residual volume (100 to 200ml) and one groin pain. We noted two exposed tapes, one granuloma, one ITU and seven lateral vaginal bands. Among the patients with urge at baseline, 61.2% were cured at 2 months and 75.5% at 1 year. De novo urge appeared in 12.8% at 2 months and 12.3% at 1 year. De novo micturation disorder was found in 9.5% at 2 months and 3.7% at 1 year. The cured patients at 1 year were 70.3%, improved 11% and fails 18.7%. The cured rate remains same between 2 months and 1 year. The improved patients (24%) at 2 months remain 11% at 1 year. The recurrence rate was 12,8% at 1 year.The results are inferior to TVT or TVT-O procedures. We probably must selected the patients for this procedure.

AIM: To study peri-surgical complications after cure of genital prolapse by vaginal route using interposition of synthetic prostheses Gynemesh Prolene Soft (Gynecare) following the Trans Vaginal Mesh (TVM) technique. METHODS: The present retrospective multicentered study comprised 684 patients who underwent surgery at seven French centers between October 2002 and December 2004. All patients had a genital prolapse >or=3 (C3/H3/E3/R3) according to International continence society (ICS) classification. According to each case, prosthetic interposition was total, or anterior only or posterior only. Patients were systematically seen 6 weeks, 3 months and 6 months after surgery. Multivaried statistical analysis followed a model of logistic regression applied to each post-surgical complication. RESULTS: The mean age of patients was 63.5 years (30-94). The mean follow-up period was 3.6 months. 84.3% of patients were post-menopause, 24.3% had hysterectomy, 16.7% previous cure of prolapse, and 11.1% cure of stress urinary incontinence (SUI). During the procedure, hysterectomy was combined in 50.3% of cases, cervix amputation in 1.5%, and cure of SUI in 40.9%. 15.8% were treated for a cystocele only. 14.8% had only a rectocele +/- elytrocele and 69.4% had a prolapse touching both compartments, anterior and posterior. In peri-surgical complications, (2%) were five bladder wounds (0.7%), one rectal wound (0.15%) and seven hemorrhages greater that 200 mL (1%). Among early post-surgical complications (during the first month after surgery) (2.8%) were two pelvic abscesses (0.29%), 13 pelvic hematomas (1.9%), one pelvic cellulitis (0.15%), two vesicovaginal fistulas and one rectovaginal fistula (0.15%). Among late post-surgical complications (33.6%) there were 77 granulomas or prosthetic expositions (11.3% [6.7% in the vaginal anterior wall, 2.1% in the vaginal posterior wall and 4.8% in the fornix]), 80 prosthetic retractions (11.7%), 36 relapse of prolapse (6.9%) and 37 SUI de novo (5.4%). Multivaried analysis shows that previous history of hysterectomy or placing of an isolated anterior prosthesis increase the risk of peri-surgical complication; preserved uterus and isolated posterior prosthesis lessen the risk of granulomas and prosthetic retractions; and association of a Richter's intervention increases the rate of prosthetic retractions. CONCLUSION: Cure of genital prolapse with synthetic prostheses interposed by vaginal route is now reliable and can be reproduced with a low rate of peri- and early post-surgical complications. However, our study shows a certain number of late post-surgical complications after insertion of strengthening synthetic vaginal implants (prosthetic expositions and prosthetic retractions). These retrospective results will soon be compared to a prospective study.

Les mastectomies prophylactiques bilaterales representent le moyen le plus efficace pour diminuer le risque de cancer du sein et le risque de deces par cancer du sein dans le cadre des familles a risque eleve.

To present a new minimal invasive suburethral tape device derivative of the classic TVT, to describe the technique of laying, to evaluate complications and results to short term.Prospective multicentric study of 110 patients presenting a stress urinary incontinence and benefiting from the laying of TVT Secur without associated operation. The tape is identical to that old-fashioned retropubic and obturator TVT, smaller, laying in "U" or in "hammock" without orifice of exit, to avoid complications due to crossed spaces of the other techniques. The device and the technique of laying are described by authors. The originality of the TVT Secur resides in the mechanism of insertion of the tape to a metallic divice. All patients have been controlled at two months and complications with notably pains (quotation VAS) as well as objective results have been reported.Pure and isolated stress urinary incontinence for 71 patients, mixed incontinence for 39 and sphincter deficient for 23. Preoperative urgency for 49 patients and dysuria for 10 of them. The method "hammock" has been used in 85.5% of cases. The type of anaesthesia has been pure local for 69.1% (0 to 98.8% for the different centers) with an average operative time of 8'30". Under local anaesthesia, the average per operative pain was quoted 2.8/10, and 0.7 at the end of intervention. Peroperative complications have revealed a wound of bladder, a vaginal wound and four bleeding of more than 100ml. In immediate continuations a total retention yielding to 24h and 13 postmicturition residual between 100 and 200ml have been mentioned. At two months, authors have observed the following: de novo urgency in 19.6%, de novo dysuria in 13.2%, one tape exposition, one granuloma, one urinary infection and seven perceptible lateral cords without pain. Thirteen patients have signalled to have had moderated pains on a duration of four to 30 days. Early objective results are globally 70.4% of dry patients (83% for pure isolated SUI, 72.2% for SUI with deficient sphincter, 50% for mixed incontinence). The pure local anaesthesia was recommended by 98% of patients.The diminution of complications ahead not to be made to the detriment of results, it is necessary to envisage multicentric studies with standardized modifications. The indications of this new device will have to be defined.

Ovarian cancer represents 4500 new cases a year in France and the prognosis of such tumor is not yet clear, even for the early stages. This is notably owing to the amount and size of peritoneal tumor residual. Recently, five therapeutic trials were published concerning the intra-peritoneal chemotherapy of ovarian cancer stage III in patients to whom an optimal debulking surgery had been done. These studies were variable in there outcome showing on the one hand, either the absence of significant difference or a significant lengthening of both total life duration and life without recurrence during the period of treatment with intra-peritoneal chemotherapy. On the other hand, there was a significant increase in hematological toxicity and temporary impairment of the quality of life during intra-peritoneal treatments. There were also complications linked to the intra-peritoneal catheter, which led to the termination of the treatment protocol in some cases. However, results showed a mattering benefit of survival in spite of a notable rate of incomplete treatment protocols. These results have demonstrated the necessity to consider the intra-peritoneal adjuvant chemotherapy as a treatment option in patients with epithelial ovarian cancer stage III. Patients must be highly selected and well counseled, in order to go for this treatment option after receiving optimal debulking surgeries.

Objectifs L’evaluation des differentes techniques chirurgicales de prise en charge des prolapsus uro-genitaux (PRL) de la femme âgee est peu connue. Cette etude comparait les resultats de 3 techniques chez des patientes de 70 a 80 ans. Methodes Il s’agit d’une etude retrospective evaluant les resultats de promontofixation (PF), voie vaginale autologue (VVA) et voie vaginale prothetique (VVP) realisees entre 2010 et 2013 dans un centre de reference chez des patientes âgees presentant un PRL grade selon la classification du POP-Q. On cherchait a comparer les resultats en analysant la correction anatomique a 1 an, les donnees perioperatoires, la qualite de vie et le taux de complications selon Dindo. Resultats Au total, 197 patientes ont ete operees ( Tableau 1 ) : 53 (26,1 %) PF, 85 (43,9 %) VVA, 59 (30 %) VVP. Les groupes presentaient des scores ASA comparables. On rapportait davantage de stade IV (p = 0,045) dans les VVA. Les VVP avait moins d’hysterectomie concomitante (p Tableau 2 ). Les PF presentaient un taux global de complications moins eleve (p = 0,041). L’analyse en sous-groupe stratifie par classification de Dindo ne rapportait pas de difference (p = 0,66). Avec un suivi median de 24,86 mois, les resultats fonctionnels etaient comparables, sans difference de temps de recouvrement postoperatoire, ni de correction anatomique, ni de changement de qualite de vie ( Tableau 2 ). Conclusion Les trois techniques chirurgicales de cure de PRL par PF, VVA ou VVP presentent des resultats comparables chez la patiente âgee. Une etude prospective multicentrique est necessaire pour confirmer ces resultats avec des experiences d’operateurs distincts.

Since the last recommendations, up to 2500 new references had been published on that topic.On the behalf of the health Minister, the Ad Hoc Committee consisted of 13 experts carried out a first version revisited by five additional experts who critically analyzed the first version of the report.Breast and ovarian cancer seem to be associated with fewer deleterious mutations of BRCA1 and BRCA2 than previously thought. The screening of ovarian cancer is still not an attractive option while in contrast MRI may be soon for these young women with dense breast, the recommended option for breast cancer screening. The effectiveness of prophylactic surgeries is now well established. French position is to favor such surgeries with regard to a quality of life in line with the expected benefit, and providing precise and standardized process described in the recommendation.Due to methodological flaws, the low power and a short follow-up of the surveys, this statement cannot however aspire to a high stability.

PURPOSE OF REVIEW This paper aims to review and comment on the developments in laparoscopic sacrocolpopexy published during the last year. RECENT FINDINGS We classified the findings reported recently in the literature for laparoscopic sacrocolpopexy as technical or tactical findings. Technical findings concern the material of the mesh, the methods of mesh fixation, the use of adapted vaginal retractors and the interest in robotic assistance. Tactical findings consist of specific modifications to the standard surgical procedure aimed at reducing the side effects and complications and ameliorating the effectiveness of this intervention. These modifications include the possibility of avoiding the placement of a posterior mesh and the fixation of the posterior mesh to the puborectal muscles or the perineal body instead of the posterior vaginal wall. A specific section has been dedicated to reviewing and commenting on those interventions associated routinely with laparoscopic sacrocolpopexy. SUMMARY Laparoscopic sacrocolpopexy is a safe surgical procedure in constant evolution which allows excellent results in the treatment of utero-vaginal prolapse. Large prospective, randomized studies comparing the different technical and tactical modifications recently introduced are needed in order to further enhance the effectiveness of this intervention.

We report a case of a primary uterine choriocarcinoma associated with adenocarcinoma occurring during peri-menopausal age, and review the literature. The clinical course and the histopathology of the case were reviewed and a Medline literature search for other cases was performed. BHCG and analysis of uterine curettage provided the diagnosis of choriocarcinoma. Polychemotherapy, started immediately after the patient's clinical condition deteriorated, was successful. Colpohysterectomy and pelvic lymphadenectomy were performed 5 months later. Treatment was completed by vaginal curietherapy. Histopathologic examination of the surgical specimen revealed only adenocarcinoma. The patient was followed for 18 months without evidence of recurrence. The literature search revealed that primary forms are exceptional; the etiology is unknown. Treatment is based on polychemotherapy. Primary choriocarcinomas are rare tumours, associated with other histopathological forms. We document a case occurring during the peri-menopausal period and review the literature on this pathology. The very poor prognosis in the past has changed with early polychemotherapy.

To describe, in view of the new standardization, the technique for urogenital prolapse repair using a one-piece synthetic mesh.The history and development steps through which the Tension free Vaginal Mesh (TVM) technique emerged are described. The use of a mesh was prompted by the 20-30% recurrence rate associated with conventional repair techniques. Selection of the type of mesh is discussed. Non-absorbable synthetic meshes have shown their usefulness in visceral surgery. A list of materials along with their respective advantages and inconveniences is reviewed and particular emphasis is put on both the tolerance and erosion issues, the latter being specific to the vaginal route. The TVM Group selected a one-thread polypropylene mesh, Prolene Soft, which seemed the most appropriate for the transvaginal approach of prolapse surgical repair. The prosthesis and its design rationale are described. Full details are given on the consecutive intervention steps and underlying concepts.The relevant literature is scarce and there is a lack of methodologically sound studies validating the materials and techniques used. After completion of a first step of technique refinement and feasibility assessment involving about 300 surgical interventions, the authors initiated a prospective multicenter study. Clinical outcome assessments using feasibility, complications, and efficacy endpoints will be published after twelve months, three years, and five years of follow-up.Fruitful reasoning led to the development of the TVM technique of complete surgical repair of genital prolapse, which uses a synthetic materiel carefully selected after several tests. All surgeons can apply this technique after a short training period.

Study Objective To assess the feasibility and results of laparoscopic sacrocolpopexy (LSC) with two separate meshes along the anterior and posterior vaginal walls in correcting multicompartment pelvic organ prolapse (POP). Design Prospective study (Canadian Task Force classification I). Setting Tertiary care university-affiliated teaching hospital. Patients Forty-six consecutive women with radiologic diagnosis of multicompartment POP with or without genuine stress urinary incontinence and no history of surgery for either disorder. Intervention LSC with or without laparoscopic Burch colposuspension or tension-free vaginal tape procedure. Measurements and Main Results LSC was performed in 89% of patients. Mean operating and hospitalization times were 171 ± 37 minutes and 4.0 ± 2.1 days, respectively. Intraoperative complications were 7% of bladder injuries successfully treated by laparoscopic suture. The success rate for POP was 83%. The main recurrence was rectocele (12%), which occurred only among women undergoing LSC plus laparoscopic Burch colposuspension (P = 0.036). The LSC was effective in treating symptoms in 95% of women. Because of excessive mesh tension, one patient (2%) developed obstructed defecation, and two (5%) had de novo urinary incontinence. In no patient did occlusion or mesh infection and/or erosion in adjacent organs occur. Conclusion LSC appears to be feasible and effective in treatment of multicompartment POP. Performing concomitant Burch colposuspension significantly enhances the risk of rectocele recurrence or development.

To propose a rational attitude to treat infraclinic breast lesions about a 176-case retrospective analysis.Between January and December 2000, 176 patients were addressed for an infraclinic breast lesion. The epidemiologic and mammographic data, diagnostic management and histological results were collected.Patients were addressed for an ACR 2 lesion in 0.8% of cases, ACR 3: 34.8%, ACR 4: 43.2% and ACR 5: 21.2%. One hundred and sixteen patients underwent a stereotactic macrobiopsy: 55 Advanced Breast Biopsy Instrumentation (ABBI), 61 Minimal Invasive Breast Biopsy (MIBB). Histologically, 59.5% were benign, 33.6% malignant, 2.6% borderline and 4.3% suspicious or non contributive. Forty-two patients underwent an open surgical biopsy. Histologically 56.1% were benign, 41.5% malignant and 2.4% borderline. Eighteen patients were controlled by mammography. Among ACR 3s there were 90% of benign lesions and 46% of malignancy in ACR 4s. Patients with malignant, borderline or suspicious result in stereotactic biopsy, underwent one-time surgery in 97% vs 55% in surgical biopsy (P0.0001).Infraclinic breast lesions must be radiologically classified with the ACR classification. Stereotactic macrobiopsies are reserved for ACR 4 and ACR 5 lesions. Because of their reliability, practice of macrobiopsies avoids surgery in about 50% of ACR 4 lesions which correspond to benign lesions. When the result is malignant, it allows most of times surgical procedure one-time.

Postoperative perineal hernia is a rare complication following abdominoperineal excision of the rectum. We report four cases illustrating its clinical presentation and modern management. Surgical technique for rectal excision and perineal closure, making of an epiplooplasty, postoperative infection may contribute to the occurrence of this complication. Mesh repair through an anterior open or laparoscopic abdominal approach is one of the surgical options if not contraindicated by age and/or general condition. Perineal or combined approaches can also be selected to solve this difficult problem.