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Resume La densite mammaire est depuis quelques annees au cœur de multiples controverses quant a sa qualite de facteur de risque independant de cancer du sein. Cet expose tentera de definir le terme de densite mammaire, d’etudier les facteurs influant sur ce parametre, d’exposer les differentes techniques disponibles pour la quantifier ainsi que les etudes suggerant une correlation avec le sur-risque de cancer du sein.

Objective To evaluate urinary dysfunction and quality of life before and after surgery for deep infiltrating endometriosis (DIE). Methods This prospective study included 50 patients with DIE who required surgery. Urinary dysfunction was evaluated before and after surgery by both urodynamic tests and electromyography, and the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) quality-of-life questionnaire. Results Preoperative electromyography showed that 14 patients (28%) had neurogenic alteration involving sacral reflex and pelvic floor muscles correlated with the presence of colorectal endometriosis ( p = 0.003). Postoperative quality of life and BFLUTS total scores were improved compared to preoperative scores ( p = 0.001 and p = 0.005, respectively). After an initial improvement in BFLUTS, an alteration is observed at long-term (median follow-up of 66 months). In the 34 patients with pre- and postoperative urodynamic measurements, no difference was found before and after surgery. De novo peripheral neuropathy was only observed in patients who underwent DIE resection with colorectal resection ( p = 0.02). Conclusions Our results support that patients with DIE have a high incidence of preoperative urinary symptoms and neurogenic dysfunction. Colorectal resection appears to be a determinant factor of de novo peripheral neuropathy.

Resume Introduction Le cancer de l’endometre est le plus frequent des cancers gynecologiques. Afin d’ameliorer et d’homogeneiser les prises en charge du cancer de l’endometre, des recommandations ont ete elaborees en novembre 2010. Le but de cette etude est d’evaluer l’application de ces recommandations. Materiel et methode Notre etude multicentrique retrospective utilise les bases de donnees de trois centres francais : le CHU de Reims, l’Hopital Tenon de Paris et le Centre de lutte contre le cancer Georges-Francois-Leclerc de Dijon de novembre 2010 a decembre 2012. Cette etude consistait en l’evaluation des modalites de prise en charge diagnostique et therapeutique des patientes presentant un cancer de l’endometre et leur concordance avec les recommandations de l’INCa. Resultats Au cours de notre etude, 161 patientes ont ete prises en charge pour un cancer de l’endometre. Un bilan preoperatoire histologique et radiologique etait realise dans 92,5 % et 73,3 % des cas respectivement. Une concordance anatomo-radiologique pre- et post-operatoire etait mise en evidence dans 62,3 % et 53,4 % des cas pour l’envahissement du myometre et la stadification de la Federation internationale de gynecologie et d’obstetrique. La voie d’abord chirurgicale et le type de chirurgie realisee etaient conformes aux referentiels dans 64,6 % ( n = 104) et 60,3 % des cas ( n = 97). Les discordances par rapport aux recommandations concernaient l’absence ou la realisation par exces d’une lymphadenectomie. Un traitement adjuvant a ete administre dans 67,1 % des cas ( n = 108) et etait en accord avec les recommandations dans 62,3 % des cas. Discussion La discordance pre- et post-operatoire des resultats histologiques et radiologiques sont a l’origine d’un defaut de prise en charge avec pour consequence un sous- et sur-traitement principalement lie a la lymphadenectomie. La procedure du ganglion sentinelle devrait contribuer a mieux adapter les traitements adjuvants. Enfin, le taux de discordance souligne la necessite du rappel des recommandations de l’INCa.

Objective The aim of this study is to assess the impact of sentinel lymph node (SLN) mapping and ultrastaging on the therapeutic management of early-stage endometrial cancer. Methods This retrospective multicenter study covered the period from January 2000 through December 2012 and included 304 women with presumed low- or intermediate-risk endometrial cancer. Node staging, histology results, and the effects of both on therapeutic management were assessed in two groups: those who underwent the SLN mapping and ultrastaging procedure and those treated in accordance with French guidelines. Results The SLN procedure detected metastatic lymph nodes in three times more women than lymphadenectomy did (16.2% versus 5.1%, p=0.03). Specifically, it found 7 macrometastases (5.1%) and 15 micrometastases (11%); 11 of the latter (8.1%) were detected by serial sectioning and immunohistochemistry (IHC), that is, pathologic ultrastaging. The SLN biopsy false-negative rate was 0% (95% CI: 0–1.6%). This ultrastaging enabled us to modify the adjuvant therapy for half the patients. Women with micrometastases detected by the SLN procedure were treated with external beam radiotherapy (EBRT), while those whose SLN biopsies were negative received vaginal brachytherapy (VBT) or clinical follow-up. SLN biopsies had no impact on recurrence-free survival. Conclusion SLN mapping and ultrastaging improved staging and made it possible to adapt adjuvant therapy to risk of recurrence.

Background One of the current therapeutic challenges for women with breast cancer receiving neoadjuvant chemotherapy (NAC) is distinguishing women with complete axillary nodal response from those with axillary residual disease to promote a personalized therapeutic strategy including sparing axillary surgery. This study set out to develop a risk scoring system (RSS) for predicting probability of nodal pathological complete response (pCR) in women presenting with cN1 breast cancer who received NAC. Methods Data of 116 women with cN1 breast cancer who received NAC between January 2009 and December 2013 were abstracted from our prospectively maintained database. A risk model based on factors impacting nodal axillary was developed. Results The overall nodal conversion rate was 36.2% (42/116). Axillary nodal response was associated with three variables: menopausal status [Odds ratio (OR) = 0.23; 95% confidence interval (CI) 0.09–0.60], the radiological % of breast tumour shrinkage ≥50% (OR = 3.71; 95% CI 1.51–9.10), and negative hormone receptors (ER-, PR-) (OR = 2.41; 95% CI 0.99–5.87). These variables were included in the RSS and assigned scores ranging from 0 to 2. The discrimination of the RSS was 0.78 [95% confidence interval (CI) 0.69–0.86]. A total score of 3 points corresponded to the optimal threshold of the RSS. The diagnostic accuracy was 74.1%. Conclusions This study shows that the probability of axillary nodal pCR after NAC can be accurately predicted so that women at high probability may be spared of axillary surgery.

Lymphovascular space involvement (LVSI) is a major prognostic factor in type 1 endometrial cancer (EC). However, its use has been criticized because of poor subjectivity. MicroRNA signatures have recently been linked to EC pathologic characteristics. The aim of this study was to evaluate whether microRNA profiles of type 1 EC can be related to LVSI status and used as a tool to adapt therapy.MicroRNA expression was assessed by chip analysis and qRT-PCR in 12 formalin-fixed paraffin-embedded grade 2 EC specimens with positive LVSI and in 12 specimens with negative LVSI. Various statistical analyses, including enrichment analysis and a minimum p-value approach, were performed.The expression levels of microRNAs 34c-5p, -23b-5p, and 23c were significantly lower in the EC with positive LVSI compared to those with negative LVSI. Women with a microRNA-34c-5p fold change0.15 were more likely to have positive LVSI status (92.3%) compared with those with a microRNA-34c-5p fold change0.15 (0.0%), p0.001. Furthermore, women with a microRNA-23b-5p fold change0.51 were more likely to have positive LVSI status (90.0%) compared with those with a microRNA-23b-5p fold change0.51 (21.4%), p=0.003.This was the first study to investigate the relative expression of microRNA in type 1 EC according to LVSI status. This microRNA expression profile may provide a basis for further study of the microRNA function in EC, and be used as a diagnostic tool for LVSI status.

Endometriosis is a condition where hormonal-responsive endometrial tissue grows outside the uterus usually within the pelvic cavity. Extra-abdominal endometriosis is less common and may involves the skin. Subcutaneous endometriosis is rare. We report the first case of spontaneous intergluteal cleft endometriosis revealed by pain and bleeding during menstruation.

To compare epidemiological, histological, therapeutic characteristics and prognosis of patients with breast cancer diagnosed during pregnancy with those diagnosed in postpartum period at a national expert center, « Cancer Associé à La Grossesse » network.Retrospective study of 108 patients with a pregnancy-associated breast cancer (PABC) between 2002 and 2016 comparing 51 patients with PABC during pregnancy and 57 patients with PABC of postpartum.Median gestational age at diagnosis was 16 weeks of gestation (WG). Median size (P=0.92), initial axillary pathology (P=0.29), histological type (P=0.33) and hormone receptor positive (P=0.93), were similar between groups. PABC during pregnancy overexpressed less frequently HER2 (12 % vs 36 %, P=0.003) and were less proliferant (Ki67≥15 %; 64 % vs 75 %, P=0.018) with less radical surgery (45 % vs 70 %, P=0.008). Sentinel lymph node biopsy was performed in 8 patients during pregnancy. Less patients of PABC during pregnancy received trastuzumab 12 % vs 37 %, P=0.003. Median delivery term was 37 WG. Median follow-up 3.2 vs 5.6 years (P=0.002) and recurrence rate for PABC during pregnancy and of postpartum were 3.2 vs 5.6 years (P=0.002) and 12 % vs 32 % (P=0.01), respectively. Our results emphasize histological, surgical and adjuvant treatment differences imposing differentiating PABC during pregnancy from those diagnosed in the postpartum period.

e17060 Background: The aim of this study was to identify prognostic factors of overall survival in patients with FIGO stage IIIc or IVa ovarian cancer treated by neo-adjuvant chemotherapy(NAC) followed by interval debulking surgery. Methods: Data of 483 patients from FRANCOGYN database, were retrospectively included in 11 French expert centers between January 2000 and December 2016. Interval cytoreductive surgery was realized in all patients after 2 or 3 or 4 or more than 4 courses of NAC. Completeness of Cancer Resection score led to define residual disease after surgery. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analysis were performed to define prognostic factors of overall survival. Results: The median overall survival was 52 months, after a median follow up of 30 months. 73.5% patients had no residual disease after surgery. After univariate analysis, factors significantly associated with decreased overall survival were; no pelvic and/or lombo-aortic lymphadenectomy (p= 0.002), residual disease after surgery ( p< 0.001), positive cytology after NAC ( p< 0.001), omental disease after NAC ( p= 0.002), no pathologic complete response (pCR) ( p= 0.002). In multivariate analysis, factors significantly associated with decreased overall survival were; residual disease after surgery (HR = 1.93; CI95% (1.16-3.21), p= 0.01) and positive cytology after NAC (HR = 1.59; CI95% (1.01-2.55), p= 0.05). Patients with no residual disease after surgery had a median overall survival of 64 months versus 35 months for patients with residual disease. Patients with negative cytology after NAC had a median overall survival of 71 months versus 43 months for patients with positive cytology after NAC. Conclusions: Residual disease after surgery and positive cytology after NAC are significantly associated with decreased overall survival of FIGO stage IIIc or IVa ovarian cancer. Therefore, complete cytoreductive surgery is ovarian cancer main prognostic factor.

5587 Background: To standardize surgical practices, ESMO-ESGO-ESTRO consensus conference published in 2016 new guidelines on the management of endometrial cancer. The main objective of this study was to evaluate the impact of non-compliance with current surgical guidelines on disease-free survival and overall survival. Methods: 852 patients with presumptive stage I and II type 1 endometrial cancer were included in a multicenter retrospective study, conducted between January 2000 and November 2015. The main objective of this study was to evaluate the impact of non-compliance with current surgical recommendations on overall survival and disease-free survival. Results: Our study shows that 34.3% of patients (n = 292) did not benefit from optimal surgical treatment. These patients did not have a lombo-aortic lymphadenectomy (LAL) and were at high risk of recurrence. There is a significant difference in disease-free survival in favor of patients undergoing surgery according to the recommendations, (Hazard Ratio (HR): 0.37 (Confidence interval (95% CI): 0.26-0.54), p < 0.001). In multivariate analysis, optimal surgical procedure performance is an independent factor for disease-free survival with HR at 2.04 (95% CI: 1.14-3.68), p = 0.01. There is a significant difference in overall survival in favor of patients undergoing surgery according to the recommendations, (HR: 0.31 (95% CI): 0.19-0.49), p < 0.001. In multivariate analysis, there is a trend toward significance with HR: 2.24 (95% CI: 1-5.05), p = 0.05. Older patients, patients with a larger BMI, patients with no indication of LAL at the preoperative ESMO classification, and no node involvement in are factors contributing to the decision of not to perform a LAL: p < 0.001, p = 0.03, p < 0.001 and p < 0.001 respectively. Conclusions: This study shows that patients with early type 1 endometrial cancer have improved recurrence-free survival and a statistical trend for an increased overall survival when recommended surgery is performed. Despite the current context of therapeutic de-escalation, we must strive to achieve the recommended optimal surgery, even if it requires secondary surgical revision, to avoid underestimation of patients with a poorer prognosis. To improve endometrial cancers management, amelioration of the preoperative assessment by increasing the sensitivity of emboli detection should be considered.

Background: We developed a nomogram based on five clinical and pathological characteristics to predict lymph-node (LN) metastasis with a high concordance probability in endometrial cancer. Sentinel LN (SLN) biopsy has been suggested as a compromise between systematic lymphadenectomy and no dissection in patients with low-risk endometrial cancer. Methods: Patients with stage I–II endometrial cancer had pelvic SLN and systematic pelvic-node dissection. All LNs were histopathologically examined, and the SLNs were examined by immunohistochemistry. We compared the accuracy of the nomogram at predicting LN detected with conventional histopathology (macrometastasis) and ultrastaging procedure using SLN (micrometastasis). Results: Thirty-eight of the 187 patients (20%) had pelvic LN metastases, 20 had macrometastases and 18 had micrometastases. For the prediction of macrometastases, the nomogram showed good discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.76, and was well calibrated (average error =2.1%). For the prediction of micro- and macrometastases, the nomogram showed poorer discrimination, with an AUC of 0.67, and was less well calibrated (average error =10.9%). Conclusion: Our nomogram is accurate at predicting LN macrometastases but less accurate at predicting micrometastases. Our results suggest that micrometastases are an ‘intermediate state' between disease-free LN and macrometastasis.

Background: To evaluate the impact of the association of endometrioma with or withoutdeep infiltrating endometriosis (DIE) after a first intra cytoplasmic sperm injection- invitro fertilization (ICSI-IVF) cycle on pregnancy rate.Materials and Methods: In this retrospective study, women with endometrioma whounderwent a first ICSI-IVF cycle from January 2007 to June 2010 were reviewed forpregnancy rate. The main outcome measure was the clinical pregnancy rate. A multiplelogistic regression (MLR) was performed; including all variables that were correlatedto the conception rate. Only independent factors of pregnancy rate were included in aRecursive Partitioning (RP) model.Results: The study population consisted of 104 patients (37 without DIE and 67 patientswith associated DIE). Using multivariable analysis, a lower pregnancy rate was associatedwith the presence of DIE (OR=0.24 (95% CI: 0.085-0.7); p=0.009) and the use ofICSI (OR=0.23 (95% CI: 0.07-0.8); p=0.02). A higher pregnancy rate was associatedwith an anti-mullerian hormone (AMH) serum level over 1 ng/ml (OR=4.3 (95% CI:1.1-19); p=0.049). A RP was built to predict pregnancy rate with good calibration [ROCAUC (95% CI) of 0.70 (0.65-0.75)].Conclusion: Our data support that DIE associated with endometrioma in infertilepatients has a negative impact on pregnancy rate after first ICSI-IVF cycle. Furthermore,our predictive model gives couples better information about the likelihood ofconceiving.

Background: Lymphocele is the principal post-operative morbidity following axillary node dissection. According to the literature, the incidence can vary from 4% to 89%. Encouraging results in terms of reducing postoperative lymphoceles as well as the volume and duration of drainage using octreotide LAR has been recently reported. Pasireotide LAR, a long acting drug designed to target multiple somatostatin receptors, was evaluated in this trial. Trial design: A phase II, two centers, randomized, double-blind, non-comparative pilot study was carried out in order to evaluate efficacy and safety of a single injection of pasireotide LAR 60 mg administered 7–10 days before scheduled mastectomy with axillary dissection surgery. This study included a parallel placebo arm to assess the natural course of the disease. Eligibility criteria: Adult female breast cancer patients planned to undergo a mastectomy (without reconstruction at the same time) and axillary node dissection. Specific aims: To assess the efficacy and safety of a single injection of pasireotide LAR 60 mg or placebo prior to mastectomy with axillary lymph node dissection surgery in reducing symptomatic lymphocele development. Symptomatic lymphocele was evaluated and was defined as: 1. total lymphocele drainage/aspiration volume (unique or iterative) >60 cc inclusive within the 28 days after surgery (excluding post-surgery drain) or; 2. a systematic aspiration volume at day 28 > 120 cc. Statistical methods: The statistical analysis was carried out sequentially after observing the absence of symptomatic lymphocele for each patient. It involves estimating the probability of a response in each group using a Bayesian design based on a beta-binomial model. The probability of response was considered random and its prior distribution was centered on 80% in the pasireotide group and 60% in the placebo group according to the investigators initial guesses. The distribution of the probability of response was updated after the observation of the patients included in the trial. Results: A total of 90 patients were included over 18 months: 42 in the treatment group and 48 in the placebo group. In the treatment group, the posterior mean estimation of the response rate (i.e. patients who did not experience a symptomatic lymphocele) was 62.4% (95% CI: 48.6%–75.3%) and 50.2% in the placebo group (95% CI: 37.6%–62.8%%). In the treatment group, one serious adverse event occurred in a patient with known insulin dependent diabetes requiring hospitalization for hyperglycaemia. Conclusion: A one time injection of pasireotide LAR to prevent symptomatic lymphocele development in women undergoing mastectomy with axillary dissection is promising. Further clinical studies are warranted. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-14-12.

International audience; Background - Little data exist about the clinical management and survival of elderly patients with endometrial cancer. This study aimed to evaluate the management of elderly and very elderly patients with endometrial cancer as well as the overall survival (OS) rate, disease-free survival (DFS) rate, and cancer-specific survival (CSS) rate in a multicenter cohort. Methods - Data from 1228 patients with endometrial cancer who received primary treatment between January 2001 and December 2012 were collected from a multicenter database. Clinical management, DFS, CSS, and OS were analyzed. Results - Based on the international endometrial cancer risk classification, 36% (212/582) of women age 65 years or younger, 42% (220/526) of women ages 65-80 years, and 48% (58/120) of women older than 80 years showed high-risk endometrial cancer (p

Conservative treatment, consisting in uterine preservation with unilateral salpingo-oophorectomy, can be proposed to selected patients with early epithelial ovarian cancer, with a desire for pregnancy after a histological review and surgical staging.

The purpose of this study was to analyse the endometrial cancer (EC) patterns of recurrence based on a large French multicentre database according to ESMO-ESGO-ESTRO classification.Data of women with histologically proven EC who received primary surgical treatment between January 2001 and December 2012 were retrospectively abstracted from seven institutions with prospectively maintained databases. The endpoints were recurrence, recurrence free survival (RFS) and overall survival (OS). Time to the first EC recurrence in a specific site was evaluated by using cumulative incidence analysis (Gray's test).Data from 829 women were analysed in whom recurrences were observed in 176 (21%) with a median and mean time to recurrence of 13 and 19.5months, respectively. High (35%) and high-intermediate risk groups (16%) were associated with higher recurrence rates compared with low (9%) and intermediate (9%) risk patients (p0.0001). Women with high risk EC had a higher 5-year cumulative incidence of distant recurrence (20.7%) than women with high-intermediate, intermediate and low risk EC (5.6%, 3.5%, 3.3%), (p0.001), respectively. Women with high risk and high-intermediate risk EC had a higher 5-year cumulative incidence of loco-regional recurrence (24.3% and 16.6%, respectively) than women with intermediate and low risk EC (6.6% and 6.5%, respectively), (p0.001).We report specific time and site patterns of first recurrence according to the ESMO/ESGO/ESTRO classification. Sites and hazard rates for recurrence differ widely between subgroups over time. Defining patterns of EC recurrence may provide useful information for developing follow-up recommendations and designing therapeutic approaches.

Background The recently developed MDACC nomogram purports to predict the risk of bone-only metastasis in women with early breast carcinoma based on five clinical and pathological characteristics. We set out to externally validate and assess its robustness using a tertiary breast cancer centre database. Methods All consecutive women treated for early breast cancer in our centre between January 1989 and December 2013 and who had all the nomogram variables documented were eligible for analysis. Results We identified 1255 eligible women for external validation analysis. The median follow-up was 54 months (range: 1–312) and time to initial metastasis 20 months (range: 1–80). The correspondence between the actual bone-only metastasis and the nomogram predictions implied poor calibration of the nomogram in the validation cohort, be it in the whole cohort or when stratified by breast cancer subtype. Conclusion This external validation study of the MDACC nomogram showed limitations in its generalizability to a new and independent European patient population.

Deep infiltrating endometriosis (DIE) affects several anatomical locations including the bladder, torus uterinum, uterosacral ligament, rectovaginal septum and bowel. It is the most debilitating form of endometriosis and causes severe pain, digestive and urinary symptoms as well as infertility. Faced with an infertile woman suffering from DIE, the dilemma is whether to opt for first-line IVF treatment or for surgery. In the absence of high-level of evidence from randomized studies, several factors should be taken into account in the decision-making process. The main criterion is whether the patient wants in-vitro fertilization (IVF) treatment or not. Secondly, while previous reports have demonstrated the positive impact of surgery on pregnancy, they also underline the risk of severe complications requiring management in expert centers. Despite the availability of predictive models or scoring systems, the decision mainly boils down to the couple's characteristics. It seems logical to propose first-line IVF when spontaneous fertility is not possible due to associated male infertility or tubal obstruction; for women aged ≥35 years; or in women with diminished ovarian reserve. Conversely, first-line surgery could be the best option for women without these characteristics. However, this strategy is mainly based on low-level of evidence underlining the requiring of randomized trials.

Study question Can a nomogram be used to predict the individual probability of live birth (LB) in women with borderline ovarian tumours (BOTs) receiving primary fertility-sparing surgery? Summary answer A nomogram built according to the woman's age, histological subtype (serous versus mucinous), type of ovarian surgical treatment and FIGO stage can accurately predict the probability of LB in women with BOT. What is known already Current prediction models determine the probability of pregnancy after medically assisted reproduction (MAR) and form the basis of patient counselling to guide the decision as to whether to consider in vitro fertilization but do not take into account prediction of the LB rate. Study design, size, duration This was a retrospective multi-centre study including 187 women with fertility-sparing surgery for BOT diagnosed between January 1980 and December 2013. Participants/materials, setting, methods A multivariate logistic regression analysis of selected factors and a nomogram to predict the subsequent LB rate was constructed. A bootstrapping technique was used for internal validation. Main results and the role of chance Fifty-one women had LB (27.3%). Taking into account multiple pregnancies, the overall LB rate was 40.1% (75/187). Federation International of Gynaecology and Obstetric (FIGO) stage, age at diagnosis, histological subtype and surgery type were included in the nomogram. The predictive model had an AUC of 0.742 (95% CI, 0.644-0.825) and 0.72 (95% CI, 0.621-0.805) before and after the 200 repetitions of bootstrap sample corrections, respectively, and showed a good calibration. Limitations, reasons for caution The retrospective nature of the study cannot exclude all biases. Our nomogram is based on simple criteria, but did not take into account the evaluation of ovarian reserve. It demonstrates a fair relevance, but requires external validation before routine use. Wider implications of the findings Clinicians are increasingly interested in such tools to support the patient in making an informed decision about treatment options. This nomogram contributes to the decision-making by defining simple risk factors of poor LB probability that can help identify good candidates for MAR. Study funding/competing interests No external funding was used for this study. There are no conflicts of interest to declare. Trial registration number N/A.

International audience; ObjectiveThe goal of this review was to assess the impact of colorectal endometriosis on spontaneous fertility and the potential benefit of Medically Assisted Reproduction (MAR) (in vitro fertilization and intrauterine insemination) and surgery on fertility outcomes.Study design: MEDLINE search for articles on fertility in women with DIE published between 1990 and December 2015 using the following terms: “deep endometriosis”, “deep infiltrating endometriosis”, “bowel endometriosis”, “colorectal endometriosis”, “fertility”, “infertility”, “IVF-ICSI”, “Assisted Reproductive Techniques (ART)”, and “MAR”.ResultsSpontaneous pregnancy rate (PR) in patients undergoing resection of DIE but leaving in situ colorectal endometriosis was 26.5% (95% CI = 14-39). PR after MAR was 27.4% (95% CI = 19-35) and the overall PR was 37.9% (95% CI = 29-37). After colorectal surgery, among the 855 patients with and without proved infertility, the spontaneous PR was 31.4% (95% CI = 28-34) without difference between the groups. PR after MAR was 19.8% (95% CI = 17-22). PR after MAR in patients with and without proved infertility was 21.4% (95% CI = 18-25) and 15.5% (95% CI = 11-20), respectively. The overall PR after colorectal surgery was 51.1% (95% CI = 48-54).ConclusionOur review supports a potential benefit of surgery on fertility outcomes for women with colorectal endometriosis. Further studies are required to determine whether surgical management should be first-intention or restricted to failure of MAR.

There is some controversy about the relevance of lymphadenectomy in patients with early stage endometrial cancer. The aim of this study was to evaluate the contribution of sentinel lymph node (SLN) biopsy in staging patients with presumed low- and intermediate-risk endometrial cancer.This retrospective multicenter study was conducted from July 2007 to December 2011 including 103 patients with presumed low- or intermediate-risk endometrial cancer who had undergone SLN biopsy. Concordance between preoperative staging and definitive histology as well as contribution of SLN biopsy and ultrastaging to upstage patients were assessed.SLNs were detected in 89 patients (86.4 %), 56 (62.9 %) of whom had presumed low-risk and 33 (37.1 %) intermediate-risk endometrial cancer. Of the 89 patients, 14 (15.7 %) had positive SLNs. Twelve (21.4 %) of the 56 patients with presumed low-risk disease were upstaged by definitive histology, among whom 3 (25 %) had pelvic positive SLNs. Seven (21.2 %) of the 33 patients with intermediate-risk disease were upstaged by definitive histology, 1 (14.3 %) of whom had positive SLNs. Ultrastaging detected metastases undiagnosed by conventional histology in 6 (42.8 %) of 14 of patients with positive SLNs.SLN biopsy associated with ultrastaging is relevant to stage low- or intermediate-risk endometrial cancer and could help guide adjuvant therapies.

ObjectiveSurgical management of advanced ovarian cancer often requires low modified posterior pelvic exenteration (MPE) to achieved complete resection. The aim of this study was to evaluate the morbidity of MPE at the time of primary cytoreductive surgery (PCS) and interval cytoreductive surgery (ICS) after neoadjuvant chemotherapy.Materials and MethodsFrom 2001 to 2009, 63 patients underwent MPE for advanced ovarian cancer. We analyzed and compared surgical characteristics and postoperative courses between PCS and ICS.ResultsModified posterior pelvic exenteration was performed during PCS for 50 patients (79%) and during ICS for 13 patients (21%). Complete cytoreduction was achieved in 80% of patients (84% in the PCS group and 69% in the ICS group; ns). There was no significant difference between the PCS and ICS groups in the type and the rate of standards or radical surgical procedures. Patients with ICS had a shorter length of stay in the intensive care unit (0.9 vs 2.7 days; P = 0.009), but there was no difference in the total length of hospitalization (P = 0.94). The global rate of postoperative complications was 76%. No differences were found between the 2 groups in digestive or extradigestive complications, iterative surgery, or interventional radiology procedures. The median overall survival was 49.4 months in the PCS group and 27.1 months in the ICS group (P = 0.27), and the median progression-free survival time in both groups was 20 months.ConclusionsThere was no difference in the occurrence of postoperative complications between PCS and ICS, especially in morbidity related to MPE. The specific morbidity of this surgical procedure remained low compared with the overall morbidity in cases of extensive surgery.

Resume L’endometriose digestive represente une des formes les plus severes d’endometriose pelvienne a l’origine de symptomes invalidants necessitant souvent une prise en charge chirurgicale. Le but de cette revue est de preciser les methodes d’imagerie non invasives permettant le diagnostic positif et le degre d’extension lesionnelle des diverses atteintes digestives. Les methodes de realisation, d’interpretation et le role respectif de l’echographie endovaginale, de l’echoendoscopie rectale, de l’IRM et du scanner multibarette seront ainsi precises.

Objective To describe the trends in the rate, treatment, and survival of late-stage vulvar carcinomas (LSVCs) over a 20-year period in the United States. Methods Demographic, pathologic, treatment, and survival data were collected from the Surveillance, Epidemiology, and End Results registry between 1988 and 2007. Trends concerning the rate of LSVC (International Federation of Gynecology and Obstetrics [FIGO] stages III and IV), its management, and outcome were studied. Five-year overall and disease-specific survival rates were calculated. Results The rate of LSVC (32.4%) as compared with early-stage disease (67.6%) did not change significantly from 1988 to 2007 (P = 0.59). Of the 2630 patients with LSVC, the median age at diagnosis was 72 years, with 88.5% of them being white. Surgery and radiation therapy were performed in 73.8% and 60.6% of cases, respectively, with 37% of the patients having no lymph node dissection. A significant trend toward removing fewer lymph nodes (P = 0.02) and offering more radiation therapy (P = 0.02) has been observed across the study period. Five-year overall and disease-specific survival rates did not change (P = 0.44 and P =0.26, respectively) from 1988 to 2007. On multivariate analysis, node positivity (hazard ratio, 3.12 [95% confidence interval, 2.30–4.24]) and surgery (hazard ratio, 0.41 [95% confidence interval, 0.24–0.69]) were found to be the 2 most predictive variables for cancer mortality, followed by age and tumor size. Conclusion Less extensive surgery and more radiation therapy did not compromise survival of LSVC over the 20-year period.

Colorectal surgery for endometriosis is increasingly performed, but its assessment is still incomplete, especially regarding its impact on quality of life, the recurrence rate and subsequent fertility. Segmental resection is the technique most often performed and best evaluated with a proven efficacy but associated with significant morbidity. Alternatives to segmental resection consisting of shaving rectal resection, discoid resection or superficial resection have recently been proposed to provide equivalent efficacy while decreasing morbidity. To date, data are insufficient to clarify the respective indications of segmental resection and alternatives. Only randomized trials will resolve the existing controversy.

Based on two randomized trials and a meta-analysis, the recommendations of the National Cancer Institute (INCa) have validated the absence of systematic pelvic lymphadenectomy for patients with endometrial cancer at low risk (type 1 histology stage IA grade 1-2) and intermediate (type 1 histology stage IA grade 3 and IB grade 1-2) but without taking into account the contribution of the sentinel node (SN) procedure. The senti-endo trial assessing the role of the SN procedure in patients with early stages endometrial cancer showed that the detection rate by hemi-pelvis right and left were 77 and 76%, respectively. The detection rate per patient was 89%. Among patients with at least a SN detected, the detection was unilateral in 34 cases (31%) and bilateral in 77 cases (69%). Of the 111 patients with at least a SN detected, 19 had lymph node metastases (17%). Considering the hemi-pelvis right and left as a unit, no false negative case was observed, hence the sensitivity and NPV was 100%. Considering the NPV per patient, three false negative cases were observed. Among the 57 patients at low risk, six (11%) had lymph node metastases on SN with negative non sentinel nodes. Of the 33 patients at intermediate risk, five (15%) had lymph node metastases on SN with negative non sentinel nodes. Senti-endo results emphasize the contribution of the SN procedure to assess the nodal status in patients with low or intermediate risk group raising the issue on new definition of the recommendations of INCa.

Background: Lymphocele is the principal post-operative morbidity following axillary node dissection. According to the literature, incidence can vary from 4 to 89%. Encouraging results in terms of reducing postoperative lymphoceles as well as drainage duration and volume using octreotide have been recorded recently. A new molecule, namely pasireotide, developed by Novartis Pharma AG, Basle Switzerland, is a somatostatin analog possessing high binding affinity to 4 of the 5 somatostatin receptors. Trial design: We are performing a prospective, randomized 1:1, double blind, multicenter trial against placebo with a Bayesian design. Eligibility criteria: any female patient scheduled for breast surgery with mastectomy and axillary node dissection indicated at the pre-surgical stage. Specific aims: The purpose of this trial is to assess the efficacy of a single pre-surgical injection of pasireotide LAR 60 mg im in reducing the postoperative incidence of symptomatic lymphoceles following mastectomy with axillary node dissection for breast cancer. Patients are followed up for 4 weeks Statistical methods: The statistical analysis will be carried out sequentially after observing the principal criterion (i.e. success is defined as a total volume of lymphocele following single or repeated aspiration ≤ 60 cc in the 28 days following surgery or a routine aspiration volume on the 28th day ≤ 120cc) of each patient included for each randomization group, with or without treatment. It involves estimating the probability of a response in each group using a Bayesian design based on a beta-binomial model. With the Bayesian approach, the response rate in each group (πi) is considered as a random variable, with a priori density focused on the anticipated response rate of 80% in the group receiving treatment and 60% in the non-treatment group, which will be sequentially updated as the observations are made according to a so-called a posteriori law. Present accrual and target accrual: The sample size consists of a total of 90 patients with 45 patients in the active treatment group and 45 patients in the placebo one. To date more than 50% of the patients have been included. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT2-07-01.

Objectives To determine the value of postcontrast MR imaging (MRI) in cases of suspected pelvic endometriosis by assessing interobserver variability of MR imaging according to the endometriotic locations. Methods This retrospective study included 158 patients with clinical suspicion of endometriosis who had undergone surgery after MRI between January 2004 and April 2009. Three radiologists with different degrees of experience were independently asked to determine the presence of rectosigmoid colon, vaginal, and bladder endometriosis using both conventional and a combination of conventional and postcontrast MRI. Descriptive analysis, ROC analysis and interobserver agreements (kappa values) were calculated. Results Rectosigmoid colon, vaginal, and bladder endometriosis was present in 65, 39 and eight patients, respectively. The accuracy of conventional assessment for readers 1, 2, and 3 for rectosigmoid colon, vaginal and bladder endometriosis was 77.2%, 74.1% and 96.8%, and 73.4%, 76.6% and 98.7%, and 86.1%, 88.6% and 99.4%, respectively. The accuracy of conventional and postcontrast MR images for readers 1, 2, and 3 for rectosigmoid colon, vaginal and bladder endometriosis was 77.8%, 78.5% and 98.1%, and 83.5%, 83.5% and 99.4%, and 87.3%, 89.2% and 99.4%, respectively. Conclusions Interobserver variability of MRI using conventional MRI alone is excellent for the diagnosis of DPE. No significant benefit of intravenous gadolinium, rectal or vaginal administration has been demonstrated.

background:Although several scoring systems have been published to evaluate the pregnancy rate after ICSI‐IVF in infertile patients, none of them are applicable for patients with deep infiltrating endometriosis (DIE) nor can they evaluate the chances of pregnancy for individual patients. The aim of this study was to develop a nomogram based on an association of patients’ characteristics to predict the clinical pregnancy rate in patients with endometriosis. methods:This prospective longitudinal study was conducted from January 2007 to June 2010. The nomogram was built from a training cohort of 94 consecutive patients (141 ICSI‐IVF cycles) and tested on an independent validation cohort of 48 patients (83 ICSI‐IVF cycles). DIE was confirmed in all participants. results:The pregnancy rate (per patient) in women with and without DIE was 58 and 83%, respectively (P!0.03). Increased patient age (P!0.04), serum anti-Mullerian hormone (AMH) level!1 ng/ml (P!0.03) and increased number of ICSI‐IVF cycles (P!0.03) were associated with a decreased clinical pregnancy rate. The presence of DIE was the strongest determinant factor of the clinical pregnancy rate in our model [odds ratio!0.26, 95% confidence interval (CI): 0.07‐0.9 (P!0.006)], which also included patient age, serum AMH level and number of attempts at ICSI‐IVF. The nomogram showed an area under the curve (AUC) of 0.76 for the training cohort (95% CI: 0.7‐0.8) and was well calibrated. The AUC for the validation cohort was 0.68 (95% CI: 0.6‐0.75) and calibration was good. conclusions:Our nomogram provides realistic and precise information about ICSI‐IVF success and can be used to guide couples and

Summary Background Retrospective single-centre series have shown the feasibility of sentinel lymph-node (SLN) identification in endometrial cancer. We did a prospective, multicentre cohort study to assess the detection rate and diagnostic accuracy of the SLN procedure in predicting the pathological pelvic-node status in patients with early stage endometrial cancer. Methods Patients with International Federation of Gynecology and Obstetrics (FIGO) stage I–II endometrial cancer had pelvic SLN assessment via cervical dual injection (with technetium and patent blue), and systematic pelvic-node dissection. All lymph nodes were histopathologically examined and SLNs were serial sectioned and examined by immunochemistry. The primary endpoint was estimation of the negative predictive value (NPV) of sentinel-node biopsy per hemipelvis. This is an ongoing study for which recruitment has ended. The study is registered with ClinicalTrials.gov, number NCT00987051. Findings From July 5, 2007, to Aug 4, 2009, 133 patients were enrolled at nine centres in France. No complications occurred after injection of technetium colloid and no anaphylactic reactions were noted after patent blue injection. No surgical complications were reported during SLN biopsy, including procedures that involved conversion to open surgery. At least one SLN was detected in 111 of the 125 eligible patients. 19 of 111 (17%) had pelvic-lymph-node metastases. Five of 111 patients (5%) had an associated SLN in the para-aortic area. Considering the hemipelvis as the unit of analysis, NPV was 100% (95% CI 95–100) and sensitivity 100% (63–100). Considering the patient as the unit of analysis, three patients had false-negative results (two had metastatic nodes in the contralateral pelvic area and one in the para-aortic area), giving an NPV of 97% (95% CI 91–99) and sensitivity of 84% (62–95). All three of these patients had type 2 endometrial cancer. Immunohistochemistry and serial sectioning detected metastases undiagnosed by conventional histology in nine of 111 (8%) patients with detected SLNs, representing nine of the 19 patients (47%) with metastases. SLN biopsy upstaged 10% of patients with low-risk and 15% of those with intermediate-risk endometrial cancer. Interpretation SLN biopsy with cervical dual labelling could be a trade-off between systematic lymphadenectomy and no dissection at all in patients with endometrial cancer of low or intermediate risk. Moreover, our study suggests that SLN biopsy could provide important data to tailor adjuvant therapy. Funding Direction Interregionale de Recherche Clinique, Ile-de-France, Assistance Publique–Hopitaux de Paris.

Objective To determine whether the surgical route of colorectal resection for endometriosis is a determinant factor for fertility. Design Prospective study. Setting Tertiary-care university hospital. Patient(s) Fifty-two patients with endometriosis were randomly assigned to laparoscopic or open surgery. Intervention(s) Laparoscopically assisted vs. open colorectal resection. Main Outcome Measure(s) Evaluation of fertility outcomes spontaneously and after assisted reproductive therapy. Result(s) The mean follow-up was 29 months. Among the 28 patients wishing to conceive, 11 (39.3%) became pregnant. Overall cumulative pregnancy rate at 52 months for these patients was 45.1%. For patients with or without infertility, the cumulative pregnancy rate was 37.6% and 55.6%, respectively, and the cumulative spontaneous pregnancy rate 13.3% and 36.5%, respectively. All the spontaneous pregnancies were observed in the laparoscopy group. Conclusion(s) This study demonstrates that spontaneous pregnancy is more frequent after laparoscopy compared with open surgery for colorectal endometriosis.

To evaluate long-term (over 4 years) functional outcomes and quality of life of transobturator (TOR) and retropubic (RPR) routes in the cure of stress urinary incontinence (SUI). Prospective, randomized multicentre study involving 88 women with SUI from March 2004 to May 2005 (RPR group (n = 42), TOR group (n = 46)). Long-term functional results and quality of life were evaluated using validated questionnaires and compared with those observed at the first year. Eight patients (19%) in the RPR group and 9 patients (19.5%) in the TOR group were lost to follow-up (NS). The mean follow-up in the RPR and the TOR groups was 52.7 months and 53.1 months, respectively. In intention to treat, the success rate at 4 years was 64.3% in the RPR group and 69.5% in the TOR group (NS). At 4 years, no significant differences in the IIQ scores were observed in either group compared to the preoperative scores with no difference between the groups (RPR group: 32 vs. 14.9 (NS), TOR group: 25.7 vs. 21.4 (NS)). Compared to 1 year UDIQ and IIQ scores, a decrease in quality of life was observed for both groups at 4 years (RPR group: 4.7 vs. 34 (P

Study Objective To estimate the association between urinary symptoms and quality of life in patients with posterior deep-infiltrating endometriosis (DIE) with anatomical locations of endometriosis. Design Prospective nonrandomized study (Canadian Task Force classification II-2). Setting Tertiary care hospital. Patients One hundred fifty-three patients with DIE and 28 control subjects. Interventions Clinical examination completed using transvaginal ultrasonography and magnetic resonance imaging. Measurements and Main Results Urinary symptoms and quality of life were evaluated using the International Prostate Symptom Score (IPSS) and Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaires. There was a higher incidence of urinary symptoms and a high IPSS in patients with posterior DIE compared with the control group. The IPSS questionnaire detected a relation between parametrial endometriosis and voiding symptoms (p = .03), altered quality of life (p = .02), and a high total score (p = 0.04) in patients with posterior DIE. No difference in urinary symptoms and total BFLUTS score was observed between the groups. A relation was found between parametrial endometriosis and urinary symptoms (p = .02), altered quality of life (p = .04), and high total score (p = .03) in patients with posterior DIE. At multivariable analysis, a correlation was found between parametrial endometriosis and IPSS total score (p = .03), IPSS voiding symptoms (p = .04), and IPSS quality of life (p = .009). Similarly, a correlation was found between parametrial endometriosis and BFLUTS symptoms (p = .003), BFLUTS quality of life (p = .003), and BFLUTS total score (p = .007). Conclusion Patients with posterior DIE have a high incidence of urinary symptoms. Moreover, parametrial endometriosis is associated with altered urinary function and should be systematically evaluated in these patients.

Treatment of advanced ovarian cancer should include surgery with optimal cytoreduction, which is the first prognosis factor. This surgery usually requires extensive resection (pelvic surgery, extensive lymphadenectomy, upper abdominal surgery and sometimes multiple intestinal resection). The complete surgery usually requires a resection of the diaphragm peritoneum in 10 to 100% of cases, intestinal resection in 20 to 100% of cases, splenectomy in 1 to 33% of cases, pancreatectomy in 0 11% of cases, resection of liver metastases in 0 to 16% of cases and cholecystectomy in 2 to 20% of cases. The main complications reported were digestive fistula (1.4 to 8.2%), lymphocyst (0.6 to 32%), septic complications (3.7 to 41.4%) and pulmonary complications (0 to 59%) in case of diaphragmatic surgery. The postoperative mortality ranges from 0.3 to 5.7%. Radical surgery increases the rate of complete cytoreduction with significant morbidity and postoperative mortality. Because these complications decrease survival, it is essential to assess the risk of occurrence of these events to inform patients.

Thin-section oblique axial magnetic resonance imaging (MRI) is useful in staging endometrial and cervical carcinomas but there are no data on its contribution to assessing deep endometriosis. We evaluated the contribution of this MRI technique to diagnosis of uterosacral ligament (USL) endometriosis.In this retrospective study, two radiologists, who were blinded to the surgical and histological results, compared the results from conventional sagittal and axial MRI with those from conventional plus thin-section (3 mm) oblique axial MRI in 100 symptomatic patients. Descriptive statistical analyses including sensitivity, specificity, positive and negative predictive values, accuracy and positive and negative likelihood ratios were performed. Kappa for inter-observer agreement was calculated.Conventional MR images for the diagnosis of left/right USL endometriosis revealed accuracies of 69/76 and 59/75%, sensitivities of 66/71 and 52/71% and specificities of 76/86 and 76/82% for senior and junior readers, respectively. The combination of conventional and thin-section oblique axial MR images revealed accuracies of 82/87 and 74/81%, sensitivities of 89/93 and 73/81% and specificities of 61/72 and 76/79%, for senior and junior readers, respectively. When conventional MRI combined with oblique axial T2-weighted MRI was compared with conventional MRI use only, significant differences in diagnostic accuracies were observed for right (P = 0.04) and left (P = 0.01) USL endometriosis.Thin-section oblique axial T2-weighted imaging can improve the success of conventional MRI for assessment of USL endometriosis. Further prospective studies are required before this new MR protocol is performed routinely for suspected pelvic endometriosis.

Resume Objectif Comparaison de la morbidite, des resultats fonctionnels et de la qualite de vie de la double promontofixation cœlioscopique pour cure du prolapsus genital selon le mode de fixation de la prothese posterieure. Patientes et methode De 2001 a 2009, 86 patientes presentant un prolapsus genital de grade superieur ou egal a 2 (POP-Q classification) ont ete operees par cœlioscopie : 47 avec fixation par suture (groupe fils) et 39 par agrafage (groupe agrafes). Les complications per- et postoperatoires ont ete evaluees. La qualite de vie a ete evaluee a l’aide des versions francaises des questionnaires Pelvic Floor Distress Inventory (PFDI 20), Pelvic Floor Impact Questionnaire (PISQ 7) et Pelvic Organ Prolaps/Urinary Incontinence Sexual Questionnaire (PISQ 12). Resultats Hormis la parite qui etait plus eleve dans le groupe agrafes, il n’existait pas de difference entre les groupes pour l’âge, les antecedents chirurgicaux et le stade du prolapsus. La duree operatoire etait plus courte dans le groupe agrafes (p = 0,005). Il n’existait pas de difference pour le taux de complications per- et postoperatoire. La duree d’hospitalisation etait plus courte pour le groupe agrafes (p = 0,007). Il n’existait pas de difference du taux de symptomes de novo et d’amelioration de la qualite de vie. Conclusion Nos resultats suggerent que l’agrafage de la prothese posterieure dans la promontofixation cœlioscopique permet une diminution de la duree operatoire et de l’hospitalisation par rapport a la suture sans difference des resultats fonctionnels et de l’amelioration de la qualite de vie.

Objectif| Evaluer a l’aide de questionnaires valides les symptomes lies au prolapsus, la qualite de vie et la sexualite des patientes avant et apres chirurgie du prolapsus genital et en deduire si la qualite de vie preoperatoire pourrait etre un critere decisionnel pour la chirurgie.

But de l’etude| Comparaison de la morbidite et des resultats fonctionnels de la double promontofixation cœlioscopique pour la cure du prolapsus genital en fonction du mode de fixation de la prothese posterieure.

But de l’etude Evaluation de la faisabilite et de la morbidite de la double promontofixation cœlioscopique pour la cure du prolapsus genital.

We report the first randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis focusing on perioperative complications, improvement in symptoms, quality of life, and fertility.Bowel endometriosis is one of the most severe forms of endometriosis. Although laparoscopically assisted surgery is a validated technique for colorectal cancer, there are serious concerns about its appropriateness for endometriosis in young women wishing to conceive because it is almost invariably a traumatic procedure.We conducted a noninferiority trial and randomly assigned 52 patients with colorectal endometriosis to undergo laparoscopically assisted or open colorectal resection. The median follow-up was 19 months. The primary end point was improvement in dyschesia.Overall, a significant improvement in digestive symptoms (dyschesia P0.0001, diarrhea P0.01, and bowel pain and cramping P0.0001), gynecologic symptoms (dysmenorrhea P0.0001 and dyspareunia P0.0001), and general symptoms (back pain P = 0.001 and asthenia P = 0.0001) was observed. No difference in the symptom delta values and quality of life was noted between the groups. Median blood loss was lower in the laparoscopic group (P0.05). Total number of complications was higher in the open surgery group (P = 0.04), especially grade 3 (P = 0.03). Pregnancy rate was higher in the laparoscopic group (P = 0.006), and the cumulative pregnancy rate was 60%.Our findings support that laparoscopy is a safe option for women requiring colorectal resection for endometriosis. Moreover, laparoscopy offers a higher pregnancy rate than open surgery with similar improvements in symptoms and in quality of life.

Objective: The aims of this prospective study were to evaluate fertility, pregnancy outcomes and their determinant factors after laparoscopic segmental colorectal resection for endometriosis. Study design: We studied 83 women who underwent colorectal resection for endometriosis. Thirty-nine women (47%) had an associated infertility and 51 (61.4%) wished to conceive after surgery. Surgical route was exclusive laparoscopy in 77 cases (92.7%) and laparoconversion in 6 (7.3%). Results: Twenty-nine pregnancies were obtained in 24 patients (43.6%) including 20 spontaneous (69%) and 9 by IVF (31%). The median time to conceive spontaneously was 6 months and 20 months by IVF. Among the 39 infertile women, 18 (46%) conceived during the study period. A relation was found between pregnancy rate and patient age (p = 0.02). Reduction in pregnancy rate was correlated to the presence of adenomyosis (p = 0.04) and high ASRM total score (p < 0.001) as well as exclusive laparoscopy compared to conversion to laparotomy for colorectal resection (p = 0.01). Conclusion: Adenomyosis and conversion to laparotomy as well as patient age, ASRM score appeared determinant factors of fertility outcome.

Objective: To assess tolerance, local control, and survival outcomes for HIV (human immunodeficiency virus) positive patients with locally advanced cervical cancer (CC) treated with external beam radiation therapy (EBRT) and/or brachytherapy from an Assistance Publique - Hôpitaux de Paris (APHP) retrospective cohort.Methods: Between 2000 and 2014, 28 HIV positive patients presenting with a non-metastatic CC were treated in one of the five APHP radiation therapy centers. Fifteen patients (54%) underwent primary surgery. Twenty-four patients (88%) received EBRT, with concurrent chemotherapy in 22 cases, and 68% received brachytherapy.Results: The median follow-up was 58 months. At 5 years, local control (LCR) and overall survival rates (OS) were 56% and 46.5% respectively. A grade 3-4 acute toxicity (mainly hematological toxicity) was reported in 18 patients (64%). In univariate analysis, total irradiation dose (p=0.03) and cisplatin-based chemotherapy (p=0.005) were predictive of acute toxicity. A grade 3-4 late toxicity (mainly gastro-intestinal and renal) was observed in 7 patients (25%). In univariate analysis, HIV stage at diagnosis (p=0.02) and an initial CD4 count

Residual disease is the first predictive factor for survival in women with ovarian cancer. Neoadjuvant chemotherapy still has not proved superiority in terms of overall survival compared with complete initial resection. Hence, initial surgery remains the cornerstone of management for patients with advanced ovarian cancer. Various parameters have been proposed to evaluate the ability of complete resection. Clinical evaluation of peritoneal carcinomatosis and ascite is not relevant enough while general status (ASA score) is correlated with the risk of postoperative complications. Preoperative dosage of CA-125 higher than 500 UI/L seems to be related with an increase risk of sub-optimal surgery. Recently, some authors challenged its prognostic value. For a CA-125 threshold at 500 UI/L, sensitivity, specificity, positive and negative predictive values range from 58 to 78%, 64 to 89%, 64 to 84% and 35.7 to 85.4%, respectively. Imaging criteria failed to report concordant results. Indeed, sensitivity, specificity, positive and negative predictive values vary from 52 to 100%, 75 to 100%, 49% to 100% and 50 to 100%, respectively. High-correlation has been demonstrated for carcinomatosis scores evaluating the dissemination of the disease (AUCs of ROCs curves higher than 0.6). At laparotomy, for an Eisenkop score under 6, 99% of patients could benefit of complete resection. At laparoscopy, for a Fagotti score under 4, a complete cytoreduction could be obtained in 78% of patients. This score had the best AUC (0.76). Various scoring systems are available for surgeons to evaluate the resecability of advanced ovarian cancer. Among them, peroperative scoring systems appear the best tool and should be recommended in routine especially at first laparoscopy. Finally, due to the impact on survival of complete initial resection, women with advanced ovarian cancer should be referred to specialized centres.

Objective To determine the morbidity of diaphragmatic peritonectomy. Design Prospective cohort study. Setting A Gynecology Department of a University Hospital. Population From 2005 to 2007, thirty-seven consecutive patients underwent surgery for stage IIIC or IV ovarian cancer. Methods Patients were separated into a diaphragmatic surgery group (n = 18) and a control group (n = 19). Diaphragmatic surgery may consist of coagulation, stripping or muscle resection. Main outcome measures Postoperative course and outcome were analysed. Results Patients in group 1 (diaphragmatic surgery) underwent more intestinal resection (89% versus 37%, P = 0.01) and pelvic (94% versus 63%, P = 0.02) or para-aortic lymphadenectomy (94% versus 53%, P = 0.04). Neither the mean estimated blood loss (960 ml versus 909 ml) nor the rates of intra-operative blood transfusion (11 versus 9) were significantly different between the two groups. The mean operative time was higher in group 1 (480 minutes versus 316 minutes, P

High recurrence rates have been reported in women treated for endometriosis despite advances in medical and surgical treatments improving both fertility and symptoms. It should therefore be considered a chronic disorder. In this particular setting, the main objectives for practitioners are to limit disease progression, recurrence and to improve quality of life (QOL). Previous studies have demonstrated a relation between an increase in pain intensity and a decrease in QOL. However, visual analogue scales to measure general well-being are insufficient to quantify the impact of endometriosis on QOL. Several generic questionnaires, mainly the SF-36, are available in various languages but are not specific of women with endometriosis. Some specific questionnaires are available but have been validated in English population for the most part rending comparison between countries difficult. Despite these limits, QOL should be systematically monitored over time by a validated questionnaire for this chronic disorder and could be a criterion for therapeutic strategy.

Lymph node status in endometrial cancer is a major prognostic factor. Sentinel lymph node (SLN) biopsy using radiocolloid and blue dye labeling has emerged as an alternative to systematic lymphadenectomy. This technique requires a preoperative lymphoscintigraphy. The aim of this study was to evaluate the limits of day-before preoperative lymphoscintigraphy to SLN biopsy.Between July 2002 and March 2007, 38 patients with endometrial cancer underwent laparoscopic SLN procedure using radiocolloid and blue dye. Those with early-stage I endometrial cancer (35 patients) underwent a SLN procedure followed by systematic pelvic lymphadenectomy and a hysterectomy with bilateral salpingo-oophorectomy while those with presumed stage IIB on MR imaging (3 patients) underwent a radical hysterectomy. Omentectomy and paraaortic lymphadenectomy were also performed for women with clear cell or serous papillary carcinoma (5 patients). The SLN identification rates and false-negative rates were studied.The detection rate of lymphoscintigraphy was 84.5% (32/38), with 1.9 nodes per patient. Eight of 17 patients (47%) with unilateral sentinel lymph node on lymphoscintigraphy had bilateral SLNs at surgery and three of 15 patients (20%) with bilateral SLN on lymphoscintigraphy had unilateral SLN at surgery. The correlation was poor (kappa=0.266). When categorized in2 andor =2 sentinel nodes, the correlation between lymphoscintigraphic and surgical SLN mapping was moderate (kappa=0.33).Our results demonstrated the low correlation between day-before lymphoscintigraphy and surgical SLN mapping raising issues of its usefulness and cost-effectiveness in routine practice.

Endometriosis is a common gynaecological condition affecting 10 to 15% of the female population. Deep infiltrating endometriosis (DIE) is diagnosed in 20% of women with endometriosis. Moreover, bowel endometriosis is found in five to 12% of patients with endometriosis. Colorectum represents 90% of all bowel locations. For women with infertility associated with colorectal endometriosis, no predictive criteria of fertility outcome are available. In a literature review, the pregnancy rate after colorectal resection reached 63%. These results, particularly high, raise the issue on legitimacy of colorectal resection in infertile women. Recent studies suggest that predictive criteria of success after colorectal resection are; a young age; a low American Society of Reproductive Medicine (ASRM) score and the laparoscopic route. In contrast, the presence of adenomyosis appears a negative predictive factor of fertility outcome. Despite encouraging results on the fertility of colorectal resection for endometriosis, only studies comparing the results of assisted reproductive therapy to those of surgery are required to identify good candidates for surgery.