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International audience; Objective: To compare survival and morbidity rates between primary cytoreductive surgery (pCRS) and interval cytoreductive surgery (iCRS) for epithelial ovarian cancer (EOC), using a propensity score.Design: We conducted a propensity score-matched cohort study, using data from the FRANCOGYN cohort.Setting: Retrospective, multicentre study of data from patients followed in 15 French department specialized in the treatment of ovarian cancer.Sample: Patients included were those with International Federation of Gynaecology and Obstetrics (FIGO) stage III or IV EOC, with peritoneal carcinomatosis, having undergone CRS.Methods: The propensity score was designed using pre-therapeutic variables associated with both treatment allocation and overall survival (OS).Main outcome measures: The primary outcome was OS. Secondary outcomes included recurrence-free survival (RFS), quality of CRS and other variables related to surgical morbidity.Results: A total of 513 patients were included. Among these, 334 could be matched, forming 167 pairs. No difference in OS was found (hazard ratio, HR = 0.8, p = 0.32). There was also no difference in RFS (median = 26 months in both groups) nor in the rate of CRS leaving no macroscopic residual disease (pCRS 85%, iCRS 81.4%, p = 0.76). The rates of gastrointestinal tract resections, stoma, postoperative complications and hospital stay were significantly higher in the pCRS group.Conclusions: Analysis of groups of patients made comparable by propensity score matching showed no difference in survival, but lower postoperative morbidity in patients treated with iCRS.

Resume Objectif Demontrer la faisabilite de l’hysterectomie par voie cœlioscopique en ambulatoire en France par l’evaluation de la qualite de vie postoperatoire. Methodes Nous avons mene une etude prospective randomisee monocentrique en France entre 2013 et 2016 incluant 42 patientes devant beneficier d’une hysterectomie par voie cœlioscopique. Le critere de jugement principal etait l’evaluation de la qualite de vie postoperatoire a l’aide du questionnaire standardise Euroquol la veille de l’intervention puis au 3e et au 30e jour postoperatoire. Les criteres de jugement secondaires etaient l’evaluation de la douleur postoperatoire, la qualite de vie globale, la consommation d’antalgiques et l’anxiete. Les patientes ont ete randomisees en deux groupe, le groupe A avec un sejour d’hospitalisation conventionnel de 2 a 3 jours et le groupe B avec un sejour court, la sortie se faisant le lendemain de l’intervention. Resultats Vingt et un patientes ont ete randomisees dans le groupe A ainsi que dans le groupe B. Nous n’avons pas releve des differences significatives entre les deux groupes de notre etude que ce soit sur notre critere de jugement principal ou nos criteres d’evaluations secondaires. A J3, la moyenne du score Euroquol etait de 0.68 pour le groupe A contre 0,50 pour le groupe B (p = 0,05). De meme, les moyennes des scores portant sur la douleur postoperatoire etaient comparables a hauteur de 70,6 dans le groupe A et 61,8 dans le groupe B (p = 0,21). La tendance etait a l’identique concernant le score de qualite de vie ou l’anxiete. Conclusion La realisation de l’hysterectomie cœlioscopique en ambulatoire parait faisable au vu de notre etude.

International audience; International Federation of Gynecology and Obstetrics (FIGO) staging classification for stage IV epithelial ovarian cancer (EOC) separates stages IVA (pleural effusion) and IVB (parenchymal and/or extra-abdominal lymph node metastases). We aimed to evaluate its prognostic impact and to compare survival according to the initial metastatic location. We conducted a multicenter study between 2000 and 2020, including patients with a FIGO stage IV EOC. Primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS) and recurrence rates. We included 307 patients: 98 (32%) had FIGO stage IVA and 209 (68%) had FIGO stage IVB. The median OS and PFS of stage IVA patients were significantly lower than those of stage IVB patients (31 versus 45 months (p = 0.02) and 18 versus 25 months (p = 0.01), respectively). Recurrence rate was higher in stage IVA than IVB patients (65% versus 47% (p = 0.004)). Initial pleural involvement was a poor prognostic factor with a median OS of 35 months versus 49 months for patients without initial pleural involvement (p = 0.024). Patients with FIGO stage IVA had a worse prognosis than patients with FIGO stage IVB EOC. Pleural involvement appears to be relevant for predicting survival. We suggest a modification of the current FIGO staging classification.

Objective Bowel resection is frequently used when performing oncological surgery to obtain complete cytoreduction or to remove endometriosis in case of intestinal invasion. Acquiring the surgical skills to perform this kind of procedure is crucial to offer to our patients an optimal management. The aim of this study is to describe a 7-years surgical experience in bowel resections of a gynecologic surgeon and to determine his learning curves. Study Design This is a monocentric retrospective cohort study reporting digestive resection performed between January 2013 and April 2020 in the Gynecology Department of Strasbourg University Hospital. Ninety-one consecutive patients were assigned in two groups: gynecological cancer (n = 44) and deep infiltrating endometriosis (DIE) (n = 47). The main outcome measure was the postoperative complications rate at 30 days, based on the modified Clavien-Dindo severity system. Learning curves were evaluated using cumulative sum (CUSUM) analysis of operative time and risk-adjusted cumulative sum (RA-CUSUM) analysis of severe perioperative complications. Identification of predictive factors for operation duration and severe perioperative complication occurrence was conducted using multivariate analysis. Results Minor complications were found in 25% of cases. Major complication rate (Clavien-Dindo ≥ IIIa) was 14% in total and only involved patients operated for cancer. The CUSUM curve for operative time peaked at the 35th case and showed a downward slope after the 45th case. Significant predictive factors of operating time were cytoreductive tumoral surgery, size of the bowel resection and laparoscopic surgery, while learning phase 3 significantly decreased it. The RA-CUSUM curve for severe perioperative complications (Clavien-Dindo ≥ IIIa) showed a progressive decrease in the complication rate as the number of interventions increases without showing clear inflection points. Only cardiopulmonary pathologies were found as significant predictive factor of severe complications. Conclusion Proficiency in performing highly complex surgery was achieved after approximately 45 cases, cancer and DIE all together. Acceptable rates of severe perioperative complications were observed even during the initial learning period and are comparable with those found in the literature concerning bowel resection performed by gynecologic oncologists but also by general and digestive surgeons.

Resume Objectif Determiner l’interet ou non de la realisation de certains gestes prophylactiques en association a une procedure chirurgicale gynecologique. Conception Un comite de consensus de 19 experts a ete constitue. Une politique de declaration et de suivi des liens d’interets a ete appliquee et respectee durant tout le processus de realisation du referentiel. De meme, celui-ci n’a beneficie d’aucun financement provenant d’une entreprise commercialisant un produit de sante (medicament ou dispositif medical). Le comite de consensus devait respecter et suivre la methode GRADE (Grading of Recommendations Assessment, Development and Evaluation) pour evaluer la qualite des donnees factuelles sur lesquelles etaient fondees les recommandations. Les inconvenients potentiels de faire des recommandations fortes en presence de donnees factuelles de mauvaise qualite ou insuffisantes ont ete soulignes. Peu de recommandations ont ete non graduees. Methodes Le comite a etudie 22 questions concernant 7 thematiques. Les gestes associes a une procedure chirurgicale gynecologique etudies etaient les suivants : 1) Salpingectomie, 2) Realisation d’une fimbriectomie, 3) Annexectomie, 4) Destruction d’endometriose superficielle, 5) Adhesiolyse, 6) Destruction endometriale, 7) Ablation du col uterin. Resultats Le travail de synthese des experts et l’application de la methode GRADE ont abouti a 34 recommandations. Parmi les recommandations formalisees, six ont un niveau de preuve eleve (GRADE 1+/−) et 28 un niveau de preuve faible (GRADE 2+/−). Pour deux questions, la methode GRADE ne pouvait pas s’appliquer en raison d’une absence de litterature medicale, ne permettant pas d’aboutir a une recommandation. Conclusion Un accord important existait parmi les experts sur des recommandations fortes dans le but de d’ameliorer les pratiques pour la realisation ou non de certains gestes prophylactiques en association a une chirurgie gynecologique.

Resume Objectif Nous ne disposons pas, en France, d’un parcours identifie pour la formation en chirurgie cancerologie gynecologique. Les quatre societes savantes francaises competentes : la SFOG, Le CNGOF, la SFCO et la SCGP soutenus par le CNU de gynecologie-Obstetrique et d’UNICANCER se sont entendues pour materialiser ce parcours et l’attester par une certification decernee par un jury national. Materiel et methodes Le comite national de certification en cancerologie gynecologique, constitue de dix membres, representant les six organismes concernes, s’est fixe cinq objectifs : la definition des criteres d’eligibilite des centres pour la formation ; la determination d’un cahier des charges a remplir par le candidat ; la determination d’un cursus fleche pour la formation en chirurgie cancerologique gynecologique ; la determination des acquis necessaires pour la certification d’un candidat deja en exercice et l’organisation pratique de la certification. Resultats Les criteres d’agrement des centres pour la formation, incluent 150 prises en charge de cancers gynecologiques, dont 100 chirurgies d’exerese, comprenant vingt cancers de l’ovaire de stades avances. Pour une certification a l’issue du cursus etabli par le comite ou par validation des acquis pour un praticien en exercice, un candidat doit valider un logbook et remplir un cahier des charges comportant quatre volets : formation theorique et pratique ; recherche et publications ; enseignements et souscription a une demarche de formation continue. Les elements du logbook et du cahier des charges accomplis seront evalues par un score. Une premiere session de certification est prevue pour la fin 2021.

Our aim was to assess the opinion of a panel of experts and obtain a consensus on the management of endometrial cancer in France and French Switzerland. A Delphi survey was carried out among a panel of French and French-speaking Swiss experts. The first questionnaire included 65 questions divided into eight categories: characterization of experts, histo-molecular characteristics and radiological data of endometrial cancer, and management of low-risk, intermediate-risk, intermediate–high-risk, high-risk, and metastatic cancers. The experts were asked to reply on a 9-point scale, both on the validity and the clarity of each question. After the answers were analyzed, a second questionnaire was sent to the same experts. The study took place between December 2021 and March 2022. Further, 58 (57.4%) of the 101 experts responded in the first round, and 39 recommendations were obtained (60%). Six questions were voted redundant and 20 discordant. These questions were reformulated, and, at the end of the second round, 17 recommendations were validated (85%). In total, the study presents an analysis of 56 questions and related responses. Expert advice helps to clarify non-consensual issues, standardize the management of endometrial cancer, and optimize clinical practices.

The latest European recommendations of the European Societies of Gynecological Oncology (ESGO), Radiotherapy and Oncology (ESTRO) and Anatomopathology (ESP) concerning the management of patients with endometrial cancer were published in 2021. On behalf of the French Society of Gynecologic Oncology (SFOG) and the SFOG campus, we wish to summarize for the French-speaking readership the main measures with a more specific application for France. We also incorporate data from a Delphi survey conducted with a panel of French and French-speaking Swiss experts. The data presented in this article relate to histo-molecular characteristics, radiological data of endometrial cancer, and management of low-risk, intermediate-risk, intermediate-high-risk, and metastatic cancers. The aim of this review article is to show the application of the latest international recommendations to clinicians and pathologists for the implementation of these recommendations.

The presence of lymphovascular space invasion (LVSI) is not yet included in international recommendations neither as a prognostic factor nor as a parameter for the decision to use adjuvant chemotherapy in FIGO stage I/IIa ovarian cancer (OC).This study set out to evaluate the impact of LVSI on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for epithelial OC.Retrospective multicenter study by the research group FRANCOGYN between January 2001 and December 2018. All patients managed for epithelial OC surgery and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No-LVSI group). A Cox analysis for OS and RFS analysis was performed in all the populations.French multicenter tertiary care centers RESULTS: Over the study period, 852 patients were included in the 13 institutions. Among them, 289 patients had LVSI (33.9%). There was a significant difference in the distribution of LVSI between early and advanced stages (p 0.001). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p 0.001) and RFS (p 0.001), LVSI affected OS and RFS for early stages (p = 0.001; p = 0.001, respectively) and also for advanced stages (p = 0.01; p = 0.009, respectively).The presence of LVSI in epithelial ovarian epithelial tumors has an impact on OS and RFS and should be included in the routine pathology examination to adapt therapeutic management, especially for women in the early stages of the disease.

Desire to homogenize advanced stage ovarian cancer management has led to a debate on the need to centralize cares. The aim was to assess current practices to compare them with centralization motivation and to overview possible perspectives of evolution.An anonymous questionnaire of 57 questions has been submitted from August 2021 to October 2021 to members of French gynecological oncological surgical societies. Questions encompassed all aspects of ovarian cancer surgical management, including institutions, technics, indications, and outcomes.Of the 40 responses, 77.5% managed less than 20 cases by themselves, but 67.5% practiced in institution managing more than 30 cases annually. Since the LION trial results' publication, 95% of practitioners have evolved their lymphadenectomy indications. More than 10% of surgery needed digestive resection for 90% of practitioners. Digestive resections rate was significantly higher for practitioners managing more than 20 cases (p0.01), but it was not for institutions managing more than 30 cases annually (p=0,07). Surgeons performing more than 20 ovarian cancers annually reported less severe complications (p=0.04) compared to low-volume surgeons independently of institution volume. For more than a quarter of the practitioners, less than half of the patients can benefit from the enhanced recovery after surgery program despite benefits of such care.Our survey provides an overview of French practices in ovarian cancer management. This survey seems to confirm that minimum volume thresholds could lead to better outcomes. It also underlines that individual performances are as valuable as center volume.

Introduction: Borderline ovarian tumours (BOT) represent 10–20% of epithelial tumours of the ovary. Although their prognosis is excellent, the recurrence rate can be as high as 30%, and recurrence in the infiltrative form accounts for 3% to 5% of recurrences. Affecting, in one third of cases, women of childbearing age, the surgical strategy with ovarian conservation is now recommended despite a significant risk of recurrence. Few studies have focused exclusively on patients who have received ovarian conservative treatment in an attempt to identify factors predictive of recurrence and the impact on fertility. The objective of this study was to identify the risk factors for recurrence of BOT after conservative treatment and the impact on fertility. Material and methods: This was a retrospective, multicentre study of women who received conservative surgery for BOT between February 1997 and September 2020. We divided the patients into two groups, the “R group” with recurrence and the “NR group” without recurrence. Results: Of 175 patients included, 35 had a recurrence (R group, 20%) and 140 had no recurrence (NR group, 80%). With a mean follow-up of 30 months (IQ 8–62.5), the overall recurrence rate was 20%. Recurrence was BOT in 17.7% (31/175) and invasive in 2.3% (4/175). The mean time to recurrence was 29.5 months (IQ 16.5–52.5). Initial complete peritoneal staging (ICPS) was performed in 42.5% of patients (n = 75). In multivariate analysis, age at diagnosis, nulliparity, advanced FIGO stage, the presence of peritoneal implants, and the presence of a micropapillary component for serous tumours were factors influencing the occurrence of recurrence. The post-surgery fertility rate was 67%. Conclusion: This multicentre study is to date one of the largest studies analysing the risk factors for recurrence of BOT after conservative surgery. Five risk factors were found: age at diagnosis, nulliparity, advanced FIGO stage, the presence of implants, and a micropapillary component. Only 25% of the patients with recurrence underwent ICPS. These results reinforce the interest of initial peritoneal staging to avoid ignoring an advanced tumour stage.

To compare a reusable hysteroscopic morcellator and standard resectoscopes in the hysteroscopic management of uterine polyps.Single-center randomized prospective single-blind trial (resectoscope-morcellator study).Centre Médico-chirurgical Obstétrique teaching hospital, Strasbourg University Hospitals, France.All patients presenting with a single endometrial polyp of size 1 cm or larger.After consent, the patients were randomized into 2 groups: hysteroscopic morcellation (HM) group or standard resection (SR) group. Office-based review hysteroscopy was performed 6 weeks to 8 weeks after surgery. Primary end point: time of morcellation or resection.total operating time (minutes), volume of fluid used (mL), fluid deficit (mL), number of morcellator or resectoscope insertions, operator comfort (visual analog scale: 0 to 10) and quality of vision (0 to 5), perioperative complications, completeness of resection, need to convert to another technique, pain assessment (visual analog scale), and length of hospitalization. At review hysteroscopy, we noted whether the resection or morcellation had been effective and if synechiae were present or absent. Statistical analyses followed Bayesian methods.Ninety patients were randomized: 45 in the HM group and 45 in the SR group. The average size of polyps at hysteroscopy was 13.3 mm. Morcellation time was lower than resection time (6.1 minutes vs 9 minutes; p [HMSR] = .996). This also applied to total operating time (12.7 minutes vs 15.6 minutes; p [HMSR] = .985), number of device insertions (1.50 vs 6; p [HMSR] .999), volume of fluid used (766.9 mL vs 1118.9 mL; p [HMSR] = .994), and fluid deficit (60.2 mL vs 169.8 mL; p [HMSR] = .989). Operator comfort was better in the HM group (8.4 vs 7.4; p [HMSR] = .999) as was visualization (4 vs 3.7; p [HMSR] = .911, highly probable). Operative complications were higher in the SR group (5 vs 0; p [HMSR] = .989]. One patient in the SR group died after surgery owing to an anesthetic complication (anaphylactic shock complicated by pulmonary embolism). No differences were noted between the groups for pain assessment, length of hospitalization, and outcome on review hysteroscopy.The reusable morcellator is quicker, uses less fluid with less deficit and fewer introductory maneuvers, and offers better comfort and visualization than the resectoscope while being as effective for the hysteroscopic treatment of uterine polyps.

Objective To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices. Materials and methods A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility. Results The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population. Conclusion BOTs remain rare, but this study – despite its small sample size – supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.

International audience; BACKGROUND: This study compares morbidity and mortality associated with retroperitoneal and transperitoneal para-aortic lymphadenectomy (PAAL) for pretherapeutic nodal staging of locally advanced cervical cancers (FIGO IB3-IVA). METHODS: Pre-, per- and postoperative data of patients treated for locally advanced stage cervical cancer between 1999 and 2018 in 12 French referral centers (FRANCOGYN Study Group) were retrospectively collected. RESULTS: The study was conducted using a sample of 448 patients, of whom 223 (49,8%) underwent retroperitoneal (group 1) and 225 (50,2%) had transperitoneal PAAL (group 2). No differences were noted concerning clinical and histological characteristics between the two groups. Among these 448 patients, 23 (5,1%) had an intraoperative complication (9 (2,0%) in group 1 and 14 (3,1%) in group 2, p = 0.28) and 47 (10,5%) had a postoperative complication (22 (4,9%) in group 1 and 25 (5,6%) in group 2, p = 0.44), only one of which required revision surgery but the patient died. The length of hospital stay was significantly shorter in group 1 than in group 2 (3.97 versus 4.88 days, p

Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care., OBJECTIVE: To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments. METHODS: We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case–cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients. RESULTS: Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1–2.7) or outpatient (OR 14.7, 95% CI 8.1–26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9–70.7). CONCLUSIONS: Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.

International audience; Introduction The aim of this study was to identify prognostic factors of overall survival in patients with FIGO stage IIIc or IVa ovarian cancer (OC) treated by neo-adjuvant chemotherapy (NAC) followed by interval debulking surgery.Materials and methods Data from 483 patients with ovarian cancer were retrospectively collected, from January 1, 2000 to December 31, 2016, from the FRANCOGYN database, regrouping data from 11 centers specialized in ovarian cancer treatment. 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 after a median follow up of 30 months. After univariate analysis, factors significantly associated with decreased overall survival were; no pelvic and/or para-aortic lymphadenectomy (p = 0.002), residual disease (CC1/CC2/CC3) 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.Conclusion In this first and largest French based retrospective study, complete cytoreductive surgery in ovarian cancer remains the main prognostic factor of overall survival.

INTRODUCTION: Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period. MATERIAL AND METHOD: Recommendations based on the consensus conference model. RESULTS: In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies. CONCLUSION: During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.

International audience; Objective - In France, we are lacking an identified pathway for training in gynaecological cancer surgery. The four competent French learned societies, the SFOG, the CNGOF, the SFCO and the SCGP, supported by the CNU of Obstetrics &Gynaecology- and UNICANCER, agreed to materialize this course and attest it by a certification awarded by a national jury. Material and methods - The national committee of certification in gynaecological oncology made up of 10 members, representing the 6 concerned organizations, set itself 5 objectives: the definition of the eligibility criteria for training centres; the determination of a check-list to be filled by the candidate; the determination of a targeted curriculum for the training in gynecological oncological surgery; the determination of the assets necessary for the certification of a candidate already in practice; and the practical organization of the certification. Results - Criteria for approval of centres for training included 150 gynaecological cancer cases per year, among which 100 excisional surgeries, including 20 advanced-stage ovarian cancers. For certification of candidate who followed the curriculum established by the committee or by validation of prior experience for an actual practitioner, a candidate must validate a logbook and fill out a checklist including 4 parts: theoretical and practical training; research and publications; teaching and subscription to a continuing education program. The accomplished elements of the logbook and the checklist will be evaluated by a score. The first certification session is planned for the end of 2021. Conclusion - The optimisation of the surgical management of patients treated for gynaecological cancer is achieved through the identification of a training course and the certification, by a national jury, of the skills of surgeons who have completed it.

Resume Objectif La faisabilite de l’hysterectomie mini-invasive pour pathologie benigne en ambulatoire a ete demontree dans de nombreuses etudes internationales. La France accuse un retard considerable d’origine multifactorielle dans ce domaine. L’objectif de cette etude est d’identifier les facteurs limitants lies aux professionnels de sante a la realisation de l’hysterectomie mini invasive en ambulatoire et d’en determiner d’eventuelles strategies permettant d’augmenter son taux. Methodes Il s’agit d’une enquete transversale menees sur 2 mois a l’aide d’un questionnaire auto-administre adresse par mail a 180 chirurgiens gynecologues repartis sur 2 regions francaises (Grand Est et Bourgogne – Franche Comte). Resultats Au total 22 % des professionnels de sante ont repondu a l’enquete. La tres grande majorite des praticiens (60 %) affirmaient ne pas realiser de prise en charge ambulatoire par simple habitude. L’apprehension de la reaction des patientes (47,5 %), la peur du retard de diagnostic des complications (12,5 %), de la prise en charge de la douleur en postoperatoire (42,5 %) participaient egalement au frein de la promotion de la prise en charge ambulatoire. Discussion L’ameliorationde l’articulation medecine de ville et structure hospitaliere permettant une meilleure continuite des soins (70 %), la valorisation economique (37,5 %) et l’augmentation de l’amplitude horaire de l’unite de chirurgie ambulatoire (5 %) permettrait une amelioration du taux de prise en charge ambulatoire des hysterectomies mini-invasives d’apres les chirurgiens gynecologues interroges. Par ailleurs, une etude prospective evaluant la qualite de vie des patientes apres prise en charge ambulatoire d’une hysterectomie mini invasive permettrait une meilleure adhesion des professionnels de sante et des patientes au projet de prise en charge ambulatoire dans 70 % des cas. Conclusion Le changement de mentalite des professionnels de sante reste une priorite pour la promotion de la chirurgie ambulatoire en gynecologie. L’information et la communication restent donc primordiales a l’essor de l’ambulatoire.

International audience; BACKGROUND: The aim of this study was to evaluate the impact of lymphovascular space invasion (LVSI) on overall survival (OS) and recurrence-free survival (RFS) in patients managed for stage I-IIa clear cell carcinoma, mucinous, low-grade serous and low-grade endometrioid ovarian cancer MATERIAL AND METHODS: Retrospective multicentre study of the research group FRANCOGYN between January 2001 and December 2018. All patients managed for stage I-IIa clear cell carcinoma, mucinous /low grade serous and endometrioid ovarian cancer and for whom the presence of histological slides for the review of LVSI was available, were included. Patient’s characteristics with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A cox analysis for OS and RFS analysis were performed in all population. RESULTS: Over the study period, 133 patients were included in the thirteen institutions. Among them, 12 patients had LVSI (9%). LVSI was an independent predictive factor for poorer Overall and recurrence free survivals. LVSI affected OS (p

Survival disparities persist in ovarian cancer and may be linked to the environments in which patients live. The main objective of this study was to analyze the global impact of the area of residence of ovarian cancer patients on overall survival. The data were obtained from the Surveillance, Epidemiology and End Results (SEER) database. We included all the patients with epithelial ovarian cancers diagnosed between 2010 and 2016. The areas of residence were analyzed by the hierarchical clustering of the principal components to group similar counties. A multivariable Cox proportional hazards model was then fitted to evaluate the independent effect of each predictor on overall survival. We included a total of 16,806 patients. The clustering algorithm assigned the 607 counties to four clusters, with cluster 1 being the most disadvantaged and cluster 4 having the highest socioeconomic status and best access to care. The area of residence cluster remained a statistically significant independent predictor of overall survival in the multivariable analysis. The patients living in cluster 1 had a risk of death more than 25% higher than that of the patients living in cluster 4. This study highlights the importance of considering the sociodemographic factors within the patient’s area of residence when developing a care plan and follow-up.

ObjectiveThe primary objective of the study was to validate the European Society for Medical Oncology (ESMO)–European Society of Gynecologic Oncology (ESGO) ovarian cancer guideline as a method of assessing quality of care, and to identify patient characteristics predictive of non-adherence to European guideline care. The secondary objectives were to analyze the evolution of practices over the years and to evaluate heterogeneity between centers.MethodsThis retrospective multicenter cohort study of invasive epithelial ovarian cancer reported to the FRANCOGYN database included data from 12 French centers between January 2000 and February 2017. The main outcome was adherence to ESMO–ESGO guidelines, defined by recommended surgical procedures according to the International Federation of Gynecology and Obstetrics (FIGO) stage and appropriate chemotherapy. Mixed multivariable logistic regression analysis with a random center effect was performed to estimate the probability of adherence to the guidelines. Survival analysis was carried out using the Kaplan–Meier method and a mixed Cox proportional hazards model.Results1463 patients were included in the study. Overall, 317 (30%) patients received complete guideline adherent care. Patients received appropriate surgical treatment in 69% of cases, while adequate chemotherapy was administered to 44% of patients. Both patient demographics and disease characteristics were significantly associated with the likelihood of receiving guideline adherent care, such as age, performance status, FIGO stage, and initial burden of disease. In univariate and multivariate survival analysis, adherence to the guidelines was a statistically significant and independent predictor of decreased overall survival. Patients receiving suboptimal care experienced an increased risk of death of more than 100% compared with those treated according to the guidelines (hazard ratio 2.14, 95% confidence interval 1.32 to 3.47, pConclusionsAdherence to ESMO–ESGO guidelines in ovarian cancer was associated with a higher overall survival and may be a useful method of assessing quality of care.

Introduction/Background* The management of ovarian cancer has rapidly become more complex in recent years due to surgical and medical advances. The aim of this study was to assess French current practice in management of patients with advanced epithelial ovarian cancer. Methodology An anonymous survey was sent to the SFOG, GINECO-ARCAGY and FRANCOGYN members. The survey consisted of 58 items divided in five sections dealing with diagnostic staging, pathological and genetic data, surgical practice patterns, adjuvant/neoadjuvant treatment, and follow-up strategies. Result(s)* Overall, 107 answers were available. Most of participants were obstetrician-gynecologists (37.4%), surgical oncologists (34.6%), and medical oncologists (17.8%). Most of participants came from University Hospitals (40.2%) and Comprehensive Cancer Center (37.4%). For 76.8% of respondents, less than 50% of patients are eligible for primary debulking surgery. In case of neoadjuvant chemotherapy, surgical resecability is assessed after 3 cycles for 92.7% of respondents. LION study’s criteria were always applied during primary surgery for 69,5% of respondents. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is used as a first-line treatment for 41.4% of respondents (26.8% within clinical trial and 14.6% outside) and during interval surgery for 37.8% of respondents. According to the completeness of cytoreduction surgery and the BRCA mutation status, association of Paclitaxel-Carboplatin (every 3 weeks) is the most used combination as adjuvant chemotherapy for 69.7 to 84.8% of respondents and bevacizumab 15mg/kg is used in case of no residual disease for 52.9 to 61.7 of respondents. In case of BRCA1-2 mutations, Olaparib is given by 75.8% to 84.8% of respondents. The delay to obtain BRCA germline mutation results is less than 1 month for 26.5% of respondents and less than 3 months for 76.5% of respondents. An Homologous Recombination Repair Deficiency is searched for 73.5% of respondents and mainly by Myriad test (91.3%). Conclusion* In our study, the rate of HIPEC was high because 2 clinical trials are currently ongoing in France on HIPEC as 1st line treatment. Our results provide an interesting picture of current management in France in relation to International Guidelines. They provide a basis for further research and raise the question of updating guidelines for ovarian cancer management.

Introduction/Background* The aim of this study was to investigate the current surgical and non-surgical therapeutic management of advanced epithelial ovarian cancer (AEOC) cases worldwide, using the data from an internationally launched survey. Methodology After the validation of a 58-item survey regarding diagnostic and pathological data, as well as surgical and chemotherapeutic strategies of AEOC in France, in the period between April and May 2021, the survey was launched among the members of the following gynecological cancer societies and study groups: IJGC Fellows, SENTICOL 3 study group, ARCAGY-GINECO, AGO, SFOG, SFOG Campus and FRANCOGYN. Result(s)* A total of 203 physicians completed the survey and majority of them, 171 (84.7%) were from Europe. Gynecological oncologists represented 49.2% of the respondents, surgical oncologists 25.1% and medical oncologists 13.7%. Most of the participants work in centers, managing more than 20 AEOC per year (91.5%). According to 66.7% of respondents, less than 50% of patients were eligible for primary debulking surgery (PDS). If neoadjuvant chemotherapy (NACT) was used, resectability was assessed after 3 cycles of NACT before interval debulking surgery (IDS) was performed. The most used peritoneal carcinomatosis index was Sugarbaker (69.8%), whereas Fagotti, modified Fagotti and Makar scores were used in 35.4%, 20.1% and 4.9%, respectively. After the initial staging, the decision between PDS and NADS-IDS was based on the number of the surgical procedures which had to be performed (82.9%), carcinosis index (61.6%), patient’s age (51.2%), global visual assessment (36.0%) and surgeon’s personal estimation (11.0%). During IDS, LION study’s criteria were always applied according to only 23.1% of the respondents. Hyperthermic intraperitoneal chemotherapy (HIPEC) was used as a first-line treatment from 16.0% of respondents within clinical trials and 14.1% out of clinical trials. Regardless of the surgical strategy (PDS or NACT-IDS) and the completeness of cytoreduction surgery, Olaparib was prescribed by 74.3% to 81.4% of the respondents and Niraparib by 8.6% to 12.9%. Bevacizumab was prescribed by 42.9% to 68.6% in case of no BRCA mutation. Conclusion* According to our study, the current management of ovarian cancer is in line with the ESGO guidelines. More participants are necessary for a more precise presentation.

International audience; Background: The aim of this study was to assess current French practices in the management of patients with advanced epithelial ovarian cancer. Method: a 58-question electronic survey was distributed anonymously to the members of the SFOG (French Society of Gynaecological Oncology), GINECO-ARCAGY (National Investigators Group for Ovarian and Breast Cancer Studies in France) and FRANCOGYN (French research group in oncological and gynaecological surgery). Initial diagnostic workup and staging, pathological data, surgical data, treatments and follow-up strategies were assessed. Results: a total of 107 participants responded to emailed surveys. Most of the respondents were obstetrician-gynaecologists (37.4%), surgical oncologists (34.6%) and medical oncologists (17.8%). According to most (76.8%) participants, less than 50% of patients were eligible for primary debulking surgery (PDS). The LION study criteria were applied in 69.5% of cases during PDS and 39% after chemotherapy. The timing of BRCA testing was very heterogeneous and ranged from 1 to 6 months. The use of bevacizumab as an adjuvant schedule was lower in cases of no residual disease (for 54.5% of respondents) compared to cases of residual disease (for 63.6% of respondents). In cases of BRCA1-2 mutations, olaparib was given by 75.8–84.8% of respondents, whereas niraparib was given in cases of BRCA wild-type diseases. Conclusion: this survey provides an extensive and a unique review of current French practices in the management of patients with advanced epithelial ovarian cancer in 2021.

International audience; Objective: To assess the surgical management and survival of severely obese patients with high-risk endometrial cancer.Materials and methods: Data from 269 patients with high-risk endometrial cancer who were treated between 2001 and 2018 were collected from a multicenter database (11 centers). We classified the patients according to their BMI and compared outcomes in two groups: a normal weight group of women with a BMI < 25 kg/m2, and a severe obesity group of women with a BMI ≥ 35 kg/m2. The groups were compared for epidemiologic, pathologic, management, relapse-free survival (RFS) and overall survival (OS) elements.Results: Patients in the severe obesity group were younger (64 years vs. 68 years, p < 0.05) and had more comorbidities (hypertension, diabetes). They also had more locally advanced tumors and pelvic lymph node involvement (47% vs 24%, p < 0.05). The severely obese patients were less likely to undergo recommended surgical staging, with fewer lumbar aortic dissections than women of normal weight (23% vs 36%, p < 0.05) and fewer pelvic sentinel lymph node biopsies (26.5% vs 12.1%, p < 0.05). No difference in RFS or OS were observed between the two groups.Conclusion: Patients with severe obesity and high-risk endometrial cancer have more locally advanced tumors, and are less likely to be managed according to surgical recommendations. However, RFS and OS do not seem to be affected.

International audience; BACKGROUND: The aim of this study was to evaluate the impact of Lymphovascular Space Invasion (LVSI) on Overall Survival (OS) and Recurrence-Free Survival (RFS) in patients managed for high-grade serous epithelial ovarian cancer (HGSOC). MATERIALS AND METHODS: Retrospective multicenter study by the FRANCOGYN research group between January 2001 and December 2018. All patients managed for HGSOC and for whom histological slides for the review of LVSI were available, were included. The characteristics of patients with LVSI (LVSI group) were compared to those without LVSI (No LVSI group). A Cox analysis for OS and RFS analysis was performed in all populations. RESULTS: Over the study period, 410 patients were included in the thirteen institutions. Among them, 289 patients had LVSI (33.9%). LVSI was an independent predictive factor for poorer Overall and Recurrence-Free Survival. LVSI affected OS (p

Resume Objectifs Les nouvelles recommandations de l’Institut national du cancer de janvier 2017 preconisent la realisation d’un test virologique papillomavirus humain (HPV) complementaire lors du diagnostic d’atypies glandulaires au frottis cervicovaginal. L’objectif de cette etude etait d’evaluer la performance du test virologique HPV dans la detection de lesions histologiques cervicales significatives (neoplasie intracervicale [CIN] de grade 2 et plus) en cas de frottis AGC, avant l’application des nouvelles recommandations. Methodes Nous avons mene une etude de cohorte descriptive et retrospective en Alsace entre janvier 2014 et decembre 2016. Nous avons inclus, a partir de la base de donnees de l’association EVE, les patientes ayant presente des atypies glandulaires au frottis cervicovaginal. Resultats Au total, 1074 patientes ont presente un frottis avec atypie glandulaire, soit 0,18 % des frottis. Cent cinquante-deux patientes ont beneficie d’une recherche d’HPV. Nous avons observe 6 cas de CIN2 (3,9 %) et 12 cas de CIN3 (7,9 %). Il n’y a pas eu de diagnostic d’adenocarcinome in situ ou de carcinome invasif. La sensibilite de ce test etait de 88,9 % (IC95 % : [0,65 ; 0,99]), la specificite etait de 65,9 % (IC95 % : [0,55 ; 0,76]), la VPP etait de 34 % (IC95 % : [0,21 ; 0,49]) et la VPN etait de 96,8 % (IC95 % : [0,89 ; 0,99]). Conclusion Le test virologique HPV semble performant dans la prise en charge des atypies glandulaires avec une excellente VPN mais en raison de sa sensibilite moyenne et du risque de progression d’une eventuelle lesion histologique sous-jacente, les recommandations actuelles doivent etre appliquees avec precaution.

Resume Objectifs Definir les modalites de surveillance apres traitement d’un cancer epithelial de l’ovaire, de la trompe ou du peritoine primitif. Definir les possibilites de traitement hormonal de la menopause et de contraception apres traitement. Methodes Recherche bibliographique en langue francaise et anglaise effectuee par consultation de la base de donnees PubMed/Medline et la Cochrane Library. Resultats Apres traitement d’un cancer epithelial de l’ovaire, de la trompe ou du peritoine primitif, il est recommande une evaluation des symptomes a 3 mois, 6 mois, 12 mois, 18 mois et 24 mois, puis 1 fois par an (grade B). Pour le suivi, il est recommande de surveiller seulement par examen paraclinique les patientes avec chirurgie initiale complete (residu tumoral macroscopique nul, CC0) et avec un bon etat general (ECOG 0) par un dosage serique (HE4 ou CA125) a partir de 6 mois apres la fin de la chimiotherapie (grade C). Il n’est pas recommande de surveillance par scanner thoraco-abdomino-pelvien systematique (Grade C). En cas d’elevation serique du HE4 ou du CA125, un examen d’imagerie est recommande (grade B). Il est recommande de proposer un THM chez les patientes de moins de 45 ans apres un traitement non conservateur d’un adenocarcinome de l’ovaire, de la trompe ou du peritoine primitif sereux de haut grade (grade C) ou mucineux (grade C). Chez les femmes de plus de 45 ans, un THM n’est pas contre-indique en cas de syndrome climaterique apres traitement d’un adenocarcinome sereux de haut grade (grade B), ou apres adenocarcinome mucineux (grade C).

International audience; Pelvic and para-aortic lymphadenectomy are associated with increased risk of complications and are responsible for a significant proportion of morbidity and impaired quality of life following surgical management of pelvic malignancies. Sentinel lymph node (SLN) was developed as a trade-off between systematic and no lymphadenectomy to limit morbidity while conserving good oncological staging and outcomes. In this comprehensive review, we aimed to synthetize the anatomical basis of the SLN procedure in patients with pelvic malignancies from a surgical perspective. The reliability of the SLN procedure is based on the knowledge of the dissemination pathways for each type of tumors. The most recent understanding of the uterine lymphatic anatomy defined three consistent channels: an upper paracervical pathway (UPP) with draining medial external and/or obturator lymph nodes; a lower paracervical pathway (LPP) with draining internal iliac and/or presacral lymph nodes and the infundibulo-pelvic pathway (IPP) with a course along the fallopian tube and upper broad ligament via the infundibulo-pelvic ligament to its origin. In patients with endometrial cancer, most SLNs are located on the UPP pathway: obturator and external iliac whereas 80% of the SLNs in patients with cervical cancer are located in the external iliac, interiliac and obturator area. Surgical training is a key step toward improving detection rates and exhaustiveness of SLN research while reducing overall morbidity. This is all the more important that the indications for performing complete lymphadenectomy are becoming increasingly rare.

To determine if the time-to-chemotherapy (TTC) after primary macroscopic complete cytoreductive surgery (CRS) influences recurrence-free survival (RFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC). We conducted an observational multicenter retrospective cohort analysis of women with EOC treated from September 2006 to November 2016 in nine institutions in France (FRANCOGYN research group) with maintained EOC databases. We included women with EOC (all FIGO stages) who underwent primary complete macroscopic CRS prior to platinum-based adjuvant chemotherapy. Two hundred thirty-three patients were included: 73 (31.3%) in the early-stage group (ESG) (FIGO I-II), and 160 (68.7%) in the advanced-stage group (ASG) (FIGO III-IV). Median TTC was 43 days (36–56). The median OS was 77.2 months (65.9–106.6). OS was lower in the ASG when TTC exceeded 8 weeks (70.5 vs. 59.3 months, p = 0.04). No impact on OS was found when TTC was below or above 6 weeks (78.5 and 66.8 months, respectively, p = 0.25). In the whole population, TTC had no impact on RFS or OS. None of the factors studied were associated with an increase in TTC. Chemotherapy should be initiated as soon as possible after CRS. A TTC greater than 8 weeks is associated with poorer OS in patients with advanced stage EOC.

Background/aim This study aimed to evaluate the relevance of laparoscopy in comparison with laparotomy in the management of ovarian cancer in well-selected patients. Patients and methods Data of consecutive ovarian cancer patients treated by laparoscopy were matched 1:1 to a cohort of patients operated by laparotomy using a propensity score matching. The inclusion criteria included patients who underwent a complete staging procedure in the early stages and optimal upfront or interval debulking surgery for advanced ovarian cancer. Results In total, 153 patients were included. Propensity score matching led to the analysis of 41 well-balanced pairs of patients. For a median follow-up of 34.0 [19.0-64.0] months and 38.0 [24.5-75.0] months, respectively, no difference was found between the two groups in regards to overall survival (p=0.28) and disease-free survival (p=0.89). Conclusion In well-selected patients, laparoscopic surgery may be a safe and effective alternative to laparotomy.

Background Borderline ovarian tumors (BOTs) are tumors with a favorable prognosis but whose management by consensus is essential to limit the risk of invasive recurrence. This study aimed to conduct an inventory of surgical practices for BOT in France and to evaluate the conformity of the treatment according to the current French guidelines. Methods This retrospective, multicenter cohort study included nine referral centers of France between January 2001 and December 2018. It analyzed all patients with serous and mucinous BOT who had undergone surgery. A peritoneal staging in accordance with the recommendations was defined by performance of a peritoneal cytology, an omentectomy, and at least one peritoneal biopsy. Results The study included 332 patients. A laparoscopy was performed in 79.5% of the cases. Treatment was conservative in 31.9% of the cases. The recurrence rate was significantly increased after conservative treatment (17.3% vs 3.1%; p < 0.001). Peritoneal cytology was performed for 95.5%, omentectomy for 83.1%, and at least one biopsy for 82.2% of the patients. The overall recurrence rate was 7.8%, and the recurrence was invasive in 1.2% of the cases. No link was found between the recurrence rate and the conformity of peritoneal staging. The overall rate of staging noncompliance was 22.9%. Conclusion The current standards for BOT management seem to be well applied.

Background Radiological preoperative assessment of endometrial cancer (EC) is in some cases not precise enough and its performances improvement could lead to a clinical benefit. Radiomics is a recent field of application of artificial intelligence (AI) in radiology. Aims To investigate the contribution of radiomics on the radiological preoperative assessment of patients with EC; and to establish a simple and reproducible AI Quality Score applicable to Machine Learning and Deep Learning studies. Methods We conducted a systematic review of current literature including original articles that studied EC through imaging-based AI techniques. Then, we developed a novel Simplified and Reproducible AI Quality score (SRQS) based on 10 items which ranged to 0 to 20 points in total which focused on clinical relevance, data collection, model design and statistical analysis. SRQS cut-off was defined at 10/20. Results We included 17 articles which studied different radiological parameters such as deep myometrial invasion, lympho-vascular space invasion, lymph nodes involvement, etc. One article was prospective, and the others were retrospective. The predominant technique was magnetic resonance imaging. Two studies developed Deep Learning models, while the others machine learning ones. We evaluated each article with SRQS by 2 independent readers. Finally, we kept only 7 high-quality articles with clinical impact. SRQS was highly reproducible (Kappa = 0.95 IC 95% [0.907–0.988]). Conclusion There is currently insufficient evidence on the benefit of radiomics in EC. Nevertheless, this field is promising for future clinical practice. Quality should be a priority when developing these new technologies.

INTRODUCTION The aim of this study was to evaluate changes in the quality of life with the connected biofeedback EMY Kegel trainer in patients suffering from stress urinary incontinence. Materiel and methods: This was a prospective, single-center, non-comparative study, which took place between September 2019 and October 2020, in the University Hospitals of Strasbourg. Eligible patients were instructed to use the EMY probe for a minimum of 10 minutes per day for five days per week. To assess quality of life and urinary symptoms, the Contilife and ICIQ-SF scores were completed each month until the final visit (M3). The PGI-I was also completed at 3 months to assess the benefit of the EMY Kegel Trainer. RESULTS A total of 55 patients were included. At the inclusion visit (M0), the mean Contilife and ICIQ-SF scores were respectively at 6.6 ± 1.5 and 10.5 ± 3.0 points. At the final visit (M3), the mean Contilife score increased to 9.2 ± 1.0, indicating an improvement in quality of life. The mean ICIQ-SF score decreased to 4.2 ± 4.0, indicating an improvement in urinary symptoms. The PGI-I questionnaire identified a positive assessement of the EMY Kegel trainer. On the 55 patients included, 35 (64%) reported completing at least 36 sessions during the study, i.e. an average of 3 sessions per week. CONCLUSIONS This study suggests that perineal rehabilitation by biofeedback using the EMY Kegel trainer might be beneficial.