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Resumen La endometriosis digestiva es la localizacion no ginecologica mas frecuente. Por tanto, los equipos quirurgicos que tratan esta patologia se ven enfrentados a ella con frecuencia. Se han descrito y desarrollado tecnicas menos «radicales» que la reseccion segmentaria y cada vez las utilizan mas equipos en la actualidad. El shaving rectal parece ser una tecnica segura, validada y particularmente adecuada para las afectaciones de la serosa o de la capa muscular superficial rectal. Esta tecnica permite disminuir las complicaciones inherentes a la anastomosis digestiva, en particular los riesgos de fistula. En caso de shaving incompleto, es preferible, sin duda, dependiendo del contexto, optar por las tecnicas de reseccion, para evitar los posibles riesgos de recidiva. Las resecciones «discoides» permiten una reseccion parcial del recto. Se han descrito varias tecnicas dependiendo de la experiencia del equipo quirurgico, la localizacion del nodulo, su tamano y su circunferencia. Se reservan a las afectaciones profundas de la capa muscular del recto o a los casos mas graves. Tienen la ventaja de limitar la diseccion del mesorrecto y, por tanto, de preservar al maximo las fibras nerviosas y la vascularizacion: reseccion y sutura manual; reseccion discoide con grapadora circular transanal; reseccion discoide con grapadora semicircular transanal Contour STARR o «tecnica de Rouen». La reseccion segmentaria sigue siendo muy interesante, en particular cuando es imposible utilizar las tecnicas conservadoras, si existe un nodulo inaccesible por via transanal, a mas de 18-20 cm del margen anal (colon sigmoide), o si hay un nodulo de un tamano y circunferencia demasiado grandes. Estas distintas tecnicas son totalmente complementarias en la estrategia quirurgica que se propondra a la paciente. En la mayoria de los casos, la eleccion de la tecnica se puede comentar antes de la cirugia en una reunion de concertacion pluridisciplinaria, gracias a los datos clinicos y a las pruebas complementarias: resonancia magnetica, ecografia endorrectal o ecografia endovaginal, segun la experiencia y las costumbres del equipo. El tamano del nodulo, su grado de infiltracion en la pared digestiva, su circunferencia, su localizacion y su distancia respecto al margen anal suelen ser elementos determinantes que se deben estudiar en funcion de los antecedentes de la paciente, de sus sintomas y de sus antecedentes quirurgicos.

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.

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

Resume Objectifs Le but de ce travail etait d’evaluer l’impact clinique du ratio de la dissemination metastatique ganglionnaire inguinale (LNR) chez les patientes prises en charge pour un cancer vulvaire de type epidermoide. Materiel et methodes La cohorte de l’etude etait representee par des patientes prises en charge pour un carcinome epidermoide vulvaire, entre janvier 2005 et decembre 2015, dans 5 institutions francaises avec bases de donnees prospectives. Population Au toal, 636 femmes, parmi lesquelles 508 (79,9 %) ont eu une chirurgie ganglionnaire inguinale. Le seuil significatif du LNR a ete determine par la methode du minimal valeur de p. Critere de jugement principal Comparaison de la survie globale et sans recidive selon le LNR. Resultats Au total, 176 femmes (34,6 %) avaient au moins un ganglion atteint. Il existait une difference significative de survie globale et de survie sans recidive selon que le LNR, soit > 0,2 ou non. Conclusion L’evaluation, dans notre etude, du ratio de ganglions positifs, semble demontrer que celui-ci pourrait etre considere comme un facteur pronostique a part entiere.

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; 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

Introduction/Background* Thanks to technical improvements, total non-conservative hysterectomy evolved towards MIS as the standard approach for early-stage endometrial cancer (EC). MIS has recently been called into question for cervical cancer treatment due to its negative prognosis impact. In this context, we carry out a study comparing OSu vs. MIS with Disease Free Survival (DFS) as primary endpoint. Methodology Retrospective study, within the French collaborative group FRANCOGYN from 1999 to 2020. All patients aged over 18 who achieved hysterectomy for endometrial cancer were included whatever the pathological subtype. Secondary endpoints were: Overall Survival (OS) and sub-group analysis according to FIGO stage, ESMO-ESGO-ESTRO Consensus Conference risk-group 2015 (E3CC), pathological sub-types, lymph node metastasis and lympho-vascular space invasion (LVSI). To assess primary endpoint, we use inverse probability of treatment weighting (IPW) based on propensity score to construct two weighted cohort. A Cox proportional-hazard model standard multivariate analysis was used for subgroup analysis. Result(s)* Nine hundred and forty-five (945) patients were included, 380 (40.2%) received OS and 565 (59.8%) received MIS. The median follow-up was 34.2 months (29.1 SD) . The study other measured characteristics were strongly unbalanced in disfavor of the OSu group for pathological subtype (p DFS was significantly impaired by the following characteristics: Age, BMI, histological grade 3 (HR=2.04, 95% CI [1.15-2.04] p = 0.015), E3CC High Risk Group (HR = 2.62, 95% CI [1.03-6.67] p = 0.43) and FIGO Stage 3 (HR= 2.21, 95% CI [1.07-4.56] p= 0.031) Conclusion* This study cover 20 years of clinical practice and consolidate MIS place for EC surgical treatment with an increasing use of MIS over years whatever the FIGO staging and clinical characteristics. Every effort should be made to improve a standardized MIS approach the more that patient is frail or at high risk of relapse.

Title: Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN). Introduction/Background* The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. (Group 1). Methodology This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Result(s)* Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusion* Patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL

International audience; INTRODUCTION: Node involvement is one of the main prognostic factors for cervical cancer. Para-aortic lymph node (PALN) assessment is crucial for treating advanced cervical cancer, to define irradiation fields. Objective of this study was to develop a score predicting para-aortic lymph node involvement in patients with advanced cervical cancer. PATIENTS AND METHOD: We performed a multicenter, retrospective, study on 9 French centers from 2000 to 2015, including patients with advanced squamous cell cervix carcinoma who had PALN status assessed by imaging and/or by surgery. Factors associated with a risk of PALN involvement were determined by univariate and multivariate analysis using a logistic regression model. A score was then developed and validated. RESULTS: A total of 1446 patients treated for cervical cancer were included. Of these, 498 had an advanced squamous cell cervical cancer. Ninety-one patients (18.3%) had positive PALN. After univariate and multivariate analysis, tumor size on pelvic MRI, initial SCC, and suspected pelvic node involvement on PET-CT were included in our score. This model allowed the population to be divided into 3 risk groups. Area under the ROC curve of the score was 0.81 (95%CI = 0.72-0.90). In the low-risk group, 9% (28/287) had PALN involvement, whereas in the high-risk group, 43% (22/51) had PALN involvement. CONCLUSION: We developed a simple score predicting PALN involvement in advanced cervical cancers. Three risk groups can be defined, and patients considered to be at low risk may avoid para-aortic staging as well as extensive field irradiation.

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.

International audience; Background. The prognosis for patients with endometrial cancer (EC) peritoneal carcinomatosis (PC) recurrence has received little study. This study aimed to determine specific risk factors and prognosis of EC with PC recurrence (PCR) versus no PC recurrence (NPCR). Methods. Data of all patients with EC who received primary surgical treatment between January 2000 and February 2017 were abstracted from the French FRANCOGYN Research Group database. Clinical and pathologic variables were compared between the two groups (PCR vs. NPCR). Multivariate analysis was performed to define prognostic factors for peritoneal recurrence. Overall survivals (OS) of patients after recurrence were compared using the Kaplan-Meier method. Results. The study analyzed 1466 patients, and 257 of these patients (17.5%) had recurrence. At presentation, 63 of these patients had PC. International Federation of Gynecology and Obstetrics (FIGO) stages 3 and 4 disease were significantly associated with PCR versus NPCR (odds ratio 2.24; 95% confidence interval 1.23-4.07; p = 0.008). The death rate for the patients with PC was 47.6%, with a median survival of 12 months after diagnosis of recurrence. According to the histologic subtype, OS was 29 months (Q1-Q3, 13-NA) for endometrioid carcinomas, 7.5 months (Q1-Q3, 4-15) for serous carcinomas, and 10 months (Q1-Q3, 5-15) for clear cell carcinomas. Chemotherapy for treatment of PCR was associated with improved OS after recurrence (OSAR; p = 0.0025). Conclusion. An initial advanced stage of EC is a risk factor for PCR. For women with PCR, a diagnosis of type 1 EC recurrence more than 12 months after the initial treatment and management of PCR with chemotherapy is associated with improved OSAR. Prospective studies are needed to determine the precise optimal management required in this clinical situation and to assess the relevance of biomarkers to predict the risk of PCR for EC patients.

The standard of care for patients with advanced cervical cancer (ACC) includes platinum-based chemotherapy. The concept of platinum sensitivity is a major prognostic factor for patients with ovarian cancer. The aim of this study was to validate the applicability of the platinum sensitivity concept to ACC patients, and to estimate its prognostic interest in terms of overall survival (OS) and pattern of recurrence (location, timing). Data of women with histologically proven FIGO 2019 stages IB3&ndash, IV ACC, treated between May 2000 and November 2017 with platinum-based regimens, were retrospectively abstracted from 12 institutions from the FRANCOGYN Group. Respective 3-year OSs were 52% (95% CI: 40.8%&ndash, 66.8%), 21.6% (95% CI: 12.6%&ndash, 37.2%), and 14.6% (95% CI: 4.2%&ndash, 50.2%), in case of recurrence &lt, 6 months, between 6 and 17 months, and &ge, 18 months (p &lt, 0.001). Risk of metastatic or multisite recurrence was significantly higher in case of recurrence &lt, 6 months, and risk of local or isolated infradiaphragmatic nodal recurrence was significantly higher in case of recurrence &gt, 0.001). In multivariate analysis, platinum sensitivity status was a strong prognostic factor for OS after recurrence, independent of histological grade, lympho-vascular space involvement, final lymph node status, and treatment. Platinum sensitivity status may help to classify patients in three prognostic subgroups for OS after recurrence, and appears to be a strong prognostic factor correlated to the pattern of recurrence.

Background and objective: according to the latest ESMO&minus, ESGO recommendations, laparotomy is the standard surgical approach to treat and stage patients with presumed early stage epithelial ovarian cancer (EOC). A few studies have investigated the efficacy and the safety of laparoscopy for the staging of early stage EOC, and this question is still in the center of debates. Recurrence-free survival (RFS) and overall survival (OS) benefits of the minimally invasive surgery (MIS) have still to be specified. The aim of this multicenter and retrospective study is to assess the survival outcomes of laparoscopic staging in comparison with laparotomic staging for patients presenting with an early stage EOC. Methods: data of patients with early stage EOC (FIGO I-IIA) who underwent primary surgery between 2000 and 2018 were extracted from the FRANCOGYN database. OS and RFS of these two groups, constituted according to the surgical route, were compared using Log rank test. Results: of the 144 patients included, 107 patients underwent laparotomy and 37 underwent laparoscopy for a staging purpose. The median follow-up was 36.0 months (18.0 to 58.0). For the laparoscopy and the laparotomy group, the median follow-up period was 24 (11.0 to 50.0) and 42.0 (24.0 to 66.0) months, respectively, (p &lt, 0.001). Tumor recurrence occurred in 33 (23%) patients: 2 (5.4%) in the laparoscopy group and 31 (29%) in the laparotomy group (p = 0.08). The OS rate at 5 years was 97.3% after laparoscopy and 79.8% after laparotomy (p = 0.19). Conclusions: there is no difference associated with the laparoscopic approach for the staging of early stage EOC on RFS and OS in comparison with laparotomy. MIS may be proposed as a safe and adequate alternative to laparotomy when performed by well-trained surgeons.

Background and objective: Elderly and/or frail women with ovarian cancer are often undertreated. The aim of the study is to compare the effects of age and frailty on surgical approaches, postoperative complications, and prognosis in elderly women with ovarian cancer. Methods: A retrospective multicenter study of women &ge, 70 years were treated for ovarian cancer at seven French university hospitals between 2007 and 2015. Results: Of the 1119 women treated for ovarian cancer during the study period, 147 were &ge, 70 years and had complete data. Of these women, 65 were aged 70&ndash, 74 years, and 82 were aged &ge, 75 years. Overall, 77% of the younger women (49/65) received optimal treatment compared with 51% (40/82) of the older women (p = 0.018). Women &ge, 75 years underwent fewer bowel resections (32% vs. 67%, p &lt, 0.001) and experienced fewer postoperative complications (22.6% vs. 38.9%, p &lt, 0.001), 53.2% of the women in this age group were treated by primary surgery or surgery only. These women also received more chemotherapy with platinum only (15% [9/56] vs. 2% [1/57], p = 0.007) and less bevacizumab (9% [5/56] vs. 32% [18/57], p = 0.003). Patients with greater frailty (a modified Charlson Comorbidity Index [mCCI] score &gt, 3) had a five-year survival rate of 30% versus 62% for those with a score &le, 3 (p &lt, 0.001). Conclusions: Surgeons modify their approach to treating ovarian cancer in women &ge, 75 years probably to reduce immediate postoperative complications. The prognosis is significantly worse in patients with greater frailty. Improvements to the sequence of treatments administered, with priority given to neoadjuvant chemotherapy in patients with greater frailty, could help increase the number of women who receive optimal treatment and improve their prognosis.

Elderly women with ovarian cancer are often undertreated due to a perception of frailty. We aimed to evaluate the management of young, elderly and very elderly patients and its impact on survival in a retrospective multicenter study of women with ovarian cancer between 2007 to 2015. We included 979 women: 615 women (62.8%) &lt, 65 years, 225 (22.6%) 65&ndash, 74 years, and 139 (14.2%) &ge, 75 years. Women in the 65&ndash, 74 years age group were more likely to have serous ovarian cancer (p = 0.048). Patients &gt, 65 years had more &gt, IIa FIGO stage: 76% for &lt, 65 years, 84% for 65&ndash, 74 years and 80% for &ge, 75 years (p = 0.033). Women &ge, 75 years had less standard procedures (40% (34/84) vs. 59% (104/177) for 65&ndash, 74 years and 72% (384/530) for &lt, 65 years (p &lt, 0.001). Only 9% (13/139) of women &ge, 75 years had an Aletti score &gt, 8 compared with 16% and 22% for the other groups (p &lt, 0.001). More residual disease was found in the two older groups (30%, respectively) than the younger group (20%) (p &lt, 0.05). Women &ge, 75 years had fewer neoadjuvant/adjuvant cycles than the young and elderly women: 23% &ge, 75 years received &lt, 6 cycles vs. 10% (p = 0.003). Univariate analysis for 3-year Overall Survival showed that age &gt, 65 years, FIGO III (HR = 3.702, 95%CI: 2.30&ndash, 5.95) and IV (HR = 6.318, 95%CI: 3.70&ndash, 10.77) (p &lt, 0.001), residual disease (HR = 3.226, 95%CI: 2.51&ndash, 4.15, p &lt, 0.001) and lymph node metastasis (HR = 2.81, 95%CI: 1.91&ndash, 4.12, 0.001) were associated with lower OS. Women &gt, 65 years are more likely to have incomplete surgery and more residual disease despite more advanced ovarian cancer. These elements are prognostic factors for women&rsquo, s survival regardless of age. Specific trials in the elderly would produce evidence-based medicine and guidelines for ovarian cancer management in this population.

This work shows the preparation of Pebax® 1041 films from solutions in DMAc and water-DMAc emulsions as alternatives to those prepared by extrusion that can be found in the literature. These membranes were tested in post-combustion CO2 capture, in the separation of a 15/85 (v/v) CO2/N2 mixture. Self-supported membranes of Pebax® 1041 were prepared by solvent evaporation and phase inversion. The characterization of these films defined the intrinsic properties of this polymer in terms of chemical structure, crystallinity, thermal stability and gas separation performance (a CO2 permeability of 30 Barrer with a CO2/N2 selectivity of 21 at 35 °C and 3 bar feed pressure). Supported Pebax® 1041 membranes were also developed to decrease the Pebax® thickness (in the 1.5-10 μm range), resulting in a higher permeance. These membranes were prepared by a phase inversion process consisting of the precipitation of a Pebax® 1041/DMAc solution in water and dispersing it to form a stable emulsion that was drop-cast on PSF asymmetric supports. Once dried, the polymer formed a dense continuous layer. The phase inversion methodology is "greener" than solvent evaporation since dimethylacetamide is not released as toxic vapour during membrane preparation. The amount drop-cast led to a different selective layer thickness, which was enhanced by the dispersion of MWCNTs in the polymer emulsion. The properties of the Pebax® selective layer were studied by thermogravimetry and by measuring the contact angle of the membrane surface, and the optimal CO2/N2 selectivity (22.6) was obtained with a CO2 permeance of 3.0 GPU.

This work shows the preparation of Pebax® 1041 films from solutions in DMAc and water–DMAc emulsions as alternatives to those prepared by extrusion that can be found in the literature. These membranes were tested in post-combustion CO2 capture, in the separation of a 15/85 (v/v) CO2/N2 mixture. Self-supported membranes of Pebax® 1041 were prepared by solvent evaporation and phase inversion. The characterization of these films defined the intrinsic properties of this polymer in terms of chemical structure, crystallinity, thermal stability and gas separation performance (a CO2 permeability of 30 Barrer with a CO2/N2 selectivity of 21 at 35 °C and 3 bar feed pressure). Supported Pebax® 1041 membranes were also developed to decrease the Pebax® thickness (in the 1.5–10 μm range), resulting in a higher permeance. These membranes were prepared by a phase inversion process consisting of the precipitation of a Pebax® 1041/DMAc solution in water and dispersing it to form a stable emulsion that was drop-cast on PSF asymmetric supports. Once dried, the polymer formed a dense continuous layer. The phase inversion methodology is “greener” than solvent evaporation since dimethylacetamide is not released as toxic vapour during membrane preparation. The amount drop-cast led to a different selective layer thickness, which was enhanced by the dispersion of MWCNTs in the polymer emulsion. The properties of the Pebax® selective layer were studied by thermogravimetry and by measuring the contact angle of the membrane surface, and the optimal CO2/N2 selectivity (22.6) was obtained with a CO2 permeance of 3.0 GPU., Financial support from the Spanish Ministry of Science, the Research Projects MAT2016-77290-R (AEI/FEDER, UE) and T43-17R (the Aragón Government and the ESF) is gratefully acknowledged. J. Sánchez-Laínez also thanks the Spanish Education Ministry Program FPU2014 for his PhD grant.

Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL, Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. Methods: This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Results: Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo&ndash, Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1).

First-line diagnostic investigations for endometriosis are physical examination and pelvic ultrasound. The second-line investigations are: targeted pelvic examination performed by an expert clinician, transvaginal ultrasound performed by an expert physician sonographer (radiologist or gynaecologist), and pelvic MRI. Management of endometriosis is recommended when the disease has a functional impact. Recommended first-line hormonal therapies for the management of endometriosis-related pain are combined hormonal contraceptives (CHCs) or the 52mg levonorgestrel-releasing intrauterine system (IUS). There is no evidence base on which to recommend systematic preoperative hormonal therapy solely to prevent surgical complications or facilitate surgery. After surgery for endometriosis, a CHC or 52mg levonorgestrel-releasing IUS is recommended as first-line treatment when pregnancy is not desired. In the event of failure of the initial treatment, recurrence, or multiorgan involvement, a multidisciplinary team meeting is recommended, involving physicians, surgeons and other professionals. A laparoscopic approach is recommended for surgical treatment of endometriosis. HRT can be offered to postmenopausal women who have undergone surgical treatment for endometriosis. Antigonadotrophic hormonal therapy is not recommended for patients with endometriosis and infertility to increase the chances of spontaneous pregnancy, including postoperatively. Fertility preservation options must be discussed with patients undergoing surgery for ovarian endometriomas.

Background Recent studies have challenged radical procedures for less extensive surgery in selected patients with early-stage cervical cancer at low risk of parametrial invasion. Our objective was to identify a subgroup of patients at low risk of parametrial invasion among women having undergone surgical treatment. Methods Data of 1447 patients with cervical cancer treated between 1996 and 2016 were extracted from maintained databases of 10 French University hospitals. Patients with early-stage (IA2–IIA) disease treated by radical surgery including hysterectomy and trachelectomy, were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariate analysis, was used to account for the influence of multiple variables. Results Out of the 263 patients included for analysis, on final pathology analysis 28 (10.6%) had parametrial invasion and 235 (89.4%) did not. Factors significantly associated with parametrial invasion on multivariate analysis were: age > 65 years, tumor > 30 mm in diameter measured by MRI, lymphovascular space invasion (LVSI) on pathologic analysis. Among the 235 patients with negative pelvic lymph nodes, parametrial disease was seen in only 7.6% compared with 30.8% of those with positive pelvic nodes (p

Background Actual European pathological classification of early-stage endometrial cancer (EC) may show insufficient accuracy to precisely stratify recurrence risk, leading to potential over or under treatment. Micro-RNAs are post-transcriptional regulators involved in carcinogenic mechanisms, with some micro-RNA patterns of expression associated with EC characteristics and prognosis. We previously demonstrated that downregulation of micro-RNA-184 was associated with lymph node involvement in low-risk EC (LREC). The aim of this study was to evaluate whether micro-RNA signature in tumor tissues from LREC women can be correlated with the occurrence of recurrences. Methods MicroRNA expression was assessed by chip analysis and qRT-PCR in 7 formalin-fixed paraffin-embedded (FFPE) LREC primary tumors from women whose follow up showed recurrences (R+) and in 14 FFPE LREC primary tumors from women whose follow up did not show any recurrence (R−), matched for grade and age. Various statistical analyses, including enrichment analysis and a minimum p-value approach, were performed. Results The expression levels of micro-RNAs-184, -497-5p, and -196b-3p were significantly lower in R+ compared to R− women. Women with a micro-RNA-184 fold change 0.083 (n = 1; 8%), p = 0.016. Women with a micro-RNA-196 fold change 0.56 (n = 2; 13%), p = 0.001. Conclusions These findings confirm the great interest of micro-RNA-184 as a prognostic tool to improve the management of LREC women.

STUDY QUESTION What are the fertility outcomes in women wishing to conceive after experiencing a severe complication from surgical removal of colorectal endometriosis? SUMMARY ANSWER The pregnancy rate (PR) among women who wished to conceive after a severe complication of surgery for colorectal endometriosis was 41.2% (spontaneously for 80%, after ART procedure for 20%). WHAT IS KNOWN ALREADY While the long-term benefit of surgery on pain and quality of life is well documented for women with colorectal endometriosis, it exposes women to the risk of severe complications. However, little is known about fertility outcomes in women experiencing such severe postoperative complications. STUDY DESIGN, SIZE, DURATION This retrospective cohort study included women who experienced a severe complication after surgery for colorectal endometriosis between January 2004 and June 2014, and who wished to conceive. A total of 53 patients met the inclusion criteria. The fertility outcome was available for 48 women, who were therefore included in the analysis. The median follow-up was 5 years. PARTICIPANTS/MATERIALS, SETTING, METHODS All the women underwent complete removal of colorectal endometriosis. Postoperative severe complications were defined as grades III-IV of the Clavien-Dindo classification. Fertility outcomes, PR and cumulative pregnancy rate (CPR), were estimated. MAIN RESULTS AND THE ROLE OF CHANCE Most women experienced a grade IIIb complication (83.3%). Of 48 women, 20 became pregnant (overall PR: 41.2%); spontaneously for 16 (80%) and after ART procedure for 4 (20%). The median interval between surgery and first pregnancy was 3 years. The live birth rate was 14/48 (29.2%). The 5-year CPR was 46%. A lower CPR was found for women who experienced anastomotic leakage (with or without rectovaginal fistula) (P = 0.02) or deep pelvic abscess (with or without anastomotic leakage) (P = 0.04). LIMITATIONS REASONS FOR CAUTION Due to a lack of information, no sub-analysis was done to investigate other parameters potentially impacting fertility outcomes. WIDER IMPLICATIONS OF THE FINDINGS The PR for our population was slightly lower to that observed in the literature for women who experience such surgery without consideration for the occurrence of complications. However, 'severe complications' covers a range of conditions which are likely to have a very different impacts on fertility. Even if the PR and CPR appear satisfactory, septic complications can negatively impact fertility outcomes. Rapid ART may be a good option for these patients. STUDY FUNDING/COMPETING INTEREST(S) No funding was required for the current study. Pr H. Roman reported personal fees from Plasma Surgical Inc. (Roswell, GA, USA) for participating in a symposium and a masterclass, in which he presented his experience in the use of PlasmaJet®. None of the other authors declared any conflict of interest. TRIAL REGISTRATION NUMBER N/A.

Endometriosis is a benign pathology that affects 3% of the general population and about 10% of women of reproductive age. Three anatomoclinical entities are described: peritoneal, ovarian (endometrioma) and deep endometriosis characterized by the infiltration of anatomical structures or organs beyond the peritoneum. Laparoscopic surgery should be performed, as this is associated with a reduction in postoperative complications, length of hospitalization and convalescence. Several surgical techniques allow the removal of deep endometriosis with colorectal involvement: rectal shaving, anterior discoid resection, segmental resection. Deep endometriosis surgery with colorectal involvement is a source of postoperative complications: anastomotic fistula, rectovaginal fistula, intestinal occlusion, digestive haemorrhage, urinary fistula, deep pelvic abscess. Involvement of the urinary tract by endometriosis affects approximately 1% of patients with endometriosis.

In France, in 2015, endometrial cancer (CE) is the first gynecological cancer in terms of incidence and the fourth cause of cancer of the woman. About 8151 new cases and nearly 2179 deaths have been reported. Treatments (surgery, external radiotherapy, brachytherapy and chemotherapy) are currently delivered on the basis of an estimation of the recurrence risk, an estimation of lymph node metastasis or an estimate of survival probability. This risk is determined on the basis of prognostic factors (clinical, histological, imaging, biological) taken alone or grouped together in the form of classification systems, which are currently insufficient to account for the evolutionary and prognostic heterogeneity of endometrial cancer. For endometrial cancer, the concept of mathematical modeling and its application to prediction have developed in recent years. These biomathematical tools have opened a new era of care oriented towards the promotion of targeted therapies and personalized treatments. Many predictive models have been published to estimate the risk of recurrence and lymph node metastasis, but a tiny fraction of them is sufficiently relevant and of clinical utility. The optimization tracks are multiple and varied, suggesting the possibility in the near future of a place for these mathematical models. The development of high-throughput genomics is likely to offer a more detailed molecular characterization of the disease and its heterogeneity.

Endometriosis is a multifactorial pathology. Trans-tubal reflux theory remains valid. Genetic and epigenetic factors associated with immunological perturbations are involved. The role of endocrine disruptors is discussed although epidemiological studies are contradictory. Therapeutics are primarily based on hormonal treatments but better understanding of pathophysiology should allow targeted non-hormonal therapy. The clinical examination is sometimes negative, which should not eliminate the diagnosis and imposes complementary examinations as best as possible by referents.

Resume Le cancer de l’endometre (CE) est une cause majeure de morbidite et de mortalite dans le monde chez la femme. En France, en 2015, le cancer de l’endometre est le premier cancer gynecologique en incidence et la 4e cause de cancer de la femme. Le pronostic de ce cancer est repute favorable car il est le plus souvent limite a l’uterus. Neanmoins, il s’agit d’une pathologie heterogene et la survie globale a 5 ans peut varier de 92 % a 42 % dans les stades Figo I selon les caracteristiques histologiques de la tumeur. Cette grande heterogeneite est a l’origine d’importantes disparites dans sa prise en charge chirurgicale ainsi que dans les indications de traitement adjuvant. Une conference de consensus regroupant differentes societes savantes europeennes (ESMO-ESGO-ESTRO) a recemment etabli de nouvelles recommandations de facon a uniformiser sa prise en charge. Il en ressort principalement l’apparition d’un nouveau sous-groupe de patientes a risque de recidive (risque intermediaire-eleve). Concernant la stadification ganglionnaire, les indications restent encore un peu floues pour les groupes intermediaire et intermediaire-eleve. Le ganglion sentinelle reste pour l’instant une procedure experimentale. Concernant les traitements adjuvants, l’interet de la chimiotherapie et de son association a la radiotherapie doit encore etre explore, en particulier pour les patientes a risque eleve et pour certains sous-types histologiques.

International audience; Objective: This study examined the impact of lockdown for SARS-CoV-2 on breast cancer management via an online survey in a French multicentre setting. Material and methods: This is a multicentre retrospective study, over the strict lockdown period from March 16th to May 11th, 2020 in metropolitan France. 20 centres were solicited, of which 12 responded to the survey. Results: 50% of the centres increased their surgical activity, 33% decreased it and 17% did not change it during containment. Some centres had to cancel (17%) or postpone (33%) patient-requested interventions due to fear of SARS-CoV-2. Four and 6 centres (33% and 50%) respectively cancelled and postponed interventions for medical reasons. In the usual period, 83% of the centres perform their conservative surgeries on an outpatient basis, otherwise the length of hospital stay was 24 to 48 h. All the centres except one performed conservative surgery on an outpatient basis during the lockdown period, for which. 8% performed mastectomies on an outpatient basis during the usual period. During lockdown, 50% of the centres reduced their hospitalization duration (25% outpatient /25% early discharge on Day 1). Conclusion: This study explored possibilities for management during the first pandemic lockdown. The COVID-19 pandemic required a total reorganization of the healthcare system, including the care pathways for cancer patients.

Resume Objectifs Etude prospective evaluant l’impact clinique du traitement osteopathique sur les symptomes et la qualite de vie (QV) chez les patientes presentant une endometriose colorectale. Methodes Quarante-six patientes presentant une endometriose colorectale ont complete les questionnaires de symptomes et de qualite de vie SF-36 (composante physique et composante mentale) avant et apres traitement osteopathique. Une analyse comparative puis en cluster a ete effectuee pour identifier les sous-groupes de patientes en fonction de leur gain au traitement osteopathique. Resultats L’âge moyen (deviation standard) 32 ± 6,2 ans. Une chirurgie pour endometriose avait ete faite chez 73,9 % des patientes mais aucune pour endometriose profonde. Pres des trois quarts des patientes etaient nullipares. Apres une periode moyenne de 28 jours (15–63), une amelioration significative de la composante physique ( p p Conclusions Nos resultats confirment que le traitement osteopathique peut ameliorer les symptomes et la qualite de vie en cas d’endometriose colorectale. De plus, l’identification de profils distincts de symptomes et de reponse au traitement osteopathique permet d’envisager un essai randomise.

En este articulo se exponen las diversas tecnicas de imagen para la exploracion de la patologia endometriosica pelvica, poniendo enfasis en el aporte de la ecografia endovaginal y de la resonancia magnetica pelvica, que son los dos principales metodos de exploracion. Al respecto, se explicara la semiologia que hace posible reconocer la enfermedad, asi como las condiciones tecnicas de adquisicion que permiten optimizar la eficacia diagnostica de cada una de ellas. Asi, de forma sucesiva se presentan la patologia anexial y las lesiones subperitoneales profundas anterior, lateral y posterior.

The FloShield Air System® is a new device for laparoscopic surgery that utilizes a continuous dry CO2 gas flow over the scope to defog the lens and protect it from condensation, debris and smoke. We set out to compare the performance and efficiency of the device in terms of operative lens vision quality (OLVQ) with the reference technique (water + povidone-iodine (PVI) solution) during gynecologic laparoscopic surgery. We conducted a single-center randomized prospective study between March and June 2016 (Trials Database Registration NCT02702531) including 53 patients undergoing gynecologic laparoscopic surgery with water + PVI solution and 51 patients who underwent surgical procedures with the FloShield Air System. The primary outcome measure was the number of laparoscope removals during surgery. Secondary outcome measures were the time to clean, assessment of the quality of vision, the correlation between the laparoscopic surgical complexity and outcomes, and cost effectiveness. Overall, the mean patient age was 43.2 years (range 22–86) and body mass index 24.8 (range 16.8–42.7). The mean number of endoscope removals during surgery was 7.0 (range 0–37) in the water + PVI solution arm and 2.8 (range 0–12) in the FloShield Air System® arm. The number of removals was significantly lower in the FloShield arm (p

Resume Objectif Comparer les caracteristiques epidemiologiques, histologiques, therapeutiques et le pronostic de patientes ayant un cancer du sein diagnostique pendant la grossesse a ceux diagnostiques en post-partum dans un centre national de reference, reseau cancer associe a la grossesse. Methodes Etude retrospective de 108 patientes ayant un cancer du sein associe a la grossesse entre 2002 et 2016 avec comparaison du groupe cancer diagnostique en cours de grossesse ( n = 51) et du groupe cancer diagnostique dans le post-partum correspondant aux cancers diagnostiques dans l’annee suivant un accouchement ( n = 57). Resultats L’âge gestationnel median au diagnostic etait de 16 semaines d’amenorrhee (SA). La taille mediane ( p = 0,92), l’atteinte axillaire initiale ( p = 0,29), le type histologique ( p = 0,33) et l’expression des recepteurs hormonaux ( p = 0,93), etaient similaires dans les 2 groupes. Les cancers diagnostiques en cours de grossesse surexprimaient moins souvent HER2 (12 % vs 36 %, p = 0,003), etaient moins proliferants (Ki67 ≥ 15 % ; 64 % vs 75 %, p = 0,018) et moins traites par mastectomie (45 % vs 70 %, p = 0,008). La procedure du ganglion sentinelle a ete realisee 8 fois pendant la grossesse. Moins de patientes avec cancer diagnostique en cours de grossesse ont beneficie d’un traitement par trastuzumab 12 % vs 37 %, p = 0,003. Le terme median d’accouchement etait de 37 SA. Le suivi median etait de 3,2 vs 5,6 annees ( p = 0,002) et le taux de recidive etait de 12 % vs 32 % ( p = 0,01) pour les cancers diagnostiques en cours de grossesse et du post-partum respectivement. Nos resultats soulignent des differences des caracteristiques histologiques, des traitements chirurgicaux et adjuvants imposant de differencier au sein des cancers associes a la grossesse ceux diagnostiques pendant la grossesse de ceux diagnostiques en post-partum.

Resume Objectif Evaluer et comparer les performances diagnostiques de l’echoendoscopie rectale (EER) et de l’imagerie par resonance magnetique (IRM) en pratique courante pour determiner le geste chirurgical colorectal permettant la resection de lesion d’endometriose profonde. Methodes Serie de cas retrospective realisee dans le service de gynecologie de l’hopital Tenon entre mars 2001 et avril 2015. Inclusion de 407 patientes operees pour une endometriose profonde avec suspicion clinique d’atteinte colorectale. Toutes les patientes ont eu en preoperatoire une IRM pelvienne, puis une EER. Resultats Dans la population, 239 patientes (59 %) avaient une endometriose colorectale confirmee par l’histologie. La sensibilite (Se), la specificite (Sp), la valeur predictive positive (VPP) et la valeur predictive negative (VPN) de l’EER et de l’IRM pour le diagnostic de l’atteinte colorectale etaient respectivement de 92 %, 87 %, 91 %, 88 % et 85 %, 88 %, 91 %, 80 %. Il n’y avait pas de difference significative entre l’EER et l’IRM dans le diagnostic d’endometriose colorectale (90 % versus 86 %, p = 0,09). Conclusion L’EER est un examen performant pour le diagnostic d’endometriose colorectale. L’utilisation de l’EER en association avec l'IRM permet d’ameliorer les performances diagnostiques.

Resume Objectif Evaluer l’impact de la chirurgie de l’endometriose profonde sans atteinte digestive sur le taux de grossesse en fecondation in vitro (FIV). Methodes Etude retrospective monocentrique de patientes infertiles ayant une endometriose profonde sans atteinte digestive. Les patientes etaient divisees en 2 groupes : « chirurgie » et « sans chirurgie » avant la prise en charge en fecondation in vitro. L’analyse s’est faite en taux de grossesse par patiente et taux de grossesse par cycle de fecondation in vitro. Resultats Soixante-douze patientes ont ete incluses, 35 patientes dans le groupe « chirurgie » et 37 dans le groupe « sans chirurgie ». Les donnees etaient comparables dans les 2 groupes en ce qui concerne les caracteristiques cliniques des patientes, l’atteinte endometriosique a l’IRM ainsi que les caracteristiques de la fecondation in vitro. On retrouvait des taux de grossesse clinique cumules par patiente similaires dans les deux groupes : 40 % dans le groupe « chirurgie » et 41 % dans le groupe « sans chirurgie » ( p = 1). Les taux de grossesse clinique par cycles etaient aussi comparables : 24 % dans le groupe « chirurgie » et 28 % dans le groupe « sans chirurgie » ( p = 0,67). Les caracteristiques de la chirurgie etaient comparables entre les patientes ayant eu une grossesse et celles n’en ayant pas eu. Seul l’âge etait significativement plus eleve chez les patientes n’ayant pas eu de grossesse ( p = 0,01) avec significativement plus de grossesse chez les patientes de moins de 35 ans ( p = 0,04). Conclusion Chez les patientes presentant une endometriose profonde sans atteinte digestive, la chirurgie ne diminue pas les resultats en FIV. Le choix therapeutique entre la chirurgie premiere et la fecondation in vitro devrait donc etre guide par d’autres criteres, tels que la symptomatologie douloureuse, l’âge, la permeabilite tubaire, la reserve ovarienne, les caracteristiques spermatiques du conjoint et la priorite de la patiente afin de determiner s’il existe des chances de grossesse spontanee apres chirurgie de l’endometriose profonde.

Background No data are available to establish whether operative hysteroscopy is superior to standard pipelle sampling to determine histological and grade status in endometrial cancer (EC). The aim of this study was to evaluate whether pipelle device sampling or operative hysteroscopy had an impact on preoperative determination of histological and grade status in EC and consequently on surgical management. Methods Data of 224 women with EC receiving primary surgical treatment between 2002 and 2014 were abstracted from a single institution with maintained database. Women were staged on the basis of preoperative and final pathological findings according to the 2009 International FIGO classification. Discrepancies in pathological analysis were assessed between pipelle sampling or operative hysteroscopy and final histology. Values of p Results 149 women underwent preoperative pipelle sampling and 75 operative hysteroscopy. Global discrepancies between pre-operative and post-operative analysis was 20.8% versus 20.0% in the pipelle device and operative hysteroscopy group, respectively, with no significant difference considering type 1 grade 1 or 2 versus type 1 grade 3 versus type 2 EC. Discrepancies in histological type between preoperative and final histology were found in 25 (16.8%) and 11 (14.7%) women in the pipelle device and operative hysteroscopy groups, respectively (p = 0.85). Discrepancies in histological grade between preoperative and final histology were found in 6 (5.8%) vs. 4 (7.0%) of the women in the pipelle device and operative hysteroscopy groups, respectively (p = 1). Conclusion This study suggests that both pipelle sampling and operative hysteroscopy are of limited value in determining definitive histological type and grade. Additional investigations should be evaluated to better characterize the risk groups.

Introduction/Background Para-aortic lymphadenectomy is currently not systematized in the pre-treatment management of advanced cervical cancer (FIGO IB3-IVA). However, metastatic lymph has prognostic and therapeutic importance. We compared morbidity and mortality of retroperitoneal para-aortic lymphadenectomy with transperitoneal approach, in the pre-therapeutic lymph node staging of cervix cancers at a locally advanced stage (FIGO IB3-IVA). Methodology All pre- and postoperative data from 331 patients operated for advanced cervical cancer with a negative Positron Emission Tomography-scanner, managed between 1999 and 2017 in 9 centers in France were listed in the FRANCOGYN database. Morbidity and mortality related to the surgical approach was assessed by studying the rate of per and postoperative complications, as well as the duration of hospitalization. Also analyzed were overall survival as well as survival without recurrence. Results 164 patients received a retroperitoneal approach (group 1) and 167 patients received a transperitoneal approach (group 2). Of these 331 patients, 12 had an intraoperative complication (4 of group 1 and 8 of group 2, p=0.36) and 34 a postoperative complication (12 of group 1 and 22 of group 2, p=0.044), none of which required surgical revision. Hospital stay was shorter in group 1 than in group 2 (3.87±2.47 days versus 5.17±3.04 days, p Conclusion The transperitoneal approach has more complications postoperatively and a longer hospital stay than the retroperitoneal approach. In contrast, there is no significant difference in survival without recurrence or overall survival depending on the approach. Disclosure Nothing to disclose.

Introduction/Background In vulvar cancer, it is admitted that tumor-free margin distance is one of the most important element for locoregional control. It is currently recommended to surgically remove the tumor with at least an 8 mm tumor-free margin. The aim of this study was to evaluate the impact of tumor-free margin distance on recurrence and survival in vulvar cancer. Methodology From 2005 to 2016, 112 patients surgically treated for a vulvar squamous cell cancer were included in a retrospective multicenter study. Overall, disease-free and metastasis-free survivals were analyzed according to tumor-free margin distance. Results Patients were divided into three groups : group 1 (margin Conclusion This study did not reveal a significant impact of tumor-free margin distance on recurrence and survival in vulvar cancer. Moreover, the benefit of re-excision seems stronger when tumor-free margins are positive or very close ( Disclosure Nothing to disclose.

Introduction/Background The most appropriate management for patients with stage IV ovarian cancer remains unclear. Our objective was to understand the main determinants associated with survival and to discuss best surgical management in these patients. Methodology Data of 1038 patients with confirmed ovarian cancer treated between 1996 and 2016 were extracted from maintained databases of 7 French referral gynecologic oncology institutions. Patients with stage IV diseases were selected for further analysis. The Kaplan Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariable analysis, was used to account for the influence of multiple variables. Results Two hundred and eight patients met our inclusion criteria: 65 (31.3%) never underwent debulking surgery, 52 (25%) underwent primary debulking surgery (PDS) and 91 (43.8%) neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS). Patients not operated had a significantly worse overall survival than patients that underwent PDS or NACT - IDS (p Conclusion Presence of distant metastases should not refrain surgeons from performing radical procedures, whenever the patient is able to tolerate. Maximal surgical efforts should be done to minimize residual disease as it is the main determinant of survival. Disclosure Nothing to disclose.

International audience; Objective - According to recent European Society of Medical Oncology, European Society of Gynaecological Oncology and European Society of Radiotherapy and Oncology guidelines, adjuvant vaginal brachytherapy (VB) is optional in patients with intermediate risk (IR) and high-intermediate risk (HIR) endometrial cancer (EC). The aim of this French retrospective, multicenter study was to assess the impact of VB in these groups on local recurrence rate, local recurrence-free survival (RFS) and overall survival (OS).Methods - Data of 191 patients with IR and HIR EC who underwent primary surgery with or without VB and no other adjuvant treatment between 2000 and 2016 were extracted from the FRANCOGYN database. Rate of local recurrence, OS and local RFS in these two groups were compared using the Kaplan-Meier method. Results - The number of patients with IR and HIR EC were 118 and 73 respectively. VB was used in 92 patients in IR group and 43 in HIR group. Median follow-up was 22 months. In the HIR group, the local recurrence rate was significantly higher in the no adjuvant therapy group in comparison with the VB group (16.7% and 0% respectively, p=0.02). There was also a significant improvement in local RFS (p=0.01) in VB group. In IR EC, there is no significant difference on local recurrence rate (4.2% and 3.2%, respectively, p=1.00) or local RFS (p=0.54) between the two groups.Conclusions - VB is an efficient adjuvant treatment for patients with HIR EC. VB is not associated with an improvement of RFS or OS in IR EC patient.

International audience; Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). After primary surgery is complete, 6 cycles of intravenous chemotherapy (grade A) are recommended, or a discussion with the patient about intraperitoneal chemotherapy, according to her risk-benefit ratio. After complete interval surgery for FIGO stage III, hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed, in accordance with the modalities of the OV-HIPEC trial (grade B). In cases of postoperative tumor residue or in FIGO stage IV tumors, chemotherapy associated with bevacizumab is recommended (grade A).

International audience; An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). For FIGO stages III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B).