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Objectives Description of fertility and prognosis of patients with borderline ovarian tumor (BOT) treated by fertility-sparing surgery through a longitudinal study from the French national cancer network. Methods All consecutive patients diagnosed with BOT from the French National Network dedicated to Ovarian Malignant Rare Tumors from 2010 and 2017 were selected. In 2018, an update was made by sending a questionnaire regarding recurrence and fertility to patients aged under 43 years at diagnosis and treated conservatively. We compared the characteristics of the patients with/without recurrence and with/without live birth. Results Fifty-two patients aged 18 to 42 years presented a desire of pregnancy. Thirty patients (58%) presented a FIGO IA tumor, and 20 patients were treated by bilateral cystectomies (38%). We observed at least one live birth for 33 patients (63%) and local recurrences in 20 patients (38%). Both recurrence and live birth in 17 patients (33%) were reported, with recurrence occurring before pregnancy, after a second fertility-sparing treatment, in half of the cases. No factors associated with recurrence or live birth in this study were identified. Moreover, in this population, both recurrence and live birth were independent of age, with a linear risk along time. Disease-free survival was worse for patients treated with bilateral cystectomy (n = 20, 38%), with no difference in terms of fertility. Conclusion Two third of the patients experienced life birth after conservation surgery. We did not highlight an age/time from surgery for which the risk of recurrence outweighs the chance of pregnancy and to radicalize surgery. Moreover, almost a quarter of the live birth occurred after recurrence, with no more further event to date in these patients. The results encourage to consider a second fertility-sparing surgery after local borderline recurrence in the case of pregnancy desire. All these decisions must be discussed in specialized multidisciplinary boards.

Introduction Reoperation after breast-conserving surgery (BCS) could be proposed for positive or close margins. Reoperation type, re-excision or mastectomy, depends on several factors in relation to patient's and tumor's characteristics. We have analyzed our breast cancer (BC) database in order to determine second and third attempts for BCS and mastectomy rates, as well as associated factors for type of surgery. Methods All patients with BCS between 1995 and 2017 were included. Patient's characteristics, pathologic results, and treatments were analyzed. Reoperation rate, type of reoperation, second reoperation, and associated factors of reoperation, mastectomy, and third intervention were determined. Three periods were determined: P1-P3. Results We analyzed 10,761 patients: 1,161 with ductal carcinoma in situ (DCIS) and 9,600 with invasive BC. The reoperation rate was 41.4% for DCIS and 28.0% for invasive BC. Using multivariate analysis, we identified tumor size >20 mm as being a risk factor for reoperation, whereas age >50 years, P2-3, and some localization decreased reoperation rates. For invasive BC, age >40 years, triple-negative tumors, neoadjuvant chemotherapy, and noncentral tumors decreased reoperation rates and lobular tumor, multifocal tumors, lymphovascular invasion, DCIS component, and Her2-positive tumors increased reoperation rates. For patients requiring reoperation, re-excision was performed in 48.1% (1,523/3,168) and mastectomy was required after first re-excision in 13.46% (205/1,523). For DCIS, mastectomy rates were higher for grade 2 and tumor ≥20 mm. For invasive BC, mastectomy rates were higher for lobular, multifocal, ≥20 mm, Her2-positive tumors and diffuse positive margins and lower for age >50 years and during the last period. Even if interval time between surgery and adjuvant treatments was higher for patients with reoperation, survival rates were not different between patients with and without reoperation. Conclusion A decrease in reoperation and mastectomy rates had been reported with several associated factors. A third intervention with mastectomy was required in 13.5% of patients. This information should be done in case of reoperation.

Background Enhanced recovery after surgery (ERAS) is a multimodal approach aiming to improve rehabilitation after surgery. In gynecologic malignancies, para-aortic lymphadenectomy (PAL) is indicated for either diagnostic or therapeutic finalities. Minimally invasive surgery (MIS) constitutes the cornerstone for ERAS programs. Methods This retrospective study conducted between November 2006 and January 2018, aims to analyze the role of ERAS implementation for patients undergoing PAL. Starting 2016, an ERAS protocol was implemented for all the patients in our institution. All patients who underwent PAL for gynecologic malignancies were included in this study. To analyze the impact of this implementation on the surgical outcomes (length of hospital stay (LOS)) and the post-operative complications, we compared the patients who underwent PAL within ERAS protocol between 2016 and 2018 ‘ERAS Group’ to the patients who underwent PAL prior to this implementation (between 2006 and 2015) ‘Prior to ERAS group’. Results A total of 193 patients were identified. ‘ERAS Group’ was associated with a significant decrease of median LOS (2 days vs. 3 days, p Conclusions Implementing ERAS protocols for patients undergoing minimally invasive PAL is an independent factor improving early recovery and decreasing the LOS without increasing severe complications. Disclosures Drs Isabelle Masquin, Mellie Heinemann, Christophe Zemmour, Camille Jauffret-Fara, Guillaume Blache, Laura Sabiani, Clement Brun, Marion Faucher and Houssein El Hajj have no conflicts of interest or financial ties to disclose. Gilles Houvenaeghel and Eric Lambaudie are proctors for Intuitive Surgical.

Background: Enhanced recovery after surgery (ERAS) is a multimodal approach aiming to improve rehabilitation after surgery. In gynecologic malignancies, para-aortic lymphadenectomy (PAL) is indicated for either diagnostic or therapeutic finalities. Minimally invasive surgery (MIS) constitutes the cornerstone for ERAS programs. Methods: This retrospective study conducted between November 2006 and January 2018, aims to analyze the role of ERAS implementation for patients undergoing PAL. Starting 2016, an ERAS protocol was implemented for all the patients in our institution. All patients who underwent PAL for gynecologic malignancies were included in this study. To analyze the impact of this implementation on the surgical outcomes (length of hospital stay (LOS)) and the post-operative complications, we compared the patients who underwent PAL within ERAS protocol between 2016 and 2018 “ERAS Group” to the patients who underwent PAL prior to this implementation (between 2006 and 2015) “Prior to ERAS group” Results: A total of 193 patients were identified. “ERAS Group” was associated with a significant decrease of median LOS (2 days vs. 3 days, p

International audience; Introduction. Only few cases of robotic latissimus dorsi flap reconstruction (RLDFR) have been reported in indication of reconstruction for breast cancer (BC). We report our experience of combined robotic nipple-sparing mastectomy (R-NSM) and RLDFR, and analyze technique, indications, and reproducibility. Methods. All patients with R-NSM and RLDFR from November 2016 to August 2, 2018, were analyzed, and technics have been described. Complication rate with Clavien-Dindo grading and postoperative hospitalization length (days) are reported. Results. Thirty-five R-NSM with RLDFR were performed in 22 cases for primitive BC and 13 for local recurrence. In 12 patients, another surgical procedure was performed during the same time (axillary lymph node dissection or contralateral breast surgery). R-NSM was realized through a short axillar incision, with inside-only installation for 12 patients (34.3%): 18 nonautologous and 17 autologous RLDFR associated with implant in 9 patients. In logistic regression, mastectomy weight >330 g was significantly associated with the use of implant (odds ratio [OR] = 17, P = .015), and significant factor of the time of anesthesia >= 380 minutes was 2 installations (OR = 10.4, P = .049). The median duration of hospitalization stay was 4 days. Complications rates were 51.4% (18/35; 9 grade-1, 2 grade-2, and 7 grade-3). In logistic regression, associated other surgical procedure was predictive of grade-3 complications (OR = 6.87, P = .053). Conclusion. We confirmed the reproducibility and safety of R-NSM and RLDFR with a decreased complication rate. NSM was performed in 42.8% of our patients after previous radiotherapy. We observed an increase of grade-3 complications when R-NSM and RLDFR was combined to another surgical procedure.

Introduction Reoperation after breast-conserving surgery (BCS) could be proposed for positive or close margins. Reoperation type, re-excision or mastectomy, depends on several factors in relation to patient’s and tumor’s characteristics. We have analyzed our breast cancer (BC) database in order to determine second and third attempts for BCS and mastectomy rates, as well as associated factors for type of surgery. Methods All patients with BCS between 1995 and 2017 were included. Patient’s characteristics, pathologic results, and treatments were analyzed. Reoperation rate, type of reoperation, second reoperation, and associated factors of reoperation, mastectomy, and third intervention were determined. Three periods were determined: P1–P3. Results We analyzed 10,761 patients: 1,161 with ductal carcinoma in situ (DCIS) and 9,600 with invasive BC. The reoperation rate was 41.4% for DCIS and 28.0% for invasive BC. Using multivariate analysis, we identified tumor size >20 mm as being a risk factor for reoperation, whereas age >50 years, P2–3, and some localization decreased reoperation rates. For invasive BC, age >40 years, triple-negative tumors, neoadjuvant chemotherapy, and noncentral tumors decreased reoperation rates and lobular tumor, multifocal tumors, lymphovascular invasion, DCIS component, and Her2-positive tumors increased reoperation rates. For patients requiring reoperation, re-excision was performed in 48.1% (1,523/3,168) and mastectomy was required after first re-excision in 13.46% (205/1,523). For DCIS, mastectomy rates were higher for grade 2 and tumor ≥20 mm. For invasive BC, mastectomy rates were higher for lobular, multifocal, ≥20 mm, Her2-positive tumors and diffuse positive margins and lower for age >50 years and during the last period. Even if interval time between surgery and adjuvant treatments was higher for patients with reoperation, survival rates were not different between patients with and without reoperation. Conclusion A decrease in reoperation and mastectomy rates had been reported with several associated factors. A third intervention with mastectomy was required in 13.5% of patients. This information should be done in case of reoperation.

Objective Para-aortic lymphadenectomy was the cornerstone of gynecologic oncology surgery. In endometrial cancer, the quality of para-aortic lymphadenectomy had direct impact on survival of patient. The launch of robot assisted laparoscopy started in 2005 in France, and in 2008 a transperitoneal para-aortic lymphadenectomy was described [1]. With the increase of robots, the robot assisted laparoscopy became more and more popular, hence the need of video tutorial to help less experienced surgeon in this surgical procedure [2]. Methods We proposed a description in 10 key steps, of a transperitoneal para-aortic lymphadenectomy by robot assisted laparoscopy (Da Vinci® Si or Xi Robot Surgical System; Intuitive Surgical Inc., Sunnyvale, CA, USA), without other surgical procedure. Results The 10 steps are: Step 1: port placement and Da Vinci robot positioning Step 2: identification of the right ureter Step 3: identification of the left renal vein Step 4: latero-caval and aorto-caval lymph nodes dissection Step 5: identification of the left ureter Step 6: creation of peritoneal tent Step 7: identification of the inferior mesenteric artery Step 8: latero-aortal lymph nodes dissection Step 9: pre-sacral lymph nodes dissection Step 10: extraction of bags with specimen and surgical textile. Conclusion A standardization of transperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy is the basis of teaching and learning process. Also it increases the quality of surgery, and consequently decreases the risk of complications.

Highlights • Our article lists all cases in the neovaginal cancer literature since 1929. • We propose an explanation of the pathophysiology of the development of neovaginal cancer. • We propose a classification of neovaginal cancers., We report a case of mucinous adenocarcinoma developed on sigmoid colpoplasty, performed for a congenital agenesis vaginal. The cancer development of neovagina remains exceptional. Its management consists, in the majority of cases, in surgery for a complete excision. Adjuvant treatments are associated according to the pathological results and the neovagina reconstruction technique performed.

Background Few studies of robotic nipple sparing mastectomy (NSM) were reported. We report feasibility of robotic NSM and determine standard surgical procedure and learning curve threefold. Methods A cohort of patients with robotic NSM for breast cancer was analyzed. Complications and post-operative hospitalization stay were reported. The same technic was used for all patients except for skin and nipple areolar complex (NAC) dissection. Differences between three surgical procedures of NAC dissection were analyzed: group 1, dissection with robotic scissors using coagulation; group 2, dissection with robotic scissors without coagulation; and group 3, dissection with non-robotic scissors and then robotic dissection. We explored possible effect of learning curve among patients from group 1 with the same surgical procedure. Results Twenty-seven NSM with immediate breast reconstruction for breast cancers, 22 invasive and 5 in situ, were performed, with robotic latissimus dorsi-flap (RLDF) only in 17 cases, RLDF and breast implant in 6 cases, and implant alone in 4 cases. Repartition according to 3 surgical procedure groups was 16, 5, and 6 patients. Mean time of surgery and anesthesia decrease according to groups 1 to 3. Among 16 patients from group 1, time of surgery and anesthesia decreased with learning curve. Post-operative hospitalization decreased from group 1 to 3. We reported a total of 11 complications, with significant difference between groups (10 for group 1). Skin complications were higher for group 1 in comparison with groups 2–3 (p = 0.02). Conclusion Robotic NSM can be performed with a brief learning. Standardized technique is proposed with non-robotic scissors superficial dissection and then dissection with robot.

Resume Objectif Souligner l’interet du mono-trocart pour realiser des annexectomies uni- ou bilaterales. Patientes et methode Etude descriptive mono-centrique. Resultats Au total, 79 annexectomies uni- ou bilaterales ont ete realisees par cœlioscopie mono-trocart entre janvier 2010 et septembre 2012, a l’institut Paoli-Calmettes (Marseille). On note trois types d’indication chirurgicale : diagnostique, therapeutique ou prophylactique. L’âge median est de 50 ans (22–78 ans). L’IMC median est de 22,4 kg/m2 (17,5–37,7 kg/m2). La mediane des pertes sanguines est de 0 cc (0 cc–50 cc). La duree d’hospitalisation mediane est d’une journee (0–6 jours). Le taux de conversions de cette etude est de 8,8 %. Discussion et conclusion L’approche cœlioscopique par trocart unique transombilical pour realiser des annexectomies uni- ou bilaterales est une evolution naturelle de la cœlioscopie conventionnelle. Si son role cosmetique semble evident, son interet therapeutique par rapport aux techniques traditionnelles doit etre demontre par des etudes portant sur des effectifs plus importants.

Controversy exists about the prognosis of breast cancer in young women. Our objective was to describe clinicopathological and prognostic features to improve adjuvant treatment indications.We conducted a retrospective multi centre study including fifteen French hospitals. Disease-free survival's data, clinical and pathological criteria were collected.5815 patients were included, 15.6% of them where between 35 and 40 years old and 8.7% below 35. In 94% of the cases, a palpable masse was found in patients ≤35 years old. Triple negative and HER2 tumors were predominantly found in patients ≤35 (22.2% and 22.1%, p 0.01). A young age ≤40 years (p 0.001; hazard ratio [HR]: 2.05; 95% confidence limit [CL]: 1.60-2.63) or ≤35 years (p 0.001; [HR]: 3.86; 95% [CL]: 2.69-5.53) impacted on the indication of chemotherapy. Age ≤35 (p 0.001; [HR]: 2.01; 95% [CL]: 1.36-2.95) was a significantly negative factor on disease-free survival. Chemotherapy (p 0.006; [HR]: 0.6; 95% [CL]: 0.40-0.86) and positive hormone receptor status (p 0.001; [HR]: 0.6; 95% [CL]: 0.54-0.79) appeared to be protector factors. Patients under 36, had a significantly higher rate of local recurrence and distant metastasis compared to patients35-40 (21.5 vs. 15.4% and 21.8 vs. 12.6%, p 0.01).Young women present a different distribution of molecular phenotypes with more luminal B and triple negative tumors with a higher grade and more lymph node involvement. A young age, must be taken as a pejorative prognostic factor and must play a part in indication of adjuvant therapy.

Resume Objectif Nous rapportons notre experience du mono-trocart en chirurgie gynecologique oncologique, et soulignons la faisabilite de ces procedures via le mono-trocart. Patientes et methode Etude retrospective, de faisabilite, monocentrique. Toutes les patientes qui ont ete operees par mono-trocart entre le 1er janvier 2010 et le 1er novembre 2011 ont ete incluses. Resultats Cent-sept patientes ont ete incluses. Nous avons realise differentes interventions : annexectomie uni- ou bilaterales, hysterectomie totale, curages pelviens et lombo-aortique. La mediane d’âge de la population et l’indice de masse corporelle sont respectivement de 52 ans et 22,6 kg/m2. Au total, six interventions seront converties. La duree mediane d’hospitalisation, toutes procedures confondues, est de deux jours. On retrouve un faible taux de complications postoperatoires. Conclusion La chirurgie oncologique gynecologique semble faisable par mono-trocart. Cependant, il faut d’autres etudes pour confirmer un avantage de l’utilisation du mono-trocart par rapport a la cœlioscopie conventionnelle.