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Purpose: To assess the agreement between biometric parameters measured by a spectral-domain optical coherence tomography optical biometer device (Optopol Revo NX) with a validated swept-source biometer (IOLMaster 700) and a validated optical low-coherence reflectometry biometer (Lenstar LS 900), in cataract surgery candidates., Methods: In this prospective comparative study, 100 patients (100 eyes) who were eligible for cataract surgery were involved. Bland-Altman plots were used to assess agreement between devices for biometric parameters including axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT)., Results: AL measurements were successful in 82 eyes (82.0%) with Revo NX, in 91 eyes (91.0%) with Lenstar LS 900, and in 97 eyes (97.0%) with IOLMaster 700. When Revo NX was compared to IOL Master 700 and Lenstar LS 900, the mean differences were as follows: -0.02 ± 0.02 mm and -0.02 ± 0.03 mm (P = 0.313, P = 0.525) for AL, 0.01 ± 0.03 mm and 0.10 ± 0.03 mm (P = 0.691, P = 0.002) for ACD, -0.15 ± 0.03 mm and 0.001 ± 0.04 mm (P < 0.001, P = 0.95) for LT, and -2.29 ± 0.92 μm, and 0.73 ± 1.43 μm (P = 0.015, P = 0.612) for CCT. Three devices were highly correlated for AL, ACD, LT, and CCT (interclass correlation coefficient > 0.75). Bland-Altman plots showed a narrower 95% limit of agreement (-0.35 to 0.31) between Revo NX and IOLMaster 700 in measuring AL., Conclusions: Despite the higher measurement failure rate in eyes with cataract, the Revo NX showed very good agreement with the IOLMaster 700 and Lenstar LS 900 optical biometers in measuring AL, ACD, LT, and CCT. However, ACD and LT measurements cannot be considered interchangeable between these devices., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Current Ophthalmology.)

The potential benefits and limitations of benign hysterectomy surgical approaches are still debated. We aimed at evaluating any differences with a systematic review and meta-analysis. PubMed, MEDLINE, and EMBASE databases were last searched on 6/2/2021 to identify English randomized controlled trials (RCTs), prospective cohort and retrospective independent database studies published between Jan 1, 2010 and Dec 31, 2020 reporting perioperative outcomes following robotic hysterectomy versus laparoscopic, open, or vaginal approach (PROSPERO #CRD42022352718). Twenty-four articles were included that reported on 110,306 robotic, 262,715 laparoscopic, 189,237 vaginal, and 554,407 open patients. The robotic approach was associated with a shorter hospital stay (p < 0.00001), less blood loss (p = 0.009), and fewer complications (OR: 0.42 [0.27, 0.66], p = 0.0001) when compared to the open approach. The main benefit compared to the laparoscopic and vaginal approaches was a shorter hospital (R/L WMD: - 0.144 [- 0.21, - 0.08], p < 0.0001; R/V WMD: - 0.39 [- 0.70, - 0.08], p = 0.01). Other benefits seen were sensitive to the inclusion of database studies. Study type differences in outcomes, a lack of RCTs for robotic vs. open comparisons, learning curve issues, and limited robotic vs. vaginal publications are limitations. While the robotic approach was mainly comparable to the laparoscopic approach, this meta-analysis confirms the classic benefits of minimally invasive surgery when comparing robotic hysterectomy to open surgery. We also reported the advantages of robotic surgery over vaginal surgery in a patient population with a higher incidence of large uterus and prior surgery., (© 2023. The Author(s).)

Minimally invasive surgery (laparoscopic or robotic assisted) is currently recommended when surgery is envisaged, including for patients in the high risk group. The place of the uterine manipulator in this indication still needs to be clarified by prospective studies. The indocyanine green sentinel lymph node procedure has become the reference technique for lymph node staging of FIGO stages I and II regardless of histological type. Management must be carried out in a specialized institution by a team specialised in the gynaecological cancers., Competing Interests: G. Canlorbe déclare des liens avec Intuitive Surgical et avoir été pris en charge, à l’occasion de déplacement pour congrès, par Applied Medical. - M. Nikpayam déclare n’avoir aucun lien d’intérêts. - J. Belghiti déclare des interventions ponctuelles pour Intuitive Surgical.

Despite conventional treatment combining complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy, residual microscopic peritoneal metastases (mPM) may persist as the cause of peritoneal recurrence in 60% of patients. Therefore, there is a real need to specifically target these mPM to definitively eradicate any traces of the disease and improve patient survival. Therapeutic targeting method, such as photodynamic therapy, would be a promising method for such a purpose. Folate receptor alpha (FRα), as it is specifically overexpressed by cancer cells from various origins, including ovarian cancer cells, is a good target to address photosensitizing molecules. The aim of this study was to determine FRα expression by residual mPM after complete macroscopic CRS in patients with advanced high-grade serous ovarian cancer (HGSOC). A prospective study conducted between 1 June 2018 and 10 July 2019 in a single referent center accredited by the European Society of Gynecological Oncology for advanced EOC surgical management. Consecutive patients presenting with advanced HGSOC and eligible for complete macroscopic CRS were included. Up to 13 peritoneal biopsies were taken from macroscopically healthy peritoneum at the end of CRS and examined for the presence of mPM. In case of detection of mPM, a systematic search for RFα expression by immunohistochemistry was performed. Twenty-six patients were included and 26.9% presented mPM. In the subgroup of patients with mPM, FRα expression was positive on diagnostic biopsy before neoadjuvant chemotherapy for 67% of patients, on macroscopic peritoneal metastases for 86% of patients, and on mPM for 75% of patients. In the subgroup of patients with no mPM, FRα expression was found on diagnostic biopsy before neoadjuvant chemotherapy in 29% of patients and on macroscopic peritoneal metastases in 78% of patients. FRα is well expressed by patients with or without mPM after complete macroscopic CRS in patients with advanced HGSOC. In addition to conventional cytoreductive surgery, the use of a therapeutic targeting method, such as photodynamic therapy, by addressing photosensitizing molecules that specifically target FRα may be studied.

Background: The objective of this work was to describe the technique of exclusive lipofilling in breast reconstruction after total mastectomy, to evaluate the satisfaction and quality of life of the patients, and to explore current literature on the subject., Methods: We conducted a retrospective observational multicentric study from January 2013 to April 2020. The modalities of surgery, esthetic result, and patient satisfaction were evaluated with the breast reconstruction module of BREAST-Q., Results: Complete data were available for 37 patients. The mean number of sessions was 2.2 (standard deviation 1.1), spread over an average of 6.8 months (SD 6.9). The average total volume of fat transferred was 566.4 mL. The complication rate was 18.9%. No severe complication was observed (Clavien-Dindo 3/4). Two patients were diagnosed with recurrence, in a metastatic mode (5.4%). The average satisfaction rate was 68.4% (SD 24.8) for psychosocial well-being and 64.5% (SD 24.1) for sexual well-being. The satisfaction rate was 60.2% (SD 20.9) for the image of the reconstructed breast and 82.7% (SD 21.9) for locoregional comfort., Conclusions: Breast reconstruction by exclusive lipofilling after total mastectomy provides satisfactory quality of life scores. The simplicity of the surgical technique and equipment required, and the high satisfaction rate confirm that lipofilling should be included in the panel of choice of breast reconstruction techniques.

Background: Epithelial ovarian cancers (EOC) are usually diagnosed at an advanced stage and managed by complete macroscopic cytoreductive surgery (CRS) and systemic chemotherapy. Peritoneal recurrence occurs in 60% of patients and may be due to microscopic peritoneal metastases (mPM) which are neither eradicated by surgery nor controlled by systemic chemotherapy. The aim of this study was to assess and quantify the prevalence of residual mPM after complete macroscopic CRS in patients with advanced high-grade serous ovarian cancer (HGSOC)., Methods: A prospective study conducted between 1 June 2018 and 10 July 2019 in a single referent center accredited by the European Society of Gynecological Oncology for advanced EOC management. Consecutive patients presenting with advanced HGSOC and eligible for complete macroscopic CRS were included. Up to 13 peritoneal biopsies were taken from macroscopically healthy peritoneum at the end of CRS and examined for the presence of mPM. A mathematical model was designed to determine the probability of presenting at least one mPM after CRS., Results: 26 patients were included and 26.9% presented mPM. There were no differences in characteristics between patients with or without identified mPM. After mathematical analysis, the probability that mPM remained after complete macroscopic CRS in patients with EOC was 98.14%., Conclusion: Microscopic PM is systematically present after complete macroscopic CRS for EOC and could be a relevant therapeutic target. Adjuvant locoregional strategies to conventional surgery may improve survival by achieving microscopic CRS.

Introduction: In France, participation in the organized breast cancer screening program remains insufficient. A personalized approach adapted to the risk factors for breast cancer (RBC) should make screening more efficient. A RBC evaluation consultation would therefore make it possible to personalize this screening. Here we report our initial experience., Material and Method: This is a prospective study on women who were seen at the RBC evaluation consultation and analyzing: their profile, their risk assessed according to Tyrer Cuzick model (TC)±Mammorisk© (MMR), the existence of an indication of oncogenetic consultation (Eisinger and Manchester score), their satisfaction and the recommended monitoring., Results: Among the women who had had a TCS and/or MMR evaluation of SCR (n=153), 76 (50%) had a high risk (n=67) or a very high risk (n=9). Almost half (47%) had a possible (15%) or certain (32%) indication to an oncogenetic consultation. Regarding this consultation, 98% of women were satisfied or very satisfied. In total, 60% of women had a change in screening methods., Conclusion: This RBC evaluation consultation satisfies women and for a majority of them, modifies their methods of breast cancer screening., (Copyright © 2020 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Background: Anti-NMDA receptor antibody (anti-NMDAr) encephalitis, although still a rare condition, is well known to neurologists as it is the leading cause of non-infectious acute encephalitis in young women. However, this is less well known to gynecologists, who may have a decisive role in etiological management. Indeed, in 30-60% of cases in women of childbearing age, it is associated with the presence of an ovarian teratoma, whose removal is crucial in the resolution of symptomatology., Objectives: Primary objective of our work was to present a review in a very schematic and practical way for gynecologists, about the data on anti-NMDAr encephalitis in terms of epidemiology, clinical symptomatology, treatment and prognosis. The second objective was to propose a decision tree for gynecologists to guide them, in collaboration with neurologists and anesthesiologists, after the diagnosis of NMDAr encephalitis associated with an ovarian mass., Method: We conducted an exhaustive review of existing data using PubMed and The Cochrane Library. Then, we illustrated this topic by presenting two typical cases from our experience., Results: Anti-NMDA antibody encephalitis association with an ovarian teratoma is common, especially in women of reproductive age. Complementary examinations in search of an ovarian teratoma must therefore be systematic to envisage a possible surgical excision that may improve patient prognosis., Conclusion: Anti-NMDA antibody encephalitis should not be ignored by gynecologists whose role in management is central.

In March 2019, Harter et al. published the results of the LION study (Lymphadenectomy in patients with advanced ovarian neoplasms) which raises the question of pelvic and para-aortic lymphadenectomy for patients with advanced-stage epithelial ovarian cancer (EOC). These results influenced the new French recommendations published in December 2018 by the French National Cancer Institute (INCa). Thus, it no longer seems consistent to perform a systematic lymphadenectomy for patients for whom there is no argument for nodal involvement, when a macroscopic complete peritoneal cytoreductive surgery has been performed. The question of preoperative lymph node assessment is therefore essential, whereas more than half of the patients in the LION study had metastatic lymph node involvement that was histologically proven. For the assessment of lymph node status by imaging, superior sensitivity for Positron Emission Tomography is demonstrated in comparison with CT-scan or Magnetic Resonance Imaging. Nevertheless, thoraco-abdomino-pelvic CT-scan with contrast injection remains the gold standard for this indication. In the absence of suspected involvement, supra-renal, mesenteric, coelio-hepatic, and cardio-phrenic lymphadenectomy are not recommended. Lymphadenectomies should always be performed in the other situations of EOC management apart from the rare case of stage 1 expansile subtype mucinous carcinoma. The aim of this review is to discuss lymphadenectomy indications for the surgical management of EOC by taking into account new data from the scientific literature., (Copyright © 2019 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Vulvar cancer is a rare disease, which represents 4% of gynecological tumors with an incidence of 0.5 to 1.5 per 100,000 women per year in France. Vulvar cancers are induced in 30 to 69% of cases by the presence of papillomavirus (HPV), in particular HPV 16 and 18, and can also occur in an inflammatory context. The diagnosis is made by histological examination of a vulvar biopsy. The histological subtype is a squamous cell carcinoma in 90% of cases. The 5-year survival of patients with vulvar cancer ranges from 86% for localized stages (FIGO I and II) to 57% for advanced stages (FIGO III and IVA), and 17% in case of metastatic disease (FIGO IVB). The treatment of vulvar cancer is mainly surgical, but radiotherapy and chemotherapy have become more important in recent years. Management has evolved into a personalized multidisciplinary approach, where each therapeutic decision must be discussed in a multidisciplinary consultation meeting. Surgical excision with tumor- free margins is central in the management of early stages. The indication for radiotherapy and brachytherapy should be discussed in the event that the excisional margins are positive in early stages. Radiotherapy is indicated in cases of lymph node involvement or in a neoadjuvant situation if the tumor is not immediately resectable. In this situation, it can be associated with chemotherapy. Chemotherapy alone is the treatment of diseases that are metastatic at the time of diagnosis., (Copyright © 2019 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

The role of pelvic sentinel lymph node dissection (SLND) is increasing in oncological pelvic surgery, especially in the management of cervical and endometrial cancer.SLND using indocyanine green (ICG) is safe and effective, and its sensitivity is higher than with other detection methods. The advantages of ICG are its low toxicity, its confinement within the vascular compartment, its rapid excretion, and the rarity of allergic reaction. These advantages confer to this fluorescent dye a superiority over blue, which can cause anaphylactic reactions. Using ICG does not require advance planning involving nuclear protection and delayed surgery, as are mandatory when using 99 Tc detection. ICG allows the surgeon to visualize the lymph nodes through the peritoneum and thus avoid wide dissection.According to European guidelines,1 the indications for SLND in cervical cancer are for patients with FIGO (International Federation of Gynecology and Obstetrics) IA1-IA2 disease, lymphovascular space involvement - positive status, without systematic pelvic lymphadenectomy - and patients with FIGO IB1-IIA1 disease, prior to systematic pelvic lymphadenectomy. Guidelines1 2 for endometrial cancer management state that SLND is indicated in cases of low-risk endometrial cancer (FIGO IA, grade 1-2), without systematic lymphadenectomy in cases of non-detection, with the technique being preferable to systematic lymphadenectomy in cases of intermediate-risk endometrial cancer (FIGO IB, grade 1-2, or FIGO IA, grade 3).2 Our objective is to review the technique of ICG injection and the real-time detection of pelvic SLNs using near-infrared imaging by means of a step-by-step explanation of the procedure using an instructional Video 1., (© IGCS and ESGO 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

As obesity prevalence increases worldwide, healthcare professionals are often faced with challenging cases associated with massive obesity. A 33-year-old woman (weight 342 kg, body mass index = 100 kg/m²) presented with respiratory failure, limb edema and ascites. Abdominal CT scan became feasible after initial weight loss and showed a large pelvic mass in contact with the left ovary. The surgical removal performed despite a high-risk profile led to the diagnosis of a giant mucinous borderline tumor whose growth was due to delayed care and responsible for multiple severe complications: sepsis, anemia, esophagitis, constipation, anorexia due to mechanical compression, undernutrition, sarcopenia and lower limb edema contributing to a severe disability. After 7 months under specialized care, her weight decreased to 180 kg, complications were treated and disability improved. This case, showing that, despite barriers, a multidisciplinary approach makes quality of care possible even in massively obese patients, is an educational example to reduce stigma.

Background: Surgical management of borderline ovarian tumors (BOTs) is similar to that of ovarian cancer apart from lymphadenectomy. However, the complete procedure including peritoneal washing, infracolic omentectomy and random peritoneal biopsies remains a subject of controversy especially in presumed early stage BOTs. To evaluate the prognostic value of complete surgical staging on recurrence rates, recurrence free (RFS) and overall survival (OS) in a multicentre cohort of BOTs., Methods: This retrospective multicentre study included 428 patients with BOTs diagnosed from January 1980 to December 2008. Survival estimates were based on Kaplan-Meier calculations and RFS defined as the time from the date of surgery to the date of recurrence., Results: The median time of follow-up was 94.9 months (range: 60.00-207.3). The overall recurrence rate was 23.8 %. There was no difference in 5-year RFS between patients with and without complete surgical staging 78.1 % (95 % CI 68.9-88.6) and 70.9 % (95 % CI 64.6-77.8), (p = 0.0806). In the whole cohort, 5-year OS was higher for patients with complete surgical staging 98.4 % (95 % CI 96.8-1.0) and 93.8 % (95 % CI 88.1-1), (p = 0.0182) but this difference was not significant for patients with FIGO stage I 98.6 % (95 % CI 96.7-1) and 92.7 % (95 % CI 83.4-1.0), p = 0.1275, respectively., Conclusions: Complete staging surgery should be considered as a cornerstone treatment for patients with advanced stage BOT but not for those with stage I disease.

Background/aim: In the era of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)FDG-PET/CT), more patients are being diagnosed with N3M0 disease. The objective of this study was to assess the prognostic impact of radical lymph node surgery (RLNS) in patients with locally advanced breast cancer classified as lymph node N3 disease according to the American Joint Committee on Cancer (AJCC) 2002 in whom there is no known distant metastasis and in the context of multimodal therapy., Patients and Methods: This was a two-Center retrospective study that included patients with breast cancer classified as N3M0 after (18)FDG-PET/CT assessment. We reviewed the clinical characteristics, surgical treatment and oncological outcomes of those patients., Results: Thirty-nine patients fulfilled the inclusion criteria. Multimodal treatment included neo-adjuvant chemotherapy (n=34), adjuvant radiotherapy (n=33), adjuvant chemotherapy (n=18) or neo- or adjuvant hormone therapy (n=17). Surgical treatment was not homogeneous. Eight patients had undergone RLNS and 31 conventional axillary lymph node dissection (CD). There was no significant difference in median overall survival between the RLNS group and the CD group (32 months (28-36) vs. 49 months (42-56) respectively (p=0.25)). The overall recurrence rate was 23%. Out of the 8 patients who had under gone RLNS, three had relapsed (two with distant metastases and one local)., Conclusion: RLNS was not proven to be beneficial in our study. In order to guide surgical management for these patients, PET/CT and magnetic resonance imaging (MRI) could be of interest, therefore a pilot study to improve reproducible surgical management would be of interest., (Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)