Search

Introduction Pelvic lymph node dissection has been the standard of care for patients with early cervical cancer. Sentinel node (SN) mapping is safe and feasible and may increase the detection of metastatic disease, but benefits of omitting pelvic lymph node dissection in terms of decreased morbidity have not been demonstrated. Materials and methods In an open-label study, patients with early cervical carcinoma (FIGO 2009 stage IA2 to IIA1) were randomly assigned to SN resection alone (SN arm) or SN and pelvic lymph node dissection (SN + PLND arm). SN resection was followed by radical surgery of the tumour (radical hysterectomy or radical trachelectomy). The primary end-point was morbidity related to the lymph node dissection; 3-year recurrence-free survival was a secondary end-point. Results A total of 206 patients were eligible and randomly assigned to the SN arm (105 patients) or SN + PLND arm (101 patients). Most patients had stage IB1 lesion (87.4%). No false-negative case was observed in SN + PLND arm. Lymphatic morbidity was significantly lower in the SN arm (31.4%) than in the SN + PLND arm (51.5%; p = 0.0046), as was the rate of postoperative neurological symptoms (7.8% vs. 20.6%, p = 0.01, respectively). However, there was no significant difference in the proportion of patients with significant lymphoedema between the two groups. During the 6-month postoperative period, the difference in morbidity decreased over time. The 3-year recurrence-free survival was not significantly different (92.0% in SN arm and 94.4% in SN + PLND arm). Conclusion SN resection alone is associated with early decreased lymphatic morbidity when compared with SN + PLND in early cervical cancer.

Hysterectomies are often linked to benign pathologies, but they are nevertheless the cause of anxiety and lead to significant physiological and psychological changes for these women. The uterus, as a symbol of femininity for women, has a unique meaning in relation to its reproductive function and its role in sexuality. Given this fact, does conversational hypnosis-used when a patient arrives at the hospital-have an impact on the pre- and postoperative anxiety of patients hospitalized for gynecological surgery in the form of a hysterectomy? To answer this question, a pilot study of comparative monocentric feasibility was performed with two parallel groups of 10 patients in 2014. The first group was received using ordinary practices, while the second group was received using techniques of conversational hypnosis. The main objective of this study was to estimate the effect of the use of conversational hypnosis upon reception compared to the use of the ordinary care protocol on perioperative anxiety upon reception, measured on the Visual Analog Scale (VAS) of anxiety for patients undergoing a hysterectomy associated with a benign pathology.The results show that patients who received the techniques of conversational hypnosis upon reception to the hospital had clearly lower pre- and postoperative anxiety.The results of this pilot feasibility study made it possible to perform follow-up research to confirm these first results in the context of a call for projects by SIRIC BRIO (Call for projects 2016: Site de Recherche Integree en Cancerologie - Bordeaux Recherche Integree en Oncologie). This research is currently underway to examine the impact of a formal preoperative hypnosis session on the perioperative anxiety of patients hospitalized for hysterectomy related to pelvic gynecologic cancer.

Hysterectomies are often linked to benign pathologies, but they are nevertheless the cause of anxiety and lead to significant physiological and psychological changes for these women. The uterus, as a symbol of femininity for women, has a unique meaning in relation to its reproductive function and its role in sexuality. Given this fact, does conversational hypnosis-used when a patient arrives at the hospital-have an impact on the pre- and postoperative anxiety of patients hospitalized for gynecological surgery in the form of a hysterectomy? To answer this question, a pilot study of comparative monocentric feasibility was performed with two parallel groups of 10 patients in 2014. The first group was received using ordinary practices, while the second group was received using techniques of conversational hypnosis. The main objective of this study was to estimate the effect of the use of conversational hypnosis upon reception compared to the use of the ordinary care protocol on perioperative anxiety upon reception, measured on the Visual Analog Scale (VAS) of anxiety for patients undergoing a hysterectomy associated with a benign pathology.The results show that patients who received the techniques of conversational hypnosis upon reception to the hospital had clearly lower pre- and postoperative anxiety.The results of this pilot feasibility study made it possible to perform follow-up research to confirm these first results in the context of a call for projects by SIRIC BRIO (Call for projects 2016: Site de Recherche Intégrée en Cancérologie - Bordeaux Recherche Intégrée en Oncologie). This research is currently underway to examine the impact of a formal preoperative hypnosis session on the perioperative anxiety of patients hospitalized for hysterectomy related to pelvic gynecologic cancer.

International audience; Background: Focusing on the current context of national and international recommendations, techniques development to evaluate and preserve fertility and patients’ claims, this study aims to make a survey about the management of patients’ breast cancer regarding oncofertility.Methods: Retrospective and analytic study of medical practices at Bergonié Institute of health professionals (medical oncologists, surgical oncologists, nurses) dedicated to the care of non-disseminated breast cancer patients younger than 37, needing medical treatment.Results: The number of participants was 230. The most interested practitioners in fertility theme are those of multidisciplinary consultation and surgeons (P < 0.001), with an increasing interest during last years (P < 0.05). The information about hypofertilizing risks of treatments are delivered most of the time by oncologists (57.7%). The motherhood project is expressed by 11 patients (4.9%) before treatment, only 4 of them receive information on the risks and 49 patients (21.7%) during follow-up. Only 24 patients (48% of the 49) are encouraged for motherhood.Conclusion: To satisfy patients’ requests, several improvements have to be made regarding the patients’ information, the health professionals’ awareness and care coordination.; Introduction: Dans le contexte actuel de revendications des patientes, développement des techniques de préservation de la fertilité, et recommandations (inter)nationales, notre étude a pour objectif de réaliser un état des lieux, concernant l’oncofertilité, chez des patientes en âge de procréer traitées pour cancer du sein.Méthodes: Étude rétrospective, unicentrique, analytique, des pratiques des intervenants de l’institut Bergonié (oncologues médicaux, chirurgiens, infirmières d’annonce), face aux patientes de moins de 37 ans, traitées pour un cancer du sein infiltrant non disséminé, nécessitant traitement médical.Résultats: Deux cents trente patientes ont été incluses, entre 2000 et 2010. Les praticiens s’intéressant le plus à la fertilité sont les chirurgiens et les comités multidisciplinaires (p < 0,001), avec une amélioration de l’intérêt des médecins ces dernières années (p < 0,05). L’information sur le caractère hypofertilisant des traitements est majoritairement donnée par l’oncologue médical (57,7 %). Un projet de maternité est exprimé par 11 patientes (4,9 %) en pré-thérapeutique dont 4 sont informées sur les risques des traitements, et par 49 patientes (21,7 %) durant le suivi. Seulement 24 patientes (48 % d’entre elles) y sont encouragées.Conclusion: Afin de répondre aux demandes des patientes, des améliorations sont à réaliser, dans l’information des patientes, la sensibilisation du personnel, et la coordination des soins.

Objectives The aim of this study was to evaluate perioperative outcomes of robotic-assisted laparoscopic para-aortic lymphadenectomy (PAL) in patients with gynecologic cancers during the learning phases of robotic surgery programs and to compare results of extraperitoneal versus transperitoneal approaches of PAL. Materials and Methods This study is a retrospective multicentric study of patients who underwent robotically assisted laparoscopic PAL (N = 487). Eleven European centers and 1 US center participated in the study. Abstracted data included age, body mass index, indication, type of surgical approach (transperitoneal or extraperitoneal), associated surgical procedures, operative time, estimated blood loss, lymph node count, hospital length of stay (LOS), and complications. Para-aortic lymphadenectomy was performed by an extraperitoneal approach in 58 cases (12%) and transperitoneal in 429 cases (88%). Results The mean (SD) para-aortic lymph node count was 12.6 (8.1), operative time was 217 (85) minutes, estimated blood loss was 105 (110) mL, and LOS was 2.8 (3.2) days. Four (0.8%) conversions to open and 2 (0.4%) conversions to laparoscopy were described. There were 32 lymphocysts (6.6%), 3 deep venous thromboses (0.6%), and 10 transfusions (2.1%). For transperitoneal approach, the average number of lymph nodes removed was higher in isolated PAL group than the hysterectomy combined group (report node counts 95% confidence interval, −7.29 to −3.52, P = 1.5 × 10−6). For isolated PAL, the LOS was shorter in the extraperitoneal group than in the transperitoneal group (report data 95% CI, −1.35 to −0.35, P = 0.001). Conclusions Robotic-assisted PAL seems safe and feasible. More lymph nodes were removed during an isolated transperitoneal PAL dissection compared with a combined procedure with hysterectomy. Extraperitoneal approach seems attractive relative to transperitoneal dissection, but the superiority of one or the other way is not demonstrated by our study.

ObjectiveTo describe the surgical technique of the V-Y cutaneous supra-fascial (modified) gluteal advancement flaps for reconstruction after radical vulvectomy and to assess the outcome of patients according to their clinical characteristics.MethodsBetween January 2006 and July 2012, 36 V-Y flaps were performed in 21 patients to cover the defect after radical surgery of primary vulvar cancers. Surgery duration, blood loss, hospital stay, and wound healing were assessed according to patient age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, and the initial defect size.ResultsMedian patient age, BMI, and ASA score were 80 (range, 31–91), 28 (range, 18–36), 3 (range, 1–3), respectively. Median surgery duration and blood loss were 180 minutes (range, 60–275) and 400 mL (range, 100–1000), respectively. Median operating time was higher in patients ASA3 than ASA less than 3, 200 versus 120 minutes (P = 0.038). Median initial defect size was higher in patients with BMI greater than 28 than 28 or less, 92 versus 55 cm2 (P = 0.004). Local scar defect was observed in 16 patients (76%), mild, less than 10 cm2 in 10 patients. Median wound healing duration was higher in patients with bilateral than unilateral flap, 16 versus 9.5 days (P = 0.034).ConclusionsThe V-Y cutaneous suprafascial gluteal advancement flap for vulvar reconstruction after vulvectomy is an easy, safe, and reliable procedure. However, even mild local scar defect after bilateral flap may impact on wound healing and hospital stay, in elderly and ASA3 patients.

Focusing on the current context of national and international recommendations, techniques development to evaluate and preserve fertility and patients' claims, this study aims to make a survey about the management of patients' breast cancer regarding oncofertility.Retrospective and analytic study of medical practices at Bergonié Institute of health professionals (medical oncologists, surgical oncologists, nurses) dedicated to the care of non-disseminated breast cancer patients younger than 37, needing medical treatment.The number of participants was 230. The most interested practitioners in fertility theme are those of multidisciplinary consultation and surgeons (P0.001), with an increasing interest during last years (P0.05). The information about hypofertilizing risks of treatments are delivered most of the time by oncologists (57.7%). The motherhood project is expressed by 11 patients (4.9%) before treatment, only 4 of them receive information on the risks and 49 patients (21.7%) during follow-up. Only 24 patients (48% of the 49) are encouraged for motherhood.To satisfy patients' requests, several improvements have to be made regarding the patients' information, the health professionals' awareness and care coordination.

The aim of this study was to evaluate perioperative outcomes of robotic-assisted laparoscopic para-aortic lymphadenectomy (PAL) in patients with gynecologic cancers during the learning phases of robotic surgery programs and to compare results of extraperitoneal versus transperitoneal approaches of PAL.This study is a retrospective multicentric study of patients who underwent robotically assisted laparoscopic PAL (N = 487). Eleven European centers and 1 US center participated in the study. Abstracted data included age, body mass index, indication, type of surgical approach (transperitoneal or extraperitoneal), associated surgical procedures, operative time, estimated blood loss, lymph node count, hospital length of stay (LOS), and complications. Para-aortic lymphadenectomy was performed by an extraperitoneal approach in 58 cases (12%) and transperitoneal in 429 cases (88%).The mean (SD) para-aortic lymph node count was 12.6 (8.1), operative time was 217 (85) minutes, estimated blood loss was 105 (110) mL, and LOS was 2.8 (3.2) days. Four (0.8%) conversions to open and 2 (0.4%) conversions to laparoscopy were described. There were 32 lymphocysts (6.6%), 3 deep venous thromboses (0.6%), and 10 transfusions (2.1%). For transperitoneal approach, the average number of lymph nodes removed was higher in isolated PAL group than the hysterectomy combined group (report node counts 95% confidence interval, -7.29 to -3.52, P = 1.5 × 10⁻⁶). For isolated PAL, the LOS was shorter in the extraperitoneal group than in the transperitoneal group (report data 95% CI, -1.35 to -0.35, P = 0.001).Robotic-assisted PAL seems safe and feasible. More lymph nodes were removed during an isolated transperitoneal PAL dissection compared with a combined procedure with hysterectomy. Extraperitoneal approach seems attractive relative to transperitoneal dissection, but the superiority of one or the other way is not demonstrated by our study.