LGSOC is a rare disease. Few data of large size have been published. We conducted a multicenter retrospective analysis of LGSC patients selected from the French Epidemiological Strategy and Medical Economics Ovarian Cancer database between 2000 and 2019. This database includes all ovarian cancer pts treated in 18 French Comprehensive Cancer Centers. The main objective was to describe the management of these patients. Secondary objectives were to analyse progression-free survival (PFS) and overall survival (OS) and prognostic factors in the stage III/IV population. Out of the 13032 pts, 230 (1.8%) with a confirmed diagnosis of stage III (n=171)/IV (n=59) LGSOC were identified. Median age at diagnosis was 55.5y (19.8-88.2). 128 (55.6%) pts had primary debulking surgery (PDS) and 35 (15.2%) neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS). 49 (21.3%) pts did not have debulking surgery and 18 (7.9%) patients had surgery after 6 courses of NACT. 223 pts (97.0%) received platinum-based chemotherapy (PBC) including bevacizumab (Bev) for 79 pts (34.3%). Endocrine therapy maintenance was given in 27 pts. After a median follow up of 73.6m [69.9-80.0], median OS was 93.4m (95%CI [71.2-176.9]) in the whole population. Median OS according to timing of surgery was 146.0m (95%CI [110.4-NR]) with PDS vs. 75.5m (95%CI [48.7-Not Reached]) with NACT-IDS vs. 61.8m (95%CI [42.4-NR]) with 6 courses of NACT and closing surgery. Patients not candidate for surgery received PBC (n=49) +/-Bev (14/49) +/- maintenance endocrine therapy (13/49). With a median follow-up of 64.6m (38.6-93.6), median PFS and OS were 15.9m (95%CI [13.4-20.6]) and 38.0 m (95%CI [33.0-65.0]) respectively. OS multivariable analyses are shown in the table. Table: 796PHR95%CIp valueInitial FIGO stageIIIIV2.401.48,3.91<0.001Timing of surgeryPrimary debulking surgeryInterval debulking surgery or closing surgery1.931.13, 3.340.018No surgery2.651.50;4.68<0.001Age (continuous variable)1.011.00, 1.030.038Bevacizumab first lineNoYes0.820.51, 1.300.393 Open table in a new tab . In this large size population of advanced LGSOC, FIGO IV stage, absence of PDS and age are associated with poorer OS.

Malignant solid tumors present a risk of lymph node diffusion. Lymphadenectomy brings information about lymph node involvement without any proved increase of overall survival. Systematic lymphadenectomies provide pain, lymphedema, seromas, abscesses and quality of life impairment. Sentinel lymph node dissection is a targeted lymph node surgery with less scare, less morbidity and short hospital stay. Thus, this targeted lymph node surgery allows getting lymph node involvement information with less morbidity than lymphadenectomy. Sentinel lymph node dissection is part of surgical de-escalation efforts in surgical oncology. It is mandatory to prove, through clinical trials, equivalence between sentinel lymph node and lymphadenectomy to recommend sentinel lymph node dissection as a standard surgical procedure instead of lymphadenectomy. The main goal of the current review is to highlight different cancer for which sentinel lymph node has replaced lymphadenectomy in standard guidelines and point example where sentinel lymph node could be outdated. (C) 2022 Published by Elsevier Masson SAS on behalf of l'Academie nationale de medecine.

Les tumeurs solides présentent un risque de diffusion ganglionnaire. Les curages ganglionnaires apportent l’information de l’envahissement ganglionnaire sans impact significatif sur la survie globale. Ces chirurgies ganglionnaires systématiques de stadification s’accompagnent de risques de complication à court, moyen ou long terme pouvant impacter de façon durable la qualité de vie des patients. La technique du ganglion sentinelle permet de cibler le premier relai ganglionnaire drainant la tumeur. Ainsi, par une chirurgie ciblée, l’information de l’envahissement ganglionnaire est obtenue avec moins de morbidité que le curage ganglionnaire. La technique du ganglion sentinelle s’inscrit dans les démarches de désescalade chirurgicale en cancérologie. Il est nécessaire de disposer des résultats d’études cliniques d’équivalence pour affirmer que la technique du ganglion sentinelle remplace, sans risque pour les patients, la technique du curage ganglionnaire. L’objectif de cette revue est de faire un point précis sur les localisations anatomiques où la détection du ganglion sentinelle est validée comme étant le standard reconnu pour la recherche de l’information de l’envahissement ganglionnaire en remplacement du curage et de montrer les pistes de poursuite de la désescalade chirurgicale au-delà de la technique du ganglion sentinelle.

Il a récemment été montré que la thérapie ciblée et l’immunothérapie par anti-PD1 améliorent la survie sans progression des patients traités en adjuvant pour un mélanome stade III y compris après ganglion sentinelle (GS) positif. Cette technique de GS est donc désormais recommandée pour les mélanomes de plus de 1 mm de Breslow et peut être proposée dans les mélanomes de Breslow 0,8 à 1 mm et les mélanomes ulcérés (quel que soit le Breslow). L’analyse du GS faisait déjà partie de la prise en charge des mélanomes de stades I–II à visée pronostique par certaines équipes, mais elle s’est généralisée depuis qu’elle a en plus un impact thérapeutique. Étude rétrospective monocentrique (centre d’onco-dermatologie de Loire-Atlantique) entre le 31/01/2019 et le 06/02/2020 de tous les patients ayant bénéficié d’une procédure d’exérèse du ganglion sentinelle pour la prise en charge d’un mélanome primitif stade AJCC I ou II. Comparaison des proportions par test de Fisher (sauf pour l’ulcération analysée par test du Chi2), comparaison des médianes par test de Wilcoxon. Soixante-dix-huit patients répondaient aux critères d’inclusion (dont une patiente incluse à 2 reprises à la suite de 2 mélanomes sur la période d’inclusion). Leurs caractéristiques sont conformes aux données connues des mélanomes primitifs en France. Parmi eux, 59 patients avaient un GS négatif, 15 patients un GS positif et chez 4 patients, aucun ganglion sentinelle n’a été détecté lors de la procédure. Nous présentons les résultats d’une étude en vie réelle de la pratique du GS depuis qu’elle a été rendue beaucoup plus systématique avec l’avènement des nouveaux traitements adjuvants. Le stade AJCC, l’ulcération et l’épaisseur du Breslow sont les seuls facteurs prédictifs de GS positif retrouvés dans cette analyse. Ces résultats sont cohérents avec les données connues de la littérature, permettant ainsi de corroborer les résultats théoriques des études à la vie réelle. D’autres facteurs, comme l’index mitotique, ont été rapportés dans d’autres analyses mais non retrouvés ici, possiblement en raison d’un manque de puissance de notre étude, lié à la petite taille de notre échantillon. Permettant une utilisation plus précoce des traitements adjuvants, le bénéfice du GS a été démontré de manière claire dans la prise en charge des mélanomes localisés stades I–II. Cette étude, préliminaire, sera suivie par une plus large incluant notamment un suivi évolutif des patients.

Adjuvant chemotherapy with carboplatin and paclitaxel is recommended for all high-grade ovarian or Fallopian tube cancers, stage FIGO I-IIA (grade A). After a complete first surgery, it is recommended to deliver 6 cycles of intravenous (grade A) or to propose intraperitoneal (grade B) chemotherapy, to be discussed with patient, according to the benefit/risk ratio. After a complete interval surgery for a FIGO Ill stage, the hyperthermic intra peritoneal chemotherapy (HIPEC) can be proposed in the same conditions of the OV-HIPEC trial (grade B). In case of tumor residue after surgery or FIGO stage IV, chemotherapy associated with bevacizumab is recommended (grade A). For BRCA mutated patient, Olaparib is recommended (grade B). (C) 2019 Elsevier Masson SAS. All rights reserved.

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). Adjuvant chemotherapy by carboplatin and paclitaxel is recommended for all high-grade ovarian and tubal cancers (FIGO stages I-IIA) (grade A). For FIGO stage 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 cancers (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). 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 disease, 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).

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<0.001). There was no significant difference in mortality between the two groups; 25 patients in group 1 died (15.24%), compared with 26 patients in group 2 (15.57%). There was no significant difference in recidivism; 40 patients in group 1 had a recurrence (24.39%), compared with 37 in group 2 (22.16%). 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.

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).

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).

Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B). (C) 2019 Elsevier Masson SAS. All rights reserved.

La chimiothérapie adjuvante par carboplatine et paclitaxel est recommandée pour tous les cancers de l’ovaire ou de la trompe de haut grade, de stade FIGO I-IIA (grade A). Après une chirurgie première complète, il est recommandé de réaliser 6 cycles de chimiothérapie intraveineuse (grade A) ou de proposer une chimiothérapie intrapéritonéale (grade B), à discuter avec la patiente en fonction du rapport bénéfice/risque. Après une chirurgie intervallaire complète pour un stade FIGO III, la chimiothérapie hyperthermique intrapéritonéale (CHIP) peut être proposée selon les modalités de l’essai OV-HIPEC (grade B). En cas de résidu tumoral post-chirurgie ou de stade FIGO IV, une chimiothérapie associée à du bévacizumab est recommandée (grade A). Pour les patientes mutées BRCA, l'Olaparib est recommandé en première ligne (grade B).

ObjectiveThis study compares two methods of evaluating para‐aortic node involvement in locally advanced cervical cancer (LACC) in order to define external radiotherapy treatment fields: laparoscopic surgical para‐aortic lymphadenectomy or PET‐CT imaging.PopulationWe selected 187 patients with LACC who had been treated by chemoradiation therapy in two comprehensive cancer centres from January 2001 to December 2013. A total of 98 underwent para‐aortic evaluation by PET‐CT (Centre 1) and 89 received surgical laparoscopic excision (Centre 2).MethodsAll patients with LACC were retrospectively collected in each centre. OS and DFS were calculated using the Kaplan–Meier's method and survival curves were compared using log‐rank test.Main outcome measuresOutcomes were the comparison of patients’ disease‐free (DFS) and overall survival (OS) between the two centres.ResultsPatients had a significantly better disease‐free survival in cohort 1 than in cohort 2, at 2 years [80.9% (71.7–87.5) versus 57.1% (46.1–67.3)] and at 5 years [70.5% (58.8–79.9) versus 49.2% (38.2–60.4)] (P = 0.009). These results are confirmed by multivariate analysis model [hazard ratio (HR) 1.93; 95% CI 1.03–3.61; P = 0.04]. The overall survival was also better in cohort 1, both at 2 and 5 years [93.5% (86.5–97.0) versus 78.5% (68.5–86.0) and 85.1% (73.2–92.2) versus 63.8% (51.9–74.2), respectively; P = 0.006]. The multivariate analysis model found concordant results with an increased relative risk of death for patients treated in cohort 2 (HR 2.55; 95% CI 1.09–5.99; P = 0.01).ConclusionIn this retrospective cohort analysis, para‐aortic surgical staging in LACC is more deleterious for patients than is radiological staging in terms of OS and DFS.Tweetable abstractPara‐aortic surgical staging in LACC is more deleterious for patients than clinical staging.

Objective: This study aims to evaluate the different surgical approaches, perioperative morbidity and surgical staging according to age in patients with endometrial cancer.Methods: Multicentre retrospective study. Cancer characteristics and perioperative data were collected for patients surgically treated for endometrial cancer. The patients were divided into 2 groups according to their age: younger or older than 75 years.Results: Surgery was performed on 270 women <75 years old and on 74 >= 75 years old. Minimally invasive surgery was performed less often in the elderly compared with their younger counterparts (58.2% vs. 74.8%; p = 0.006). Independently of the surgical approach, the rate of pelvic and para-aortic lymphadenectomy was lower in women older than 75 years old than their younger counterparts (52.7% vs. 74.8%; p < 0.001; 8.1% vs. 21.8%; p = 0.007 respectively). According to the guidelines, more frequent surgical understaging was seen in the elderly compared with the younger (37% vs. 15.2%; p = 0.002). In the comparison of complications for each surgical approach, there was no statistical difference in the >= 75-year-old age group in terms of intra- or postoperative complications between the laparotomy, laparoscopy or robotic surgery group. We found a shorter length of hospital stay for the women who underwent laparoscopy or robotic surgery compared with laparotomy (p < 0.0001).Conclusion: Elderly women with endometrial cancer are often surgically understaged whereas there is no evidence of greater perioperative complications than for their younger counterparts. They should benefit from minimally invasive surgery and optimal surgical staging to the same extent as younger women. (C) 2016 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Médecine nucléaire et radiologie apportent des informations complémentaires et pertinentes dans la prise en charge du cancer de l’ovaire. Chaque modalité fait l’objet de recommandations nationales ou internationales, toute démontrant leur importance, en particulier lors du bilan d’opérabilité. Nous présentons ici les performances des divers outils d’imagerie disponibles en insistant sur leur rôle et place dans l’exploration du cancer de l’ovaire.

Ovarian carcinoma is often diagnosed at an advanced stage, and so far, the prognosis remains poor. To date, surgery, associated with chemotherapy, is the cornerstone for the treatment of advanced stage ovarian cancer. The aim of this study is to clarify current recommendations on surgical management of this cancer. When it is realized, cytoreductive surgery must be macroscopically complete. The management must be discussed in multidisciplinary consultation meetings and be realized in suitable and dedicated institutions. (C) 2016 Elsevier Masson SAS. All rights reserved.

Objective Endometrial cancer primarily affects elderly women. The aim of the present literature review is to define the population of elderly women with this disease and to define the characteristics of this cancer in elderly people as well as its surgical treatment. Materials and methods A systematic review of the English-language literature of the last 20 years indexed in the PubMed database. Results Endometrial cancer is more aggressive in elderly women. However, surgical staging performed in elderly patients is often not concomitant with the disease's aggressiveness in this group. Mini-invasive surgery is performed less often, for no obvious reason. Of note, oncogeriatric evaluation was not usually ruled out to determine the most appropriate surgical modality. Conclusion Studies are needed to evaluate surgical management of endometrial cancer in elderly women, notably with the aid of oncogeriatric scores to predict surgical morbidity.

Nuclear medicine and radiology provide additive information in the management of ovarian cancer. Each modality is subject to international or national guidelines, all demonstrating the importance of imagery especially in the operability staging. Here we present the performance of various available imaging tools with emphasis on their role and place in the exploration of ovarian cancer. (C) 2016 Elsevier Masson SAS. All rights reserved.

Le cancer de l’ovaire est très souvent diagnostiqué à un stade avancé (FIGO III/IV), ce qui en fait une maladie dont le pronostic reste sombre. Aujourd’hui encore, la chirurgie, associée à la chimiothérapie, constitue la pierre angulaire de la prise en charge thérapeutique de ce cancer. Le but de ce travail est d’effectuer une synthèse des recommandations actuelles sur la prise en charge chirurgicale de ce cancer. Lorsqu’elle est réalisée, la chirurgie de cytoréduction doit être macroscopiquement complète. La prise en charge doit se discuter en réunion de concertation pluridisciplinaire et être réalisée dans des établissements adaptés.

Transverse septa underneath the cervix are thick and have above them a funnel-shaped vault covered by pathological mucous membranes. The surgical procedures that are normally used to try to treat the condition and to avoid soft tissue dystocia by carrying out V-Y plasties using Garcia's technique or Z-plasties, or even radial incisions followed by the insertion of a pack, are all somewhat unsatisfactory. The authors, confronted with a similar case, decided to cut out the dome of the vagina and the diaphragm and followed that by a small amputation of the cervix, with anastomosis of the uterus and the remaining vagina.