Gynaecologic cancer surgery and preservation of fertility.

For gynecological cancers, even at an early stage, the standard treatment is "radical excision" involving hysterectomy (radical or not) with bilateral salpingo-oophorectomy. But for young patients with early stage disease, many recent studies have focused on preservation of subsequent fertility by keeping at least one ovary and the uterus. The main objective of this fertility-sparing surgery is to preserve fertility, if this can be accomplished without increasing the oncological risks. Whether the initial site of the cancer is the cervix, uterine fundus or ovary, the oncologic validation of fertility-sparing treatment requires several evaluation criteria: a rigorous clinical, radiological and surgical staging to verify that the pathology is truly at an early initial stage; expert pathologic interpretation of biopsy specimens to validate the histological criteria of "good prognosis"; provision of complete and understandable patient education verifying the true objectives for this fertility-sparing treatment (whose intent is to retain a potential for subsequent fertility without guaranteeing it) and provision of an explanation of the oncological constraints and implications of fertility-sparing surgery in the event of a possible pregnancy. As always in oncology, this strategy demands teamwork requiring successive discussions with the patient and spouse and thorough discussion of the oncological safety of this fertility-sparing strategy in multidisciplinary consultation meetings before "giving a green light".

A new animal model for hyperthermic intraperitoneal chemotherapy (HIPEC) in tumor-bearing mice in the treatment of peritoneal carcinomatosis of ovarian origin.

AIM OF THE STUDY: We set out to develop and evaluate the morbidity of a non-invasive hyperthermic intraperitoneal chemotherapy (HIPEC) procedure in mice. HIPEC has been shown to improve overall survival in treating ovarian cancer with peritoneal carcinomatosis. However, related complications, toxicity and the lack of randomized trials limits its widespread use. To improve the surgical technique, there is a need for animal models that allow teams to work on large groups without burdensome logistics. MATERIALS AND METHODS: To develop the model, we first determined optimal HIPEC conditions in 20 Black Six mice without carcinomatosis. To evaluate HIPEC morbidity, peritoneal carcinomatosis cells of ovarian origin were injected into the peritoneum of 10 pathogen-free Nude mice. The mice underwent HIPEC 21 days later under general anesthesia. An inflow catheter was introduced into the left hypochondria and an outflow catheter was introduced into the left iliac fossa. Bath infusion was oxaliplatin (920mg/m2) at 43°C for 12minutes. The mice were monitored and sacrificed two weeks after the procedure. RESULTS: No deaths were observed during the procedure and infusion was well tolerated throughout the HIPEC. One mouse died the day after the procedure. No major dehydration, hemoperitoneum or evisceration was observed. CONCLUSION: This mouse model of closed abdomen HIPEC has limited morbidity and could be a useful model to study HIPEC regimens and its effects on peritoneal carcinomatosis.