Oncologic results of fertility sparing surgery of cervical cancer: An updated systematic review.

BACKGROUND: Several techniques can be proposed as fertility sparing surgery in young patients treated for cervical cancer but uncertaincies remain concerning their outcomes. Analysis of oncological issues is then the first aim of this review in order to evaluate the best strategy. RESULTS: Data were identified from searches of MEDLINE, Current Contents, PubMed and from references in relevant articles from January 1987 to 15th of September 2021. We carry out an updated systematic review involving 5862 patients initially selected for fertility-sparing surgery in 275 series. FINDINGS: In patients having a stage IB1 disease, recurrence rate/RR in patients undergoing simple conisation/trachelectomy, radical trachelectomy/RT by laparoscopico-vaginal approach, laparotomic or laparoscopic approaches are respectively: 4.1%, 4.7%, 2.4% and 5.2%. In patients having a stage IB2 disease, RR after neoadjuvant chemotherapy or RT by laparotomy are respectively 13.2% and 4.8% (p = .0035). After neoadjuvant treatment a simple cone/trachelectomy was carried out in 91 (30%) patients and a radical one in 210 (70%) cases. But the lowest pregnancy rate is observed in patients undergoing RT by laparotomy (36%). CONCLUSIONS: The choice between these treatments should be based above all, on objective oncological data that strike a balance for each procedure between the best chances for cure and the fertility results. In patients having a stage IB1 disease, oncological results are quite similar according to the procedure used. In patients having a stage IB2 disease, RT by open approach has the lowest RR. Anyway the lowest pregnancy rate is observed in patients undergoing RT by laparotomy.

[Fertility preservation in cervical cancer, analysis of 30 years of practice and immersion in future developments]. / La préservation de fertilité en cas de cancer du col, analyse de 30 ans de pratique et immersion dans les évolutions à venir.

OBJECTIVES: The strategy of fertility preservation (FP) in cervical cancer has been challenged for several years and a therapeutic de-escalation seems to be necessary. In this context, we evaluated the oncological, fertility and obstetric outcomes of surgical techniques performed in our centre for FP. METHODS: This retrospective uni centric trial included 75 patients, managed at the Gustave Roussy Institute between 1995 and 2020, for cervical cancer (stage IB1 FIGO 2018) and having conducted a fertility preservation project after a complete pre-therapy work-up. The objective of this study was to understand our results on fertility and obstetrical outcomes and to correlate them with oncological data and finally to evaluate the evolution of our surgical practices. RESULTS: 54 patients benefited from an extended trachelectomy and no lymph node involvement was found. 1 patient received a complementary treatment postoperatively which did not allow to preserve her fertility. The recurrence rate was 4.8% (4/75) with one death described. 31 pregnancies were obtained, representing a pregnancy rate of 50%. 74% of pregnancies were obtained spontaneously and 60% of pregnancies were carried to term. CONCLUSION: Our results are similar to those in the literature. Despite a fertility preservation project, only half of the patients were able to achieve a pregnancy.

[Low-grade serous ovarian carcinoma: A retrospective study on 34 complete cytoreductive surgeries]. / Carcinome séreux de bas grade ovarien à un stade avancé : étude rétrospective sur 34 patientes en résection complète.

AIM OF THE STUDY: Low-grade serous ovarian cancer is a distinct, slow-growing entity that affects mainly young women. The objective of this study was to describe the clinical characterisitics and survival outcomes of a population of patients suffering from advanced stage CSBG. PATIENTS AND METHODS: A retrospective study was carried out in patients with advanced stage ovarian CSBG (FIGO IIIb-IV) who had complete macroscopic cytoreductive surgery, at Gustave Roussy Institut, Villejuif, between 2004 and 2017. RESULTS: Thirty-four patients were included, who were mainly young women (mean age 41.3 years), diagnosed at FIGO stage IIIC (91 %). The median follow-up was 41 months. Neoadjuvant chemotherapy was administered in 16 patients (47.1 %), and complete response never occurred. Upper abdominal surgical procedures were necessary in 90 % of cases and a bowel resection was performed in more than 80 % of cases. Over 90 % of patients received adjuvant chemotherapy followed by maintenance treatment with bevacizumab in over 40 % of cases. During follow-up, 9 (26 %) deaths occurred. Five-year overall survival was 70 % and disease-free survival was 20 %. CONCLUSION: CSBG of the ovary has a low chemosensitivity and requires maximum surgical management, which should be performed in expert centers.

Management of a cornual ectopic pregnancy.

Cornual pregnancy is rare. Treatment involves expulsion of the pregnancy and hemostasis of the cornus if required by hemorrhagic rupture. Two techniques are proposed to achieve hemostasis of the uterine cornus, cornuotomy with suture, or corneal resection with salpingectomy, generally laparoscopically.

Association between oocyte donation and maternal and perinatal outcomes in women aged 43 years or older.

BACKGROUND: Although older maternal age is a risk factor for pregnancy complications, an increasing number of women delay conception until the age of 40, and some must resort to IVF with oocyte donation. Our objective was to study the association between IVF, both with and without oocyte donation, and maternal and perinatal outcomes in a population of older women. METHODS: This retrospective study covered all women, aged 43 or more, who gave birth between 2008 and 2010. Univariate and multivariate analyses with logistic regression models were used to compare maternal and perinatal outcomes as a function of mode of conception: without IVF, with IVF using own oocytes or with IVF and oocyte donation. RESULTS: The study included 380 women, including 40 who had IVF without oocyte donation (10.5%) and 104 who had both (27.4%). There were 326 singleton and 54 multiple pregnancies. Overall, the complication rate was high: 8.7% pre-eclampsia, 6.1% gestational diabetes, 20.2% preterm delivery and 8.2% very preterm delivery (before 33 weeks), 44.8% Cesarean sections and 7.4% severe post-partum hemorrhage (PPH). The pre-eclampsia rate differed significantly between the groups (3.8% after no IVF, 10.0% after IVF only and 19.2% after IVF with oocyte donation, P< 0.001). After adjustment, the risk of pre-eclampsia was significantly higher in women with donated oocytes compared with pregnant women without IVF [adjusted OR = 3.3 (1.2-8.9)]. The rate of twin pregnancy was significantly higher in women with IVF and oocyte donation (39.4 versus 15.0% with IVF only and 2.5% without IVF, P< 0.001). Twin pregnancy was significantly associated with the risk of preterm delivery [adjusted OR = 8.9 (4.0-19.9)] and PPH [adjusted OR = 3.5 (1.3-9.5)]. CONCLUSION: In women aged 43 years or older, pregnancies obtained by IVF with oocyte donation are associated with higher rates of pre-eclampsia and twin pregnancies than those obtained without IVF or with IVF using their own oocytes.

[Anaesthesic management of vaginal delivery in a parturient with C1 esterase deficiency]. / Prise en charge anesthésique d'un accouchement chez une patiente atteinte d'un déficit en inhibiteur de C1 estérase.

Hereditary and acquired angioedema (HAE/AAE) are the clinical translation of a qualitative or a quantitative deficit of C1 esterase inhibitor (C1 INH). The frequency and severity of clinical manifestations vary greatly, ranging from a moderate swelling of the extremities to obstruction of upper airway. Anaesthesiologists and intensivists must be prepared to manage acute manifestations of this disease in case of life-threatening laryngeal edema. Surgery, physical trauma and labour are classical triggers of the disease. The anaesthesiologists should be aware of the drugs used as prophylaxis and treatment of acute attacks when considering labour and caesarean section. Androgens are contraindicated during pregnancy. If prophylaxis is required, tranexamic acid may be used with caution. The safest obstetric approach appears to be to administer a predelivery infusion of C1 INH concentrate. It is important to avoid manipulation of the airway as much as possible by relying on regional techniques. We report the case of a patient suffering from an HAE discovered during pregnancy. The management included administration of C1 INH during labor and early epidural analgesia for pain relief. A short review of the pathophysiology and therapeutic options follows.