Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 87
Filtrar
1.
Ann Surg Oncol ; 28(1): 212-221, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32648177

RESUMO

BACKGROUND: The prognosis for patients with endometrial cancer (EC) peritoneal carcinomatosis (PC) recurrence has received little study. This study aimed to determine specific risk factors and prognosis of EC with PC recurrence (PCR) versus no PC recurrence (NPCR). METHODS: Data of all patients with EC who received primary surgical treatment between January 2000 and February 2017 were abstracted from the French FRANCOGYN Research Group database. Clinical and pathologic variables were compared between the two groups (PCR vs. NPCR). Multivariate analysis was performed to define prognostic factors for peritoneal recurrence. Overall survivals (OS) of patients after recurrence were compared using the Kaplan-Meier method. RESULTS: The study analyzed 1466 patients, and 257 of these patients (17.5%) had recurrence. At presentation, 63 of these patients had PC. International Federation of Gynecology and Obstetrics (FIGO) stages 3 and 4 disease were significantly associated with PCR versus NPCR (odds ratio 2.24; 95% confidence interval 1.23-4.07; p = 0.008). The death rate for the patients with PC was 47.6%, with a median survival of 12 months after diagnosis of recurrence. According to the histologic subtype, OS was 29 months (Q1-Q3, 13-NA) for endometrioid carcinomas, 7.5 months (Q1-Q3, 4-15) for serous carcinomas, and 10 months (Q1-Q3, 5-15) for clear cell carcinomas. Chemotherapy for treatment of PCR was associated with improved OS after recurrence (OSAR; p = 0.0025). CONCLUSION: An initial advanced stage of EC is a risk factor for PCR. For women with PCR, a diagnosis of type 1 EC recurrence more than 12 months after the initial treatment and management of PCR with chemotherapy is associated with improved OSAR. Prospective studies are needed to determine the precise optimal management required in this clinical situation and to assess the relevance of biomarkers to predict the risk of PCR for EC patients.


Assuntos
Neoplasias do Endométrio , Neoplasias Peritoneais , Neoplasias do Endométrio/patologia , Feminino , Humanos , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
2.
Prog Urol ; 31(7): 439-443, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33867213

RESUMO

OBJECTIVE: In a menopausal woman scheduled for curative surgery for pelvic organ prolapse (POP) by sacral colpopexy (SC), the question of concomitant hysterectomy is frequently considered by the surgeon. The risk of endometrial cancer (EC) exists in this population, and increases with age and body mass index. The French college of gynecologists and obstetricians (CNGOF) decided to issue good practice guidelines on subtotal hysterectomy (SH) for postmenopausal women scheduled for SC for POP. METHODS: The CNGOF has decided to adopt the AGREE II and GRADE systems for grading scientific evidence. Each recommendation for practice was allocated a grade, which depends on the quality of evidence (QE) (clinical practice guidelines). RESULTS: The prevalence of occult endometrial cancer (EC) found on pathological analysis after SH in this context (concomitant SH associated with SC) is low (<1%) (QE: high). Few studies have assessed the value of preoperative uterine exploration. Performing SH during SC is associated with its own risks, which may diminish the potential "carcinological prevention benefit". Uterine morcellation, performed by laparoscopy or a robot-assisted procedure, is associated with a low risk (<0.6%) of dissemination of an unknown sarcoma/EC (QE: moderate) A risk of dissemination of parasitic myomas (<0.5%) is also possible (QE: moderate). CONCLUSION: It is not recommended to perform a subtotal hysterectomy associated with sacral colpopexy for the sole purpose of reducing the occurrence of endometrial cancer (Recommendation: STRONG [GRADE 1-]; the level of evidence was considered to be low and the risk-benefit balance was considered not to be favorable).


Assuntos
Neoplasias do Endométrio/prevenção & controle , Histerectomia/métodos , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Profiláticos/métodos , Neoplasias do Endométrio/etiologia , Feminino , Humanos , Prolapso de Órgão Pélvico/complicações , Fatores de Risco , Sacro , Vagina
3.
Ann Chir Plast Esthet ; 65(4): e1-e5, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32536474

RESUMO

Immediate vaginal reconstruction is usually offered following pelvic exenteration for recurrent cervical cancer in women previously treated with radiotherapy or with severe radiation-induced fistulae. Introduction of muscle-sparing flaps, such as the pedicled vertical deep inferior epigastric perforator (DIEP) flap, provides viable tissues for vaginal reconstruction and is associated with reduced donor-site morbidity. This report describes the surgical technique, which is one of the procedures of choice for vaginal reconstruction. It is safe and beneficial, especially for women with gynecologic cancer who have undergone pelvic exenteration after failed radiation therapy.


Assuntos
Mamoplastia , Exenteração Pélvica , Retalho Perfurante , Artérias Epigástricas/cirurgia , Feminino , Humanos , Vagina/cirurgia
4.
Prog Urol ; 30(6): 332-338, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32331954

RESUMO

INTRODUCTION: Prostate cancer (PCa) is the most common cancer amongst men in 2018 in Europe. The issue of PCa screening in the general population has been debated following the publication of international European (ERSPC) and North American (PLCO) studies. There is currently no organised PCa screening. The objective of this analysis was to evaluate the practice of PCa screening in the French population with no history of cancer between 2005 and 2016. METHODS: Since 2005, the EDIFICE surveys have focused on the knowledge and behaviour of French people with regard to cancer screening. The practice of screening was evaluated according to the answer to the question: "Have you ever done PCa screening?" Responses were analysed according to age, socio-professional category and level of social precariousness. RESULTS: After a strong increase between 2005 and 2008 (from 36% to 49%, P≤0.01), a significant decrease in the reported PCa screening rate was observed between 2014 (49%) and 2016 (42%; P=0.02). This decrease was mainly reflected in the socially advantaged categories and in the youngest age group (50-54 years). Screening practices remain the same in older men. CONCLUSION: The perception of the effectiveness of PCa screening could explain the changes of behavior in the French population. This decrease in participation in PCa screening requires monitoring to avoid a general loss of confidence in cancer screening. LEVEL OF EVIDENCE: 3.


Assuntos
Detecção Precoce de Câncer , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias da Próstata/diagnóstico , Idoso , França , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade
5.
Ann Surg Oncol ; 24(6): 1660-1666, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28058558

RESUMO

BACKGROUND: The European Society of Medical Oncology (ESMO)/European Society of Gynaecological Oncology (ESGO)/European Society for Radiotherapy & Oncology (ESTRO) classification for endometrial cancer (EC) now includes a high-intermediate risk (HIR) group of recurrence due to the adverse prognostic role of lymphovascular space involvement (LVSI) and grade 3 for women at intermediate risk. However, optimal surgical staging, and especially the place of lymphadenectomy, remains to be elucidated. We aimed to establish whether systematic nodal staging should be part of surgical staging for women with HIR EC. METHODS: We abstracted from a prospectively maintained multicentre database the data of 181 women with HIR EC based on uterine factors (endometrioid type 1, grade 1-2 tumors with deep (≥50%) myometrial invasion and unequivocally positive LVSI, and those with grade 3 tumors with <50% myometrial invasion regardless of LVSI status), who received primary surgical treatment between January 2001 and December 2013. We recorded frequency of lymph node (LN) metastases in those who underwent nodal staging. The secondary outcomes were overall survival and recurrence patterns. RESULTS: Overall, 145 (80.1%) women underwent nodal staging consisting of at least pelvic lymphadenectomy. Of these, 62 (42.7%) had LN disease (9.7% with micrometastases). The respective 5-year overall survival rates according to LN status were 85.0% (95% confidence interval [CI] 76.5-91.4), 71.8% (95% CI 61.9-80.4) and 36.0% (95% CI 26.6-46.2) for women with negative LN, positive LN, and unstaged (p = 0.047). Unstaged women were more likely to experience nodal recurrence than surgically staged/LN negative women (p = 0.05). CONCLUSIONS: Systematic nodal staging should be part of surgical staging for women with apparent ESMO/ESGO/ESTRO HIR EC. Sentinel LN biopsy (SLNB) could be an option in this specific setting that may possibly substitute comprehensive staging, for the identification of patients with lymphatic dissemination.


Assuntos
Neoplasias do Endométrio/patologia , Excisão de Linfonodo , Recidiva Local de Neoplasia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Oncologia , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Estudos Prospectivos , Fatores de Risco , Biópsia de Linfonodo Sentinela , Sociedades Médicas , Taxa de Sobrevida
6.
Hum Mol Genet ; 23(R1): R69-75, 2014 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-24833724

RESUMO

Large-scale, genomic studies of specific tumors such as The Cancer Genome Atlas have provided a better understanding of the alterations of pathways involved in the development of solid tumors including glioblastoma, breast cancer, ovarian and endometrial cancers, colon cancer and lung squamous cell carcinoma. This tremendous effort of the scientific community has confirmed the view that cancer actually represents a wide variety of diseases originating from different organs. These studies showed that TP53 and PI3KCA are the two most mutated genes in all types of cancers and that 30-70% of all solid tumors harbor potentially 'actionable' mutations that can be exploited for patient stratification or treatment optimization. Translation of this huge oncogenomic data set to clinical application in personalized medicine programs is now the main challenge for the future. The gap between our basic knowledge and clinical application is still wide. Closing the gap will require translational personalized trials, which may initiate a radical change in our routine clinical practice in oncology.


Assuntos
Genômica/métodos , Neoplasias/genética , Carcinogênese , Ensaios Clínicos como Assunto , Genoma Humano , Humanos , Mutação , Fosfatidilinositol 3-Quinases/genética , Medicina de Precisão , Proteína Supressora de Tumor p53/genética
7.
Eur J Cancer Care (Engl) ; 25(3): 458-65, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26891443

RESUMO

The question of returning to work and pursuing professional activity during cancer treatment is an increasingly important consideration. The present work focuses on factors affecting the feasibility of maintaining professional activity during treatment for breast cancer, for women who wished to do so. Written questionnaires were collected from 216 patients between March and November 2012. Since the onset of their treatment, 31.4% of the women (68/216) had not been on sick-leave. The main factors associated with the pursuit of professional activity were: considering the availability of their physician to answer questions as unimportant [OR = 18.83 (3.60-98.53); P ≤ 0.05]; considering the diagnosis of cancer as likely to have a weak impact on career perspectives [OR = 4.07 (2.49-6.64); P ≤ 0.05]; not having any children in the household [OR = 3.87 (2.38-6.28); P ≤ 0.05]; being in a managerial position [OR = 3.13 (1.88-5.21); P ≤ 0.05]. Negative predictive factors were: physician mentioning adverse effects of the treatment [OR = 0.31 (0.16-0.58); P ≤ 0.05], and patient rating workload as high [OR = 0.26 (0.15-0.46); P ≤ 0.05]. As a result of advances in therapeutic strategies, more patients will expect healthcare professionals, as well as employers and occupational health societies, to prioritise issues pertaining to the maintenance of professional activities during cancer treatment.


Assuntos
Neoplasias da Mama/terapia , Emprego/psicologia , Adulto , Idoso , Atitude Frente a Saúde , Neoplasias da Mama/psicologia , Escolha da Profissão , Feminino , Humanos , Intenção , Satisfação no Emprego , Pessoa de Meia-Idade , Relações Médico-Paciente , Retorno ao Trabalho/psicologia , Licença Médica/estatística & dados numéricos , Inquéritos e Questionários
8.
Br J Cancer ; 112(5): 793-801, 2015 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-25675149

RESUMO

BACKGROUND: To compare the accuracy of five major risk stratification systems (RSS) in classifying the risk of recurrence and nodal metastases in early-stage endometrial cancer (EC). METHODS: Data of 553 patients with early-stage EC were abstracted from a prospective multicentre database between January 2001 and December 2012. The following RSS were identified in a PubMed literature search and included the Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC-1), the Gynecologic Oncology Group (GOG)-99, the Survival effect of para-aortic lymphadenectomy (SEPAL), the ESMO and the ESMO-modified classifications. The accuracy of each RSS was evaluated in terms of recurrence-free survival (RFS) and nodal metastases according to discrimination. RESULTS: Overall, the ESMO -modified RSS provided the highest discrimination for both RFS and for nodal metastases with a concordance index (C-index) of 0.73 (95% CI, 0.70-0.76) and an area under the curve (AUC) of 0.80 (0.78-0.72), respectively. The other RSS performed as follows: the PORTEC1, GOG-99, SEPAL, ESMO classifications gave a C-index of 0.68 (0.66-0.70), 0.65 (0.63-0.67), 0.66 (0.63-0.69), 0.71 (0.68-0.74), respectively, for RFS and an AUC of 0.69 (0.66-0.72), 0.69 (0.67-0.71), 0.68 (0.66-0.70), 0.70 (0.68-0.72), respectively, for node metastases. CONCLUSIONS: None of the five major RSS showed high accuracy in stratifying the risk of recurrence or nodal metastases in patients with early-stage EC, although the ESMO-modified classification emerged as having the highest power of discrimination for both parameters. Therefore, there is a need to revisit existing RSS using additional tools such as biological markers to better stratify risk for these patients.


Assuntos
Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/patologia , Recidiva Local de Neoplasia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/classificação , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Estadiamento de Neoplasias , Medição de Risco , Análise de Sobrevida
9.
Cancer Causes Control ; 26(6): 949-52, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25822574

RESUMO

PURPOSE: Our previously published data showed rapidly increasing rates of prostate cancer screening in men aged 50-74, which rose from 36% in 2005 to 48% in 2008. Based on men's reported intentions at that time, this was expected to rise to 70% in 2011. Here we report the actual rate of prostate cancer screening. METHOD: Three nationwide observational telephone surveys (EDIFICE opinion polls) were conducted in 2005, 2008, and 2011. The overall target was a representative sample of > 1,500 individuals living in France and aged 40-75 years, including 481 men aged 50-74 years. RESULTS: Within this male population, the rate of screening reported remained stable between 2008 and 2011 (48 and 49%, respectively). However, comparison of privileged versus disadvantaged populations showed significant differences, with a relative decrease in screening among those of higher socioprofessional status (p = 0.03) and from higher-income groups (p = 0.02). For households with a monthly income above 2,500€, the screening rate decreased from 61% in 2008 to 51% in 2011 (p = 0.05), while for those with an income below 2,500€, it increased from 36% in 2008 to 44 % in 2011 (p = 0.18). CONCLUSION: A plateau or even a reduction in prostate cancer screening is currently being observed; this is possibly due to progressive recognition among the population at large of the controversy surrounding prostate cancer screening, whereas this speculation was formerly limited to health-care professionals. After previously being more likely to undergo prostate cancer screening, it is the younger, wealthier populations that are currently showing the most noteworthy step backwards.


Assuntos
Detecção Precoce de Câncer/tendências , Programas de Rastreamento/tendências , Neoplasias da Próstata/diagnóstico , Adulto , Idoso , França , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Antígeno Prostático Específico
10.
J Eur Acad Dermatol Venereol ; 29 Suppl 2: 2-5, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25639925

RESUMO

BACKGROUND: Melanoma accounts for a small proportion of skin cancers but is the most serious. The prognosis is, however, good if it is diagnosed early, before the metastatic stages. For these reasons, population awareness and knowledge with regard to melanoma and the associated risk factors are critical to improving the effectiveness of melanoma primary prevention campaigns. OBJECTIVES: The EDIFICE Melanoma survey was designed to cover a large number of topics related to sun exposure and melanoma: knowledge and awareness of the risks associated with sun and artificial ultraviolet exposure, knowledge of melanoma and the associated risk factors, behaviour regarding protective measures in adults and children. METHODS: The survey questionnaire was administered by experienced independent interviewers from the Kantar Health Institute using the Computer-Assisted Telephone Interview technique. It was important to avoid the effects of 'contamination' in answers to questions about sun exposure habits. Questions about exposure habits were therefore asked before those relating to knowledge of best practices for sun protection. A sample of 1502 individuals aged 18 years and over was interviewed. The survey data were weighted to eliminate structural variations between the sample interviewed and the reference population. Quantitative data were described by the means and standard deviations and categorical data by the numbers in each category and corresponding percentages. Three multivariate logistic regression analyses were conducted and expressed in terms of odds ratio and 95% confidence intervals. RESULTS: In addition to the classic questions relating to sociodemographic characteristics, the EDIFICE Melanoma study questionnaire was organized around three themes: the opinion, attitude and knowledge of individuals regarding sun exposure and melanoma. The survey questionnaire lasted approximately 20 min. CONCLUSIONS: This study provided a complete 'snapshot' of opinions, attitudes and knowledge of French people in 2011 with regard to sun exposure.


Assuntos
Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Luz Solar , Adolescente , Adulto , Idoso , Exposição Ambiental , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
11.
J Eur Acad Dermatol Venereol ; 29 Suppl 2: 6-10, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25639926

RESUMO

BACKGROUND: The incidence of melanoma is increasing worldwide, causing significant economic burden at community and individual levels. Ultraviolet radiation, from natural sunlight or artificial sources, is the main environmental, modifiable risk factor for melanoma. OBJECTIVES: The present analysis assesses the profile of sun exposure in the French population as well as the level of awareness about ultraviolet risk and protection. METHODS: The survey was conducted via telephone interviews in September and October 2011. In total, 1502 respondents were questioned about their own sun exposure with the question "do you ever, even occasionally, spend time in the sun, during leisure-time, vacation or your professional occupation?" They were also asked about sun protection measures used: protective clothing, a hat or sunscreen. RESULTS: More than three respondents out of four (78%) declared exposing themselves to the sun, with an average of 113 days per year. Of these, 38% did not use appropriate sun protection measures. We identified the following characteristics of individuals declaring high sun exposure: chiefly men under the age of 40, higher socio-professional levels, and adults with no children. Individuals who make a poor use of protective measures are mostly men and of low educational levels. Individuals declaring low sun exposure were chiefly: women, individuals over the age of 60, and those with no professional activity. The high sun protection population comprises mostly: women, higher socio-professional levels, with no specific age-group profile. CONCLUSIONS: Analysis of the EDIFICE Melanoma survey provides information about the attitudes of the French population towards sun exposure. The most frequent contexts of sun exposure and the associated socio-demographic characteristics of the population with at-risk attitudes regarding sun exposure are identified. This deeper insight into the profile of at-risk populations will allow interventions to be more accurately targeted, thus potentially improving public health benefits.


Assuntos
Exposição Ambiental , Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Luz Solar , Coleta de Dados , Feminino , França/epidemiologia , Humanos , Masculino
12.
Br J Cancer ; 110(11): 2640-6, 2014 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-24809776

RESUMO

BACKGROUND: Lymphovascular space invasion (LVSI) is one of the most important predictors of nodal involvement and recurrence in early stage endometrial cancer (EC). Despite its demonstrated prognostic value, LVSI has not been incorporated into the European Society of Medical Oncology (ESMO) classification. The aim of this prospective multicentre database study is to investigate whether it may improve the accuracy of the ESMO classification in predicting the recurrence risk. METHODS: Data of 496 patients with apparent early-stage EC who received primary surgical treatment between January 2001 and December 2012 were abstracted from prospective multicentre database. A modified ESMO classification including six risk groups was created after inclusion of the LVSI status in the ESMO classification. The primary end point was the recurrence accuracy comparison between the ESMO and the modified ESMO classifications with respect to the area under the receiver operating characteristic curve (AUC). RESULTS: The recurrence rate in the whole population was 16.1%. The median follow-up and recurrence time were 31 (range: 1-152) and 27 (range: 1-134) months, respectively. Considering the ESMO modified classification, the recurrence rates were 8.2% (8 out of 98), 23.1% (15 out of 65), 25.9% (15 out of 58), and 45.1% (28 out of 62) for intermediate risk/LVSI-, intermediate risk/LVSI+, high risk/LVSI-, and high risk/LVSI+, respectively (P<0.001). In the low risk group, LVSI status was not discriminant as only 7.0% (14 out of 213) had LVSI+. The staging accuracy according to AUC criteria for ESMO and ESMO modified classifications were of 0.71 (95% CI: 0.68-0.74) and 0.74 (95% CI: 0.71-0.77), respectively. CONCLUSIONS: The current modified classification could be helpful to better define indications for nodal staging and adjuvant therapy, especially for patients with intermediate risk EC.


Assuntos
Neoplasias do Endométrio/patologia , Vasos Linfáticos/patologia , Recidiva Local de Neoplasia/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Intervalo Livre de Doença , Neoplasias do Endométrio/classificação , Neoplasias do Endométrio/terapia , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Pessoa de Meia-Idade , Análise Multivariada , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Melhoria de Qualidade , Curva ROC , Risco , Medição de Risco
13.
Gynecol Oncol ; 131(3): 708-13, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24125751

RESUMO

BACKGROUND: Our objective was to concomitantly assess distribution of lymphatic and nerve structures in the parametrium. METHODS: Twenty hemipelvises from ten fresh cadavers were dissected to differentiate between, three different parts of the parametrium: the lateral parametrium, the proximal and the distal part of the posterior parametrium. Histologic and immunofluorescence analyses of nerve and lymphatic structures were performed using NSE and LYVE-1 staining, respectively. The percentage of structures was independently scored as 0 (0%), 1 (1-20%), 2 (20-50%), 3 (50-80%), 4 (>80%). RESULTS: The lateral parametrium and the proximal part of the posterior parametrium contained both nerve (scored 2.25 and 2.50, respectively) and lymphatic (scored 2.50 and 2.00, respectively) structures. The distal part of the posterior parametrium also contained numerous nerve structures (scored 2.00) but lymphatic structures were rare (scored 0.88). No difference in nerve distribution was found according to the parts of parametrium while a significantly lower distribution of lymphatic vessels was observed in the distal part of the posterior parametrium (p=0.03). CONCLUSION: The distal part of the posterior parametrium is of high nerve density and low lymphatic density raising the issue as to whether it should be removed during radical hysterectomy.


Assuntos
Ligamento Largo/anatomia & histologia , Ligamento Largo/inervação , Sistema Linfático/anatomia & histologia , Ligamento Largo/citologia , Ligamento Largo/cirurgia , Cadáver , Feminino , Imunofluorescência , Formaldeído , Humanos , Histerectomia , Sistema Linfático/citologia , Polímeros , Fixação de Tecidos , Ureter/anatomia & histologia , Ureter/inervação
14.
Prog Urol ; 23(4): 270-5, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23544985

RESUMO

PURPOSE: Evaluate anatomic and functional outcomes of genital prolapse repair by vaginal route using a mixed polypropylene and porcine skin mesh. PATIENTS AND METHODS: Prospective pilot study from January 2009 to January 2011 in the gynecologic department of a tertiary university hospital. Twenty patients with stage II-III genital prolapse underwent anterior wall prolapse repair with anterior Avaulta Plus mesh. Functional results were evaluated using the pelvic floor distress inventory-short form (PFDI-20), the pelvic floor impact questionnaire-7 (PFIQ-7) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual questionnaires (PISQ-12). RESULTS: No per-operative complications occurred. One postoperative hematoma (5%) occurred requiring a second surgery. At a mean follow-up of 19.7 months, three patients had vaginal mesh exposure (15%) requiring a second surgery for two of them. Of the 20 women, 17 (85%) had optimal anatomic results and three (15%) had residual genital prolapse (Ba=-2 in two cases and Bp = -2 in the one). No recurrence was observed during the study period. A significant improvement in the PFDI-20 (P<0.001) and PFIQ-7 scores (P<0.001) was observed but no improvement in the PISQ-12 score. CONCLUSION: In this series, we reported that genital prolapse repair using Avaulta Plus mesh resulted in a high success rate and improved quality of life but with an important prevalence of vaginal mesh exposure.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Qualidade de Vida , Telas Cirúrgicas , Idoso , Bioprótese , Feminino , Humanos , Polipropilenos , Estudos Prospectivos , Desenho de Prótese
15.
Minerva Med ; 103(1): 63-72, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22278069

RESUMO

Colorectal resection for endometriosis is a major operation exposing patients to the risk of severe digestive and urological complications. The objective of this review is to evaluate surgery-related urological morbidity of which little is known to date. We searched MEDLINE for articles published on colorectal resection for endometriosis between 1998 and March 2011 using the following terms: "bowel", "rectal", "colorectal", "rectovaginal", "rectosigmoid", "resection" and "endometriosis". We were not able to perform a meta- analysis due to a lack of complete data on urological complications so have focused this review on voiding dysfunction and ureteral injury. Thirty-two articles reporting on 3047 colorectal resections for endometriosis including 1930 segmental resections, 271 discoid resections and 846 rectal shavings were analysed. For voiding dysfunction, 28 series including 2563 colorectal resections were available. Postoperative voiding dysfunction varied from 0% to 30.4% with a mean value of 3.4% (73/2118). Fourteen series reported an incidence of ureterolysis comprising between 8.5% and 100% with a mean value of 46% (815/1772 patients). The risk of urinary fistulae evaluated in 26 series was estimated at 0.9% (24/2581 patients). Only one case of hydronephrosis was reported in 9 series including 1256 patients (0.07%). The incidence of urological morbidity associated with colorectal endometriosis is poorly documented and probably underestimated due to the short follow-up reported in the series. Moreover, as complication rates varied widely according to the type of surgery and the experience of the teams, further studies are required to identify risk factors of urological morbidity so as to adequately inform patients.


Assuntos
Doenças do Colo/cirurgia , Endometriose/cirurgia , Complicações Pós-Operatórias , Doenças Retais/cirurgia , Uretra/lesões , Transtornos Urinários/etiologia , Feminino , Humanos , Incidência , Complicações Pós-Operatórias/epidemiologia , Transtornos Urinários/epidemiologia
16.
J Gynecol Obstet Hum Reprod ; 50(10): 102188, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34166864

RESUMO

OBJECTIVE: To provide guidelines from the French College of Obstetricians and Gynaecologists (CNGOF), based on the best evidence available, concerning the impact of endometrial destruction on bleeding and endometrial cancer risk reduction in patients candidates for operative hysteroscopy. METHODS: Recommendations were made according to AGREE II and the GRADE® (Grading of Recommendations Assessment, Development and Evaluation) systems to determine separately the quality of evidence (QE) and in the level of recommendation. RESULTS: In a retrospective study comparing the incidence of endometrial cancer in 4776 patients with menorrhagia treated with endometrial destruction vs 229 945 patients with a medical treatment. There was a non-significant reduced risk of developing endometrial cancer (HR, 0.45; 95% CI, 0.15-1.40; p = .17). In premenopausal women, five studies compared the incidence of endometrial cancer in patients treated with endometrial ablation/destruction (EA/D) to the incidence of endometrial cancer in a comparable population of women from national registers, all of which show reduced risk of endometrial cancer after endometrectomy. In case of menopausal metrorrhagia, the prevalence of endometrial cancer is 9%, by analogy with the results found in premenopausal patients, the combination of endometrial ablation during operative hysteroscopy seems justified. In a retrospective cohort of 177 non-menopausal patients treated with myomectomy for metrorrhagia and/or menorrhagia, a significantly better control of bleeding at 12 months was found when myomectomy was combined with endometrectomy using roller-ball (OR: 0.18 [95% Cl 0.05-0.63]; p = 0.003). CONCLUSION: In premenopausal women with heavy menstrual bleeding, when an operative hysteroscopy is performed, it is recommended to propose an endometrial ablation/destruction in order to prevent the risk of endometrial cancer, (QE3) and to prevent recurrence of bleeding (QE2). In menopausal women, it is probably recommended to also perform an endometrial ablation/destruction in case of operative hysteroscopy in order to prevent the risk of endometrial cancer (QE1).


Assuntos
Técnicas de Ablação Endometrial/métodos , Guias como Assunto , Ginecologia/métodos , Histerectomia/métodos , Adulto , Técnicas de Ablação Endometrial/instrumentação , Técnicas de Ablação Endometrial/normas , Endométrio/cirurgia , Feminino , França , Ginecologia/organização & administração , Ginecologia/tendências , Humanos , Histerectomia/tendências , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Eur J Surg Oncol ; 47(11): 2900-2906, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34274203

RESUMO

INTRODUCTION: Node involvement is one of the main prognostic factors for cervical cancer. Para-aortic lymph node (PALN) assessment is crucial for treating advanced cervical cancer, to define irradiation fields. Objective of this study was to develop a score predicting para-aortic lymph node involvement in patients with advanced cervical cancer. PATIENTS AND METHOD: We performed a multicenter, retrospective, study on 9 French centers from 2000 to 2015, including patients with advanced squamous cell cervix carcinoma who had PALN status assessed by imaging and/or by surgery. Factors associated with a risk of PALN involvement were determined by univariate and multivariate analysis using a logistic regression model. A score was then developed and validated. RESULTS: A total of 1446 patients treated for cervical cancer were included. Of these, 498 had an advanced squamous cell cervical cancer. Ninety-one patients (18.3%) had positive PALN. After univariate and multivariate analysis, tumor size on pelvic MRI, initial SCC, and suspected pelvic node involvement on PET-CT were included in our score. This model allowed the population to be divided into 3 risk groups. Area under the ROC curve of the score was 0.81 (95%CI = 0.72-0.90). In the low-risk group, 9% (28/287) had PALN involvement, whereas in the high-risk group, 43% (22/51) had PALN involvement. CONCLUSION: We developed a simple score predicting PALN involvement in advanced cervical cancers. Three risk groups can be defined, and patients considered to be at low risk may avoid para-aortic staging as well as extensive field irradiation.


Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Metástase Linfática , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia , Carcinoma de Células Escamosas/diagnóstico por imagem , Feminino , França , Humanos , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Neoplasias do Colo do Útero/diagnóstico por imagem
18.
Gynecol Obstet Fertil Senol ; 49(11): 805-815, 2021 Nov.
Artigo em Francês | MEDLINE | ID: mdl-34520857

RESUMO

OBJECTIVE: To draw up recommendations on the use of prophylactic gynecologic procedures during surgery for other indications. DESIGN: A consensus panel of 19 experts was convened. A formal conflict of interest policy was established at the onset of the process and applied throughout. The entire study was performed independently without funding from pharmaceutical companies or medical device manufacturers. The panel applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system to evaluate the quality of evidence on which the recommendations were based. The authors were advised against making strong recommendations in the presence of low-quality evidence. Some recommendations were ungraded. METHODS: The panel studied 22 key questions on seven prophylactic procedures: 1) salpingectomy, 2) fimbriectomy, 3) salpingo-oophorectomy, 4) ablation of peritoneal endometriosis, 5) adhesiolysis, 6) endometrial excision or ablation, and 7) cervical ablation. RESULTS: The literature search and application of the GRADE system resulted in 34 recommendations. Six were supported by high-quality evidence (GRADE 1+/-) and 28 by low-quality evidence (GRADE 2+/-). Recommendations on two questions were left ungraded due to a lack of evidence in the literature. CONCLUSIONS: A high level of consensus was achieved among the experts regarding the use of prophylactic gynecologic procedures. The ensuing recommendations should result in improved current practice.


Assuntos
Anestesia , Ginecologia , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Salpingectomia , Salpingo-Ooforectomia
19.
Eur J Obstet Gynecol Reprod Biol ; 256: 412-418, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33296755

RESUMO

OBJECTIVE: To assess the diagnostic and prognostic characteristics of borderline ovarian tumours (BOTs) detected during pregnancy, and to establish an inventory of French practices. MATERIALS AND METHODS: A retrospective multi-centre case study of 14 patients treated for BOTs, diagnosed during pregnancy between 2005 and 2017, in five French pelvic cancerology expert centres, including data on clinical characteristics, histological tumour characteristics, surgical procedure, adjuvant treatments, follow-up and fertility. RESULTS: The mean age of patients was 29.3 [standard deviation (SD) 6.2] years. Most BOTs were diagnosed on ultrasonography in the first trimester (85.7 %), and most of these cases (78.5 %) also underwent magnetic resonance imaging to confirm the diagnosis (true positives 54.5 %). Most patients underwent surgery during pregnancy (57 %), with complete staging surgery in two cases (14.3 %). Laparoscopy was performed more frequently than other procedures (50 %), and unilateral adnexectomy was more common than cystectomy (57.5 %). Tumour size influenced the surgical approach significantly (mean size 7.5 cm for laparoscopy, 11.9 cm for laparoconversion, 14 cm for primary laparotomy; P = 0.08), but the type of resection did not. Most patients were initially diagnosed with International Federation of Gynecology and Obstetrics stage IA (92.8 %) tumours, but many were upstaged after complete restaging surgery (57.1 %). Most BOTs were serous (50 %), two cases had a micropapillary component (28.5 %), and one case had a micro-invasive implant. BOTs were bilateral in two cases (14.2 %). Mean follow-up was 31.4 (SD 14.8) months. Recurrent lesions occurred in two patients (14.2 %) and no deaths have been recorded to date among the study population. CONCLUSION: BOTs remain rare, but this study - despite its small sample size - supports the hypothesis that BOTs during pregnancy have potentially aggressive characteristics.


Assuntos
Laparoscopia , Neoplasias Ovarianas , Criança , Cistectomia , Feminino , Humanos , Estudos Multicêntricos como Assunto , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Gravidez , Estudos Retrospectivos
20.
J Gynecol Obstet Hum Reprod ; 49(2): 101655, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31760177

RESUMO

INTRODUCTION: Patients with Mayer - Rokitansky - Küster - Hauser (MRKH) syndrome often experience chronic pelvic pain negatively impacting their life's quality. Our understanding of the factors involved in this symptom remains poor. The aim of our study was to further investigate the different components of this pelvic pain in patients with MRKH undergoing pelvic surgery. Our second objective was to assess the evolution of this pain in patients undergoing surgical removal of their uterine horn remnant. MATERIAL AND METHODS: We conducted a retrospective analysis of a cohort of patients treated in our tertiary referring gynaecological department. Patients included had a MRKH syndrome with at least one uterine horn remnant and all underwent at least one surgical procedure in our centre. Descriptive analysis of the main characteristics and of the management of these patients was conducted. Postoperative pain was evaluated using simple words and / or analgesic consumption evaluation. RESULTS: Between 1991 and 2013, twenty-one patients were included in our centre. Out of them, 20 (95 %) had chronic pelvic pain, mostly cyclic pain lasting 2-3 days. Fourteen patients had surgical removal of their uterine horns remnant and only 3 patients (21 %) had persistent pain at their postoperative visit. Surgical findings included peritoneal endometriosis in 8 patients (38 %) and other unexpected findings in 6. At pathological analysis, secretary endometrium in the uterine horn remnant was found in 11 patients (79 %). CONCLUSION: The origin of chronic pain in MRKH is combining several factors such as endometriosis or secretary endometrium. Surgical removal of uterine horn remnant improved most of our patients' pelvic chronic pain. Further studies should help improve our understanding of this specific entity.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/complicações , Dor Crônica/diagnóstico , Dor Crônica/etiologia , Ductos Paramesonéfricos/anormalidades , Dor Pélvica/diagnóstico , Dor Pélvica/etiologia , Útero/anormalidades , Útero/cirurgia , Adolescente , Anormalidades Congênitas , Feminino , Procedimentos Cirúrgicos em Ginecologia , Ginecologia , Humanos , Período Pós-Operatório , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA