[Seven-year follow-up of 331 I-Stop transobturator sling cases in female urinary incontinence treatment]. / Analyse à 7ans d'une série de 331 bandelettes I-Stop trans-obturatrices implantées pour traitement de l'incontinence urinaire d'effort de la femme.

PURPOSE: The aim was to evaluate results and morbidity for the I-Stop sling using the transobturator approach with seven years of follow-up on a large number of patients. MATERIAL: Three hundred and thirty-one files out of 430 surgeries performed in 2005 by four different surgeons has been reviewed, collecting data in sending a detailed form. A statistical and correlation analysis has been performed then. RESULTS: After seven years, the subjective success rate was 72% and 80% of the patients were satisfied. Cases of revision were rare and a systemic analysis has been performed: 0.9% of second surgery for SUI and 0.3% of sling exposure. Recurrence of SUI and decrease of efficacy occurred on older population. CONCLUSION: Functional results are similar to those published already but complication rate is significantly lower. Decrease of efficacy by time occurred mainly after 80 years old seemed to be related to tissue aging.

[Ovarian cancer: anatomo-clinical classifications]. / Cancers de l'ovaire: les classifications anatomo cliniques.

There are important barriers in the correct evaluation of the anatomic involvement of malignant ovarian tumors. Nevertheless, it seems advisable to rationalise the criteria of involvement. The authors relate the past classifications of Heyman, Helsel, Munnel, Davis, Gellé, Rutledge and Burns. The most widely accepted present-day classifications are the TNM system of the UICC and above all that of the FIGO. It seems that an attempt at unification between the two systems is recommendable. However, all classifications are arbitrary in nature because of the very diversity of carcinoma of the ovary.

[Primary surgery in the treatment of invasive cancer of the cervix uteri]. / La chirurgie première dans le traitement du cancer invasif du col utérin.

The statistical data reported in this study show that the results obtained with surgery in invasive carcinoma of the cervix uteri are equivalent to those obtained with radiotherapy alone or associated with surgery. The overall proportion of operable patients in this series was 94% (stage I: 98%, stage II: 89%, stage III: 72% and stage IV: 23%). The overall survival rates at 5 years were 90.7% for stage I patients (stage I A 98.0%, stage I B 84.9%), 54.6% for stage II patients (stage II A 68.9%, stage II B proximal 67.1%, stage II B distal 25%). 20.2% for stage III patients and 7.6% for stage IV patients. The drawbacks (mortality, morbidity) of surgery and its advantages (lower psychological and financial cost) are examined. The possibility to adjust the surgical operation to the local and regional extension of the cancerous lesions and the indications for supplementary radiotherapy are discussed.

Sub-urethral tape treatment of female urinary incontinence--morbidity assessment of the trans-obturator route and a new tape (I-STOP): a multi-centre experiment involving 604 cases.

PURPOSE: To make an assessment of the morbidity related to using the trans-obturator route (TOT); findings after one year for the 140 first cases and preliminary results of short term morbidity after 604 implants. PATIENTS AND METHOD: This retrospective, multi-centre study involves the 604 first procedures with a 1-3 month follow-up. The mean patient age was 57 years. 92% of the patients underwent an isolated urinary incontinence cure and 8% had associated surgery. 47.3% of the cases had pure stress urinary incontinence and 52.7% had mixed incontinence. A 12-month minimum follow-up period was applied to the first 140 cases operated between September 2002 and January 2003. Patient assessment was made by a clinical examination in the first three months and their satisfaction rate expressed after 1 year. RESULTS: Operative complications were very few: 0.5% vesical perforations, 0.3% vaginal perforations, no urethral wounds, 0.8% 200-300 ml haemorrhages, two perineal haematomas (0.33%). The post-operative period was marked by: 1.5% transient retentions, 2.3% transient pain, 2.5% urinary infections, 1.3% transient dysuria. The 1-3 month follow-up of 572 patients shows a 5.2% rate of de novo symptoms. Patient assessment of 131 subjects after one year revealed an encouraging satisfaction rate of 85.5% with a 1.5% rate of de novo dysuria and urgency. To date there have been no serious or specific complications attributable to the surgical route adopted. The morbidity is not affected by associated surgery. CONCLUSION: The trans-obturator route combines low morbidity with a low rate of de novo symptoms on a large series. These results will have to be corroborated by further studies.

V factor (tumor volume) and T factor (FIGO classification) in the assessment of cervix cancer prognosis: the risk of lymph node spread.

An attempt was made by investigation of the operative specimens from 98 patients suffering from epidermoid carcinoma of the cervix to assess the relationship between lymphatic spread on one hand and tumor volume and anatomical stage on the other hand. Within the same anatomical stage the risk of lymphatic spread is more important as the tumor volume increases. The reverse is also true. Within the same volume the risk of lymphatic spread increases when cancer extends beyond the "cervix-parametrium" barrier. The anatomical classification based on the T factor deserves to be retained, classification which some wanted to replace by another one based exclusively on the V factor.

Multicenter phase II-III study of oxaliplatin plus cyclophosphamide vs. cisplatin plus cyclophosphamide in chemonaive advanced ovarian cancer patients.

PURPOSE: A phase II-III randomised study to compare safety and efficacy of an oxaliplatin/cyclophosphamide (OXAC) combination, vs. the reference combination of cisplatin/cyclophosphamide (CPC), in untreated advanced ovarian cancer patients. PATIENTS AND METHODS: 182 patients were enrolled, of whom 177 were treated: 86 with OXAC (130 mg/m2 oxaliplatin two-hour intravenous (i.v.) infusion, 1,000 mg/m2 cyclophosphamide two-hour i.v. infusion), and 91 with CPC (100 mg/m2 cisplatin one-hour i.v. infusion. 1,000 mg/m2 cyclophosphamide two-hour i.v. infusion). Treatment cycles were repeated every three weeks (maximum of six cycles). RESULTS: The main toxicities, which were significantly less severe in the OXAC arm, were myelosuppression and vomiting, including (OXAC vs CPC, % patients): grade 3-4 leukopenia (37% vs. 56%), and anaemia (7% vs. 32%), with blood transfusions in 8% vs. 21%. In the OXAC arm, 64% of surgically assessable patients and 33% of clinically assessable patients achieved an objective response. In the CPC arm, 67% patients achieved a surgical response and 42% achieved an objective clinical response. In the OXAC and CPC arms, median progression free-survival was 13.0 and 13.3 months, and overall survival was 36.0 and 25.1 months respectively, without statistically significant difference. CONCLUSION: The activity and time-related parameters of the OXAC and CPC combinations in advanced ovarian cancer patients, are comparable. Combined with the better safety profile of the oxaliplatin-containing regimen, this confirms the interest of oxaliplatin combined with active new agents in this indication.