Mesenchymal cell interaction with ovarian cancer cells triggers pro-metastatic properties

Tumor microenvironement is an important actor of ovarian cancer progression but the relations between mesenchymal cells and ovarian cancer cells remain unclear. The objective of this study was to determine the ovarian cancer cells' biological modifications induced by mesenchymal cells. To address this issue, we used two different ovarian cancer cell lines (NIH:OVCAR3 and SKOV3) and co-cultured them with mesenchymal cells. Upon co-culture the different cell populations were sorted to study their transcriptome and biological properties. Transcriptomic analysis revealed three biological-function gene clusters were enriched upon contact with mesenchymal cells. These were related to the increase of metastatic abilities (adhesion, migration and invasion), proliferation and chemoresistance in vitro. Therefore, contact with the mesenchymal cell niche could increase metastatic initiation and expansion through modification of cancer cells. Taken together these findings suggest that pathways involved in hetero-cellular interaction may be targeted to disrupt the acquired pro-metastatic profile.

Abstract 5105: Genetic alterations of the metastatic lesions in ovarian carcinoma

Background: Ovarian cancer is the most deadly gynecological cancer. The high rate of mortality is due to the large tumor burden with extensive metastatic lesion of the abdominal cavity. There are few studies on genetic alterations and their consequences in peritoneal metastatic tumors when compared to their matched ovarian primary tumors. Our hypothesis is that differences between the metastatic and primary lesions might be the cause of residual disease and, most importantly may have a role in post-chemotherapeutic recurrences. Methods: We conducted integrated genomics analysis on matched primary and metastatic tumors from 9 patients. In the papers presented here we analyze genome-wide Copy Number Variations (CNVs) using SNP Arrays targeting peritoneal metastasis differences, Gene expression differences using Microarrays also targeting peritoneal metastasis differences, and for some patients, Single Nucleotide Polymorphisms (SNPs) in genes through Exome sequencing. Results: Here we show that CNVs vary significantly between primary and metastatic tumors and include genes that have been considered potential chemotherapeutic targets based on primary tumor only data. Gene expression differences, while minor, showed highly statistically significant enrichment of genes in ovarian cancer critical pathways. In agreement with findings in other cancers, exome sequencing data revealed very few SNP differences of which most metastasis enriched SNPs were present at very low levels in the primary tumor. The results presented here should allow better design of therapies to target residual ovarian cancer disease.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5105. doi:1538-7445.AM2012-5105

The effect of HIV and HPV coinfection on cervical COX-2 expression and systemic prostaglandin E2 levels

Human immunodeficiency virus (HIV-1) infection causes chronic inflammation. COX-2-derived prostaglandin E(2) (PGE(2)) has been linked to both inflammation and carcinogenesis. We hypothesized that HIV-1 could induce COX-2 in cervical tissue and increase systemic PGE(2) levels and that these alterations could play a role in AIDS-related cervical cancer. Levels of cervical COX-2 mRNA and urinary PGE-M, a biomarker of systemic PGE(2) levels, were determined in 17 HIV-negative women with a negative cervical human papilloma virus (HPV) test, 18 HIV-infected women with a negative HPV test, and 13 HIV-infected women with cervical HPV and high-grade squamous intraepithelial lesions on cytology. Cervical COX-2 levels were significantly associated with HIV and HPV status (P = 0.006 and 0.002, respectively). Median levels of urinary PGE-M were increased in HIV-infected compared with uninfected women (11.2 vs. 6.8 ng/mg creatinine, P = 0.02). Among HIV-infected women, urinary PGE-M levels were positively correlated with plasma HIV-1 RNA levels (P = 0.003). Finally, levels of cervical COX-2 correlated with urinary PGE-M levels (P = 0.005). This study shows that HIV-1 infection is associated with increased cervical COX-2 and elevated systemic PGE(2) levels. Drugs that inhibit the synthesis of PGE(2) may prove useful in reducing the risk of cervical cancer or systemic inflammation in HIV-infected women.

Copy number variation analysis of matched ovarian primary tumors and peritoneal metastasis

Ovarian cancer is the most deadly gynecological cancer. The high rate of mortality is due to the large tumor burden with extensive metastatic lesion of the abdominal cavity. Despite initial chemosensitivity and improved surgical procedures, abdominal recurrence remains an issue and results in patients' poor prognosis. Transcriptomic and genetic studies have revealed significant genome pathologies in the primary tumors and yielded important information regarding carcinogenesis. There are, however, few studies on genetic alterations and their consequences in peritoneal metastatic tumors when compared to their matched ovarian primary tumors. We used high-density SNP arrays to investigate copy number variations in matched primary and metastatic ovarian cancer from 9 patients. Here we show that copy number variations acquired by ovarian tumors are significantly different between matched primary and metastatic tumors and these are likely due to different functional requirements. We show that these copy number variations clearly differentially affect specific pathways including the JAK/STAT and cytokine signaling pathways. While many have shown complex involvement of cytokines in the ovarian cancer environment we provide evidence that ovarian tumors have specific copy number variation differences in many of these genes.

Oncologic trogocytosis with Hospicells induces the expression of N-cadherin by breast cancer cells

In breast cancers, the appearance of metastasis is synonymous with poor prognosis. The metastatic process is usually associated with epithelial-mesenchymal transition (EMT) which is often induced by several soluble factors produced either by the tumour cells themselves or by cells constituting the tumour microenvironment. The aim of the present study was to determine whether the mesenchymal properties given by some molecules such as N-cadherin, for instance, could be acquired by cancer cells via the trogocytosis process with cells of the tumour microenvironment. Hospicells are stromal cells which were first isolated from cancer cell aggregates of patients with ovarian cancer. We recently showed that these cells are immunosuppressive for T lymphocyte functions and confer chemoresistance to cancer cells by the transfer of the MDR protein via trogocytosis. In this study, we showed that a mammary cancer cell line (MDA-MB-231) acquires patches of membrane via oncologic trogocytosis with Hospicells. This unidirectional and active process depends on actin polymerization and can be increased via inhibition of the Src family and decreased via inhibition of PI3K. Trogocytosis between Hospicells and MDA-MB-231 does not lead to the direct acquisition of N-cadherin but rather it leads to the production of soluble factor(s) which induce de novo expression of N-cadherin by the cancer cells. The novelty here is that this factor is produced only if cancer cells interact and undergo trogocytosis with Hospicells. This new expression could confer a more invasive phenotype to the cancer cells and thus can explain the correlation of the presence of Hospicells with the number of invaded lymph nodes in patients with mammary adenocarcinoma.

Tumor associated mesenchymal stem cells protects ovarian cancer cells from hyperthermia through CXCL12

Hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promise in treatment of ovarian carcinosis. Despite its efficiency for the treatment of peritoneal carcinosis from digestive tract neoplasia, it has failed to demonstrate significant benefit in ovarian cancers. It is therefore essential to understand the mechanism underlying resistance to HIPEC in ovarian cancers. Mesenchymal stem cells (MSC) play an important role in the development of ovarian cancer metastasis and resistance to treatments. A recent study suggests that MSCs may be cytotoxic for cancer cells upon heat shock. In contrast, we describe the protective role of MSC against hyperthermia. Using cytokine arrays we determined that the tumor associated MSC (TAMC) secrete pro-tumoral cytokines. We studied the effect of hyperthermia in co-culture setting of TAMC or BM-MCS associated with ovarian cancer cell lines (SKOV3 and CaOV3) with polyvariate flow cytometry. We demonstrate that hyperthermia does not challenge survival of TAMC or bone marrow derived MSC (BM-MSC). Both TAMC and BM-MSC displayed strong protective effect inducing thermotolerance in ovarian cancer cells (OCC). Transwell experiments demonstrated the role of secreted factors. We showed that CXCL12 was inducing thermotolerance and that inhibition of CXCL12/CXCR4 interaction restored cytotoxicity of hyperthermia in co-culture experiments. Contrary to the previous published study we demonstrated that TAMC and BM-MSC co-cultured with OCC induced thermotolerance in a CXCL12 dependant manner. Targeting the interaction between stromal and cancer cells through CXCL12 inhibition might restore hyperthermia sensitivity in ovarian cancers, and thus improve HIPEC efficiency.

Abstract 1006: Tumor associated mesenchymal stem cells protect ovarian cancer cells from hyperthermia through stromal cell derived factor-1 (SDF-1) secretion

Background: Hyperthermia therapy is a medical procedure where local body tissues are exposed to high temperatures ranging from 40oC to 43oC with the aim of killing microscopic tumor residue, being more susceptible to heat than normal cells. When combined with hyperthermia during cytoreductive surgeries, intraperitoneal chemotherapy was clinically proved to be more effective. While hyperthermia's cytotoxicity was tested on cancer cells, its effect on interactions between cancer cells and tumor stroma cells was minimally scrutinized. In this study, we investigate the effect of tumor associated mesenchymal stem cells, on inducing resistance of ovarian cancer cells (OCC) to hyperthermia.

Methods: OCC viability was challenges by heat shock at 42 degrees, in simple or co-culture systems. Cell viability was determined using Calcein Violet AM by Fluorescence Activated Cell Sorting, FACS. The same experiment was replicated using a transwell system. Using the trogocytosis assay we measured the interaction between the different cell types. Multiparameter flow cytometry was used to study the relation between intercellular interaction and thermoresistance. Finally using inhibitors and blocking antibodies we were able to analyse the role of SDF1 pathway in thermoresistance.

Results: At 42oC, an increase in viability of OCC, co-cultured with ‘MSC, was detected in comparison to cells cultured alone. The same result was attained using the transwell experiment. Antibody and siRNA for CXCR4 reversed the heat resistant effect of MSC cells on OCC. More interestingly we were able to demonstrate an increased expression of CXCR4 in cancer cells co-cultured with the MSC, and increased thermoresistance in the subset of cancer cells with more interaction (as measured by oncologic trogocytosis).

Conclusions: This study proved that contact and non contact-based cell to cell interactions between MSC cells and OCC help ovarian cancer cells resist hyperthermia. Within these interactions, MSC-secreted SDF-1 could be the major inducer of heat resistance. Combining monoclonal antibody against CXCR4 with hyperthermic intraperitoneal chemotherapy could eliminate the protective effect of tumor associated mesenchymal stem cells.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1006.

Hospicells (ascites-derived stromal cells) promote tumorigenicity and angiogenesis

The microenvironment is known to play a dominant role in cancer progression. Cells closely associated with tumoral cells, named hospicells, have been recently isolated from the ascites of ovarian cancer patients. Whilst these cells present no specific markers from known cell lineages, they do share some homology with bone marrow-derived or adipose tissue-derived human mesenchymal stem cells (CD9, CD10, CD29, CD146, CD166, HLA-1). We studied the role of hospicells in ovarian carcinoma progression. In vitro, these cells had no effect on the growth of human ovarian carcinoma cell lines OVCAR-3, SKOV-1 and IGROV-1. In vivo, their co-injection with adenocarcinoma cells enhanced tumor growth whatever the tumor model used (subcutaneous and intraperitoneally established xenografts in athymic mice). In addition, their injection increased the development of ascites in tumor-bearing mice. Fluorescent macroscopy revealed an association between hospicells and ovarian adenocarcinoma cells within the tumor mass. Tumors obtained by coinjection of hospicells and human ovarian adenocarcinoma cells presented an increased microvascularization indicating that the hospicells could promote tumorigenicity of ovarian tumor cells in vivovia their action on angiogenesis. This effect on angiogenesis could be attributed to the increased HIF1alpha and VEGF expression associated with the presence of the hospicells. Collectively, these data indicate a role for these ascite-derived stromal cells in promoting tumor growth by increasing angiogenesis.

Hospicells derived from ovarian cancer stroma inhibit T-cell immune responses

With metastatic disease at diagnosis for 70% of patients, ovarian cancer represents the most lethal gynecological malignancy. Ovarian carcinomas are aggressive malignancies that can evade immune surveillance and frequently develop into metastases. The tumor microenvironment is decisive for preventing immune attack but, in the case of ovarian carcinoma, the mechanisms are unclear. We recently isolated a novel type of stromal cell from the ascitis of patients with ovarian carcinoma that interacts with epithelial ovarian cancers conferring them chemoresistance. These cells, called Hospicells, have the cell surface markers CD9, CD10, CD29, CD146 and CD166. Here, we investigated whether Hospicells also have immunomodulatory functions that might interfere with immunity to cancer. We report that Hospicells inhibit the proliferation of human CD4(+), CD8(+) and Vgamma9Vdelta2 T cells in vitro and the production of cytokines by these immune cells. The immunosuppression of CD4(+) T cells is independent of direct contact with the Hospicells and is mainly due to nitric oxide produced by the inducible nitric oxide synthase and to products of the tryptophan degradation by indoleamine 2,3-dioxygenase. We proposed that Hospicells in the microenvironment of the tumor mediate immunosuppression of T cells and thus allow ovarian cancers to evade immune surveillance. Targeting of Hospicells could be an alternative to strong chemotherapy through the recovery of immune responses against tumor cells.

A comparative study of laparoscopic extraperitoneal lymphadenectomy [correction of laparoscopy] with the use of ultrasonically activated shears

OBJECTIVE

We evaluated the use of the harmonic scalpel in reducing the occurrence of symptomatic lymphoceles and its related complications in paraaortic laparoscopic lymphadenectomies (PALLs).

STUDY DESIGN

All PALL that were performed at the Institut Claudius Regaud between January 2003 and June 2007 were included. Since January 2006, the harmonic scalpel has been used systematically for all lymphostasis. Lymphoceles that required treatment were recorded as a complication.

RESULTS

Ninety-eight patients were enrolled, 62 PALLs were performed with the standard technique (control group), and 36 PALLs were performed with the harmonic scalpel (study group). There were no differences regarding operating time, blood loss, median nodal yield, and duration of hospital stay. Seven patients of the control group vs none of the study group (P = .03) experienced a symptomatic lymphocele that required medical treatment; 4 patients had radiologic drainage, and 1 patient had surgical drainage.

CONCLUSION

We demonstrate the efficacy of harmonic scalpel in reducing the occurrence of symptomatic lymphoceles in paraaortic extraperitoneal lymphadenectomy.

Vasculogenic mimicry of acute leukemic bone marrow stromal cells

Angiogenesis is thought to be involved in the development of acute leukemia (AL). We investigated whether bone marrow stromal cells (BMSCs) derived from stem cells might be responsible for the increase in microvascular density (MVD), and compared 13 bone marrow samples from AL patients with 23 samples from patients in complete remission (controls). We demonstrated that AL-derived BMSC secreted more insulin growth factor-1 (IGF-1) and SDF-1alpha than controls. In addition, in contrast to normal adherent BMSCs, adherent BMSCs derived from CD133+/CD34+ stem cells from AL patients were able to form capillary-like structures ('vasculogenic mimicry') on Matrigel. The increase in vasculogenic mimicry occurred through PI3 kinase and rho GTPase pathway as inhibitors of these signaling pathways (wortmannin and GGTI-298, respectively) were able to reduce or prevent capillary tube formation. In normal BMSC, addition of exogenous IGF-1 generated capillary-like tubes through the same pathway as observed spontaneously in AL-derived BMSC. The involvement of IGF-1 in the mimicry process was confirmed by the addition of a neutralizing antibody against IGF-1R or a IGF-1R pathway inhibitor (picropodophyllin). In conclusion, AL-derived BMSC present functional abnormalities that may explain the increase in MVD in the bone marrow of AL patients.

Oncologic trogocytosis of an original stromal cells induces chemoresistance of ovarian tumours

BACKGROUND

The microenvironment plays a major role in the onset and progression of metastasis. Epithelial ovarian cancer (EOC) tends to metastasize to the peritoneal cavity where interactions within the microenvironment might lead to chemoresistance. Mesothelial cells are important actors of the peritoneal homeostasis; we determined their role in the acquisition of chemoresistance of ovarian tumours.

METHODOLOGY/PRINCIPAL FINDINGS

We isolated an original type of stromal cells, referred to as "Hospicells" from ascitis of patients with ovarian carcinosis using limiting dilution. We studied their ability to confer chemoresistance through heterocellular interactions. These stromal cells displayed a new phenotype with positive immunostaining for CD9, CD10, CD29, CD146, CD166 and Multi drug resistance protein. They preferentially interacted with epithelial ovarian cancer cells. This interaction induced chemoresistance to platin and taxans with the implication of multi-drug resistance proteins. This contact enabled EOC cells to capture patches of the Hospicells membrane through oncologic trogocytosis, therefore acquiring their functional P-gp proteins and thus developing chemoresistance. Presence of Hospicells on ovarian cancer tissue micro-array from patients with neo-adjuvant chemotherapy was also significantly associated to chemoresistance.

CONCLUSIONS/SIGNIFICANCE

This is the first report of trogocytosis occurring between a cancer cell and an original type of stromal cell. This interaction induced autonomous acquisition of chemoresistance. The presence of stromal cells within patient's tumour might be predictive of chemoresistance. The specific interaction between cancer cells and stromal cells might be targeted during chemotherapy.

Efficacy of selective arterial embolisation for the treatment of life-threatening post-partum haemorrhage in a large population

BACKGROUND

The objective of this study was to assess efficacy and determine the optimal indication of selective arterial embolisation (SAE) in patients with life-threatening post-partum haemorrhage (PPH).

METHODOLOGY/PRINCIPAL FINDINGS

One hundred and two patients with PPH underwent SAE and were included from January 1998 to January 2002 in our university care center. Embolisation was considered effective when no other surgical procedure was required. Univariate and multivariate statistical analysis were performed. SAE was effective for 73 patients (71.5%), while 29 required surgical procedures. SAE was effective in 88.6% of women with uterine atony that was associated with positive outcome (OR 4.13, 1.35-12.60), whereas caesarean deliveries (OR 0.16, 0.04-0.5) and haemodynamic shock (OR 0.21, 0.07-0.60) were associated with high failure rates, 47.6% and 39.1%, respectively.

CONCLUSIONS/SIGNIFICANCE

Success rate for SAE observed in a large population is lower than previously reported. It is most likely to succeed for uterine atony but not recommended in case of haemodynamic shock or after caesarean section.

Treatment of FIGO stage IV ovarian carcinoma: results of primary surgery or interval surgery after neoadjuvant chemotherapy: a retrospective study

The objective of the study is to determine whether surgery influences the outcome of stage IV ovarian cancer. The study design is as follows: From May 1995 to December 2000, 129 patients with FIGO stage IV ovarian cancer, recruited in 42 centers, were prospectively included in GINECO first-line randomized studies of platinum-based regimens with paclitaxel administered simultaneously or sequentially. In all, 109 were eligible for this study. Standard peritoneal cytoreductive surgery was defined as a procedure including at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and peritoneal debulking. Surgery was considered optimal if residual lesions were smaller than 1 cm. The Kaplan-Meier method was used to compare survival. Initial abdominopelvic cytoreductive surgery was considered standard in 55 (54%) patients. Abdominopelvic surgery was optimal in 29 patients and nonoptimal in 26. Twenty-two (22%) patients had a simple biopsy, and 25 (24%) patients underwent substandard surgery. Twenty-two of these 47 patients without initial standard surgery underwent a second surgical procedure, and 17 of the 22 patients completed standard surgery. The median overall survival time in the entire population was 24.3 months (95% confidence interval [CI], 19.5-29.1 months). Patients treated without a cytoreductive surgical procedure had significantly worse median survival (15.1 months; 95% CI, 5.4-24.9 months) than patients who had optimal primary surgery (22.9 months; 95% CI, 15.6-30.1 months), nonoptimal primary surgery (27.1 months; 95% CI, 21.2-32.9 months), or neoadjuvant chemotherapy followed by surgery (45.5 months; 95% CI, 23.5-67.5 months) (P= .001). In conclusion, this study shows a significant benefit of debulking surgery in stage IV ovarian cancer patients who responded to neoadjuvant chemotherapy. Neoadjuvant chemotherapy can help to select patients for surgery.

Topographical CT-data analysis of the human orbital floor

The aim of this study was to evaluate the topographical anatomy of the human orbital floor for the production of prefabricated implants on the basis of computer tomography data. A database of 279 CT scans of Caucasian patients without traumatic deformation of the midface was analysed. 3D-image segmentation of the midfacial skeleton was performed using a computer-assisted protocol. A virtual plane (50 x 50 mm (2)) was constructed using defined landmarks above the orbital floor. An automated procedure was used to measure the distance between the orbital floor and the constructed plane at 400 distinct points. A mathematical algorithm was used to analyse the data, and to calculate a map of the orbital floor. Statistical analysis of the data revealed that orbital floor topography could be classified as distinct clusters. There were 12 variations of orbital floor anatomy: three unique patterns of the orbital floor for the right orbit and three corresponding patterns for the left side, all of which varied between the sexes. The 12 patterns were constructed with a statistical confidence interval of 1.36+/-0.6mm.

Obturator abscess after transobturator tape for stress urinary incontinence

BACKGROUND

A transobturator tape is a nonwoven, thermally bonded polypropylene tape recently approved in Europe for minimally invasive treatment of stress urinary incontinence.

CASE

Three cases of obturator abscess after transobturator tape procedures are reported. Patients presented with groin pain and vaginal discharge, and physical examination showed vaginal erosions. Magnetic resonance imaging confirmed the obturator abscess. All patients had complete sling removal and were treated with antibiotics. The organism responsible for the obturator abscess was Bacteroides fragilis in all three cases, suggesting that the infection occurred through a vaginal erosion.

CONCLUSION

Persistent painful or irritating symptoms after suburethral tape procedures may be due to a vaginal erosion that can be associated with an obturator abscess. Appropriate evaluation and treatment result in marked symptomatic improvement, although stress incontinence may recur.

Stromal cells extracted from ovarian cancer express functional multi drugs resistance proteins: ATP bindig casset and Major vault protein

2072

Background: Stromal cells play a central role for the growth of tumor cells. The functional contribution of these cells in cancer therapy is poorly understood. Here we studied the presenceofthe proteins ABC (ATP binding Cassette) and MVP (Major vault protein) implicated in the multi drugs resistance (MDR) phenomena in stromal cells isolated from ascitis of patients with ovarian carcinoma. Methods: Stromal cells were extracted from ascitis of patients with ovarian carcinoma. The expression of MDR proteins as p-gp (Permeability-glycoprotein), BCRP (breast cancer resistance protein) and MRPs (multidrug related proteins) as well as LRP (lung resistance protein that is a MVP) was studied by two different technique (immunocytochemistry and flow cytometry) using specific antibodies against these proteins. The functionality of the pumps or efflux, was studied by incorporation of fluorescent probes, Rhodamine 123 and JC1, substrate for p-gp, calcéine-AM substrate for p-gp and MRPs and at last Mitoxantrone substratum of BCRP, in the presence of specific inhibitors: as the cyclosporine HAS, the GG918 and the MK571 for the pumps Pgp, BCRP and MRPs respectively. Then the expression of the genes was assessed by RT-PCR. Results: 1) The expression of the proteins ABC is confirmed by immunocytochemistry and by flow cytometry. The Pgp and LRP proteins were strongly expressed and they are functional, the MRP-1, 2, 3 and BCRP proteins are weakly expressed and the MRP-5 protein is not detected. 2) The RNAm corresponding to all of these proteins is found by RT-PCR in the stromal cells. Conclusions: All of these results suggest that the MDR proteins are present on the cells surface of the tumour cell microenvironnement. The functionality of these proteins allows supposing their implication in the phenomena of multi drugs resistance to chemotherapy. The interaction between cancer cells and stromal cells should be targeted during specific chemotherapy.

No significant financial relationships to disclose.

Objective and Subjective Cure Rates after Trans-Obturator Tape (OBTAPE®) Treatment of Female Urinary Incontinence

OBJECTIVE(S)

To evaluate the safety and efficacy of a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure (OBTAPE), Mentor-Porges, Le Plessis Robinson, France) for women with stress urinary incontinence.

METHODS

Between January 2003 and January 2005, 129 consecutive women (mean age 57.2 years) underwent OBTAPE) in two academic centers. All the patients had stress urinary incontinence preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical examination and the subjective cure rate was assessed using the KHQ and BFLUTS questionnaire.

RESULTS

Mean follow-up was 17.2+/-4.7 months (range 4 to 28 months). The objective and subjective cure rates were respectively 89.9% and 77.5%. Most of the patients received general anesthesia (85.3%). Urinary retention was observed in two women (1.5%), necessitating tape adjustment. Voiding difficulties were observed in 7 cases (5.4%) necessitating intermittent self-catheterization for 4.2+/-2.4 days (range 1 to 7 days). Seven patients developed vaginal erosion (one with vaginal extrusion, and two with an obturator abscess). Complete mesh removal was necessary in 6 patients, four of whom had recurrent stress urinary incontinence.

CONCLUSIONS

Our results suggest that the OBTAPE) is an effective treatment for women with stress urinary incontinence. However, vaginal mesh erosion occurred in 6.2% of women, and this implies the need for careful follow-up.

Abdominal wall metastasis of ovarian carcinoma after low transverse abdominal incision: report of two cases and review of literature

Occurrence of parietal metastases after surgery for a suspect adnexal mass may worsen the prognosis of the disease. However, it is not clear whether abdominal wall metastases is related to specific biologic features or simply to surgical mismanagement involving small incisions and traumatic extraction of the specimen, resulting in direct seeding of cancer cells. We report two cases with development of parietal dissemination of ovarian carcinomas after Pfannenstiel incision. The two patients needed parietal resection to obtain optimal surgical cytoreduction. Pfannenstiel incisions for exploration of suspicious adnexal masses increase the risk of extensive parietal metastasis in case of malignancy because they require reflection of several sheaths of tissue. The parietal extension of the disease may need major parietal resection that can worsen the functional and general outcome of the patients.

Abdominal wall metastasis of ovarian carcinoma after low transverse abdominal incision: report of two cases and review of literature

Occurrence of parietal metastases after surgery for a suspect adnexal mass may worsen the prognosis of the disease. However, it is not clear whether abdominal wall metastases is related to specific biologic features or simply to surgical mismanagement involving small incisions and traumatic extraction of the specimen, resulting in direct seeding of cancer cells. We report two cases with development of parietal dissemination of ovarian carcinomas after Pfannenstiel incision. The two patients needed parietal resection to obtain optimal surgical cytoreduction. Pfannenstiel incisions for exploration of suspicious adnexal masses increase the risk of extensive parietal metastasis in case of malignancy because they require reflection of several sheaths of tissue. The parietal extension of the disease may need major parietal resection that can worsen the functional and general outcome of the patients.

Laparoscopic obturator nerve neurolysis after pelvic lymphadenectomy

Postoperative neuropathy is a known complication of major pelvic oncologic surgery. Obturator nerve injury complicating pelvic lymph node dissection has been reported in the literature. Severity and duration of symptoms are determined by the severity of the initial nerve lesion. Different management options have been described in the literature. We report here on a patient who developed right obturator neuropathy after pelvic lymphadenectomy. Initial management by physical therapy was unsuccessful, and the patient underwent a successful laparoscopic surgical neurolysis. Whereas preventive measures remain essential to avoid any nerve injury, this case illustrates the use of laparoscopy to perform neurolysis with a favorable outcome; therefore, persistent pain or motor loss should motivate at least surgical exploration that can be done with low morbidity by laparoscopy.

Vaginal hysterectomy for benign disorders in obese women: a prospective study

OBJECTIVE

To compare the morbidity of vaginal hysterectomy in obese and non-obese women in a single institution.

DESIGN

Obese and non-obese women with benign uterine disorders matched for age, parity and race underwent vaginal hysterectomy without laparoscopic assistance. Peri-operative outcome complications were compared. Thirty-eight women had a BMI over 30 kg/m(2) (study group) and 178 women had a BMI below 30 kg/m(2) (control group).

SETTING

Gynaecologic department of a university hospital.

POPULATION

Women who were referred to our department with an indication of vaginal hysterectomy for benign disorders.

METHODS

Case control study.

MAIN OUTCOME MEASURES

Peri-operative complications, the fall in the haemoglobin concentration, the duration of the procedure, the length of the hospital stay and uterine weight were analysed.

RESULTS

Mean BMI was 33.2 and 23.7 kg/m(2) in the study and control groups, respectively. None of the obese women had severe co-morbidity contraindicating surgery. There were no significant differences in surgical or anaesthetic risk factors, including parity, hormonal status, pre-existing disease and estimated mean uterine weight. The overall complication rates were 14% and 16% in the obese and non-obese groups, respectively (P= 0.7). Obesity did not increase the duration of the procedure (48 [7] minutes vs 50 [10] minutes, P= 0.1) or the length of hospitalisation (5.8 [1.4] days vs 5.5 [1.2] days, P= 0.2).

CONCLUSION

Vaginal hysterectomy can be successfully performed, with acceptable morbidity, in obese women.

Previous abdominal surgery and closed entry for gynaecological laparoscopy: a prospective study

OBJECTIVES

To assess the morbidity from closed laparoscopic access and define the role of previous surgery on the occurrence of these complications.

DESIGN AND METHODS

We prospectively recorded data on all laparoscopic procedures between January 2000 and January 2001. We compared results from patients without previous abdominal surgery (group I) with patients with prior abdominal surgery (group II). The insertion site for the Verres needle was trans-umbilical for patients in group I and in the left upper quadrant for patients in group II.

SETTING

Gynaecology department of a University Hospital.

POPULATION

All laparoscopic procedures between January 2000 and January 2001.

MAIN OUTCOME MEASURES

We compared results from patients without previous abdominal surgery (group I) with patients with prior abdominal surgery (group II). The insertion site for the Verres needle was trans-umbilical for patients in group I and the left upper quadrant for patients in group II.

RESULTS

Four hundred and seventy-seven laparoscopies were carried out during the study period, 368 women without previous surgery were included in group I, and 109 women were included in group II. We recorded 1 complication (overall complication rate of 0.2% and 31 incidents (6.4%). One complication (small bowel injury) was related to the insertion of the Verres needle (0.2%). The incidents and complications occurred only in group II (P < 0.05). All the complications were treated by laparoscopy.

CONCLUSION

The complication rate of the entry step is low in gynaecological laparoscopy. A previous history of laparotomy increases the risk of these complications and incidents. Safety rules and other access method should be investigated for these patients.