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Zhou Y, Rassy E, Coutte A, Achkar S, Espenel S, Genestie C, Pautier P, Morice P, Gouy S, Chargari C. Current Standards in the Management of Early and Locally Advanced Cervical Cancer: Update on the Benefit of Neoadjuvant/Adjuvant Strategies. Cancers (Basel) 2022; 14:cancers14102449. [PMID: 35626051 PMCID: PMC9139662 DOI: 10.3390/cancers14102449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Cervical cancers is a human papillomavirus infection-induced gynecologic cancer. Due to the uneven access to prevention measures in the world, it is still a leading cause of cancer death in women in low- and middle-income countries. The mainstay of treatment for early-stage cervical cancers is upfront surgery. Clinical trials confirmed the place of adjuvant radiotherapy to improve disease control, but also highlighted the need for a careful selection of patients prior to surgery, in order to avoid the cumulative morbidities of each treatment. In locally advanced cervical cancers, the standard of care remains concurrent pelvic chemoradiotherapy followed by an image-guided adaptive brachytherapy boost allowing for dose escalation and leading to a very high probability of local control. Systemic failures remain a major concern, and neoadjuvant or adjuvant approaches in this context are discussed in the light of recent literature. Abstract Globally, cervical cancers continue to be one of the leading causes of cancer-related deaths. The primary treatment of patients with early-stage disease includes surgery or radiation therapy with or without chemotherapy. The main challenge in treating these patients is to maintain a curative approach and limit treatment-related morbidity. Traditionally, inoperable patients are treated with radiation therapy solely and operable patients undergo upfront surgery followed by adjuvant (chemo) radiotherapy in cases with poor histopathological prognostic features. Patients with locally advanced cervical cancers are treated with concurrent chemoradiotherapy followed by an image-guided brachytherapy boost. In these patients, the main pattern of failure is distant relapse, encouraging intensification of systemic treatments to improve disease control. Ongoing trials are evaluating immunotherapy in locally advanced tumours following its encouraging efficacy reported in the recurrent and metastatic settings. In this article, clinical evidence of neoadjuvant and adjuvant treatments in cervical cancer patients is reviewed, with a focus on potential strategies to improve patients’ outcome and minimize treatment-related morbidity.
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Affiliation(s)
- Yuedan Zhou
- Department of Radiation Oncology, Centre Hospitalier Universitaire, 80000 Amiens-Picardie, France; (Y.Z.); (A.C.)
| | - Elie Rassy
- Department of Medical Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (E.R.); (P.P.)
| | - Alexandre Coutte
- Department of Radiation Oncology, Centre Hospitalier Universitaire, 80000 Amiens-Picardie, France; (Y.Z.); (A.C.)
| | - Samir Achkar
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
| | - Sophie Espenel
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
| | - Catherine Genestie
- Department of Pathology, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France;
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (E.R.); (P.P.)
| | - Philippe Morice
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France; (P.M.); (S.G.)
| | - Sébastien Gouy
- Department of Surgery, Gustave Roussy Comprehensive Cancer Center, 94800 Villejuif, France; (P.M.); (S.G.)
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Comprehensive Cancer Centre, 94800 Villejuif, France; (S.A.); (S.E.)
- Correspondence:
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Technical Aspects of Endosurgical Extraperitoneal Aortic Lymph Node Dissection in Gynaecologic Oncology. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gorostidi M, Villalain C, Ruiz R, Jaunarena I, Cobas P, Lekuona A. Prevention of lymphorrhea in aortic lymphadenectomy. Int J Gynecol Cancer 2019; 29:645-646. [PMID: 30833448 DOI: 10.1136/ijgc-2018-000128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/15/2019] [Accepted: 01/22/2019] [Indexed: 11/03/2022] Open
Abstract
The objective of this video 1 is to describe the technique to avoid postoperative lymphorrhea after a lumboaortic lymphadenectomy. All procedures were performed at Donostia University Hospital, a tertiary referral and educational center in San Sebastián, Spain. Lumboaortic extra-peritoneal lymphadenectomy was performed for several gynecological malignancies (endometrial and cervical cancer). During the procedure, afferent lymphatic capillaries were identified at the infra-renal aortic level and clipped to avoid retrograde lymphorrhea at this level. Numerous strategies have been described to reduce the likelihood of lymphorea and lymphocele formation.1 Harmonic scalpel and other sealing advanced devices are not useful to secure lymphatic leakage at this level, although some authors have published a clinical benefit in their use,2 while clips have been found useful to prevent leakage in other lymphatic locations.3 The use of harmonic scalpel, biological agents or surgical patch has been ineffective in our experience, but sealing clips and peritonization (marsupialization),4 once the procedure is concluded, could be an effective approach. Performing simple gestures during lumboaortic lymphadenectomy can help to reduce the appearance of posterior lymphorrhea.
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Affiliation(s)
| | - Cecilia Villalain
- Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ruben Ruiz
- Hospital Universitario Donostia, San Sebastian, Spain
| | | | - Paloma Cobas
- Hospital Universitario Donostia, San Sebastian, Spain
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Jaunarena I, Ruiz R, Gorostidi M, Cobas P, Avila M, Valle DD, Cespedes J, Lekuona A. Efficacy of a Fibrin Sealant (Tissucol Duo) for the Preventionof Lymphocele after Laparoscopic Pelvic Lymphadenectomy:A Randomized Controlled Trial. J Minim Invasive Gynecol 2018; 26:954-959. [PMID: 30296475 DOI: 10.1016/j.jmig.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/29/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE To assess the efficacy of Tissucol Duo (Baxter AG, Vienna, Austria) fibrin sealant in decreasing the incidence of lymphocele (LC) after pelvic laparoscopic lymph node dissection using harmonic shears. DESIGN Randomized controlled trial (Canadian Task Force classification level I). SETTING Tertiary referral and educational center. PATIENTS Seventy-four patients randomized to the use of sealant per hemipelvis. INTERVENTION Fibrin sealant. MEASUREMENTS AND MAIN RESULTS After bilateral pelvic lymphadenectomy a fibrin sealant was used in 1 hemipelvis but not the other, applied in 41 patients (55.4%) to the left and 33 patients (44.6%) to the right hemipelvis. The primary outcome was the incidence of LC after surgery in symptomatic and asymptomatic patients. Imaging (ultrasound, computed tomography, and magnetic resonance) was performed to detect LC at 3, 6, and 12 months after surgery. Overall, 26 patients (35.1%) developed LC, and 4 were symptomatic (5.4%). Allowing patients to serve as their own treatment group and control, the hemipelvis treated with Tissucol Duo corresponding to the treatment group and that not treated to the control group, LCs were found in 17 (23%) and 14 (19%) cases, respectively, but the difference was not significant. The mean initial LC maximum diameter was 27.1 mm (standard deviaiotn, 35.2), and LCs tended to decrease in size during the first year to a mean of 8.7 mm. CONCLUSION Application of Tissucol Duo fibrin sealant after laparoscopic pelvic lymphadenectomy using ultrasonic shears does not decrease the occurrence of symptomatic or asymptomatic LC.
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Affiliation(s)
- Ibon Jaunarena
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)..
| | - Ruben Ruiz
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - Mikel Gorostidi
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - Paloma Cobas
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - Marisa Avila
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - David Del Valle
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - Juan Cespedes
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
| | - Arantza Lekuona
- Gynecologic Oncology Unit, Department of Gynaecology and Obstetrics, Hospital Universitario Donostia, San Sebastián, Spain (all authors)
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Morbidity of Staging Inframesenteric Paraaortic Lymphadenectomy in Locally Advanced Cervical Cancer Compared With Infrarenal Lymphadenectomy. Int J Gynecol Cancer 2017; 27:575-580. [DOI: 10.1097/igc.0000000000000921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lee J, Choi YY, An JY, Seo SH, Kim DW, Seo YB, Nakagawa M, Li S, Cheong JH, Hyung WJ, Noh SH. Do All Patients Require Prophylactic Drainage After Gastrectomy for Gastric Cancer? The Experience of a High-Volume Center. Ann Surg Oncol 2015; 22:3929-37. [PMID: 25845430 DOI: 10.1245/s10434-015-4521-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Although our previous randomized controlled trial showed that there was no difference in postoperative complications after gastric cancer surgery between patients with and without a prophylactic drains (PDs), PDs are commonly used by most surgeons and at most institutions. However, these results have not yet been validated elsewhere. The purpose of this study was to analyze the incidence, characteristics, and risk factors for a postoperative percutaneous catheter drainage (PCD) procedure after gastric cancer surgery when PDs were not used. METHODS We reviewed data from 1989 patients who underwent gastrectomy with lymphadenectomy for gastric cancer with curative intent from January 2012 to December 2013. RESULTS The incidence of PCD in the abdomen was 1.8 % (22/1249) and 9.1 % (67/740) in patients with and without PD, respectively. In the without-PD group, age [odds ratio (OR) 1.032; p = 0.013], male gender (OR for female 0.38; p = 0.005), open surgery (OR for minimally invasive surgery 0.16; p = 0.013), and longer operative time (OR 1.01; p < 0.001) were independent risk factors for postoperative PCD in the abdomen. In the without-PD group, no microbes were detected in the peritoneal fluid obtained by PCD in 72.1 % (44/61) of patients who underwent PCD, and the most commonly identified organisms were Escherichia coli and Candida albicans. CONCLUSION Not using a PD increased the risk of PCD postoperatively, but no microbes in peritoneal fluid were detected in the most patients. Selective use of PD in patients during gastric cancer surgery may be possible using our risk factor analysis.
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Affiliation(s)
- Janghee Lee
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoon Young Choi
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Sang Hyuk Seo
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Biostatistics Collaboration Unit, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu Bin Seo
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Masatoshi Nakagawa
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Shuangxi Li
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Republic of Korea
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Lamblin G, Chauvy L, Rannou C, Mathevet P, Chabert P, Mellier G, Chene G. Does ultrasonic advanced energy reduce lymphocele incidence in laparoscopic para-aortic lymphadenectomy? Eur J Obstet Gynecol Reprod Biol 2014; 185:53-8. [PMID: 25528730 DOI: 10.1016/j.ejogrb.2014.11.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/10/2014] [Accepted: 11/21/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the use of ultrasonic advanced energy in reducing the occurrence of symptomatic lymphocele and its related complications in laparoscopic extra-peritoneal para-aortic lymphadenectomy in patients with gynecological cancer. STUDY DESIGN A retrospective cohort study of consecutive patients in a tertiary referral center identified 2 groups of patients, undergoing laparoscopic extra-peritoneal para-aortic lymphadenectomy with or without the use of ultrasonic advanced energy. Surgery time, hospital stay, number of retrieved nodes and lymphocele requiring treatment were studied. Results were also compared between trained and trainee surgeons. RESULTS 163 patients were scheduled for laparoscopic extra-peritoneal para-aortic lymphadenectomy: 81 treated using bipolar energy (control group: group 1) between August 1999 and January 2005, and 82 treated using ultrasonic advanced energy (study group: group 2) between July 2010 and March 2014. The main indication (90% in group 1, 61% in group 2) was advanced cervical carcinoma (stage IB2 and above). Ultrasonic advanced energy significantly decreased operative time (p=0.001) and intra-operative bleeding (p=0.01) and increased the number of para-aortic nodes retrieved (p=0.02). There was no significant difference in hospital stay or lymphocele requiring treatment (8.6% in group 1, 8.5% in group 2: p=0.98). For senior than for junior surgeons, surgery time was shorter but not significantly (p=0.80) and postoperative lymphocele rates were identical. CONCLUSION Ultrasonic advanced energy may provide benefit in laparoscopic para-aortic lymphadenectomy, facilitating surgical ergonomics, but did not decrease post-surgery lymphocele.
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Affiliation(s)
- Gery Lamblin
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France.
| | - Lauriane Chauvy
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Corinne Rannou
- Department of Radiology, Femme Mère Enfant University Hospital, Lyon, France
| | - Patrice Mathevet
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Philippe Chabert
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Georges Mellier
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
| | - Gautier Chene
- Department of Obstetrics and Gynecology, Femme Mère Enfant University Hospital, Lyon, France
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Osmonov DK, Boller A, Aksenov A, Naumann M, Jünemann KP. [Intermediate and high risk prostate cancer patients. Clinical significance of extended lymphadenectomy]. Urologe A 2013; 52:240-5. [PMID: 23150089 DOI: 10.1007/s00120-012-3005-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION We examined the quantity and localization of pelvic lymph node (LN) metastases in patients undergoing extended pelvic lymphadenectomy (ePLND). MATERIALS AND METHODS A total of 174 patients with intermediate and high-risk prostate cancer underwent radical prostatectomy (RP) and ePLND. We analyzed the relationship between the number of LNs removed and the number, frequency and topography of LN metastases. RESULTS In group 1 (intermediate risk patients, n=115) the average number of LNs removed was 20.5, LN metastases were found in 15 patients (13 %) and the localizations were in the external iliac artery 19 %, the internal iliac artery 32 %, the obturator foramen 36 %, the common iliac artery 7 %, Marcille's triangle 3 % and sacral regions 3 %. In group 2 (high-risk patients, n=59) the average number of LNs removed was 23.9, LN metastases were found in 19 patients (32 %) and the localizations were the external iliac artery 15 %, the internal iliac artery 26 %, the obturator foramen 19 %, the common iliac artery 29 %, Marcille's triangle 6 % and sacral regions 5 %. The full number of metastases was detected only if more than 15 LNs were removed in group 1 and 18 LNs in group 2. CONCLUSIONS At least 15 LNs in the intermediate risk group and at least 18 LNs in high risk group should be removed. The ePLND should include the common iliac artery, the internal iliac artery, Marcille's triangle and sacral regions.
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Affiliation(s)
- D K Osmonov
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig Holstein, Campus Kiel, Arnold-Heller-Straße 3, Kiel, Germany.
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Gouy S, Morice P, Narducci F, Uzan C, Gilmore J, Kolesnikov-Gauthier H, Querleu D, Haie-Meder C, Leblanc E. Nodal-staging surgery for locally advanced cervical cancer in the era of PET. Lancet Oncol 2012; 13:e212-20. [PMID: 22554549 DOI: 10.1016/s1470-2045(12)70011-6] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chemoradiation therapy is deemed the standard treatment by many North American and European teams for treatment of locally advanced cervical cancer. The prevalence of para-aortic nodal metastasis in these tumours is 10-25%. PET (with or without CT) is the most accurate imaging modality to assess extrapelvic disease in such tumours. The true-positive rate of PET is high, suggesting that surgical staging is not necessary if uptake takes place in the para-aortic region. Nevertheless, false-negative results (in the para-aortic region) have been recorded in 12% of patients, rising to 22% in those with uptake during PET of the pelvic nodes. In such situations, laparoscopic surgical para-aortic staging still has an important role for detection of patients with occult para-aortic spread misdiagnosed on PET or PET-CT, allowing optimisation of treatment (extension of radiation therapy fields to include the para-aortic area). Complications of the laparoscopic procedure were noted in 0-7% of patients. Survival of individuals (missed by PET) with para-aortic nodal metastasis of 5 mm or less (and managed by extended field chemoradiation therapy) seems to be similar to survival of those without para-aortic spread, suggesting a positive therapeutic effect of the addition of staging surgery. Nevertheless, the effect on survival of potential delay of chemoradiation owing to use of PET and staging surgery, and acute and late complications of surgery followed by chemoradiation therapy (particularly in case of extended field chemoradiation to para-aortic area), need to be studied.
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Affiliation(s)
- Sebastien Gouy
- Department of Gynaecological Surgery, Institut Gustave Roussy, Villejuif, France
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[Prevention of lymphoceles and gynaecologic cancers]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2011; 39:698-703. [PMID: 22104967 DOI: 10.1016/j.gyobfe.2011.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 09/20/2011] [Indexed: 02/06/2023]
Abstract
Lymphoceles are the most frequent complications following systematic lymphadenectomy in gynaecologic cancers. Some of them may have clinical significance with high morbidity. Through a review of literature, we describe surgical methods (way of surgery, lymphadenectomy type, sentinel lymph node, peritonization, drainages, lymphostasis, surgical patch) and medical methods (somatostatin analogs and nutrition treatment) which could prevent lymphoceles formation after pelvic and lumboaortic lymphadenectomy.
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Gouy S, Kane A, Uzan C, Gauthier T, Gilmore J, Morice P. Single-port laparoscopy and extraperitoneal para-aortic lymphadenectomy: About fourteen consecutive cases. Gynecol Oncol 2011; 123:329-32. [DOI: 10.1016/j.ygyno.2011.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 07/05/2011] [Accepted: 07/09/2011] [Indexed: 10/17/2022]
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Complications de la chirurgie radicale des cancers de l’ovaire de stade avancé. ACTA ACUST UNITED AC 2011; 39:21-7. [DOI: 10.1016/j.gyobfe.2010.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Accepted: 03/18/2010] [Indexed: 12/25/2022]
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Current world literature. Curr Opin Obstet Gynecol 2010; 22:354-9. [PMID: 20611001 DOI: 10.1097/gco.0b013e32833d582e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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