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Collin-Bund V, Viviani V, Meyer N, Goetsch T, Boisramé T, Faller E, Lecointre L, Gabriele V, Akladios C, Garbin O, Host A. Study of the feasibility of outpatient sacrocolpopexy by laparoscopy. J Gynecol Obstet Hum Reprod 2024; 53:102792. [PMID: 38663686 DOI: 10.1016/j.jogoh.2024.102792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/18/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Laparoscopic sacrocolpopexy (LSCP) is currently the gold standard surgical technique for treating pelvic prolapse. This study aimed to evaluate the feasibility of laparoscopic sacrocolpopexy in ambulatory care. PATIENTS AND METHODS This prospective study was conducted to evaluate the feasibility of LSCP in women who visited the outpatient department of obstetrics and gynecology at the University Hospital of Strasbourg between July 2018 and December 2021. All women with indications for laparoscopic sacrocolpopexy for prolapse treatment who were willing to be treated as outpatients were included. The main criterion of the study was to evaluate the rate of re-hospitalization between discharge from the outpatient department after LSCP and postoperative follow-up consultations. RESULTS Among the whole population (57/200, 28.5 %) included, 4 (7 %) were hospitalized. The quality of life was not altered with a preserved EuroQol (EQ-5D) quality of life score with a mean score of 73±18.4 standard deviation (SD) 95 % confidence interval (CI) (67.9; 78.1) on postoperative day 3 (D3) and 91.2 ± 16.3 SD 95 % CI (86.2-96) on D30. On D1, D2, D3, and D7, the anxiety rate evaluated by State-Trait Anxiety Inventory score (STAI Y-A) remained low, with mean scores of 24.8 ± 9.6 SD 95 % [23.4-26.5] on D30. All patients were satisfied or very satisfied with the procedure and outpatient management, with an average score of 9.6/10 (range: 8-10). CONCLUSION This prospective, monocentric study evaluating the feasibility of outpatient LSCP reported demonstrated low rates of complications and re-hospitalization after outpatient management. Furthermore, the patients' quality of life was not altered, and they patients were satisfied with this type of management.
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Affiliation(s)
- V Collin-Bund
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - V Viviani
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - N Meyer
- Department of Public Health, Biostatistic laboratory, Université de Strasbourg, 67081 Strasbourg, France
| | - T Goetsch
- Department of Public Health, Biostatistic laboratory, Université de Strasbourg, 67081 Strasbourg, France
| | - T Boisramé
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - E Faller
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - L Lecointre
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France; I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, 67081 Strasbourg, France; Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, France
| | - V Gabriele
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - C Akladios
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - O Garbin
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
| | - A Host
- Department of Gynecologic Surgery, Strasbourg University Hospital, Strasbourg, France
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Brun JL, Plu-Bureau G, Huchon C, Ah-Kit X, Barral M, Chauvet P, Cornelis F, Cortet M, Crochet P, Delporte V, Dubernard G, Giraudet G, Gosset A, Graesslin O, Hugon-Rodin J, Lecointre L, Legendre G, Maitrot-Mantelet L, Marcellin L, Miquel L, Le Mitouard M, Proust C, Roquette A, Rousset P, Sangnier E, Sapoval M, Thubert T, Torre A, Trémollières F, Vernhet-Kovacsik H, Vidal F, Marret H. Management of women with abnormal uterine bleeding: Clinical practice guidelines of the French National College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2023; 288:90-107. [PMID: 37499278 DOI: 10.1016/j.ejogrb.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/25/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To provide French guidelines for the management of women with abnormal uterine bleeding (AUB). DESIGN A consensus committee of 26 experts was formed. A formal conflict-of-interest policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding (i.e. pharmaceutical or medical device companies). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The last guidelines from the Collège National des Gynécologues et Obstétriciens Français on the management of women with AUB were published in 2008. The literature seems now sufficient for an update. The committee studied questions within 7 fields (diagnosis; adolescents; idiopathic AUB; endometrial hyperplasia and polyps; type 0-2 fibroids; type 3 or higher fibroids; and adenomyosis). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and evidence profiles were compiled. The GRADE® methodology was applied to the literature review and the formulation of recommendations. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 36 recommendations. Among the formalized recommendations, 19 are strong and 17 weak. No response was found in the literature for 14 questions. We chose to abstain from recommendations rather than providing advice based solely on expert clinical experience. CONCLUSIONS The 36 recommendations make it possible to specify the diagnostic and therapeutic strategies for various clinical situations practitioners encounter, from the simplest to the most complex.
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Affiliation(s)
- J L Brun
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France.
| | - G Plu-Bureau
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - C Huchon
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2 rue Ambroise Paré, 75010 Paris, France
| | - X Ah-Kit
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - M Barral
- Service de radiologie interventionnelle, hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - P Chauvet
- Service de chirurgie gynécologique, CHU Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63000 Clermont-Ferrand, France
| | - F Cornelis
- Service de radiologie interventionnelle, hôpital Tenon, 4 rue de la Chine, 75020 Paris, France
| | - M Cortet
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - P Crochet
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147 boulevard Baille, 13005 Marseille, France
| | - V Delporte
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49 rue de Valmy, 59000 Lille, France
| | - G Dubernard
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - G Giraudet
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49 rue de Valmy, 59000 Lille, France
| | - A Gosset
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - O Graesslin
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45 rue Cognac-Jay, 51092 Reims, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Lecointre
- Service de chirurgie gynécologique, CHU Strasbourg, 1 avenue Molière, 67200 Strasbourg, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU Angers, 4 rue Larrey, 49933 Angers, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Marcellin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - L Miquel
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147 boulevard Baille, 13005 Marseille, France
| | - M Le Mitouard
- Service de gynécologie, hôpital Croix Rousse, CHU Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Proust
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37044 Tours, France
| | - A Roquette
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - P Rousset
- Service de radiologie, hôpital Sud, CHU Lyon, 165 chemin du Grand Revoyet, 69495 Pierre-Benite, France
| | - E Sangnier
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45 rue Cognac-Jay, 51092 Reims, France
| | - M Sapoval
- Service de radiologie interventionnelle, hôpital europeen Georges-Pompidou, APHP, 20 rue Leblanc, 75015 Paris, France
| | - T Thubert
- Service de gynécologie-obstétrique, Hotel Dieu, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - A Torre
- Centre de procréation médicalement assistée, centre hospitalier Sud Francilien, 40 avenue Serge Dassault, 91106 Corbeil-Essonnes, France
| | - F Trémollières
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Vernhet-Kovacsik
- Service d'imagerie thoracique et vasculaire, hôpital Arnaud-de-Villeneuve, CHU Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - F Vidal
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330 Avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37044 Tours, France
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Gaultier V, Mounien D, Faller E, Boisramé T, Gabriele V, Lecointre L, Martel C, Akladios C. [How i do… laparotomy omentosplenectomy during complete cytoreductive surgery?]. Gynecol Obstet Fertil Senol 2022; 50:689-692. [PMID: 36028185 DOI: 10.1016/j.gofs.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/13/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Affiliation(s)
- V Gaultier
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France.
| | - D Mounien
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - E Faller
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - T Boisramé
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - V Gabriele
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - L Lecointre
- IHU-Strasbourg (institut hospitalo-universitaire), institut de chirurgie guidée par image, Strasbourg, France; ICube UMR 7357 - laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, CNRS, université de Strasbourg, Strasbourg, France
| | - C Martel
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - C Akladios
- Service de chirurgie gynécologique, CHRU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
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4
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Brun JL, Plu-Bureau G, Huchon C, Ah-Kit X, Barral M, Chauvet P, Cornelis F, Cortet M, Crochet P, Delporte V, Dubernard G, Giraudet G, Gosset A, Graesslin O, Hugon-Rodin J, Lecointre L, Legendre G, Maitrot-Mantelet L, Marcellin L, Miquel L, Le Mitouard M, Proust C, Roquette A, Rousset P, Sangnier E, Sapoval M, Thubert T, Torre A, Trémollières F, Vernhet-Kovacsik H, Vidal F, Marret H. [Management of women with abnormal uterine bleeding: Clinical practice guidelines of the French National College of Gynecologists and Obstetricians (CNGOF)]. Gynecol Obstet Fertil Senol 2022; 50:345-373. [PMID: 35248756 DOI: 10.1016/j.gofs.2022.02.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To provide French guidelines for the management of women with abnormal uterine bleeding (AUB). DESIGN A consensus committee of 26 experts was formed. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, or medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The last guidelines from the Collège national des gynécologues et obstétriciens français (CNGOF) on the management of women with AUB was published in 2008. The literature seems now sufficient for an update. The committee studied questions within 7 fields (diagnosis; adolescent; idiopathic AUB; endometrial hyperplasia and polyps; fibroids type 0 to 2; fibroids type 3 and more; adenomyosis). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS The experts' synthesis work and the application of the GRADE method resulted in 36 recommendations. Among the formalized recommendations, 19 present a strong agreement and 17 a weak agreement. Fourteen questions did not find any response in the literature. We preferred to abstain from recommending instead of providing expert advice. CONCLUSIONS The 36 recommendations made it possible to specify the diagnostic and therapeutic strategies of various clinical situations managed by the practitioner, from the simplest to the most complex.
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Affiliation(s)
- J-L Brun
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - G Plu-Bureau
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - C Huchon
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - X Ah-Kit
- Service de chirurgie gynécologique, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - M Barral
- Service de radiologie interventionnelle, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - P Chauvet
- Service de chirurgie gynécologique, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63000 Clermont-Ferrand, France
| | - F Cornelis
- Service de radiologie interventionnelle, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - M Cortet
- Service de gynécologie, hôpital Croix-Rousse, CHU Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - P Crochet
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147, boulevard Baille, 13005 Marseille, France
| | - V Delporte
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49, rue de Valmy, 59000 Lille, France
| | - G Dubernard
- Service de gynécologie, hôpital Croix-Rousse, CHU Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - G Giraudet
- Service de gynécologie, hôpital Jeanne de Flandre, CHU Lille, 49, rue de Valmy, 59000 Lille, France
| | - A Gosset
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - O Graesslin
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45, rue Cognac-Jay, 51092 Reims, France
| | - J Hugon-Rodin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Lecointre
- Service de chirurgie gynécologique, CHU Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU Angers, 4, rue Larrey, 49933 Angers, France
| | - L Maitrot-Mantelet
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Marcellin
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - L Miquel
- Service de gynécologie-obstétrique, hôpital de la Conception, CHU Marseille, 147, boulevard Baille, 13005 Marseille, France
| | - M Le Mitouard
- Service de gynécologie, hôpital Croix-Rousse, CHU Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Proust
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - A Roquette
- Unité de gynécologie médicale, hôpital Port-Royal Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Rousset
- Service de radiologie, hôpital Sud, CHU Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France
| | - E Sangnier
- Service de gynécologie-obstétrique, institut mère enfant Alix de Champagne, CHU Reims, 45, rue Cognac-Jay, 51092 Reims, France
| | - M Sapoval
- Service de radiologie interventionnelle, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - T Thubert
- Service de gynécologie-obstétrique, Hôtel-Dieu, CHU Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - A Torre
- Centre de procréation médicalement assistée, centre hospitalier Sud Francilien, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - F Trémollières
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Vernhet-Kovacsik
- Service d'imagerie thoracique et vasculaire, hôpital Arnaud-de-Villeneuve, CHU Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier, France
| | - F Vidal
- Centre de ménopause et maladies osseuses métaboliques, hôpital Paule de Viguier, CHU, 330, avenue de Grande-Bretagne, 31059 Toulouse, France
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU Tours, 2, boulevard Tonnellé, 37044 Tours, France
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Sangnier E, Ouldamer L, Bendifallah S, Huchon C, Collinet P, Bricou A, Mimoun C, Lecointre L, Graesslin O, Raimond E, Creton de Limerville H. 258. Risk factors for recurrence of borderline ovarian tumors in France: A multicenter retrospective study by the francogyn group. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wehr M, Lecointre L, Schneider H, Schwartz L, Faller E, Boisramé T, Baldauf JJ, Akladios C. [Outpatient laparoscopic hysterectomy in France: A monocentric randomized trial]. ACTA ACUST UNITED AC 2021; 50:33-39. [PMID: 34509670 DOI: 10.1016/j.gofs.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of outpatient laparoscopic hysterectomy using the assessment of post-operative quality of life. METHODS A prospective randomized single-center trial was performed in France between 2013 and 2016. A total of 42 patients needed laparoscopic hysterectomy was included. Postoperative quality of life was assessed using the standardized Euroquol questionnaire. Patients filled the score before the operation and then on the 3rd and 30th postoperative day. Secondary outcomes were assessment of postoperative pain, overall quality of life, analgesic use, and anxiety. The patients were randomized into two groups, group A with a conventional hospital stay of 2 to 3 days and group B with a short stay and a discharge the day after the intervention. RESULTS Twenty-one patients were randomized to group A as well as group B. We did not find any significant differences between the two groups in our study either on our primary outcome or in the seconds ones. On day 3, the average of Euroquol score was 0.68 for group A against 0.50 for group B (P=0.05). Likewise, the scores for postoperative pain were similar with 70.6 in group A and 61.8 in group B (P=0.21). The trend was the same for quality of life score or anxiety. CONCLUSION Our study shows the possibility and the safety of outpatient laparoscopic hysterectomy.
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Affiliation(s)
- M Wehr
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - L Lecointre
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France; I-Cube UMR 7357 laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, université de Strasbourg, 67081 Strasbourg, France; Institut hospitalo-universitaire (IHU) Institute for Minimally Invasive Hybrid Image-Guided Surgery, université de Strasbourg, 67081 Strasbourg, France.
| | - H Schneider
- Centre hospitalier de Saverne, Saverne et Haguenau, France.
| | - L Schwartz
- Centre hospitalier de Haguenau, Saverne et Haguenau, France.
| | - E Faller
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - T Boisramé
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - J-J Baldauf
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
| | - C Akladios
- Department of gynecologic surgery, hôpitaux universitaires de Strasbourg, 67091 Strasbourg, France.
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Azaïs H, Lecointre L, Canlorbe G. [What's new in the management of endometrial cancer? Update on the new European recommendations for 2021]. ACTA ACUST UNITED AC 2021; 49:691-697. [PMID: 33757927 DOI: 10.1016/j.gofs.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Indexed: 10/21/2022]
Abstract
The new European guidelines for the management of patients with endometrial cancer were published in early 2021. These recommendations are joint to the three European Learned Societies of Gynecologic Oncology (ESGO), Radiation Therapy and Oncology (ESTRO) and Anatomical Pathology (ESP). On behalf of the French Society of Gynecologic Oncology (SFOG), we wish to bring to the knowledge of the French-speaking readership the main measures for the management of patients which represent an advance compared to the 2016 recommendations. The new European recommendations for the management of patients with endometrial cancer emphasize the generalization of micro-satellite instability (MSI) or immunohistochemical analysis of MMR system proteins for all patients. Also, the classification into 4 prognostic risk groups integrates data from molecular analysis (p53, MSI, POLE) to guide initial surgical management as well as adjuvant treatment modalities. The indocyanine green sentinel node procedure has also become the reference technique for FIGO I and II lymph node staging regardless of histological type. It should be remembered that management should be provided in a specialized institution by a team specialized in the management of gynecological cancers, particularly for high-risk and/or advanced cancer patients.
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Affiliation(s)
- H Azaïs
- Department of Gynecologic and Breast Oncological Surgery, European Georges-Pompidou Hospital, APHP. Centre, France
| | - L Lecointre
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, France; I-Cube UMR 7357 - Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie. Université de Strasbourg, Strasbourg, France
| | - G Canlorbe
- Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, 75013 Paris, France; Sorbonne University, Inserm UMR_S_938, Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine (CRSA), 75012 Paris, France.
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Bourdel N, Huchon C, Abdel Wahab C, Azaïs H, Bendifallah S, Bolze PA, Brun JL, Canlorbe G, Chauvet P, Chereau E, Courbiere B, De La Motte Rouge T, Devouassoux-Shisheboran M, Eymerit-Morin C, Fauvet R, Gauroy E, Gauthier T, Grynberg M, Koskas M, Larouzee E, Lecointre L, Levêque J, Margueritte F, Mathieu D'argent E, Nyangoh-Timoh K, Ouldamer L, Raad J, Raimond E, Ramanah R, Rolland L, Rousset P, Rousset-Jablonski C, Thomassin-Naggara I, Uzan C, Zilliox M, Daraï E. Borderline ovarian tumors: Guidelines from the French national college of obstetricians and gynecologists (CNGOF). Eur J Obstet Gynecol Reprod Biol 2020; 256:492-501. [PMID: 33262005 DOI: 10.1016/j.ejogrb.2020.11.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
It is recommended to classify Borderline Ovarian Tumors (BOTs) according to the WHO classification. Transvaginal and suprapubic ultrasonography are recommended for the analysis of an ovarian mass (Grade A). In case of an undetermined ovarian lesion on ultrasonography, it is recommended to perform a pelvic MRI (Grade A) with a score for malignancy (ADNEX MR/O-RADS) (Grade C) included in the report and to formulate a histological hypothesis (Grade C). Pelvic MRI is recommended to characterize a tumor suspected of being BOT (Grade C). It is recommended to evaluate serum levels of HE4 and CA125 and to use the ROMA score for the diagnosis of indeterminate ovarian mass on imaging (grade A). If there is a suspicion of a mucinous BOT on imaging, serum levels of CA 19-9 may be proposed (Grade C). For Early Stages (ES) of BOT, if surgery without risk of tumor rupture is possible, laparoscopy with protected extraction is recommended over laparotomy (Grade C). For treatment of a bilateral serous ES BOT with a strategy to preserve fertility and/or endocrine function, bilateral cystectomy is recommended where possible (Grade B). For mucinous BOTs with a treatment strategy of fertility and/or endocrine function preservation, unilateral salpingo-oophorectomy is recommended (grade C). For mucinous BOTs treated by initial cystectomy, unilateral salpingo-oophorectomy is recommended (grade C). For serous or mucinous ES BOTs, routine hysterectomy is not recommended (Grade C). For ES BOTs, lymphadenectomy is not recommended (Grade C). For ES BOTs, appendectomy is recommended only in case of a macroscopically pathological appendix (Grade C). Restaging surgery is recommended in cases of serous BOTs with micropapillary architecture and an incomplete abdominal cavity inspection during initial surgery (Grade C). Restaging surgery is recommended for mucinous BOTs after initial cystectomy or in cases where the appendix was not examined (Grade C). If restaging surgery is decided for ES BOTs, the following procedures should be performed: peritoneal washing (grade C), omentectomy (grade B), complete exploration of the abdominal cavity with peritoneal biopsies (grade C), visualization of the appendix and appendectomy in case of a pathological macroscopic appearance (grade C) as well as unilateral salpingo-oophorectomy in case of a mucinous BOT initially treated by cystectomy (grade C). In advanced stages (AS) of BOT, it is not recommended to perform a lymphadenectomy as a routine procedure (Grade C). For AS BOT in a patient with a desire to fall pregnant, conservative treatment involving preservation of the uterus and all or part of the ovary may be proposed (Grade C). Restaging surgery aimed at removing all lesions, not performed initially, is recommended for AS BOTs (Grade C). After treatment, follow-up for a duration greater than 5 years is recommended due to the median recurrence time of BOTs (Grade B). It is recommended that a systematic clinical examination be carried out during follow-up of a treated BOT (Grade B). If the determination of tumor markers is normal preoperatively, the routine dosage of tumor markers in BOT follow-up is not recommended (Grade C). In case of an initial elevation in serum CA 125 levels, it is recommended to monitor CA 125 during follow up (Grade B). In case of conservative treatment, it is recommended to use transvaginal and transabdominal ultrasound during follow up of a treated BOT (Grade B). In the event of a BOT recurrence in a woman of childbearing age, a second conservative treatment may be proposed (Grade C). A consultation with a physician specialized in Assisted Reproductive Technique (ART) should be offered in the case of BOTs in women of childbearing age (Grade C). When possible, a conservative surgical strategy is recommended to preserve fertility in women of childbearing age (Grade C). In the case of optimally treated BOT, there is no evidence to contraindicate the use of ART. The use of hormonal contraception after serous or mucinous BOT is not contraindicated (Grade C). After management of mucinous BOT, for women under 45 years, given the benefit of Hormonal Replacement Therapy (HRT) on cardiovascular and bone risks, and the lack of hormone sensitivity of mucinous BOTs, it is recommended to offer HRT (Grade C). Over 45 years of age, HRT can be prescribed in case of a climacteric syndrome after individual benefit to risk assessment (Grade C).
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Affiliation(s)
- N Bourdel
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - C Huchon
- Service de Gynécologie & Obstétrique, Hopital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, France; Université de Paris, Paris, France.
| | - C Abdel Wahab
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France; Faculté De Médecine UPMC, Sorbonne Université, France
| | - H Azaïs
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - S Bendifallah
- Service De Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
| | - P A Bolze
- Service De Chirurgie Gynécologique Et Oncologique, Obstétrique, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre Bénite, France; Université Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100, Villeurbanne, France
| | - J L Brun
- Service De Chirurgie Gynécologique, Centre Aliénor d'Aquitaine, Hôpital Pellegrin, 33076 Bordeaux, Société Française De Gynéco Pathologie, 81 Rue Verte, 76000 Rouen, France
| | - G Canlorbe
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - P Chauvet
- Service de Chirurgie Gynécologique, CHU de Clermont Ferrand, 1 Place Lucie Aubrac, 63 003 Clermont Ferrand, France
| | - E Chereau
- Service De Gynécologie Obstétrique, Hopital Saint Joseph, Marseille, France
| | - B Courbiere
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | | | - M Devouassoux-Shisheboran
- Institut De Pathologie Multi-Sites Des HOSPICES CIVILS De LYON, Centre Hospitalier Lyon Sud, Centre De Biologie Et Pathologie Sud, 165 Chemin Du Grand Revoyet, 69495 Pierre Bénite. Société Française de Gynéco Pathologie, 81 Rue Verte, 76000 Rouen, France
| | - C Eymerit-Morin
- Service d'Anatomie Et Cytologie Pathologiques, Hôpital Tenon, HUEP, UPMC Paris VI, Sorbonne Universities, 4 rue de la Chine, 75020 Paris, France; Institut de Pathologie de Paris, 35 boulevard Stalingrad, 92240 Malakoff, France
| | - R Fauvet
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Caen, Caen, France
| | - E Gauroy
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - T Gauthier
- Service De Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 Av Dominique Larrey 87042 Limoges, France
| | - M Grynberg
- Service De Médecine De La Reproduction, Hôpital Antoine Béclère, 157 Rue De La Porte De Trivaux, 92140 Clamart, France
| | - M Koskas
- Service De Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - E Larouzee
- Service de Gynécologie-Obstétrique, Hôpital Bichat, 46 Rue Henri Huchard, 75018 Paris, France; Université de Paris, Paris, France
| | - L Lecointre
- Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, CHRU Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - J Levêque
- Département De Gynécologie Obstétrique Et Reproduction Humaine, 16, Boulevard De Bulgarie, 35000 CHU Anne De Bretagne, UFR Médecine Université de Rennes 1, Rennes, Bretagne, France
| | - F Margueritte
- Service De Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Limoges, 8 Av Dominique Larrey, 87042 Limoges, France
| | - E Mathieu D'argent
- Service de Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
| | - K Nyangoh-Timoh
- Département De Gynécologie Obstétrique Et Reproduction Humaine, 16, Boulevard De Bulgarie, 35000 CHU Anne De Bretagne, UFR Médecine Université de Rennes 1, Rennes, Bretagne, France
| | - L Ouldamer
- Département De Gynécologie, Centre Hospitalier Universitaire De Tours, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37000, Tours, France
| | - J Raad
- Service De Médecine De La Reproduction, Hôpital Antoine Béclère, 157 Rue De La Porte De Trivaux, 92140 Clamart, France
| | - E Raimond
- Département de Gynécologie Obstétrique, Institut Alix De Champagne, CHU Reims, Reims, France
| | - R Ramanah
- Pôle Mère-Femme, CHU Besançon, 3 Boulevard Fleming, 25000 Besançon, France
| | - L Rolland
- Centre Clinico-Biologique d'AMP, Pôle Femmes - Parents- Enfants, AP-HM, Hôpital de La Conception, 147 Bd Baille, 13005 Marseille, France
| | - P Rousset
- Service de Radiologie, Centre Hospitalier Lyon Sud, HCL, EMR 3738, 165 Chemin du Grand Revoyet, 69310, Lyon Sud, Pierre-Bénite, France; Université Lyon 1, 43 Boulevard Du 11 Novembre 1918, 69100, Villeurbanne, France
| | - C Rousset-Jablonski
- Centre Léon Bérard, 28 Rue Laënnec, 69008, Lyon, France; Centre Hospitalier Lyon Sud, Pierre-Bénite, France; Université Claude Bernard Lyon 1, EA 7425 Hesper, Health Service and Performance Research, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon Cedex 8, France
| | - I Thomassin-Naggara
- APHP.6 Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - C Uzan
- AP-HP, Hôpital Pitié-Salpêtrière, Service De Chirurgie Et Oncologie Gynécologique Et Mammaire, 75013 Paris, France; Faculté de Médecine UPMC, Sorbonne Université, France
| | - M Zilliox
- Centre Hospitalier Universitaire Hautepierre, Hôpital De Hautepierre, CHRU Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - E Daraï
- Service de Gynécologie-Obstétrique Et Médecine De La Reproduction, Hôpital Tenon, Assistance Publique Des Hôpitaux De Paris (AP-HP), Institut Universitaire de Cancérologie (IUC), Centre CALG (Cancer Associé à La Grossesse), UMRS-938, Faculté de Médecine UPMC, Sorbonne Université, France
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Zilliox M, Lecointre L, Azais H, Ballester M, Bendifallah S, Bolze PA, Bourdel N, Bricou A, Canlorbe G, Carcopino X, Chauvet P, Collinet P, Coutant C, Dabi Y, Dion L, Gauthier T, Graesslin O, Huchon C, Koskas M, Lavoue V, Mezzadri M, Mimoun C, Ouldamer L, Raimond E, Touboul C, Lapointe M, Akladios C. Management of borderline ovarian tumours during pregnancy: Results of a French multi-centre study. Eur J Obstet Gynecol Reprod Biol 2020; 256:412-418. [PMID: 33296755 DOI: 10.1016/j.ejogrb.2020.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/05/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- M Zilliox
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France.
| | - L Lecointre
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France; I-Cube UMR 7357 Science Laboratory, Strasbourg, France; IHU: Institute for Minimally Invasive Hybrid Image Guided Surgery, Strasbourg, France
| | - H Azais
- Department of Gynaecology, Pitié Salpetriere Hospital, Paris, France
| | - M Ballester
- Department of Gynaecology, Diaconesses Croix Saint Simon, Paris, France
| | - S Bendifallah
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - P A Bolze
- Department of Gynaecology, University Hospital South Lyon, Pierre-Bénite, France
| | - N Bourdel
- Department of Gynaecology, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - A Bricou
- Department of Gynaecology, Diaconesses Croix Saint Simon, Paris, France
| | - G Canlorbe
- Department of Gynaecology, Pitié Salpetriere Hospital, Paris, France
| | - X Carcopino
- Department of Gynaecology, La Timone Hospital, Marseille, France
| | - P Chauvet
- Department of Gynaecology, University Hospital of Clermont Ferrand, Clermont Ferrand, France
| | - P Collinet
- Department of Gynaecology, Jeanne de Flandres Hospital, Lille, France
| | - C Coutant
- Centre de Lutte Contre le Cancer, Dijon, France
| | - Y Dabi
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - L Dion
- Department of Gynaecology, University South Hospital, Rennes, France
| | - T Gauthier
- Department of Gynaecology, University Hospital, Limoges, France
| | - O Graesslin
- Department of Gynaecology, University Hospital, Reims, France
| | - C Huchon
- Department of Gynaecology, Intercommunal Hospital of Poissy, Poissy, France
| | - M Koskas
- Department of Gynaecology, Bichat Hospital, Paris, France
| | - V Lavoue
- Department of Gynaecology, University South Hospital, Rennes, France
| | - M Mezzadri
- Department of Gynaecology, Lariboisière Hospital, Paris, France
| | - C Mimoun
- Department of Gynaecology, Lariboisière Hospital, Paris, France
| | - L Ouldamer
- Department of Gynaecology, University Hospital of Tours, Tours, France
| | - E Raimond
- Department of Gynaecology, University Hospital, Reims, France
| | - C Touboul
- Department of Gynaecology, Tenon Hospital, Paris, France
| | - M Lapointe
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France
| | - C Akladios
- Department of Gynaecology, University Hospital of Hautepierre, Strasbourg, France
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Sangnier E, Ouldamer L, Bendifallah S, Huchon C, Collinet P, Bricou A, Mimoun C, Lecointre L, Graesslin O, Raimond E. Risk factors for recurrence of borderline ovarian tumors in France: A multicenter retrospective study by the FRANCOGYN group. J Gynecol Obstet Hum Reprod 2020; 50:101961. [PMID: 33127559 DOI: 10.1016/j.jogoh.2020.101961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Borderline ovarian tumors (BOTs) although rare, have shown an increase in the incidence worldwide. Although the survival rate is high, the recurrence rate is estimated to be between 5% and 34%. The objective of this study was to identify risk factors for recurrence of BOTs. METHODS This retrospective multicenter study included 493 patients treated surgically for BOT between January 2001 and December 2018. RESULTS Thirty-seven patients showed recurrence (group R, 7.5%), while 456 did not (group NR, 92.5%). With an average follow-up of 30.5 months (1-276), the overall recurrence rate was 7.5%. Recurrence rates for the BOT and invasive types were 5.7% (n = 28) and 1.4% (n = 7), respectively. The mean time to recurrence was 44.1 (3-251) months. Univariate analysis showed that age at diagnosis, type of surgical procedure, histological type, and FIGO stage were factors influencing recurrence. Multivariate analysis showed that the risk factors for recurrence of BOT were conservative treatment (OR = 7 [95% CI 3.01-16.23]; p < 0.05) and advanced FIGO stage (OR = 5.86 [95% CI 2.21-15.5]; p < 0.05). DISCUSSION To the best of our knowledge, this multicenter study was one of the largest studies on the risk factors for BOT recurrence. Conservative treatment and advanced FIGO stage were identified as risk factors for BOT recurrence. These results reinforce the need for restaging of patients who did not have an optimal initial surgical staging so as not to avoid missing a tumor in the advanced stage. Referral to a surgical oncology center is suggested to optimize overall patient management.
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Affiliation(s)
- E Sangnier
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes university, Reims, France
| | - L Ouldamer
- Department of Obstetrics and Gynaecology, Regional University Hospital Center of Tours, Bretonneau Hospital, Tours, France; INSERM U1069, Université François-Rabelais, Tours, France
| | - S Bendifallah
- Department of Obstetrics and Gynaecology, Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - C Huchon
- Department of Obstetrics and Gynaecology, Intercommunal Hospital Center of Poissy, Poissy, France
| | - P Collinet
- Department of Obstetrics and Gynaecology, Regional University Hospital Center of Lille, Lille, France
| | - A Bricou
- Department of Obstetrics and Gynaecology, Jean Verdier Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - C Mimoun
- Department of Obstetrics and Gynaecology, Lariboisière University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris 7, Paris, France
| | - L Lecointre
- Department of Obstetrics and Gynaecology, University Hospital Center, Strasbourg, France
| | - O Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes university, Reims, France
| | - E Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims Champagne Ardennes university, Reims, France.
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Vermel M, Lecointre L, Faller É, Boisramé T, Akladios C. [Care management and elective carcinological surgery place during the COVID-19 pandemic: A case report]. ACTA ACUST UNITED AC 2020; 48:774-776. [PMID: 32417400 PMCID: PMC7224657 DOI: 10.1016/j.gofs.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 12/15/2022]
Affiliation(s)
- M Vermel
- Service de chirurgie gynécologique, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | - L Lecointre
- Service de chirurgie gynécologique, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - É Faller
- Service de chirurgie gynécologique, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - T Boisramé
- Service de chirurgie gynécologique, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
| | - C Akladios
- Service de chirurgie gynécologique, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France
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Minella C, Simeu B, Rohr S, Akladios C, Lecointre L. [Perineal vaginal evisceration of the hail through a fistulized elythrocele due to negligence of a pessary with ulceration: A case report]. Gynecol Obstet Fertil Senol 2020; 48:464-465. [PMID: 31991175 DOI: 10.1016/j.gofs.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Indexed: 06/10/2023]
Affiliation(s)
- C Minella
- Service de Gynécologie, Hôpital universitaire de Strasbourg-hôpital d'Hautepierre, 1, avenue Molière, 67098 Strasbourg, France.
| | - B Simeu
- Service de chirurgie digestive, Hôpital Universitaire de Strasbourg, 1, avenue Moliere, 67098, Strasbourg, France
| | - S Rohr
- Service de chirurgie digestive, Hôpital Universitaire de Strasbourg, 1, avenue Moliere, 67098, Strasbourg, France
| | - C Akladios
- Service de Gynécologie, Hôpital universitaire de Strasbourg - hôpital d'Hautepierre, 1, avenue Molière, 67098 Strasbourg, France
| | - L Lecointre
- Service de Gynécologie, Hôpital universitaire de Strasbourg - hôpital d'Hautepierre, 1, avenue Molière, 67098 Strasbourg, France
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Akladios C, Azais H, Ballester M, Bendifallah S, Bolze PA, Bourdel N, Bricou A, Canlorbe G, Carcopino X, Chauvet P, Collinet P, Coutant C, Dabi Y, Dion L, Gauthier T, Graesslin O, Huchon C, Koskas M, Kridelka F, Lavoue V, Lecointre L, Mezzadri M, Mimoun C, Ouldamer L, Raimond E, Touboul C. [Guidelines for surgical management of gynaecological cancer during pandemic COVID-19 period - FRANCOGYN group for the CNGOF]. ACTA ACUST UNITED AC 2020; 48:444-447. [PMID: 32222433 PMCID: PMC7103920 DOI: 10.1016/j.gofs.2020.03.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Recommendations for the management of patients with gynecological cancer during the COVID-19 pandemic period. MATERIAL AND METHOD Recommendations based on the consensus conference model. RESULTS In the case of a COVID-19 positive patient, surgical management should be postponed for at least 15 days. For cervical cancer, the place of surgery must be re-evaluated in relation to radiotherapy and Radio-Chemotherapy-Concomitant and the value of lymph node staging surgeries must be reviewed on a case-by-case basis. For advanced ovarian cancers, neo-adjuvant chemotherapy should be favored even if primary cytoreduction surgery could be envisaged. It is lawful not to offer hyperthermic intraperitoneal chemotherapy during a COVID-19 pandemic. In the case of patients who must undergo interval surgery, it is possible to continue the chemotherapy and to offer surgery after 6 cycles of chemotherapy. For early stage endometrial cancer, in case of low and intermediate preoperative ESMO risk, hysterectomy with bilateral annexectomy associated with a sentinel lymph node procedure should be favored. It is possible to consider postponing surgery for 1 to 2 months in low-risk endometrial cancers (FIGO Ia stage on MRI and grade 1-2 endometrioid cancer on endometrial biopsy). For high ESMO risk, it ispossible to favor the MSKCC algorithm (combining PET-CT and sentinel lymph node biopsy) in order to omit pelvic and lumbar-aortic lymphadenectomies. CONCLUSION During COVID-19 pandemic, patients suffering from cancer should not lose life chance, while limiting the risks associated with the virus.
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Affiliation(s)
- C Akladios
- Service de gynécologie, CHU de Hautepierre, 67000 Strasbourg, France
| | - H Azais
- Service de gynécologie, hôpital la Pitié-Salpêtrière, 75013 Paris, France
| | - M Ballester
- Service de gynécologie, Dioconessess Croix Saint Simon, 75012 Paris, France
| | - S Bendifallah
- Service de gynécologie obstétrique, hôpital Tenon, 75020 Paris, France
| | - P-A Bolze
- Service de gynécologie obstétrique, CHU Lyon Sud, 69000 Lyon, France
| | - N Bourdel
- Service de gynécologie obstétrique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - A Bricou
- Service de gynécologie, Dioconessess Croix Saint Simon, 75012 Paris, France
| | - G Canlorbe
- Service de gynécologie, hôpital la Pitié-Salpêtrière, 75013 Paris, France
| | - X Carcopino
- Service de gyécologie, La Timone, 13000 Marseille, France
| | - P Chauvet
- Service de gynécologie obstétrique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - P Collinet
- Service de gynécologie, hôpital Jeanne de Flandres, 59000 Lille, France
| | - C Coutant
- Centre de lutte contre le cancer, 21000 Dijon, France
| | - Y Dabi
- Service de gynécologie obstétrique, hôpital Tenon, 75020 Paris, France
| | - L Dion
- Service de gynécologie, CHU hôpital Sud, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - T Gauthier
- Service de gynécologie obstétrique, CHU, 87000 Limoges, France
| | - O Graesslin
- Service de gynécologie obstétrique, CHU, 51000 Reims, France
| | - C Huchon
- Service de gynécologie obstétrique, CHI Poissy, 78300 Poissy, France
| | - M Koskas
- Service de gynécologie obstétrique, hôpital Bichat, 75018 Paris, France
| | - F Kridelka
- Service de chirurgie oncologique, CHU, Liège, Belgique
| | - V Lavoue
- Service de gynécologie, CHU hôpital Sud, 16, boulevard de Bulgarie, 35000 Rennes, France.
| | - L Lecointre
- Service de gynécologie obstétrique, hôpital Tenon, 75020 Paris, France
| | - M Mezzadri
- Service de gynécologie, hôpital Lariboisière, 75010 Paris, France
| | - C Mimoun
- Service de gynécologie, hôpital Lariboisière, 75010 Paris, France
| | - L Ouldamer
- Service de gynécologie, CHU Tours, 37000 Tours, France
| | - E Raimond
- Service de gynécologie obstétrique, CHU, 51000 Reims, France
| | - C Touboul
- Service de chirurgie oncologique, CHU, Liège, Belgique
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Lecointre L, Velten M, Akladios C. Impact sur la survie du nombre de cycles de chimiothérapie néo-adjuvante dans les cancers de l’ovaire de stade avancé – Étude multicentrique FRANCOGYN. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2019.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Canlorbe G, Lecointre L, Chauvet P, Azaïs H, Fauvet R, Uzan C. [Borderline Ovarian Tumours: CNGOF Guidelines for Clinical Practice - Therapeutic Management of Early Stages]. ACTA ACUST UNITED AC 2020; 48:287-303. [PMID: 32004786 DOI: 10.1016/j.gofs.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To provide guidelines for clinical practice from the French College of Obstetrics and Gynecology (CNGOF), based on the best evidence available, concerning early stage borderline ovarian tumors (BOT). METHODS Bibliographical search in French and English languages by consultation of Pubmed, Cochrane, Embase, and international databases. RESULTS Considering management of early stage BOT, if surgery is possible without a risk of tumor rupture, the laparoscopic approach is recommended compared to laparotomy (Grade C). In BOT, it is recommended to take all the measures to avoid tumor rupture, including the peroperative decision of laparoconversion (Grade C). In BOT, extraction of the surgical specimen using an endoscopic bag is recommended (Grade C). In case of early stage, uni or bilateral BOT, suspected in preoperative imaging in a postmenopausal patient, bilateral adnexectomy is recommended (Grade B). In cases of bilateral BOT and desire of fertility preservation, a bilateral cystectomy is recommended (Grade B). In case of mucinous BOT and desire of fertility preservation, it is recommended to perform a unilateral adnexectomy (Grade C). In case of endometrioid BOT and desire of fertility preservation, it is not possible to establish a recommendation of treatment choice between cystectomy and unilateral adnexectomy. In case of mucinous BOT at definitive histological analysis in a woman of childbearing age who had an initial cystectomy, surgical revision for unilateral adnexectomy is recommended (Grade C). In the case of serous BOT with definitive histological analysis in a woman of childbearing age who has had an initial cystectomy, it is not recommended to repeat surgery for adnexectomy in the absence of residual suspicious lesion during initial surgery and/or on postoperative imaging (referent ultrasound or pelvic MRI) (Grade C). An omentectomy is recommended for complete initial surgical staging when BOT is diagnosed on extemporaneous analysis or suspected on preoperative radiological elements (Grade B). There is no data in the literature to recommend the type of omentectomy to be performed. If restaging surgery is decided for a presumed early stage BOT, an omentectomy is recommended (Grade B). Multiple peritoneal biopsies are recommended for complete initial surgical staging when BOT is diagnosed on extemporaneous or suspected on preoperative radiological elements (Grade C). In case of restaging surgery for a presumed early stage BOT, exploration of the abdominal cavity should be complete and peritoneal biopsies should be performed on suspicious areas or systematically (Grade C). A primary peritoneal cytology is recommended in order to achieve complete initial surgical staging when BOT is suspected on preoperative radiological elements (Grade C). In case of restaging surgery for presumed early stage BOT, a first peritoneal cytology is recommended (Grade C). For early serous or mucinous BOT, it is not recommended to perform a systematic hysterectomy (Grade C). For early stage endometrioid BOT, and in the absence of a desire to maintain fertility, hysterectomy is recommended for initial surgery or if restaging surgery is indicated (Grade C). For endometrioid-type early stage BOT, if there is a desire for fertility preservation, the uterus may be retained subject to good evaluation of the endometrium by imaging and endometrial sampling (Grade C). In case of surgery (initial or restaging if indicated) for early stage BOT, it is recommended to evaluate the macroscopic appearance of the appendix (Grade B). In case of surgery (initial or restaging if indicated) for early stage BOT, appendectomy is recommended only in case of macroscopically pathological appearance of the appendix (Grade C). Pelvic and lumbar aortic lymphadenectomy is not recommended for initial surgery or restaging surgery for early stage BOT regardless of histologic type (Grade C). In case of BOT diagnosed on definitive histology, the indication of restaging surgery should be discussed in Multidisciplinary Collaborative Meeting. For presumed early stage BOT, it is recommended to use the laparoscopic approach to perform restaging surgery (Grade C). Restaging surgery is recommended for serous BOT with micropapillary appearance and unsatisfactory abdominal cavity inspection during initial surgery (Grade C). Restaging surgery is recommended in case of mucinous BOT if only a cystectomy has been performed or the appendix has not been visualized, then a unilateral adnexectomy will be performed (Grade C). If a restaging surgery is decided in the management of a presumed early stage BOT, the actions to be carried out are as follows: a peritoneal cytology (Grade C), an omentectomy (there is no data in the literature recommending the type of omentectomy to be performed) (Grade B), a complete exploration of the abdominal cavity with peritoneal biopsies on suspect areas or systematically (Grade C), visualization of the appendix± the appendectomy in case of pathological macroscopic appearance (Grade C), unilateral adnexectomy in case of mucinous TFO (Grade C).
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Affiliation(s)
- G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, AP-HP, hôpital Pitié-Salpêtrière, 75013 Paris, France; Biologie et thérapeutique du cancer, centre de recherche Saint-Antoine (CRSA), Sorbonne université, 75012 Paris, France.
| | - L Lecointre
- Centre hospitalier universitaire Hautepierre, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - P Chauvet
- Département de chirurgie gynécologique, CHU Estaing, Clermont-Ferrand, France; EnCoV, IP, UMR 6602 CNRS, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, AP-HP, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - R Fauvet
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Caen, 14000 Caen, France; Unité de recherche Inserm U1086 « ANTICIPE » - Axe 2 : biologie et thérapies innovantes des cancers localement agressifs (BioTICLA), université de Normandie Unicaen, 14000 Caen, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, AP-HP, hôpital Pitié-Salpêtrière, 75013 Paris, France; Biologie et thérapeutique du cancer, centre de recherche Saint-Antoine (CRSA), Sorbonne université, 75012 Paris, France
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Pontvianne M, Riss J, Goillot V, Aubry G, Lecointre L, Akladios C. [Ambulatory minimally invasive hysterectomy: Limiting factors related to health professionals]. ACTA ACUST UNITED AC 2019; 47:831-835. [PMID: 31614229 DOI: 10.1016/j.gofs.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The feasibility of minimally invasive hysterectomy for ambulatory benign pathology has been demonstrated in many international studies. France has a considerable delay of multifactorial origin in this field. The objective of this study is to identify the limiting factors related to health professionals to the realization of minimally invasive ambulatory hysterectomy and to determine possible strategies to increase its rate. METHODS This is a cross-sectional survey conducted over 2 months using a self-administered questionnaire sent by email to 180 gynecological surgeons in 2 French regions (Grand Est and Bourgogne-Franche Comté). RESULTS A total of 22% of health professionals responded to the survey. The vast majority of practitioners (60%) said they did not carry out ambulatory care by habit. The apprehension of the reaction of the patients (47.5%), the fear of delayed diagnosis of complications (12.5%), the management of pain in the postoperative period (42.5%) also participated in brake of the promotion of ambulatory care. DISCUSSION Improvement of the organisation of city and hospital management allowing a better continuity of care (70%), the economic valuation (37.5%) and the increase in the hourly amplitude of the ambulatory surgery unit (5%) would improve the rate of ambulatory care of minimally invasive hysterectomies, according to the gynecologist surgeons surveyed. In addition, a prospective study evaluating the quality of life of patients after ambulatory care of minimally invasive hysterectomy would allow better adherence of health professionals and patients to the ambulatory care project in 70% of cases. CONCLUSION The change of mentality of health professionals remains a priority for the promotion of ambulatory surgery in gynecology. Information and communication are therefore essential to the expansion of the ambulatory.
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Affiliation(s)
- M Pontvianne
- Pole de gynécologie Obstétrique Hôpitaux, Universitaires de Strasbourg, CHU Hautepierre, 67000 Strasbourg, France.
| | - J Riss
- Pole de gynécologie Obstétrique Hôpitaux, Universitaires de Strasbourg, CHU Hautepierre, 67000 Strasbourg, France
| | - V Goillot
- Pole de gynécologie Obstétrique Hôpitaux, Universitaires de Strasbourg, CHU Hautepierre, 67000 Strasbourg, France
| | - G Aubry
- Service de chirurgie gynécologique, CHU Hautepierre, Strasbourg, France
| | - L Lecointre
- Service de chirurgie gynécologique, CHU Hautepierre, Strasbourg, France
| | - C Akladios
- Service de chirurgie gynécologique, CHU Hautepierre, Strasbourg, France
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Goillot V, Paté M, Delaitre A, Akladios C, Baldauf JJ, Lecointre L. [Use of HPV virologic test for atypical glandular cells in Alsace between 2014 and 2016]. ACTA ACUST UNITED AC 2019; 47:802-807. [PMID: 31336187 DOI: 10.1016/j.gofs.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The new recommendations by the National Institute of Cancer (January 2017) recommend the use of a complementary human papillomavirus (HPV) virologic test during the diagnosis of atypical glandular cells in pap smear. The aim of this study was the performance analysis of the HPV virologic test for the detection of significant histological cervical abnormalities (CIN2 or more) in case of atypical glandular cells before the new recommendations were published. METHODS We performed a descriptive and retrospective cohort study in Alsace between January 2014 and December 2016. We have included, from the EVE-association database, the patients with atypical glandular cells in pap smear. RESULTS In total, 1074 patients had a pap smear with atypical glandular cells ; 0.18% of total pap smears. This study included 152 patients who had a HPV test. We observed 6 cases of CIN2 (3.9%) and 12 cases of CIN3 (7.9%). No in situ adenocarcinoma nor invasive carcinoma were detected. The sensitivity of the HPV test was 88.9% (95% CI: [0.65; 0.99]), the specificity was 65.9% (95% CI: [0.55; 0.76]), the positive predictive value was 34% (95% CI: [0.21; 0.49]) and the negative predictive value was 96.8% (95% CI: [0.89; 0.99]). CONCLUSION The detection of HPV in atypical glandular cells seems to be powerful with an excellent negative predictive value but, because of moderate sensitivity and due to the risk of histologic lesion progression, the current recommendations should to be applied with care.
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Affiliation(s)
- V Goillot
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - M Paté
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France.
| | - A Delaitre
- Département de médecine générale, 4, rue Kirschleger, 67058 Strasbourg cedex, France
| | - C Akladios
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - J-J Baldauf
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
| | - L Lecointre
- Service de gynécologie, pôle de gynécologie-obstétrique, CHRU de Strasbourg, 5, avenue Molière, 67200 Strasbourg cedex, France
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Ducellier-Azzola G, Lecointre L, Hummel M, Pontvianne M, Garbin O. Hysteroscopic enlargement metroplasty for T-shaped uterus: 24 years’ experience at the Strasbourg Medico-Surgical and Obstetrical Centre (CMCO). Eur J Obstet Gynecol Reprod Biol 2018; 226:30-34. [DOI: 10.1016/j.ejogrb.2018.04.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/21/2018] [Accepted: 04/28/2018] [Indexed: 11/29/2022]
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Pinton A, Lecointre L, Hummel M, Metten MA, Rodriguez M, Bryand A, Baldauf JJ, Garbin O, Akladios C. Laparoscopic pelvic lymphadenectomy in patients with intermediate-risk endometrial cancer: Is it worth it? J Gynecol Obstet Hum Reprod 2017; 47:51-55. [PMID: 29196157 DOI: 10.1016/j.jogoh.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 11/13/2017] [Accepted: 11/23/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The main aim of this study is to evaluate operative and postoperative morbidity of laparoscopic pelvic lymphadenectomy as well as its potential impact on the postoperative management in patients with an intermediate-risk of endometrial cancer. METHODS We did a retrospective study between January 2009 and December 2013. We included all patients operated by laparoscopy for endometrial cancer presumed to have an intermediate-risk of recurrence. Pelvic lymphadenectomy in this group of patients was performed at the discretion of operating surgeons. Patients were consequently divided into two groups according to whether or not pelvic lymphadenectomy was performed. We made a comparative analysis between these two groups. RESULTS Overall, 116 patients were managed for endometrial cancer presumed to be intermediate-risk. Among these, 93 received treatment with laparoscopy and were included in the study. Patients' characteristics did not differ between the two groups. The mean duration of surgery was significantly longer when pelvic lymphadenectomy was performed. The average number of retrieved lymph nodes was 13 and we had seven patients with positive lymph nodes (10%). CONCLUSION Pelvic lymphadenectomy allows a better postoperative classification for some patients without more complication.
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Affiliation(s)
- A Pinton
- Department of Obstetrics and Gynaecology, Strasbourg University, Hôpital de Hautepierre, avenue Molière, 67091 Strasbourg, France
| | - L Lecointre
- Department of Obstetrics and Gynaecology, Strasbourg University, Hôpital de Hautepierre, avenue Molière, 67091 Strasbourg, France
| | - M Hummel
- Department of Obstetrics and Gynaecology, Hôpital du CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - M-A Metten
- Department of Biostatistics, Strasbourg University, Strasbourg, France
| | - M Rodriguez
- Department of Obstetrics and Gynaecology, Strasbourg University, Hôpital de Hautepierre, avenue Molière, 67091 Strasbourg, France
| | - A Bryand
- Department of Obstetrics and Gynaecology, Strasbourg University, Hôpital de Hautepierre, avenue Molière, 67091 Strasbourg, France; Department of Obstetrics and Gynaecology, Hôpital du CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - J-J Baldauf
- Department of Obstetrics and Gynaecology, Strasbourg University, Hôpital de Hautepierre, avenue Molière, 67091 Strasbourg, France
| | - O Garbin
- Department of Obstetrics and Gynaecology, Hôpital du CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
| | - C Akladios
- Department of Obstetrics and Gynaecology, Hôpital du CMCO, 19, rue Louis-Pasteur, 67300 Schiltigheim, France
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Koch A, Favre R, Viville B, Fritz G, Kohler M, Guerra F, Lecointre L, Gaudineau A, Langer B, Weingertner AS, Sananès N. Expectant management and laser photocoagulation in isolated selective intra-uterine growth restriction: A single-center series. J Gynecol Obstet Hum Reprod 2017; 46:731-736. [DOI: 10.1016/j.jogoh.2017.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/07/2017] [Accepted: 09/19/2017] [Indexed: 11/15/2022]
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21
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Tissot M, Lecointre L, Faller E, Afors K, Akladios C, Audebert A. Clinical presentation of endometriosis identified at interval laparoscopic tubal sterilization: Prospective series of 465 cases. J Gynecol Obstet Hum Reprod 2017; 46:647-650. [DOI: 10.1016/j.jogoh.2017.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/01/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
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Delaine M, Lecointre L, Akladios CY, Hummel M, Host A, Garbin O. [Laparoscopic treatment of cesarean scar pouch - A case series study of 9 patients]. ACTA ACUST UNITED AC 2017; 45:262-268. [PMID: 28476591 DOI: 10.1016/j.gofs.2017.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/21/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study the effects of laparoscopic repair of isthmoceles acquired after a cesarean section on symptoms and fertility. METHODS This retrospective case series study included symptomatic women (abnormal uterine bleeding and/or pelvic pain and/or infertility) suffering from a large isthmocele and treated laparoscopically in our center. The surgical procedure consisted in resecting the pouch and suturing the scar in 2 layers. The patient follow-up has been realised through the postoperative control, the medical file and a survey, and concerned the evolution of the symptoms and fertility. RESULTS Nine patients have been included, all suffering from large isthmoceles, diagnosed by transvaginal ultrasound associated with hysteroscopy, hysterosalpingography or MRI. Postoperatively, the symptoms disappeared in 78% of the patients. There have been 4 spontaneous pregnancies in 4 patients, 3 of them had been diagnosed with infertility. The median patient medical follow-up lasted 28 months. CONCLUSION The diagnosis of a large isthmocele in patients suffering from invalidant symptoms and infertility should lead to consider a surgical treatment which is an efficient and surgically safe procedure.
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Affiliation(s)
- M Delaine
- Unité de chirurgie gynécologique, pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France.
| | - L Lecointre
- Unité de chirurgie gynécologique, pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - C Y Akladios
- Unité de chirurgie gynécologique, pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - M Hummel
- Unité de chirurgie gynécologique, pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - A Host
- Unité de chirurgie gynécologique, pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - O Garbin
- Unité de chirurgie gynécologique, pôle de gynécologie obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
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Koch A, Lecointre L, Garbin O. Pelvic tuberculosis mimicking deep endometriosis. J Gynecol Obstet Hum Reprod 2017; 46:463-464. [PMID: 28411084 DOI: 10.1016/j.jogoh.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 11/25/2022]
Abstract
Pelvic tuberculosis is most frequently observed in developing countries and often leads to the misdiagnosis of pelvic malignancy. We report the first case of pelvic tuberculosis mimicking deep endometriosis.
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Affiliation(s)
- A Koch
- Pôle de gynécologie-obstétrique, centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, BP 120, 67300 Schiltigheim, France.
| | - L Lecointre
- Pôle de gynécologie-obstétrique, centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, BP 120, 67300 Schiltigheim, France
| | - O Garbin
- Pôle de gynécologie-obstétrique, centre médico-chirurgical obstétrique, hôpitaux universitaires de Strasbourg, 19, rue Louis-Pasteur, BP 120, 67300 Schiltigheim, France
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Lecointre L, Sananès N, Weingertner AS, Gaudineau A, Akladios C, Cavillon V, Langer B, Favre R. [Fetoscopic laser coagulation in 200 consecutive monochorionic pregnancies with twin-twin transfusion syndrome]. J Gynecol Obstet Hum Reprod 2017; 46:175-181. [PMID: 28403975 DOI: 10.1016/j.jogoh.2016.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 10/09/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To report preoperative data, surgical characteristics, complications and perinatal outcome of twin-twin transfusion syndrome (TTTS) managed with laser ablation surgery, to analyze predictors of neonatal survival and to compare the 100 most recent cases with the older 100. MATERIALS AND METHODS Observational cohort moncentric study of 200 cases of TTTS consecutively treated with fetoscopic laser coagulation between January 2004 and December 2014. RESULTS There were 49 stage I, 88 stage II, 55 stage III and eight stage IV. Median gestation at time of laser was 20.1±3.0 weeks' gestation (WG) whereas median gestation at delivery was 31.6±5.4 WG. Overall perinatal survival rate was 68.0% and 84.0% have one or more surviving twins. Preterm premature rupture of membranes occurred in 39 cases with and the median gestational age for this complication was 28.8±4.6 SA. Predictive factors to have at least one living birth were Quintero stage and gestational age at delivery. In the most recent period, there were significantly more TTTS Quintero stage I treated with laser, more coagulation by the Solomon technique and a larger number of coagulated vessels. CONCLUSION The neonatal survival of TTTS is improved by fetoscopic laser coagulation, preferely by using Solomon tecnhique. The use of active management of stage I is currently on research.
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Affiliation(s)
- L Lecointre
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - N Sananès
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Inserm, UMR-S 1121, « Biomatériaux et Bioingénierie », 11, rue Humann, 67085 Strasbourg cedex, France
| | - A S Weingertner
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France
| | - A Gaudineau
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - C Akladios
- Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - V Cavillon
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France
| | - B Langer
- Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - R Favre
- Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France
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Koch A, Frigo S, Lecointre L, Hummel M, Akladios CY, Bergerat JP, Noël G, Wattiez A. Retroperitoneal primitive neuroectodermal tumor (PNET): case report and review of literature. EUR J GYNAECOL ONCOL 2017; 38:314-318. [PMID: 29953804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Primitive Neuroectodermal tumor belongs to the family of Ewing's tumor and is characterized by at (11;22) (q24;ql2) or at (21;22) (q22;ql2) translocation. Retroperitoneal primitive neuroectodermal tumor (PNET) are rare, usually affect young adults, and are often diagnosed late. There is no specific characteristics for imaging. The diagnosis is made on histological examination of the surgical spec- imen or biopsies. Radiotherapy and chemotherapy complete the treatment. The authors report the case of a 26-year-old patient who only had pelvic discomfort. Diagnostic laparoscopy showed a retroperitoneal and retrovesical mass of five centimeters. The patient benefited from adjuvant chemotherapy and radiotherapy. She is free of disease 30 months after treatment.
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Marcillac FDD, Pinton A, Guillaume A, Lecointre L, Sagot P, Rongieres C. Which results in IVF/ICSI when the rate of AMH and FSH are discordant? Eur J Obstet Gynecol Reprod Biol 2016. [DOI: 10.1016/j.ejogrb.2016.07.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Daney de Marcillac F, Lecointre L, Guillaume A, Sananes N, Fritz G, Viville B, Boudier E, Nisand I, Gaudineau A, Langer B, Akladios C. Morbimortalité maternelle associée au traitement conservateur d’un placenta anormalement adhérent (accreta) diagnostiqué en anténatal. À propos d’une série continue de 15 cas. ACTA ACUST UNITED AC 2016; 45:849-858. [DOI: 10.1016/j.jgyn.2016.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
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Lecointre L, Gaudineau A, Hild C, Sananes N, Langer B. [Squamous cell carcinoma of the vulva and pregnancy: Tough choices]. ACTA ACUST UNITED AC 2015; 43:625-7. [PMID: 26297158 DOI: 10.1016/j.gyobfe.2015.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 07/06/2015] [Indexed: 11/15/2022]
Affiliation(s)
- L Lecointre
- Pôle de gynécologie-obstétrique, unité d'obstétrique, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France.
| | - A Gaudineau
- Pôle de gynécologie-obstétrique, unité d'obstétrique, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - C Hild
- Pôle de gynécologie-obstétrique, unité d'obstétrique, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - N Sananes
- Pôle de gynécologie-obstétrique, unité d'obstétrique, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
| | - B Langer
- Pôle de gynécologie-obstétrique, unité d'obstétrique, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France
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Lecointre L, Sananes N, Weingertner AS, Kohler M, Guerra F, Fritz G, Viville B, Langer B, Nisand I, Favre R. Fetoscopic laser coagulation for twin-twin transfusion syndrome before 17 weeks' gestation: laser data, complications and neonatal outcome. Ultrasound Obstet Gynecol 2014; 44:299-303. [PMID: 24677292 DOI: 10.1002/uog.13375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/22/2014] [Accepted: 03/14/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare laser data, complications and neonatal outcome in pregnancies that undergo 'early' (≤ 17 weeks' gestation) fetoscopic laser ablation of placental vascular anastomoses for twin-twin transfusion syndrome (TTTS) with those from 'conventional' cases treated after 17 weeks. METHODS This was a cohort study of data collected prospectively between January 2004 and December 2012. We included monochorionic diamniotic twin pregnancies complicated by TTTS and treated by fetoscopic laser coagulation. Pregnancies were grouped according to laser treatment ≤ 17 gestational weeks or > 17 weeks and obstetric and neonatal outcomes were compared between groups. RESULTS A total of 178 pregnancies with TTTS underwent laser therapy: 40 at or before 17 weeks and 138 after 17 weeks. There was no statistically significant difference between these two groups with respect to the rate of preterm prelabor rupture of membranes (PPROM), gestational age at PPROM and rate of PPROM occurring in the 7 days following fetoscopic laser coagulation. In the early group, the interval between performing fetoscopic laser coagulation and the time of delivery was significantly longer (104 days vs 74 days, P=0.0002) and the delivery rate within 7 days of laser treatment was significantly lower (2.5% vs 15.9%, P=0.026). There was no significant difference between the two groups with regard to the rates of pregnancy without live birth (15.4% vs 15.4%, P=0.993), with one live birth (84.6% vs 84.6%, P=0.993) and with two live births (64.1% vs 58.1%, P=0.500). CONCLUSION In the event of early TTTS, fetoscopic laser coagulation is technically feasible before 17 gestational weeks and obstetric and neonatal outcomes are comparable with those in cases of laser treatment performed after 17 weeks.
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Affiliation(s)
- L Lecointre
- Fetal Medicine, CMCO-HUS, Schiltigheim/Strasbourg, France
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Lecointre L, Akladios CY, Averous G, Lefebvre F, Baulon E, Thoma V, Fender M, Baldauf JJ. [Reliability of endocervical curettage after conservative treatment of intraepithelial neoplasia of the cervix]. ACTA ACUST UNITED AC 2014; 44:145-53. [PMID: 24485807 DOI: 10.1016/j.jgyn.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 12/21/2013] [Accepted: 01/03/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the reliability of endocervical curettage (ECC) in patients previously treated for CIN. PATIENTS AND METHODS Retrospective analysis of data from 85 patients between January 1985 and December 2011 who received an ECC during monitoring after treatment of CIN. The reliability of the ECC was evaluated by comparison with the final histological analysis of the surgical specimen or the data for subsequent cyto-colpo-histological follow-up. RESULTS Patients were referred to colposcopy either within the immediate post-treatment monitoring (n=42), meanly 9.7±5.3 months after treatment, or if cytological abnormalities were detected during long-term monitoring, meanly 78.6±52.4 months after treatment. Colposcopy was unsatisfactory in 75.3% of patients and normal colposcopic findings were found in 80% of patients. A perfect agreement between the ECC and the endocervical final diagnosis was noted in 68 patients (80%). For the diagnosis of severe cervical lesions (CIN 2+) ECC had a sensitivity of 86.2% (68.3-96.1), a specificity of 94.6% (85.1-98.9) and positive and negative predictive values of 61.4% (47.6-74.0) and 93% (83.0-98.1), respectively. CONCLUSION The high sensitivity and negative predictive value of ECC for the diagnosis of severe post-therapeutic endocervical lesions avoid iterative treatment without increasing the risk of progression of a lesion to cancer.
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Affiliation(s)
- L Lecointre
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - C-Y Akladios
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - G Averous
- Service de pathologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - F Lefebvre
- Pôle de santé publique et de santé au travail, secteur méthodologie et biostatistique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - E Baulon
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - V Thoma
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France
| | - M Fender
- Association EVE, 67400 Illkirch-Graffenstaden, France
| | - J-J Baldauf
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
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Lecointre L, Gaudineau A, Langer B. [Stage IV uterine prolapse and pregnancy: a case report]. ACTA ACUST UNITED AC 2013; 43:530-2. [PMID: 24332740 DOI: 10.1016/j.jgyn.2013.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 09/19/2013] [Accepted: 10/01/2013] [Indexed: 11/18/2022]
Affiliation(s)
- L Lecointre
- Pôle de gynécologie-obstétrique, unité d'obstétrique, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France.
| | - A Gaudineau
- Pôle de gynécologie-obstétrique, unité d'obstétrique, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France.
| | - B Langer
- Pôle de gynécologie-obstétrique, unité d'obstétrique, CHRU de Strasbourg, avenue Molière, 67200 Strasbourg cedex, France.
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Lecointre L, Faller E, Albornoz J, Messori P, Nacif J, Wattiez A. Laparoscopic Anterior Uterine Ligamentopexy for Pelvic Pain in a Selected Population of Patients. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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