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Weyl A, Chollet C, Gabiache E, Cancès-Lauwers V, Gallo F, Martinez A, Courbon F, Leguevaque P, Brenot Rossi I, Jalaguier A, Lambaudie E, Chantalat E, Motton S. PET-MRI for evaluation of response to radiochemotherapy in patients with locally advanced cervical cancer. Int J Gynecol Cancer 2023; 33:676-682. [PMID: 36822657 DOI: 10.1136/ijgc-2022-003958] [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] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE We aimed to analyze the diagnostic test accuracy of positron emission tomography and a magnetic resonance imaging scan (PET-MRI) fusion in evaluating tumor response after radiochemotherapy in patients with locally advanced cervical cancer. METHODS Patients treated at two institutes between January 2008 and December 2016 were studied retrospectively. Re-evaluation by positron emission tomography (PET) and magnetic resonance imaging (MRI) was performed in a non-concurrent way 4-8 weeks after treatment. A nuclear medicine doctor and a radiologist (subsequently referred as "radiologists"), both experts in gynecological oncology, re-examined the post-treatment MRI and positron emission tomography-computed tomography (PET-CT) separately, and then performed a fusion of these examinations. In this study we describe this "a posteriori fusion methodology", with two levels, enabling limitation of anatomical shifts. The gold standard was anatomical pathology analysis of the surgical specimen, since all patients underwent surgery following this radiological re-evaluation. The radiologists' degree of certainty in their diagnoses, and the impact of fusion on their diagnostic confidence were assessed by the radiologists, using two Likert judgment scales. They also adjudicated on possible changes of interpretation after the fusion. RESULTS Thirty-one patients were included. The PET-MRI fusion has a sensitivity of 79% and a specificity of 90%. The positive predictive value (PPV) was 94%, and the negative predictive value (NPV) was 69%. In 45% of cases (n=13), radiologists reported an improvement in their degree of certainty in their diagnosis using a Likert judgment scale, due to inspecting the PET and MRI fused. A change in interpretation of tumor response was observed using a Likert judgment scale in 31% of cases. CONCLUSION PET-MRI fusion improves the radiologist's own diagnostic confidence in assessing response to concurrent radiochemotherapy in locally advanced cervical cancer. More studies using a latest generation hybrid system will be necessary to further compare to MRI and PET-CT.
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Affiliation(s)
- Ariane Weyl
- Gynecologic Surgery, CHU Toulouse, Toulouse, Occitanie, France
| | | | - Erwan Gabiache
- Nuclear Medicine, Cancer University Institute Toulouse Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | | | | | | | - Frederic Courbon
- Nuclear Medicine, Cancer University Institute Toulouse Oncopole, Toulouse, Languedoc-Roussillon-Midi, France
| | | | | | - Aurélie Jalaguier
- Paoli-Calmettes Institute, Marseille, Provence-Alpes-Côte d'Azu, France
| | | | - Elodie Chantalat
- Gynecologic Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrénées, France
| | - Stephanie Motton
- Gynecologic Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, Midi-Pyrénées, France
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Weyl A, Sevy V, Lepage B, Vidal F, Kirzin S, Legac YT, Lesourd F, Gosset A, Capdet J, Leguevaque P, Bournet B, Lenfant F, Brierre T, Gornes H, Buscail E, Chantalat E. Study of postoperative complications after the implementation of a multidisciplinary care pathway for patients with digestive endometriosis. Arch Gynecol Obstet 2022; 307:1459-1468. [PMID: 36581714 DOI: 10.1007/s00404-022-06899-1] [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: 09/26/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess the quality of care following the establishment of a multidisciplinary care pathway for patient operated on for deep pelvic endometriosis with digestive impairment. METHODS We conducted a retrospective monocentric study of patients suffering from deep infiltrating endometriosis, treated in Gynaecological Department at Toulouse University Hospital from January 2018 to December 2020. We compared our results to those of our previous study, Gornes et al. which showed a postoperative complication occurred in 37.8% of the cases and a postoperative severe complication according to the Clavien-Dindo classification (grades 3b) rate of 18.3%. RESULTS 98 patients were included. Our study shows a clear decrease in postoperative complications with an overall complication rate of 19.4% and severe complications (grades 3b) of 4.1%. The rate of complication appeared to be significantly less frequent in the case of shaving in relation to other digestive procedures (p = 0.008) and in the case of a lesion of < 20 mm by MRI (p = 0.01). The use of multidisciplinary surgical care was more frequent in the case of multiple locations (66.7% vs. 41.8%, p = 0.07) and was more frequent in the case of transmural damage with echo endoscopy (and to a lesser degree in the case of damage of the muscularis or mucous membrane) (p = 0.05). CONCLUSIONS Multidisciplinary care of endometriosis with digestive damage appears to be indispensable. The intraoperative intervention of a skilled digestive surgeon of bowel endometriosis helps create the best balance between effectiveness-complications-functional prognosis, with a reduction of severe postoperative complications.
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Affiliation(s)
- Ariane Weyl
- Department of Gynecologic Surgery, University Hospital Center, Toulouse, France.,I2MC, National Institute of Health and Medical Research (INSERM) U1297, University of Toulouse 3 and Toulouse University Hospital, Toulouse, France
| | - Virginie Sevy
- Department of Gynecologic Surgery, Hospital Center, Montauban, France
| | - Benoît Lepage
- Department of Epidemiology, University Hospital Center, Toulouse, France
| | - Fabien Vidal
- Department of Gynecologic Surgery, La Croix du Sud Hopital, Quint Fonsegrives, France
| | - Sylvain Kirzin
- Department of Digestive Surgery, La Croix du Sud Hopital, Quint Fonsegrives, France
| | - Yann Tanguy Legac
- Department of Gynecologic Surgery, University Hospital Center, Toulouse, France
| | - Florence Lesourd
- Department of Medical Gynecology, University Hospital Center, Toulouse, France
| | - Anna Gosset
- Department of Medical Gynecology, University Hospital Center, Toulouse, France
| | - Jérome Capdet
- Department of Gynecologic Surgery, Rive Gauche Hospital, Toulouse, France
| | - Pierre Leguevaque
- Department of Gynecologic Surgery, Pasteur Hospital, Toulouse, France
| | - Barbara Bournet
- Department of Gastroenterology, University Hospital Center, Toulouse, France
| | - Françoise Lenfant
- I2MC, National Institute of Health and Medical Research (INSERM) U1297, University of Toulouse 3 and Toulouse University Hospital, Toulouse, France
| | - Thibaut Brierre
- Department of Urology, University Hospital Center, Toulouse, France
| | - Hugo Gornes
- Department of Gynecologic Surgery, Occitanie Hospital, Toulouse, France
| | - Etienne Buscail
- Department of Digestive Surgery, University Hospital Center, Toulouse, France
| | - Elodie Chantalat
- Department of Gynecologic Surgery, University Hospital Center, Toulouse, France. .,I2MC, National Institute of Health and Medical Research (INSERM) U1297, University of Toulouse 3 and Toulouse University Hospital, Toulouse, France.
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Gornes H, Vaysse C, Leguevaque P, Gallini A, André B, Guerby P, Kirzin S, Suc B, Motton S, Rimailho J, Weyl A, Chantalat E. Identification of a group with high risk of postoperative complications after deep bowel endometriosis surgery: a retrospective study on 164 patients. Arch Gynecol Obstet 2020; 302:383-391. [PMID: 32500217 DOI: 10.1007/s00404-020-05604-4] [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: 11/18/2019] [Accepted: 05/15/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Identify a group with a high risk of postoperative complications after deep bowel endometriosis surgery. METHODS We conducted a retrospective study on patients treated from 2012 to 2018 in two departments of gynecological surgery at the Toulouse University Hospital, France. The postoperative complications were evaluated in relation to the surgical management, associated with or without non-digestive surgical procedures, initial disease and patient's characteristics. RESULTS 164 patients were included. A postoperative complication occurred in 37.8% (n = 62) of the cases and required a secondary surgery in 18.3% (n = 30) of the cases. In the univariate analysis, the risk of postoperative complications increased significantly in the presence of segmental resection, disease progression, and associated urinary tract procedure or vaginal incision. In the multivariate analysis, the risk of overall postoperative complications was associated with the surgical management (p = 0.013 and 0.017) and particularly in the presence of segmental resection [Odds Ratio (OR): 20.87; CI 95% (1.96-221.79)]. The risk of rectovaginal fistula increased in the presence of segmental resection [OR: 22.71; CI 95% (2.74-188.01)] as well as in vaginal incision [OR: 19.67; CI 95% (2.43-159.18); p = 0.005]. CONCLUSION The risk of overall postoperative complications and rectovaginal fistula in particular increases significantly in the presence of vaginal incision, segmental resection and urinary tract procedures after deep bowel endometriosis surgery.
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Affiliation(s)
- H Gornes
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - C Vaysse
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - P Leguevaque
- Department of General Gynecological Surgery and Breast Diseases, Clinique Pasteur - Toulouse, Toulouse, France
| | - A Gallini
- Epidemiology Department, Research Methodology Support Unit (USMR), Toulouse University Hospital Center, Toulouse, France
| | - B André
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - P Guerby
- Department of Gynecological Surgery, University Hospital Center-Purpan, Hôpital Paule de Viguier, Toulouse, France
| | - S Kirzin
- Department of Digestive Surgery, University Hospital Center-Rangueil, Toulouse, France
| | - B Suc
- Department of Digestive Surgery, University Hospital Center-Rangueil, Toulouse, France
| | - S Motton
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - J Rimailho
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - A Weyl
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - E Chantalat
- Department of General and Gynecological Surgery, University Hospital Center (CHU)-Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France.
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Chantalat E, Tuyeras G, Leguevaque P, Delchier MC, Vaysse C, Genre L. Consequences of delayed diagnosis of acute gastrointestinal intussusception, secondary to endometriosis. J Obstet Gynaecol Res 2016; 43:595-598. [PMID: 27935169 DOI: 10.1111/jog.13236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Elodie Chantalat
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France
| | - Géraud Tuyeras
- Department of Visceral Surgery, CHU Rangueil, Toulouse, France
| | | | | | - Charlotte Vaysse
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France
| | - Ludivine Genre
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France
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Hudry D, Ahmad S, Zanagnolo V, Narducci F, Fastrez M, Ponce J, Tucher E, Lécuru F, Conri V, Leguevaque P, Goffin F, Holloway RW, Lambaudie E. Robotically assisted para-aortic lymphadenectomy: surgical results: a cohort study of 487 patients. Int J Gynecol Cancer 2015; 25:504-11. [PMID: 25628104 DOI: 10.1097/igc.0000000000000373] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate perioperative outcomes of robotic-assisted laparoscopic para-aortic lymphadenectomy (PAL) in patients with gynecologic cancers during the learning phases of robotic surgery programs and to compare results of extraperitoneal versus transperitoneal approaches of PAL. MATERIALS AND METHODS This study is a retrospective multicentric study of patients who underwent robotically assisted laparoscopic PAL (N = 487). Eleven European centers and 1 US center participated in the study. Abstracted data included age, body mass index, indication, type of surgical approach (transperitoneal or extraperitoneal), associated surgical procedures, operative time, estimated blood loss, lymph node count, hospital length of stay (LOS), and complications. Para-aortic lymphadenectomy was performed by an extraperitoneal approach in 58 cases (12%) and transperitoneal in 429 cases (88%). RESULTS The mean (SD) para-aortic lymph node count was 12.6 (8.1), operative time was 217 (85) minutes, estimated blood loss was 105 (110) mL, and LOS was 2.8 (3.2) days. Four (0.8%) conversions to open and 2 (0.4%) conversions to laparoscopy were described. There were 32 lymphocysts (6.6%), 3 deep venous thromboses (0.6%), and 10 transfusions (2.1%). For transperitoneal approach, the average number of lymph nodes removed was higher in isolated PAL group than the hysterectomy combined group (report node counts 95% confidence interval, -7.29 to -3.52, P = 1.5 × 10⁻⁶). For isolated PAL, the LOS was shorter in the extraperitoneal group than in the transperitoneal group (report data 95% CI, -1.35 to -0.35, P = 0.001). CONCLUSIONS Robotic-assisted PAL seems safe and feasible. More lymph nodes were removed during an isolated transperitoneal PAL dissection compared with a combined procedure with hysterectomy. Extraperitoneal approach seems attractive relative to transperitoneal dissection, but the superiority of one or the other way is not demonstrated by our study.
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Affiliation(s)
- Delphine Hudry
- *Georges-François Leclerc Cancer Center, Dijon, France; †Florida Hospital Cancer Institute, Orlando, FL; ‡European Institute of Oncology, Milan, Italy; §Centre Oscar Lambret, Lille, France; ∥St Pierre University Hospital, Brussels, Belgium; ¶UZ Leuven, Leuven, Belgium; #Institute of Oncology, IDIBELL, Idibell, Spain; **Charité University Medicine, Berlin, Germany; ††European Hospital, Paris, France; ‡‡University Hospital, Bordeaux, France; §§Claudius Regaud Institute, Toulouse, France; ∥∥Citadelle Hospital, Liège, Belgium; and ¶¶Paoli Calmettes Institute, Marseille, France
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Chantalat E, Vidal F, Leguevaque P, Lepage B, Mathevet P, Deslandres M, Motton S. Cervical cancer with paraaortic involvement: do patients truly benefit from tailored chemoradiation therapy? A retrospective study on 8 French centers. Eur J Obstet Gynecol Reprod Biol 2015; 193:118-22. [DOI: 10.1016/j.ejogrb.2015.07.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 07/21/2015] [Accepted: 07/28/2015] [Indexed: 11/26/2022]
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7
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Chantalat E, Vidal F, Leguevaque P, Lepage B, Lambaudie E, Hebert T, Motton S. Para-aortic workup in locally advanced cervical cancer: heterogeneity is still the rule. Results from a retrospective multicenter study. Arch Gynecol Obstet 2015; 293:1081-6. [PMID: 26385726 DOI: 10.1007/s00404-015-3885-9] [Citation(s) in RCA: 9] [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: 04/23/2015] [Accepted: 09/09/2015] [Indexed: 01/18/2023]
Abstract
PURPOSE We retrospectively studied the different strategies of para-aortic (PA) staging of patients with PA involvement in locally advanced cervical cancer as conducted in eight centers in France and their impact upon survival and management. METHODS All patients enrolled in this multicenter study presented with cervical cancer with PA involvement. The diagnosis of PA spread was based on imaging assessment of the PA area and/or pathological examination of harvested PA lymph nodes when staging lymphadenectomy was performed. Imaging modalities comprised positron emission tomography (PET), magnetic resonance imaging and/or computed tomography. Survival outcomes were evaluated retrospectively. RESULTS One hundred and fifteen women were retrospectively studied. Radiological staging was conducted in 101 (87.8 %) patients. PET was performed in 66 patients (57.4 %). Its FN rate was 22.7 % (15/66) and its sensitivity 77.3 %. Para-aortic lymphadenectomy was conducted in a large proportion of patients (67.8 %). Its indications were not restricted to negative radiological workup. The lymphadenectomy rate was significantly higher in patients with earlier stages (p = 0.02) and lower tumor volume (p = 0.01). Treatment consisted of chemoradiation therapy with extended-field radiotherapy in all patients, followed by intracavitary brachytherapy in 94 cases (81.7 %) and completion surgery in 69 cases (60 %). Patients without para-aortic metastasis on radiological examination were more likely to receive all treatment modalities (p = 0.04). CONCLUSION Despite established recommendations, our results point out the tremendous heterogeneity regarding para-aortic assessment. These differences in management are perhaps related to a recommended therapeutic strategy that does not appear to improve the poor prognosis associated with PA involvement.
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Affiliation(s)
- Elodie Chantalat
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France.
| | - Fabien Vidal
- Department of Gynecological Surgery, CHU Purpan, Toulouse, France
| | | | - Benoît Lepage
- Department of Epidemiology, CHU Rangueil, Toulouse, France
| | - Eric Lambaudie
- Department of Gynecological Surgery, Institut Paoli-Calmettes, Marseille, France
| | - Thomas Hebert
- Department of Gynecological Surgery, CHU Bretonneau, Tours, France
| | - Stéphanie Motton
- Department of Gynecological Surgery, CHU Rangueil, Toulouse, France
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Lunardi P, Vidal F, Accadbled F, Leguevaque P, Soule-Tholy M, Beauval JB, Motton S. Bilateral femur metastases in low-grade endometrial carcinoma. Clin Case Rep 2015; 3:582-6. [PMID: 26273447 PMCID: PMC4527801 DOI: 10.1002/ccr3.263] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/25/2015] [Accepted: 02/26/2015] [Indexed: 11/20/2022] Open
Abstract
Lower-limb bone metastases are uncommon in low-grade endometrial carcinoma, and are mostly located on the axial skeleton. Here, we present a rare case of bilateral femur metastases in low-grade endometrial carcinoma and performed a review of the current literature.
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Affiliation(s)
- Pierre Lunardi
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil Toulouse, France
| | - Fabien Vidal
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
| | | | - Pierre Leguevaque
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
| | - Marc Soule-Tholy
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
| | - Jean Baptiste Beauval
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil Toulouse, France
| | - Stéphanie Motton
- Department of Gynaecology and General Surgery, CHU Rangueil Toulouse, France
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9
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Simorre M, Chaput B, Voglimacci Stephanopoli M, Garrido I, Soule-Tholy M, Leguevaque P, Vaysse C. [Lipofilling in breast reconstruction: is there any population with higher risk of local recurrence? Literature systematic review]. ACTA ACUST UNITED AC 2015; 43:309-18. [PMID: 25813431 DOI: 10.1016/j.gyobfe.2015.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 10/14/2014] [Accepted: 02/18/2015] [Indexed: 12/13/2022]
Abstract
Safety of the autologous fat grafting (AFG) in the breast parenchyma remains a debated topic, particularly in reconstruction following breast cancer. This procedure still raises many questions, especially considering recent in vitro studies warning about the fact that lipofilling could promote tumor recurrence through increased neoangiogenesis, or facilitate metastasis. Through a systematic literature review on oncological risk and radiological follow-up, conducted from January 2010 to August 2014, we tried to identify populations at risk of recurrence after AFG. The study selection process was adapted from the Prisma statement. Out of the seven analysed patients cohorts, i.e. approximately 1500 AFG procedures, results on the risk of local recurrence appear reassuring after an average follow-up of 42 months. These results should be cautiously interpreted because of the heterogeneity of the studies. However, recurrences have been analysed based on the characteristics of the original tumor and many of them warn about population that seem more at risk of recurrence. Studies on radiological modifications after AFG emphasize the need for the radiologists to know the importance of radiological images induced by this procedure, however, AFG does not seem to interfere with radiological screening of local recurrence. In order to deliver clear information to patients receiving breast reconstruction by lipofilling, prospective studies focused on populations that seem to be most at risk of recurrence are required.
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Affiliation(s)
- M Simorre
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France.
| | - B Chaput
- Service de chirurgie plastique, reconstructrice et esthétique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - M Voglimacci Stephanopoli
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - I Garrido
- Service de chirurgie plastique, reconstructrice et esthétique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - M Soule-Tholy
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - P Leguevaque
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
| | - C Vaysse
- Service de chirurgie générale et gynécologique oncologique, CHU-Hôpital Rangueil, 1, avenue Professeur Jean-Poulhès, 31056 Toulouse cedex 9, France
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10
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Collinet P, Leguevaque P, Neme RM, Cela V, Barton-Smith P, Hébert T, Hanssens S, Nishi H, Nisolle M. Robot-assisted laparoscopy for deep infiltrating endometriosis: international multicentric retrospective study. Surg Endosc 2014; 28:2474-9. [DOI: 10.1007/s00464-014-3480-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 02/03/2014] [Indexed: 12/21/2022]
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11
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Boussaïd K, Meduri G, Maiza JC, Gennero I, Escourrou G, Bros A, Leguevaque P, Bennet A, Caron P. Virilizing sclerosing-stromal tumor of the ovary in a young woman with McCune Albright syndrome: clinical, pathological, and immunohistochemical studies. J Clin Endocrinol Metab 2013; 98:E314-20. [PMID: 23365131 DOI: 10.1210/jc.2012-3551] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT McCune-Albright syndrome (MAS) is characterized by polyostotic fibrous dysplasia, café-au-lait skin pigmentations, and gonadotropin-independent sexual precocious puberty, resulting from a somatic postzygotic activating mutation of the GNAS1 gene. SETTING We report a virilizing sclerosing-stromal tumor of the ovary in a young female with MAS. PATIENT She presented polyostotic fibrous dysplasia of the left upper and lower limbs and a café-au-lait skin spot in the posterior area of the neck. She had a history of precocious puberty, diagnosed at the age of 6 years and treated with cyproterone acetate until the age of 10 years; then she developed central puberty with severe oligomenorrhea. At the age of 23 years, she was hospitalized for a virilization syndrome including hirsutism, acne, deepening of the voice, amenorrhea, and clitoromegaly. Serum levels of T were dramatically increased (1293 ng/dl; normal range, 10-80). The abdominal computed tomography scan revealed a solid mass located on the left ovary. INTERVENTION An ovariectomy was performed, and histological examination revealed a sclerosing-stromal tumor with pseudolobular pattern. RESULTS Immunohistochemical studies revealed that the tumor cells expressed all steroidogenic enzymes involved in androgen synthesis. Molecular analysis revealed that ovarian tumor cells harbored the Arg 201 activating mutation in the GNAS1 gene. After surgery, T levels returned to normal, the patient retrieved a normal gonadal function, and she was able to become pregnant. CONCLUSION This observation extends the clinical spectrum of ovarian pathology of women with MAS. However, the mechanisms causing this ovarian tumor remain unclear, even if the gsp oncogene has been implicated in the pathogenesis of some gonadal tumors.
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Affiliation(s)
- Kahina Boussaïd
- Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Universitaire Rangueil-Larrey, 24 Chemin de Pourvouville, TSA 30030, 31059 Toulouse Cedex 9, France
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12
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Le Brun JF, Ferron G, Vaysse C, Baujat M, Leguevaque P, Filleron T, Querleu D. Laparoscopic observation of the diaphragm undersurface in the staging of peritoneal carcinomatosis: comparison of three optical systems. Eur J Obstet Gynecol Reprod Biol 2012; 164:65-8. [PMID: 22910337 DOI: 10.1016/j.ejogrb.2012.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 04/16/2012] [Accepted: 05/04/2012] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Endoscopy is a key tool in the diagnosis and management planning of peritoneal carcinomatosis. The aim of this study was to determine which type of endoscope is the most efficient for comprehensive staging of the upper abdomen peritoneal surface. METHODS From April 2010 to February 2011, endoscopies were performed on five human female fresh-frozen cadavers. Three endoscopes (rigid 0°, 30° and flexible) were used consecutively and compared. RESULTS The diaphragmatic areas explored with the flexible endoscope were significantly larger than those with the other two. On average, 135 (range 66-225), 168 (range 96-306), and 201 (range 128-399)cm(2) were observed using the 0°, 30°, and flexible laparoscopes, respectively. The p value obtained using the exact Wilcoxon test for paired data was 0.0019 between the 0° and 30° endoscopes and between the 30° and flexible endoscopes. The 30° endoscope was consistently better than the 0° endoscope for the observation of the diaphragm and spleen undersurface. CONCLUSION Flexible endoscopy seemed to be the most efficient for the evaluation of peritoneal carcinomatosis. However, due to a poorer image, the need for considerable practice, and the high equipment and maintenance cost of the flexible endoscope, the rigid 30° endoscope seems to be the best compromise.
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Affiliation(s)
- Jean-François Le Brun
- Centre de lutte contre le cancer Claudius Regaud, 20-24 rue du pont Saint Pierre 31052 Toulouse Cédex 3, France.
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Vaysse C, Touboul C, Filleron T, Mery E, Jouve E, Leguevaque P, Morice P, Leblanc E, Querleu D. Early stage (IA-IB) primary carcinoma of the fallopian tube: case-control comparison to adenocarcinoma of the ovary. J Gynecol Oncol 2011; 22:9-17. [PMID: 21607090 PMCID: PMC3097339 DOI: 10.3802/jgo.2011.22.1.9] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Revised: 11/24/2010] [Accepted: 12/01/2010] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Early stage primary carcinoma of the fallopian tube (PCFT) is an uncommon condition when strict criteria are applied. The aim of this study was to compare the outcome stage IA-IB PCFT to a matched group of ovarian cancer (OC). METHODS Between 1990 and 2008, 32 patients with stage IA-IB of PCFT were recorded in the database of three French Institutions. A control group of patients with OC was constituted. RESULTS Eleven eligible PCFT cases and 29 OC controls fulfilled the stringent inclusion criteria. Median follow-up was 70.2 months. Five-year overall survival was 83.3% (95% confidence interval [CI], 27.3 to 97.5) for PCFT and 88.0% (95% CI, 66.9 to 96.0) for OC (p=0.93). In the subgroup of patients with grade 2-3, the outcome was similar in PCFT compared to OC patients (p=0.75). Five-year relapse-free survival was respectively 62.5% (95% CI, 22.9 to 86.1) and 85.0% (95% CI, 64.6 to 94.2) in the PCFT and OC groups (p=0.07). In the subgroup of patients (grade 2-3), there was no difference between PCFT and OC (p=0.65). CONCLUSION The findings did not reveal any difference in prognosis between early stage of PCFT and OC when grade is taken into account. Management of PCFT should mirror that of ovarian carcinoma.
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Affiliation(s)
- Charlotte Vaysse
- Department of Surgery, Institut Claudius Regaud, Toulouse, France
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14
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Persechini ML, Motton S, Leguevaque P, Donadille F, Escourrou G, Vierasu B, Hamdi S, Bennet A, Caron P. Virilising ovarian tumour: a case associating a Sertoli-Leydig cell tumour and a Brenner tumour. Gynecol Endocrinol 2011; 27:345-50. [PMID: 20569103 DOI: 10.3109/09513590.2010.492883] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ovarian Sertoli-Leydig cell tumours (SLCT), also termed arrhenoblastomas, are the most frequent virilising tumours in women of reproductive age. Very rare secretory Brenner tumours (BT) have been described, generally after the menopause. A 31-year-old woman sought medical advice for secondary amenorrhoea, progressive hirsutism and a 5-year history of virilisation syndrome with clitoromegaly. Testosterone was markedly high (285 ng/dl, N<85) with moderate elevation of delta 4-androstenedione (D4AD) (311 ng/dl, N <270), dehydroepiandrosterone sulfate (DHEAS) (366 μg/dl, N <340) and 17-hydroxyprogesterone (17OHP) (275 ng/dl). LH was 9 IU/l, FSH 4.3 IU/l, estradiol 60 pg/ml and progesterone 314 ng/100 ml. Cortisol was decreased (1.3 μg/dl) after the dexamethasone suppression test. Pelvic MRI showed a 5-cm right ovarian tumour with a 2.5 cm nodular component and cystic areas, and two nodules measuring 11 mm and 15 mm above the right and left ovaries. After right ovariectomy by laparoscopy, pathological examination concluded on a 3-cm SLCT and a 2-cm BT; the nodules above the ovaries were dysembryoplastic cysts. Postoperatively, testosterone level was normal after 24 h (26 ng/dl), estradiol and progesterone rapidly decreased, cyclic secretion then resumed and the patient menstruated at day 27. To our knowledge, this is the first report of an ovarian tumour associating a Sertoli-Leydig cell tumour and a Brenner tumour in a patient with virilisation syndrome which resolved after ovariectomy.
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Affiliation(s)
- Marie-Laure Persechini
- Service d'Endocrinologie et Maladies Métaboliques, Centre Hospitalier Universitaire Larrey, Toulouse, France
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15
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Vaysse C, Escourrou G, Motton S, Garrido I, Hoff J, Leguevaque P. Tumeur fibreuse solitaire de la vulve : à propos d’un cas. ACTA ACUST UNITED AC 2011; 39:e49-51. [DOI: 10.1016/j.gyobfe.2010.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 04/05/2010] [Indexed: 10/18/2022]
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Vaysse C, Charitansky H, Alunni JP, Garrido I, Leguevaque P, Lacroix-Triki M. [Voluminous juvenile papillomatosis: Diagnostic, therapeutic and prognostic difficulties - a case report]. Gynecol Obstet Fertil 2011; 39:e23-e26. [PMID: 21183390 DOI: 10.1016/j.gyobfe.2010.08.008] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 05/10/2010] [Indexed: 05/30/2023]
Abstract
The juvenile papillomatosis is a rare entity. We shall systematically check for a cancer. A 20-year-old woman patient without any familial medical history of breast carcinoma, was presenting a voluminous nodule of the left breast. A core needle biopsy allowed to diagnose papilloma. A conservative surgical treatment was proposed and realized despite any possibility of complete resection. Histological examination of the surgical specimen concluded to a juvenile papillomatosis. A closed follow-up was proposed to the patient. This case illustrates the difficulty of a voluminous tumor surgery on a young woman. The main problem is to combine the cosmetic constraints with oncology risk.
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Affiliation(s)
- C Vaysse
- Institut Claudius-Regaud, Toulouse, France.
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17
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Basarab A, Vidal F, Abbal R, Delachartre P, Vayssiere C, Leguevaque P, Kouame D. Motion estimation in ultrasound imaging applied to the diagnostic of pelvic floor disorders. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2011:8058-8061. [PMID: 22256211 DOI: 10.1109/iembs.2011.6091987] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The main purpose of this paper is to show the potential of tissue motion estimation in ultrasound imaging for the diagnostic of pelvic floor disorders. We propose to evaluate the tissue motion using a method based on a local deformable model and on image features (local phase and orientation) extracted from the monogenic signal. The proposed method is well adapted to the pelvic organ deformations and estimates motion with subpixel precision without the need for interpolation. The estimated motion is used to visualize the bladder local deformation and to extract quantitative figures such as the deformation parameters and the bladder angle variation. These results could potentially be interesting to characterize the degree of the pelvic organ prolapse.
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Leguevaque P, Motton S, Decharme A, Soulé-Tholy M, Escourrou G, Hoff J. Predictors of recurrence in high-grade cervical lesions and a plan of management. Eur J Surg Oncol 2010; 36:1073-9. [PMID: 20870375 DOI: 10.1016/j.ejso.2010.08.135] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Revised: 07/21/2010] [Accepted: 08/19/2010] [Indexed: 10/19/2022] Open
Abstract
UNLABELLED PRÉCIS: Positive endocervical margins are an important predictor of recurrence in high-grade cervical lesions, and though they do not always warrant retreatment, closer surveillance is recommended. OBJECTIVE To identify predictors of recurrence and persistence of high-grade cervical dysplasia and to determine appropriate follow-up. DESIGN prospective pilot study. SETTING Gynaecological surgical center. POPULATION Three hundred fifty-two patients were treated between 1999 and 2002 for high-grade lesions. METHODS According to the accessibility of the transformation zone and the degree of dysplasia, patients were treated either by conization or by loop electrosurgical excision procedure (LEEP). Follow-up comprised colposcopy and Pap-smear screening 4-6 months after treatment as well as high-risk human papillomavirus (HR-HPV) testing before and after treatment. MAIN OUTCOME MEASURES underscore predictors of recurrence and propose a treatment flowchart for both management and follow-up. RESULTS Of the 352 patients, 37 (10.5%) had true recurrence 6 months after initial surgical treatment and 6 patients (1.7%) had persistent lesions. Overall, 43 patients (12.2%) were considered as having recurrent disease. Patients were followed up for 5 years with a mean of 73 months. The most important predictor of recurrence was a positive HR-HPV test at 6 months postoperatively (odds ratio 38.8, 95% confidence interval 14.09, 107.05). The second significant predictor was positive endocervical margins and the third was positive pre-treatment HPV typing. A positive post-treatment HPV test had a more significant influence on risk than a positive test before treatment. CONCLUSION In agreement with recent findings, our study supports the usefulness of the HR-HPV test in the follow-up of treated high-grade lesions, especially when excision margins were positive.
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Affiliation(s)
- P Leguevaque
- Department of General and Gynecological Surgery, CHU Rangueil, Toulouse, France
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Garrido I, Leguevaque P, Gangloff D, Mojallal A. [The adipose tissue transfer in the mammary parenchyma (part I): Review of the literature on modifications of the radiological images]. ANN CHIR PLAST ESTH 2010; 55:568-77. [PMID: 21144953 DOI: 10.1016/j.anplas.2009.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Accepted: 11/13/2009] [Indexed: 10/19/2022]
Abstract
The adipose tissue transfer (ATT) in the mammary parenchyma is a subject of controversy and generates passionate debates in scientific meetings. So far, many phenomena remain unexplained. Among these phenomena, changes in mammogram images generated by the grafted adipose tissue and the interactions between the grafted adipose tissue and a clinically undetectable breast cancer are the most important. We will present a series of articles with a critical analysis of the scientific literature on each of these phenomena. This first article presents the review of the literature on modifications of the radiological images after ATT. Two types of images are most common in mammograms after ATT. These are oil cysts and microcalcifications. Regarding to the presented review of literature, there is not yet sufficient evidence to prove a similarity or not between these images generated by the ATT and those from a breast malignancy. Therefore, clinically, patients must be included in a prospective clinical trial and in terms of research, the first step should be an exhaustive description of radiological images after ATT and a comparison of these images to images of malignancy. So, it's important to include these patients in prospective protocols with close and long term follow-up.
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Affiliation(s)
- I Garrido
- Service de chirurgie oncologique, 20-24, rue du pont-Saint-Pierre, 31052 Toulouse, France.
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Astudillo L, Lacroix-Triki M, Game X, Asnasios A, Leguevaque P, Roché H. An unusual case of sarcoma of the breast. Breast J 2005; 11:74-5. [PMID: 15647085 DOI: 10.1111/j.1075-122x.2005.21409.x] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Leonardo Astudillo
- Department of Internal Medicine, University School of Medicine Purpan, Toulouse, France.
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