1
|
Lambaudie E, Bogart E, Le Deley MC, El Hajj H, Gauthier T, Hebert T, Collinet P, Classe JM, Lecuru F, Motton S, Conri V, Ferrer C, Marchal F, Ferron G, Probst A, Jauffret C, Narducci F. The Influence of Surgical Complexity and Center Experience on Postoperative Morbidity After Minimally Invasive Surgery in Gynecologic Oncology: Lessons Learned from the ROBOGYN-1004 Trial. Ann Surg Oncol 2024:10.1245/s10434-024-15265-1. [PMID: 38616209 DOI: 10.1245/s10434-024-15265-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND This study was a secondary analysis of the ROBOGYN-1004 trial conducted between 2010 and 2015. The study aimed to identify factors that affect postoperative morbidity after either robot-assisted laparoscopy (RL) or conventional laparoscopy (CL) in gynecologic oncology. METHODS The study used two-level logistic regression analyses to evaluate the prognostic and predictive value of patient, surgery, and center characteristics in predicting severe postoperative morbidity 6 months after surgery. RESULTS This analysis included 368 patients. Severe morbidity occurred in 49 (28 %) of 176 patients who underwent RL versus 41 (21 %) of 192 patients who underwent CL (p = 0.15). In the multivariate analysis, after adjustment for the treatment group (RL vs CL), the risk of severe morbidity increased significantly for patients who had poorer performance status, with an odds ratio (OR) of 1.62 for the 1-point difference in the WHO performance score (95 % CI 1.06-2.47; p = 0.027) and according to the type of surgery (p < 0.001). A focus on complex surgical acts showed significant more morbidity in the RL group than in the CL group at the less experienced centers (OR, 3.31; 95 % CI 1.0-11; p = 0.05) compared with no impact at the experienced centers (OR, 0.87; 95 % CI 0.38-1.99; p = 0.75). CONCLUSION The findings suggest that the center's experience may have an impact on the risk of morbidity for patients undergoing complex robot-assisted surgical procedures.
Collapse
Affiliation(s)
| | | | - Marie-Cécile Le Deley
- Oscar Lambret Cancer Center, Lille, France
- Université Paris-Sud, UVSQ, CESP, INSERM, Université Paris-Saclay, Villejuif, France
| | - Houssein El Hajj
- Paoli Calmettes Institute, Marseille, France.
- Oscar Lambret Cancer Center, Lille, France.
| | | | | | | | | | | | | | | | | | - Frederic Marchal
- CRAN, UMR 7039, CNRS Institut de Cancérologie de Lorraine Vandoeuvre les-Nancy, Université de Lorraine, Nancy, France
| | - Gwenael Ferron
- Institut Claudius Regaud Cancer Center-Toulouse, Toulouse, France
| | | | | | | |
Collapse
|
2
|
Sourzac J, Germain C, Frison E, Sztark F, Conri V, Floccia M. Effect of a hypnosis session before hysterectomy on pre- and postoperative anxiety. Int J Gynaecol Obstet 2021; 155:156-157. [PMID: 34174088 DOI: 10.1002/ijgo.13800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Jennie Sourzac
- Institut de Médecine Intégrative et Complémentaire, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Christine Germain
- Service d'information Médicale, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Eric Frison
- Service d'information Médicale, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Francois Sztark
- Institut de Médecine Intégrative et Complémentaire, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Vanessa Conri
- Service de Chirurgie Gynécologique et Oncologique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marie Floccia
- Institut de Médecine Intégrative et Complémentaire, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| |
Collapse
|
3
|
Narducci F, Bogart E, Hebert T, Gauthier T, Collinet P, Classe JM, Lecuru F, Delest A, Motton S, Conri V, Ferrer C, Marchal F, Ferron G, Probst A, Thery J, Le Deley MC, Lefebvre D, Francon D, Leblanc E, Lambaudie E. Severe perioperative morbidity after robot-assisted versus conventional laparoscopy in gynecologic oncology: Results of the randomized ROBOGYN-1004 trial. Gynecol Oncol 2020; 158:382-389. [PMID: 32467054 DOI: 10.1016/j.ygyno.2020.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 12/13/2019] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In gynecologic oncology, minimally invasive surgery using conventional laparoscopy (CL) decreases the incidence of severe morbidity compared to open surgery. In 2005, robot-assisted laparoscopy (RL) was approved for use in gynecology in the US. This study aimed to assess whether RL is superior to CL in terms of morbidity incidence. METHODS ROBOGYN-1004 (ClinicalTrials.gov, NCT01247779) was a multicenter, phase III, superiority randomized trial that compared RL and CL in patients with gynecologic cancer requiring minimally invasive surgery. Patients were recruited between 2010 and 2015. The primary endpoint was incidence of severe perioperative morbidity (severe complications during or 6 months after surgery). RESULTS Overall, 369 of 385 patients were included in the as-treated analysis: 176 and 193 underwent RL and CL, respectively. The median operating time for RL was 190 (range, 75-432) minutes and for CL was 145 (33-407) minutes (p < 0.001). The blood loss volumes for the corresponding procedures were 100 (0-2500) and 50 (0-1000) mL (p = 0.003), respectively. The overall rates of conversion to open surgery for the corresponding procedures were 7% (10/176) and 5% (10/193), respectively (p = 0.52). Severe perioperative morbidity occurred in 28% (49/176) and 21% (41/192) of patients who underwent RL and CL, respectively (p = 0.15). At a median follow-up of 25.1 months (range, 0.6-78.2), no significant differences in overall and disease-free survival were observed between the groups. CONCLUSIONS RL was not found superior to CL with regard to the incidence of severe perioperative morbidity in patients with gynecologic cancer. In addition, RL involved a longer operating time than CL.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Alain Delest
- Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | | | | | - Frederic Marchal
- CRAN, UMR 7039, Université de Lorraine, CNRS Institut de Cancérologie de Lorraine Vandoeuvre-les-Nancy, France
| | - Gwenael Ferron
- Institut Claudius Regaud Cancer Center, Toulouse, France
| | | | | | - Marie-Cécile Le Deley
- Oscar Lambret Cancer Center, Lille, France; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | | | - Daniel Francon
- Institut Paoli Calmettes Cancer Center, Marseille, France
| | | | - Eric Lambaudie
- Institut Paoli Calmettes Cancer Center, Marseille, France
| |
Collapse
|
4
|
Sourzac J, Berger V, Conri V. L’impact de l’hypnose conversationnelle sur l’anxiété pré et post opératoire des patientes en chirurgie gynécologique versus pratique courante : étude comparative. Rech Soins Infirm 2018:83-90. [DOI: 10.3917/rsi.135.0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
5
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Chirol A, Debled M, Fournier M, Papaxanthos A, Hoppe S, Brouste V, Conri V, Bonnefoi H, Von Théobald P, Mathoulin S, Hocké C, Tunon de Lara C. [Oncofertility and breast cancer: Where have we come from, where are we going?]. Bull Cancer 2015; 102:489-96. [PMID: 25991386 DOI: 10.1016/j.bulcan.2015.04.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/04/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Focusing on the current context of national and international recommendations, techniques development to evaluate and preserve fertility and patients' claims, this study aims to make a survey about the management of patients' breast cancer regarding oncofertility. METHODS Retrospective and analytic study of medical practices at Bergonié Institute of health professionals (medical oncologists, surgical oncologists, nurses) dedicated to the care of non-disseminated breast cancer patients younger than 37, needing medical treatment. RESULTS The number of participants was 230. The most interested practitioners in fertility theme are those of multidisciplinary consultation and surgeons (P<0.001), with an increasing interest during last years (P<0.05). The information about hypofertilizing risks of treatments are delivered most of the time by oncologists (57.7%). The motherhood project is expressed by 11 patients (4.9%) before treatment, only 4 of them receive information on the risks and 49 patients (21.7%) during follow-up. Only 24 patients (48% of the 49) are encouraged for motherhood. CONCLUSION To satisfy patients' requests, several improvements have to be made regarding the patients' information, the health professionals' awareness and care coordination.
Collapse
Affiliation(s)
- Aurélie Chirol
- Institut de lutte contre le cancer, institut Bergonié, service de chirurgie, Bordeaux, France; Université de Bordeaux, Bordeaux, France; Université de la Réunion, France
| | - Marc Debled
- Institut de lutte contre le cancer, institut Bergonié, service d'oncologie médicale, Bordeaux, France
| | - Marion Fournier
- Institut de lutte contre le cancer, institut Bergonié, service de chirurgie, Bordeaux, France
| | - Aline Papaxanthos
- CHU Pellegrin, service de biologie de la reproduction, Bordeaux, France
| | - Stéphanie Hoppe
- Institut de lutte contre le cancer, institut Bergonié, service de biostatistiques, Bordeaux, France
| | - Véronique Brouste
- Institut de lutte contre le cancer, institut Bergonié, service de biostatistiques, Bordeaux, France
| | - Vanessa Conri
- CHU Pellegrin, service de gynécologie et reproduction, Bordeaux, France
| | - Hervé Bonnefoi
- Institut de lutte contre le cancer, institut Bergonié, service d'oncologie médicale, Bordeaux, France; Université de Bordeaux, Bordeaux, France
| | - Peter Von Théobald
- CHU Felix-Guyon, service de gynécologie, 97400 Saint-Denis, Réunion; Université de la Réunion, France
| | - Simone Mathoulin
- Institut de lutte contre le cancer, institut Bergonié, service de biostatistiques, Bordeaux, France; Université de Bordeaux, Bordeaux, France
| | - Claude Hocké
- CHU Pellegrin, service de gynécologie et reproduction, Bordeaux, France; Université de Bordeaux, Bordeaux, France
| | - Christine Tunon de Lara
- Institut de lutte contre le cancer, institut Bergonié, service de chirurgie, Bordeaux, France.
| |
Collapse
|