Aminata Kane

Outcomes after conservative treatment of advanced-stage serous borderline tumors of the ovary

BACKGROUND The aim of this study was to assess the outcomes of the largest series of patients treated conservatively for a stage II or III serous borderline ovarian tumor. MATERIALS AND METHODS From 1969 to 2006, 41 patients were treated conservatively for an advanced-stage serous borderline ovarian tumor. Patient outcomes were reviewed. RESULTS Twenty patients had undergone a unilateral salpingo-oophorectomy, 18 a unilateral cystectomy and two bilateral cystectomy (unknown for one patient). Three patients had invasive implants. The median duration of follow-up was 57 months (range 4-235). The recurrence rate was high (56%), but overall survival remained excellent (100% at 5 years, 92% at 10 years). One death had occurred due to an invasive ovarian recurrence. Eighteen pregnancies (nine spontaneous) were observed in 14 patients. CONCLUSIONS This study demonstrates that spontaneous pregnancies can be achieved after conservative treatment of advanced-stage borderline ovarian tumors (with noninvasive implants) but the recurrence rate is high. Nevertheless, this high rate has no impact on survival. Conservative surgery can be proposed to patients with a borderline tumor of the ovary and noninvasive peritoneal implants. Should infertility persist following treatment of the borderline tumor, an in vitro fertilization procedure can be cautiously proposed.

Prognostic Factors in Patients with Ovarian Serous Low Malignant Potential (Borderline) Tumors with Peritoneal Implants

BACKGROUND The objective of this study was to determine prognostic factors in a large series of patients with stage II or III serous low malignant potential ovarian tumor (LMPOT) and peritoneal implants. METHODS Patients with a serous LMPOT and peritoneal implants treated at or referred to our institution were retrospectively reviewed. The slides of ovarian tumors and peritoneal implants were reviewed by the same pathologist. RESULTS From 1969 to 2006, 168 patients were reviewed, 21 of whom had invasive implants. Tumors exhibited a micropapillary pattern in 56 patients. Adjuvant treatment had been administered to 61 patients. The median duration of follow-up was 57 months (range, 1-437). Forty-four patients had relapsed and 10 patients had died. The 5-year overall survival rate was 98%. Among patients with noninvasive and invasive implants, 8% and 10%, respectively, had relapsed at 5 years in the form of invasive disease (p = .08). In a multivariate analysis, the use of conservative treatment was the only prognostic factor. INTERPRETATION The prognosis of serous LMPOT with peritoneal implants remains good. The strongest prognostic factor in patients with an advanced-stage borderline tumor is the use of conservative surgery. In this series, a micropapillary pattern and implant subtype (invasive versus noninvasive) were not prognostic factors.

Single-port laparoscopy and extraperitoneal para-aortic lymphadenectomy: about fourteen consecutive cases.

OBJECTIVE To report the feasibility and reproducibility of single port extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer. METHODS The same single port was used for the transperitoneal step and the extraperitoneal approach used thereafter (in the absence of peritoneal disease) for the lymphadenectomy. Para-aortic lymphadenectomy was performed via a left-sided extraperitoneal approach. RESULTS Fourteen consecutive patients with cervical cancer underwent a laparoscopic staging procedure (3 stage IB2, 10 IIB and 1 stage IVA). No patient had para-aortic FDG uptake on PET/CT. In one case lymphadenectomy was unfeasible because of vascular anomalies of the renal vessels (low insertion of 2 left renal arteries). The median operative time was 190 min (range, 135-250). The median number of lymph nodes removed was 14 [range, 2-23]. The definitive pathological analysis revealed that three patients had metastatic disease. No conversion to conventional multiport laparoscopy was necessary. CONCLUSIONS This series reports that para-aortic lymphadenectomy technique via the extraperitoneal approach with a multichannel single port is feasible and reproducible.

Prognostic value of lymph node involvement in ovarian serous borderline tumors

OBJECTIVE This study was conducted to evaluate the prognosis value of lymph node involvement (LN positive) lymph node involvement for borderline ovarian tumor (BOT). STUDY DESIGN This was a retrospective study on 49 patients treated at our institution for advanced-stage serous BOT (International Federation of Gynecology and Obstetrics [FIGO] III or IV). Pathological characteristics and survival were compared according to the lymph node status. The same analysis was performed on 1503 patients of the Surveillance, Epidemiology, and End Results (SEER) database. RESULTS In our institution, 14 patients were LN positive. Eight patients have been upstaged after lymph node dissection. No patient has died during follow-up (median 53 months). LN positivity was not associated with recurrence. In the SEER registry, 93 patients (6.2%) had LN positivity. These patients were younger and with more advanced local extension. Survival curves were similar after adjustment for FIGO stage. CONCLUSION Lymph node involvement does not appear as a prognosis factor for advanced-stage BOT.

The role of Oncoplastic Breast Surgery in the management of breast cancer treated with primary chemotherapy

OBJECTIVE The purpose of this study was to evaluate the benefit of Oncoplastic Breast Conserving Surgery (BCS) compared to standard BCS after primary CT, in terms of oncologic safety and cosmetic outcomes. BACKGROUND The development of new drugs has led to greater use of primary chemotherapy (CT) for bulky breast cancer (BC) and has allowed wider indications for conservative surgery. PATIENTS AND METHODS We identified 259 patients consecutively treated with BCS for primary BC from January 2002 to November 2010. All patients had undergone Oncoplastic Breast Surgery (OBS) or standard BCS after primary CT. Mastectomy rates, and oncological and cosmetic outcomes were compared. RESULTS A total of 45 OBS and 214 standard BCS were analyzed. The median tumor size was 40 mm in the two groups (p = 0.66). The median operative specimen volumes were larger in the OBS group than in the standard group (respectively, 180 cm3 and 98 cm3, p < 0.0001). Re-excision (9% vs. 2%) and mastectomy (24% vs. 18%) rates were similar (p = 0.22 and p = 0.30) in the standard BCS group and in the OBS group respectively. At a median follow-up of 46 months, local relapse (p = 0.23) and distant relapse (p = 0.35) rates were similar. CONCLUSION OBS allows excision of larger volumes of residual tumor after primary CT. OBS outcomes results were similar to those of standard BCS. Oncoplastic Breast Conserving Surgery (BCS) after primary chemotherapy allows wider breast resection than standard BCS. Survival and relapse probabilities are similar in both groups.

How to follow up advanced-stage borderline tumours? Mode of diagnosis of recurrence in a large series stage II–III serous borderline tumours of the ovary

BACKGROUND The aim of this study was to describe how recurrences were diagnosed in the largest series of patients treated for an advanced-stage serous borderline ovarian tumour. PATIENTS AND METHODS From 1973 to 2006, 45 patients with a serous borderline tumour and peritoneal implants relapsed among 162 patients with a follow-up exceeding 1 year. Data concerning recurrences and the mode of diagnosis were reviewed. RESULTS The median follow-up interval was 8.2 years (range 19-286 months). The mode of diagnosis of recurrences was imaging (n = 19), clinical symptoms (n = 8), cancer antigen (CA) 125 elevation (n = 7), secondary surgery (n = 5) and unknown (n = 6). The median time to recurrence was 31 months (range 4-242 month). The type of recurrence was invasive low-grade serous carcinoma in 14 patients. Five patients died of recurrent tumour. Among the 39 patients with a known mode of diagnosis of recurrence, the most frequent diagnostic method for invasive recurrences was blood CA 125 elevation (6 of 13) and the majority of noninvasive recurrences were diagnosed by imaging (16 of 23). CONCLUSIONS This study demonstrates that ultrasound is the most relevant follow-up procedure in this context. Nevertheless, the blood CA 125 test is of particular interest for detecting invasive recurrent disease, which is the most crucial event.

A New Single-Port Approach to Perform a Transperitoneal Step and an Extraperitoneal Para-Aortic Lymphadenectomy with a Single Incision

Chemoradiation therapy (CRT), a combination of external beam irradiation and brachytherapy with concurrent chemotherapy, is considered the standard treatment for bulky cervical cancer ( stage IB2 according to the International Federation of Gynecology and Obstetrics [FIGO] classification) by many North American and Western European teams. The incidence of para-aortic (PA) nodal metastasis n these tumors ranges from 10% to 25%. Positron emission tomography (PET) with or without CT imaging is the most accurate imaging modality for evaluating extrapelvic disease in locally advanced cervical cancer (LACC), When PA nodes are known to be metastatic, the radiation field is extended from the pelvis to include the PA area. However, the rate of false negatives at PET-CT assessment of PA metastasis in LACC is 12%, increasing to 22% if PET-CT reveals pelvic lymph nodes with suspicious metastases. The concept of surgical staging has gained momenum with the development of laparoscopy, which reduces urgical complications. Since January 2011, this surgical taging procedure has been performed more often in our nstitution using a single-port extraperitoneal approach, hich was previously described by our team. We have efined this procedure and developed a “real” single-port pproach avoiding a second transumbilical port (to explore he peritoneum), which was used in the first procedure. We eport in this series a new procedure for performing these wo steps via a single access with only one incision.

Intrauterine fallopian tube incarceration: an uncommon complication of termination of pregnancy by vacuum aspiration

A 34-year-old woman presented with an intermittent abdominal pain 5 years after voluntary vacuum aspiration for interruption of a first-trimester pregnancy. Magnetic resonance imaging demonstrated complete septate uterus and a cystic mass that infiltrated the posterior myometrial wall of the right side of the uterus. Laparoscopy and hysteroscopy revealed an intra uterine fallopian tube incarceration.

Fertility sparing treatment of recurrent stage I serous borderline ovarian tumours

Here we report the outcomes of 26 patients who relapsed following conservative surgical treatment of stage I serous borderline ovarian tumours treated initially with fertility-sparing surgery. All recurrences were diagnosed by systematic ultrasonography during follow-up. Eleven patients relapsed at least twice after such management. Twenty-one pregnancies were observed in 13 patients. Eleven of these patients became pregnant after the treatment of their first recurrence. All patients had a borderline ovarian tumour and/or non-invasive peritoneal implants at the time of the first recurrence but two of them had invasive ovarian and peritoneal disease at the time of the second or third recurrence (one of them died of disease). Fertility-preserving surgery remains a valuable alternative (if technically feasible), in young patients with recurrent SBOT, in the form of a non-invasive ovarian lesion, who wish to start a pregnancy. However, it should be associated with meticulous follow-up because the risk of progression to carcinoma exists, albeit small.

Fertility results and outcomes after pure laparoscopic management of advanced-stage serous borderline tumors of the ovary

The outcomes of 18 patients treated with pure laparoscopic management (treated conservatively in 14 patients) of serous borderline ovarian tumors with peritoneal implants were reviewed. Eight patients relapsed (three with an invasive recurrence), but none of the patients without residual disease at the end of surgery, or invasive implants or disease with a micropapillary pattern relapsed under the form of invasive carcinoma.