Sophie Camatte

Clinical outcomes and fertility after conservative treatment of ovarian borderline tumors

OBJECTIVE To assess clinical outcome and fertility in patients treated conservatively for a low malignant potential (LMP) ovarian tumor. DESIGN Retrospective study. SETTING Gynecologic oncology department of a cancer care center in France. PATIENT(S) Forty-four patients treated with conservative management for a stage I (n = 32) or stage II or III (n = 12) LMP tumor. INTERVENTION(S) Thirty-three patients had unilateral adnexectomy and 11 had cystectomy. Cystectomy was bilateral in 1 patient and was done in conjunction with contralateral adnexectomy in 5 patients. MAIN OUTCOME MEASURE(S) Tumor recurrence and pregnancy rates. RESULT(S) Tumor recurrence rates after radical surgery (hysterectomy with bilateral salpingo-oophorectomy), adnexectomy, and cystectomy were 5.7%, 15.1%, and 36.3%, respectively (P<.01). Among patients who initially received conservative treatment, tumors did not recur in the form of invasive carcinoma. Five patients who had recurrence underwent repeated conservative management; these patients are alive and free of disease. Seventeen pregnancies (of which 15 were spontaneous) occurred in 14 patients; 13 pregnancies occurred in patients with stage I disease and 4 occurred in patients with stage III disease. CONCLUSION(S) Conservative management of LMP tumor significantly increases the risk of recurrence but does not affect overall survival. Such management offers even patients with advanced disease the chance to have spontaneous pregnancy. Conservative management might be proposed in young patients who wish to preserve their fertility, but careful follow-up will be required to detect tumor recurrence.

Fertility results after conservative treatment of advanced stage serous borderline tumour of the ovary

Objective To assess the fertility of patients treated conservatively for a Stage II or III borderline ovarian tumour.

Longterm followup of posthysterectomy vaginal vault prolapse abdominal repair: a report of 85 cases.

BACKGROUND There are many surgical procedures to treat posthysterectomy vaginal vault prolapse. Abdominal sacral colpopexy is one of these procedures. The aim of this study was to review the cases of 85 consecutive patients treated by this technique since 1978 by the same surgical team using the same procedure. Our surgical procedure will be explained. STUDY DESIGN Eighty-five patients were treated in our department between 1978 and 1998 for posthysterectomy vaginal vault prolapse. The mean age was 55.42 years. The mean weight was 63.37 kg. Their parity ranged from 0 to 5 (mean, 2.54). The interval of time between hysterectomy and vaginal vault prolapse repair ranged from 1 to 37 years (mean, 17.92 years). The main indication for hysterectomy was uterine leiomyomas. Of these patients, 67.05% had stress urinary incontinence, and mean urethral closure pressure was 48.7 cm H2O. All patients had abdominal sacral colpopexy associated with a Burch procedure and a posterior perineal repair. RESULTS Seventeen patients had postoperative fever. Twenty-two had urinary tract infections. Two patients had to undergo blood transfusion. Three patients had postoperative urinary retention. The median longterm followup was 10.5 years; 27.05% of patients had relapsing stress urinary incontinence. Two patients had a relapse of the vaginal vault prolapse. CONCLUSIONS The abdominal sacral colpopexy is a safe operation with low morbidity and long-standing good results. It can be recommended for sexually active women. Nevertheless, the Burch procedure performed with this operation failed to prevent recurrence of urinary incontinence.

Lymph node disorders and prognostic value of nodal involvement in patients treated for a borderline ovarian tumor: an analysis of a series of 42 lymphadenectomies.

BACKGROUND The aim of this study is to evaluate the rate and the clinical outcomes of lymph node involvement in patients treated for borderline ovarian tumor (BOT). STUDY DESIGN Forty-two patients were treated for BOT with a procedure that included lymphadenectomy. Twenty-four patients underwent a pelvic lymphadenectomy, 6 a paraaortic lymphadenectomy, and 12 both procedures. Thirty-two patients underwent systematic lymphadenectomy, five because of associated cancer (uterine cervix or corpus) and five because of bulky nodes discovered during the surgical procedure. RESULTS An endosalpingiosis was present in 11 (26%) patients who underwent lymphadenectomy. Eight patients had nodal involvement related to the BOT. All patients with nodal involvement had serous BOT with peritoneal implants. None of the patients with a mucinous tumor had nodal involvement. None of the patients with early-stage disease (without peritoneal disease) had nodal involvement discovered after routine lymphadenectomy. None of the patients with nodal involvement died of borderline tumor. One patient died of a complication of adjuvant therapy (leukemia after chemotherapy). CONCLUSIONS The prognosis of patients with borderline tumors of the ovary and nodal involvement is excellent. Routine lymphadenectomy should not be performed in patients with early-stage disease. This procedure should be carried out in patients with serous tumor and enlarged lymph nodes.

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.

Outcomes after combined therapy including surgical resection in patients with epithelial ovarian cancer recurrence(s) exclusively in lymph nodes.

Background: The aim was to study the prognosis for and survival of patients treated with combined therapy (including surgical resection) for nodal recurrences from epithelial ovarian cancer (EOC).Methods: This was a retrospective study of a group of 12 patients with a recurrence from EOC, a priori, exclusively located in lymph node(s). All patients underwent surgical resection of nodal metastases, followed by adjuvant therapy.Results: The median age of patients was 51 (range, 42–71) years. The initial disease stages were as follows: stage IA, n = 5; stage IIA, n = 1; and stage IIIC, n = 6. The median interval between the end of initial treatment and the nodal relapse was 21 (range, 6–72) months. The recurrence was located in the abdominal nodes in 10 patients (pelvic and/or para-aortic area) and was extra-pelvic in one patient, and the last patient had concomitant para-aortic and supraclavicular nodal involvement. Ten patients received postoperative chemotherapy and two had radiation therapy (one patient received both treatments). Eight patients relapsed and four did not. To date, three patients have died of the disease, three are alive with persistent disease, and six are alive and disease-free (including two patients who were treated by surgical resection after relapses twice in abdominal nodes). Five-year overall survival from the time of treatment of recurrent disease is 71% (confidence interval, 41%–90%).Conclusions: The prognosis of patients with an a priori isolated nodal recurrence from EOC was good in this group of treated with surgical resection followed by chemoradiation or radiation therapy. This finding argues in favor of proposing surgical resection in such patients.

Port-site implantation after laparoscopic treatment of borderline ovarian tumors.

BACKGROUND: The aim of this article is to report 3 cases of port-site implantation after laparoscopic treatment of a borderline ovarian tumor. CASES: Three patients underwent a laparoscopic procedure for a serous (2 patients) or mucinous (1 patient) borderline ovarian tumor. In 2 patients, the port-site implantation was discovered during a later surgical procedure, and one was discovered clinically 11 months after the initial laparoscopic oophorectomy. Surgical resection of the port-site was the only treatment in all cases. These women are currently alive and disease-free 11, 23, and 51 months after the treatment of the scar metastasis. CONCLUSIONS: These results suggest that, unlike port-site metastasis in other gynecologic malignancies, the prognosis in patients with a port-site implantation after laparoscopic management of borderline ovarian tumor is excellent. The treatment of this complication is surgical resection.

Chirurgie des sarcomes utérins : revue de la littérature et recommandations sur la prise en charge chirurgicale

Hysterectomy and bilateral salpingo-oophorectomy is the gold standard for the surgical procedure of uterine sarcoma in case of tumor limited to the uterine corpus. Omentectomy and lymphadenectomy should be performed in carcinosarcoma. In others histologic subtypes, lymphadenectomy should be performed only in patients with enlarged nodes discovered at the time of the surgical procedure. Surgical resection should be ideally performed without uterine parcelling out and so using a laparotomy in order to avoid this risk.

Peritoneal tuberculosis revealed by carcinomatosis on CT scan and uptake at FDG‐PET

Peritoneal tuberculosis is uncommon in industrialised countries. The resurgence of this insidious and non-specific form of ‘carcinomatosis’ is promoted by immune suppression (especially Human Immunodeficiency Virus), migration, and poverty. There are no pathognomonic clinical, radiologic or laboratory tests. In its peritoneal form, tuberculosis cannot be differentiated from ovarian cancer except by histopathology.

Previous abdominal surgery and closed entry for gynaecological laparoscopy: a prospective study

Objectives  To assess the morbidity from closed laparoscopic access and define the role of previous surgery on the occurrence of these complications.