Abdominal adhesions: current and novel therapies.

BACKGROUND: The purpose was to determine the factors influencing nodal involvement and topography of pelvic and paraaortic node involvement in ovarian carcinoma. STUDY DESIGN: Between 1985 and 2001, 276 women with epithelial ovarian carcinoma underwent systematic bilateral pelvic and paraaortic lymphadenectomy. RESULTS: The overall frequency of lymph node involvement was 44% (122 of 276). The frequency of pelvic and paraaortic metastases were 30% (82 of 276) and 40% (122 of 276), respectively. The frequency of lymph node metastases according to the stage of the disease (stages I, II, and III + IV) were: 20% (17 of 85), 40% (6 of 15), and 55% (99 of 176), respectively. In patients with stage IA, IB, and IC disease, the rates of nodal involvement were 13% (8 of 60), 33% (4 of 12), and 38% (5 of 13), respectively. None of 15 patients with stage IA grade 1 disease had nodal involvement. None of the 20 patients with mucinous tumors confined to the ovary(ies) (stage I disease) had nodal involvement. When paraaortic nodes were involved, the left paraaortic chain above the level of the inferior mesenteric artery was the most frequently involved site (70 patients, 63%). One of nine patients (11%) with a macroscopic stage I unilateral tumor and paraaortic involvement had contralateral metastases. CONCLUSIONS: Lymphadenectomy should be performed even in patients with stage IA disease. This procedure could be omitted in patients with mucinous apparent stage I disease and stage I grade 1 tumor. Lymphadenectomy should involve the whole pelvic and paraaortic chain up to the level of the left renal vein. A bilateral dissection should be performed even in cases of patients with a unilateral tumor.

Lymph node involvement in epithelial ovarian cancer: Analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications

Purpose To determine the patterns of regional recurrence in patients treated with definitive radiotherapy (RT) for cervical cancer. Methods and Materials The records of 198 patients treated with definitive RT for cervical cancer between 1980 and 2000 who experienced a regional recurrence without a central or distal vaginal recurrence were reviewed. All patients received a combination of external-beam RT and intracavitary brachytherapy. In the 180 patients with a documented location of regional recurrence, the relationship between the recurrence and the radiation fields was determined. Results The median time to regional recurrence was 13 months (range, 2–85 months). Of the 180 patients who had an evaluable regional recurrence, 119 (66%) had a component of marginal failure; 71 patients recurred above-the-field, 2 patients occurred in the inguinal nodes, and 2 patients recurred above-the-field and in the inguinal nodes. In addition, 105 patients (58%) had a component of in-field failure; 59 patients recurred in-field only, 39 patients recurred in-field and above-the-field, 2 patients recurred in-field, above-the-field, and in the inguinal nodes, and 5 patients recurred in-field and in the inguinal nodes. The median survival after regional recurrence was 8 months (range, 0–194 months). Conclusions Most regional recurrences after definitive RT for cervical cancer include a component of marginal failure, usually immediately superior to the radiation field. These recurrences suggest a deficiency in target volume. Recurrences also occur in-field, suggesting a deficiency in dose. Developments in pretreatment staging, field delineation, dose escalation, and posttreatment surveillance may help to improve outcome in these patients.

Patterns of regional recurrence after definitive radiotherapy for cervical cancer.

Total laparoscopic radical hysterectomy with intraoperative sentinel node identification in patients with early invasive cervical cancer.

Total laparoscopic radical hysterectomy (type II-III) with pelvic lymphadenectomy in early invasive cervical cancer.

Resume Objectif. – Evaluer les complications des lymphadenectomies pelviennes et lomboaortiques par voie cœlioscopique en oncologie gynecologique pour en valider la pratique courante. Patientes et methodes. – De decembre 1988 a mars 2004, 915 patientes ont fait l'objet d'une lymphadenectomie pelvienne et/ou aortique sous controle cœlioscopique. Les interventions — 771 au centre Oscar-Lambret, et 144 a l'institut Claudius-Regaud — ont ete realisees dans le cadre d'une (re)stadification pour 98 cancers debutants de l'ovaire, 237 cancers du col aux stades precoces et 216 cancers avances du col. Elles ont ete associees a un traitement chirurgical radical ou conservateur (trachelectomie), par cœlioscopie ou voie vaginale, dans 161 cas de cancer de l'endometre et 203 cancers du col uterin. Resultats. – Un total de 1102 lymphadenectomies pelviennes ou aortiques a ete pratique : 714 pelviennes (694 transperitoneales, 20 extraperitoneales) et 388 aortiques (154 transperitoneales, 234 extraperitoneales. Dix-sept laparotomies (1,85 %) ont ete necessaires pour impossibilite technique ou complications. Discussion et conclusions. – La technique peut etre consideree comme sure, avec un taux de complications non superieur a celui de la laparotomie, et une mortalite nulle jusqu'a aujourd'hui.

Complications des lymphadénectomies coelioscopiques en oncologie gynécologique : 1102 interventions chez 915 patientes

Resume Deux progres auront marque cette fin de siecle dans la prise en charge des cancers du col uterin : la demonstration de l'efficacite de la chimioradiotherapie concomitante dans les formes avancees et le developpement de la chirurgie a invasion minimale (laparoscopie et chirurgie vaginale). A partir d'une experience de 304 cas de cancer du col uterin, les performances des differentes techniques cœliochirurgicales actuellement utilisees (lymphadenectomies pelviennes, para-aortiques, paracervicales, transposition ovarienne, hysterectomies cœliopreparees) sont exposees et discutees. Les resultats a long terme dans les differentes indications protocolaires, sont rapportes et illustres. Il ressort de cette serie et de la litterature que : 1 ) la cœliochirurgie peut eviter une laparotomie dans les cancers de bas stades de faible volume tumoral sans envahissement ganglionnaire ; 2) elle evite, en cas d'atteinte ganglionnaire pelvienne, ou de stade localement evolue, une irradiation etendue systematique para-aortique si l'exploration est negative a ce niveau ; 3) elle limite le nombre de chirurgies « inutilespour les formes relevant d'une exenteration pelvienne qui presenterait une diffusion metastatique intra- ou retroperitoneale infraclinique. L'utilisation de plus en plus large de la chimioradiotherapie concomitante dans les formes avancees relance encore l'interet de cette technique a invasion minimale afin d'en preciser les indications actuelles et futures. Ces diverses methodes nouvelles de classification et de traitement peuvent et doivent donc s'integrer dans de nouveaux schemas d'un traitement devenu de plus en plus multidisciplinaire et de plus en plus specialise.

Rôle de la cœliochirurgie dans la prise en charge des cancers du col utérin

Pelvic lymphadenectomy under celioscopic guidance

[Celioscopic pelvic and para-aortic lymphadenectomy].

Resume But Faire le point sur la prise en charge des cancers du col uterin invasif (des le stade IB) diagnostiques en cours de grossesse en reference aux recommandations francaises recentes de decembre 2008. Patientes et methodes Analyse retrospective d’une serie de cinq patientes ayant presente un cancer du col invasif en cours de grossesse et prises en charge conjointement par les maternites de Jeanne-de-Flandre et de Roubaix et le centre regional de lutte contre le cancer de Lille (centre Oscar-Lambret) entre 2002 et 2009. Resultats Cinq patientes ont ete incluses : quatre stades IB1 et un stade IB2. Cinq grossesses ont abouti a la naissance de six enfants vivants. Trois patientes ont beneficie d’une chimiotherapie neoadjuvante pendant la grossesse. Une patiente a eu un curage pelvien par voie cœlioscopique au premier trimestre. Deux curages lomboaortiques par voie retroperitoneale ont ete effectues. La duree moyenne de suivi est de 47,5 mois (12–94 mois). Une patiente est decedee de son cancer. Conclusion Le diagnostic d’un cancer du col uterin pendant la grossesse implique les memes orientations therapeutiques qu’en l’absence de grossesse. La lymphadenectomie pelvienne par voie cœlioscopique (possible jusqu’a 20–24 SA) est decisive dans la prise en charge therapeutique pour les tumeurs inferieures a 4 cm. La chimiotherapie neoadjuvante pendant la grossesse peut etre employee des le deuxieme trimestre pour les patientes refusant l’interruption medicale de grossesse.

Cancer du col utérin invasif et grossesse : cinq cas observés à Lille de 2002 à 2009. Évaluation des pratiques en référence aux recommandations françaises

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