Camille Mimoun

Impact of lymph node staging on survival in presumed early-stage ovarian cancer: a multicentric retrospective study

This study aimed to assess the impact of comprehensive staging on survival outcomes in this population. Patients who underwent surgery for epithelial ovarian cancer in one of the 14 Francogyn cancer centers between 2000 and 2020 were included in the study. The primary analysis evaluated the impact of lymphadenectomy on overall survival and recurrence-free survival. Lymph node count was analyzed as a continuous variable, and its association with survival, considered as a continuous outcome was assessed using linear regression (secondary analysis). Survival was compared using the log-rank test, and multivariate analysis was performed using a Cox model. A total of 467 patients with presumed early-stage epithelial ovarian cancer were included, of which 198 underwent complete lymphadenectomy and 266 did not. No significant association was found between lymph node staging and survival in the primary analysis, possibly due to limited statistical power and a selection bias, as patients without lymphadenectomy had more favorable disease profiles (p=0.600 and p=0.700, respectively). Complete lymphadenectomy was associated with a significantly higher risk of complications (34.5% vs. 14%, p<0.001). In secondary analysis, the number of para-aortic lymph nodes harvested was identified as an independent predictor of both overall survival and recurrence-free survival (p=0.007 and p=0.002, respectively). Histological characteristics and adjuvant chemotherapy also showed a significant correlation with improved survival outcomes. Extensive para-aortic lymphadenectomy in early-stage epithelial ovarian cancer is associated with better overall and recurrence-free survival but comes with an increased risk of complications.

Impact of morbid obesity on surgical and oncological outcomes in patients with endometrial cancer undergoing robotic assisted laparoscopic hysterectomy and pelvic lymph node staging

Minimally invasive surgery is the preferred surgical approach in endometrial cancer. Robotic assisted laparoscopy could provide benefits in the obese population. To compare surgical and oncological outcomes between patients with a BMI < 35 kg/m This retrospective monocentric study was conducted at Saint-Louis University Hospital in Paris. The two groups were compared using a univariate analysis. 52 patients were included, 39 patients in Group 1 and 13 patients in Group 2. Operative room occupancy time and operative time were significantly longer in Group 2 than in Group 1 (255.1 min ± 57.0 vs 210.5 min ± 38.3, p = 0.02 and 166.8 min ± 39.7 vs 139.6 min ± 35.3, p = 0.04 respectively). No significant difference was found in length of hospital stay between the 2 groups even if it appears that patients in Group 2 had slightly longer hospitalization than patients in Group 1 (2 days vs 1 day). Only one complication (laparotomy conversion for digestive injury) was observed in Group 2. No significant difference was found in recurrence between the 2 groups. Severe morbid obesity does not affect surgical morbidity or oncological outcomes in women with endometrial cancer who underwent robotic-assisted laparoscopic hysterectomy, bilateral adnexectomy, and pelvic lymph node staging. Optimizing operating room occupancy management must be improved in this patient population.

Using a new diagnostic tool to predict lymph node metastasis in advanced epithelial ovarian cancer leads to simple lymphadenectomy decision rules: A multicentre study from the FRANCOGYN group

Objective The aim of this study was to develop a new diagnostic tool to predict lymph node metastasis (LNM) in patients with advanced epithelial ovarian cancer undergoing primary cytoreductive surgery. Materials and method The FRANCOGYN group’s multicenter retrospective ovarian cancer cohort furnished the patient population on which we developed a logistic regression model. The prediction model equation enabled us to create LNM risk groups with simple lymphadenectomy decision rules associated with a user-friendly free interactive web application called shinyLNM. Results 277 patients from the FRANCOGYN cohort were included; 115 with no LNM and 162 with LNM. Three variables were independently and significantly (p&lt;0.05) associated with LNM in multivariate analysis: pelvic and/or para-aortic LNM on CT and/or PET/CT (p&lt;0.00), initial PCI ≥ 10 and/or diaphragmatic carcinosis (p = 0.02), and initial CA125 ≥ 500 (p = 0.02). The ROC-AUC of this prediction model after leave-one-out cross-validation was 0.72. There was no difference between the predicted and the observed probabilities of LNM (p = 0.09). Specificity for the group at high risk of LNM was 83.5%, the LR+ was 2.73, and the observed probability of LNM was 79.3%; sensitivity for the group at low-risk of LNM was 92.0%, the LR- was 0.24, and the observed probability of LNM was 25.0%. Conclusion This new tool may prove useful for improving surgical planning and provide useful information for patients.