Phuong Lien Tran

Human papillomavirus genotyping on Reunion Island: A cross-sectional study of stored tissue samples

We aim to illustrate and evaluate the prevalence and distribution pattern of cervical human papilloma virus (HPV) genotypes on La Réunion Island, a French overseas territory, with the aim to guide future vaccination policies. Between January 2008 and July 2012, files of women undergoing gynaecological examination were retrospectively evaluated at the University Hospital, Reunion Island. Inclusion criteria required cervical biopsies with histopathological diagnosis of high-grade lesions or cancer and ASCUS Pap Smears (atypical squamous cells undetermined significance) results. The INNO-LIPA HPV Genotyping Extra® test was used for HPV genotyping. A total of 401 ASCUS Pap Smears and 94 cervical biopsies were analyzed, of which 162 smears and 63 biopsies were HPV DNA positive (40.4 % and 67 % respectively). Detailed breakdowns of HPV genotype-specific distribution reported prevalence of HPV 16, 31, 33, 51 and 52. Of the 63 HPV-positive biopsies, 61 (96.8 %) contained at least one HPV genotype that is contained in the 9-valent HPV vaccine. The incremental preventable fraction of HPV infections that could have been added by the new 9-valent vaccine to the current bivalent vaccine was estimated at 26.2 %. Immunization with 9-valent vaccine should be effective, and in the long term, may reduce cervical cancer incidence in Reunion Island. Nevertheless, vaccination rates and coverage need to be maintained and improved.

Variability of treatment of locally advanced cervical cancer: How French multidisciplinary teams follow European guidelines?

Cervical cancer is a global public health concern. Despite ESGO recommendations and FIGO classification changes, management of locally advanced cervical cancer (LACC) remains debated in France. Our study aimed to review LACC treatment practices and assess adherence to ESGO recommendations among different practitioners. From February 2021 to August 2022, we conducted a survey among gynecologic oncology surgeons, radiation oncologists, and medical oncologists practicing in France and managing LACC (FIGO stages IB3-IVA) according to the 2018 FIGO classification. We analyzed responses against the 2018 ESGO recommendations as a "gold standard." Among 115 respondents (56% radiation oncologists, 30% surgeons, 13% medical oncologists), 48.6% of gynecologic surgeons didn't perform para-aortic lymphadenectomy (PAL) with significant radiologic pelvic involvement. PAL, when indicated by PET-CT, was more common in university hospitals (66.7% of surgeons). Surgeons in university hospitals also followed ESGO recommendations more closely. Overall, compliance with all ESGO recommendations was low: 5.7% of surgeons, 21.5% of radiation oncologists, and 60% of medical oncologists. Prophylactic para-aortic irradiation, per ESGO, was more frequent in comprehensive cancer centers (52% of radiation oncologists). Adherence to ESGO recommendations for LACC treatment appears low in France, particularly in surgery, with limited PAL in cases of lymph node negativity on PET-CT. However, these recommendations are more often followed by surgeons in university hospitals and radiation oncologists in cancer centers. Adherence to these recommendations may impact patient survival and warrants evaluation of care quality, justifying the organization of LACC management in expert centers.

Fertility preservation in gynecologic oncology: evaluating knowledge, practices, and barriers among French healthcare providers

To assess the knowledge, practices, and referral patterns of health care professionals and fertility preservation specialists regarding fertility preservation in gynecologic oncology in France. In this cross sectional study, an electronic questionnaire was distributed between June 2023 and January 2024 to health care professionals in metropolitan and overseas territories. It included sections on demographics, fertility preservation practices, and technical knowledge, with tailored sections for physicians who are specialists and non-specialists in reproductive medicine. Sixty-four professionals participated (mean experience: 12 years); 65.6% (42/64) were gynecologic surgeons, and 18.8% (12/64) were specialists in reproductive medicine. Among non-specialists (52/64), 82.7% (43/52) routinely discussed fertility with patients of childbearing age, and 94.2% (49/52) had referred patients for fertility preservation. The mean knowledge score was 1.4/6. Only 23.1% (12/52) reported having written materials for patients, and 65.4% (34/52) indicated that no fertility specialist was present at multidisciplinary meetings. All reproductive medicine specialists (n = 12) reported access to oocyte and ovarian tissue cryopreservation, but 83.3% (10/12) believed patients were under-referred. They emphasized the need for systematic discussions of fertility preservation in multidisciplinary settings and highlighted risks associated with ovarian stimulation and tissue reimplantation. The upper age limit for oocyte cryopreservation was generally under 40 years. Pregnancy outcomes following fertility preservation were limited, primarily in cases of borderline ovarian tumors. Fertility preservation is recognized as a critical component of gynecologic oncology care, but significant gaps remain in knowledge, referrals, and integration into multidisciplinary care. Strengthening collaboration between oncology and fertility teams, standardizing care pathways, and enhancing education for health care providers are essential steps to improving access and outcomes for patients.

Tips and tricks: How to control bleeding in mini invasive myomectomy?

Myomectomy using laparoscopic approach offers patients reduced abdominal scars, better post surgical rehabilitation. However, bleeding control may pose a challenge in spite of techniques already described [1,2]. Our objective is to show a reproducible technique of bleeding control during mini invasive myomectomy. We performed a mini-invasive myomectomy using with robotic surgery, with Da Vinci, X. We describe the case of a 35 year-old women, gesta 0 para 0, who presented with menorrhagia, avec pelvic pain, because of a fibroma FIGO 2-5 of 8 cm. She had a desire of pregnancy. We show tips and tricks to control bleeding: (a) two ways of accessing to uterine artery for its occlusion, using either a vascular clamp or a metallic clip; (b) sub serous infiltration with 20 mL of xylocaine with 1% adrenalin, diluated in 100 mL of NaCl serum using a oocyte punction needle; (c) suture with barbed suture. Blood loss was <200 mL.