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D Dargent

Publications and source records attributed to D Dargent.

At least 37 records · Page 2Linked to original sources
PubMed2000

Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer.

OBJECTIVE: The aim of this study was to describe a minimally invasive technique enabling us to identify the sentinel lymph node in patients affected by early stage cervical cancer and to report the preliminary data. METHOD: Patent Blue Violet was injected around the tumor. Laparoscopy was undertaken and the blue-dyed lymph nodes (BDLN) were sought. The evidenced BDLN were removed, and then the systematic dissection was carried out. Material. Thirty-five patients were submitted to surgery. A systematic dissection was performed on 69 pelvic sidewalls (no dissection was performed on the second side of the patient for whom we decided to renounce surgery after assessment of the first side). RESULTS: One or more BDLN was evidenced in 59 of 69 dissections. The rate of failure depends on the quantity of injected blue dye. Failure to identify a BDLN depended on the quantity of injected blue dye: 3 of 6 (50%) for 1.5 ml or less, 3 of 18 (17%) for 2 ml, and only 4 of 45 (10%) after injection of 4 ml (P = 0.05). Among the 63 BDLN (in 4 cases 2 BDLN were identified), 53 were located in contact with the external iliac vein, lateral to the inferior vesical artery, and ventral to the origin of the uterine artery, 7 were located close to the origin of one of the collaterals of the internal iliac artery, and 3 were adjacent to the left common iliac vein. One or more positive pelvic lymph nodes was found in 11 pelvic wall dissections done on 8 patients. The BDLN was the positive node or one of them in all cases. CONCLUSION: If the sensitivity of the assessment of the BDLN is confirmed to be 100%, this laparoscopic approach could transform the management of early cervical cancer.

Adenocarcinoma↗
PubMed2000

[Laparoscopic surgery in gynecologic oncology].

Panoramic retroperitoneal pelviscopy, introduced in 1987 was the first of the laparaoscopic operations used in the field of gyneceologic oncology. It was divised in order to enable the assessment of the pelvic lymph nodes prior to decision making in the management of patients with early cervical cancer. Starting from 1992, laparaoscopic surgery to all fields of gynecologic oncology and all the operations of the classical repertoire were transcribed in the new repertoire. This evolution is not without danger. Direct manipulation of an organ harboring a malignant tumor increases the chances of diffusion of malignant cells. Working with micro-instruments under CO(2) insufflation is likely to favor chances of dissemination. The true place of laparoscopic surgery is, as it has assuredly been since the beginning of its use, in the assessment of tumor surroundings and not in direct manipulation of the organ harboring the tumor. In the cases where imaging clearly shows regional and/or distal spread, it would be better to avoid laparoscopic dissection and retrieval. The most difficult problem in laparaoscopic onco-surgery is not the surgery itself, but in determining in which cases is can be used and in which it cannot.

Female↗
PubMed2000

[Laparoscopic lumbo-aortic lymphadenectomy in early-stage non-seminomatous germ cell tumors of the testis: Why? How?].

OBJECTIVES: Laparoscopic lumbo-aortic lymphadenectomy is proposed in order to decrease the morbidity of pretreatment lymph node dissections for early stage NSGCT of the testis. Two approaches are presented and compared retrospectively: the transperitoneal approach and the extraperitoneal approach. MATERIAL AND METHODS: From 1991 to 1999, 57 patients with clinical stage I (50) to IIA (7) NSGCT underwent pretreatment laparoscopic investigation of the para-aortic lymph nodes: 32 transumbilical transperitoneal dissections and 25 internal iliac extraperitoneal dissections were performed. RESULTS: Only the 19 patients with lymph node invasion received chemotherapy. All serious complications occurred in the transperitoneal group: 1 case of chylous ascites and 2 cases of transient neurological complications, 2 cases of permanent ejaculation failure and 2 extranodal recurrences among the 38 pN0 patients. CONCLUSIONS: Laparoscopy, especially extraperitoneal, appears to be a safe, effective and appropriate modality for pretreatment lumbo-aortic lymph node evaluation in early stage NSGCT of the testis.

Adult↗
PubMed1997

[Cancer of the vulva].

Vulvar cancer develops onto vulvar dystrophies. Its development is linked with HPV infection in half of the cases. It can appear as a carcinoma in situ, a microinvasive carcinoma or a true invasive carcinoma. Prurit is the most common symptom. In situ carcinomas have to be treated by skinning vulvectomies. Radical vulvectomy was considered as mandatory for truly infiltrative cancers. One prefers today use the "wider local excision". However lymphadenectomy is still mandatory (less than 1 mm) in case of very limited dermal infiltration.

Adenocarcinoma↗
PubMed1996

Intraoperative radiation therapy in recurrent carcinoma of the uterine cervix: report of the French intraoperative group on 70 patients.

PURPOSE: To evaluate the feasibility and oncologic results of intraoperative radiation therapy (IORT) for recurrent uterine cervical carcinoma in a cohort of patients treated in seven French institutions. METHODS AND MATERIALS: From 1985 to 1993, 70 patients with pelvic recurrences underwent IORT with/ without external radiation therapy (ERT) and chemotherapy (CT). Treatment modalities for recurrence were IORT alone (40 out of 70), IORT + ERT (30 out of 70), additional chemotherapy (20 out of 70). Gross complete resection (CR) was performed in 30 out of 70 cases, partial resection (PR) in 37 out of 70, and unspecified surgery in 3 out of 70. Sixty-five patients had electron beam IORT and 5, 100 KV photon IORT. Mean IORT cone size, electron beam energy, and dose (calculated at the 90% isodose line) were, respectively, 75 mm (40 to 90), 12 MeV (6 to 20), and 18 Gy (10 to 25) after CR and 80 mm (45 to 100), 15 MeV (7 to 24), and 19 Gy (10 to 30) after PR. RESULTS: Mean follow-up after IORT was 15 months (2 to 69). One, 2- and 3-year overall survival rates were 47, 17, and 8%, respectively; median survival was 11 months and local control, 21%. Median survival and local control rates increased after CR (13 months, 27%) vs. PR (10 months, 17%) and when initial treatment consisted of surgery (S) alone (15 months, 25%) vs. radiation therapy (RT +/- S) (10 months, 16%). However, these differences were not statistically significant. No death-related toxicity was observed. Grade 2 or 3 toxicity was observed in 19 out of 70 patients (27%), including 9 not directly IORT-related complications (13%) (three digestive tract fistulas, one rectal stricture, three urinary fistulas, two infections) and 10 directly IORT-related complications (14%) (five neuropathies, four ureteral obstructions, and one rectal stricture). CONCLUSION: This retrospective study demonstrates the feasibility of IORT. The usefulness of IORT still needs to be evaluated in primary treatment of advanced stages of cervical carcinoma.

Adult↗