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Denis Querleu

Publications and source records attributed to Denis Querleu.

27 records · Page 2Linked to original sources
PubMed2003

Radical trachelectomy via a trans-sacral approach: a case report.

BACKGROUND: Endometrial cancer may arise in patients previously treated for rectal cancer. Surgical management can be challenging, and the gynecologic oncologist may need to employ alternative surgical approaches. CASE: A 71-year-old female with a history of Dukes class B rectal cancer previously treated by abdominoperineal resection and pelvic radiation therapy subsequently developed an endometrial cancer. Initial surgical management was difficult, and the entire cervix could not be removed. The patient recurred locally the following year and was managed by radical trachelectomy via a trans-sacral approach. CONCLUSION: Locally recurrent endometrial cancer can pose difficult management decisions. Radical resection may be the only alternative. Unusual situations may require adaptation of different surgical approaches of which the gynecologic oncologist must be aware.

Aged↗
PubMed2003

Laparoscopic surgery for gynaecological oncology.

PURPOSE OF REVIEW: The use of laparoscopic staging and/or surgery in the field of gynaecological oncology was pioneered in the early 1990s. The issue has been very controversial from the beginning, with some justification in view of the possible consequences of faulty cancer surgery. After more than 10 years, long-term follow-up and comparative studies, both of which are required in clinical oncological research, are now available. RECENT FINDINGS: A number of papers have confirmed the absence of significant adverse effects on survival after laparoscopic diagnosis or surgery in gynaecological cancers. New developments cover virtually all the basic techniques in cancer surgery, excluding major exenterative surgery. The use of an extraperitoneal technique for aortic dissections is emerging. New indications, such as radical vaginal trachelectomy, pelvic sentinel node identification, interval debulking surgery of adnexal malignancies, or the liberal use of surgical staging of uterine cancers, have been developed as a direct result of the availability of laparoscopic techniques. SUMMARY: Continuing worldwide interest clearly demonstrates that laparoscopic techniques are now part of the armamentarium of the gynaecological oncologist. Postoperative morbidity and recurrence risk do not seem to be affected. Cost-efficiency of laparoscopic procedures is based on the reduction of hospital stay. Combined training in gynaecological oncology and in laparoscopic surgery is, more than ever, mandatory as a means of avoiding the risk of inadequate staging or the mismanagement of pelvic malignancies. The diversity of techniques, including laparotomy, laparoscopy, and vaginal surgery, allows the individualization of surgical approaches, whereby tumour size and local or general conditions can be taken into account.

Female↗
PubMed2003

[The choice of approach in the surgical management of endometrial carcinoma: a retrospective serie of 155 cases].

SETTING: Retrospective study of patients consecutively managed surgically for apparent stage I endometrial carcinoma in a comprehensive cancer center, using a standardized protocol for the choice of surgical approach: laparoscopically assisted vaginal hysterectomy (LAVH) as standard procedure, vaginal surgery in apparent stage IA grade 1 or in patients in poor medical condition, laparotomy in the case of subserous myometrial involvement at imaging or in patients with enlarged uteri or in the presence of a contra-indication to laparoscopy. MATERIALS AND METHODS: Excluding 2 patients in whom laparoscopy was converted in laparotomy, and 1 patient who had a full laparoscopic hysterectomy, the records of 155 patients were reviewed. All patients had a preoperative sonogram, and 74% had a preoperative MRI. Preoperative data, preoperative staging, operative data, pathological staging, postoperative complications, recurrence and survival were recorded. RESULTS: 69 patients (43.6%) had a LAVH procedure (group LAVH), 58 patients (36.7%) were treated by laparotomy (group TAH), and 28 patients (18%) were treated by simple vaginal hysterectomy (group VH). Patients in the vaginal group were significantly heavier (VH 91.3 kg 33, range 53-175) than those of the other two groups (TAH 76.5 12.7, range 48-142; LAVH 71.1 18.5, range 47-102). The number of large (> 10 cm) uteri was significantly greater in the TAH group (46.5%) than the LAVH group (26.1%, p = 0.02) or the VH group (14.3%, p = 0.007). Myometrial invasion was suspected in 53.6% of the VH group, 72.6% of the LAVH group, and 71.4% of the TAH group. Deep myometrial invasion was suspected in no patient of the VH group, 14.5% of the LAVH group and 70.7% of the TAH group. The LAVH group had a significantly longer mean operative time than the TAH group or the VH group. The number of perioperative complications was significantly higher in the TAH group (22.4%) compared to the LAVH group (5.6%) and the VH group (0%). Blood loss was significantly elevated in the laparotomy group compared to the other two groups. The mean number of nodes removed was significantly higher in the LAVH group (15.8 7.8, range 4-37) compared to the TAH group (11 5.3, range 2-25, p = 0.002). Of 155 patients, 100 (64.5%) had correct preoperative staging. In 19 (12.3%), FIGO stage was overestimated preoperatively, and in 36 (23.2%) the FIGO stage was underestimated preoperatively. Survival curves were not found significantly different between groups.

Adult↗
PubMed2003

[Vaginal reconstruction after pelvic exenteration: when and which techniques?].

Pelvic exenterations are commonly performed to treat locally advanced or recurrent tumours of the pelvic organs to achieve long-term survival. Those procedures may present complications. Reconstructive procedures have become an important part of radical pelvic surgery to improve quality of life. Various surgical procedure of vaginal reconstruction have been describe. Myocutaneous flaps are effective in the prevention of major morbidity with pelvic filling and physiological neovagina. Vertical rectus abdominis myocutaneous flap is the technique of choice with simple harvesting and large pelvic filling. Gracilis and gluteal thight flaps are particularly adapted in pelvectomy with perineal resection. Enteroclpoplasty and omental flap must be used in radical colpectomie or difficulty pelvic access.

Female↗
PubMed2002

Modified radical vaginal hysterectomy with or without laparoscopic nerve-sparing dissection: a comparative study.

OBJECTIVE: Nerve-sparing dissection of the lateral portion of the cardinal ligament (paracervical lymphadenectomy) has been recently developed with the goal of reducing the late urinary adverse effects of radical hysterectomy without impairing the outcome. This work has been carried out in order to investigate the influence of additional paracervical lymph node dissection at the time of laparoscopically assisted modified radical hysterectomy on outcome and urinary sequelae. METHODS: A total of 95 patients underwent a modified radical hysterectomy using a combined laparoscopic and vaginal approach since 1991. In 47 of these patients treated since 1996 an additional laparoscopic paracervical lymphadenectomy was performed. The operative, postoperative, and survival outcomes were assessed. In 60 patients, 32 and 28 in the groups of patients with or without paracervical dissection, respectively, a careful interview on urinary symptoms was conducted by an independent investigator. RESULTS: Paracervical dissection involves no operative complication and lenghthens the postoperative urinary retention, but has no adverse influence on long-term urinary discomfort. The yield of paracervical dissection is negligible for small tumors: no positive node was found in 38 patients with tumors less than 2 cm in diameter. The outcome of patients after minimal access surgery for tumors less than 2 cm is excellent whether or not a paracervical dissection has been performed. CONCLUSION: Paracervical dissection does not worsen the late urinary symptoms after vaginal radical hysterectomy. It has a limited value in the surgical management of small-size (less than 2 cm) cervical cancers, although it may prevent long-term lateropelvic recurrences.

Female↗
PubMed2002

Dienogest is as effective as triptorelin in the treatment of endometriosis after laparoscopic surgery: results of a prospective, multicenter, randomized study.

OBJECTIVE: To compare the efficacy of Dienogest versus Decapeptyl at 3.75 mg as consolidation therapy for surgery in the treatment of endometriosis. DESIGN: Multicenter, open, randomized, parallel-group clinical trial. SETTING: Volunteer patients in an academic research environment. PATIENT(S): Women with grade 2, 3, and 4 (</=70) endometriosis at initial laparoscopy. INTERVENTION(S): We provided 16 weeks of treatment with Dienogest, 1 mg tablet daily; or with Decapeptyl, 3.75 mg IM injection every 4 weeks. MAIN OUTCOME MEASURE(S): A change in the patient's Revised American Fertility Society score at the post-treatment laparoscopy. RESULT(S): From June 1994 to July 1998, 142 patients were enrolled in the trial. After exclusion for major protocol deviations, 59 patients were included in the Dienogest group and 61 in the Decapeptyl group. This study group was comparable to the first inclusion group. The patient demographic and clinical characteristics, median duration of endometriosis, Revised American Fertility Society scores, and Visual Analogic Squale (VAS) scores were comparable in both groups. Statistical analysis of efficacy was not significantly different between the two groups. Adverse events were reported by 87.7% of patients in the Dienogest group and 85.1% in the Decapeptyl group. Neither treatment affected patient body weight or vital signs. CONCLUSION(S): Dienogest is as effective as Decapeptyl for consolidation therapy after surgery for the treatment of endometriosis. The safety profile of dienogest differed from Decapeptyl (3.75 mg). Dienogest constitutes a new therapeutic alternative to the GnRH analogues.

Adolescent↗
PubMed2002

[MR imaging of endometrial carcinoma: role and limits].

PURPOSE: To assess the MR imaging (MRI) in initial decision making of endometrial carcinoma. PATIENTS AND METHODS: From january 1997 to march 2002, 86 patients with clinical stage I endometrial carcinoma were studied by pelvic (22) or abdomino-pelvic (64) MRI. The size and signal of lesions and junctional zone, the enhancement after contrast administration, the associated benign lesions and the pelvic and lumbo-aortic lymph nodes were assessed without knowledge of surgical results in viewing to identify pitfalls in MRI staging. RESULTS: MRI allows correct staging in 81.4% (70/86) of cases. Nine cases of false negative on T2 weighted images were correctly staged after contrast administration and dynamic study. Limits of MRI are due to presence of thin or lack of junctional zone, polyps, myomas, adenomyosis, intra cavitary bleeding, and myometrium thinning by large tumors. Eighteen patients were N+, with MRI sensitivity of 82% and specificity of 94%. CONCLUSION: MRI is the best modality for pretherapeutic assessment of endometrial carcinoma. MRI allows to choose type of surgery: laparoscopy or laparotomy and define volume of radiotherapy.

Adult↗
PubMedDate not supplied

Laparoscopic obturator nerve neurolysis after pelvic lymphadenectomy.

Postoperative neuropathy is a known complication of major pelvic oncologic surgery. Obturator nerve injury complicating pelvic lymph node dissection has been reported in the literature. Severity and duration of symptoms are determined by the severity of the initial nerve lesion. Different management options have been described in the literature. We report here on a patient who developed right obturator neuropathy after pelvic lymphadenectomy. Initial management by physical therapy was unsuccessful, and the patient underwent a successful laparoscopic surgical neurolysis. Whereas preventive measures remain essential to avoid any nerve injury, this case illustrates the use of laparoscopy to perform neurolysis with a favorable outcome; therefore, persistent pain or motor loss should motivate at least surgical exploration that can be done with low morbidity by laparoscopy.

Carcinoma, Squamous Cell↗