• Langue : Français
• Discipline : Médecine. Oncologie
• Identifiant : 2018LILUM102
• Type de thèse : Doctorat de médecine
• Date de soutenance : 26/04/2018

Résumé en langue originale

Background: Risk-reducing salpingo-oophorectomy is the gold standard to prevent the development of a pelvic high grade serous carcinoma (HGSC) in women at risk of breast/ovarian cancer. However, some are reluctant to perform this surgery due to significant related adverse effects. Most of HGSCs stem from the distal fimbrial part of fallopian tubes. Thus we suggested a new prophylactic procedure called radical fimbriectomy (RF), which consists of the resection of both tubes along with the fimbrio-ovarian junction (attached ovarian fragment), completed at 50 years-old or menopause by a bilateral oophorectomy. We present the first results of this operation focused on perioperative morbidity and pathological observations. Methods: BRCA1/2 carriers or any women with a documented familial risk of breast/ovarian cancer were first counseled to perform a classical laparoscopic RRSO. If they denied, they were offered to enter the RF controlled study. All pathological specimens were examined using the SEE-FIM protocol. Intra- and 30-day post-operative events and pathological data were recorded according to protocol. Results: From January 2012 to June 2014, 121 laparoscopic RF were performed. Intraoperative complications were: 1 laparo-conversion for adhesions and 2 grade I procedural hemorrhages. 20 patients (16.5%) complained of Clavien grade I, and 2 (1.7%) grade II adverse effects. Pathologically, we found one (0.8%) invasive HGSC, two (1.7%) Serous Tubal Intraepithelial Carcinoma (STIC), one (0.8%) Serous Tubal Intraepithelial Lesion (STIL) and 21 (17.7%) p53 signatures. All lesions were located at the fimbria, except the HGSC found at a tubal isthmus. Conclusion: In this cohort, 2.5% of patients had a diagnostic of occult tubal neoplasia, as observed in the literature. Tubal examination by a trained pathologist, using SEE-FIM protocol, is necessary to detect precancerous lesions. A longer time is still necessary to report the efficacy of RF in terms of cancer prevention. Meanwhile, we can conclude that RF is safe, well tolerated and effective in term of occult neoplasia detection.

Résumé traduit

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