Marcos Ballester

Publications (48)159.35 Total impact

• Article: Contribution of immunohistochemical profile in assessing histological grade of endometrial cancer.

  Geoffroy Canlorbe, Enora Laas, Sofiane Bendifallah, Emile Daraï, Marcos Ballester
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  ABSTRACT: The aim of this study was to correlate immunostaining expression profiles with histological grade using a predictive model. Samples were collected from 69 women with endometrial cancer. Immunostaining for expression of estrogen receptor (ER), progesteron receptor (PR), Ki67 and p53 in grade 1 or 2 and grade 3 tumors were compared. After determining optimal immunostaining cut-offs, we built a model to predict the final histological grade. Higher immunostaining of ER and PR was found in grade 1 or 2 (p=0.01) compared with grade 3 tumors. Higher immunostaining for Ki67 (p<0.0001) and p53 (p<0.001) was found in grade 3 than in grade 1 or 2 tumors. The recursive partitioning model predicted a grade 1 or 2 tumor in 98% of cases when Ki67 and p53 were underexpressed. The mis-classification rate was 13%. Our results show that integrating immunohistochemical profiles in a simple predictive model could help predict the final histological grade of endometrial tumors, especially for grade 1 or 2.
  Anticancer research 05/2013; 33(5):2191-8. · 1.73 Impact Factor
• Article: The Role of Completion Surgery After Concurrent Radiochemotherapy in Locally Advanced Stages IB2-IIB Cervical Cancer.

  Elisabeth Chereau, Claire DE LA Hosseraye, Marcos Ballester, Laurie Monnier, Roman Rouzier, Emmanuel Touboul, Emile Daraï
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  ABSTRACT: The gold standard for treating patients with locally advanced stages of cervical cancer is concurrent radiochemotherapy (CRT), but recent studies have failed to demonstrate the effect of completion surgery on survival. The aim of this study was to evaluate the role of completion surgery in stage IB2-IIB cervical cancer. From 2002 to 2012, 80 women (stage IB2-IIB disease) underwent a pre-therapeutic pelvic and para-aortic lymphadenectomy associated with CRT. Forty-six patients (57.5%) underwent completion surgery. Multivariate analysis identified pelvic lymph node status as a predictive factor for completion surgery (p<0.001) and histological type for tumor residue (p=0.04). In multivariate analysis, positivity of para-aortic nodes (p=0.01 for DFS and p=0.01 for OS) and emboli on completion hysterectomy (p=0.03 for DFS and p=0.006 for OS) were significant. Only patients without para-aortic metastases or limited pelvic involvement and with residual disease and emboli seem to be good candidates for completion surgery.
  Anticancer research 04/2013; 33(4):1661-6. · 1.73 Impact Factor
• Article: Partial Colpectomy is a Risk Factor for Urologic Complications of Colorectal Resection for Endometriosis.

  Sonia Zilberman, Marcos Ballester, Cyril Touboul, Elisabeth Chéreau, Philippe Sèbe, Marc Bazot, Emile Daraï
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  ABSTRACT: STUDY OBJECTIVE: To evaluate urologic complications after colorectal resection for endometriosis. DESIGN: Cohort study (Canadian Task Force classification II-2). SETTING: Tertiary referral university hospital and expert center in endometriosis. PATIENTS: One hundred sixty-six women with colorectal endometriosis proven by transvaginal sonography and magnetic resonance imaging. INTERVENTION: Open or laparoscopic colorectal resection for endometriosis. MEASUREMENTS AND MAIN RESULTS: Forty-four patients (26.5%) experienced at least 1 urologic complication, including infection. Eight patients (4.8%) experienced postoperative symptomatic hydronephrosis requiring ureteral stent in 3 cases, a percutaneous nephrostomy in 1 case, and expectant management for the last 4. Urologic fistulas occurred in 5 patients (3%). Postoperative voiding dysfunction requiring self-catheterization was observed in 48 patients (28.9%). With univariate analysis, a relationship was found between voiding dysfunction and partial colpectomy (p = .001) and American Society of Reproductive Medicine total score (p = .02), and between the occurrence of urinary fistula and the use of prophylactic ureteral catheterization (p = .015) and parametrectomy (p = .02). A relationship was found between postoperative symptomatic hydronephrosis and the use of prophylactic ureteral catheterization (p = .003). CONCLUSION: Colorectal resection for endometriosis can lead to urologic complications, particularly for patients requiring partial colpectomy, of which patients need to be informed.
  Journal of Minimally Invasive Gynecology 11/2012; · 1.74 Impact Factor
• Article: Sentinel Node Biopsy Upstages Patients with Presumed Low- and Intermediate-risk Endometrial Cancer: Results of a Multicenter Study.

  Marcos Ballester, Iptissem Naoura, Elisabeth Chéreau, Julien Seror, Anne-Sophie Bats, Alexandre Bricou, Emile Daraï
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  ABSTRACT: BACKGROUND: There is some controversy about the relevance of lymphadenectomy in patients with early stage endometrial cancer. The aim of this study was to evaluate the contribution of sentinel lymph node (SLN) biopsy in staging patients with presumed low- and intermediate-risk endometrial cancer. METHODS: This retrospective multicenter study was conducted from July 2007 to December 2011 including 103 patients with presumed low- or intermediate-risk endometrial cancer who had undergone SLN biopsy. Concordance between preoperative staging and definitive histology as well as contribution of SLN biopsy and ultrastaging to upstage patients were assessed. RESULTS: SLNs were detected in 89 patients (86.4 %), 56 (62.9 %) of whom had presumed low-risk and 33 (37.1 %) intermediate-risk endometrial cancer. Of the 89 patients, 14 (15.7 %) had positive SLNs. Twelve (21.4 %) of the 56 patients with presumed low-risk disease were upstaged by definitive histology, among whom 3 (25 %) had pelvic positive SLNs. Seven (21.2 %) of the 33 patients with intermediate-risk disease were upstaged by definitive histology, 1 (14.3 %) of whom had positive SLNs. Ultrastaging detected metastases undiagnosed by conventional histology in 6 (42.8 %) of 14 of patients with positive SLNs. CONCLUSIONS: SLN biopsy associated with ultrastaging is relevant to stage low- or intermediate-risk endometrial cancer and could help guide adjuvant therapies.
  Annals of Surgical Oncology 10/2012; · 4.17 Impact Factor
• Article: Comparison of morbidity and survival between primary and interval cytoreductive surgery in patients after modified posterior pelvic exenteration for advanced ovarian cancer.

  Aurélie Revaux, Roman Rouzier, Marcos Ballester, Frédéric Selle, Emile Daraï, Elisabeth Chéreau
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  ABSTRACT: Surgical management of advanced ovarian cancer often requires low modified posterior pelvic exenteration (MPE) to achieved complete resection. The aim of this study was to evaluate the morbidity of MPE at the time of primary cytoreductive surgery (PCS) and interval cytoreductive surgery (ICS) after neoadjuvant chemotherapy. From 2001 to 2009, 63 patients underwent MPE for advanced ovarian cancer. We analyzed and compared surgical characteristics and postoperative courses between PCS and ICS. Modified posterior pelvic exenteration was performed during PCS for 50 patients (79%) and during ICS for 13 patients (21%). Complete cytoreduction was achieved in 80% of patients (84% in the PCS group and 69% in the ICS group; ns). There was no significant difference between the PCS and ICS groups in the type and the rate of standards or radical surgical procedures. Patients with ICS had a shorter length of stay in the intensive care unit (0.9 vs 2.7 days; P = 0.009), but there was no difference in the total length of hospitalization (P = 0.94). The global rate of postoperative complications was 76%. No differences were found between the 2 groups in digestive or extradigestive complications, iterative surgery, or interventional radiology procedures. The median overall survival was 49.4 months in the PCS group and 27.1 months in the ICS group (P = 0.27), and the median progression-free survival time in both groups was 20 months. There was no difference in the occurrence of postoperative complications between PCS and ICS, especially in morbidity related to MPE. The specific morbidity of this surgical procedure remained low compared with the overall morbidity in cases of extensive surgery.
  International Journal of Gynecological Cancer 09/2012; 22(8):1349-54. · 1.65 Impact Factor
• Article: Eutopic endometrium and peritoneal, ovarian and colorectal endometriotic tissues express a different profile of Nectin-1, -3, -4 and nectin-like molecule 2.

  Marcos Ballester, Julie Gonin, Anita Rodenas, Jean-François Bernaudin, Roman Rouzier, Charles Coutant, Emile Daraï
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  ABSTRACT: How is the expression of nectins and nectin-like molecules (Necls) detected by immunostaining altered by endometriosis? SUMMARY ANSWER: Our results suggest that Nectin-1, -3, -4 and Necl-2 may contribute to the pathogenesis of endometriosis. Immunostaining of nectins and Necls varies according to the anatomical location of endometriosis. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Nectin and Necl molecules are immunoglobulin-like cell adhesion molecules involved in apoptosis, cell proliferation and in metastases. Previous studies have demonstrated the involvement of adhesion molecules in the development of endometriotic lesions but no data exist on immunostaining of nectins and Necls molecules in endometriosis. This retrospective study was conducted in a tertiary-care hospital (Tenon Hospital, Paris, France). Samples were collected from 55 women undergoing endometrial biopsy or surgery for endometriosis and 20 controls having hysterectomy or endometrial biopsy for other reasons; multiple samples were collected from 15 women. We studied the immunostaining of Nectin-1, -3, -4 and Necl-2 in secretory and proliferative endometrium from women with (n = 20) or without endometriosis (i.e. control group, n = 20), and in peritoneal (n = 20), ovarian (n = 20) and colorectal endometriosis (n = 20). Semi-quantitative immunostaining demonstrated that (1) Necl-2 staining was stronger in all types of endometriotic lesions than in the eutopic endometrium from patients with endometriosis (P < 0.0125) and in ovarian endometriotic cysts compared with other locations (P < 0.001); (2) Nectin-3 staining was stronger in the eutopic endometrium of patients with endometriosis compared with controls (P = 0.03) and in all endometriotic lesions compared with the eutopic endometrium from patients with endometriosis (P < 0.0125); (3) Nectin-4, staining was stronger in the eutopic endometrium of patients with endometriosis compared with controls (P = 0.04) and (4) Nectin-1 staining was significantly increased in colorectal endometriosis compared with other locations (P = 0.004). BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION: We did not assess the pattern of expression in endometriosis of all nectins and Necl molecules. Indeed, Necl-5 is implicated in many pathophysiological processes such as cell movement and proliferation with potential relevance to endometriosis. GENERALISABILITY TO OTHER POPULATIONS: At present, few data on implication of nectins and Necl molecules in endometriosis exist. Hence, our results should be confirmed by further quantitative studies at protein or RNA levels. STUDY FUNDING/COMPETING INTEREST(S): No funding source. All the authors declare no conflict of interest.
  Human Reproduction 08/2012; 27(11):3179-86. · 4.47 Impact Factor
• Article: The value of MRI in assessing parametrial involvement in endometriosis.

  Marc Bazot, Lamia Jarboui, Marcos Ballester, Cyril Touboul, Isabelle Thomassin-Naggara, Emile Daraï
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  ABSTRACT: What is the accuracy of magnetic resonance imaging (MRI) in the diagnosis of parametrial endometriosis in comparison with surgicopathological findings? SUMMARY ANSWER: MRI displayed an accuracy of 96.4% in the preoperative diagnosis of parametrial involvement by deep infiltrating endometriosis (DIE). WHAT IS KNOWN AND WHAT THIS PAPER ADDS: MRI is the best technique for preoperative mapping of DIE. This preliminary paper shows that T2-weighted MRI is a valuable tool for the preoperative evaluation of parametrial involvement by endometriosis. A retrospective study of an MRI database was used to identify examinations performed in women, who had a clinical suspicion of pelvic endometriosis (n=666), between 2005 and 2009 in a university medical centre in France. Exclusion criteria were previous surgery for DIE, incomplete surgical evaluation, repeat MRI examinations and incomplete MR protocol. Only symptomatic patients who underwent surgery with a pathological correlation were included (n=83). An experienced radiologist, blind to the surgical and histological findings, evaluated sagittal, axial and thin-section oblique axial MR images obtained from the 83 patients. DATA ANALYSIS METHOD: Descriptive statistics and Fisher exact test were used. The prevalence of DIE and parametrial endometriosis was 76/83 (91.6%) and 12/83 (14.5%), respectively. The sensitivity, specificity, positive and negative predictive values, accuracy and positive and negative likelihood ratios for the diagnosis of parametrial endometriosis of low signal intensity on T2-weighted MRI, pelvic wall involvement and ureteral dilatation, were 83.3%, 98.6%, 90.9%, 97.2%, 96.4%, 59.2 and 0.17, 58.3%, 98.6%, 87.5%, 93.3%, 92.8%, 41.4 and 0.42 and 16.7%, 100%, 100%, 87.7%, 88%, infinity and 0.83, respectively, with the patient as the unit of analysis. BIAS AND LIMITATIONS: The study design was retrospective, and thus prone to bias. Only one experienced reader performed the analysis, so no data are available on intra- or interobserver variability. GENERALISABILITY: At present, no consensus exists on the optimal MR protocol to be used for the evaluation of DIE, thus limiting the wider implications of this study. STUDY FUNDING AND COMPETING INTERESTS: No funding was obtained for this study. The authors have no conflict of interest.
  Human Reproduction 06/2012; 27(8):2352-8. · 4.47 Impact Factor
• Article: Comparison of diagnostic accuracy of frozen section with imprint cytology for intraoperative examination of sentinel lymph node in early-stage endometrial cancer: results of senti-endo study.

  Marcos Ballester, Gil Dubernard, Anne-Sophie Bats, Denis Heitz, Patrice Mathevet, Henri Marret, Denis Querleu, François Golfier, Eric Leblanc, Roman Rouzier, Emile Daraï
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  ABSTRACT: In early-stage endometrial cancer, intraoperative examination of sentinel lymph nodes (SLNs) can predict nodal involvement and avoid a second surgical procedure. Our goal was to determine the diagnostic accuracy (DA) of intraoperative examination in diagnosing metastatic pelvic SLNs. This was a retrospective study, including 125 patients with early stage endometrial cancer. Results of intraoperative examination by frozen section (FS) or imprint cytology (IC) were compared with final histology (serial sectioning and immunohistochemistry (IHC)). The diagnostic value of intraoperative examination was calculated. Of the 111 patients with SLNs detected (89 %), 87 (78.5 %) had an intraoperative examination (30 with FS and 57 with IC). Intraoperative examination detected SLN metastases in 9 of 16 patients with metastatic SLN at definitive histology (sensitivity = 56.3 %): macrometastasis in 8 and micrometastasis in 1. Seven false-negative cases were found (43.7 %; micrometastases in 6 and isolated tumor cells in 1). The DA of intraoperative examination was 92 % (95 % confidence interval (CI), 84-96.7). For FS and IC, DA was 97.3 % (95 % CI, 85.8-99.9) and 88 % (95 % CI, 75.7-95.5), respectively. FS has better DA than IC for intraoperative examination of SLNs in endometrial cancer. The main limitation of both techniques is in detecting micrometastasis and isolated tumor cells.
  Annals of Surgical Oncology 05/2012; 19(11):3515-21. · 4.17 Impact Factor
• Article: The survival impact of systematic lymphadenectomy in endometrial cancer with the use of propensity score matching analysis.

  Sofiane Bendifallah, Martin Koskas, Marcos Ballester, Anne-Sophie Genin, Emile Darai, Roman Rouzier
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  ABSTRACT: We sought to evaluate whether patients with endometrial cancer in the Surveillance, Epidemiology, and End Results database who underwent lymphadenectomy demonstrate improved survival. The study population comprised 50,969 patients. The 3-year cause-specific survival was tested by using propensity score matching (PSM) analysis. The PSM analysis generated a balanced, matched cohort in which baseline characteristics were not significantly different. The benefit of systematic lymphadenectomy appears to be significant for presumed stage I International Federation of Gynecology and Obstetrics grade 3 cancers and presumed stages II-III cancer. The omission of lymphadenectomy in stage I did not appear to show a deleterious survival consequence if the differentiation grade was moderate (grade 2) or well (grade 1). Using PSM analysis, our results show no evidence of benefit in terms of survival for systematic lymphadenectomy in women with stage I endometrial cancer, except for grade 3 cancers.
  American journal of obstetrics and gynecology 03/2012; 206(6):500.e1-11. · 3.28 Impact Factor
• Source

  Available from: PubMed Central

  Article: Potential relevance of pre-operative quality of life questionnaires to identify candidates for surgical treatment of genital prolapse: a pilot study.

  Christian Chauvin, Elisabeth Chéreau, Marcos Ballester, Emile Daraï
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  ABSTRACT: To evaluate prolapse-related symptoms, quality of life and sexuality of patients with validated questionnaires before and after surgery for genital prolapse and assess relevance of such an evaluation to select women for surgery. From November 2009 to April 2010, 16 patients operated on for genital prolapse of grade greater than or equal to 2 (POP-Q classification) were evaluated prospectively by three questionnaires of quality of life Pelvic Floor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Organ Prolaps/Urinary Incontinence Sexual Questionnaire (PISQ-12). Data were collected the day before surgery and 6 weeks postoperatively. Eleven patients had laparoscopic surgery and five vaginal surgery. There was a significant decrease in pelvic heaviness, vaginal discomfort and urinary symptoms after surgery. The score of symptoms of prolapse, the PFDI-20 score was 98.5 preoperatively and 31.8 postoperatively (p < 0.0001). The score for quality of life, the PFIQ-7 score was 54.5 preoperatively and 7.4 postoperatively (p = 0.001). The score of sexuality, the PISQ-12 score was 35.3 preoperatively and 37.5 postoperatively (p = 0.1). Two of the 3 patients with a PFIQ 7 under or equal to 20 were not improved while all the women with a preoperative PFIQ-7 over 20 were improved after surgery. This study suggests that surgery improves quality of life of patients with genital prolapse. Quality of life questionnaires could help select good candidates for surgery. Further studies are required to determine threshold to standardize indications of surgery.
  BMC Urology 03/2012; 12:9. · 1.45 Impact Factor
• Article: Trends in of late-stage squamous cell vulvar carcinomas: analysis of the surveillance, epidemiology, and end results (SEER) database.

  Rajeev Ramanah, Bénédicte Lesieur, Marcos Ballester, Emile Darai, Roman Rouzier
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  ABSTRACT: To describe the trends in the rate, treatment, and survival of late-stage vulvar carcinomas (LSVCs) over a 20-year period in the United States. Demographic, pathologic, treatment, and survival data were collected from the Surveillance, Epidemiology, and End Results registry between 1988 and 2007. Trends concerning the rate of LSVC (International Federation of Gynecology and Obstetrics [FIGO] stages III and IV), its management, and outcome were studied. Five-year overall and disease-specific survival rates were calculated. The rate of LSVC (32.4%) as compared with early-stage disease (67.6%) did not change significantly from 1988 to 2007 (P = 0.59). Of the 2630 patients with LSVC, the median age at diagnosis was 72 years, with 88.5% of them being white. Surgery and radiation therapy were performed in 73.8% and 60.6% of cases, respectively, with 37% of the patients having no lymph node dissection. A significant trend toward removing fewer lymph nodes (P = 0.02) and offering more radiation therapy (P = 0.02) has been observed across the study period. Five-year overall and disease-specific survival rates did not change (P = 0.44 and P =0.26, respectively) from 1988 to 2007. On multivariate analysis, node positivity (hazard ratio, 3.12 [95% confidence interval, 2.30-4.24]) and surgery (hazard ratio, 0.41 [95% confidence interval, 0.24-0.69]) were found to be the 2 most predictive variables for cancer mortality, followed by age and tumor size. Less extensive surgery and more radiation therapy did not compromise survival of LSVC over the 20-year period.
  International Journal of Gynecological Cancer 03/2012; 22(5):854-9. · 1.65 Impact Factor
• Article: Letter to the editor.

  Emile Daraï, Marcos Ballester, Chrysoula Zacharopoulou, Marc Bazot
  Journal of Minimally Invasive Gynecology 03/2012; 19(2):267; author reply 267-8. · 1.74 Impact Factor
• Article: Cumulative pregnancy rate after ICSI-IVF in patients with colorectal endometriosis: results of a multicentre study.

  Marcos Ballester, Emmanuelle Mathieu d'Argent, Karine Morcel, Joëlle Belaisch-Allart, Michelle Nisolle, Emile Daraï
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  ABSTRACT: There is currently no consensus about indications for surgery for infertility associated with colorectal endometriosis. The aim of this study was to evaluate cumulative pregnancy rates (CPRs) after ICSI-IVF cycles in patients with colorectal endometriosis and to identify determinant factors of fertility outcome. Prospective longitudinal multicentre study from January 2005 to June 2011. We included 75 patients with colorectal endometriosis and proved infertility without prior surgery for deep infiltrating endometriosis. Univariable analysis was used to identify determinant factors of pregnancy rate. CPR was calculated using cumulative-incidence methods from log-rank test and Kaplan-Meier curves. For multivariable analysis, Cox proportional hazards model was used. For CPR per patient analysis, the total number of cycles was 113 and the median number of cycles per patient was 1 (range: 1-3). In the whole population the CPR per patient after three ICSI-IVF cycles was 68.6%. The CPR for patients with or without associated adenomyosis was 19 and 82.4%, respectively (P= 0.01). In addition, a patient age over 35 years (P= 0.02) and anti-Mullerian hormone serum level under 2 ng/ml (P= 0.02) were associated with a decreased CPR per patient. At multivariable analysis, adenomyosis [HR = 0.34, 95% CI (0.12-0.99), P= 0.49] was associated with a decreased CPR. Our data confirm that ICSI-IVF offers a high CPR per patient. However, determinant factors of CPR should be taken into account when informing couples of their options.
  Human Reproduction 02/2012; 27(4):1043-9. · 4.47 Impact Factor
• Article: Anorectal symptoms before and after laparoscopic sacrocolpoperineopexy for pelvic organ prolapse.

  Rajeev Ramanah, Marcos Ballester, Elisabeth Chereau, Charles Bui, Roman Rouzier, Emile Daraï
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  ABSTRACT: To evaluate changes in anorectal symptoms before and after pelvic organ prolapse (POP) surgery, using laparoscopic sacrocolpoperineopexy. Preoperative and postoperative anorectal symptoms, colorectal-anal distress inventory (CRADI) and colorectal-anal impact questionnaire (CRAIQ) scores were prospectively compared from 90 consecutive women undergoing laparoscopic sacrocolpoperineopexy. After a median follow-up of 30.7 months, laparoscopic surgery significantly worsened CRADI (p = 0.02) with no effect on CRAIQ (p = 0.37) scores. Post-operative and de novo straining (27%) and the need for digital assistance (17%) were the most frequent anorectal symptoms. No correlation was found between laparoscopic surgery and anorectal symptoms after multivariate analysis (OR = 2.45[95% confidence interval 0.99-6.05], p = 0.05). Anorectal symptoms are not improved after POP surgery by laparoscopic sacrocolpoperineopexy.
  International Urogynecology Journal 01/2012; 23(6):779-83. · 1.83 Impact Factor
• Article: [Sentinel node procedure and endometrial cancer: senti-endo results].

  Emile Daraï, Chrysoula Zacharopoulou, Cyril Touboul, Elisabeth Chéreau, Marcos Ballester
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  ABSTRACT: Based on two randomized trials and a meta-analysis, the recommendations of the National Cancer Institute (INCa) have validated the absence of systematic pelvic lymphadenectomy for patients with endometrial cancer at low risk (type 1 histology stage IA grade 1-2) and intermediate (type 1 histology stage IA grade 3 and IB grade 1-2) but without taking into account the contribution of the sentinel node (SN) procedure. The senti-endo trial assessing the role of the SN procedure in patients with early stages endometrial cancer showed that the detection rate by hemi-pelvis right and left were 77 and 76%, respectively. The detection rate per patient was 89%. Among patients with at least a SN detected, the detection was unilateral in 34 cases (31%) and bilateral in 77 cases (69%). Of the 111 patients with at least a SN detected, 19 had lymph node metastases (17%). Considering the hemi-pelvis right and left as a unit, no false negative case was observed, hence the sensitivity and NPV was 100%. Considering the NPV per patient, three false negative cases were observed. Among the 57 patients at low risk, six (11%) had lymph node metastases on SN with negative non sentinel nodes. Of the 33 patients at intermediate risk, five (15%) had lymph node metastases on SN with negative non sentinel nodes. Senti-endo results emphasize the contribution of the SN procedure to assess the nodal status in patients with low or intermediate risk group raising the issue on new definition of the recommendations of INCa.
  Bulletin du cancer 12/2011; 99(1):35-41. · 0.67 Impact Factor
• Article: Deep infiltrating endometriosis is a determinant factor of cumulative pregnancy rate after intracytoplasmic sperm injection/in vitro fertilization cycles in patients with endometriomas.

  Marcos Ballester, Anne Oppenheimer, Emmanuelle Mathieu d'Argent, Cyril Touboul, Jean-Marie Antoine, Michelle Nisolle, Emile Daraï
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  ABSTRACT: To evaluate the cumulative pregnancy rate (CPR) per patient after in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) cycles in patients with endometriomas and to evaluate the determinant factors of CPR per patient. Retrospective study from January 2007 to October 2008. Tertiary care university hospital. 103 patients who had undergone IVF treatment, comprising isolated endometriomas (n = 30) and endometriomas with associated deep infiltrating endometriosis (DIE) (n = 73). None. Clinical pregnancy rate after IVF-ICSI cycle. The total number of cycles was 162, and the median number of cycles per patient was 1 (1 to 5). Fifty-eight women (56.3%) became pregnant. The total number of endometriomas and size of the largest endometrioma and bilateral endometriomas had no impact on the CPR per patient. Using multivariable analysis, the associated DIE and antimüllerian hormone serum level (≤ 1 ng/mL) were independent factors associated with a decrease in the pregnancy rate per patient. Overall, the CPR per patient was 73.7%, and it increased until the third cycle with no benefit for additional cycles. The CPR per patient for women with isolated endometriomas and women with endometriomas and associated DIE was 82.5% and 69.4%, respectively. Associated DIE has a negative impact on assisted reproduction results in patients with endometriomas. Moreover, our data show that after three IVF-ICSI cycles the CPR per patient is not improved and that surgery should be considered.
  Fertility and sterility 12/2011; 97(2):367-72. · 3.97 Impact Factor
• Article: Nomogram to predict pregnancy rate after ICSI-IVF cycle in patients with endometriosis.

  Marcos Ballester, Anne Oppenheimer, Emmanuelle Mathieu d'Argent, Cyril Touboul, Jean-Marie Antoine, Charles Coutant, Emile Daraï
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  ABSTRACT: Although several scoring systems have been published to evaluate the pregnancy rate after ICSI-IVF in infertile patients, none of them are applicable for patients with deep infiltrating endometriosis (DIE) nor can they evaluate the chances of pregnancy for individual patients. The aim of this study was to develop a nomogram based on an association of patients' characteristics to predict the clinical pregnancy rate in patients with endometriosis. This prospective longitudinal study was conducted from January 2007 to June 2010. The nomogram was built from a training cohort of 94 consecutive patients (141 ICSI-IVF cycles) and tested on an independent validation cohort of 48 patients (83 ICSI-IVF cycles). DIE was confirmed in all participants. The pregnancy rate (per patient) in women with and without DIE was 58 and 83%, respectively (P = 0.03). Increased patient age (P = 0.04), serum anti-Mullerian hormone (AMH) level ≤ 1 ng/ml (P = 0.03) and increased number of ICSI-IVF cycles (P = 0.03) were associated with a decreased clinical pregnancy rate. The presence of DIE was the strongest determinant factor of the clinical pregnancy rate in our model [odds ratio = 0.26, 95% confidence interval (CI): 0.07-0.9 (P = 0.006)], which also included patient age, serum AMH level and number of attempts at ICSI-IVF. The nomogram showed an area under the curve (AUC) of 0.76 for the training cohort (95% CI: 0.7-0.8) and was well calibrated. The AUC for the validation cohort was 0.68 (95% CI: 0.6-0.75) and calibration was good. Our nomogram provides realistic and precise information about ICSI-IVF success and can be used to guide couples and practitioners.
  Human Reproduction 11/2011; 27(2):451-6. · 4.47 Impact Factor
• Article: Effects of pelvic organ prolapse repair on urinary symptoms: a comparative study between the laparoscopic and vaginal approach.

  Rajeev Ramanah, Marcos Ballester, Elisabeth Chereau, Roman Rouzier, Emile Daraï
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  ABSTRACT: To compare changes in urinary symptoms before and after pelvic organ prolapse (POP) surgery, using either laparoscopic sacrocolpopexy (LSC) or transvaginal porcine dermis hammock placement with sacrospinous ligament suspension (VS). Data were prospectively collected from all women undergoing POP surgery between May 2001 and October 2009. Pre- and postoperative urinary symptoms, Urinary Distress Inventory (UDI), and Urinary Impact Questionnaires (UIQ) scores were compared within and between groups. A generalized linear model was used for multivariate analysis. Out of the 151 patients included, 87 patients underwent LSC, and 64 VS. Overall, after a median follow-up of 32.4 months, POP surgery improved urinary frequency (P = 0.006), voiding difficulty (P = 0.001), stress urinary incontinence (SUI) (P = 0.001), but not urgency (P = 0.29). VS was more effective in treating SUI (P < 0.001 vs. 0.52) while LSC more effective on voiding difficulty (P = 0.01 vs. 0.08). Postoperative de novo symptoms were observed in 35.8% of patients with no difference between the groups (P = 0.06). UDI (P = 0.04) and UIQ (P = 0.01) scores were significantly lower after surgery. However, LSC significantly improved UDI (P = 0.03) with no effect on UIQ (P = 0.29) scores while VS significantly improved both scores (P = 0.02 and 0.001, respectively). Upon multivariate analysis, only the improvement in the impact of urinary symptoms on daily living was independently associated to VS (OR = 5.45 [95% confidence interval 2.20-13.44], P = 0.01). Most preoperative urinary symptoms decreased after POP surgery with equivalent proportion of de novo symptoms after vaginal and laparoscopic approaches.
  Neurourology and Urodynamics 09/2011; 31(1):126-31. · 2.96 Impact Factor
• Article: Rectovaginal Endometriosis

  Emile Daraï, Roman Rouzier, Marcos Ballester, Marc Bazot
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  ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
  Annals of Surgery 08/2011; 254(3):540–541. · 7.49 Impact Factor
• Article: Letter to the Editor.

  Emile Daraï, Roman Rouzier, Marcos Ballester, Marc Bazot
  Annals of surgery 08/2011; · 7.90 Impact Factor