F Lécuru

Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest), Lutetia Parisorum, Île-de-France, France

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Publications (134)227.75 Total impact

  • Journal de gynecologie, obstetrique et biologie de la reproduction. 09/2014;
  • Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 01/2014;
  • F Lécuru
    Gynécologie Obstétrique & Fertilité 11/2013; · 0.55 Impact Factor
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    ABSTRACT: La biopsia del linfonodo sentinella è una metodica diagnostica che permette il prelievo linfonodale mirato delle prime stazioni linfonodali di un tumore, rappresentativo dei linfonodi a valle. Questa tecnica si sviluppa da una decina di anni nei cancri dell’utero, per i quali lo status linfonodale è un fattore prognostico principale. I suoi obiettivi principali sono di ridurre la morbilità degli svuotamenti completi, di individuare dei territori di drenaggio inattesi e, anche, di realizzare un’ultrastadiazione linfonodale. La tecnica di rilevamento combinata, con coloranti e isotopi, è quella che apporta i migliori risultati in termini di tasso di individuazione. I dati della letteratura sulla biopsia del linfonodo sentinella nei cancri del collo precoci hanno dimostrato ampiamente la sua fattibilità. I tassi di individuazione sono molto buoni, come anche il suo valore diagnostico. La tecnica permette di realizzare un’ultrastadiazione linfonodale evidenziando delle micrometastasi. Il prelievo del linfonodo sentinella è realizzabile anche nei cancri dell’endometrio, con, tuttavia, dei tassi di individuazione e di falsi negativi molto variabili secondo le casistiche, influenzati soprattutto dalla via di iniezione. Se l’iniezione intratumorale, realizzata soprattutto mediante isteroscopia, è quella che permette di evidenziare meglio il vero drenaggio linfatico del tumore, la sua attuazione è, tuttavia, assai poco riproducibile.
    EMC - Tecniche Chirurgiche - Chirurgia Generale. 11/2013; 13(1):1–10.
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    ABSTRACT: The aim of this study was to evaluate the diagnosis and impact of residual disease (RD) after concurrent chemoradiation therapy (CRT) in locally advanced cervical cancer (FIGO IB2-IVA). This retrospective multicenter study included 159 patients who were treated with completion surgery after CRT between 2006 and 2012. Magnetic resonance imaging (MRI) was performed 4-6 weeks after CRT and compared to pathological evidence of residual disease. Kaplan-Meier survival curves were plotted and univariate/multivariate analyses were performed to assess the association between RD and the outcome. Residual disease was present in 45.3% of the patients and detected by MRI in 57.1%. The MRI had a 29.2% false positive rate and an 11.1% false negative rate. The overall survival (OS) rates at 3 and 5 years were 78.6% (CI 95% [71%-86.9%]) and 76.5% (CI 95% [68.2%-85.7%]), respectively. The disease free survival (DFS) rates at 3 and 5 years were 73.4% (CI 95% [65.6%-82%]) and 71.1% (CI 95% [62.7%-80.1%]), respectively. RD greater than 10 mm decreased DFS (HR = 4.84, p = 0.03), whereas RD between 1 and 10 mm (HR = 0.31, p = 0.58) and less than 1 mm (HR = 0.37, p = 0.54) had no impact on DFS. The OS was not changed by RD. The MRI accuracy value is not sufficient to select patients who might benefit from completion surgery. Residual disease over 10 mm decreased DFS but did not impact OS.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 10/2013; · 2.56 Impact Factor
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    ABSTRACT: Based on registries, the European experience has been that <50% of patients are treated according to protocols and/or benefit from the minimum required surgery for ovarian cancer. The French Cancer Plan 2009-2013 considers the definition of qualitative indicators in ovarian cancer surgery in France. This endeavour was undertaken by the French Society of Gynaecologic Oncology (SFOG) in partnership with the French National College of Obstetricians and Gynecologists and all concerned learned societies in a multidisciplinary mindset. The quality indicators for the initial management of patients with ovarian cancer were based on the standards of practice determined from scientific evidence or expert consensus. The indicators were divided into structural indicators, including material (equipment), human (number and qualification of staff), and organizational resources, process indicators, and outcome indicators. The enforcement of a quality assurance programme in any country would undoubtedly promote improvement in the quality of care for ovarian cancer patients and would result in a dramatic positive impact on their survival. Such a policy is not only beneficial to the patient, but is also profitable for the healthcare system.
    Annals of Oncology 07/2013; · 7.38 Impact Factor
  • Gynecologic Oncology. 07/2013; 130(1):e10.
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    ABSTRACT: OBJECTIVES: Residual disease after excision surgery is the main prognostic factor in advanced ovarian cancer. Open surgery can delay neoadjuvant chemotherapy initiation. Therefore, a minimally invasive method for evaluating resectability would be of great interest. Aim of our study is to evaluate a new technique for assessing the extent of peritoneal carcinomatosis, combining manual palpation and standard laparoscopy. METHODS: Prospective single-center study from October 2008 to January 2010. Patients with peritoneal carcinomatosis from gynecological malignancies were investigated by standard laparoscopy followed by laparoscopy plus manual palpation using Lapdisc(®) (Ethicon Inc.), at 43 abdominopelvic sites. When both techniques indicated resectability, standard cytoreduction surgery was performed via a midline laparotomy. The Fagotti, modified Fagotti, and Sugarbaker scores were computed. The diagnostic performance of each evaluation criterion was assessed by computing sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver-operating characteristic curves (ROC-AUCs). RESULTS: Of the 29 included patients, 18 (62.1%) were considered to have resectable disease. Fourteen (14/18, 77.8%) had macroscopically complete cytoreduction. With Lapdisc(®), sensitivity was 100%, specificity 73.3%, PPV 77.8%, NPV 100%, and ROC-AUC 0.87. Corresponding values were as follows: laparoscopy, 100%, 40%, 60.9%, 100%, and 0.70; Fagotti and modified Fagotti scores, 100%, 46.7%, 63.6%, 100%, and 0.73; Sugarbaker score, 64.3%, 93.3%, 90%, 73.7%, and 0.79. The ROC-AUCs showed significantly better performance of Lapdisc(®) than of standard laparoscopy (P = 0.008). CONCLUSION: Hand-assisted laparoscopy may perform better than laparoscopy alone for predicting the resectability of peritoneal carcinomatosis by increasing the number of sites evaluated.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 04/2013; · 2.56 Impact Factor
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    ABSTRACT: Background:We developed a nomogram based on five clinical and pathological characteristics to predict lymph-node (LN) metastasis with a high concordance probability in endometrial cancer. Sentinel LN (SLN) biopsy has been suggested as a compromise between systematic lymphadenectomy and no dissection in patients with low-risk endometrial cancer.Methods:Patients with stage I-II endometrial cancer had pelvic SLN and systematic pelvic-node dissection. All LNs were histopathologically examined, and the SLNs were examined by immunohistochemistry. We compared the accuracy of the nomogram at predicting LN detected with conventional histopathology (macrometastasis) and ultrastaging procedure using SLN (micrometastasis).Results:Thirty-eight of the 187 patients (20%) had pelvic LN metastases, 20 had macrometastases and 18 had micrometastases. For the prediction of macrometastases, the nomogram showed good discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.76, and was well calibrated (average error =2.1%). For the prediction of micro- and macrometastases, the nomogram showed poorer discrimination, with an AUC of 0.67, and was less well calibrated (average error =10.9%).Conclusion:Our nomogram is accurate at predicting LN macrometastases but less accurate at predicting micrometastases. Our results suggest that micrometastases are an 'intermediate state' between disease-free LN and macrometastasis.British Journal of Cancer advance online publication, 12 March 2013; doi:10.1038/bjc.2013.95 www.bjcancer.com.
    British Journal of Cancer 03/2013; · 5.08 Impact Factor
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    ABSTRACT: La biopsia del ganglio centinela es un método diagnóstico que permite la extirpación dirigida de las primeras invasiones ganglionares de un tumor, una muestra que es representativa de los ganglios subsiguientes. Esta técnica se está desarrollando desde hace unos 10 años con relación a los cánceres del útero, en los cuales el estado ganglionar es un factor pronóstico principal. Sus objetivos principales son limitar la morbilidad de los vaciamientos ganglionares completos, detectar territorios de drenaje inesperados y efectuar una ultraestadificación ganglionar. La técnica de detección combinada, por tinción e isotópica, produce los mejores resultados en cuanto a índices de detección. Los datos de las publicaciones sobre la biopsia precoz del ganglio centinela en los cánceres del cuello uterino confirman ampliamente la utilidad de esta práctica. Los índices de detección y el valor diagnóstico son muy buenos. La técnica hace posible una ultraestadificación ganglionar para demostrar micrometástasis. La biopsia del ganglio centinela también es factible en los cánceres de endometrio, pero los índices de detección y de falsos negativos varían mucho según las series, principalmente en relación con la vía de inyección. Aunque la inyección intratumoral por histeroscopia es la que permite demostrar mejor el verdadero drenaje linfático del tumor, su realización es bastante poco reproducible.
    EMC - Ginecología-Obstetricia. 03/2013; 49(1):1–11.
  • F. Lécuru
    Gynécologie Obstétrique & Fertilité 01/2013; 41(11):625–626. · 0.55 Impact Factor
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    ABSTRACT: INTRODUCTION: Symptomatic postoperative lymphocysts (SPOLs) and lower-limb lymphedema (LLL) are probably underestimated complications of lymphadenectomy for gynecologic malignancies. Here, our objective was to evaluate the incidence and risk factors of SPOLs and LLL after pelvic and/or aortocaval lymphadenectomy for gynecologic malignancies. METHODS: Single-center retrospective study of consecutive patients who underwent pelvic and/or aortocaval lymphadenectomy for ovarian cancer, endometrial cancer, or cervical cancer between January 2007 and November 2008. The incidences of SPOL and LLL were computed with their 95% confidence intervals (95%CIs). Multivariate logistic regression was performed to identify independent risk factors for SPOL and LLL. RESULTS: We identified 88 patients including 36 with ovarian cancer, 35 with endometrial cancer, and 17 with cervical cancer. The overall incidence of SPOL was 34.5% (95%CI, 25-45) and that of LLL was 11.4% (95% confidence interval [95%CI], 5-18). Endometrial cancer was independently associated with a lower risk of SPOL (adjusted odds ratio [aOR], 0.09; 95%CI, 0.02-0.44) and one or more positive pelvic nodes with a higher risk of SPOL (aOR, 4.4; 95%CI, 1.2-16.3). Multivariate logistic regression failed to identify factors significantly associated with LLL. CONCLUSION: Complications of lymphadenectomy for gynecologic malignancies are common. This finding supports a more restrictive use of lymphadenectomy or the use of less invasive techniques such as sentinel node biopsy.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 10/2012; · 2.56 Impact Factor
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    ABSTRACT: El síndrome de Lynch se caracteriza por una predisposición genética a sufrir cáncer colorrectal, relacionada con la mutación de un gen de reparación del ácido desoxirribonucleico (ADN). Los pacientes afectados están expuestos al riesgo de desarrollar cáncer colorrectal, pero también muchos otros tumores que pertenecen al espectro del cáncer colorrectal no polipósico hereditario (HNPCC, por sus siglas en inglés), y, entre éstos, en primer lugar, el cáncer de endometrio: el riesgo acumulado de desarrollar la enfermedad a la edad de 80 años llega al 40%. Estos cánceres de endometrio tienen la particularidad de presentarse a una edad temprana y, desde un buen comienzo, en un estadio avanzado. Aunque no está validada, debe recomendarse la detección precoz de los tumores ginecológicos. Se basa en la exploración física, la ecografía pélvica y la extracción de una muestra de endometrio. Toda hemorragia anormal debe motivar una consulta urgente. Una vez satisfechos los proyectos de maternidad, debe proponerse la cirugía profiláctica (histerectomía total no conservadora).
    EMC - Ginecología-Obstetricia. 09/2012; 48(3):1–9.
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    ABSTRACT: Robotic surgery had spread for a few years. This access is now important in urologic surgery, especially for prostatic procedures. Development of robotic surgery in gynecology is more recent. Gynecologic oncology is probably one of the most interesting fields of development of this access. Robotic surgery is frequently used in endometrial cancer. As no randomized study is available, it seems to be interesting to make a review of retrospective studies. Feasibility seems to be high and the learning curve is short (around 20 cases). Operative lengths are longer when compared to laparotomy, but are similar or shorter than laparoscopy. Robot setting increases the global length of the procedure, but decreases with experience. Operative blood loss, as well as transfusion rate are decreased when compared to laparotomy, but are similar to those of laparoscopy. The overall morbidity rate seems lower than with other approaches. Postoperative pain, hospital stay and time to recovery are decreased when compared to laparotomy as well as to laparoscopy for some authors. The main limit to the diffusion of robotic surgery is accessibility because of its important cost. Other limits are pointed out by the most trained teams.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction. 05/2012; 41(3):219–226.
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    ABSTRACT: Robotic surgery has spread for a few years. This access is now important in urologic surgery, especially for prostatic procedures. Development of robotic surgery in gynecology is more recent. Gynecologic oncology is probably one of the most interesting fields of development of this access. Robotic surgery is frequently used in endometrial cancer. As no randomized study is available, it seems to be interesting to make a review of retrospective studies. Feasibility seems to be high and the learning curve is short (around 20 cases). Operative lengths are longer when compared to laparotomy, but are similar or shorter than laparoscopy. Robot setting increases the global length of the procedure, but decreases with experience. Operative blood loss, as well as transfusion rate are decreased when compared to laparotomy, but are similar to those of laparoscopy. The overall morbidity rate seems lower than with other approaches. Postoperative pain, hospital stay and time to recovery are decreased when compared to laparotomy as well as to laparoscopy for some authors. The main limit to the diffusion of robotic surgery is accessibility because of its important cost. Other limits are pointed out by the most trained teams.
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 04/2012; 41(3):219-26. · 0.45 Impact Factor
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    ABSTRACT: Each year, 13,000 newly gynecologic cancers are diagnosed in France. Gynecologic cancers were specifically heterogeneous (localisations, histologic subgroups, age class, etc). This work was delineated for a national call dedicated to gynecologic cancers. This review reports the major needs in terms of scientific research dedicated to gynecologic cancers in the biologic, epidemiology, human and sociologic fields. For example, medico-economic strategies adapted to ethnosociologic context, specifically for cervix cancer, took important part of the epidemiologic research. Impact of gynecologic cancer in terms of symptoms and late effects, quality of life after treatments and fertility needs to be specifically explored. For fundamental research, molecular characterisation, biologic markers, impact of immunology and genetics represent the major part of the field need to be explored. Finally, therapeutic and diagnosis innovations, optimization of treatments strategies and development of predictive models in order to perform individual prediction taking into account several risk factors (clinical and molecular) to offer help in management of gynecologic cancers are required.
    Bulletin du cancer 03/2012; 99(4):479-98. · 0.61 Impact Factor
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    ABSTRACT: While optimal cytoreduction is the standard of care for advanced ovarian cancer, the related post-operative morbidity has not been clearly documented outside pioneering centers. Indeed most of the studies are monocentric with inclusions over several years inducing heterogeneity in techniques and goals of surgery. We assessed the morbidity of optimal cytoreduction surgery for advanced ovarian cancer within a short inclusion period in 6 referral centers dedicated to achieve complete cytoreduction. The 30 last optimal debulking surgeries of 6 cancer centers were included. Inclusion criteria included: stage IIIc- IV ovarian cancer and optimal surgery performed at the site of inclusion. All post-operative complications within 30 days of surgery were recorded and graded using the Memorial secondary events grading system. Student-t, Chi2 and non-parametric statistical tests were performed. 180 patients were included. There was no demographic differences between the centers. 63 patients underwent surgery including intestinal resections (58 recto-sigmoid resection), 24 diaphragmatic resections, 17 splenectomies. 61 patients presented complications; One patient died post-operatively. Major (grade 3-5) complications requiring subsequent surgeries occurred in 21 patients (11.5%). 76% of patients with a major complication had undergone an ultraradical surgery (P = 0.004). While ultraradical surgery may result in complete resection of peritoneal disease in advanced ovarian cancer, the associated complication rate is not negligible. Patients should be carefully evaluated and the timing of their surgery optimized in order to avoid major complications.
    PLoS ONE 01/2012; 7(7):e39415. · 3.53 Impact Factor
  • Journal de Gynécologie Obstétrique et Biologie de la Reproduction 12/2011; 41(1):3-5. · 0.45 Impact Factor
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    ABSTRACT: To study the correlation between the nature of the ovarian tumors presumed according to the ultrasound criteria of Timmerman and the final histological diagnosis. We made a prospective study during a period of 4 years, concerning consecutive patients having an ovarian tumor, investigated by pelvic ultrasonography using Timmerman's rules estimating their benign or malignant characteristics in order to determine the efficiency of this score. The diagnostic reference was histology. Sensitivity and specificity of these criteria were calculated with their 95% confidence intervals. One hundred and twenty-two patients having adnexal masse were included between January 2002 and December 2005. Among these tumors, 88.5% (108/122) were benign, and 11.5% (14/122) were malignant or borderline. The ultrasound-based rules of classification were applicable for 89.3% (109/122) of them. The sensitivity of these rules was 73% (95% CI [45-100]) and the specificity was 97% (IC 95% CI [94-100]). Most adnexal masses can be classified according to the ultrasound simple rules of the score of Timmerman with a good specificity to eliminate their malignant or borderline characteristics. Tumors which cannot be classified according to these rules must be referred to an expert ultrasonographist.
    Gynécologie Obstétrique & Fertilité 08/2011; 39(9):477-81. · 0.55 Impact Factor
  • Gynécologie Obstétrique & Fertilité 05/2011; 39(5):272–273. · 0.55 Impact Factor

Publication Stats

877 Citations
227.75 Total Impact Points

Institutions

  • 2002–2014
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      • Service de Chirurgie Cancérologique Gynécologique et du Sein
      Lutetia Parisorum, Île-de-France, France
  • 2013
    • Université Paris Descartes
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2006–2013
    • Université René Descartes - Paris 5
      • • Faculty of medicine
      • • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
  • 2011
    • Insitute de Cancérologie de l'Ouest - Centre René Gauducheau
      Naoned, Pays de la Loire, France
  • 2004
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2002–2003
    • Assistance Publique Hôpitaux de Marseille
      • Service de gynécologie obstétrique
      Marseille, Provence-Alpes-Cote d'Azur, France
  • 2001
    • College of Obstetrics and Gynecology of Leon
      Aquitaine, France