The IX t h Makassed Medical Congress - American University of Beirut

proportion of patients in each cohort undergoing maximal interval cytoreductive surgery was
associated with a 1.9 month increase in median survival time (95%CI=0.23 months–3.50 months,
p=0.027). However, few centers around the world have adopted a more aggressive surgical
approach to patients with extensive ovarian carcinomatosis, which include extensive upper
abdominal surgeries. Until recently, however, no prospective RCT confirming the widely held
belief that aggressive cytoreductive surgery should be the 1st step in the treatment.
Role of interval debulking: In an effort to increase the proportion of patients with advanced
ovarian cancer that are ultimately left with an optimal volume of residual disease, the concept of
interval cytoreduction has evolved into the treatment approach now referred to as neoadjuvant
chemotherapy in which the initial attempt at cytoreduction is abandoned in favor of chemotherapy
in order to reduce the extent of disease or improve patient performance A recent prospective
European trial has confirmed that surgery performed following neoadjuvant chemotherapy is
routinely shorter in time, associated with a better nutritional state preoperatively, less blood loss,
shorter intensive care unit stays, shorter hospitalizations, reduced risk of peri-operative morbidity,
and a higher rate of optimal resection. More importantly survival was not compromised.
The role of surgery in recurrent disease: In properly selected patients, secondary aggressive
debulking has a major impact on PFS similar, but to a lesser extent than in the primary setting.
During this presentation, we will present convincing data on the role of aggressive surgery,
including upper abdominal surgery, in the management of primary and recurrent ovarian cancer.
TWIN PREGNANCIES FRENCH 2009 GUIDELINES
Philippe Deruelle, MD
Development of new technologies and dissemination of new scientific information and
incorporation of research findings into practice are major challenges to health professionals.
Twin pregnancies are a high risk group which needs more intensive care than singleton. However,
in France, the management may be widely different between centers and countries leading to
inappropriate or usefulness practices.
Therefore in December 2099, the “College National des Gynécologues Obstétriciens Français”
coordinated a National Consensus Conference in order to define, based upon the best evidence
available, the standard care of twin gestation. The purpose of this guideline is to describe and,
if possible, quantify the problems associated with twin management and to identify the best
evidence to guide clinical care.
Methods: fourteen questions were identified including epidemiology of twins, ultrasound diagnosis
of chorionicity, screening for aneuploidies, management of monoamniotic, monochorionic
diamniotic and dichorionic twin pregancies, prevention of spontaneous preterm birth, delivery and
social and economic aspects of twin gestation. The MEDLINE database, the EMBASE database,
the Cochrane Library, and the Guidelines published by foreign organizations or institutions
such as Royal College of obstetrics and Gynaecology, American College of Obstetricians and
Gynecologists, were used to conduct a literature search to locate relevant articles published.
Additional studies were located by reviewing bibliographies of identified articles. The quality
of evidence was evaluated and recommendations were made according to guidelines for
assessing medical literature published by “Haute Autorité de la Santé”.
101