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Objective In 2013, our group assessed a risk stratification tool of endometrial cancer (EC), called REM (Risk of Endometrial Malignancy). A well known risk factor for EC is body mass index (BMI). In fact, (BMI > 30 and 35 kg/m2) were associated with a 2.6-fold and a 4.7-fold increase in EC risk, respectively. Therefore, in the present study we aim to improve the performance of REM, including BMI and developing a new scoring system, called REM-B (Risk of Endometrial Malignancy score associated to BMI), to classify patients into high risk or low risk groups for EC. Study design Women, between 45 and 80 years, diagnosed with ultrasound endometrial abnormalities and scheduled to have surgery were enrolled on a prospective study at Department of Gynaecologic Oncology of Campus Bio-Medico of Rome. Preoperative clinical, ultrasound and laboratory features were taken into account. Results A total of 675 patients (88 with EC and 587 with benign endometrial disease) were divided in training set (TS) and verification set (VS). Age, symptom, BMI, HE4 levels and ultrasound endometrial thickness were found statistically significant and included into multivariate logistic regression model in order to determine the probability to have EC. REM-B showed an overall sensitivity of 94.7% (versus 92% of REM) and a specificity of 97.4% (versus 96% of REM). Conclusions Our data support the use of REM-B to triage patients into low and high risk of EC, even if an external validation of model is needed.

Objective Pelvic floor disorders, in particular pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are common in women. There is a described higher risk to develop postoperative SUI also in preoperatively continent women: this happens because in 30% of women the relief of the urethral obstruction caused by prolapse, unmasks a pre-existing compromised urethral function and thus an “occult” or potential SUI. The aims of this study were to evaluate the role of Macroplastique® implant, TVT-O or surgery alone in the management of occult urinary stress incontinence during prolapse surgery in terms of success rate and adverse events. Study design We enrolled 47 consecutive patients scheduled to vaginal prolapse surgery who did not report symptoms of stress incontinence. We collected surgical data, success and complication rates. Moreover we compared all the data with retrospective ones regarding surgery plus concomitant TVT-O (39 pts) and surgery alone (41 pts). Results At 12-months follow-up, we reported a success rate of 87,2% in the “macroplastique group”, comparable to the “surgery plus TVT-O group”, with a statistically significant difference in comparison to the “surgery alone” group. “Surgery + TVT-O” group reported a higher rate of major complications (p Conclusions Postoperative SUI prevention at the time of prolapse repair remains a challenging issue. In selected patients, Macroplastique may play an interesting role having a good success rate and a low complication rate and for these reasons it may be proposed as A concomitant procedure during POP surgery.

Objectives To assess patients’ perceptions of physician, nurse, and care organization quality of care and services received during hospitalization with or without a sub-specialized setting in gynaecological oncology. Study design Consecutive patients affected by gynaecologic cancer, referred to the Division of Gynaecology of University Campus Bio-Medico of Rome to underwent to surgery (surgical ward) or to chemotherapy (medical ward) from January 2010 to April 2014, were enrolled. Eligible subjects were divided into two groups: Group A: standard unit care, consisting of doctors and nurses without a specific training and Group B: Expert unit care, consisting of doctors and nurses with specific training in gynecologic oncology. Patients were asked to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Cancer Module (QLQ-C30) and the Patient Satisfaction Questionnaire (IN-PATSAT32). Results The sample ( n = 150) is organized into two groups: 78 patients (Group A) and 72 patients (Group B). Analysing the results of IN-PATSAT32, comparing Group A versus Group B, we find statistically significant difference considering doctors’ information provision (items 7–9) ( p = 0.0470), nurses’ technical skills (items 12–14) ( p = 0.0369) and nurses’ information provision (items 18–20) ( p = 0.0089) and general satisfaction (item 32) ( p = 0.0214). Conclusions This study highlights the potential benefits specialty training for doctors and nurses that work in an oncologic ward (surgical or medical). In fact, the necessity for a separate sub-specialty in gynaecological oncology and a distinct training programme may be the key to achieve the higher satisfaction in this setting of patients.

Recto-vaginal endometriosis remains a surgical challenge. We propose a systematic surgical approach combining vaginal and laparoscopic steps for patients affected by deep endometriosis infiltrating the vaginal wall.This is a prospective observational study, performed at Campus Bio-Medico of Rome, University Teaching Hospital. All consecutive patients, from 2008 to 2011, affected by symptomatic deep recto-vaginal endometriosis with full thickness vaginal wall involvement, underwent a systematic surgical approach, based on three consecutive surgical steps: vaginal route, laparoscopic approach and final vaginal excision. All patients included in the study were scheduled for two years' follow-up with pelvic examination, transvaginal ultrasound and visual analog scale (VAS) evaluation of symptoms (dysmenorrhea, dyspareunia and chronic pelvic pain) at 3, 6, 12 and 24 months.Thirty-four patients were enrolled. No major complications were registered. Complications included superficial vascular lesions in two cases (5.9%), ureteral stenosis two weeks after surgery in one patient (2.9%), and bowel obstruction for paralytic ileus in one patient (2.9%). A de novo endometrioma was found at 12 months after surgery and a recurrent endometrioma was evident at 24 months. For all symptoms evaluated, there was a significant improvement within 3 months after surgery (p0.05) and no statistically significant difference during follow-up (at 3, 6, 12 and 24 months).The proposed systematic surgical approach consisting of three consecutive steps could simplify the approach to deep endometriosis while at the same time increasing the quality of endometriosis surgery, with important benefit for the women affected.