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2. Atezolizumab and chemotherapy for advanced or recurrent endometrial cancer (AtTEnd): a randomised, double-blind, placebo-controlled, phase 3 trial

Author

Colombo, N, Biagioli, E, Harano, K, Galli, F, Hudson, E, Antill, Y, Choi, C, Rabaglio, M, Marmé, F, Marth, C, Parma, G, Fariñas-Madrid, L, Nishio, S, Allan, K, Lee, Y, Piovano, E, Pardo, B, Nakagawa, S, Mcqueen, J, Zamagni, C, Manso, L, Takehara, K, Tasca, G, Ferrero, A, Tognon, G, Lissoni, A, Petrella, M, Laudani, M, Rulli, E, Uggeri, S, Barretina Ginesta, M, Zola, P, Casanova, C, Arcangeli, V, Antonuzzo, L, Gadducci, A, Cosio, S, Clamp, A, Persic, M, Mcneish, I, Tookman, L, Redondo Sanchez, A, Baldini, E, Palaia, I, Benedetti Panici, P, Takahashi, N, Lombard, J, Ardizzoia, A, Bologna, A, Herrero Ibáñez, A, Musolino, A, Márquez Vázquez, R, Pietzner, K, Braicu, E, Heinzelmann-Schwarz, V, Powell, M, Yokoyama, Y, Baron-Hay, S, Abeni, C, Martin Lorente, C, Cueva, J, Trillsch, F, Heitz, F, Ataseven, B, Petru, E, Heubner, M, Sadozye, A, Dubey, S, Tazbirkova, A, Tiley, S, Chrystal, K, Kim, S, Fehr, M, Scatchard, K, Anand, A, Taylor, A, Watary, H, Enomoto, T, Yoshihara, K, Selva-Nayagam, S, Karki, B, Harrison, M, Wilkinson, K, Goh, J, Glasgow, A, Chantrill, L, Lee, C, Bertolini, A, Narducci, F, Bellotti, G, Fusco, V, Aebi, S, Del Grande, M, Colombo, I, Tokunaga, H, Shigeta, S, Goss, G, Siow, Z, Steer, C, Lin, H, Colombo N., Biagioli E., Harano K., Galli F., Hudson E., Antill Y., Choi C. H., Rabaglio M., Marmé F., Marth C., Parma G., Fariñas-Madrid L., Nishio S., Allan K., Lee Y. C., Piovano E., Pardo B., Nakagawa S., McQueen J., Zamagni C., Manso L., Takehara K., Tasca G., Ferrero A., Tognon G., Lissoni A. A., Petrella M., Laudani M. E., Rulli E., Uggeri S., Barretina Ginesta M. P., Zola P., Casanova C., Arcangeli V., Antonuzzo L., Gadducci A., Cosio S., Clamp A., Persic M., McNeish I., Tookman L., Redondo Sanchez A., Baldini E., Palaia I., Benedetti Panici P., Takahashi N., Lombard J., Ardizzoia A., Bologna A., Herrero Ibáñez A. M., Musolino A., Márquez Vázquez R., Pietzner K., Braicu E., Heinzelmann-Schwarz V. A., Powell M., Yokoyama Y., Baron-Hay S., Abeni C., Martin Lorente C., Cueva J. F., Trillsch F., Heitz F., Ataseven B., Petru E., Heubner M. L., Sadozye A. H., Dubey S., Tazbirkova A., Tiley S., Chrystal K., Kim S. W., Fehr M., Scatchard K., Anand A., Taylor A., Watary H., Enomoto T., Yoshihara K., Selva-Nayagam S., Karki B., Harrison M., Wilkinson K., Goh J., Glasgow A., Chantrill L., Lee C., Bertolini A., Narducci F., Bellotti G., Fusco V., Aebi S., Del Grande M., Colombo I., Tokunaga H., Shigeta S., Goss G., Siow Z. R., Steer C., Lin H., Colombo, N, Biagioli, E, Harano, K, Galli, F, Hudson, E, Antill, Y, Choi, C, Rabaglio, M, Marmé, F, Marth, C, Parma, G, Fariñas-Madrid, L, Nishio, S, Allan, K, Lee, Y, Piovano, E, Pardo, B, Nakagawa, S, Mcqueen, J, Zamagni, C, Manso, L, Takehara, K, Tasca, G, Ferrero, A, Tognon, G, Lissoni, A, Petrella, M, Laudani, M, Rulli, E, Uggeri, S, Barretina Ginesta, M, Zola, P, Casanova, C, Arcangeli, V, Antonuzzo, L, Gadducci, A, Cosio, S, Clamp, A, Persic, M, Mcneish, I, Tookman, L, Redondo Sanchez, A, Baldini, E, Palaia, I, Benedetti Panici, P, Takahashi, N, Lombard, J, Ardizzoia, A, Bologna, A, Herrero Ibáñez, A, Musolino, A, Márquez Vázquez, R, Pietzner, K, Braicu, E, Heinzelmann-Schwarz, V, Powell, M, Yokoyama, Y, Baron-Hay, S, Abeni, C, Martin Lorente, C, Cueva, J, Trillsch, F, Heitz, F, Ataseven, B, Petru, E, Heubner, M, Sadozye, A, Dubey, S, Tazbirkova, A, Tiley, S, Chrystal, K, Kim, S, Fehr, M, Scatchard, K, Anand, A, Taylor, A, Watary, H, Enomoto, T, Yoshihara, K, Selva-Nayagam, S, Karki, B, Harrison, M, Wilkinson, K, Goh, J, Glasgow, A, Chantrill, L, Lee, C, Bertolini, A, Narducci, F, Bellotti, G, Fusco, V, Aebi, S, Del Grande, M, Colombo, I, Tokunaga, H, Shigeta, S, Goss, G, Siow, Z, Steer, C, Lin, H, Colombo N., Biagioli E., Harano K., Galli F., Hudson E., Antill Y., Choi C. H., Rabaglio M., Marmé F., Marth C., Parma G., Fariñas-Madrid L., Nishio S., Allan K., Lee Y. C., Piovano E., Pardo B., Nakagawa S., McQueen J., Zamagni C., Manso L., Takehara K., Tasca G., Ferrero A., Tognon G., Lissoni A. A., Petrella M., Laudani M. E., Rulli E., Uggeri S., Barretina Ginesta M. P., Zola P., Casanova C., Arcangeli V., Antonuzzo L., Gadducci A., Cosio S., Clamp A., Persic M., McNeish I., Tookman L., Redondo Sanchez A., Baldini E., Palaia I., Benedetti Panici P., Takahashi N., Lombard J., Ardizzoia A., Bologna A., Herrero Ibáñez A. M., Musolino A., Márquez Vázquez R., Pietzner K., Braicu E., Heinzelmann-Schwarz V. A., Powell M., Yokoyama Y., Baron-Hay S., Abeni C., Martin Lorente C., Cueva J. F., Trillsch F., Heitz F., Ataseven B., Petru E., Heubner M. L., Sadozye A. H., Dubey S., Tazbirkova A., Tiley S., Chrystal K., Kim S. W., Fehr M., Scatchard K., Anand A., Taylor A., Watary H., Enomoto T., Yoshihara K., Selva-Nayagam S., Karki B., Harrison M., Wilkinson K., Goh J., Glasgow A., Chantrill L., Lee C., Bertolini A., Narducci F., Bellotti G., Fusco V., Aebi S., Del Grande M., Colombo I., Tokunaga H., Shigeta S., Goss G., Siow Z. R., Steer C., and Lin H.

Abstract

Background: At the time of AtTEnd trial design, standard treatment for advanced or recurrent endometrial cancer included carboplatin and paclitaxel chemotherapy. This trial assessed whether combining atezolizumab with chemotherapy might improve outcomes in this population. Methods: AtTEnd was a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial done in 89 hospitals in 11 countries across Europe, Australia, New Zealand, and Asia. Enrolled patients were aged 18 years or older, and had advanced or recurrent endometrial carcinoma or carcinosarcoma, an Eastern Cooperative Oncology Group performance status of 0–2, and received no previous systemic chemotherapy for recurrence. Patients were randomly assigned (2:1) using an interactive web response system (block size of six) to either atezolizumab 1200 mg or placebo given intravenously with chemotherapy (carboplatin at area under the curve of 5 or 6 and paclitaxel 175 mg/m2 intravenously on day 1 every 21 days) for 6–8 cycles, then continued until progression. Stratification factors were country, histological subtype, advanced or recurrent status, and mismatch repair (MMR) status. Participants and treating clinicians were masked to group allocation. The hierarchically tested co-primary endpoints were progression-free survival (in patients with MMR-deficient [dMMR] tumours, and in the overall population) and overall survival (in the overall population). Primary analyses were done in the intention-to-treat population, defined as all randomly assigned patients who gave their full consent to participation in the study and data processing. Safety was assessed in all patients included in the intention-to-treat population who received at least one dose of study treatment. Here, we report the primary progression-free survival and the interim overall survival results. This study is ongoing and is registered with ClinicalTrials.gov, NCT03603184. Findings: Between Oct 3, 2018, and Jan 7, 2022, 551 patients were r

Published
2024

3. How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

Author

Siragusa, L, Angelico, R, Angrisani, M, Zampogna, B, Materazzo, M, Sorge, R, Giordano, L, Meniconi, R, Coppola, A, Marino, A, Giraudo, G, Esposito, S, Urbani, A, De Pastena, M, Mastrapasqua, R, Garancini, M, Frontal, A, Pascal, G, Martellucc, J, Falb, F, Boscarelli, A, Bertoglio, P, Trecca, E, Galassi, L, Vento, V, Chiappini, A, Antonelli, A, Bennardo, F, Familiari, F, Giannaccare, G, Zappia, A, Giuliani, G, Falcone, F, Sebastiani, S, Montuori, M, Rossi, S, Sagnotta, A, Giuliani, B, Imbriani, G, Restaino, S, Andreani, L, Di Maria, F, Lagana, A, Vitiello, L, Berton, F, Virgilio, E, Palisi, M, Portigliotti, L, Calussi, M, Conti, L, Mauriello, C, Barone, M, Saladino, E, Giaquinta, A, Zerb, D, Frazzetta, G, Merola, G, Chierici, A, Bini, R, Centonze, L, De Carlis, R, Ferrario, L, Giani, A, Lauterio, A, Tamini, N, Corti, S, Botteri, E, Andreuccetti, J, D'Alessio, R, Cestaro, G, Clarizia, G, Spolini, A, Carboni, A, Benzoni, E, Galiffa, G, Perotti, B, Veroux, M, Randazzo, V, Topa, D, Pranteda, C, Contini, G, Iacusso, C, Voglino, V, Vita, P, Carrano, F, Ambrosio, L, Cammarata, R, Capolupo, G, Caputo, D, Carannante, F, Cascone, C, Esperto, F, Farolfi, T, Frasca, L, Gallo, I, Gibin, G, Giurazza, G, Improta, L, La Vaccara, V, Luffarelli, P, Luvero, D, Marangi, G, Masciana, G, Mazzola, A, Mazzotta, E, Miligi, C, Montelione, N, Nenna, A, Orsaria, P, Papalia, R, Papalia, G, Parisi, F, Prata, F, Salzillo, R, Santini, S, Sofo, F, Zampoli, A, Tanda, C, Altieri, G, Ardito, F, Belia, F, Bianchi, V, Biondi, A, Brisinda, G, Chiappetta, M, Ciolli, G, Ciolli, A, Ferracci, F, Ferri, L, Fico, V, Fiorillo, C, Fransvea, P, Galiandro, F, Giovinazzo, F, La Greca, A, Litta, F, Mele, C, Pafundi, D, Panettieri, E, Papa, V, Patini, R, Perrotta, G, Puccioni, C, Santocchi, P, Armatura, G, Olmi, S, Casoni Pattacini, G, Salgarello, S, Trompetto, M, Bombardini, C, La Rocca, R, Celentano, G, Micalef, A, Mazzella, A, Settembrini, A, Zoia, C, Degrate, L, Musumeci, G, Palopoli, C, Montori, G, Bonati, E, Dinuzzi, V, Velluti, F, Balla, A, Bonasia, D, Coletta, D, Berardi, G, Colasanti, M, Ferretti, S, Gasparoli, C, Mariano, G, Avenia, S, Cianci, P, Cestino, L, Festa, F, Fazio, F, Ascari, F, Desio, M, Arroyo Murillo, G, Cereda, M, Galleano, R, David, G, Pansini, A, Gazia, C, Atzori, G, Desideri, L, Famularo, S, Galvanin, J, Giudici, V, Mangiameli, G, Mei, S, Milana, F, Pansa, A, Sacchi, M, Testori, A, Di Carlo, G, Paratore, M, Perrone, U, Vagge, A, Vigano, J, Torre, B, Scotti, M, Carbone, G, Cerchione, R, De Nardi, P, Gozzini, L, Ottaviani, L, Senni, C, Piccin, O, Pio, L, Colombo, F, Avantifiori, R, Baldassarri, V, Caronna, R, Cicerchia, P, Corallino, D, Crocetti, D, Gallo, G, Giovanardi, F, Giovannetti, F, Hassan, R, Iossa, A, Lai, Q, Lancellotti, F, Lucarini, A, Lucchese, S, Mazzarella, G, Melandro, F, Minervini, A, Muttillo, E, Palmieri, L, Pasqua, R, Rosiello, F, Salina, G, Sibio, S, Sirignano, P, Tarallo, M, Usai, S, Vanni, C, Viglietta, E, Zambon, M, Conversano, N, Epifani, A, Milano, V, Sacco, L, Nava, M, Maffioli, A, Giuratrabocchetta, S, Baracchi, F, Zuolo, M, Ceresoli, M, Verdi, D, Belli, A, Pata, F, Piovano, E, Pastore, G, Bernabei, F, Deiana, S, Arceri, A, D'Agostino, C, Marafante, C, Moggia, E, Parini, S, Moretti, M, Uggeri, F, Pontarolo, N, Fontana, T, Palmisano, G, Giuffrida, M, Guaitoli, E, Ferretti, C, Iacopino, G, Gioco, R, Roscitano, G, Montanelli, P, Pinotti, E, Monati, E, Fazio, G, Di Pietro, F, Damarco, F, Barberis, A, Razzore, A, Pascale, A, Loi, S, Ferrara, F, Rossi, M, Lisi, G, Viel, G, Sasia, D, Bono, D, Cordaro, E, Giacomelli, E, Giani, I, Seriau, L, Pellino, G, Sparavigna, M, Trigiante, G, D'Ambrogio, R, Cardella, F, Guzzetti, S, Luzzi, A, Carganico, G, Drago, B, Micheletto, G, Orlandi, R, Cutolo, C, Gibello, U, Mistrangelo, M, Forcignano, E, D'Ugo, S, Losurdo, P, Manitto, M, Caroli, G, Franco, M, Tilocca, P, Mendogni, P, Sena, G, Sambucci, D, Luciani, C, Atelli, P, Guida, A, Marino, F, Morini, A, Sibilla, M, Longo, F, Giaccari, S, Vigorita, V, Balduzzi, A, Barra, F, Delogu, D, Milone, E, Bencini, L, Aprile, V, Papini, P, Montemurro, N, Cavallo, M, Picciariello, A, Tomasicchio, G, Fittipaldi, A, Maruccia, M, Gerardi, S, Cillara, N, Deidda, S, Demarinis, G, Peiretti, E, Tatti, F, Iovino, C, Isola, G, Progno, V, Migliore, M, Badessi, G, Barilla, C, Calleri, G, Cianci, S, Fama, F, Fleres, F, Mazzeo, C, Visaloco, M, Marchetto, C, Bolognesi, F, Benuzzi, L, Bracchetti, G, Brucchi, F, Manzo, C, Scaravilli, L, Ferrari, C, Rocca, A, Napolitano, P, Anoldo, P, Caricato, C, Manigrasso, M, Milone, M, Napolitano, L, Palomba, G, Schiavone, V, Vetrella, M, Grossi, U, Moletta, L, Annicchiarico, A, Vella, I, Talesa, G, Boggi, U, Aiello, F, Anselmo, A, Bacchiocchi, G, Beati, F, Bellato, V, Billeci, F, Blasi, F, Buonomo, O, Campanelli, M, Coco, G, Contadini, A, Conte, L, D'Ippolito, G, Di Marcantonio, A, Spicchiale, C, Afflitto, G, Gismondi, A, Gorgolini, G, Granai, A, Grande, S, Gravina, A, Ingallinella, S, Keci, L, Latini, E, Marino, D, Oddi, F, Orecchia, L, Don, C, Pellicciaro, M, Petagna, L, Pirozzi, B, Quaranta, C, Rho, M, Rosina, A, Santicchia, M, Saraceno, F, Schiavone, A, Sensi, B, Spina, A, Sullo, L, Tacconi, F, Taje, R, Vanni, G, Vinci, D, Vita, G, Alba, G, Badalucco, S, Carbone, L, Samorani, O, Chisci, G, Cuomo, R, Francia, A, Fusario, D, Gargiulo, B, Pasqui, E, Pasquetti, L, Puoti, P, Resca, L, Cumbo, J, Ganio, S, Vizzielli, G, Anastasi, M, Guerra, D, Romanzi, A, Vannelli, A, Baia, M, Siragusa L., Angelico R., Angrisani M., Zampogna B., Materazzo M., Sorge R., Giordano L., Meniconi R., Coppola A., Marino A., Giraudo G., Esposito S., Urbani A., De Pastena M., Mastrapasqua R., Garancini M., Frontal A., Pascal G., Martellucc J., Falb F., Boscarelli A., Bertoglio P., Trecca E., Galassi L., Vento V., Chiappini A., Antonelli A., Bennardo F., Familiari F., Giannaccare G., Zappia A. S., Giuliani G., Falcone F., Sebastiani S., Montuori M., Rossi S., Sagnotta A., Giuliani B., Imbriani G. C., Restaino S., Andreani L., Di Maria F., Lagana A. S., Vitiello L., Berton F., Virgilio E., Palisi M., Portigliotti L., Calussi M., Conti L., Mauriello C., Barone M., Saladino E., Giaquinta A., Zerb D., Frazzetta G., Merola G., Chierici A., Bini R., Centonze L., De Carlis R., Ferrario L., Giani A., Lauterio A., Tamini N., Corti S., Botteri E., Andreuccetti J., D'Alessio R., Cestaro G., Clarizia G., Spolini A., Carboni A. S., Benzoni E., Galiffa G., Perotti B., Veroux M., Randazzo V., Topa D., Pranteda C., Contini G., Iacusso C., Voglino V., Vita P., Carrano F. M., Ambrosio L., Cammarata R., Capolupo G. T., Caputo D., Carannante F., Cascone C., Esperto F., Farolfi T., Frasca L., Gallo I. F., Gibin G., Giurazza G., Improta L., La Vaccara V., Luffarelli P., Luvero D., Marangi G., Masciana G., Mazzola A., Mazzotta E., Miligi C. I., Montelione N., Nenna A., Orsaria P., Papalia R., Papalia G. F., Parisi F. R., Prata F., Salzillo R., Santini S., Sofo F., Zampoli A., Tanda C., Altieri G., Ardito F., Belia F., Bianchi V., Biondi A., Brisinda G., Chiappetta M., Ciolli G., Ciolli A., Ferracci F., Ferri L., Fico V., Fiorillo C., Fransvea P., Galiandro F., Giovinazzo F., La Greca A., Litta F., Mele C., Pafundi D. P., Panettieri E., Papa V., Patini R., Perrotta G., Puccioni C., Santocchi P., Armatura G., Olmi S., Casoni Pattacini G., Salgarello S., Trompetto M., Bombardini C., La Rocca R., Celentano G., Micalef A., Mazzella A., Settembrini A., Zoia C., Degrate L., Musumeci G., Palopoli C. A. M., Montori G., Bonati E., Dinuzzi V. P., Velluti F., Balla A., Bonasia D. E., Coletta D., Berardi G., Colasanti M., Ferretti S., Gasparoli C., Mariano G., Avenia S., Cianci P., Cestino L., Festa F., Fazio F., Ascari F., Desio M., Arroyo Murillo G. A., Cereda M., Galleano R., David G., Pansini A., Gazia C., Atzori G., Desideri L. F., Famularo S., Galvanin J., Giudici V. M., Mangiameli G., Mei S., Milana F., Pansa A., Sacchi M., Testori A., Di Carlo G., Paratore M., Perrone U., Vagge A., Vigano J., Torre B., Scotti M. A., Carbone G., Cerchione R., De Nardi P., Gozzini L., Ottaviani L., Senni C., Piccin O., Pio L., Colombo F., Avantifiori R., Baldassarri V., Caronna R., Cicerchia P. M., Corallino D., Crocetti D., Gallo G., Giovanardi F., Giovannetti F., Hassan R., Iossa A., Lai Q., Lancellotti F., Lucarini A., Lucchese S., Mazzarella G., Melandro F., Minervini A., Muttillo E. M., Palmieri L., Pasqua R., Rosiello F., Salina G., Sibio S., Sirignano P., Tarallo M., Usai S., Vanni C., Viglietta E., Zambon M., Conversano N. I., Epifani A. G., Milano V., Sacco L., Nava M., Maffioli A., Giuratrabocchetta S., Baracchi F., Zuolo M., Ceresoli M., Verdi D., Belli A., Pata F., Piovano E., Pastore G., Bernabei F., Deiana S., Arceri A., D'Agostino C., Marafante C., Moggia E., Parini S., Moretti M., Uggeri F., Pontarolo N., Fontana T., Palmisano G., Giuffrida M., Guaitoli E., Ferretti C., Iacopino G., Gioco R., Roscitano G., Montanelli P., Chiappetta M. F., Pinotti E., Monati E., Fazio G., Di Pietro F., Damarco F., Barberis A., Razzore A., Pascale A., Loi S., Ferrara F., Rossi M., Lisi G., Viel G., Sasia D., Bono D., Cordaro E. R., Giacomelli E., Giani I., Seriau L., Pellino G., Sparavigna M., Trigiante G., D'Ambrogio R. G., Cardella F., Guzzetti S., Luzzi A. -P., Carganico G., Drago B., Micheletto G., Orlandi R., Cutolo C., Gibello U., Mistrangelo M., Forcignano E., D'Ugo S., Losurdo P., Manitto M., Caroli G., Franco M., Tilocca P. L., Mendogni P., Sena G., Sambucci D., Luciani C., Atelli P., Guida A., Marino F., Morini A., Sibilla M. G., Longo F., Giaccari S., Vigorita V., Balduzzi A., Barra F., Delogu D., Milone E., Bencini L., Aprile V., Papini P., Montemurro N., Cavallo M., Picciariello A., Tomasicchio G., Fittipaldi A., Maruccia M., Gerardi S., Cillara N., Deidda S., Demarinis G., Peiretti E., Tatti F., Iovino C., Isola G., Progno V. C., Migliore M., Badessi G., Barilla C., Calleri G. S., Cianci S., Fama F., Fleres F., Mazzeo C., Visaloco M. G., Marchetto C., Bolognesi F., Benuzzi L., Bracchetti G., Brucchi F., Manzo C. A., Scaravilli L., Ferrari C., Rocca A., Napolitano P., Anoldo P., Caricato C., Manigrasso M., Milone M., Napolitano L., Palomba G., Schiavone V., Vetrella M., Grossi U., Moletta L., Annicchiarico A., Vella I., Talesa G., Boggi U., Aiello F., Anselmo A., Bacchiocchi G., Beati F., Bellato V., Billeci F., Blasi F., Buonomo O. C., Campanelli M., Coco G., Contadini A., Conte L. E., D'Ippolito G., Di Marcantonio A., Spicchiale C. F., Afflitto G. G., Gismondi A., Gorgolini G., Granai A. V., Grande S., Gravina A., Guida A. M., Ingallinella S., Keci L., Latini E., Marino D., Oddi F. M., Orecchia L., Don C. B. P., Pellicciaro M., Petagna L., Pirozzi B. M., Quaranta C., Rho M., Rosina A., Santicchia M. S., Saraceno F., Schiavone A., Sensi B., Spina A., Sullo L., Tacconi F., Taje R., Vanni G., Vinci D., Vita G., Alba G., Badalucco S., Carbone L., Samorani O. C., Chisci G., Cuomo R., Francia A., Fusario D., Gargiulo B., Pasqui E., Pasquetti L., Puoti P., Resca L., Cumbo J., Ganio S., Vizzielli G., Anastasi M., Guerra D., Romanzi A., Vannelli A., Baia M., Siragusa, L, Angelico, R, Angrisani, M, Zampogna, B, Materazzo, M, Sorge, R, Giordano, L, Meniconi, R, Coppola, A, Marino, A, Giraudo, G, Esposito, S, Urbani, A, De Pastena, M, Mastrapasqua, R, Garancini, M, Frontal, A, Pascal, G, Martellucc, J, Falb, F, Boscarelli, A, Bertoglio, P, Trecca, E, Galassi, L, Vento, V, Chiappini, A, Antonelli, A, Bennardo, F, Familiari, F, Giannaccare, G, Zappia, A, Giuliani, G, Falcone, F, Sebastiani, S, Montuori, M, Rossi, S, Sagnotta, A, Giuliani, B, Imbriani, G, Restaino, S, Andreani, L, Di Maria, F, Lagana, A, Vitiello, L, Berton, F, Virgilio, E, Palisi, M, Portigliotti, L, Calussi, M, Conti, L, Mauriello, C, Barone, M, Saladino, E, Giaquinta, A, Zerb, D, Frazzetta, G, Merola, G, Chierici, A, Bini, R, Centonze, L, De Carlis, R, Ferrario, L, Giani, A, 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Abstract

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March–April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients’ management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons’ personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon–patient/family communication. From the Italian surgeons’ perspective, COVID-related measures will continue to influence

Published
2023

6. How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

Author

Siragusa, L., Angelico, R., Angrisani, M., Zampogna, B., Materazzo, M., Sorge, R., Giordano, Lucia, Meniconi, R., Coppola, A., Marino, A., Giraudo, G., Esposito, S., Urbani, A., De Pastena, M., Mastrapasqua, R., Garancini, M., Frontal, A., Pascal, G., Martellucc, J., Falb, F., Boscarelli, A., Bertoglio, P., Trecca, E., Galassi, L., Vento, V., Chiappini, A., Antonelli, A., Bennardo, F., Familiari, F., Giannaccare, G., Zappia, A. S., Giuliani, G., Falcone, F., Sebastiani, S., Montuori, M., Rossi, S., Sagnotta, A., Giuliani, B., Imbriani, G. C., Restaino, S., Andreani, L., Di Maria, F., Lagana, A. S., Vitiello, L., Berton, F., Virgilio, E., Palisi, M., Portigliotti, L., Calussi, M., Conti, L., Mauriello, C., Barone, Alessia Maria Addolorata, Saladino, E., Giaquinta, A., Zerb, D., Frazzetta, G., Merola, G., Chierici, A., Bini, R., Centonze, L., De Carlis, R., Ferrario, L., Giani, A., Lauterio, A., Tamini, N., Corti, Serafino, Botteri, E., Andreuccetti, J., D'Alessio, R., Cestaro, G., Clarizia, G., Spolini, A., Carboni, A. S., Benzoni, E., Galiffa, G., Perotti, B., Veroux, M., Randazzo, V., Topa, D., Pranteda, C., Contini, G., Iacusso, C., Voglino, V., Vita, P., Carrano, F. M., Ambrosio, L., Cammarata, R., Capolupo, G. T., Caputo, D., Carannante, F., Cascone, C., Esperto, F., Farolfi, T., Frasca, L., Gallo, I. F., Gibin, G., Giurazza, G., Improta, L., La Vaccara, V., Luffarelli, P., Luvero, D., Marangi, Giuseppe, Masciana, G., Mazzola, A., Mazzotta, E., Miligi, C. I., Montelione, N., Nenna, A., Orsaria, P., Papalia, R., Papalia, G. F., Parisi, F. R., Prata, F., Salzillo, R., Santini, Stefano Angelo, Sofo, F., Zampoli, A., Tanda, C., Altieri, G., Ardito, Francesco, Belia, Francesco, Bianchi, V., Biondi, Alberto, Brisinda, Giuseppe, Chiappetta, M., Ciolli, G., Ciolli, Alessandro, Ferracci, Federica, Ferri, L., Fico, V., Fiorillo, Claudio, Fransvea, Pietro, Galiandro, F., Giovinazzo, F., La Greca, Antonio, Litta, Francesco, Mele, C., Pafundi, D. P., Panettieri, Elena, Papa, Valerio, Patini, Romeo, Perrotta, Generoso, Puccioni, Caterina, Santocchi, P., Armatura, G., Olmi, S., Casoni Pattacini, G., Salgarello, S., Trompetto, M., Bombardini, C., La Rocca, R., Celentano, G., Micalef, A., Mazzella, A., Settembrini, A., Zoia, C., Degrate, L., Musumeci, Giampaolo, Palopoli, C. A. M., Montori, G., Bonati, E., Dinuzzi, V. P., Velluti, F., Balla, A., Bonasia, D. E., Coletta, D., Berardi, Giulia, Colasanti, M., Ferretti, Serena, Gasparoli, C., Mariano, Giuseppantonio, Avenia, S., Cianci, P., Cestino, L., Festa, F., Fazio, F., Ascari, F., Desio, M., Arroyo Murillo, G. A., Cereda, M., Galleano, R., David, G., Pansini, A., Gazia, C., Atzori, G., Desideri, L. F., Famularo, S., Galvanin, J., Giudici, V. M., Mangiameli, Gaetano, Mei, S., Milana, F., Pansa, A., Sacchi, Dario Marco, Testori, A., Di Carlo, Giampiero, Paratore, Mattia, Perrone, U., Vagge, A., Vigano, J., Torre, B., Scotti, M. A., Carbone, G., Cerchione, R., De Nardi, P., Gozzini, L., Ottaviani, Letizia, Senni, C., Piccin, O., Pio, L., Colombo, F., Avantifiori, R., Baldassarri, V., Caronna, R., Cicerchia, P. M., Corallino, D., Crocetti, D., Gallo, Giuseppe, Giovanardi, F., Giovannetti, F., Hassan, R., Iossa, A., Lai, Q., Lancellotti, F., Lucarini, A., Lucchese, S., Mazzarella, Giulio, Melandro, F., Minervini, A., Muttillo, E. M., Palmieri, L., Pasqua, R., Rosiello, F., Salina, Giulia, Sibio, S., Sirignano, P., Tarallo, M., Usai, S., Vanni, C., Viglietta, E., Zambon, M., Conversano, N. I., Epifani, A. G., Milano, Valentina, Sacco, L., Nava, Bruna Maria, Maffioli, A., Giuratrabocchetta, S., Baracchi, F., Zuolo, M., Ceresoli, M., Verdi, D., Belli, Andrea, Pata, F., Piovano, E., Pastore, G., Bernabei, F., Deiana, S., Arceri, A., D'Agostino, Cinzia, Marafante, C., Moggia, E., Parini, S., Moretti, M., Uggeri, F., Pontarolo, N., Fontana, T., Palmisano, Gerardo, Giuffrida, M., Guaitoli, E., Ferretti, C., Iacopino, G., Gioco, R., Roscitano, G., Montanelli, P., Chiappetta, M. F., Pinotti, E., Monati, E., Fazio, G., Di Pietro, F., Damarco, F., Barberis, A., Razzore, A., Pascale, A., Loi, S., Ferrara, F., Rossi, Marco, Lisi, G., Viel, G., Sasia, D., Bono, D., Cordaro, E. R., Giacomelli, E., Giani, I., Seriau, L., Pellino, Giuseppe, Sparavigna, M., Trigiante, G., D'Ambrogio, R. G., Cardella, F., Guzzetti, S., Luzzi, A. -P., Carganico, G., Drago, B., Micheletto, G., Orlandi, R., Cutolo, C., Gibello, U., Mistrangelo, M., Forcignano, E., D'Ugo, S., Losurdo, P., Manitto, M., Caroli, G., Franco, Manuela, Tilocca, P. L., Mendogni, P., Sena, G., Sambucci, D., Luciani, C., Atelli, P., Guida, Maria Antonietta, Marino, Filippo, Morini, A., Sibilla, M. G., Longo, Fabio, Giaccari, S., Vigorita, V., Balduzzi, A., Barra, F., Delogu, D., Milone, E., Bencini, L., Aprile, V., Papini, P., Montemurro, N., Cavallo, Michele, Picciariello, A., Tomasicchio, G., Fittipaldi, A., Maruccia, M., Gerardi, S., Cillara, N., Deidda, Silvia, Demarinis, G., Peiretti, E., Tatti, F., Iovino, C., Isola, G., Progno, V. C., Migliore, M., Badessi, G., Barilla, C., Calleri, G. S., Cianci, Stefano, Fama, F., Fleres, F., Mazzeo, C., Visaloco, M. G., Marchetto, C., Bolognesi, F., Benuzzi, L., Bracchetti, G., Brucchi, F., Manzo, C. A., Scaravilli, L., Ferrari, C., Rocca, A., Napolitano, Paola, Anoldo, P., Caricato, Chiara, Manigrasso, M., Milone, Maria, Napolitano, L., Palomba, G., Schiavone, V., Vetrella, M., Grossi, U., Moletta, L., Annicchiarico, A., Vella, I., Talesa, G., Boggi, U., Aiello, F., Anselmo, Anna, Bacchiocchi, G., Beati, F., Bellato, V., Billeci, F., Blasi, F., Buonomo, O. C., Campanelli, M., Coco, G., Contadini, A., Conte, L. E., D'Ippolito, G., Di Marcantonio, A., Spicchiale, C. F., Afflitto, G. G., Gismondi, A., Gorgolini, G., Granai, A. V., Grande, S., Gravina, A., Guida, A. M., Ingallinella, S., Keci, L., Latini, E., Marino, D., Oddi, F. M., Orecchia, L., Don, C. B. P., Pellicciaro, M., Petagna, L., Pirozzi, B. M., Quaranta, Caterina, Rho, M., Rosina, Alessandro, Santicchia, M. S., Saraceno, F., Schiavone, A., Sensi, B., Spina, A., Sullo, L., Tacconi, F., Taje, R., Vanni, G., Vinci, D., Vita, G., Alba, G., Badalucco, S., Carbone, Luigi, Samorani, O. C., Chisci, G., Cuomo, Rosa, Francia, A., Fusario, D., Gargiulo, B., Pasqui, E., Pasquetti, L., Puoti, P., Resca, L., Cumbo, J., Ganio, S., Vizzielli, Giuseppe, Anastasi, M., Guerra, D., Romanzi, A., Vannelli, A., Baia, M., Giordano L., Barone M., Corti S., Marangi G. (ORCID:0000-0002-6898-8882), Santini S. (ORCID:0000-0003-1956-5899), Ardito F. (ORCID:0000-0003-1596-2862), Belia F., Biondi A. (ORCID:0000-0002-2470-7858), Brisinda G. (ORCID:0000-0001-8820-9471), Ciolli A., Ferracci F., Fiorillo C. (ORCID:0000-0001-7681-3567), Fransvea P. (ORCID:0000-0003-4969-3373), La Greca A. (ORCID:0000-0002-7587-7427), Litta F., Panettieri E., Papa V. (ORCID:0000-0002-3709-8924), Patini R. (ORCID:0000-0001-7358-8763), Perrotta G., Puccioni C., Musumeci G., Berardi G., Ferretti S., Mariano G., Mangiameli G., Sacchi M. (ORCID:0000-0003-2826-8431), Di Carlo G., Paratore M., Ottaviani L. (ORCID:0009-0001-0967-8809), Gallo G., Mazzarella G., Salina G., Milano V., Nava M., Belli A., D'Agostino C., Palmisano G., Rossi M. (ORCID:0000-0002-4539-5670), Pellino G., Franco M., Guida A., Marino F., Longo F., Cavallo M., Deidda S., Cianci S., Napolitano P., Caricato C., Milone M., Anselmo A., Quaranta C., Rosina A. (ORCID:0000-0002-0158-0583), Carbone L., Cuomo R., Vizzielli G., Siragusa, L., Angelico, R., Angrisani, M., Zampogna, B., Materazzo, M., Sorge, R., Giordano, Lucia, Meniconi, R., Coppola, A., Marino, A., Giraudo, G., Esposito, S., Urbani, A., De Pastena, M., Mastrapasqua, R., Garancini, M., Frontal, A., Pascal, G., Martellucc, J., Falb, F., Boscarelli, A., Bertoglio, P., Trecca, E., Galassi, L., Vento, V., Chiappini, A., Antonelli, A., Bennardo, F., Familiari, F., Giannaccare, G., Zappia, A. S., Giuliani, G., Falcone, F., Sebastiani, S., Montuori, M., Rossi, S., Sagnotta, A., Giuliani, B., Imbriani, G. C., Restaino, S., Andreani, L., Di Maria, F., Lagana, A. S., Vitiello, L., Berton, F., Virgilio, E., Palisi, M., Portigliotti, L., Calussi, M., Conti, L., Mauriello, C., Barone, Alessia Maria Addolorata, Saladino, E., Giaquinta, A., Zerb, D., Frazzetta, G., Merola, G., Chierici, A., Bini, R., Centonze, L., De Carlis, R., Ferrario, L., Giani, A., Lauterio, A., Tamini, N., Corti, Serafino, Botteri, E., Andreuccetti, J., D'Alessio, R., Cestaro, G., Clarizia, G., Spolini, A., Carboni, A. S., Benzoni, E., Galiffa, G., Perotti, B., Veroux, M., Randazzo, V., Topa, D., Pranteda, C., Contini, G., Iacusso, C., Voglino, V., Vita, P., Carrano, F. M., Ambrosio, L., Cammarata, R., Capolupo, G. T., Caputo, D., Carannante, F., Cascone, C., Esperto, F., Farolfi, T., Frasca, L., Gallo, I. F., Gibin, G., Giurazza, G., Improta, L., La Vaccara, V., Luffarelli, P., Luvero, D., Marangi, Giuseppe, Masciana, G., Mazzola, A., Mazzotta, E., Miligi, C. I., Montelione, N., Nenna, A., Orsaria, P., Papalia, R., Papalia, G. F., Parisi, F. R., Prata, F., Salzillo, R., Santini, Stefano Angelo, Sofo, F., Zampoli, A., Tanda, C., Altieri, G., Ardito, Francesco, Belia, Francesco, Bianchi, V., Biondi, Alberto, Brisinda, Giuseppe, Chiappetta, M., Ciolli, G., Ciolli, Alessandro, Ferracci, Federica, Ferri, L., Fico, V., Fiorillo, Claudio, Fransvea, Pietro, Galiandro, F., Giovinazzo, F., La Greca, Antonio, Litta, Francesco, Mele, C., Pafundi, D. P., Panettieri, Elena, Papa, Valerio, Patini, Romeo, Perrotta, Generoso, Puccioni, Caterina, Santocchi, P., Armatura, G., Olmi, S., Casoni Pattacini, G., Salgarello, S., Trompetto, M., Bombardini, C., La Rocca, R., Celentano, G., Micalef, A., Mazzella, A., Settembrini, A., Zoia, C., Degrate, L., Musumeci, Giampaolo, Palopoli, C. A. M., Montori, G., Bonati, E., Dinuzzi, V. P., Velluti, F., Balla, A., Bonasia, D. E., Coletta, D., Berardi, Giulia, Colasanti, M., Ferretti, Serena, Gasparoli, C., Mariano, Giuseppantonio, Avenia, S., Cianci, P., Cestino, L., Festa, F., Fazio, F., Ascari, F., Desio, M., Arroyo Murillo, G. A., Cereda, M., Galleano, R., David, G., Pansini, A., Gazia, C., Atzori, G., Desideri, L. F., Famularo, S., Galvanin, J., Giudici, V. M., Mangiameli, Gaetano, Mei, S., Milana, F., Pansa, A., Sacchi, Dario Marco, Testori, A., Di Carlo, Giampiero, Paratore, Mattia, Perrone, U., Vagge, A., Vigano, J., Torre, B., Scotti, M. A., Carbone, G., Cerchione, R., De Nardi, P., Gozzini, L., Ottaviani, Letizia, Senni, C., Piccin, O., Pio, L., Colombo, F., Avantifiori, R., Baldassarri, V., Caronna, R., Cicerchia, P. M., Corallino, D., Crocetti, D., Gallo, Giuseppe, Giovanardi, F., Giovannetti, F., Hassan, R., Iossa, A., Lai, Q., Lancellotti, F., Lucarini, A., Lucchese, S., Mazzarella, Giulio, Melandro, F., Minervini, A., Muttillo, E. M., Palmieri, L., Pasqua, R., Rosiello, F., Salina, Giulia, Sibio, S., Sirignano, P., Tarallo, M., Usai, S., Vanni, C., Viglietta, E., Zambon, M., Conversano, N. I., Epifani, A. G., Milano, Valentina, Sacco, L., Nava, Bruna Maria, Maffioli, A., Giuratrabocchetta, S., Baracchi, F., Zuolo, M., Ceresoli, M., Verdi, D., Belli, Andrea, Pata, F., Piovano, E., Pastore, G., Bernabei, F., Deiana, S., Arceri, A., D'Agostino, Cinzia, Marafante, C., Moggia, E., Parini, S., Moretti, M., Uggeri, F., Pontarolo, N., Fontana, T., Palmisano, Gerardo, Giuffrida, M., Guaitoli, E., Ferretti, C., Iacopino, G., Gioco, R., Roscitano, G., Montanelli, P., Chiappetta, M. F., Pinotti, E., Monati, E., Fazio, G., Di Pietro, F., Damarco, F., Barberis, A., Razzore, A., Pascale, A., Loi, S., Ferrara, F., Rossi, Marco, Lisi, G., Viel, G., Sasia, D., Bono, D., Cordaro, E. R., Giacomelli, E., Giani, I., Seriau, L., Pellino, Giuseppe, Sparavigna, M., Trigiante, G., D'Ambrogio, R. G., Cardella, F., Guzzetti, S., Luzzi, A. -P., Carganico, G., Drago, B., Micheletto, G., Orlandi, R., Cutolo, C., Gibello, U., Mistrangelo, M., Forcignano, E., D'Ugo, S., Losurdo, P., Manitto, M., Caroli, G., Franco, Manuela, Tilocca, P. L., Mendogni, P., Sena, G., Sambucci, D., Luciani, C., Atelli, P., Guida, Maria Antonietta, Marino, Filippo, Morini, A., Sibilla, M. G., Longo, Fabio, Giaccari, S., Vigorita, V., Balduzzi, A., Barra, F., Delogu, D., Milone, E., Bencini, L., Aprile, V., Papini, P., Montemurro, N., Cavallo, Michele, Picciariello, A., Tomasicchio, G., Fittipaldi, A., Maruccia, M., Gerardi, S., Cillara, N., Deidda, Silvia, Demarinis, G., Peiretti, E., Tatti, F., Iovino, C., Isola, G., Progno, V. C., Migliore, M., Badessi, G., Barilla, C., Calleri, G. S., Cianci, Stefano, Fama, F., Fleres, F., Mazzeo, C., Visaloco, M. G., Marchetto, C., Bolognesi, F., Benuzzi, L., Bracchetti, G., Brucchi, F., Manzo, C. A., Scaravilli, L., Ferrari, C., Rocca, A., Napolitano, Paola, Anoldo, P., Caricato, Chiara, Manigrasso, M., Milone, Maria, Napolitano, L., Palomba, G., Schiavone, V., Vetrella, M., Grossi, U., Moletta, L., Annicchiarico, A., Vella, I., Talesa, G., Boggi, U., Aiello, F., Anselmo, Anna, Bacchiocchi, G., Beati, F., Bellato, V., Billeci, F., Blasi, F., Buonomo, O. C., Campanelli, M., Coco, G., Contadini, A., Conte, L. E., D'Ippolito, G., Di Marcantonio, A., Spicchiale, C. F., Afflitto, G. G., Gismondi, A., Gorgolini, G., Granai, A. V., Grande, S., Gravina, A., Guida, A. M., Ingallinella, S., Keci, L., Latini, E., Marino, D., Oddi, F. M., Orecchia, L., Don, C. B. P., Pellicciaro, M., Petagna, L., Pirozzi, B. M., Quaranta, Caterina, Rho, M., Rosina, Alessandro, Santicchia, M. S., Saraceno, F., Schiavone, A., Sensi, B., Spina, A., Sullo, L., Tacconi, F., Taje, R., Vanni, G., Vinci, D., Vita, G., Alba, G., Badalucco, S., Carbone, Luigi, Samorani, O. C., Chisci, G., Cuomo, Rosa, Francia, A., Fusario, D., Gargiulo, B., Pasqui, E., Pasquetti, L., Puoti, P., Resca, L., Cumbo, J., Ganio, S., Vizzielli, Giuseppe, Anastasi, M., Guerra, D., Romanzi, A., Vannelli, A., Baia, M., Giordano L., Barone M., Corti S., Marangi G. (ORCID:0000-0002-6898-8882), Santini S. (ORCID:0000-0003-1956-5899), Ardito F. (ORCID:0000-0003-1596-2862), Belia F., Biondi A. (ORCID:0000-0002-2470-7858), Brisinda G. (ORCID:0000-0001-8820-9471), Ciolli A., Ferracci F., Fiorillo C. (ORCID:0000-0001-7681-3567), Fransvea P. (ORCID:0000-0003-4969-3373), La Greca A. (ORCID:0000-0002-7587-7427), Litta F., Panettieri E., Papa V. (ORCID:0000-0002-3709-8924), Patini R. (ORCID:0000-0001-7358-8763), Perrotta G., Puccioni C., Musumeci G., Berardi G., Ferretti S., Mariano G., Mangiameli G., Sacchi M. (ORCID:0000-0003-2826-8431), Di Carlo G., Paratore M., Ottaviani L. (ORCID:0009-0001-0967-8809), Gallo G., Mazzarella G., Salina G., Milano V., Nava M., Belli A., D'Agostino C., Palmisano G., Rossi M. (ORCID:0000-0002-4539-5670), Pellino G., Franco M., Guida A., Marino F., Longo F., Cavallo M., Deidda S., Cianci S., Napolitano P., Caricato C., Milone M., Anselmo A., Quaranta C., Rosina A. (ORCID:0000-0002-0158-0583), Carbone L., Cuomo R., and Vizzielli G.

Abstract

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March–April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients’ management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons’ personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon–patient/family communication. From the Italian surgeons’ perspective, COVID-related measures will continue to influence

Published
2023

10. ffectiveness of Intensive Versus Minimalist Follow-Up Regimen on Survival in Patients With Endometrial Cancer (TOTEM Study): A Randomized, Pragmatic, Parallel Group, Multicenter Trial

Author

Zola, P, Ciccone, G, Piovano, E, Fuso, L, Di Cuonzo, D, Castiglione, A, Pagano, E, Peirano, E, Landoni, F, Sartori, E, Narducci, F, Bertetto, O, Ferrero, A, TOTEM Collaborative, Group., Zola, P, Ciccone, G, Piovano, E, Fuso, L, Di Cuonzo, D, Castiglione, A, Pagano, E, Peirano, E, Landoni, F, Sartori, E, Narducci, F, Bertetto, O, and Ferrero, A

Subjects
Cancer Research, Oncology, multicenter trial, follow-up endometrial cancer
Abstract

PURPOSE In the absence of clear evidence from randomized trials, the intensity of follow-up regimens after surgical treatment of endometrial cancer is highly variable in clinical practice. To reduce this uncertainty, we conducted a randomized trial to test whether an intensive (INT) versus a minimalist (MIN) follow-up regimen improves overall survival (OS) in patients undergoing operation for endometrial cancer. METHODS The TOTEM study was a large, pragmatic randomized trial, conducted in 42 hospitals (in Italy and France) including patients surgically treated for endometrial cancer, in complete clinical remission, International Federation of Gynecology and Obstetrics stage I-IV. After stratification by center and risk of relapse (low or high), patients were randomly assigned (1:1) to INT or MIN hospital-based follow-up regimens. The study was powered to demonstrate an absolute improvement of 5% of the 5-year OS with the INT regimen. RESULTS In total, 1,871 patients were randomly assigned between November 2008 and July 2018, and 1,847 patients (98.7%) were available for the final analysis (60% low risk). After a median follow-up of 69 months, the 5-year OS was 90.6% in the INT and 91.9% in the MIN arms (hazard ratio, 1.13, 95% CI, 0.86 to 1.50, P = .380). No differences in OS were found in subgroup analyses considering age, cancer treatment, risk of relapse, and degree of adherence of the center to the scheduled follow-up. The probability of detecting a relapse was slightly higher in the INT arm (hazard ratio, 1.17; 95% CI, 0.92 to 1.48; P = .194). CONCLUSION An INT follow-up in endometrial cancer–treated patients does not improve OS, even in high-risk patients. According to available evidence, there is no need to routinely add vaginal cytology, laboratory, or imaging investigations to the MIN regimens used in this trial.

Published
2022

11. Effectiveness of Intensive Versus Minimalist Follow-Up Regimen on Survival in Patients with Endometrial Cancer (TOTEM Study): A Randomized, Pragmatic, Parallel Group, Multicenter Trial

Author

Zola, P, Ciccone, G, Piovano, E, Fuso, L, Di Cuonzo, D, Castiglione, A, Pagano, E, Peirano, E, Landoni, F, Sartori, E, Narducci, F, Bertetto, O, Ferrero, A, Zola, Paolo, Ciccone, Giovannino, Piovano, Elisa, Fuso, Luca, Di Cuonzo, Daniela, Castiglione, Anna, Pagano, Eva, Peirano, Elena, Landoni, Fabio, Sartori, Enrico, Narducci, Fabrice, Bertetto, Oscar, Ferrero, Annamaria, Zola, P, Ciccone, G, Piovano, E, Fuso, L, Di Cuonzo, D, Castiglione, A, Pagano, E, Peirano, E, Landoni, F, Sartori, E, Narducci, F, Bertetto, O, Ferrero, A, Zola, Paolo, Ciccone, Giovannino, Piovano, Elisa, Fuso, Luca, Di Cuonzo, Daniela, Castiglione, Anna, Pagano, Eva, Peirano, Elena, Landoni, Fabio, Sartori, Enrico, Narducci, Fabrice, Bertetto, Oscar, and Ferrero, Annamaria

Abstract

PURPOSEIn the absence of clear evidence from randomized trials, the intensity of follow-up regimens after surgical treatment of endometrial cancer is highly variable in clinical practice. To reduce this uncertainty, we conducted a randomized trial to test whether an intensive (INT) versus a minimalist (MIN) follow-up regimen improves overall survival (OS) in patients undergoing operation for endometrial cancer.METHODSThe TOTEM study was a large, pragmatic randomized trial, conducted in 42 hospitals (in Italy and France) including patients surgically treated for endometrial cancer, in complete clinical remission, International Federation of Gynecology and Obstetrics stage I-IV. After stratification by center and risk of relapse (low or high), patients were randomly assigned (1:1) to INT or MIN hospital-based follow-up regimens. The study was powered to demonstrate an absolute improvement of 5% of the 5-year OS with the INT regimen.RESULTSIn total, 1,871 patients were randomly assigned between November 2008 and July 2018, and 1,847 patients (98.7%) were available for the final analysis (60% low risk). After a median follow-up of 69 months, the 5-year OS was 90.6% in the INT and 91.9% in the MIN arms (hazard ratio, 1.13, 95% CI, 0.86 to 1.50, P =.380). No differences in OS were found in subgroup analyses considering age, cancer treatment, risk of relapse, and degree of adherence of the center to the scheduled follow-up. The probability of detecting a relapse was slightly higher in the INT arm (hazard ratio, 1.17; 95% CI, 0.92 to 1.48; P =.194).CONCLUSIONAn INT follow-up in endometrial cancer-treated patients does not improve OS, even in high-risk patients. According to available evidence, there is no need to routinely add vaginal cytology, laboratory, or imaging investigations to the MIN regimens used in this trial.

Published
2022

12. O004/#393 Does intensive follow-up improve overall survivalin endometrial cancer patients? Results from the totem randomized controlled trial

Author

Zola, P, primary, Ciccone, G, additional, Angioli, R, additional, Terranova, C, additional, Piovano, E, additional, Fuso, L, additional, Di Cuonzo, D, additional, Peirano, E, additional, Perrone, AM, additional, Mandato, VD, additional, Zavallone, L, additional, Chiudinelli, F, additional, Berretta, R, additional, Loda, S, additional, Greggi, S, additional, Adorni, M, additional, Busato, E, additional, Comerci, G, additional, Fambrini, M, additional, and Ferrero, A, additional

Published
2021
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13. 673 An audit and feedback intervention to monitor quality of care of ovarian cancer according to ESGO guidelines in the Piemonte cancer network

Author

Ferrero, A, primary, Pagano, E, additional, Mistrangelo, M, additional, Fuso, L, additional, Martins, VH, additional, Valabrega, G, additional, Laudani, ME, additional, Marocco, F, additional, Surico, D, additional, Piovano, E, additional, Barbero, M, additional, Camanni, M, additional, Delpiano, EM, additional, Puppo, A, additional, Daniele, A, additional, Zavallone, L, additional, Aguggia, V, additional, Fiorentino, R, additional, Ciccone, G, additional, and Zola, P, additional

Published
2021
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14. 259 The impact of intensive follow-up on health-related quality of life and costs in endometrial cancer patients: data from the TOTEM trial NCT00916708

Author

Zola, P, primary, Ciccone, G, additional, Piovano, E, additional, Fuso, L, additional, Peirano, E, additional, Cuonzo, DDI, additional, Pagano, E, additional, Castiglione, A, additional, Perrone, AM, additional, Mandato, VD, additional, Zavallone, L, additional, Chiudinelli, F, additional, Berretta, R, additional, Loda, S, additional, Valenzano Menada, M, additional, Greggi, S, additional, Adorni, M, additional, Comerci, G, additional, Fambrini, M, additional, and Ferrero, A, additional

Published
2021
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16. LBA40 Phase III double-blind randomized placebo controlled trial of atezolizumab in combination with carboplatin and paclitaxel in women with advanced/recurrent endometrial carcinoma

Author

Colombo, N., Harano, K., Hudson, E., Galli, F., Antill, Y., Choi, C.H., Rabaglio, M., Marmé, F., Petru, E., Lai, C-H., Biagioli, E., Fariñas Madrid, L., Takehara, K., Allan, K., Lee, Y.C., Piovano, E., Zamagni, C., Tasca, G., Ferrero, A., and Barretina Ginesta, M.P.

Published
2023
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17. The impact of COVID-19 pandemic on surgical residency programmes in Italy: a nationwide analysis on behalf of the Italian Polyspecialistic Young Surgeons Society (SPIGC)

Author

Pertile, D., Gallo, G., Barra, F., Pasculli, A., Batistotti, P., Sparavigna, M., Vizzielli, G., Soriero, D., Graziano, G., Di Saverio, S., Meniconi, R. L., Guaitoli, E., Mazzarri, A., Aprile, A., Aprile, V., Botteri, E., Brascia, D., Cozza, V., Damarco, F., Di Marco, C., Gallazzi, M., Giovenzana, M., Giuffrida, M., Lanari, J., Lanza, G., Lo Surdo, P., Maglitto, F., Manitto, M., Minuzzo, A., Montelione, N., Palmieri, G., Pasqui, E., Perelli, F., Piovano, E., Portigliotti, L., Ribolla, M., Romano, A., Romboli, A., Sena, G., Settembrini, A., Sturiale, A., Velluti, F., 1, Davide Pertile, 2, Gaetano Gallo, 3, Fabio Barra, 4, Alessandro Pasculli, 1, Paola Batistotti, 1, Marco Sparavigna, 5, Giuseppe Vizzielli, 1, Domenico Soriero, 6, Giusi Graziano, 7, Salomone Di Saverio, 8, Roberto Luca Meniconi, 9, Eleonora Guaitoli, Mazzarri 10, Andrea, Working Group (Alessandra Aprile, Spigc, Aprile, Vittorio, Botteri, Emanuele, Brascia, Debora, Cozza, Valerio, Damarco, Francesco, Di Marco, Carlo, Gallazzi, Mariasole, Giovenzana, Marco, Giuffrida, Mario, Lanari, Jacopo, Lanza, Giovanni, Lo Surdo, Pasquale, Maglitto, Fabio, Manitto, Mattia, Minuzzo, Alessio, Montelione, Nunzio, Palmieri, Gerardo, Pasqui, Edoardo, Perelli, Federica, Piovano, Elisa, Portigliotti, Luca, Ribolla, Marta, Romano, Angela, Romboli, Andrea, Sena, Giuseppe, Settembrini, Alberto, Sturiale, Alessandro, and Velluti), Francesco

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Demographics, Pneumonia, Viral, Surgical activity, Economic shortage, Subgroup analysis, 030230 surgery, Italian surgical residents, Specialties, Surgical, 03 medical and health sciences, 0302 clinical medicine, Clinical activity, Medical, Surgical, Surveys and Questionnaires, Pandemic, medicine, Humans, Viral, COVID-19, Research activity, Survey, Internship and Residency, Italy, Societies, Medical, Coronavirus Infections, Pandemics, Training programme, Government, business.industry, Pneumonia, Surgery, 030220 oncology & carcinogenesis, Family medicine, Original Article, business, Societies, Specialties, Regional differences
Abstract

Introduction Recently, Italy has been heavily hit by COVID-19 pandemic and today it is still one of the most affected countries in the world. The subsequent necessary lockdown decreed by the Italian Government had an outstanding impact on the daily life of the entire population, including that of Italian surgical residents’ activity. Our survey aims to evaluate the impact of COVID-19 on the training programme of Italian surgical residents. Materials and methods We designed a 12-item-electronic anonymous questionnaire on SurveyMonkey© web application. The survey was composed of different sections concerning demographic characteristics and impacts of COVID-19 on the concrete participation in clinical, surgical and research activities. Future perspectives of responders after the pandemic were also investigated. Results Eighty hundred responses were collected, and 756 questionnaires were considered eligible to be included in the study analysis. Almost 35 and 27% of respondents experienced, respectively, complete interruption of surgical and clinical activities. A subgroup analysis, comparing the COVID-19 impact on clinical activities with demographics data, showed a statistically significant difference related to specialties (p = 0.0062) and Italian regions (p

Published
2020

22. Sentinel Lymph Node Biopsy in the Treatment of Endometrial Cancer: Why We Fail? Results of a Prospective Multicenter Study on the Factors Associated with Failure of Node Mapping with Indocyanine Green

Author

Andrea Puppo, Tommaso Staniscia, Giovanni Roviglione, F. Campolo, Marcello Ceccaroni, Di Martino G, Francesco Bruni, Piovano E, Manuel Maria Ianieri, Daniele Mautone, and Antonia Novelli

Subjects
Adult, Indocyanine Green, medicine.medical_specialty, Multivariate analysis, Sentinel lymph node, chemistry.chemical_compound, Risk Factors, Biopsy, medicine, Humans, Prospective Studies, Treatment Failure, Coloring Agents, Lymph node, Aged, Neoplasm Staging, Aged, 80 and over, medicine.diagnostic_test, business.industry, Sentinel Lymph Node Biopsy, Endometrial cancer, Uterus, Systematic lymphadenectomy, Obstetrics and Gynecology, Middle Aged, medicine.disease, Endometrial Neoplasms, medicine.anatomical_structure, Reproductive Medicine, Multicenter study, chemistry, Lymphatic Metastasis, Multivariate Analysis, Lymph Node Excision, Female, Laparoscopy, Radiology, Sentinel Lymph Node, business, Indocyanine green
Abstract

Background: The sentinel lymph node (SLN) mapping for endometrial cancer staging is gaining wide diffusion, but there is no definitive evidence on the factors associated with the failure of mapping. Objectives: To analyze the factors associated with the possible failure of bilateral SLN mapping with indocyanine green (ICG). Methods: A prospective observational study without control on 110 patients with endometrial cancer apparently confined to the uterus, underwent laparoscopic surgical staging with SLN mapping with ICG. Results: Possible risk factors associated with bilateral mapping failure were analyzed, and a multivariate analysis was performed. The bilateral detection rate for SLNs mapping was 72.7%, whereas at least one SLN was detected in 79.1% of patients. No SLNs were identified in 6.3%. None of the patients or features related to tumor were associated with a risk of failure of the method. The only factor analyzed that was significantly associated with the success of bilateral mapping was the surgeon (p = 0.003). Conclusions: Neither obesity nor the presence of lymph node metastases was associated with mapping failure. However, there remains a need for further studies to understand all the mechanisms linked to the unsuccessful method results and to reduce the use of systematic lymphadenectomy in the case of mapping failure.

Published
2018

27. Is there a role for postoperative treatment in patients with stage Ib 2-IIb cervical cancer treated with neo-adjuvant chemotherapy and radical surgery? An Italian multicenter retrospective study

Author

Landoni, F, Sartori, E, Maggino, T, Zola, P, Zanagnolo, V, Cosio, S, Ferrari, F, Piovano, E, Gadducci, A, Landoni F., Sartori E., Maggino T., Zola P., Zanagnolo V., Cosio S., Ferrari F., Piovano E., Gadducci A., Landoni, F, Sartori, E, Maggino, T, Zola, P, Zanagnolo, V, Cosio, S, Ferrari, F, Piovano, E, Gadducci, A, Landoni F., Sartori E., Maggino T., Zola P., Zanagnolo V., Cosio S., Ferrari F., Piovano E., and Gadducci A.

Abstract

Purpose Neoadjuvant chemotherapy [NACT] followed by radical hysterectomy is an alternative therapeutic option to concurrent chemotherapy-radiotherapy for locally advanced cervical cancer. However there are very few data about the effectiveness of any post-operative treatment in this clinical setting. The purpose of this study was to correlate the patterns of recurrence and the clinical outcomes of cervical cancer patients who received NACT, with postoperative adjuvant treatment. Patients and methods This retrospective multicenter study included 333 patients with FIGO stage Ib2-IIb cervical cancer who underwent platinum-based NACT followed by radical surgery. Pathological responses were retrospectively assessed as complete; optimal partial; and suboptimal response. Overall optimal response rate was the sum of complete and optimal partial response rates. Results On the whole series, recurrence-free survival was significantly longer in patients who achieved an overall optimal response than in those who did not (p < 0.0001), and in patients who received adjuvant chemotherapy compared to those who did not (p = 0.0001). On multivariate analysis, consolidation therapy (p = 0.0012) was the only independent prognostic variable for recurrence-free survival; whereas FIGO stage (p = 0.0169) and consolidation therapy (p = 0.0016) were independent prognostic variables for overall survival. Conclusion Optimal responders after chemo-surgical treatment for FIGO stage Ib2-IIb cervical cancer do not need any further treatment. Additional cycles of chemotherapy could be of benefit for patients with suboptimal response and intra-cervical residual disease. Both adjuvant chemotherapy and adjuvant radiation treatments do not seem to improve the clinical outcome of patients with extra-cervical residual disease compared to no further treatment. © 2014 Elsevier Inc.

Published
2014

28. The role of HE4 in ovarian cancer follow-up: A review

Author

Piovano, E, Attamante, L, Macchi, C, Cavallero, C, Romagnolo, C, Maggino, T, Landoni, F, Gadducci, A, Sartori, E, Gion, M, Zola, P, Piovano E., Attamante L., Macchi C., Cavallero C., Romagnolo C., Maggino T., Landoni F., Gadducci A., Sartori E., Gion M., Zola P., Piovano, E, Attamante, L, Macchi, C, Cavallero, C, Romagnolo, C, Maggino, T, Landoni, F, Gadducci, A, Sartori, E, Gion, M, Zola, P, Piovano E., Attamante L., Macchi C., Cavallero C., Romagnolo C., Maggino T., Landoni F., Gadducci A., Sartori E., Gion M., and Zola P.

Abstract

Objective: The aim of this review was to analyze the state of the art about HE4 and follow-up in patients treated for ovarian cancer. Methods: A literature search was conducted in the MEDLINE database using the key words "HE4" and "ovarian cancer" and "recurrence" or "relapse" or "follow up." Results: Seven of 28 clinical studies were selected. Four studies were prospective, and all of them were based on a small number of patients (8Y73 women). A failure of HE4 levels to normalize at completion of standard therapy may indicate a poor prognosis, thus suggesting the need of a closer follow-up. Moreover, HE4 showed better sensibility and specificity in the diagnosis of ovarian cancer recurrence with respect to CA-125, being also an earlier indicator of the relapse with a lead time of 5 to 8 months. HE4 showed a better performance in this setting if performed in association with other markers (CA-125, CA-72.4). HE4 seems to be an independent predictive factor for the surgical outcome at secondary cytoreductive surgery and to maintain its prognostic role even after the recurrence. Conclusions: These preliminary data start to suggest a superiority of HE4 over CA-125 in the detection of ovarian cancer recurrence. Moreover, the prognostic role of HE4 could help clinicians to personalize the follow-up program, whereas its predictive role could be useful to plan the treatment of the relapse. The role of HE4 in ovarian cancer follow-up deserves to be further investigated in prospective randomized multicentric studies.

Published
2014

29. Comparing proxy and model estimates of hydroclimate variability and change over the Common Era

Author

Smerdon, JE, Luterbacher, J, Phipps, SJ, Anchukaitis, KJ, Ault, T, Coats, S, Cobb, KM, Cook, BI, Colose, C, Felis, T, Gallant, A, Jungclaus, JH, Konecky, B, LeGrande, A, Lewis, S, Lopatka, AS, Man, W, Mankin, JS, Maxwell, JT, Otto-Bliesner, BL, Partin, JW, Singh, D, Steiger, NJ, Tierney, JE, Zanchettin, D, Zhang, H, Atwood, AR, Andreu-Hayles, L, Baek, SH, Buckley, B, Cook, ER, D’Arrigo, R, Dee, SG, Griffiths, ML, Kulkarni, C, Kushnir, Y, Lehner, F, Leland, C, Okazaki, A, Palmer, J, Piovano, E, Raible, CC, Rao, MP, Scheff, J, Schmidt, GA, Seager, R, Widmann, M, Xoplaki, E, Smerdon, JE, Luterbacher, J, Phipps, SJ, Anchukaitis, KJ, Ault, T, Coats, S, Cobb, KM, Cook, BI, Colose, C, Felis, T, Gallant, A, Jungclaus, JH, Konecky, B, LeGrande, A, Lewis, S, Lopatka, AS, Man, W, Mankin, JS, Maxwell, JT, Otto-Bliesner, BL, Partin, JW, Singh, D, Steiger, NJ, Tierney, JE, Zanchettin, D, Zhang, H, Atwood, AR, Andreu-Hayles, L, Baek, SH, Buckley, B, Cook, ER, D’Arrigo, R, Dee, SG, Griffiths, ML, Kulkarni, C, Kushnir, Y, Lehner, F, Leland, C, Okazaki, A, Palmer, J, Piovano, E, Raible, CC, Rao, MP, Scheff, J, Schmidt, GA, Seager, R, Widmann, M, and Xoplaki, E

Abstract

Water availability is fundamental to societies and ecosystems, but our understanding of variations in hydroclimate (including extreme events, flooding, and decadal periods of drought) is limited because of a paucity of modern instrumental observations that are distributed unevenly across the globe and only span parts of the 20th and 21st centuries. Such data coverage is insufficient for characterizing hydroclimate and its associated dynamics because of its multidecadal to centennial variability and highly regionalized spatial signature. High-resolution (seasonal to decadal) hydroclimatic proxies that span all or parts of the Common Era (CE) and paleoclimate simulations from climate models are therefore important tools for augmenting our understanding of hydroclimate variability. In particular, the comparison of the two sources of information is critical for addressing the uncertainties and limitations of both while enriching each of their interpretations. We review the principal proxy data available for hydroclimatic reconstructions over the CE and highlight the contemporary understanding of how these proxies are interpreted as hydroclimate indicators. We also review the available last-millennium simulations from fully coupled climate models and discuss several outstanding challenges associated with simulating hydroclimate variability and change over the CE. A specific review of simulated hydroclimatic changes forced by volcanic events is provided, as is a discussion of expected improvements in estimated radiative forcings, models, and their implementation in the future. Our review of hydroclimatic proxies and last-millennium model simulations is used as the basis for articulating a variety of considerations and best practices for how to perform proxy-model comparisons of CE hydroclimate. This discussion provides a framework for how best to evaluate hydroclimate variability and its associated dynamics using these comparisons and how they can better inform interpreta

Published
2017

30. Pathological response on surgical samples is an independent prognostic variable for patients with Stage Ib2-IIb cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy: An Italian multicenter retrospective study (CTF Study)

Author

Gadducci, A, Sartori, E, Maggino, T, Zola, P, Cosio, S, Zizioli, V, Lapresa, M, Piovano, E, Landoni, F, Gadducci A., Sartori E., Maggino T., Zola P., Cosio S., Zizioli V., Lapresa M., Piovano E., Landoni F., Gadducci, A, Sartori, E, Maggino, T, Zola, P, Cosio, S, Zizioli, V, Lapresa, M, Piovano, E, Landoni, F, Gadducci A., Sartori E., Maggino T., Zola P., Cosio S., Zizioli V., Lapresa M., Piovano E., and Landoni F.

Abstract

Objectives The purpose of this retrospective multicenter study was to correlate patterns of recurrences and clinical outcome of cervical cancer patients who underwent neoadjuvant chemotherapy [NACT] to surgery. Methods This study was conducted on 333 patients with FIGO stage Ib2-IIb cervical cancer who underwent NACT to surgery with pelvic lymphadenectomy. The median follow-up was 66.5 months (range, 8-212 months). Overall optimal response rate was the sum of complete and optimal partial response rates. Results An overall optimal response was obtained in 64 patients (19.2%). As for the 220 sub-optimal responders (66.1%), 127 patients had negative nodes and negative parametria and/or surgical margins, 75 patients had positive nodes with positive or negative parametria and/or surgical margins, and 18 patients had positive parametria and/or surgical margins with negative nodes. At the time of the present analysis, 79 (23.7%) of the 333 patients had a recurrence after a median time of 14.9 months (range, 4.5-123 months). Recurrent disease was pelvic in 50 (63.3%), extra-pelvic in 22 (27.9%), and both in 7 (8.8%). On multivariate analysis, pathological response to NACT was an independent prognostic variable for recurrence-free and overall survival. Patients who did not achieve an overall optimal response had a 2.757-fold higher risk of recurrence and a 5.413-fold higher risk of death than those who obtained an overall optimal response. Conclusions Results appear to suggest that the chemo-surgical approach is an effective therapeutic option for patients with stage Ib2-IIb cervical cancer and that pathological response to NACT is the strongest prognostic factor for the outcome. © 2013 Elsevier Inc.

Published
2013

32. Surveillance procedures for patients treated for endometrial cancer: A review of the literature

Author

Sartori, E, Pasinetti, B, Chiudinelli, F, Gadducci, A, Landoni, F, Maggino, T, Piovano, E, Zola, P, Sartori E., Pasinetti B., Chiudinelli F., Gadducci A., Landoni F., Maggino T., Piovano E., Zola P., Sartori, E, Pasinetti, B, Chiudinelli, F, Gadducci, A, Landoni, F, Maggino, T, Piovano, E, Zola, P, Sartori E., Pasinetti B., Chiudinelli F., Gadducci A., Landoni F., Maggino T., Piovano E., and Zola P.

Abstract

Objectives: The aim of this review was to analyze the role of follow-up in patients treated for endometrial cancer and to provide some compelling issues that may contribute to improve daily practice while waiting for evidence-based guidelines. Methods/Materials: A literature search has been conducted in MEDLINE database using key words "endometrial neoplasms" and "follow up". Results: Endometrial cancer represents the most common gynecologic malignancy after breast cancer. The overall recurrence rate is 13% and correlates with prognostic factors of the primary tumor. The anatomic sites of endometrial cancer relapse are mostly equivalently distributed between local (pelvic) and distant (abdominal and chest). Most endometrial cancer recurrences are symptomatic, even if vaginal vault relapses represent a particular setting of a more frequently asymptomatic disease. Most of endometrial cancer recurrences occur within 3 years since diagnosis of primary tumor. Long-term surveillance programs are mainly addressed to the early detection of recurrence, the rationale of follow-up being that an earlier diagnosis of relapse correlates with lower morbidity and mortality rates. Adjunctive objectives of routine follow-up are identification of treatment complications and detection of possible second tumors associated with endometrial cancer. Conclusions: No rationale (examination sensitivity/sensibility, cost-effectiveness, or patient's survival benefit) is available today for any particular follow-up protocol; follow-up procedures should probably be tailored according to different prognostic factors; only physical examination, including pelvic-rectal examination, showed some utility in detecting recurrence. In this uncertain setting, follow-up interval should be defined with the consideration of the patient's will. Copyright © 2010 by IGCS and ESGO.

Published
2010

33. Could follow-up different modalities play a role in asymptomatic cervical cancer relapses diagnosis?. An Italian multicenter retrospective analysis

Author

Zola, P, Fuso, L, Mazzola, S, Piovano, E, Perotto, S, Gadducci, A, Galletto, L, Landoni, F, Maggino, T, Raspagliesi, F, Sartori, E, Scambia, G, Zola P., Fuso L., Mazzola S., Piovano E., Perotto S., Gadducci A., Galletto L., Landoni F., Maggino T., Raspagliesi F., Sartori E., Scambia G., Zola, P, Fuso, L, Mazzola, S, Piovano, E, Perotto, S, Gadducci, A, Galletto, L, Landoni, F, Maggino, T, Raspagliesi, F, Sartori, E, Scambia, G, Zola P., Fuso L., Mazzola S., Piovano E., Perotto S., Gadducci A., Galletto L., Landoni F., Maggino T., Raspagliesi F., Sartori E., and Scambia G.

Abstract

Objective: The aim of this study was to evaluate how much clinical surveillance performed by follow-up scheduled appointments may correctly identify asymptomatic recurrences and describe the pattern of relapse detected by procedures. Methods: The records of 327 consecutive women with recurrent cervical cancer treated from 1980 to 2005 were retrospectively collected in 8 Italian Institutions. Primary disease and recurrence data were picked up: diagnosis, type of treatment, FIGO stage, tumour grade, histology, clinical lesion size, number of localizations and site of relapse, presence of symptoms and primary method of detection, the type of treatment of recurrence and follow-up data, such as appointment date, clinical status and procedure performed. A multivariate analysis was carried out using the Cox proportional hazards regression model. Survival curves were calculated using the Kaplan-Meier technique. Survival differences were evaluated by the log-rank test. Results: Sixty-seven out of 327 patients (20.5%) had a local recurrence on vaginal vault, 120 (36.7%) in central pelvis, 31 (9.5%) in pelvic wall, 16 cases (4.9%) in lymph nodes. Seventy-nine patients (24.2%) showed a distant relapse while 14 (4.3%) developed both a distant and local relapse. Among patients with distant relapses 39 (49.4%) had lung metastasis, 41 (51.9%) an hepatic recurrence, 4 (5.1%) a bone relapse. Among distant sites 32 out of 79 patients (40.5%) had single relapse and 46 (58.2%) had multiple localizations. The site of relapse influenced survival since patients with vaginal vault recurrences lived significantly longer than patients with recurrences in other sites. Ninety-seven (29.7%) patients were symptomatic and anticipated the scheduled visit, 66 (20.2%) reported their symptoms during the follow-up visit and 164 (50.1%) were asymptomatic and the diagnostic path was introduced by a planned visit or exam. Between asymptomatic patients the first procedure was clinical visit for 85 patients

Published
2007

34. Could follow-up different modalities play a role in asymptomatic cervical cancer relapses diagnosis? An Italian multicenter retrospective analysis

Author

Zola P., Fuso L., Mazzola S., Piovano E., Perotto S., Gadducci A., Galletto L., Landoni F., Maggino T., Raspagliesi F., Sartori E., Scambia G., Zola, P, Fuso, L, Mazzola, S, Piovano, E, Perotto, S, Gadducci, A, Galletto, L, Landoni, F, Maggino, T, Raspagliesi, F, Sartori, E, and Scambia, G

Subjects
Vaginal Smears, Uterine Cervical Neoplasm, Follow-up, Uterine Cervical Neoplasms, Follow-Up Studie, Retrospective Studie, Recurrence, Multivariate Analysis, Cervical cancer, Proportional Hazards Model, Humans, Female, Relapse, Neoplasm Recurrence, Local, Multivariate Analysi, Human, Follow-Up Studies, Papanicolaou Test, Proportional Hazards Models, Retrospective Studies
Abstract

Objective: The aim of this study was to evaluate how much clinical surveillance performed by follow-up scheduled appointments may correctly identify asymptomatic recurrences and describe the pattern of relapse detected by procedures. Methods: The records of 327 consecutive women with recurrent cervical cancer treated from 1980 to 2005 were retrospectively collected in 8 Italian Institutions. Primary disease and recurrence data were picked up: diagnosis, type of treatment, FIGO stage, tumour grade, histology, clinical lesion size, number of localizations and site of relapse, presence of symptoms and primary method of detection, the type of treatment of recurrence and follow-up data, such as appointment date, clinical status and procedure performed. A multivariate analysis was carried out using the Cox proportional hazards regression model. Survival curves were calculated using the Kaplan-Meier technique. Survival differences were evaluated by the log-rank test. Results: Sixty-seven out of 327 patients (20.5%) had a local recurrence on vaginal vault, 120 (36.7%) in central pelvis, 31 (9.5%) in pelvic wall, 16 cases (4.9%) in lymph nodes. Seventy-nine patients (24.2%) showed a distant relapse while 14 (4.3%) developed both a distant and local relapse. Among patients with distant relapses 39 (49.4%) had lung metastasis, 41 (51.9%) an hepatic recurrence, 4 (5.1%) a bone relapse. Among distant sites 32 out of 79 patients (40.5%) had single relapse and 46 (58.2%) had multiple localizations. The site of relapse influenced survival since patients with vaginal vault recurrences lived significantly longer than patients with recurrences in other sites. Ninety-seven (29.7%) patients were symptomatic and anticipated the scheduled visit, 66 (20.2%) reported their symptoms during the follow-up visit and 164 (50.1%) were asymptomatic and the diagnostic path was introduced by a planned visit or exam. Between asymptomatic patients the first procedure was clinical visit for 85 patients out of 164 patients (51.8%), imaging for 60 patients (36.6%), both clinical visit and imaging for 14 (8.5%) and cytology for 5 (3%, Pap smear test). The median OS of symptomatic patients was 37months versus 109months of asymptomatic patients (Log rank, p = 0.00001). The median survival since recurrence was 9months for symptomatic patients and median was not reached for asymptomatic patients (p < 0.0001). The median disease-free interval was 24months for asymptomatic patients vs. 36months for symptomatic patients (p = 0.03). Conclusions: Our study helps demonstrate the great need of prospective cost-effectiveness studies which are lacking at the present time

Published
2007

36. Palaeolimnology of Lake Hess (Patagonia, Argentina): multi-proxy analyses in short sediment cores

Author

Guilizzoni P., Massaferro J. (1), Lami A., Piovano E. (2), Ribeiro Guevara S. (3), Formica S. (2), Daga R. (3), Rizzo A. (3), and Gerli S.

Subjects
pigments, Patagonia, chironomids, palaeolimnology, South America
Abstract

By contrast with the extensive palaeolimnological studies carried out in North America and Europe, relatively few studies have described the anthropogenic and/or climate impacts in Patagonian lakes. We addressed these issues by analysing geochemistry, lithology, pigments and chironomid remains from sediment cores collected from Lake Hess (41° 22´ 20” S, 71° 44´ 0” W) located in the Nahuel Huapi National Park, in northern Patagonia. The aim of this study is to provide a palaeoenvironmental and climate reconstruction of the past ca. three centuries for this cold oligotrophic, quasi-pristine lake which receives melt waters from the Tronador ice cap. Chronology was based on 137Cs and 210Pb measurements of the upper sediments and the inferred sedimentation rate of 23.2 mg cm-2 y-1 (0.15 cm y-1) was consistent with both sets of measurements. The sediment from Lake Hess was rich in tephra deposits particularly evident in the lower part of the cores. Tephras are valuable to use for core correlation and can be traced through peaks in the magnetic susceptibility profiles. Results from the multiproxy analyses in the longest core (83 cm) identify three main phases of change. From the bottom up to 42 cm (ca. A.D.1800), the sediment is composed of light-grey organically rich clays. Both pigments and chironomids suggest variable trends in productivity and precipitation regime. At the end of the Little Ice Age chronozone (A.D. 1770-1850), pigment concentrations were very low. From 42 cm to ca. 25 cm (A.D. 1800-1940), the sedimentary record is composed of alternating black and dark organic-matter rich mud with variable amounts of macrophyte remains. Pigment concentrations and chironomid head capsule counts were also very low. These facies are composed of very fine plastic sediments with some faintly laminated intervals and an organic matter composition gradually decreasing towards the top of the zone. A sharp change occurs at 25 cm (ca. A.D. 1940) showing a strong increase in organic matter content, algal nutrients, and plant pigments together with a change in the chironomid assemblages. This might document a change in the trophic condition of the lake associated with changes in erosion/deposition rates. Although there are records of human impact in the area studied, involving the use of fires, most of the observed chemical and biological changes in Lake Hess sediment sequence were interpreted in terms of climate changes, especially to changes in moisture balance brought about by variations in the strength of the westerlies.

Published
2009

39. Total Microlaparoscopic Radical Hysterectomy in Early Cervical Cancer

Author

Fanfani, Francesco, Gallotta, V, Fagotti, Anna, Rossitto, C, Piovano, E, Scambia, Giovanni, Fagotti, A (ORCID:0000-0001-5579-335X), Scambia, Giovanni (ORCID:0000-0003-2758-1063), Fanfani, Francesco, Gallotta, V, Fagotti, Anna, Rossitto, C, Piovano, E, Scambia, Giovanni, Fagotti, A (ORCID:0000-0001-5579-335X), and Scambia, Giovanni (ORCID:0000-0003-2758-1063)

Abstract

BACKGROUND AND OBJECTIVE: In less than 2 decades, laparoscopy has contributed to modification in the management of early cervical cancer patients, and all comparisons between open and laparoscopic-based radical operations showed an identical oncological outcome. The aim of this study is to describe surgical instrumentations and technique to perform total microlaparoscopy radical hysterectomy in early cervical cancer patients and report our preliminary results in terms of operative time and perioperative outcomes. METHODS: Between January 1, 2012, and March 25, 2012, 4 consecutive early cervical cancer patients were enrolled in this study. RESULTS: We performed 3 type B2 and 1 type C1-B2 total microlaparoscopy radical hysterectomy, and in all cases concomitant bilateral salpingo-oophorectomy and pelvic lymphadenectomy were carried out. Median operative time was 165 minutes (range: 155 to 215) (mean: 186), and median estimated blood loss was 30 mL (range: 20 to 50). Median number of pelvic lymph nodes removed was 12 (range: 11 to 15). All procedures were completed without 5-mm port insertion and without conversion. No intraoperative or early postoperative complications were reported. CONCLUSIONS: This report suggests a role of microlaparoscopy in the surgical management of early cervical cancer with adequate oncological results, superimposable operative time, and perioperative outcomes with respect to standard laparoscopy.

Published
2013

40. Cytoreductive surgery plus HIPEC in platinum-sensitive recurrent ovarian cancer patients: A case-control study on survival in patients with two year follow-up

Author

Fagotti, Anna, Costantini, Barbara, Petrillo, Marco, Vizzielli, Giuseppe, Fanfani, Francesco, Margariti, Pasquale Alessandro, Turco, Luigi Carlo, Piovano, E, Scambia, Giovanni, Fagotti, Anna (ORCID:0000-0001-5579-335X), Fanfani, Francesco (ORCID:0000-0003-1991-7284), Margariti, Pasquale Alessandro (ORCID:0000-0002-7811-8565), Scambia, Giovanni (ORCID:0000-0003-2758-1063), Fagotti, Anna, Costantini, Barbara, Petrillo, Marco, Vizzielli, Giuseppe, Fanfani, Francesco, Margariti, Pasquale Alessandro, Turco, Luigi Carlo, Piovano, E, Scambia, Giovanni, Fagotti, Anna (ORCID:0000-0001-5579-335X), Fanfani, Francesco (ORCID:0000-0003-1991-7284), Margariti, Pasquale Alessandro (ORCID:0000-0002-7811-8565), and Scambia, Giovanni (ORCID:0000-0003-2758-1063)

Abstract

OBJECTIVES: To compare survival data in platinum-sensitive recurrent ovarian cancer patients submitted to secondary cytoreduction (SCR) plus hyperthermic intraperitoneal intraoperative chemotherapy (HIPEC) (Cases) and a similar group of women not experiencing HIPEC (Controls). METHODS: Case-control study, matching 30 Cases with 37 Controls, with at least 24 months of follow-up. RESULTS: Groups were comparable for all characteristics, except for a higher proportion of patients with single-nodule relapses is the Controls (19 vs. 6; p=0.011). Median follow-up time was 46 months in the Cases and 36 months in the Controls. Twenty patients (66.6%) experienced secondary recurrence in the Cases and 37 women (100%) in the Controls (p=0.001). Moreover, 7 (23.3%) and 23 (62.2%) patients died of disease in the Cases and Controls respectively (p=0.003). The duration of secondary response was 26 months in the Cases and 15 months in the Controls (p=0.004). CONCLUSIONS: The combination of SCR and HIPEC seems to improve survival rate in patients suffering from platinum-sensitive EOC recurrence with respect to no-HIPEC treatments. This result further supports the need of a randomized trial.

Published
2012

41. Determination of the temporal ciclicity of the varvate sediments from Laguna Mar Chiquita (Córdoba, República Argentina)

Author

Morales González, Juan Antonio|||0000-0003-3148-7424, Piovano, E. L., Damatto Moreira, S. R., Mazzilli, B. P., Depetris, P. J., Borrego Flores, José|||0000-0002-7079-0197, and Monterde, J.

Subjects
Pb-210 radiometric ages, Lacustrine sediments, Accumulation rates, Laminae scale cyclicity
Abstract

Laguna Mar Chiquita is the biggest lake in Argentina, probably originated 30.000 years ago. Three are the rivers discharging to this lake, which can pass from brackish-saline to hypersaline conditions related to changes in its water level. Changes in water salinity induce consequent changes in the sedimentary conditions, originating a varvate sedimentation consisting in a cyclic lamination when organic, non-organic and evaporitic laminae alternate. The combination between granulometric, radiometric and historic data permit to assert that the milimetric laminae correspond to normal varves, nevertheless centimetric varves and evaporitic levels are not originated by seasonal variations in the lake, but by cyclic wet and dry climatic periods

Published
1999

42. Determinación de la ciclicidad temporal en los sedimentos varvados de la Laguna Mar Chiquita (Córdoba, República Argentina)

Author

Morales González, Juan Antonio, Piovano, E. L., Damatto Moreira, S. R., Mazzilli, B. P., Depetris, P. J., Borrego Flores, José, and Monterde, J.

Subjects
Pb-210 radiometric ages, Lacustrine sediments, Accumulation rates, Laminae scale cyclicity
Abstract

Laguna Mar Chiquita is the biggest lake in Argentina, probably originated 30.000 years ago. Three are the rivers discharging to this lake, which can pass from brackish-saline to hypersaline conditions related to changes in its water level. Changes in water salinity induce consequent changes in the sedimentary conditions, originating a varvate sedimentation consisting in a cyclic lamination when organic, non-organic and evaporitic laminae alternate. The combination between granulometric, radiometric and historic data permit to assert that the milimetric laminae correspond to normal varves, nevertheless centimetric varves and evaporitic levels are not originated by seasonal variations in the lake, but by cyclic wet and dry climatic periods

Published
1999

48. Coupling statistically downscaled GCM outputs with a basin-lake hydrological model in subtropical South America: evaluation of the influence of large-scale precipitation changes on regional hydroclimate variability.

Author

Troin, M., Vrac, M., Khodri, M., Vallet-Coulomb, C., Piovano, E., and Sylvestre, F.

Abstract

We explore the reliability of large-scale climate variables, namely precipitation and temperature, as inputs for a basin-lake hydrological model in central Argentina. We used data from two regions in NCEP/NCAR reanalyses and three regions from LMDZ model simulations forced with observed sea surface temperature (HadISST) for the last 50 years. Reanalyses data cover part of the geographical area of the Sali-Dulce Basin (region A) and a zone at lower latitudes (region B). The LMDZ selected regions represent the geographical area of the Sali-Dulce Basin (box A), and two areas outside of the basin at lower latitudes (boxes B and C). A statistical downscaling method is used to connect the large-scale climate variables inferred from LMDZ and the reanalyses, with the hydrological Soil Water Assessment Tool (SWAT) model in order to simulate the Rio Sali-Dulce discharge during 1950-2005. The SWAT simulations are then used to force the water balance of Laguna Mar Chiquita, which experienced an abrupt level rise in the 1970's attributed to the increase in Rio Sali-Dulce discharge. Despite that the lowstand in the 1970's is not well reproduced in either simulation, the key hydrological cycles in the lake level are accurately captured. Even though satisfying results are obtained with the SWAT simulations using downscaled reanalyses, the lake level are more realistically simulated with the SWAT simulations using downscaled LMDZ data in boxes B and C, showing a strong climate influence from the tropics on lake level fluctuations. Our results highlight the ability of downscaled climatic data to reproduce regional climate features. Laguna Mar Chiquita can therefore be considered as an integrator of large-scale climate changes since the forcing scenarios giving best results are those relying on global climate simulations forced with observed sea surface temperature. This climate-basin-lake model is a promising approach for understanding and simulating long-term lake level variations. [ABSTRACT FROM AUTHOR]

Published
2010
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49. Recent aquatic ecosystem response to environmental events revealed from 210Pb sediment profiles.

Author

Mulsow, S., Piovano, E., and Cordoba, F.

Subjects
RADIOACTIVE dating, HEAVY metal content of sediments, LEAD & the environment, LEAD isotopes, GEOLOGICAL time scales, PALEOMAGNETISM, BIOGEOCHEMISTRY, RIVERS, LAKES, ESTUARIES
Abstract

Abstract: The 210Pb dating method was first introduced by , and since then has been applied to study sediment from lakes, estuaries and coastal marine environments. Hundreds of studies around the world have used 210Pb as a geochronological tool in aquatic ecosystems. However little attention has been paid to the potential of this naturally occurring isotope as an environmental tracer of ecological events. Here we report three instances in which 210Pb profiles measured on undisturbed sediment cores from lakes, rivers and fjords show us the potential of 210Pb profile as a tracer of natural and anthropogenic processes. The methodology used here is a suite of techniques combining biogeochemistry (micro-electrodes), paleomagnetism (susceptibility), sediment characteristics (LOI) and visualization (SPI and X-ray) applied to the interpretation of 210Pb profiles. We measured 210Pb profiles on sediments from a river, Cruces River (Chile), which recorded a clear shift in the water chemistry caused by a pulp mill effluent to the river. Here metal mobilization and remobilization of the tracer may be the cause of the observed profile. We also measured 210Pb profiles in sediment from two fjords of Southern Chile (Pillan and Reñihue), the sudden deposition change of fresh 210Pb with depth observed could very well be the result of bioturbation but it occurred in a seafloor area deprived of bioturbators. In this case, 210Pb recorded the onset of aquaculture activities (fish farming) that took place two decades ago. Finally, 210Pb profiles measured in two lakes in the “pampa Argentina”: Epecuen and Venado showed a particular shape with depth. These profiles apparently registered a sudden depositional event with recent 210Pb material, probably related to strong shifts in precipitation and drought cycles in that part of the world. These three examples show that 210Pb profiles provide valuable information not only on geochronology, but also related to natural and anthropogenic short term processes, as shown here, but these are not always reported and well understood. [Copyright &y& Elsevier]

Published
2009
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50. Pretreatment platelet and hemoglobin levels are neither predictive nor prognostic variables for patients with locally advanced cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy: a retrospective Italian study

Author

Gadducci, A., Cosio, S., Zola, P., Tisi, G., Annamaria Ferrero, Piovano, E., Cristofani, R., Greco, C., and Sartori, E.

Subjects
Adult, Time Factors, Platelet Count, Uterine Cervical Neoplasms, Adenocarcinoma, Middle Aged, Prognosis, Hemoglobins, Young Adult, Italy, Predictive Value of Tests, Carcinoma, Squamous Cell, Disease Progression, Humans, Female, cervical cancer platelets chemotherapy, Aged, Retrospective Studies
Abstract

To assess the predictive and prognostic values of pretreatment platelet and hemoglobin levels in patients with locally advanced cervical cancer who underwent neoadjuvant chemotherapy followed by radical hysterectomy.The authors retrospectively assessed 140 patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB2-IIB cervical cancer who underwent chemosurgical treatment.Median pretreatment platelet and hemoglobin levels were 272,000/μL and 12.5 g/dL, respectively. Fourteen patients achieved a pathologically complete response, and 26 had an optimal partial response, with an optimal pathological response rate of 28.6%. By univariate analysis, optimal pathological response rate was associated with well/moderately differentiated grade (P = 0.02) and platinum-/paclitaxel-based chemotherapy regimen (P = 0.04), but not with platelet and hemoglobin levels. Multiple logistic regression confirmed that tumor grade (odds ratio, 2.827; 95% confidence interval [95% CI], 1.250-6.397; P = 0.01) and chemotherapy regimen (odds ratio, 5.416; 95% CI, 1.459-20.110; P = 0.01) were independent predictors of optimal pathological response. Five-year recurrence-free survival and 5-year overall survival were 66 % and 73%, respectively. By log-rank test, recurrence-free survival and overall survival were associated with pathological response (P = 0.0002 and P = 0.001), lymph node status, (P = 0.008 and P = 0.002), lymphovascular space status (P = 0.005 and P = 0.003), and parametrial and/or surgical margin status (P = 0.004 and P = 0.001), but not with platelet and hemoglobin levels. On multivariate analysis, pathological response (hazard ratio [HR], 7.999; 95% CI, 1.916-33.394; and HR, 6.007; 95% CI, 1.426-25.307) and parametrial and/or surgical margin status (HR, 2.061; 95%CI, 1.047-4.058; and HR, 2.561; 95% CI, 1.244-5.271) were independent prognostic variables of recurrence-free survival and overall survival.The achievement of an optimal pathological response is the strongest independent prognostic variable for patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy, whereas pretreatment platelet and hemoglobin levels seem to be neither predictive of response to chemotherapy nor prognostic of long-term outcome.

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