97 results on '"Vargiu V"'
Search Results
2. Pattern of recurrence in endometrial cancer. The murderer always returns to the scene of the crime
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Capozzi, V. A., Monfardini, L., Maglietta, G., Barresi, G., De Finis, A., Rosati, A., Vargiu, V., Cosentino, F., Sozzi, G., Chiantera, V., Bogani, G., Carnelli, M., Scambia, Giovanni, Fanfani, Francesco, Ghi, T., Berretta, R., Scambia G. (ORCID:0000-0003-2758-1063), Fanfani F. (ORCID:0000-0003-1991-7284), Capozzi, V. A., Monfardini, L., Maglietta, G., Barresi, G., De Finis, A., Rosati, A., Vargiu, V., Cosentino, F., Sozzi, G., Chiantera, V., Bogani, G., Carnelli, M., Scambia, Giovanni, Fanfani, Francesco, Ghi, T., Berretta, R., Scambia G. (ORCID:0000-0003-2758-1063), and Fanfani F. (ORCID:0000-0003-1991-7284)
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Background: Endometrial cancer recurrence occurs in about 18 % of patients. This study aims to analyze the pattern recurrence of endometrial cancer and the relationship between the initial site of primary disease and the relapse site in patients undergoing surgical treatment. Methods: We retrospectively reviewed all surgically treated patients with endometrial cancer selecting those with recurrence. We defined primary site disease as uterus, lymph nodes, or peritoneum according to pathology analysis of the surgical specimen. The site of recurrence was defined as vaginal cuff, lymph nodes, peritoneum, and parenchymatous organs. Our primary endpoint was to correlate the site of initial disease with the site of recurrence. Results: The study enrolled 1416 patients. The overall recurrence rate was 17,5 % with 248 relapses included in the study. An increase of 9.9, 5.7, and 5.7 times in the odds of relapse on the lymph node, peritoneum, and abdominal parenchymatous sites respectively was observed in case of nodal initial disease (p < 0.001). A not significant difference in odds was observed in terms of vaginal cuff relapse (OR 0.9) between lymph node ad uterine primary disease (p = 0.78). An increasing OR of 8.7 times for nodal recurrences, 46.6 times for peritoneum, and 23.3 times for parenchymatous abdominal recurrences were found in the case of primary peritoneal disease (p < 0.001). Conclusion: Endometrial cancer tends to recur at the initial site of the disease. Intraoperative inspection of the adjacent sites of primary disease and targeted instrumental examination of the initial sites of disease during follow-up are strongly recommended.
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- 2024
3. Sentinel-node biopsy in apparent early stage ovarian cancer: final results of a prospective multicentre study (SELLY)
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Nero, Camilla, Bizzarri, Nicolo', Di Berardino, Stefano, Sillano, F., Vizzielli, Giuseppe, Cosentino, F., Vargiu, V., De Iaco, P., Perrone, A. M., Vizza, E., Chiofalo, B., Uccella, S., Ghezzi, F., Turco, L. C., Corrado, Giacomo, Giannarelli, Diana, Pasciuto, Tina, Zannoni, Gian Franco, Fagotti, Anna, Scambia, Giovanni, Nero C., Bizzarri N., Di Berardino S., Vizzielli G., Corrado G., Giannarelli D., Pasciuto T. (ORCID:0000-0003-2959-8571), Zannoni G. F. (ORCID:0000-0003-1809-129X), Fagotti A. (ORCID:0000-0001-5579-335X), Scambia G. (ORCID:0000-0003-2758-1063), Nero, Camilla, Bizzarri, Nicolo', Di Berardino, Stefano, Sillano, F., Vizzielli, Giuseppe, Cosentino, F., Vargiu, V., De Iaco, P., Perrone, A. M., Vizza, E., Chiofalo, B., Uccella, S., Ghezzi, F., Turco, L. C., Corrado, Giacomo, Giannarelli, Diana, Pasciuto, Tina, Zannoni, Gian Franco, Fagotti, Anna, Scambia, Giovanni, Nero C., Bizzarri N., Di Berardino S., Vizzielli G., Corrado G., Giannarelli D., Pasciuto T. (ORCID:0000-0003-2959-8571), Zannoni G. F. (ORCID:0000-0003-1809-129X), Fagotti A. (ORCID:0000-0001-5579-335X), and Scambia G. (ORCID:0000-0003-2758-1063)
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Aim: To evaluate the sensitivity and specificity of sentinel-lymph-node mapping compared with the gold standard of systematic lymphadenectomy in detecting lymph node metastasis in apparent early stage ovarian cancer. Methods: Multicenter, prospective, phase II trial, conducted in seven centers from March 2018 to July 2022. Patients with presumed stage I-II epithelial ovarian cancer planned for surgical staging were eligible. Patients received injection of indocyanine green in the infundibulo-pelvic and, when feasible, utero-ovarian ligaments and sentinel lymph node biopsy followed by pelvic and para-aortic lymphadenectomy was performed. Histopathological examination of all nodes was performed including ultra-staging protocol for the sentinel lymph node. Results: 174 patients were enrolled and 169 (97.1 %) received study interventions. 99 (58.6 %) patients had successful mapping of at least one sentinel lymph node and 15 (15.1 %) of them had positive nodes. Of these, 11 of 15 (73.3 %) had a correct identification of the disease in the sentinel lymph node; 7 of 11 (63.6 %) required ultra-staging protocol to detect nodal metastasis. Four (26.7 %) patients with node-positive disease had a negative sentinel-lymph-node (sensitivity 73.3 % and specificity 100.0 %). Conclusions: In a multicenter setting, identifying sentinel-lymph nodes in apparent early stage epithelial ovarian cancer did not reach the expected sensitivity: 1 of 4 patients might have metastatic lymphatic disease unrecognized by sentinel-lymph-node biopsy. Nevertheless, 35.0 % of node positive patients was identified only thanks to ultra-staging protocol on sentinel-lymph-nodes.
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- 2024
4. Minimal residual disease at primary debulking surgery versus complete tumor resection at interval debulking surgery in advanced epithelial ovarian cancer: A survival analysis
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Ghirardi, V., Moruzzi, M.C., Bizzarri, N., Vargiu, V., D'Indinosante, M., Garganese, G., Pasciuto, T., Loverro, M., Scambia, G., and Fagotti, A.
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- 2020
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5. Rectosigmoid Mesorectal-Sparing Resection in Advanced Ovarian Cancer Surgery
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Rosati, A., Vargiu, V., Santullo, F., Lodoli, C., Attalla El Halabieh, M., Scambia, G., Fagotti, A., and Costantini, B.
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- 2021
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6. ASO Author Reflections: Rectosigmoid Mesorectal Sparing Resection: A Feasible Technique and a Viable Option in Advanced Ovarian Cancer Surgery
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Rosati, A., Vargiu, V., Santullo, F., Lodoli, C., Attalla El Halabieh, M., Scambia, G., Fagotti, A., and Costantini, B.
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- 2021
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7. OPTIMAL RESIDUAL DISEASE AT PRIMARY DEBULKING SURGERY VERSUS COMPLETE TUMOR RESECTION AT INTERVAL DEBULKING SURGERY IN ADVANCED EPITHELIAL OVARIAN CANCER: A CASE-CONTROL SURVIVAL ANALYSIS: EP856
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Ghirardi, V, Bizzarri, N, Vargiu, V, DʼIndinosante, M, Loverro, M, Pasciuto, T, Scambia, G, and Fagotti, A
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- 2019
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8. PREDICTORS AND CLINICAL OUTCOME OF PANCREATIC FISTULA IN PATIENTS RECEIVING SPLENECTOMY FOR ADVANCED OR RECURRENT OVARIAN CANCER: A LARGE MULTICENTRIC EXPERIENCE: EP1224
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Sozzi, G, Cicero, C, Fagotti, A, Petrillo, M, Domingo, S, Lago, V, Berretta, R, Paci, G, Vargiu, V, Scambia, G, and Chiantera, V
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- 2019
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9. Visual Peritoneal Evaluation of Residual Disease After Neoadjuvant Chemotherapy in Advanced Ovarian Cancer Patients: The VIPER Study
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Costantini, Barbara, Rosati, A., Vargiu, V., Gallitelli, Vitalba, Di Ilio, Chiara, Moroni, R., Scambia, Giovanni, Fagotti, Anna, Costantini B., Gallitelli V., Di Ilio C., Scambia G. (ORCID:0000-0003-2758-1063), Fagotti A. (ORCID:0000-0001-5579-335X), Costantini, Barbara, Rosati, A., Vargiu, V., Gallitelli, Vitalba, Di Ilio, Chiara, Moroni, R., Scambia, Giovanni, Fagotti, Anna, Costantini B., Gallitelli V., Di Ilio C., Scambia G. (ORCID:0000-0003-2758-1063), and Fagotti A. (ORCID:0000-0001-5579-335X)
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Background: Chemotherapy induces histopathological tumor necrosis and fibrosis which results in macroscopic tissue changes, making surgeons’ intraoperative visual evaluation of the disease distribution more difficult to interpret. The aim of the study was to assess the sensitivity, specificity, and accuracy of intraoperative laparoscopic visual evaluation of the diaphragmatic peritoneum and compare it with histopathological examination. Methods: Patients receiving diaphragmatic peritonectomy at time of IDS were retrospectively included. The population was grouped based on the surgeon’s assessment of the diaphragmatic peritoneum during diagnostic laparoscopy. Group 1 included patients with a “visually pathologic” diaphragmatic peritoneum, and group 2 included patients with a “visually dubious” diaphragmatic peritoneum. Sensitivity, specificity, predictive values, and accuracy were calculated considering the final formalin-fixed pathology as the reference standard. Results: 155 patients were included (92 in group 1 and 63 in group 2). The accuracy rate of visual examination was 67.1%, the negative predictive value was 19%, specificity was 100%, and sensitivity was 64.3%. Conclusion: NACT strongly affects the ability of the surgeon to discern between peritoneal scars and truly pathologic peritoneum. The diaphragmatic laparoscopic visual examination showed a low overall accuracy. We propose an algorithm that can guide the surgeon towards a more tailored approach to diaphragmatic peritonectomy during IDS.
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- 2023
10. Major determinants of survival in recurrent endometrial cancer - The role of secondary cytoreductive surgery: A multicenter study
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Vargiu, V., Rosati, A., Capozzi, V. A., Gioe, A., Restaino, S., Berretta, R., Cosentino, F., Scambia, Giovanni, Fanfani, Francesco, Scambia G. (ORCID:0000-0003-2758-1063), Fanfani F. (ORCID:0000-0003-1991-7284), Vargiu, V., Rosati, A., Capozzi, V. A., Gioe, A., Restaino, S., Berretta, R., Cosentino, F., Scambia, Giovanni, Fanfani, Francesco, Scambia G. (ORCID:0000-0003-2758-1063), and Fanfani F. (ORCID:0000-0003-1991-7284)
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Objective The main objective of the study was to assess the influence of different clinical and therapeutic variables on the oncological outcomes of patients with endometrial cancer relapse. In particular, we evaluated the impact of cytoreductive surgery with the achievement of complete gross resection. Methods This is a multicenter retrospective cohort study conducted in three centers in Italy and including all patients with first relapse of endometrial cancer from January 2010 to December 2021. Results Data from 331 women with recurrent endometrial cancer were analyzed. Secondary cytoreductive surgery was performed in 56.2% of cases (186 patients). Complete gross resection was achieved in 178 patients (95.7%). Complete gross resection conferred a statistically significant survival benefit both for post-relapse survival and post-relapse free survival (3 years post-relapse survival: 75.4% vs 56.4%, p<0.001; 3 years post-relapse free survival: 32.6% vs 26.5%, p=0.027). At multivariate Cox regression analysis, age ≥75 years, Eastern Cooperative Oncology Group Performance Status ≥2, the advanced-metastatic risk group, complete gross resection, and multiple site relapses were identified as independent significant predictors for post-relapse survival; regarding post-relapse free survival, only age ≥75, the high and advanced-metastatic risk groups, and complete gross resection confirmed their statistical significance. Conclusions Secondary cytoreductive surgery with achievement of complete gross resection was confirmed to be an independent positive predictor for survival in patients with recurrent endometrial cancer and should be considered a valid primary treatment in the therapeutic decision-making process.
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- 2023
11. Long-term survival outcomes in high-risk endometrial cancer patients undergoing sentinel lymph node biopsy alone versus lymphadenectomy
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Capozzi, V. A., Rosati, A., Maglietta, G., Vargiu, V., Scarpelli, E., Cosentino, F., Sozzi, G., Chiantera, V., Ghi, T., Scambia, Giovanni, Berretta, R., Fanfani, Francesco, Scambia G. (ORCID:0000-0003-2758-1063), Fanfani F. (ORCID:0000-0003-1991-7284), Capozzi, V. A., Rosati, A., Maglietta, G., Vargiu, V., Scarpelli, E., Cosentino, F., Sozzi, G., Chiantera, V., Ghi, T., Scambia, Giovanni, Berretta, R., Fanfani, Francesco, Scambia G. (ORCID:0000-0003-2758-1063), and Fanfani F. (ORCID:0000-0003-1991-7284)
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Objective Endometrial cancer is the most common gynecologic neoplasm. To date, international guidelines recommend sentinel lymph node biopsy for low-risk neoplasms, while systematic lymphadenectomy is still considered for high-risk cases. This study aimed to compare the long-term survival of high-risk patients who were submitted to sentinel lymph node biopsy alone versus systematic pelvic lymphadenectomy. Methods Patients with high-risk endometrial cancer according to the 2021 European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology risk classification were retrospectively analyzed. The primary aim of the study was to compare the long-term overall survival and disease-free survival of high-risk endometrial cancer patients undergoing sentinel lymph node biopsy versus systematic lymphadenectomy. A supplementary post-hoc survival analysis of cases with nodal metastasis was performed to compare sentinel lymph node and lymphadenectomy survival outcomes in this subset of patients. Results The study enrolled 237 patients with histologically proven high-risk endometrial cancer. Patients were followed up for a median of 31 months (IQR 18-40). During the follow-up, 38 (16.0%) patients had a recurrence, and 19 (8.0%) patients died. Disease-free survival (85.2% vs 82.8%; p=0.74) and overall survival (91.3% vs 92.6%; p=0.62) were not different between the sentinel lymph node alone and lymphadenectomy groups. Furthermore, neither overall survival (96.1% vs 91.4%; p=0.43) nor disease-free survival (83.7% vs 76.4%; p=0.46) were different among sentinel lymph node alone and lymphadenectomy groups in patients with nodal metastasis. Conclusions Sentinel lymph node mapping alone in high-risk endometrial cancer appears to be an oncologically safe technique over a long observational time. Systematic lymphadenectomy in this population does not offer a survival advantage.
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- 2023
12. Safety of PGE2 induction of labor: results of a multicenter observational study
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Pellegrini, R., primary, Monari, F., additional, Bettini, C., additional, Tartarotti, E., additional, Lecis, S., additional, Lazzarin, S., additional, Vargiu, V., additional, Di Tommaso, M., additional, and Facchinetti, F., additional
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- 2023
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13. OVA-LEAK: Prognostic score for colo-rectal anastomotic leakage in patients undergoing ovarian cancer surgery
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Lago, V., Segarra-Vidal, B., Cappucio, S., Angeles, M. A., Fotopoulou, C., Muallem, M. Z., Manzanedo, I., Iglesias, J. L. S., Chacon, E., Padilla-Iserte, P., Fagotti, Anna, Ferron, G., Kluge, L., Vargiu, V., Del, M., Scambia, Giovanni, Minig, L., Tejerizo, A., Segovia, M. G., Cascales-Campos, P. A., Gil-Moreno, A., Chiva, L., Rinne, N., Martinez, A., Matute, L., Gurrea, M., Sala Climent, L., Montesinos, M., Hervas, D., Domingo, S., Fagotti A. (ORCID:0000-0001-5579-335X), Scambia G. (ORCID:0000-0003-2758-1063), Lago, V., Segarra-Vidal, B., Cappucio, S., Angeles, M. A., Fotopoulou, C., Muallem, M. Z., Manzanedo, I., Iglesias, J. L. S., Chacon, E., Padilla-Iserte, P., Fagotti, Anna, Ferron, G., Kluge, L., Vargiu, V., Del, M., Scambia, Giovanni, Minig, L., Tejerizo, A., Segovia, M. G., Cascales-Campos, P. A., Gil-Moreno, A., Chiva, L., Rinne, N., Martinez, A., Matute, L., Gurrea, M., Sala Climent, L., Montesinos, M., Hervas, D., Domingo, S., Fagotti A. (ORCID:0000-0001-5579-335X), and Scambia G. (ORCID:0000-0003-2758-1063)
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Objective: The objective of the present study was to define and validate an anastomotic leak prognostic score based on previously described and reported anastomotic leak risk factors (OVA-LEAK: https://n9.cl/ova-leakscore) and to establish if the use of OVA-LEAK score is better than clinical criteria (surgeon's choice) selecting anastomosis to be protected with a diverting ileostomy. Material & methods: This is a retrospective, multicentre cohort study that included patients who underwent cytoreductive surgery for primary advanced or relapsed ovarian cancer with colorectal resection and anastomosis between January 2011 and June 2021. Data from patients already included in the previous predictive model were not considered in the present analysis. To validate the performance of our logistic regression model, we used the OVA-LEAK formula (Annex I: https://n9.cl/ova-leakscore) for estimating leakage probabilities in a new independent cohort. Then, receiver operating characteristic (ROC) analysis was performed and area under the curve (AUC) was used to measure the performance of the model. Additionally, the Brier score was also estimated. 95% confidence intervals (CI) for each of the estimated performance measures were also calculated. Results: 848 out of 1159 recruited patients were finally included in the multivariable logistic regression model validation. The AUC of the new cohort was 0.63 for predicting anastomotic leak. Considering a cut-off point of 22.1% to be ‘positive’ (to get a leak) this would provide a sensitivity of 0.45, specificity of 0.80, positive predictive value of 0.09 and negative predictive value of 0.97 for anastomotic leak. If we consider this cut-off point to select patients at risk of leak for bowel diversion, up to 22.5% of the sampled patients would undergo a diverting ileostomy and 47% (18/40) of the anastomotic leaks would be ‘protected’ with the stoma. Nevertheless, if we consider only the ‘clinical criteria’ for performing or not a div
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- 2022
14. Risk Factors for Anastomotic Leakage in Advanced Ovarian Cancer Surgery: A Large Single-Center Experience
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Costantini, Barbara, Vargiu, V., Santullo, F., Rosati, A., Bruno, M., Gallotta, Valerio, Lodoli, C., Moroni, R., Pacelli, Fabio, Scambia, Giovanni, Fagotti, Anna, Costantini B., Gallotta V., Pacelli F. (ORCID:0000-0002-2013-6525), Scambia G. (ORCID:0000-0003-2758-1063), Fagotti A. (ORCID:0000-0001-5579-335X), Costantini, Barbara, Vargiu, V., Santullo, F., Rosati, A., Bruno, M., Gallotta, Valerio, Lodoli, C., Moroni, R., Pacelli, Fabio, Scambia, Giovanni, Fagotti, Anna, Costantini B., Gallotta V., Pacelli F. (ORCID:0000-0002-2013-6525), Scambia G. (ORCID:0000-0003-2758-1063), and Fagotti A. (ORCID:0000-0001-5579-335X)
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Background: Cytoreductive surgery is currently the main treatment for advanced epithelial ovarian cancer (OC), and several surgical maneuvers, including colorectal resection, are often needed to achieve no residual disease. High surgical complexity carries an inherent risk of postoperative complications, including anastomosis leakage (AL). Albeit rare, AL is a life-threatening condition. The aim of this single-center retrospective study is to assess the AL rate in patients undergoing colorectal resection and anastomosis during primary surgery for advanced epithelial OC through a standardized surgical technique and to evaluate possible pre/intra- and postoperative risk factors to identify the population at greatest risk. Methods: A retrospective analysis of clinical and surgical characteristics of 515 patients undergoing colorectal resection and anastomosis during primary or interval debulking surgery between December 2011 and October 2019 was performed. Several pre/intra- and postoperative variables were evaluated by multivariate analysis as potential risk factors for AL. Results: The overall anastomotic leakage rate was 2.9% (15/515) with a significant negative impact on postoperative course. Body mass index < 18 kg/m2, preoperative albumin value lower than 30 mg/dL, section of the inferior mesenteric artery at its origin, and medium–low colorectal anastomosis (< 10 cm from the anal verge) were identified as independent risk factors for AL on multivariate analysis. Conclusions: AL is confirmed to be an extremely rare but severe postoperative complication of OC surgery, being responsible for increased early postoperative mortality. Preoperative nutritional status and surgical characteristics, such as blood supply and anastomosis level, appear to be the most significant risk factors.
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- 2022
15. A large multicenter propensity match study of sentinel lymph node biopsy feasibility in endometrioid variants of endometrial cancer
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Capozzi, V. A., Rosati, A., Vargiu, V., Sozzi, G., Cosentino, F., Chiantera, V., Scambia, Giovanni, Berretta, R., Fanfani, Francesco, Scambia G. (ORCID:0000-0003-2758-1063), Fanfani F. (ORCID:0000-0003-1991-7284), Capozzi, V. A., Rosati, A., Vargiu, V., Sozzi, G., Cosentino, F., Chiantera, V., Scambia, Giovanni, Berretta, R., Fanfani, Francesco, Scambia G. (ORCID:0000-0003-2758-1063), and Fanfani F. (ORCID:0000-0003-1991-7284)
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Introduction: Sentinel lymph node (SLN) biopsy algorithm has been routinely applied in all endometrial endometrioid tumors, however, no studies analyzed the feasibility of SLN mapping in endometrioid variants (EV), which included villoglandular, secretory, ciliated cell, mucinous, and squamous differentiation. This study aimed to demonstrate the feasibility of SLN biopsy in EV of EC. Materials and methods: All patients undergoing minimally invasive surgical treatment for early-stage EC were included in the study. Patients were divided into 2 study groups: Group 1 which included patients with EV, and Group 2 which included patients with typical endometrioid histology. A propensity match analysis was performed according to age (≥65 years vs. no), BMI (≥30 kg/m2 vs. no), and LVSI (present vs. absent). Results: After a 1:5 propensity-matched analysis, a total of 458 patients were identified (Group 1 n = 77, Group 2 n = 381). Overall detection rate was not statistically significant between the EV and the typical endometrioid group (94.8% vs. 92.4%, p = 0.319). Furthermore, neither bilateral nor unilateral detection rate was different between the two groups (70.1% vs. 74.8%, p = 0.267, and 23.4% vs. 17.8%, p = 0.120). BMI ≥30 kg/m2 was the only factor influencing SLN failure (p = 0.013). SLN technique showed excellent sensitivity in both the EV (100% sensitivity, p < 0.001) and the typical endometrioid unit (93.8% sensitivity, p < 0.001). Conclusion: SLN research/detection for EV of endometrial cancer is a feasible and highly sensitive technique. Obesity was confirmed to be a risk factor for SLN failure.
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- 2022
16. Impact of Obesity on Sentinel Lymph Node Mapping in Patients with apparent Early-Stage Endometrial Cancer: The ObeLyX study
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Vargiu, V., Rosati, A., Capozzi, V. A., Sozzi, G., Gioe, Alessandro, Berretta, R., Chiantera, V., Scambia, Giovanni, Fanfani, Francesco, Cosentino, F., Gioe A., Scambia G. (ORCID:0000-0003-2758-1063), Fanfani F. (ORCID:0000-0003-1991-7284), Vargiu, V., Rosati, A., Capozzi, V. A., Sozzi, G., Gioe, Alessandro, Berretta, R., Chiantera, V., Scambia, Giovanni, Fanfani, Francesco, Cosentino, F., Gioe A., Scambia G. (ORCID:0000-0003-2758-1063), and Fanfani F. (ORCID:0000-0003-1991-7284)
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Objective: Conflicting data exists on the impact of Body Mass Index (BMI) on sentinel lymph-node (SLN) detection. The primary study endpoint was to investigate the impact of obesity on overall detection rate, bilateral mapping, and mapping failure rate of SLN. In addition, we evaluated possible differences in terms of surgical management and “empty-packet dissection” rate among obese and non-obese patients. Methods: Multicenter, propensity-matched, retrospective study. Patients with apparent early-stage endometrial cancer were included. Study population was divided into women with BMI
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- 2022
17. EPV138/#609 Sentinel lymph-node in aged endometrial cancer patients ‘the sage study’: a multicenter experience
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Rosati, A, primary, Cianci, S, additional, Vargiu, V, additional, Capozzi, VA, additional, Sozzi, G, additional, Berretta, R, additional, Cosentino, F, additional, Gueli Alletti, S, additional, Ercoli, A, additional, Chiantera, V, additional, Scambia, G, additional, and Fanfani, F, additional
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- 2021
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18. 689 Is the sarcomatous component the prognostic ‘driving force’ in early-stage uterine carcinosarcomas?
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Rosati, A, primary, Vargiu, V, additional, Certelli, C, additional, Arcieri, M, additional, Vizza, E, additional, Legge, F, additional, Cosentino, F, additional, Ferrandina, G, additional, Fanfani, F, additional, Scambia, G, additional, and Corrado, G, additional
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- 2021
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19. 806 Impact of obesity on sentinel lymph-node mapping in patients with apparent early-stage endometrial cancer: a propensity-matched multicenter study
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Vargiu, V, primary, Rosati, A, additional, Capozzi, VA, additional, Sozzi, G, additional, Berretta, R, additional, Chiantera, V, additional, Scambia, G, additional, Fanfani, F, additional, and Cosentino, F, additional
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- 2021
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20. 4K versus 3D total laparoscopic hysterectomy by resident in training: a prospective randomised trial
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Restaino, S, primary, Vargiu, V, additional, Rosati, A, additional, Bruno, M, additional, Dinoi, G, additional, Cola, E, additional, Moroni, R, additional, Scambia, G, additional, and Fanfani, F, additional
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- 2021
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21. Disseminated peritoneal leiomyomatosis and malignant transformation: A case series in a single referral center
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Rosati, A., Vargiu, V., Angelico, G., Zannoni, Gian Franco, Ciccarone, F., Scambia, Giovanni, Fanfani, Francesco, Zannoni G. F. (ORCID:0000-0003-1809-129X), Scambia G. (ORCID:0000-0003-2758-1063), Fanfani F. (ORCID:0000-0003-1991-7284), Rosati, A., Vargiu, V., Angelico, G., Zannoni, Gian Franco, Ciccarone, F., Scambia, Giovanni, Fanfani, Francesco, Zannoni G. F. (ORCID:0000-0003-1809-129X), Scambia G. (ORCID:0000-0003-2758-1063), and Fanfani F. (ORCID:0000-0003-1991-7284)
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Objective: The aim of this study was to describe one of the largest series of disseminated peritoneal leiomyomatosis (DPL) and its malignant counterpart, evaluating possible risk factors for both the benign and malignant condition, and highlighting any differences between them in terms of surgical and clinical management. Study Design: Clinical, surgical and histopathological characteristics of patients diagnosed with DPL (group 1) and malignant-DPL (group 2), between July 2010 and July 2020, were retrospectively retrieved. Results: A total of 14 benign and 5 malignant cases were selected. The duration of preoperative hormonal therapy was significantly longer in the benign condition while malignant DPL showed significantly larger lesions (median nodule size: 12 cm). However, surgical procedures and surgical outcomes did not differ among the two conditions, with highly complex surgery and relatively high post-operative complications in both groups. Conclusion: Preoperative discrimination between benign and malignant DPL is challenging. Given the high surgical complexity required in both cases, addressing patients to referral cancer centers is strictly recommend, in order to offer them the best possible treatment and allowing a continuous and accurate collection of clinical information that might be crucial for further studies.
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- 2021
22. Sentinel Lymph Node in Aged Endometrial Cancer Patients “The SAGE Study”: A Multicenter Experience
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Cianci, Stefano, Rosati, A., Vargiu, V., Capozzi, V. A., Sozzi, G., Gioe, Alessandro, Gueli Alletti, Salvatore, Ercoli, Alfredo, Cosentino, F., Berretta, R., Chiantera, V., Scambia, Giovanni, Fanfani, Francesco, Cianci S., Gioe A., Gueli Alletti S., Ercoli A., Scambia G. (ORCID:0000-0003-2758-1063), Fanfani F. (ORCID:0000-0003-1991-7284), Cianci, Stefano, Rosati, A., Vargiu, V., Capozzi, V. A., Sozzi, G., Gioe, Alessandro, Gueli Alletti, Salvatore, Ercoli, Alfredo, Cosentino, F., Berretta, R., Chiantera, V., Scambia, Giovanni, Fanfani, Francesco, Cianci S., Gioe A., Gueli Alletti S., Ercoli A., Scambia G. (ORCID:0000-0003-2758-1063), and Fanfani F. (ORCID:0000-0003-1991-7284)
- Abstract
Objective: The incidence of endometrial cancer is increasing in elderly people. Considering that aging progressively affects lymphatic draining function, we aimed to define its impact on IGC uptake during SLN mapping. Methods: A multicenter retrospective cohort of endometrial cancer patients with apparently early-stage endometrial cancer undergoing complete surgical staging with SLN dissection was identified in four referral cancer centers from May 2015 to March 2021. Patients were classified in Group 1 (<65 years old) and Group 2 (≥65 years old). The primary endpoint was the assessment of the overall, bilateral, and unsuccessful SLN mapping in the two groups. Secondary outcomes were the evaluation of SLN anatomical distribution and the identification of predictors for mapping failure applying a logistic regression. Results: A total of 844 patients were enrolled in the study (499 in Group 1 and 395 in Group 2). The overall detection rate, the successful bilateral mapping, and the mapping failure rate of the SLN were 93.8% vs. 87.6% (p = 0.002), 77.1% vs. 66.8% (p = 0.001), and 22.9% vs. 33.2% (p = 0.001), respectively, in Group 1 vs. Group 2. The advanced age affects the anatomical distribution of the SLN leading to a stepwise reduction of “unexpected” mapping sites (left hemipelvis: p < 0.001; right hemipelvis: p = 0.058). At multivariate analysis age ≥ 65 (OR: 1.495, 95% CI: 1.095–2.042, p = 0.011), BMI (OR: 1.023, 95% CI: 1.000–1.046, p = 0.047), non-endometrioid histotype (OR: 1.619, 95% CI: 1.067–2.458, p = 0.024), and LVSI (OR: 1.407, 95% CI: 1.010–1.961, p = 0.044) represent independent predictors of unsuccessful mapping. Applying binomial logistic regression analysis, there was a 1.280-fold increase in the risk of failed mapping for every 10-year-old increase in age (OR: 1.280, 95% CI: 1.108–1.479, p = 0.001). A higher rate of surgical under-staging (0.9% vs. 3.3%, p = 0.012) and adjuvant undertreatment (p = 0.018) was reported in Group 2. Co
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- 2021
23. Surgery-related complications and long-term functional morbidity after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT morb)
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Turco, L. C., Tortorella, L., Tuscano, A., Palumbo, M. A., Fagotti, Anna, Uccella, S., Fanfani, Francesco, Ferrandina, Maria Gabriella, Nicolotti, Nicola, Vargiu, V., Lodoli, C., Scaldaferri, Franco, Scambia, Giovanni, Cosentino, F., Fagotti A. (ORCID:0000-0001-5579-335X), Fanfani F. (ORCID:0000-0003-1991-7284), Ferrandina G. (ORCID:0000-0003-4672-4197), Nicolotti N., Scaldaferri F. (ORCID:0000-0001-8334-7541), Scambia G. (ORCID:0000-0003-2758-1063), Turco, L. C., Tortorella, L., Tuscano, A., Palumbo, M. A., Fagotti, Anna, Uccella, S., Fanfani, Francesco, Ferrandina, Maria Gabriella, Nicolotti, Nicola, Vargiu, V., Lodoli, C., Scaldaferri, Franco, Scambia, Giovanni, Cosentino, F., Fagotti A. (ORCID:0000-0001-5579-335X), Fanfani F. (ORCID:0000-0003-1991-7284), Ferrandina G. (ORCID:0000-0003-4672-4197), Nicolotti N., Scaldaferri F. (ORCID:0000-0001-8334-7541), and Scambia G. (ORCID:0000-0003-2758-1063)
- Abstract
Purpose: Segmental resection has been generally associated with increased peri-operative risk of major complications. While major complications are widely acknowledged, minor complications, such as slight, to moderate infections, peripheral sensory disturbances, bladder voiding dysfunction, postoperative urinary obstruction, and sexual disorders are less reported. The aim of this study is to investigate the surgery-related complications and functional disorders, as well as to evaluate their persistence after long-term follow-up in women undergone segmental resection for deep infiltrating endometriosis. Special attention is given to evaluating impairments of bowel, bladder, and sexual function. Methods: All clinical data obtained from medical records of women who underwent segmental resection for intestinal endometriosis between October 2005, and November 2017, in Catholic University Institutions. Perioperative morbidity was classified by Extended Clavien–Dindo classification. Postoperative intestinal, voiding, and sexual morbidity was estimated by the compilation of specific questionnaires. Results: Fifty women were included in the study. Forty-three high colorectal resections (86%), 6 low resections (12%), and 1 ultra-low resection (2%) were performed, while in 3 cases (6%) multiple resections were needed. The overall complication rate was 44%. Nineteen women (38%) experienced early complications and 3 women (6%) late complications. Long-term functional postoperative complications were composed of intestinal in 30%, urinary in 50%, and sexual in 64% of the study population. Median follow-up was 55.5 months. Conclusions: Segmental resection, when indicated, offers a radical and feasible approach for bowel deep infiltrating endometriosis, resulting in an improved general quality of life. The bowel and bladder complications appear to be acceptable and often reversible. Postoperative sexual dysfunctions, such as anorgasmia and insufficient vaginal lubrication, app
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- 2020
24. Hormone replacement therapy and cervical cancer: a systematic review of the literature
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Vargiu, V., Amar, Inbal Dona, Rosati, A., Dinoi, G., Turco, L. C., Capozzi, V. A., Scambia, Giovanni, Villa, Paola, Amar I. D., Scambia G. (ORCID:0000-0003-2758-1063), Villa P. (ORCID:0000-0002-4402-6988), Vargiu, V., Amar, Inbal Dona, Rosati, A., Dinoi, G., Turco, L. C., Capozzi, V. A., Scambia, Giovanni, Villa, Paola, Amar I. D., Scambia G. (ORCID:0000-0003-2758-1063), and Villa P. (ORCID:0000-0002-4402-6988)
- Abstract
Gynecological tumor treatment, including cervical cancer (CC) treatment, often leads to iatrogenic premature menopause. This highlights the critical importance of investigating indications for hormone replacement therapy (HRT), as most patients, thanks to the improvement in diagnosis and treatment, have to deal with the sequelae of their cancer treatments for many years. This systematic review aims to provide an overview of the current knowledge regarding the risks of HRT and CC. In particular, we aim to investigate whether the use of HRT can increase CC incidence, and evaluate its risk in CC survivors. A systematic review, in agreement with PRISMA guidelines, of the English literature present in PubMed and SCOPUS has been performed. A total of 2805 articles have been screened, of which 10 were considered eligible. Several studies reported a significantly reduced risk of developing cervical squamous cell carcinoma in postmenopausal women treated with HRT, while a weak increase in the incidence of adenocarcinoma has been shown. No evidence reports a harmful effect of HRT on CC oncological outcome, while several benefits, in terms of reduced metabolic risk and increased quality of life, have been described, thus concluding that HRT should be offered to young CC survivors for the management of early menopause.
- Published
- 2020
25. Incidence, predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer: a large multicentric experience
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Sozzi, G., Petrillo, M., Berretta, R., Capozzi, V. A., Paci, G., Musico, G., Di Donna, M. C., Vargiu, V., Bernardini, F., Lago, V., Domingo, S., Fagotti, A., Scambia, G., Chiantera, V., Petrillo M., Bernardini F., Fagotti A. (ORCID:0000-0001-5579-335X), Scambia G. (ORCID:0000-0003-2758-1063), Sozzi, G., Petrillo, M., Berretta, R., Capozzi, V. A., Paci, G., Musico, G., Di Donna, M. C., Vargiu, V., Bernardini, F., Lago, V., Domingo, S., Fagotti, A., Scambia, G., Chiantera, V., Petrillo M., Bernardini F., Fagotti A. (ORCID:0000-0001-5579-335X), and Scambia G. (ORCID:0000-0003-2758-1063)
- Abstract
Purpose: To evaluate the incidence, predictors and clinical outcome of pancreatic fistulas in patients receiving splenectomy during cytoreductive surgery for advanced or recurrent ovarian cancer. Methods: Data of women who underwent splenectomy during cytoreduction for advanced or recurrent ovarian cancer from December 2012 to May 2018 were retrospectively retrieved from the oncological databases of five institutions. Surgical, post-operative and follow-up data were analysed. Results: Overall, 260 patients were included in the study. Pancreatic resection was performed in 45 (17.6%) women, 23 of whom received capsule resection alone, while 22 required tail resection. Hyperthermic intraperitoneal chemotherapy (HIPEC) was administered in 28 (10.8%) patients. In the overall population, a pancreatic fistula was detected in 32 (12.3%) patients, and pancreatic resection (p-value = 0.033) and HIPEC administration (p-value = 0.039) were associated with fistula development. In multivariate analysis, HIPEC (OR = 2.573; p-value = 0.058) was confirmed as a risk factor for fistula development in women receiving splenectomy alone, while concomitant cholecystectomy (OR = 2.680; p-value = 0.012) was identified as the only independent predictor of the occurrence of pancreatic fistulas in those receiving additional distal pancreatectomy. Although the median length of hospital stay was higher in women with pancreatic leakage (p-value = 0.008), the median time from surgery to adjuvant treatment was not significantly increased. Conclusion: HIPEC was identified as a risk factor for pancreatic fistulas in patients who underwent splenectomy alone, while concomitant cholecystectomy was the only independent predictor of fistula in those receiving additional pancreatectomy. The development of pancreatic leakage was not associated with increased post-operative mortality or delay in the initiation of chemotherapy.
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- 2020
26. Laparotomy approach to sentinel lymph node detection in ovarian cancer using a near-infrared fluorescent system camera with indocyanine green dye
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Turco, L. C., Vargiu, V., Nero, Camilla, Fagotti, Anna, Scambia, Giovanni, Cosentino, Francesco, Nero C., Fagotti A. (ORCID:0000-0001-5579-335X), Scambia G. (ORCID:0000-0003-2758-1063), Cosentino F., Turco, L. C., Vargiu, V., Nero, Camilla, Fagotti, Anna, Scambia, Giovanni, Cosentino, Francesco, Nero C., Fagotti A. (ORCID:0000-0001-5579-335X), Scambia G. (ORCID:0000-0003-2758-1063), and Cosentino F.
- Abstract
Current guidelines for complete surgical staging in early-stage ovarian cancer recommend systematic lumbo-aortic and pelvic lymphadenectomy,1 despite their controversial therapeutic value with only 14% of patients upstaged.2 Sentinel lymph node (SLN) detection with indocyanine green in ovarian cancer is a feasible technique and could provide useful information on nodal status,3 avoiding future lymphadenectomy in the majority of patients. SLN biopsy is not yet the standard approach, and is currently under investigation.3 Laparoscopy is the most tested approach,3 but it is not advisable in voluminous ovarian masses.4 The patient in this video is a 70-year-old woman with a 20 cm ovarian mass suspected for cancer, who was enrolled in our prospective trial SELLY (NCT03452982) (Video 1).3 After mobilization of the ovarian mass, 2 mL of 1.25 mg/mL indocyanine green solution (Verdye 5 mg/mL injection, 25 mg/50 mg, powder for solution for injection, Diagnostic Green GmbH Aschheim-Dornach Germany) was injected with a 20 gauge spinal needle into the perivascular connectival tissue of the infundibulo-pelvic and the utero-ovarian ligament of the affected ovary. The ovarian mass was removed after 15 min and subjected to frozen sectioning. After a diagnosis of cancer, the retro-peritoneum was exposed on both sides along the Toldt fascia up to the left renal vein and inspected using the NIR mode of the Olympus laparoscopic camera (VISERA-ELITE II-Olympus Winter & Ibe GmbH, Hamburg, Germany) with overhead lights switched-off. The first fluorescent lymph node of the lymphatic chain, identified as an inter-cavo-aortic SLN, was removed and examined separately with ultra-staging at final pathology. No pelvic lymph nodes were identified because of diffuse tissue fluorescence. Systematic lymphadenectomy was then performed.
- Published
- 2020
27. Feasibility and safety of two different surgical routes for the eradication of recto-vaginal endometriosis with vaginal mucosa infiltration (Endo-Vag-r study)
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Raimondo, D., Turco, L. C., Cosentino, F., Mabrouk, M., Mastronardi, M., Borghese, G., Giaquinto, I., Vargiu, V., Fagotti, A., Meriggiola, M. C., Chiantera, V., Scambia, G., Seracchioli, R., Cosentino F., Fagotti A. (ORCID:0000-0001-5579-335X), Scambia G. (ORCID:0000-0003-2758-1063), Raimondo, D., Turco, L. C., Cosentino, F., Mabrouk, M., Mastronardi, M., Borghese, G., Giaquinto, I., Vargiu, V., Fagotti, A., Meriggiola, M. C., Chiantera, V., Scambia, G., Seracchioli, R., Cosentino F., Fagotti A. (ORCID:0000-0001-5579-335X), and Scambia G. (ORCID:0000-0003-2758-1063)
- Abstract
Introduction: Recto-vaginal endometriosis surgical management needing partial colpectomy is a surgically challenging condition and has been associated with a notable risk of major postoperative complications. In the present study we sought to compare feasibility and safety of total laparoscopic (TL) and vaginal-assisted (VA) routes in women affected by symptomatic recto-vaginal endometriosis with vaginal mucosa infiltration scheduled for minimally invasive surgery. Material and methods: Multi-centric, retrospective cohort study on medical records of consecutive reproductive age women submitted to complete macroscopic eradication of symptomatic recto-vaginal endometriosis with vaginal mucosa infiltration between March 2013 and November 2017. The two groups were compared in terms of preoperative data and surgical outcomes. Results: 84 women were included in the study (TL = 57 and VA = 27). The two groups were comparable in terms of preoperative, surgical and postoperative data. The major postoperative complications rate was 5.3% (3 of 57) in the TL group and 7.4% (2 of 27) in the VA group, without a significant difference. In the TL group we reported one case of bowel anastomosis dehiscence and two cases of pelvic abscess. In the VA group, one case of small bowel perforation after extensive adhesiolysis treated with ileal resection and one case of rectal sub-occlusion after segmental resection and mechanical anastomosis were noticed. Conclusions: In women affected by recto-vaginal endometriosis with vaginal mucosal infiltration, perioperative outcomes do not seem to be influenced by the surgical route adopted.
- Published
- 2020
28. Long-term evaluation of quality of life and gastrointestinal well-being after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT QoL)
- Author
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Turco, L. C., Scaldaferri, Franco, Chiantera, V., Cianci, Stefano, Ercoli, A., Fagotti, Anna, Fanfani, Francesco, Ferrandina, Maria Gabriella, Nicolotti, N., Tamburrano, A., Vargiu, V., Scambia, Giovanni, Cosentino, Francesco, Scaldaferri F. (ORCID:0000-0001-8334-7541), Cianci S., Fagotti A. (ORCID:0000-0001-5579-335X), Fanfani F. (ORCID:0000-0003-1991-7284), Ferrandina G. (ORCID:0000-0003-4672-4197), Scambia G. (ORCID:0000-0003-2758-1063), Cosentino F., Turco, L. C., Scaldaferri, Franco, Chiantera, V., Cianci, Stefano, Ercoli, A., Fagotti, Anna, Fanfani, Francesco, Ferrandina, Maria Gabriella, Nicolotti, N., Tamburrano, A., Vargiu, V., Scambia, Giovanni, Cosentino, Francesco, Scaldaferri F. (ORCID:0000-0001-8334-7541), Cianci S., Fagotti A. (ORCID:0000-0001-5579-335X), Fanfani F. (ORCID:0000-0003-1991-7284), Ferrandina G. (ORCID:0000-0003-4672-4197), Scambia G. (ORCID:0000-0003-2758-1063), and Cosentino F.
- Abstract
Purposes: The primary objective is to assess the long-term quality of life (QoL) and gastrointestinal well-being in patients with endometriosis (DIE) who underwent segmental resection (SR), through specific questionnaires focused on endometriosis and specific gastrointestinal evaluation. The secondary objectives are represented by the evaluation of peri-operative and post-operative outcomes of the procedure. Methods: This observational cohort study ENDO-RESECT (ClinicalTrials.gov ID: NCT03824054) reports all clinical data about women who underwent SR for DIE between October 2005 and November 2017. In the part of the study dedicated to the QoL assessment, the questionnaires adopted were the Endometriosis Health Profile (EHP30), the Psychological General Well-Being Index and the Hospital Anxiety and Depression Scale, the Gastrointestinal Well-being questionnaire and the Bristol Stool chart. Major post-surgical morbidity and obstetric outcomes were also collected. Results: 50 women (18% stage III and 82% stage IV rAFS) were considered for enrollment. EHP-30 interpretation demonstrated a significant improvement in all continuous variables, except for fertility concerns. The overall gastrointestinal QoL and most of the specific symptoms improved after surgery. Frequent bowel movements appeared in the 13% of the series not resulting in an impairment of general and gastrointestinal QoL. Constipation remained unchanged. Patients with depressive mood managed with laparoscopy, benefited the most from SR; moreover, patients with multinodular bowel localizations experienced a greater reduction in abdominal pain. Median FU after SR was 42.5 months (range 12–157 months). Only three (6%) cases of late major grade III complications were documented. The pregnancy rate was 50%. Conclusions: Improvement of general QoL and most of gastrointestinal symptoms was documented after SR.
- Published
- 2020
29. Hormone replacement therapy and cervical cancer: a systematic review of the literature
- Author
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Vargiu, V., primary, Amar, I. D., additional, Rosati, A., additional, Dinoi, G., additional, Turco, L. C., additional, Capozzi, V. A., additional, Scambia, G., additional, and Villa, P., additional
- Published
- 2020
- Full Text
- View/download PDF
30. 72 Can intraoperative visual examination of diaphragmatic peritoneum be a reliable tool to modulate the extent of interval debulking surgery in advanced ovarian cancer?
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Vargiu, V, primary, Rosati, A, additional, Gallitelli, V, additional, Scambia, G, additional, Fagotti, A, additional, and Costantini, B, additional
- Published
- 2020
- Full Text
- View/download PDF
31. Malignant rhadboid tumor of the peritoneum, mimicking an advanced ovarian cancer: a case report with literature review
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Vargiu, V., primary, Turco, L.C., additional, Zannoni, G.F., additional, Inzani, F., additional, Ferrandina, G., additional, Scambia, G., additional, and Costantini, B., additional
- Published
- 2020
- Full Text
- View/download PDF
32. EP1224 Predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer: a large multicentric experience
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Sozzi, G, primary, Cicero, C, additional, Fagotti, A, additional, Petrillo, M, additional, Domingo, S, additional, Lago, V, additional, Berretta, R, additional, Paci, G, additional, Vargiu, V, additional, Scambia, G, additional, and Chiantera, V, additional
- Published
- 2019
- Full Text
- View/download PDF
33. EP856 Optimal residual disease at primary debulking surgery versus complete tumor resection at interval debulking surgery in advanced epithelial ovarian cancer: a case-control survival analysis
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Ghirardi, V, primary, Bizzarri, N, additional, Vargiu, V, additional, D’Indinosante, M, additional, Loverro, M, additional, Pasciuto, T, additional, Scambia, G, additional, and Fagotti, A, additional
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- 2019
- Full Text
- View/download PDF
34. Hormone replacement therapy and cervical cancer: a systematic review of the literature.
- Author
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Vargiu, V., Amar, I. D., Rosati, A., Dinoi, G., Turco, L. C., Capozzi, V. A., Scambia, G., and Villa, P.
- Subjects
- *
CERVICAL cancer , *HORMONE therapy , *CANCER treatment , *PREMATURE menopause , *TUMOR treatment - Abstract
Gynecological tumor treatment, including cervical cancer (CC) treatment, often leads to iatrogenic premature menopause. This highlights the critical importance of investigating indications for hormone replacement therapy (HRT), as most patients, thanks to the improvement in diagnosis and treatment, have to deal with the sequelae of their cancer treatments for many years. This systematic review aims to provide an overview of the current knowledge regarding the risks of HRT and CC. In particular, we aim to investigate whether the use of HRT can increase CC incidence, and evaluate its risk in CC survivors. A systematic review, in agreement with PRISMA guidelines, of the English literature present in PubMed and SCOPUS has been performed. A total of 2805 articles have been screened, of which 10 were considered eligible. Several studies reported a significantly reduced risk of developing cervical squamous cell carcinoma in postmenopausal women treated with HRT, while a weak increase in the incidence of adenocarcinoma has been shown. No evidence reports a harmful effect of HRT on CC oncological outcome, while several benefits, in terms of reduced metabolic risk and increased quality of life, have been described, thus concluding that HRT should be offered to young CC survivors for the management of early menopause. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
35. Endometrial stromal sarcoma arising from endometriosis
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Cosentino, Francesco, Turco, L. C., Ferrandina, Maria Gabriella, Fagotti, Anna, Alletti, S. G., Cianci, S., Vizzielli, G., Vargiu, Virginia, Scambia, Giovanni, Cosentino F., Ferrandina G. (ORCID:0000-0003-4672-4197), Fagotti A. (ORCID:0000-0001-5579-335X), Vargiu V., Scambia G. (ORCID:0000-0003-2758-1063), Cosentino, Francesco, Turco, L. C., Ferrandina, Maria Gabriella, Fagotti, Anna, Alletti, S. G., Cianci, S., Vizzielli, G., Vargiu, Virginia, Scambia, Giovanni, Cosentino F., Ferrandina G. (ORCID:0000-0003-4672-4197), Fagotti A. (ORCID:0000-0001-5579-335X), Vargiu V., and Scambia G. (ORCID:0000-0003-2758-1063)
- Abstract
The malignant transformation of endometriosis is a very uncommon event but can occur in 0.7% to 1% of all cases. Any histological type of tumor found in the endometrium might also occur in endometriosis. Most malignant tumors that originate from endometriosis are endometrioid adenocarcinomas and also clear-cell type carcinomas. On the other hand, sarcomas, especially endometrial stromal sarcoma (ESS), are extremely unusual representing 12% of all cases. ESS is an uncommon neoplasm and accounts for 0.2% of the uterine malignances. Malignant tumors arising from endometriosis can derive from the uterine wall as well as from extra-uterine sites. The most frequent extrauterine location is the ovary (78.7%), followed by the pelvic peritoneum (5.7%), the rectovaginal septum (4.3%), the colon (4.3%) and the vagina (2%), representing the majority of extragonadal sites. ESSs arising from the extrauterine and extraovarian endometriosis sites in the absence of a primary uterine lesion are extremely rare and the treatment options are not clear. Surgical debulking seems to be the best treatment. Adjuvant therapy, such as radiation, hormonal therapy and chemotherapy are not yet proven to be effective. Molecular target therapy could be a future possibility of treatment. A systematic review of English Medical Literature about incidence, treatment and prognosis of extrauterine ESS arising from endometriosis foci was performed. The selected articles on which this review is based are the following: 9 literature reviews, 8 retrospective studies, 7 case series, 1 prospective trial and 11 case reports.
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- 2017
36. Long-term evaluation of quality of life and gastrointestinal well-being after segmental colo-rectal resection for deep infiltrating endometriosis (ENDO-RESECT QoL)
- Author
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Francesco Fanfani, Giovanni Scambia, Andrea Tamburrano, Alfredo Ercoli, Francesco Cosentino, Franco Scaldaferri, Anna Fagotti, Virginia Vargiu, Luigi Carlo Turco, Gabriella Ferrandina, Nicola Nicolotti, Stefano Cianci, Vito Chiantera, Turco, L. C., Scaldaferri, F., Chiantera, V., Cianci, S., Ercoli, A., Fagotti, A., Fanfani, F., Ferrandina, G., Nicolotti, N., Tamburrano, A., Vargiu, V., Scambia, G., Cosentino, F., Turco L.C., Scaldaferri F., Chiantera V., Cianci S., Ercoli A., Fagotti A., Fanfani F., Ferrandina G., Nicolotti N., Tamburrano A., Vargiu V., Scambia G., and Cosentino F.
- Subjects
Adult ,Quality of life ,medicine.medical_specialty ,Abdominal pain ,Constipation ,Adolescent ,Gastrointestinal Diseases ,Endometriosis ,Segmental colo-rectal resection ,Hospital Anxiety and Depression Scale ,Gastrointestinal symptoms ,Cohort Studies ,Young Adult ,Postoperative Complications ,Pregnancy ,Surveys and Questionnaires ,Internal medicine ,Gastrointestinal symptom ,medicine ,Humans ,Deep infiltrating endometriosis ,Intestinal endometriosis ,Personalized medicine ,Colorectal Neoplasms ,Female ,Middle Aged ,Quality of Life ,Treatment Outcome ,business.industry ,Intestinal endometriosi ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Deep infiltrating endometriosi ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Defecation ,Segmental resection ,medicine.symptom ,business ,Cohort study - Abstract
Purposes: The primary objective is to assess the long-term quality of life (QoL) and gastrointestinal well-being in patients with endometriosis (DIE) who underwent segmental resection (SR), through specific questionnaires focused on endometriosis and specific gastrointestinal evaluation. The secondary objectives are represented by the evaluation of peri-operative and post-operative outcomes of the procedure. Methods: This observational cohort study ENDO-RESECT (ClinicalTrials.gov ID: NCT03824054) reports all clinical data about women who underwent SR for DIE between October 2005 and November 2017. In the partof thestudy dedicated to the QoL assessment, the questionnaires adopted were the Endometriosis Health Profile (EHP30), the Psychological General Well-Being Index and the Hospital Anxiety and Depression Scale, the Gastrointestinal Well-being questionnaire and the Bristol Stool chart. Major post-surgical morbidity and obstetric outcomes were also collected. Results: 50 women (18% stage III and 82% stage IV rAFS) were considered for enrollment. EHP-30 interpretation demonstrated a significant improvement in all continuous variables, except for fertility concerns. The overall gastrointestinal QoL and most of the specific symptoms improved after surgery. Frequent bowel movements appeared in the 13% of the series not resulting in an impairment of general and gastrointestinal QoL. Constipation remained unchanged. Patients with depressive mood managed with laparoscopy, benefited the most from SR; moreover, patients with multinodular bowel localizations experienced a greater reduction in abdominal pain. Median FU after SR was 42.5months (range 12–157months). Only three (6%) cases of late major grade III complications were documented. The pregnancy rate was 50%. Conclusions: Improvement of general QoL and most of gastrointestinal symptoms was documented after SR.
- Published
- 2019
37. A large multicenter propensity match study of sentinel lymph node biopsy feasibility in endometrioid variants of endometrial cancer
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Vito Andrea Capozzi, Andrea Rosati, Virginia Vargiu, Giulio Sozzi, Francesco Cosentino, Vito Chiantera, Giovanni Scambia, Roberto Berretta, Francesco Fanfani, Capozzi V.A., Rosati A., Vargiu V., Sozzi G., Cosentino F., Chiantera V., Scambia G., Berretta R., and Fanfani F.
- Subjects
Indocyanine Green ,Endometrioid variants ,Sentinel Lymph Node Biopsy ,Endometrioid variant ,General Medicine ,Endometrial Neoplasms ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Endometrial cancer ,Oncology ,Feasibility Studies ,Humans ,Lymph Node Excision ,Female ,Surgery ,Lymph Nodes ,Sentinel Lymph Node ,Carcinoma, Endometrioid ,Aged ,Neoplasm Staging - Abstract
Introduction: Sentinel lymph node (SLN) biopsy algorithm has been routinely applied in all endometrial endometrioid tumors, however, no studies analyzed the feasibility of SLN mapping in endometrioid variants (EV), which included villoglandular, secretory, ciliated cell, mucinous, and squamous differentiation. This study aimed to demonstrate the feasibility of SLN biopsy in EV of EC. Materials and methods: All patients undergoing minimally invasive surgical treatment for early-stage EC were included in the study. Patients were divided into 2 study groups: Group 1 which included patients with EV, and Group 2 which included patients with typical endometrioid histology. A propensity match analysis was performed according to age (≥65 years vs. no), BMI (≥30 kg/m2 vs. no), and LVSI (present vs. absent). Results: After a 1:5 propensity-matched analysis, a total of 458 patients were identified (Group 1 n = 77, Group 2 n = 381). Overall detection rate was not statistically significant between the EV and the typical endometrioid group (94.8% vs. 92.4%, p = 0.319). Furthermore, neither bilateral nor unilateral detection rate was different between the two groups (70.1% vs. 74.8%, p = 0.267, and 23.4% vs. 17.8%, p = 0.120). BMI ≥30 kg/m2 was the only factor influencing SLN failure (p = 0.013). SLN technique showed excellent sensitivity in both the EV (100% sensitivity, p < 0.001) and the typical endometrioid unit (93.8% sensitivity, p < 0.001). Conclusion: SLN research/detection for EV of endometrial cancer is a feasible and highly sensitive technique. Obesity was confirmed to be a risk factor for SLN failure.
- Published
- 2022
38. Impact of Obesity on Sentinel Lymph Node Mapping in Patients with apparent Early-Stage Endometrial Cancer: The ObeLyX study
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Virginia Vargiu, Andrea Rosati, Vito Andrea Capozzi, Giulio Sozzi, Alessandro Gioè, Roberto Berretta, Vito Chiantera, Giovanni Scambia, Francesco Fanfani, Francesco Cosentino, Vargiu V., Rosati A., Capozzi V.A., Sozzi G., Gioe A., Berretta R., Chiantera V., Scambia G., Fanfani F., and Cosentino F.
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Indocyanine Green ,Empty-packet dissection ,Sentinel Lymph Node Biopsy ,Obstetrics and Gynecology ,Endometrial Neoplasms ,Sentinel lymph-node ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Oncology ,Endometrial cancer ,Humans ,Lymph Node Excision ,Female ,Lymph Nodes ,Obesity ,Sentinel Lymph Node ,Aged ,Neoplasm Staging ,Retrospective Studies - Abstract
Conflicting data exists on the impact of Body Mass Index (BMI) on sentinel lymph-node (SLN) detection. The primary study endpoint was to investigate the impact of obesity on overall detection rate, bilateral mapping, and mapping failure rate of SLN. In addition, we evaluated possible differences in terms of surgical management and "empty-packet dissection" rate among obese and non-obese patients.Multicenter, propensity-matched, retrospective study. Patients with apparent early-stage endometrial cancer were included. Study population was divided into women with BMI/≥ 30 (Group-1 and Group-2). To lower the selection bias, a propensity-matched analysis was performed. Matching was based on histotype (endometrioid vs non-endometrioid), age (/≥65 years old), and presence of lymph-vascular space invasion.Eight-hundred forty-four women were enrolled. After a 1:1 propensity-matched analysis, 764 patients were identified (Group-1 n = 382, Group-2 n = 382). A 1.156-fold increase in the risk of mapping failure for every 5 units of BMI increase was found (OR 1.156, 95% CI 1.033-1.294, p = 0.012), with a consequently decrease in bilateral mapping and overall detection rate (respectively OR 0.865, 95% CI 0.773-0.968, p = 0.012 and OR 0.785, 95% CI 0.670-0.920, p = 0.003). Obese patients were surgically under-staged in 9.4% of cases and showed an 8.2% of empty packet dissection (surgical under-staging: 5.0% vs 9.4%, p = 0.017; empty-packet dissection: 3.9% vs 8.2%, p = 0.022).BMI was confirmed as a statistically relevant predictor of mapping failure and decreased overall detection rate. In addition, obese women had a significantly higher odds of empty packet dissection.
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- 2022
39. Management of postoperative chylous ascites after surgery for ovarian cancer: a single-institution experience
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Giuseppe Scaletta, L. Quagliozzi, Virginia Vargiu, Maria Cristina Mele, Giovanni Scambia, Stefano Cianci, Anna Fagotti, Scaletta, G., Quagliozzi, L., Cianci, S., Vargiu, V., Mele, M. C., Scambia, G., and Fagotti, A.
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medicine.medical_specialty ,Total parenteral nutrition ,medicine.medical_treatment ,Population ,Conservative Treatment ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Ovarian cancer ,Risk Factors ,Chylous ascites ,medicine ,Humans ,Stage (cooking) ,education ,Personalized medicine ,Chylous Ascites ,Aged ,Neoplasm Staging ,Retrospective Studies ,Ovarian Neoplasms ,education.field_of_study ,business.industry ,Cisterna chyli ,Length of Stay ,Middle Aged ,medicine.disease ,Primary tumor ,Hormones ,Surgery ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,Parenteral Nutrition, Total ,030211 gastroenterology & hepatology ,Lymphadenectomy ,Chylous ascite ,Somatostatin ,business ,Complication - Abstract
Postoperative chylous ascites is a rare complication from operative trauma to the cisterna chyli or lymphatic vessels in the retroperitoneum. In the present study, we aimed to identify the incidence of postoperative chylous ascites in patients treated for ovarian cancer and to describe its management. We retrospectively reviewed all patients submitted to surgery for ovarian cancer at our Institution from October 2016 to November 2018. We analyzed the clinicopathological features, including the primary tumor histology, stage, grade, surgical procedure, median number of harvested pelvic and para-aortic lymph nodes. We described our experience in the diagnosis and management of chylous ascites. Five hundred and forty-six patients were submitted to surgery for ovarian cancer and 298 patients received pelvic and/or para-aortic lymphadenectomy. Chylous ascites occurred in 8 patients with an incidence of 1.4% in the overall population and a 2.68% among patients receiving lymphadenectomy. All patients received total parenteral nutrition (TPN) with Olimel N4E 2000mL (Baxter®) and somatostatin therapy with 0.2mL per 3 times/day for a median of 9days (range 7–11). Median hospital stay was 15days (range 7–16). All patients were successfully managed conservatively and none required surgical correction. Conservative management of chylous ascites with TPN, somatostatin and paracentisis is feasible and effective. These data should be confirmed by prospective multicentric studies.
- Published
- 2019
40. Near-Infrared Imaging with Indocyanine Green for Detection of Endometriosis Lesions (Gre-Endo Trial): A Pilot Study
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Gabriella Ferrandina, Giovanni Scambia, Virginia Vargiu, Anna Fagotti, Stefano Cianci, Giuseppe Vizzielli, Luigi Carlo Turco, Gian Franco Zannoni, Francesco Cosentino, Cosentino, F., Vizzielli, G., Turco, L. C., Fagotti, A., Cianci, S., Vargiu, V., Zannoni, G. F., Ferrandina, G., and Scambia, G.
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Adult ,Indocyanine Green ,Laparoscopic surgery ,medicine.medical_specialty ,Microscopic endometriosis ,medicine.medical_treatment ,Endometriosis ,Radiation imaging ,Predictive Value of Test ,Pilot Projects ,Occult endometriosis ,White light imaging ,Sensitivity and Specificity ,Occult endometriosi ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Predictive Value of Tests ,medicine ,Humans ,Pilot Project ,Near infrared imaging ,Prospective Studies ,Endometriosi ,Microscopic endometriosi ,Coloring Agent ,Coloring Agents ,Prospective cohort study ,Spectroscopy, Near-Infrared ,030219 obstetrics & reproductive medicine ,Task force ,business.industry ,Obstetrics and Gynecology ,Middle Aged ,medicine.disease ,Occult ,Prospective Studie ,chemistry ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,Radiology ,business ,Indocyanine green ,Human - Abstract
Study Objective To evaluate near-infrared radiation imaging with intravenous indocyanine green (NIR-ICG) during laparoscopic intervention to identify endometriosis lesions. Design A single-center, prospective, single-arm pilot study (Canadian Task Force classification II-2). Setting An academic tertiary care and research center. Patients Twenty-seven patients with symptomatic endometriosis were enrolled. Interventions Patients underwent laparoscopic surgery using a laparoscopic system prototype with NIR-ICG. Measurements and Main Results A total of 116 suspected endometriosis lesions were removed from 27 patients. One hundred lesions had already been visualized in white light imaging by an expert surgeon; the remaining 16 were detected and removed using NIR-ICG. A total of 111 specimens were positive for endometriosis pathology. Positive predictive value of 95% and 97.8% and negative predictive value of 86.2% and 82.3% were found by white light imaging and NIR-ICG, respectively, with sensitivity of 85.6% and 82% and specificity of 95.2% and 97.9%, respectively. Conclusion NIR-ICG may be a tool for intraoperative diagnosis, confirmation of visible endometriosis lesions, and a marker for identifying occult endometriosis. Further prospective studies with a larger population sample are warranted to validate these encouraging preliminary results.
- Published
- 2018
41. Sentinel Lymph Node in Aged Endometrial Cancer Patients 'The SAGE Study': A Multicenter Experience
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Stefano Cianci, Andrea Rosati, Virginia Vargiu, Vito Andrea Capozzi, Giulio Sozzi, Alessandro Gioè, Salvatore Gueli Alletti, Alfredo Ercoli, Francesco Cosentino, Roberto Berretta, Vito Chiantera, Giovanni Scambia, Francesco Fanfani, Cianci S., Rosati A., Vargiu V., Capozzi V.A., Sozzi G., Gioe A., Gueli Alletti S., Ercoli A., Cosentino F., Berretta R., Chiantera V., Scambia G., and Fanfani F.
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aged population ,Cancer Research ,medicine.medical_specialty ,indocyanine green ,Sentinel lymph node ,sentinel lymph node (SLN) ,Logistic regression ,elderly ,lymphatic anatomy ,Internal medicine ,Clinical endpoint ,Medicine ,Risk factor ,RC254-282 ,Original Research ,business.industry ,Incidence (epidemiology) ,Endometrial cancer ,Cancer ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Retrospective cohort study ,medicine.disease ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,endometrial cancer ,Oncology ,business - Abstract
ObjectiveThe incidence of endometrial cancer is increasing in elderly people. Considering that aging progressively affects lymphatic draining function, we aimed to define its impact on IGC uptake during SLN mapping.MethodsA multicenter retrospective cohort of endometrial cancer patients with apparently early-stage endometrial cancer undergoing complete surgical staging with SLN dissection was identified in four referral cancer centers from May 2015 to March 2021. Patients were classified in Group 1 (ResultsA total of 844 patients were enrolled in the study (499 in Group 1 and 395 in Group 2). The overall detection rate, the successful bilateral mapping, and the mapping failure rate of the SLN were 93.8% vs. 87.6% (p = 0.002), 77.1% vs. 66.8% (p = 0.001), and 22.9% vs. 33.2% (p = 0.001), respectively, in Group 1 vs. Group 2. The advanced age affects the anatomical distribution of the SLN leading to a stepwise reduction of “unexpected” mapping sites (left hemipelvis: p < 0.001; right hemipelvis: p = 0.058). At multivariate analysis age ≥ 65 (OR: 1.495, 95% CI: 1.095–2.042, p = 0.011), BMI (OR: 1.023, 95% CI: 1.000–1.046, p = 0.047), non-endometrioid histotype (OR: 1.619, 95% CI: 1.067–2.458, p = 0.024), and LVSI (OR: 1.407, 95% CI: 1.010–1.961, p = 0.044) represent independent predictors of unsuccessful mapping. Applying binomial logistic regression analysis, there was a 1.280-fold increase in the risk of failed mapping for every 10-year-old increase in age (OR: 1.280, 95% CI: 1.108–1.479, p = 0.001). A higher rate of surgical under-staging (0.9% vs. 3.3%, p = 0.012) and adjuvant undertreatment (p = 0.018) was reported in Group 2.ConclusionsOld age represents a risk factor for SLN mapping failure both intrinsically and in relation to the greater incidence of other independent risk factors such as LVSI, non-endometrioid histotype, and BMI. Surgeons should target the usual uptake along UPP during the SLN dissection in this subgroup of patients to minimize mapping failure and the consequent risk of surgical under-staging and adjuvant undertreatment.
- Published
- 2021
42. Feasibility and safety of two different surgical routes for the eradication of recto-vaginal endometriosis with vaginal mucosa infiltration (Endo-Vag-r study)
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Maria Cristina Meriggiola, Giovanni Scambia, Virginia Vargiu, Francesco Cosentino, Giulia Borghese, Diego Raimondo, Mohamed Mabrouk, Vito Chiantera, Ilaria Giaquinto, Anna Fagotti, Luigi Carlo Turco, Renato Seracchioli, Manuela Mastronardi, Raimondo D., Turco L.C., Cosentino F., Mabrouk M., Mastronardi M., Borghese G., Giaquinto I., Vargiu V., Fagotti A., Meriggiola M.C., Chiantera V., Scambia G., Seracchioli R., Raimondo, Diego, Turco, Luigi Carlo, Cosentino, Francesco, Mabrouk, Mohamed, Mastronardi, Manuela, Borghese, Giulia, Giaquinto, Ilaria, Vargiu, Virginia, Fagotti, Anna, Meriggiola, Maria Cristina, Chiantera, Vito, Scambia, Giovanni, and Seracchioli, Renato
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Adult ,medicine.medical_specialty ,Vaginal Diseases ,rectovaginal endometriosi ,Endometriosis ,vaginal-assisted route ,Dehiscence ,Anastomosis ,laparoscopic route ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,medicine ,Humans ,Minimally Invasive Surgical Procedures ,030212 general & internal medicine ,endometriosis surgical treatment ,Digestive System Surgical Procedures ,minimally invasive surgery ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,business.industry ,Medical record ,rectovaginal endometriosis ,Obstetrics and Gynecology ,Retrospective cohort study ,General Medicine ,Perioperative ,Middle Aged ,medicine.disease ,Settore MED/40 - Ginecologia E Ostetricia ,Surgery ,usability ,Rectal Diseases ,Italy ,Feasibility Studies ,Female ,Patient Safety ,Segmental resection ,business ,Infiltration (medical) - Abstract
Introduction: Recto-vaginal endometriosis surgical management needing partial colpectomy is a surgically challenging condition and has been associated with a notable risk of major postoperative complications. In the present study we sought to compare feasibility and safety of total laparoscopic (TL) and vaginal-assisted (VA) routes in women affected by symptomatic recto-vaginal endometriosis with vaginal mucosa infiltration scheduled for minimally invasive surgery. Material and methods: Multi-centric, retrospective cohort study on medical records of consecutive reproductive age women submitted to complete macroscopic eradication of symptomatic recto-vaginal endometriosis with vaginal mucosa infiltration between March 2013 and November 2017. The two groups were compared in terms of preoperative data and surgical outcomes. Results: 84 women were included in the study (TL=57 and VA=27). The two groups were comparable in terms of preoperative, surgical and postoperative data. The major postoperative complications rate was 5.3% (3 of 57) in the TL group and 7.4% (2 of 27) in the VA group, without a significant difference. In the TL group we reported one case of bowel anastomosis dehiscence and two cases of pelvic abscess. In the VA group, one case of small bowel perforation after extensive adhesiolysis treated with ileal resection and one case of rectal sub-occlusion after segmental resection and mechanical anastomosis were noticed. Conclusions: In women affected by recto-vaginal endometriosis with vaginal mucosal infiltration, perioperative outcomes do not seem to be influenced by the surgical route adopted.
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- 2020
43. Real three-dimensional approach vs two-dimensional camera with and without real-time near-infrared imaging with indocyanine green for detection of endometriosis: A case-control study
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Manuela Mastronardi, Giovanni Scambia, Mohamed Mabrouk, Diego Raimondo, Virginia Vargiu, Giuseppe Vizzielli, Renato Seracchioli, Luigi Carlo Turco, Francesco Cosentino, Raffaella Iodice, Vizzielli G., Cosentino F., Raimondo D., Turco L.C., Vargiu V., Iodice R., Mastronardi M., Mabrouk M., Scambia G., and Seracchioli R.
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Adult ,endometriosis ,medicine.medical_specialty ,indocyanine green ,Lesion Identification ,Endometriosis ,Sensitivity and Specificity ,03 medical and health sciences ,chemistry.chemical_compound ,Imaging, Three-Dimensional ,0302 clinical medicine ,Robotic Surgical Procedures ,Predictive Value of Tests ,medicine ,Humans ,Near infrared imaging ,030212 general & internal medicine ,endometriosis surgical treatment ,Coloring Agents ,minimally invasive surgery ,Retrospective Studies ,Spectroscopy, Near-Infrared ,030219 obstetrics & reproductive medicine ,Pelvic endometriosis ,business.industry ,Medical record ,endometriosi ,Case-control study ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Occult ,Surgery, Computer-Assisted ,chemistry ,Case-Control Studies ,Injections, Intravenous ,near-infrared radiation ,Female ,Laparoscopy ,Radiology ,business ,Indocyanine green - Abstract
Introduction: The complete surgical removal of endometriosis lesions is not always feasible because some implants may be very small or hidden. The use of intraoperative near-infrared radiation (NIR) imaging after intravenous injection of indocyanine green (ICG) coupled with robotic technical advances, including 3-dimensional (3D) and high-resolution vision, might improve detection rates. Material and methods: This is a retrospective, multicenter case-control study (Canadian Task Force classification II-2) on medical records of women with endometriosis who underwent surgery at the Catholic University of Rome (Controls) and the University of Bologna (Cases) between January 2016 and March 2018. Surgical and post-surgical data from the procedures were collected. We compared the visual detection rate of endometriotic lesions using near-infrared radiation imaging after intravenous injection of indocyanine green (NIR-ICG) in Real 3D (Cases) with the 2D Camera approach (Controls) in symptomatic women with pelvic endometriosis. Results: Twenty cases were matched as closely as possible with 27 controls. The numbers of suspected lesions identified both with the white light and the NIR-ICG approach were 116 and 70 in the Controls (2D) and Cases (3D), respectively. Among them, 16 of 116 controls (13.8%) and 12 of 70 cases (17.1%) were identified using only NIR-ICG imaging and collected as occult lesions (P=.536). The overall NIR-ICG lesion identification showed a positive predictive value of 97.8%, negative predictive value of 82.3%, sensitivity of 82.0%, and specificity of 97.9% for the Control group, and a positive predictive value of 100%, negative predictive value of 97.1%, sensitivity of 97.1%, and specificity of 100% for the Case group, confirming that NIR-ICG imaging is a good diagnostic and screening test (P=.643 and P=.791, according to the Cohen κ tests, respectively for the laparoscopic and robotic groups). Conclusions: The few differences observed did not seem to be clinically relevant, making the 2 procedures comparable in terms of the ability to visually detect endometriotic lesions. Further prospective trials are needed to confirm our results.
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- 2020
44. Incidence, predictors and clinical outcome of pancreatic fistula in patients receiving splenectomy for advanced or recurrent ovarian cancer: a large multicentric experience
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Virginia Vargiu, Mariano Catello Di Donna, Giovanni Scambia, Marco Petrillo, Giuseppe Paci, Federica Bernardini, Anna Fagotti, Santiago Domingo, Vito Andrea Capozzi, Vito Chiantera, Roberto Berretta, Víctor Lago, Giulia Musicò, Giulio Sozzi, Sozzi G., Petrillo M., Berretta R., Capozzi V.A., Paci G., Musico G., Di Donna M.C., Vargiu V., Bernardini F., Lago V., Domingo S., Fagotti A., Scambia G., and Chiantera V.
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Fistula ,Splenectomy ,Population ,Cytoreduction ,03 medical and health sciences ,Pancreatic Fistula ,0302 clinical medicine ,Pancreatectomy ,Retrospective Studie ,Ovarian cancer ,medicine ,Humans ,education ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Incidence ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Concomitant ,Hyperthermic intraperitoneal chemotherapy ,Cholecystectomy ,Female ,Neoplasm Recurrence, Local ,business - Abstract
Purpose: To evaluate the incidence, predictors and clinical outcome of pancreatic fistulas in patients receiving splenectomy during cytoreductive surgery for advanced or recurrent ovarian cancer. Methods: Data of women who underwent splenectomy during cytoreduction for advanced or recurrent ovarian cancer from December 2012 to May 2018 were retrospectively retrieved from the oncological databases of five institutions. Surgical, post-operative and follow-up data were analysed. Results: Overall, 260 patients were included in the study. Pancreatic resection was performed in 45 (17.6%) women, 23 of whom received capsule resection alone, while 22 required tail resection. Hyperthermic intraperitoneal chemotherapy (HIPEC) was administered in 28 (10.8%) patients. In the overall population, a pancreatic fistula was detected in 32 (12.3%) patients, and pancreatic resection (p-value = 0.033) and HIPEC administration (p-value = 0.039) were associated with fistula development. In multivariate analysis, HIPEC (OR = 2.573; p-value = 0.058) was confirmed as a risk factor for fistula development in women receiving splenectomy alone, while concomitant cholecystectomy (OR = 2.680; p-value = 0.012) was identified as the only independent predictor of the occurrence of pancreatic fistulas in those receiving additional distal pancreatectomy. Although the median length of hospital stay was higher in women with pancreatic leakage (p-value = 0.008), the median time from surgery to adjuvant treatment was not significantly increased. Conclusion: HIPEC was identified as a risk factor for pancreatic fistulas in patients who underwent splenectomy alone, while concomitant cholecystectomy was the only independent predictor of fistula in those receiving additional pancreatectomy. The development of pancreatic leakage was not associated with increased post-operative mortality or delay in the initiation of chemotherapy.
- Published
- 2020
45. Endometrial stromal sarcoma arising from endometriosis
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Anna Fagotti, Luigi Carlo Turco, Francesco Cosentino, Virginia Vargiu, Giovanni Scambia, Gabriella Ferrandina, Giuseppe Vizzielli, Salvatore Gueli Alletti, Stefano Cianci, Cosentino, F., Turco, L. C., Ferrandina, G., Fagotti, A., Alletti, S. G., Cianci, S., Vizzielli, G., Vargiu, V., and Scambia, G.
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Pathology ,medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Endometrial stromal sarcoma ,Histological type ,business.industry ,Event (relativity) ,Endometriosis ,Extrauterine sarcoma ,medicine.disease ,Endometrium ,Malignant transformation ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,030220 oncology & carcinogenesis ,medicine ,Endometriosi ,business - Abstract
The malignant transformation of endometriosis is a very uncommon event but can occur in 0.7% to 1% of all cases. Any histological type of tumor found in the endometrium might also occur in endometriosis. Most malignant tumors that originate from endometriosis are endometrioid adenocarcinomas and also clear-cell type carcinomas. On the other hand, sarcomas, especially endometrial stromal sarcoma (ESS), are extremely unusual representing 12% of all cases. ESS is an uncommon neoplasm and accounts for 0.2% of the uterine malignances. Malignant tumors arising from endometriosis can derive from the uterine wall as well as from extra-uterine sites. The most frequent extrauterine location is the ovary (78.7%), followed by the pelvic peritoneum (5.7%), the rectovaginal septum (4.3%), the colon (4.3%) and the vagina (2%), representing the majority of extragonadal sites. ESSs arising from the extrauterine and extraovarian endometriosis sites in the absence of a primary uterine lesion are extremely rare and the treatment options are not clear. Surgical debulking seems to be the best treatment. Adjuvant therapy, such as radiation, hormonal therapy and chemotherapy are not yet proven to be effective. Molecular target therapy could be a future possibility of treatment. A systematic review of English Medical Literature about incidence, treatment and prognosis of extrauterine ESS arising from endometriosis foci was performed. The selected articles on which this review is based are the following: 9 literature reviews, 8 retrospective studies, 7 case series, 1 prospective trial and 11 case reports.
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- 2017
46. Robotic approach for the treatment of gynecological cancers recurrences: A ten-year single-institution experience.
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Certelli C, Palmieri L, Federico A, Oliva R, Conte C, Rosati A, Vargiu V, Tortorella L, Chiantera V, Foschi N, Ardito F, Lodoli C, Bruno M, Santullo F, De Rose AM, Fagotti A, Fanfani F, Scambia G, and Gallotta V
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- Humans, Female, Middle Aged, Retrospective Studies, Aged, Adult, Operative Time, Endometrial Neoplasms surgery, Endometrial Neoplasms pathology, Postoperative Complications epidemiology, Peritoneal Neoplasms secondary, Peritoneal Neoplasms surgery, Ovarian Neoplasms surgery, Ovarian Neoplasms pathology, Blood Loss, Surgical statistics & numerical data, Lymphatic Metastasis, Obesity complications, Aged, 80 and over, Robotic Surgical Procedures methods, Neoplasm Recurrence, Local, Genital Neoplasms, Female surgery, Genital Neoplasms, Female pathology, Cytoreduction Surgical Procedures methods
- Abstract
Introduction: Although the management of gynecological cancers recurrences may be challenging, due to the heterogeneity of recurrent disease, the aim of this work is to present a descriptive analysis of gynecological malignancies recurrences in our institution treated by robotic approach., Materials and Methods: We performed a retrospective review and analysis of data of patients who underwent robotic surgery for recurrent gynecological malignancies at Catholic University of the Sacred Hearth, Rome, from January 2013 to January 2024., Results: A total of 54 patients underwent successful robotic cytoreductive surgery. The median age was 63 years; the median BMI was 33 kg/m
2 and most of the patients (59 %) were obese. In 12 cases (22 %) the relapse presented was the second or third relapse. The most frequent patterns of recurrence were represented by lymph nodes (41 %), followed by peritoneal (26 %), pelvic (22 %) and parenchymal (11 %). In all patients complete cytoreduction was achieved. In 29 patients (54 %) the surgical field was previous treated. The median operative time and estimated blood loss were, respectively, 270 min and 100 ml. There were 2 intraoperative complications, managed endoscopically; 10 early postoperative complications, and 3 late postoperative complications. The 2-year progression-free-survival and overall survival were, respectively, 39.8 % and 72.3 %., Conclusion: Robotic approach in the treatment of recurrent gynecological cancers should be considered in selected patients with oligometastatic disease, in high-volume centers with expert surgeons, particularly in obese patients., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)- Published
- 2024
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47. Port Site Metastasis in Women with Low- or Intermediate-Risk Endometrial Carcinoma: A Systematic Review of Literature.
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Raffone A, Raimondo D, Colalillo A, Raspollini A, Neola D, Travaglino A, Vargiu V, Turco LC, Vastarella MG, Seracchioli R, Fanfani F, Cobellis L, and Cosentino F
- Abstract
Background: Port site metastasis (PSM) has been reported as a rare metastasis in women with endometrial carcinoma (EC). However, even more rarely, it has also been described in patients with low- or intermediate-risk EC. Unfortunately, knowledge appears limited on the topic. Objectives: Our objective was to systematically review the literature on PSM in low- or intermediate-risk EC. Search Strategy: A systematic review of the literature was performed by searching six electronic databases from their inception to January 2023. Selection Criteria: We included in our research all peer-reviewed studies which reported PSM in low- or intermediate-risk EC women. Data Collection and Analysis: Data on PSM were collected from the included studies and compared. Results: Seven studies with 13 patients (including our case) were included in the systematic review. PSM was reported in patients with low- or intermediate-risk EC independently from tumor histologic characteristics, endoscopic approach, lymph node staging type, number and site of the port, route of specimen removal, prevention strategies for PSM, and concomitant metastases. Among several proposed treatments, local resection and radiotherapy with or without chemotherapy might be the most appropriate ones. Nevertheless, the prognosis appears poor. Conclusions: In patients with low- or intermediate-risk EC, PSM can occur as a rare metastasis, regardless of tumor characteristics or surgical strategy. Unfortunately, no consensus has been reached regarding treatment, and the prognosis appears poor. Additional cases are needed in order to confirm and further explore this rare EC metastasis.
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- 2024
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48. Concurrent endometrial cancer in atypical endometrial hyperplasia and the role of sentinel lymph nodes: clinical insights from a multicenter experience.
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Rosati A, Vargiu V, Capozzi VA, Giannarelli D, Palmieri E, Baroni A, Perrone E, Berretta R, Cosentino F, Scambia G, and Fanfani F
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- Humans, Female, Retrospective Studies, Middle Aged, Aged, Adult, Salpingo-oophorectomy, Endometrial Neoplasms pathology, Endometrial Neoplasms surgery, Endometrial Hyperplasia pathology, Endometrial Hyperplasia surgery, Endometrial Hyperplasia epidemiology, Sentinel Lymph Node Biopsy, Sentinel Lymph Node pathology, Sentinel Lymph Node surgery, Hysterectomy
- Abstract
Objective: This study aimed to evaluate the prevalence of concurrent endometrial cancer in patients pre-operatively diagnosed with atypical endometrial hyperplasia undergoing hysterectomy. Additionally, we assessed the occurrence of high to intermediate-risk and high-risk tumors according to the ESGO-ESTRO-ESP classification. The study also compared surgical outcomes and complications between patients undergoing simple hysterectomy and those undergoing hysterectomy with sentinel lymph node biopsy., Methods: In this multicenter retrospective study, patients with a pre-operative diagnosis of atypical endometrial hyperplasia were identified and divided into two groups: Group 1, which included patients treated with total hysterectomy with or without bilateral salpingo-oophorectomy, and Group 2, where sentinel lymph node biopsy was incorporated into the standard surgical treatment., Results: Among 460 patients with atypical endometrial hyperplasia, 192 received standard surgical management (Group 1) and 268 underwent sentinel lymph node biopsy (Group 2). A total of 47.2% (95% CI 42.6% to 51.7%) of patients were upgraded to endometrial cancer on final histopathological examination. High to intermediate-risk and high-risk tumors constituted 12.3% and 9.2% in Group 2 and 7.4% and 3.7% in Group 1. Lymph node metastases were identified in 7.6% of patients with concurrent endometrial cancer who underwent nodal assessment with at least unilateral mapping. Of the 12 sentinel lymph node metastases, 75.0% were micrometastases, 16.7% macrometastases, and 8.3% isolated tumor cells. No significant differences were found in estimated blood loss, operative time, and intra-operative and post-operative complications between the two groups. The rate of patients undergoing sentinel lymph node biopsy doubled every 2 years (OR 2.010, p<0.001), reaching 79.1% in the last 2 years., Conclusion: This study found a prevalence of concurrent endometrial cancer of 47.2%, and sentinel lymph node biopsy provided prognostic and therapeutic information in 60.8% of cases. It also allowed for the adjustment of adjuvant therapy in 12.3% of high to intermediate-risk patients without increasing operative time or complication rates., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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49. Optimizing patient selection for secondary cytoreductive surgery in recurrent endometrial cancer.
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Vargiu V, Rosati A, Tortorella L, Giannarelli D, Capozzi VA, Gallotta V, Gioè A, Di Stefano E, Corrado M, Berretta R, Cosentino F, Scambia G, and Fanfani F
- Abstract
Objective: This retrospective, multicenter, observational study aimed to refine patient selection criteria for secondary cytoreductive surgery in recurrent endometrial cancer. The objective was to identify preoperative predictors of complete cytoreduction, assess surgical complexity, and propose a preoperative predictive scoring system to identify suitable candidates for secondary cytoreductive surgery., Methods: Data from 331 women with recurrent endometrial cancer were analyzed across three Italian centers from January 2010 to December 2021. Patients were categorized based on treatment received (medical treatment, diagnostic laparoscopy/examination under anesthesia, or secondary cytoreductive surgery). Preoperative predictors, surgical complexity, complications, and a predictive scoring system were assessed. Logistic regression and receiver operating characteristic analysis were used for statistical evaluation., Results: Of the cohort, 56.2% underwent debulking surgery, 17.2% had diagnostic laparoscopy, and 26.6% received medical treatment. Patients undergoing secondary cytoreductive surgery were younger, with a lower body mass index, better performance status, and fewer comorbidities. Single site locoregional relapse was common in secondary cytoreductive surgery patients. Age <65 years, single site relapse, lymph node, and hematogenous relapse were independent predictors of complete cytoreduction. A predictive scoring system demonstrated a clear relationship between the score and the likelihood of complete cytoreduction., Conclusion: This study identified age <65 years, single site recurrence, as well as nodal and hematogenous recurrence, as predictive factors for achieving optimal cytoreduction. A predictive scoring system incorporating these factors has been proposed to identify optimal candidates for secondary cytoreductive surgery in recurrent endometrial cancer. The scoring system showed promising predictive accuracy and could aid in refining the decision making process, ensuring appropriate patient selection for secondary cytoreductive surgery. Further prospective studies are warranted to validate and enhance the predictive model., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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50. Pattern of recurrence in endometrial cancer. The murderer always returns to the scene of the crime.
- Author
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Capozzi VA, Monfardini L, Maglietta G, Barresi G, De Finis A, Rosati A, Vargiu V, Cosentino F, Sozzi G, Chiantera V, Bogani G, Carnelli M, Scambia G, Fanfani F, Ghi T, and Berretta R
- Subjects
- Female, Humans, Retrospective Studies, Neoplasm Staging, Crime, Recurrence, Lymph Node Excision, Neoplasm Recurrence, Local pathology, Endometrial Neoplasms surgery, Endometrial Neoplasms pathology
- Abstract
Background: Endometrial cancer recurrence occurs in about 18 % of patients. This study aims to analyze the pattern recurrence of endometrial cancer and the relationship between the initial site of primary disease and the relapse site in patients undergoing surgical treatment., Methods: We retrospectively reviewed all surgically treated patients with endometrial cancer selecting those with recurrence. We defined primary site disease as uterus, lymph nodes, or peritoneum according to pathology analysis of the surgical specimen. The site of recurrence was defined as vaginal cuff, lymph nodes, peritoneum, and parenchymatous organs. Our primary endpoint was to correlate the site of initial disease with the site of recurrence., Results: The study enrolled 1416 patients. The overall recurrence rate was 17,5 % with 248 relapses included in the study. An increase of 9.9, 5.7, and 5.7 times in the odds of relapse on the lymph node, peritoneum, and abdominal parenchymatous sites respectively was observed in case of nodal initial disease (p < 0.001). A not significant difference in odds was observed in terms of vaginal cuff relapse (OR 0.9) between lymph node ad uterine primary disease (p = 0.78). An increasing OR of 8.7 times for nodal recurrences, 46.6 times for peritoneum, and 23.3 times for parenchymatous abdominal recurrences were found in the case of primary peritoneal disease (p < 0.001)., Conclusion: Endometrial cancer tends to recur at the initial site of the disease. Intraoperative inspection of the adjacent sites of primary disease and targeted instrumental examination of the initial sites of disease during follow-up are strongly recommended., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (© 2024 Elsevier Ltd, BASO ∼ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
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- 2024
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