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RISS 인기검색어
- 검색키워드
- 저자 : Emanuela Spagnolo (검색결과 3 건)
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Casas Sara Gortázar de las,Spagnolo Emanuela,Saverio Salomone Di,Álvarez-Gallego Mario,Carrasco Ana López,López María Carbonell,Cobos Sergio Torres,Campo Constantino Fondevila,Gutiérrez Alicia Hernánd 대한대장항문학회 2023 Annals of Coloproctolgy Vol.39 No.3
Purpose: The surgical management of deep infiltrative endometriosis (DE) involving the rectum remains a challenge. The objective of this study was to assess the outcomes from a single tertiary center over a decade with an emphasis on the role of a protective loop ileostomy (PI).Methods: A retrospective review of outcomes for 168 patients managed between 2008 and 2018 is presented including 57 rectal shaves, 23 discoid excisions, and 88 segmental rectal resections.Results: The nodule size (mean±standard deviation) in the segmental resection group was 32.7±11.2 mm, 23.4±10.5 mm for discoid excision, and 18.8±6.0 mm for rectal shaves. A PI was performed in 19 elective cases (11.3%) usually for an ultra-low anastomosis <5 cm from the anal verge. All Clavien-Dindo grade III/IV complications occurred after segmental resections and included 5 anastomotic leaks, 6 rectovaginal fistulas, 2 ureteric fistulas, and 1 ureteric stenosis. Of 26 stomas (15.5%), there were 19 PIs, 3 secondary ileostomies (after complications), and 4 end colostomies. The median time to PI closure was 5.8 months (range, 0.4–16.7 months) in uncomplicated disease compared with 9.2 months (range, 4.7–18.4 months) when initial postoperative complications were recorded (P=0.019). Only 1 patient with a recurrent rectovaginal fistula had a permanent colostomy.Conclusion: In patients with DE and rectal involvement a PI is selectively used for low anastomoses and complex pelvic reconstructions. Protective stomas and those used in the definitive management of a major postoperative complication can usually be reversed.
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Marcello Ceccaroni,Giovanni Roviglione,Mario Malzoni,Francesco Cosentino,Emanuela Spagnolo,Roberto Clarizia,Paolo Casadio,Renato Seracchioli,Fabio Ghezzi,Daniele Mautone,Francesco Bruni,Stefano Uccell 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.1
Objective: Total laparoscopic nerve-sparing radical hysterectomy (TL-NSRH) has beenconsidered a promising approach, however, surgical, clinical, oncological and functionaloutcomes have not been systematically addressed. We present a large retrospective multi center experience comparing TL-NSRH vs. open abdominal NSRH (OA-NSRH) for early andlocally-advanced cervical cancer, with particular emphasis on post-surgical pelvic function. Methods: All consecutive patients who underwent class C1-NSRH plus bilateral pelvic + para aortic lymphadenectomy for stage IA2–IIB cervical cancer at 4 Italian gynecologic oncologiccenters (Negrar, Varese, Bologna, Avellino) were enrolled. Patients were divided into TL NSRH and OA-NSRH groups and were investigated with preoperative questionnaires onurinary, rectal and sexual function. Postoperatively, patients filled a questionnaire assessingquality of life, taking into account sexual function and psychological status. Oncologicaloutcomes were analyzed using Kaplan-Meyer method. Results: 301 consecutive patients were included in this study: 170 in the TL-NSRH group and131 in the OA-NSRH group. Patients in the OA-NSRH group were more likely to experienceurinary incontinence and (after 12-months follow-up) urinary retention. No patient in theTL-NSRH group vs. 5 (5.5%) in the OA-NSRH group had complete urinary retention (at the>24-month follow-up [p=0.02]). A total of 20 (11.8%) in the TL-NSRH and 11 (8.4%) patientsin the OA-NSRH had recurrence of disease (p=0.44) and 14 (8.2%) and 9 (6.9%) died ofdisease during follow-up, respectively (p=0.83). Conclusion: Our study shows that TL-NSRH is feasible, safe and effective and conjugatesadequate radicality and improvement in post-operative functional outcomes. Oncologicaloutcomes of laparoscopic procedures deserve further investigation.
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Martina Aida Angeles,Bastien Cabarrou,Antonio Gil-Moreno,Asunción Pérez-Benavente,Emanuela Spagnolo,Agnieszka Rychlik,Carlos Martínez-Gómez,Frédéric Guyon,Ignacio Zapardiel,Denis Querleu,Claire Illac 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.6
Objective: We sought to evaluate the impact on survival of tumor burden and surgical complexity in relation to the number of cycles of neoadjuvant chemotherapy (NACT) in patients with advanced ovarian cancer (OC) with minimal (CC-1) or no residual disease (CC-0). Methods: This retrospective study included patients with International Federation of Gynaecology and Obstetrics IIIC–IV stage OC who underwent debulking surgery at 4 high- volume institutions between January 2008 and December 2015. We assessed the overall survival (OS) of primary debulking surgery (PDS group), early interval debulking surgery after 3–4 cycles of NACT (early IDS group) and delayed debulking surgery after 6 cycles (DDS group) with CC-0 or CC-1 according to peritoneal cancer index (PCI) and Aletti score. Results: Five hundred forty-nine women were included: 175 (31.9%) had PDS, 224 (40.8%) early IDS and 150 (27.3%) DDS. Regardless of Aletti score, median OS after PDS was significantly higher than after early IDS or DDS, but the survival difference was higher in women with an Aletti score <8. Among patients with PCI ≤10, median OS after PDS was significantly higher than after early IDS or DDS. In women with PCI >10, there were no differences between PDS and early IDS, but DDS was associated with decreased OS. Conclusion: The benefit of complete PDS compared with NACT was maximal in patients with a low complexity score. In patients with low tumor burden, there was a survival benefit of PDS over early IDS or DDS. In women with high tumor load, DDS impaired the oncological outcome.
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