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Fertility sparing surgery in early stage epithelial ovarian cancer
Antonino Ditto,Fabio Martinelli,Domenica Lorusso,Edward Haeusler,Marialuisa Carcangiu,Francesco Raspagliesi 대한부인종양학회 2014 Journal of Gynecologic Oncology Vol.25 No.4
Objective: Fertility sparing surgery (FSS) is a strategy often considered in young patients with early epithelial ovarian cancer. We investigated the role and the outcomes of FSS in eEOC patients who underwent comprehensive surgery. Methods: From January 2003 to January 2011, 24 patients underwent fertility sparing surgery. Eighteen were one-to-one matched and balanced for stage, histologic type and grading with a group of patients who underwent radical comprehensive staging (n=18). Demographics, surgical procedures, morbidities, pathologic findings, recurrence-rate, pregnancy-rate and correlations with disease-free survival were assessed. Results: A total of 36 patients had a complete surgical staging including lymphadenectomy and were therefore analyzed. Seven patients experienced a recurrence: four (22%) in the fertility sparing surgery group and three (16%) in the control group (p=not significant). Sites of recurrence were: residual ovary (two), abdominal wall and peritoneal carcinomatosis in the fertility sparing surgery group; pelvic (two) and abdominal wall in the control group. Recurrences in the fertility sparing surgery group appeared earlier (mean, 10.3 months) than in radical comprehensive staging group (mean, 53.3 months) p<0.001. Disease-free survival were comparable between the two groups (p=0.422). No deaths were reported. All the patients in fertility sparing surgery group recovered a regular period. Thirteen out of 18 (72.2%) attempted to have a pregnancy. Five (38%) achieved a spontaneous pregnancy with a full term delivery. Conclusion: Fertility sparing surgery in early epithelial ovarian cancer submitted to a comprehensive surgical staging could be considered safe with oncological results comparable to radical surgery group.
Oncologic effectiveness of nerve-sparing radical hysterectomy in cervical cancer
Antonino Ditto,Giorgio Bogani,Umberto Leone Roberti Maggiore,Fabio Martinelli,Valentina Chiappa,Carlos Lopez,Stefania Perotto,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.3
Objective: Nerve-sparing radical hysterectomy (NSRH) was introduced with the aim to reduce pelvic dysfunctions related to conventional radical hysterectomy (RH). Here, we sought to assess the effectiveness and safety of NSRH in a relatively large number of the patients of cervical cancer (CC) patients undergoing either primary surgery or neoadjuvant chemotherapy (NACT) followed by surgery. Methods: Outcomes of consecutive patients undergoing NSRH and of a historical cohort of patients undergoing conventional RH were retrospectively reviewed. Results: This study included 325 (49.8%) and 327 (50.2%) undergoing NSRH and RH, respectively. Via a multivariable model, nodal status was the only factor predicting for DFS (hazard ratio [HR]=2.09; 95% confidence interval [CI]=1.17–3.73; p=0.01). A trend towards high risk of recurrence was observed for patients affected by locally advanced cervical cancer (LACC) undergoing NACT followed by surgery (HR=2.57; 95% CI=0.95–6.96; p=0.06). Type of surgical procedures (NSRH vs. RH) did not influence risk of recurrence (p=0.47). Similarly, we observed that the execution of NSRH rather than RH had not a detrimental effect on OS (HR=1.19; 95% CI=0.16–9.01; p=0.87). Via multivariable model, no factor directly correlated with OS. No difference in early complication rates was observed between the study groups. Conversely, a significant higher number of late complications was reported in RH versus NSRH groups (p=0.02). Conclusion: Our data suggested that NSRH upholds effectiveness of conventional RH, without increasing recurrence and complication rates but improving pelvic dysfunction rates.
Treatment modalities for recurrent high-grade vaginal intraepithelial neoplasia
Giorgio Bogani,Antonino Ditto,Stefano Ferla,Biagio Paolini,Claudia Lombardo,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.2
Objective: We have investigated outcomes of women presenting with recurrent high-grade vaginal intra-epithelial neoplasia. Methods: Data of consecutive women diagnosed with recurrent high-grade vaginal intraepithelial neoplasia after primary treatment(s) were retrieved. Risk of developing new recurrence over the time was assessed using Kaplan-Meier and Cox models. Results: Data of 117 women were available for the analysis. At primary diagnosis, 41 (35%), 4 (3.4%) and 72 (61.6%) patients had had laser, pure surgical and medical treatments, respectively. Secondary treatments included: laser ablation and medical treatment in 95 (81.2%) and 22 (18.8%) cases, respectively. After a mean (standard deviation) follow-up of 72.3 (±39.5) months, 37 (31.6%) out of the entire cohort of 117 patients developed a second recurrence. Median time to recurrence was 20 (range, 5–42) months. Patients with recurrent high-grade vaginal intra-epithelial neoplasia undergoing medical treatments were at higher risk of developing a second recurrence in comparison to women having laser treatment (p=0.013, log-rank test). After we corrected our results for type of treatment used for recurrent disease, we observed that the execution of primary laser treatment was independently associated with a lower risk of developing new recurrences (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.21–0.99; p=0.050). The other variable that is independently associated with a new recurrence is the persistent infection from HPV16 or 18 (HR=3.87; 95% CI=1.15–13.0; p=0.028). Conclusion: Patients with recurrent high-grade vaginal intra-epithelial neoplasia are at high risk of developing new recurrences. Our data underline that the choice of primary treatment might have an impact of further outcomes.
A critical assessment on the role of sentinel node mapping in endometrial cancer
Giorgio Bogani,Antonino Ditto,Fabio Martinelli,Mauro Signorelli,Stefania Perotto,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2015 Journal of Gynecologic Oncology Vol.26 No.4
Endometrial cancer is the most common gynecologic malignancy in the developed countries. Although the high incidence of this occurrence no consensus, about the role of retroperitoneal staging, still exists. Growing evidence support the safety and efficacy of sentinel lymph node mapping. This technique is emerging as a new standard for endometrial cancer staging procedures. In the present paper, we discuss the role of sentinel lymph node mapping in endometrial cancer, highlighting the most controversies features.
Impact of COVID-19 in gynecologic oncology: a Nationwide Italian Survey of the SIGO and MITO groups
Giorgio Bogani,Giovanni Apolone,Antonino Ditto,Giovanni Scambia,Pierluigi Benedetti Panici,Roberto Angioli,Sandro Pignata,Stefano Greggi,Paolo Scollo,Mezzanzanica Delia,Massimo Franchi,Fabio Martinell 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.6
Objective: Coronavirus disease 2019 (COVID-19) has caused rapid and drastic changesin cancer management. The Italian Society of Gynecology and Obstetrics (SIGO), andthe Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO)promoted a national survey aiming to evaluate the impact of COVID-19 on clinical activity ofgynecologist oncologists and to assess the implementation of containment measures againstCOVID-19 diffusion. Methods: The survey consisted of a self-administered, anonymous, online questionnaire. The survey was sent via email to all the members of the SIGO, and MITO groups on April 7, 2020,and was closed on April 20, 2020. Results: Overall, 604 participants completed the questionnaire with a response-rate of70%. The results of this survey suggest that gynecologic oncology units had set a proactiveapproach to COVID-19 outbreak. Triage methods were adopted in order to minimizein-hospital diffusion of COVID-19. Only 38% of gynecologic surgeons were concernedabout COVID-19 outbreak. Although 73% of the participants stated that COVID-19 hasnot significantly modified their everyday practice, 21% declared a decrease of the use oflaparoscopy in favor of open surgery (19%). However, less than 50% of surgeons adoptedspecific protection against COVID-19. Additionally, responders suggested to delay cancertreatment (10%–15%), and to perform less radical surgical procedures (20%–25%) duringCOVID-19 pandemic. Conclusions: National guidelines should be implemented to further promote the safety ofpatients and health care providers. International cooperation is of paramount importance,as heavily affected nations can serve as an example to find out ways to safely preserve clinicalactivity during the COVID-19 outbreak.
Giorgio Bogani,Diego Rossetti,Antonino Ditto,Fabio Martinelli,Valentina Chiappa,Chiara Leone,Umberto Leone Roberti Maggiore,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.2
Objectives: Nerve-sparing radical hysterectomy has been implemented in order to reduce pelvic floor dysfunctions in women undergoing radical surgery for cervical cancer. Here, we aimed to investigate if the adoption of laparoscopic surgery impacts on patients' outcomes. Methods: Data of consecutive patients affected by cervical cancer who had laparoscopic nerve-sparing radical hysterectomy were matched 1:1 with an historical cohort of patients undergoing open procedure. A propensity-score matched algorithm was applied. Results: Thirty-five patients' pairs (70 patients: 35 undergoing laparoscopic vs. 35 undergoing open abdominal nerve-sparing radical hysterectomy) were included. Demographic and baseline oncologic characteristics were balanced between groups. Patients undergoing laparoscopic surgery had similar operative time than patients undergoing open abdominal procedures (249 [±91.5] vs. 223 [±65.0] minutes; p=0.066). Laparoscopic approach correlated with lower blood loss (30.5 [±11.0] vs. 190 [90.4] mL; p<0.001) and shorter hospital stay (3.2 [±1.2] vs. 5.4 [2.0] days; p=0.023). Patients undergoing laparoscopy experienced a lower 30-day pelvic floor dysfunction rate than patients having open surgery. Moreover, they experienced shorter recovery of bladder function than patients having open procedures (median, 7 vs. 9 days; p=0.004, log-rank test). Conclusion: Laparoscopic approach resulted in a faster recovery of bladder function in comparison to open surgery for patients undergoing nerve-sparing radical hysterectomy.
Giorgio Bogani,Diego Rossetti,Antonino Ditto,Fabio Martinelli,Valentina Chiappa,Lavinia Mosca,Umberto Leone Roberti Maggiore,Stefano Ferla,Domenica Lorusso,Francesco Raspagliesi 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.5
Objective: Accumulating evidence support that complete cytoreduction (CC) at the time of secondary cytoreductive surgery (SCS) improves survival in patients affected by recurrent ovarian cancer (ROC). Here, we aimed to determine whether artificial intelligence (AI) might be useful in weighting the importance of clinical variables predicting CC and survival. Methods: This is a retrospective study evaluating 194 patients having SCS for ROC. Using artificial neuronal network (ANN) analysis was estimated the importance of different variables, used in predicting CC and survival. ANN simulates a biological neuronal system. Like neurons, ANN acquires knowledge through a learning-phase process and allows weighting the importance of covariates, thus establishing how much a variable influences a multifactor phenomenon. Results: Overall, 82.9% of patients had CC at the time of SCS. Using ANN, we observed that the 3 main factors driving the ability of achieve CC included: disease-free interval (DFI) (importance: 0.231), retroperitoneal recurrence (importance: 0.178), residual disease at primary surgical treatment (importance: 0.138), and International Federation of Gynecology and Obstetrics (FIGO) stage at presentation (importance: 0.088). Looking at connections between different covariates and overall survival (OS), we observed that DFI is the most important variable influencing OS (importance: 0.306). Other important variables included: CC (importance: 0.217), and FIGO stage at presentation (importance: 0.100). Conclusion: According to our results, DFI should be considered as the most important factor predicting both CC and OS. Further studies are needed to estimate the clinical utility of AI in providing help in decision making process.