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O’Dwyer J, O’Cearbhaill RE, Wylie R, O’Mahony S, O’Dwyer M, Duffy GP, Dolan EB. Enhancing delivery of small molecule and cell-based therapies for ovarian cancer using advanced delivery strategies. ADVANCED THERAPEUTICS 2020; 3:2000144. [PMID: 33709016 PMCID: PMC7942751 DOI: 10.1002/adtp.202000144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 12/17/2022]
Abstract
Ovarian cancer is the most lethal gynecological malignancy with a global five-year survival rate of 30-50%. First-line treatment involves cytoreductive surgery and administration of platinum-based small molecules and paclitaxel. These therapies were traditionally administered via intravenous infusion, although intraperitoneal delivery has also been investigated. Initial clinical trials of intraperitoneal administration for ovarian cancer indicated significant improvements in overall survival compared to intravenous delivery, but this result is not consistent across all studies performed. Recently cell-based immunotherapy has been of interest for ovarian cancer. Direct intraperitoneal delivery of cell-based immunotherapies might prompt local immunoregulatory mechanisms to act synergistically with the delivered immunotherapy. Based on this theory, pre-clinical in vivo studies have delivered these cell-based immunotherapies via the intraperitoneal route, with promising results. However, successful intraperitoneal delivery of cell-based immunotherapy and clinical adoption of this technique will depend on overcoming challenges of intraperitoneal delivery and finding the optimal combinations of dose, therapeutic and delivery route. We review the potential advantages and disadvantages of intraperitoneal delivery of cell-based immunotherapy for ovarian cancer and the pre-clinical and clinical work performed so far. Potential advanced delivery strategies, which might improve the efficacy and adoption of intraperitoneal delivery of therapy for ovarian cancer, are also outlined.
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Affiliation(s)
- Joanne O’Dwyer
- Department of Biomedical Engineering, School of Engineering, College of Science and Engineering, National University of Ireland Galway, Ireland; Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Roisin E. O’Cearbhaill
- Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Ireland; Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Robert Wylie
- Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Saoirse O’Mahony
- Department of Biomedical Engineering, School of Engineering, College of Science and Engineering, National University of Ireland Galway, Ireland
| | - Michael O’Dwyer
- Apoptosis Research Centre, National University of Ireland Galway, Ireland
| | - Garry P. Duffy
- Anatomy & Regenerative Medicine Institute, School of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Eimear B. Dolan
- Department of Biomedical Engineering, School of Engineering, College of Science and Engineering, National University of Ireland Galway, Ireland
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Edelblute CM, Guo S, Hornef J, Yang E, Jiang C, Schoenbach K, Heller R. Moderate Heat Application Enhances the Efficacy of Nanosecond Pulse Stimulation for the Treatment of Squamous Cell Carcinoma. Technol Cancer Res Treat 2019; 17:1533033818802305. [PMID: 30253713 PMCID: PMC6156209 DOI: 10.1177/1533033818802305] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Nanosecond pulse stimulation as a tumor ablation therapy has been studied for the treatment of various carcinomas in animal models and has shown a significant survival benefit. In the current study, we found that moderate heating at 43°C for 2 minutes significantly enhanced in vitro nanosecond pulse stimulation-induced cell death of KLN205 murine squamous cell carcinoma cells by 2.43-fold at 600 V and by 2.32-fold at 900 V, as evidenced by propidium iodide uptake. Furthermore, the ablation zone in KLN205 cells placed in a 3-dimensional cell-culture model and pulsed at a voltage of 900 V at 43°C was 3 times larger than in cells exposed to nanosecond pulse stimulation at room temperature. Application of moderate heating alone did not cause cell death. A nanosecond pulse stimulation electrode with integrated controllable laser heating was developed to treat murine ectopic squamous cell carcinoma. With this innovative system, we were able to quickly heat and maintain the temperature of the target tumor at 43°C during nanosecond pulse stimulation. Nanosecond pulse stimulation with moderate heating was shown to significantly extend overall survival, delay tumor growth, and achieve a high rate of complete tumor regression. Moderate heating extended survival nearly 3-fold where median overall survival was 22 days for 9.8 kV without moderate heating and over 63 days for tumors pulsed with 600, 100 ns pulses at 5 Hz, at voltage of 9.8 kV with moderate heating. Median overall survival in the control groups was 24 and 31 days for mice with untreated tumors and tumors receiving moderate heat alone, respectively. Nearly 69% (11 of 16) of tumor-bearing mice treated with nanosecond pulse stimulation with moderate heating were tumor free at the completion of the study, whereas complete tumor regression was not observed in the control groups and in 9.8 kV without moderate heating. These results suggest moderate heating can reduce the necessary applied voltage for tumor ablation with nanosecond pulse stimulation.
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Affiliation(s)
- Chelsea M Edelblute
- 1 Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA
| | - Siqi Guo
- 1 Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA
| | - James Hornef
- 1 Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA.,2 Department of Biomedical Engineering, College of Engineering, Old Dominion University, Norfolk, VA, USA
| | - Enbo Yang
- 1 Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA
| | - Chunqi Jiang
- 1 Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA.,2 Department of Biomedical Engineering, College of Engineering, Old Dominion University, Norfolk, VA, USA
| | - Karl Schoenbach
- 1 Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA.,3 School of Medical Diagnostic & Translational Sciences, College of Health Sciences, Old Dominion University, Norfolk, VA, USA
| | - Richard Heller
- 1 Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA.,3 School of Medical Diagnostic & Translational Sciences, College of Health Sciences, Old Dominion University, Norfolk, VA, USA
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Ceresoli M, Verrengia A, Montori G, Busci L, Coccolini F, Ansaloni L, Frigerio L. Effect of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on relapse pattern in primary epithelial ovarian cancer: a propensity score based case-control study. J Gynecol Oncol 2018. [PMID: 29533028 PMCID: PMC5920229 DOI: 10.3802/jgo.2018.29.e53] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Hyperthermic intraperitoneal chemotherapy (HIPEC) has been proposed as a treatment in ovarian cancer. A recently published RCT demonstrated that HIPEC prolongs disease-free survival (DFS) and overall survival (OS) in ovarian cancer. The aim of the study was to investigate oncologic results of cytoreductive surgery+HIPEC compared with cytoreductive surgery alone in advanced primary ovarian cancer with a particular attention to the pattern of recurrence. METHODS This is a retrospective case control study with a propensity score (PS) matching of the patients. All the patients treated for primary advanced ovarian cancer who underwent interval surgery with or without HIPEC were collected; a PS was calculated in order to match cases to controls. RESULTS Among 77 eligible patients 56 patients were included in the study. Preoperative patients' characteristics were homogeneous. No difference in morbidity and mortality after surgery were recorded. DFS was not different among the 2 groups (13.2 vs. 13.9 months, p=0.454) but OS was better in patients treated with HIPEC with no median reached vs. 35.5 months (p=0.048). Patients treated with cytoreductive surgery alone were more likely to have a peritoneal recurrence (43% vs. 14%). CONCLUSION HIPEC seems to affect the relapse pattern with lesser peritoneal recurrence. This difference in relapse pattern seems to affect the OS with better results in patients treated with HIPEC. Further studies are needed to confirm these findings.
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Affiliation(s)
- Marco Ceresoli
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | | | - Giulia Montori
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luisa Busci
- Unit of Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Federico Coccolini
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca Ansaloni
- Unit of General and Emergency Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luigi Frigerio
- Unit of Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Rodríguez Silva C, Moreno Ruiz FJ, Bellido Estévez I, Carrasco Campos J, Titos García A, Ruiz López M, González Poveda I, Toval Mata JA, Mera Velasco S, Santoyo Santoyo J. Are there intra-operative hemodynamic differences between the Coliseum and closed HIPEC techniques in the treatment of peritoneal metastasis? A retrospective cohort study. World J Surg Oncol 2017; 15:51. [PMID: 28222738 PMCID: PMC5320712 DOI: 10.1186/s12957-017-1119-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/08/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although two main methods of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) are currently accepted, the superiority of one over the other has not yet been demonstrated. The purpose of this study was to determine whether there are hemodynamic and temperature differences between patients who received HIPEC in two different techniques, open versus closed abdomen. METHODS This retrospective study was conducted in our center between 2011-2015 in 30 patients who underwent surgery for peritoneal carcinomatosis secondary to colorectal cancer, in whom cytoreduction and HIPEC were performed by the Coliseum (15) or closed techniques (15). The main end points were morbidity, mortality, hemodynamic changes, and abdominal temperature. The comparative analysis of quantitative variables at different times was done with the parametric repeated measure ANOVA for those variables that fulfilled the suppositions of normality and independence and the Friedman non-parametric test for the variables that did not fulfill either of these suppositions. RESULTS There were no deaths in either group. The incidence of postoperative complications in the Coliseum group was 53% (8 patients), grade II-III. The incidence of complications in the closed group was 13% (2 patients), grade II-III. The intra-operative conditions regarding the systolic and diastolic pressures were more stable using the closed abdomen technique (but not significantly so). We found statistically significant differences in abdominal temperature in favor of the closed technique (p = 0.009). CONCLUSIONS Both HIPEC procedures are similar. In our series, the closed technique resulted in a more stable intra-abdominal temperature.
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Affiliation(s)
- Cristina Rodríguez Silva
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain.
| | - Francisco Javier Moreno Ruiz
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Inmaculada Bellido Estévez
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Joaquin Carrasco Campos
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Alberto Titos García
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Manuel Ruiz López
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Ivan González Poveda
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Jose Antonio Toval Mata
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Santiago Mera Velasco
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
| | - Julio Santoyo Santoyo
- Universidad de Málaga, Departamento de Farmacología, Servicio de Cirugía General, Digestiva y Trasplantes, Hospital Regional Universitario de Málaga, Avda Carlos Haya, 29020, Malaga, Spain
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Bhatt A, Goéré D. Cytoreductive Surgery plus HIPEC for Peritoneal Metastases from Colorectal Cancer. Indian J Surg Oncol 2016; 7:177-87. [PMID: 27065708 DOI: 10.1007/s13193-016-0499-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 01/28/2016] [Indexed: 02/06/2023] Open
Abstract
Occurring either synchronously or metachronously to the primary tumor, peritoneal metastases (PM) are diagnosed in 8 to 20 % of the patients with colorectal cancer (CRC). Prognosis of these patients appears to be worse than those with other sites of metastases. While systemic therapy has shown significant prolongation of survival in patients with stage IV colorectal cancer, the outcomes in the subset of patients with PM has been much inferior. Over the last 2 decades, cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC) have been effective in substantially prolonging survival in patients with colorectal PM and have the potential to cure certain patients as well. This article reviews the current evidence for CRS and HIPEC to treat colorectal PM as well as future research going on in this form of locoregional treatment.
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Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, Fortis Hospital, 154/9 Bannerghatta road, Opposite IIM-Bangalore, Bangalore, -560076 India
| | - Diane Goéré
- Department of Surgical Oncology, Gustave Roussy, Cancer Campus, Villejuif, France
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Randle RW, Griffith KF, Fino NF, Swett KR, Stewart JH, Shen P, Levine EA, Votanopoulos KI. Appendiceal goblet cell carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Surg Res 2015; 196:229-34. [PMID: 25881787 DOI: 10.1016/j.jss.2015.03.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/09/2015] [Accepted: 03/19/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment commonly applied to peritoneal surface disease from low-grade mucinous tumors of the appendix. Some centers have extended this therapy to carcinomatosis from more aggressive malignancies. Therefore, we reviewed our experience with CRS/HIPEC for patients with goblet cell carcinomatosis. METHODS Patients with carcinomatosis from appendiceal primaries with goblet cell features were identified in a prospectively maintained database of 1198 CRS/HIPEC procedures performed between 1991 and 2014. Patient demographics, disease characteristics, morbidity, mortality, and survival were reviewed. RESULTS A total of 31 patients with carcinomatosis originating from appendiceal goblet cell tumors underwent CRS/HIPEC during the study period. Patients were generally young (mean age, 53 y) and otherwise healthy (84% without comorbidities) with good performance status (94% Eastern Cooperative Oncology Group 0 or 1). The mean number of visceral resections was 3.5, and complete cytoreduction of macroscopic disease was accomplished in 36%. Major 90-d morbidity and mortality rates were 38.7% and 9.7%, respectively. Median overall survival (OS) for all patients was 18.4 mo. Patients with negative nodes had better survival than those with positive nodes (median OS, 29.2 versus 10.2 mo), respectively (P = 0.002). Although complete cytoreduction was associated with longer median OS after CRS/HIPEC (R0/R1 28.6 versus R2 17.2 mo, P = 0.47), the observed difference did not reach statistical significance. CONCLUSIONS CRS/HIPEC may improve survival in patients with node negative goblet cell carcinomatosis when a complete cytoreduction is achieved. Patients with disease not amenable to complete cytoreduction should not be offered CRS/HIPEC.
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Affiliation(s)
- Reese W Randle
- Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Kayla F Griffith
- Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Nora F Fino
- Department of Biostatistics, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Katrina R Swett
- Department of Biostatistics, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - John H Stewart
- Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Perry Shen
- Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Edward A Levine
- Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Konstantinos I Votanopoulos
- Section of Surgical Oncology, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina.
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Coccolini F, Campanati L, Catena F, Ceni V, Ceresoli M, Jimenez Cruz J, Lotti M, Magnone S, Napoli J, Rossetti D, De Iaco P, Frigerio L, Pinna A, Runnebaum I, Ansaloni L. Hyperthermic intraperitoneal chemotherapy with cisplatin and paclitaxel in advanced ovarian cancer: a multicenter prospective observational study. J Gynecol Oncol 2015; 26:54-61. [PMID: 25376916 PMCID: PMC4302286 DOI: 10.3802/jgo.2015.26.1.54] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/09/2014] [Accepted: 10/15/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been recently reported with favorable oncological outcomes as treatment of advanced epithelial ovarian cancer (EOC). The aim of this study was to demonstrate the feasibility of CRS+HIPEC with cisplatin and paclitaxel for the treatment of advanced EOC. METHODS This is a prospective observational study of 54 patients, from April 2007 to October 2013, with primary or recurrent peritoneal carcinomatosis due to EOC. The mean age was 54.51±9.34. Thirty patients (59%) had primary EOC, and 24 patients (41%) had recurrent disease. RESULTS Mean peritoneal cancer index was 10.11 (range, 0 to 28), complete cytoreduction (CC0) was achieved for 47 patients (87%), CC1 for seven patients (13%). Patients with suboptimal cytoreduction (CC2 and CC3) were not included in the study. The mean stay in intensive care unit was 4.73±5.51 days and the mean hospitalization time was 24.0±10.03 days. We did not observe any intraoperative death. Seven patients (13%) required additional operations. Three patients (5.6%) died within 30 days from the procedure. Severe complications were seen in 19 patients (35.2%). During the follow-up period, disease recurred in 33 patients (61.1%); the median disease-free survival time was 12.46 months and the median overall survival time was 32.91 months. CONCLUSION CRS+HIPEC with cisplatin and paclitaxel for advanced EOC is feasible with acceptable morbidity and mortality. Additional follow-up and further studies are needed to determine the effects of HIPEC on long term survival.
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Affiliation(s)
| | - Luca Campanati
- Unit of General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fausto Catena
- Unit of General, Emergency and Transplant Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Valentina Ceni
- Unit of Gynecologic Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Marco Ceresoli
- Unit of General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | | | - Marco Lotti
- Unit of General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Magnone
- Unit of General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Diego Rossetti
- Unit of Gynecologic Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Pierandrea De Iaco
- Unit of Gynecologic Oncology, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luigi Frigerio
- Unit of Gynecologic Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Antonio Pinna
- Unit of General, Emergency and Transplant Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ingo Runnebaum
- Unit of Gynaecology, Jena University Hospital, Jena, Germany
| | - Luca Ansaloni
- Unit of General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
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