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Bernson E, Huhn O, Karlsson V, Hawkes D, Lycke M, Cazzetta V, Mikulak J, Hall J, Piskorz AM, Portuesi R, Vitobello D, Fiamengo B, Siesto G, Horowitz A, Ghadially H, Mavilio D, Brenton JD, Sundfeldt K, Colucci F. Identification of Tissue-Resident Natural Killer and T Lymphocytes with Anti-Tumor Properties in Ascites of Ovarian Cancer Patients. Cancers (Basel) 2023; 15:3362. [PMID: 37444472 PMCID: PMC10340516 DOI: 10.3390/cancers15133362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/30/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Women with ovarian cancer have limited therapy options, with immunotherapy being unsatisfactory for a large group of patients. Tumor cells spread from the ovary or the fallopian tube into the abdominal cavity, which is commonly accompanied with massive ascites production. The ascites represents a unique peritoneal liquid tumor microenvironment with the presence of both tumor and immune cells, including cytotoxic lymphocytes. We characterized lymphocytes in ascites from patients with high-grade serous ovarian cancer. Our data reveal the presence of NK and CD8+ T lymphocytes expressing CD103 and CD49a, which are markers of tissue residency. Moreover, these cells express high levels of the inhibitory NKG2A receptor, with the highest expression level detected on tissue-resident NK cells. Lymphocytes with these features were also present at the primary tumor site. Functional assays showed that tissue-resident NK cells in ascites are highly responsive towards ovarian tumor cells. Similar results were observed in an in vivo mouse model, in which tissue-resident NK and CD8+ T cells were detected in the peritoneal fluid upon tumor growth. Together, our data reveal the presence of highly functional lymphocyte populations that may be targeted to improve immunotherapy for patients with ovarian cancer.
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Affiliation(s)
- Elin Bernson
- Department of Obstetrics and Gynaecology, University of Cambridge School of Clinical Medicine, NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hosptial, Cambridge CB2 0QQ, UK
- Sahlgrenska Center for Cancer Research, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Oisín Huhn
- Department of Obstetrics and Gynaecology, University of Cambridge School of Clinical Medicine, NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hosptial, Cambridge CB2 0QQ, UK
| | - Veronika Karlsson
- Sahlgrenska Center for Cancer Research, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Delia Hawkes
- Department of Obstetrics and Gynaecology, University of Cambridge School of Clinical Medicine, NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hosptial, Cambridge CB2 0QQ, UK
| | - Maria Lycke
- Sahlgrenska Center for Cancer Research, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Valentina Cazzetta
- Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20122 Milan, Italy
| | - Joanna Mikulak
- Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - James Hall
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 1TN, UK
| | - Anna M. Piskorz
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 1TN, UK
| | - Rosalba Portuesi
- Unit of Gynecology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Domenico Vitobello
- Unit of Gynecology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Barbara Fiamengo
- Unit of Pathological Anatomy, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Gabriele Siesto
- Unit of Gynecology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Amir Horowitz
- Department of Oncological Sciences, Lipschultz Precision Immunology Institute, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Hormas Ghadially
- AstraZeneca, Oncology R&D, Granta Park, Cambridge CB21 6GP, UK
- Department of Pathology, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Mahatma Gandhi Road, Blantyre Private Bag 360, Malawi
| | - Domenico Mavilio
- Laboratory of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Department of Medical Biotechnologies and Translational Medicine, University of Milan, 20122 Milan, Italy
| | - James D. Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 1TN, UK
| | - Karin Sundfeldt
- Sahlgrenska Center for Cancer Research, Department of Obstetrics and Gynecology, Institute of Clinical Sciences, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Francesco Colucci
- Department of Obstetrics and Gynaecology, University of Cambridge School of Clinical Medicine, NIHR Cambridge Biomedical Research Centre, Addenbrooke’s Hosptial, Cambridge CB2 0QQ, UK
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2
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Bogani G, Scambia G, Cimmino C, Fanfani F, Costantini B, Loverro M, Ferrandina G, Landoni F, Bazzurini L, Grassi T, Vitobello D, Siesto G, Perrone AM, Zanagnolo V, De Iaco P, Multinu F, Ghezzi F, Casarin J, Berretta R, Capozzi VA, Zupi E, Centini G, Pellegrino A, Corso S, Stevenazzi G, Montoli S, Boschi AC, Comerci G, Greco P, Martinello R, Sopracordevole F, Giorda G, Simoncini T, Caretto M, Sartori E, Ferrari F, Cianci A, Sarpietro G, Matarazzo MG, Zullo F, Bifulco G, Morelli M, Ferrero A, Biglia N, Barra F, Ferrero S, Leone Roberti Maggiore U, Cianci S, Chiantera V, Ercoli A, Sozzi G, Martoccia A, Schettini S, Orlando T, Cannone FG, Ettore G, Puppo A, Borghese M, Martinelli C, Muzii L, Di Donato V, Driul L, Restaino S, Bergamini A, Candotti G, Bocciolone L, Plotti F, Angioli R, Mantovani G, Ceccaroni M, Cassani C, Dominoni M, Giambanco L, Amodeo S, Leo L, Thomasset R, Raimondo D, Seracchioli R, Malzoni M, Gorlero F, Di Luca M, Busato E, Kilzie S, Dell'Acqua A, Scarfone G, Vercellini P, Petrillo M, Dessole S, Capobianco G, Ciavattini A, Delli Carpini G, Giannella L, Mereu L, Tateo S, Sorbi F, Fambrini M, Cicogna S, Romano F, Ricci G, Trojano G, Consonni R, Cantaluppi S, Lippolis A, Tinelli R, D'Ippolito G, Aguzzoli L, Mandato VD, Palomba S, Calandra D, Rosati M, Gallo C, Surico D, Remorgida V, Ruscitto F, Beretta P, Benedetti Panici P, Raspagliesi F. Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic. J Gynecol Oncol 2021; 33:e10. [PMID: 34910391 PMCID: PMC8728669 DOI: 10.3802/jgo.2022.33.e10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/03/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic. The prevalence of patients with early-stage endometrial cancer (EC) has been lower during coronavirus disease 2019 (COVID-19) pandemic than before its onset. Further evidence is needed to assess the impact of COVID-19 pandemic on survival outcomes of EC patients.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Cimmino
- Department of Obstetrics and Gynaecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Barbara Costantini
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Matteo Loverro
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, Monza, Italy
| | - Luca Bazzurini
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, Monza, Italy
| | - Tommaso Grassi
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, Monza, Italy
| | - Domenico Vitobello
- Unit of Gynecology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Gabriele Siesto
- Unit of Gynecology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | | | - Vanna Zanagnolo
- Department of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Francesco Multinu
- Department of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynaecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Roberto Berretta
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Vito A Capozzi
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Errico Zupi
- Department of Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynaecology, ASST Lecco - Ospedale Alessandro Manzoni, Lecco, Italy
| | - Silvia Corso
- Department of Obstetrics and Gynaecology, ASST Lecco - Ospedale Alessandro Manzoni, Lecco, Italy
| | - Guido Stevenazzi
- Department of Obstetrics and Gynaecology, ASST OVEST MI, Legnano (Milan) Hospital, Legnano, Italy
| | - Serena Montoli
- Department of Obstetrics and Gynaecology, ASST OVEST MI, Legnano (Milan) Hospital, Legnano, Italy
| | - Anna Chiara Boschi
- Department of Obstetrics and Gynaecology, AUSL Romagna, Ospedale "Santa Maria delle Croci", Ravenna, Italy
| | - Giuseppe Comerci
- Department of Obstetrics and Gynaecology, AUSL Romagna, Ospedale "Santa Maria delle Croci", Ravenna, Italy
| | - Pantaleo Greco
- Clinica Ostetrica e Ginecologica - Dipartimento Scienze Mediche - Università di Ferrara, Ferarra, Italy
| | - Ruby Martinello
- Clinica Ostetrica e Ginecologica - Dipartimento Scienze Mediche - Università di Ferrara, Ferarra, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Caretto
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Sartori
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Catania, Italy
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Catania, Italy
| | - Maria Grazia Matarazzo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Catania, Italy
| | - Fulvio Zullo
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria - Federico II, Naples, Italy
| | - Giuseppe Bifulco
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria - Federico II, Naples, Italy
| | - Michele Morelli
- Department of Obstetrics and Gynaecology, AO "S.S. Annunziata", Cosenza, Italy
| | - Annamaria Ferrero
- Academic Department of Obstetrics and Gynecology, Mauriziano Hospital, Torino, Italy
| | - Nicoletta Biglia
- Academic Department of Obstetrics and Gynecology, Mauriziano Hospital, Torino, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Stefano Cianci
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Alfredo Ercoli
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Angela Martoccia
- Department of Obstetrics and Gynaecology, AOR San Carlo, Potenza, Italy
| | - Sergio Schettini
- Department of Obstetrics and Gynaecology, AOR San Carlo, Potenza, Italy
| | - Teresa Orlando
- Department of Obstetrics and Gynaecology, AOR San Carlo, Potenza, Italy
| | - Francesco G Cannone
- Department of Obstetrics and Gynaecology, ARNAS Garibaldi Catania, Catania, Italy
| | - Giuseppe Ettore
- Department of Obstetrics and Gynaecology, ARNAS Garibaldi Catania, Catania, Italy
| | - Andrea Puppo
- Department of Obstetrics and Gynaecology, ASO Santa Croce e Carle, Cuneo, Italy
| | - Martina Borghese
- Department of Obstetrics and Gynaecology, ASO Santa Croce e Carle, Cuneo, Italy
| | - Canio Martinelli
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lorenza Driul
- Department of Maternal and Child Health, University-Hospital of Udine, Udine, Italy
| | - Stefano Restaino
- Department of Maternal and Child Health, University-Hospital of Udine, Udine, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giorgio Candotti
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Bocciolone
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giulia Mantovani
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital Negrar, Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital Negrar, Verona, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Laura Giambanco
- Department of Obstetrics and Gynecology, S. Antonio Abate Hospital, Trapani, Italy and Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Silvia Amodeo
- Department of Obstetrics and Gynecology, S. Antonio Abate Hospital, Trapani, Italy and Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Livio Leo
- Departments of Gynecology & Obstetrics, Hopital Beauregard, AUSL Valleè d'Aoste, Aosta, Italy
| | - Raphael Thomasset
- Departments of Gynecology & Obstetrics, Hopital Beauregard, AUSL Valleè d'Aoste, Aosta, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | - Franco Gorlero
- Department of Obstetrics and Gynaecology, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Martina Di Luca
- Department of Obstetrics and Gynaecology, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Enrico Busato
- Department of Obstetrics and Gynaecology, Ospedale di Treviso, Treviso, Italy
| | - Sami Kilzie
- Department of Obstetrics and Gynaecology, Ospedale di Treviso, Treviso, Italy
| | - Andrea Dell'Acqua
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Scarfone
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Dessole
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giampiero Capobianco
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Giannella
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Liliana Mereu
- Gynecological Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Saverio Tateo
- Gynecological Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Flavia Sorbi
- Gynecology Unit, Careggi University Hospital, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Massimiliano Fambrini
- Gynecology Unit, Careggi University Hospital, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Stefania Cicogna
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Federico Romano
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Giuseppe Ricci
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Trojano
- Department of Obstetrics and Gynaecology, Madonna delle Grazie Hospital ASM, Matera, Italy
| | | | | | - Antonio Lippolis
- Unit of Obstetrics and Gynaecology, Valle D'Itra Hospital, Martina Franca, Taranto, Italy
| | - Raffaele Tinelli
- Unit of Obstetrics and Gynaecology, Valle D'Itra Hospital, Martina Franca, Taranto, Italy
| | - Giovanni D'Ippolito
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Vincenzo D Mandato
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Stefano Palomba
- Unit of Obstetrics and Gynecology, GOM of Reggio Calabria & Magna Grcia University of Catanzaro, Catanzaro, Italy
| | - Davide Calandra
- Unit of Obstetrics and Gynecology, University G. D'Annunzio of Chieti, Pescara, Italy
| | - Maurizio Rosati
- Unit of Obstetrics and Gynecology, University G. D'Annunzio of Chieti, Pescara, Italy.,Unit of Obstetrics and Gynecology, Santo Spirito Hospital, Pescara, Italy
| | - Cinzia Gallo
- Unit of Obstetrics and Gynecology, Università "Magna Graecia" di Catanzaro - AO "Pugliese - Ciaccio" Catanzaro, Italy
| | - Daniela Surico
- Unit of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Valentino Remorgida
- Unit of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Francesco Ruscitto
- Gynecology Unit, Ospedale Valduce, Como - ASST Lariana, S. Anna, Como, Italy
| | - Paolo Beretta
- Gynecology Unit, Ospedale Valduce, Como - ASST Lariana, S. Anna, Como, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Siesto G, Romano F, Iedà NP, Vitobello D. Survival outcomes after surgical management of endometrial cancer: Analysis after the first 10-year experience of robotic surgery in a single center. Int J Med Robot 2020; 16:1-9. [PMID: 32845062 DOI: 10.1002/rcs.2157] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To report the 5-year survival rates of patients undergone surgery for endometrial cancer, within a 10-year study. METHODS Single institution series with a minimum 2-year follow-up. The 5-year survival outcomes of patients managed by robotics, laparoscopy and open surgery during the same period were compared. Multivariable analyses were performed to identify prognostic factors. RESULTS Three hundred and sixty-three consecutive patients were analysed. Open surgery showed a higher rate of abdominal recurrences (17.2% vs. 3.3%; p < 0.001); no differences were recorded in terms of vaginal, nodal or distant recurrences between open and minimally invasive surgery. At multivariable analyses, type II histology, peritoneal cytology and lympho-vascular space invasion were independent predictors for survival. Based on each FIGO (The International Federation of Gynecology and Obstetrics) stage, no differences were found in terms of 5-year disease-free survival and overall survival between the approaches. CONCLUSIONS The surgical route does not affect the 5-year survival in patients with endometrial cancer. Both robotics and laparoscopy are confirmed as viable options.
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Affiliation(s)
- Gabriele Siesto
- Unit of Gynecology, IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | - Fabrizio Romano
- Unit of Gynecology, IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Domenico Vitobello
- Unit of Gynecology, IRCCS, Humanitas Clinical and Research Center, Milan, Italy
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Grazia A, Pietrafesa A, Capece A, Pietrafesa R, Siesto G, Romano P. Exploitation of technological variability among wild non-Saccharomyces yeasts to select mixed starters for the production of low alcohol wines. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191502031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Increase of the sugar content in grape must, and consequently, alcohol levels in wine are some of the principal problems affecting the winemaking industry. High alcohol content can compromise wine quality, creating sensory imbalances, as well as decreasing the perception of some flavors. The technological approaches proposed at this aim, although allowing achievement of the purpose, can determine negative influence on quality of wine. A promising strategy is based on the use of specific microorganisms, such as selected yeast strains, mainly non-Saccharomyces, able to convert grape must sugars towards secondary metabolites rather than ethanol. This study aims at screening of wild non-Saccharomyces strains in order to identify those suitable for the use in mixed starter for the production of wine with reduced alcohol content and, at the same time, with improved aromatic characteristics.
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Siesto G, Finco A, Portuesi RAV, Romano F, Ieda' NP, Vitobello D. Survival outcomes of robotic radical hysterectomy for early stage cervical cancer: A 9-year study. Int J Med Robot 2019; 15:e2003. [PMID: 31039279 DOI: 10.1002/rcs.2003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Recently, the results of a RCT have raised concerns on the management of cervical cancer through a minimally invasive approach. This study reports on the outcomes of patients with early stage cervical cancer submitted to robotics. METHODS Retrospective review of a consecutive series of patients with an early cervical cancer treated with robotics at a single Institution over a 9-year period. RESULTS A total of 91 women were managed; 39 (41.1%) had cervical adenocarcinoma. One (1.1%) conversion to laparotomy and one (1.1%) intraoperative complication occurred. Five (5.5%) patients experienced postoperative (>G2) complications; 24 (26.4%) patients required further adjuvant therapies. After a median follow-up of 40.7 (3.8-96.6) months, the DFS and OS were 90.4 (95%CI 85.3-95.6)% and 94.5 (95%CI 91.8-97.2)%, respectively. CONCLUSIONS According to the available literature, the survival outcomes of this series of RRH for ECC are not inferior to what recorded in the past by an open approach.
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Affiliation(s)
- Gabriele Siesto
- Department of Gynecology, IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | - Andrea Finco
- Department of Gynecology, IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | | | - Fabrizio Romano
- Department of Gynecology, IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | - Nicoletta Palma Ieda'
- Department of Gynecology, IRCCS, Humanitas Clinical and Research Center, Milan, Italy
| | - Domenico Vitobello
- Department of Gynecology, IRCCS, Humanitas Clinical and Research Center, Milan, Italy
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Alberico G, Pietrafesa A, Capece A, Pietrafesa R, Siesto G, Romano P. Erratum to: Exploitation of technological variability among wild non- Saccharomyces yeasts to select mixed starters for the production of low alcohol wines. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191502041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Siesto G, Romano F, Fiamengo B, Vitobello D. Sentinel Node Mapping Using Indocyanine Green and Near-infrared Fluorescence Imaging Technology for Uterine Malignancies: Preliminary Experience With the Da Vinci Xi System. J Minim Invasive Gynecol 2016; 23:470-1. [PMID: 26767824 DOI: 10.1016/j.jmig.2015.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 12/29/2015] [Accepted: 12/29/2015] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE Sentinel lymph node (SLN) mapping has emerged as the new frontier for the surgical staging of apparently early-stage cervical and endometrial cancer. Different colorimetric and radioactive tracers, alone and in combination, have been proposed with encouraging results. Fluorometric mapping using indocyanine green (ICG) appears to be a suitable and attractive alternative to provide reliable staging [1-4]. DESIGN In this video, we present the technique of SLN mapping in 2 cases (1 endometrial and 1 cervical cancer, respectively) using ICG and the near-infrared technology provided by the newest Da Vinci Xi robotic system (Intuitive Surgical Inc., Sunnyvale, CA). Together we report the results of our preliminary experience on the first 20 cases performed. The new robotic Da Vinci Xi system was available at our institution since May 2015. INTERVENTION Upon institutional review board/ethical committee approval, all consecutive patients with early-stage endometrial and cervical cancer who were judged suitable for robotic surgery have been enrolled for SLN mapping with ICG. We adopted the Memorial Sloan Kettering Cancer Center SLN algorithm; the tracer was delivered into the cervix in all cases. Four milliliters (1.25 mg/mL) of ICG was injected divided into the 3- and 9-o'clock positions of the cervix alone, with 1 mL deep into the stroma and 1 mL submucosally at the skin incision. Sentinel lymph nodes were examined with a protocol including both ultrastaging with immunohistochemistry [3] and 1-step nucleic acid amplification assay [5,6] under a parallel protocol of study. During the study period, 20 cases were managed; 14 and 6 patients had endometrial and cervical cancer, respectively. SLN was detected in all cases (20/20, 100%). Bilateral SLNs were detected in 17 of 20 (85.0%) cases. Based on preoperative and intraoperative findings, 13 (65.0%) patients received systematic pelvic lymphadenectomy after SLN mapping. Three (15.0%) patients had microscopic nodal metastases on SLN. No patients had positive regional nodes other than SLN. No perioperative complications were recorded. CONCLUSION SLN mapping has been acknowledged by the National Comprehensive Cancer Network guidelines as a viable option for the management of selected uterine malignancies [7,8]. Currently, the near-infrared technology built in the Da Vinci Xi system provides an enhanced real-time imaging system that improves the advantages given by ICG. Together with our experience, these conditions indicate that SLN mapping is an effective and safe procedure with high overall detection and low false-negative rates.
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Affiliation(s)
- Gabriele Siesto
- Gynecologic Unit, Humanitas Clinical and Research Hospital, Milan, Italy.
| | - Fabrizio Romano
- Gynecologic Unit, Humanitas Clinical and Research Hospital, Milan, Italy
| | - Barbara Fiamengo
- Pathology Unit, Humanitas Clinical and Research Hospital, Milan, Italy
| | - Domenico Vitobello
- Gynecologic Unit, Humanitas Clinical and Research Hospital, Milan, Italy
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Leone Roberti Maggiore U, Bizzarri N, Scala C, Tafi E, Siesto G, Alessandri F, Ferrero S. Symptomatic endometriosis of the posterior cul-de-sac is associated with impaired sleep quality, excessive daytime sleepiness and insomnia: a case-control study. Eur J Obstet Gynecol Reprod Biol 2015; 209:39-43. [PMID: 26700500 DOI: 10.1016/j.ejogrb.2015.11.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/09/2015] [Accepted: 11/17/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the impact of endometriosis of the posterior cul-de-sac on quality of sleep, average daytime sleepiness and insomnia. STUDY DESIGN This age-matched case-control study was conducted in a tertiary referral centre for the diagnosis and treatment of endometriosis between May 2012 and December 2013. It included 145 women with endometriosis of the posterior cul-de-sac (cases; group E) and 145 patients referred to our Institution because of routine gynaecologic consultations (controls; group C). This study investigated whether sleep is impaired in patients with endometriosis of the posterior cul-de-sac. Sleep quality, daytime sleepiness and insomnia were assessed using the following self-administered questionnaires: the Pittsburgh Sleep Quality Index, the Epworth sleepiness scale and the Insomnia Severity Index, respectively. The primary objective of the study was to evaluate sleep quality in the two study groups. Secondary outcomes of the study were to assess average daytime sleepiness and insomnia in the two study groups. RESULTS The prevalence of poor sleep quality was significantly higher in group E (64.8%) than in group C (15.1%; p<0.001). The prevalence of excessive daytime sleepiness was significantly higher in group E (23.4%) than in group C (12.9%; p=0.033). Patients of group E experienced subthreshold insomnia (29.0%) and moderate clinical insomnia (16.6%) significantly more frequently than patients in group C (24.4% and 5.0%; p=0.002). CONCLUSION A substantial proportion of women with endometriosis of the posterior cul-de-sac experiences poor sleep quality, excessive daytime sleepiness and insomnia.
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Affiliation(s)
- Umberto Leone Roberti Maggiore
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Nicolò Bizzarri
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Carolina Scala
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Emanuela Tafi
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy
| | - Gabriele Siesto
- Department of Gynaecology, IRCCS Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089 Rozzano (Milan), Italy
| | - Franco Alessandri
- Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino-IST, Largo R. Benzi 10, 16132 Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Largo R. Benzi 10, 16132 Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Italy.
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Serati M, Braga A, Sorice P, Siesto G, Salvatore S, Ghezzi F. Solifenacin in Women with De Novo Overactive Bladder after Tension-Free Obturator Vaginal Tape—Is it Effective? J Urol 2014; 191:1322-6. [PMID: 24148761 DOI: 10.1016/j.juro.2013.10.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Paola Sorice
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Gabriele Siesto
- Department of Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Clinical Institute, Rozzano, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Milan, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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Serati M, Braga A, Siesto G, Sorice P, Cattoni E, Uccella S, Cromi A, Salvatore S, Ghezzi F. Risk Factors for the Failure of Antimuscarinic Treatment With Solifenacin in Women With Overactive Bladder. Urology 2013; 82:1044-8. [PMID: 24054438 DOI: 10.1016/j.urology.2013.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/02/2013] [Accepted: 08/04/2013] [Indexed: 01/16/2023]
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Siesto G, Vitobello D. Robotic radical hysterectomy following neoadjuvant chemotherapy in FIGO stage IIIB cervical cancer: a case report. Int J Med Robot 2013; 10:98-102. [PMID: 24019289 DOI: 10.1002/rcs.1529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 07/12/2013] [Accepted: 07/30/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND The management of advanced cervical cancer is challenging. The administration of neoadjuvant chemotherapy (NACT) followed by radical hysterectomy has proved to be safe in selected cases. Nevertheless, data on the use of minimally invasive surgery is lacking with this clinical application. METHODS A 31 year-old woman was diagnosed with a FIGO stage IIIB squamous cell cervical carcinoma. During multidisciplinary consultation it was decided that she should receive NACT, followed by robotic hysterectomy. RESULTS After three cycles of TIP (paclitaxel, ifosfamide and cisplatin), the patient achieved a complete clinical and radiological response. She underwent robotic type III/C2 radical hysterectomy with bilateral salpingo-oophorectomy and bilateral systematic pelvic lymphadenectomy. No complications were recorded. The complete response was confirmed at pathological examination. Two additional cycles of adjuvant chemotherapy were administered, and the patient is currently without evidence of disease at 18 months of follow-up. CONCLUSIONS In selected patients, robotics is a viable option to accomplish radical hysterectomy, including cases of advanced cervical cancer. Further experiences are needed to confirm our findings.
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Affiliation(s)
- Gabriele Siesto
- Department of Gynaecology, IRCCS, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
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Siesto G, Ieda N, Rosati R, Vitobello D. Robotic surgery for deep endometriosis: a paradigm shift. Int J Med Robot 2013; 10:140-6. [PMID: 23766030 DOI: 10.1002/rcs.1518] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 04/16/2013] [Accepted: 05/09/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Minimally invasive surgery represents the gold standard for the management of deep infiltrating endometriosis (DIE). This study aimed to evaluate the feasibility of robotic surgery for the management of DIE. METHODS A 5-year retrospective cohort study was made of robotic procedures including: segmental bowel resections, removal of nodules from the rectovaginal septum (RVS) with or without rectal shaving and partial bladder resection. RESULTS Overall, 19 bowel resections, 23 removals of RVS nodules and five bladder resections were performed, alone or in combination. Associated posterior vaginal resections were performed in 12 cases. Neither intra-operative complications, nor conversion to laparotomy occurred. One anastomotic leakage was recorded. CONCLUSION This series of robotic procedures for DIE represents the largest currently available and it helps to promote robotics as a safe and attractive alternative to accomplish a comprehensive surgical treatment of DIE, especially when bowel or bladder resections are needed.
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Affiliation(s)
- Gabriele Siesto
- Department of Gynecology, IRCCS, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
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Serati M, Cattoni E, Siesto G, Braga A, Sorice P, Cantaluppi S, Cromi A, Ghezzi F, Vitobello D, Bolis P, Salvatore S. Urodynamic evaluation: can it prevent the need for surgical intervention in women with apparent pure stress urinary incontinence? BJU Int 2013; 112:E344-50. [PMID: 23421421 DOI: 10.1111/bju.12007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To identify how many patients with symptoms of pure stress urinary incontinence (SUI) do not require any surgical treatment on the basis of urodynamics (UDS) and how many patients still do not require surgery 1 year after UDS. To assess the outcomes of these patients at 12-month follow-up. PATIENTS AND METHODS Women with pure SUI received UDS and were prospectively divided into four groups, comprising women with: urodynamic stress incontinence (USI); detrusor overactivity (DO); USI + DO; and inconclusive UDS. Women with USI underwent a Tension Free Vaginal Tape (Obturator) (TVT-O) procedure (Gynecare; Ethicon Inc., Somerville, NJ, USA), whereas women with DO ±/- USI were recommended 24-week antimuscarinic therapy. Follow-up was scheduled at 3 and 12 months. To define subjective outcomes, all patients completed the International Consultation on Incontinence Questionnaire - short form, the Patient Global Impression - Improvement and the Urinary Distress Inventory. Patients were considered cured if they presented a negative stress test, a score reduction of at least 80% on the Urinary Distress Inventory and a response of 'much better' or 'very much better' on the Patient Global Impression - Improvement. RESULTS Of the 263 women with pure SUI, 74.5% had a urodynamic diagnosis of USI, 10.6% had DO, 8% had USI + DO and 6.8% had inconclusive UDS. At 12-month follow-up, 165/181 (91.6%) women in group 1 were considered cured post-TVT-O; in the other groups, 33/67 (49.2%) patients were considered cured simply as a result of taking antimuscarinics; 13 of these 67 patients required TVT-O. CONCLUSIONS UDS is able to show that several patients with symptoms of pure SUI present an underlying DO and do not require surgery, even 1 year after UDS. In these patients, antimuscarinic treatment appears to ensure a good rate of cure; thus, UDS could lead to the avoidance of several surgical procedures.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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Vitobello D, Siesto G, Pirovano C, Ieda N. Surgical outcomes of robotic radical hysterectomy after neoadjuvant chemotherapy for locally advanced cervical cancer: Comparison with early stage disease. Eur J Surg Oncol 2013; 39:87-93. [DOI: 10.1016/j.ejso.2012.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 08/18/2012] [Accepted: 10/03/2012] [Indexed: 01/07/2023] Open
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Serati M, Bauer R, Cornu JN, Cattoni E, Braga A, Siesto G, Lizée D, Haab F, Torella M, Salvatore S. TVT-O for the treatment of pure urodynamic stress incontinence: efficacy, adverse effects, and prognostic factors at 5-year follow-up. Eur Urol 2012; 63:872-8. [PMID: 23274106 DOI: 10.1016/j.eururo.2012.12.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/10/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inside-out tension-free vaginal transobturator tape (TVT-O) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI), but data reporting long-term outcomes are scarce. OBJECTIVE To evaluate the efficacy and safety of TVT-O 5-yr implantation for management of pure SUI in women. DESIGN, SETTING, AND PARTICIPANTS A prospective observational study was conducted in four tertiary reference centers. Consecutive women presenting with urodynamically proven, pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded. INTERVENTION TVT-O implantation without any associated procedure. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Data regarding subjective outcomes (International Consultation on Incontinence-Short Form [ICIQ-SF], Patient Global Impression of Improvement, patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Multivariable analyses were performed to investigate outcomes. RESULTS AND LIMITATIONS Of the 191 women included, 21 (11.0%) had previously undergone a failed anti-incontinence surgical procedure. Six (3.1%) patients were lost to follow-up. The 5-yr subjective and objective cure rates were 90.3% and 90.8%, respectively. De novo overactive bladder (OAB) was reported by 24.3% of patients at 5-yr follow-up. Median ICIQ-SF score significantly improved from 17 (interquartile range [IQR]:16-17) preoperatively to 0 (IQR: 0-2) (p<0.0001). Failure of a previous anti-incontinence procedure was the only independent predictor of subjective recurrence of SUI (hazard ratio [HR]: 4.4; p = 0.009) or objective (HR: 3.7; p = 0.02). No predictive factor of de novo OAB was identified. CONCLUSIONS TVT-O implantation is a highly effective option for the treatment of women with pure SUI, showing a very high cure rate and a low incidence of complications after 5-yr follow-up.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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Capece A, Romaniello R, Siesto G, Romano P. Diversity of Saccharomyces cerevisiae yeasts associated to spontaneously fermenting grapes from an Italian “heroic vine-growing area”. Food Microbiol 2012; 31:159-66. [DOI: 10.1016/j.fm.2012.03.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 03/02/2012] [Accepted: 03/19/2012] [Indexed: 11/30/2022]
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Serati M, Siesto G, Carollo S, Formenti G, Riva C, Cromi A, Ghezzi F. Risk factors for cervical intraepithelial neoplasia recurrence after conization: a 10-year study. Eur J Obstet Gynecol Reprod Biol 2012; 165:86-90. [PMID: 22771223 DOI: 10.1016/j.ejogrb.2012.06.026] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 05/17/2012] [Accepted: 06/15/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To evaluate the risk factors potentially involved in the development of cervical intraepithelial neoplasia (CIN) recurrence after cervical conization in a long-term follow-up period. STUDY DESIGN Consecutive patients with histologically proven CIN who had undergone either cold knife conization or a loop electrosurgical excision procedure were enrolled and scheduled for serial follow-up examinations over a 10-year period. Data were stored in a digital database. Multivariate analysis was performed to identify factors for recurrence. RESULTS Between January 1999 and December 2009, 282 patients fulfilled the inclusion criteria and were included in the final statistical analysis. After a median follow-up of 26.7 months (range 6-100), 64 (22.7%) women developed histologically confirmed recurrence. The 2-year recurrence-free survival was 83.7% and 66.7% for women with negative and positive margins, respectively (p=0.008). The 5-year recurrence-free survival was 75.4% and 50.3% for patients with negative and positive margins, respectively (p=0.0004). Positive surgical margin was the most important independent predictor of recurrence [HR 2.5 (95%CI 1.5-4.5), p=0.0007; Wald 11.338]. After multinomial logistic regression the indication for conization based on persistent CIN1 was the only independent predictor for negative margin [OR 0.3 (95%CI 0.1-0.7), p=0.008]. CONCLUSIONS Our study demonstrated that the surgical margin status represents the most important predictor for CIN recurrence after conization. After excisional therapy, close follow-up is mandatory for the early detection of recurrent disease. The identification of risk factors for recurrence may guide clinical decision-making on expectant management versus re-intervention.
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Affiliation(s)
- Maurizio Serati
- Dept. of Obstetrics and Gynaecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
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Vitobello D, Siesto G, Bulletti C, Accardi A, Iedà N. Robotic radical parametrectomy with pelvic lymphadenectomy: Our experience and review of the literature. Eur J Surg Oncol 2012; 38:548-54. [PMID: 22425283 DOI: 10.1016/j.ejso.2012.02.188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 12/24/2011] [Accepted: 02/27/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- D Vitobello
- Dept. of Gynecology, Cancer Center, IRCCS, Humanitas Clinical Institute, Via Manzoni 56, 20089 Rozzano, Milan, Italy
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Vitobello D, Siesto G, Bulletti C. Robotic sacral hysteropexy for pelvic organ prolapse. Int J Med Robot 2011; 8:114-7. [PMID: 22110011 DOI: 10.1002/rcs.447] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 08/23/2011] [Accepted: 09/30/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND In recent years the number of reconstructive procedures for pelvic organ prolapse (POP) through robotic surgery has constantly increased. This paper describes the technical aspects of robotic hysteropromontopexy using the da Vinci surgical system. METHODS Two consecutive 35-year-old patients with POP, who wished to preserve the uterus, underwent hysteropromontopexy by robotic surgery. RESULTS Both procedures were performed successfully using a robotic approach. No additional reconstructive procedures were thought to be necessary at the end of surgery. Neither intra- nor post-operative complications occurred. After a follow-up of 18 and 6 months for case 1 and 2, respectively, both patients declared themselves satisfied with the anatomical and functional results achieved. CONCLUSIONS This procedure represents an effective option for the management of POP in selected women requiring fertility-sparing options.
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Affiliation(s)
- Domenico Vitobello
- Department. of Obstetrics and Gynecology, IRCCS, Humanitas Clinical Institute, Rozzano, Milan, Italy.
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Siesto G, Bulletti C, Ieda’ N, Accardi A, Vitobello D. Robotic assisted approach for rectosigmoid resection in patients with deep infiltrating endometriosis. Placenta 2011. [DOI: 10.1016/j.placenta.2011.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Serati M, Salvatore S, Siesto G, Cattoni E, Braga A, Sorice P, Cromi A, Ghezzi F, Bolis P. Urinary Symptoms and Urodynamic Findings in Women with Pelvic Organ Prolapse: Is There a Correlation? Results of an Artificial Neural Network Analysis. Eur Urol 2011; 60:253-60. [PMID: 21420230 DOI: 10.1016/j.eururo.2011.03.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 03/07/2011] [Indexed: 11/15/2022]
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Serati M, Cattoni E, Braga A, Siesto G, Salvatore S. Coital incontinence: Relation to detrusor overactivity and stress incontinence. A controversial topic. Neurourol Urodyn 2011; 30:1415. [PMID: 21661041 DOI: 10.1002/nau.21115] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 03/02/2011] [Indexed: 11/11/2022]
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Ghezzi F, Cromi A, Siesto G, Uccella S, Boni L, Serati M, Bolis P. Minilaparoscopic versus conventional laparoscopic hysterectomy: results of a randomized trial. J Minim Invasive Gynecol 2011; 18:455-61. [PMID: 21640669 DOI: 10.1016/j.jmig.2011.03.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 03/26/2011] [Accepted: 03/31/2011] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To compare operative outcomes and postoperative pain of laparoscopic hysterectomy (LH) versus minilaparoscopic hysterectomy (MLH). DESIGN Randomized controlled trial (Canadian Task Force Classification I). SETTING Tertiary care center. PATIENTS Seventy-six women scheduled to undergo a hysterectomy for a supposed benign gynecologic condition. INTERVENTIONS Participants were randomly assigned to LH (n = 38) or MLH (n = 38). MLH was performed with use of 3-mm ports. Both patients and assessors of the postoperative outcomes were blinded to the size of port used, and patients' wounds were concealed by standard-size nontransparent dressings. MEASUREMENTS Primary outcome was postoperative pain (both rest and incident on coughing and abdominal pain, as well as shoulder pain) by use of a 100-mm visual analogue scale. MAIN RESULTS The two groups were similar in terms of operative outcomes. No intraoperative conversion from MLH to both LH and open surgery occurred. No significant difference in pain scores at 1, 3, 8, and 24 hours after surgery between groups was found. Rescue analgesic requirement was similar in the MLH and LH groups (21.1% vs 13.2%, p =.54). CONCLUSIONS Ports can safely be reduced in size without a negative impact on the surgeon's ability to perform LH. MLH appears to have no advantage over LH in terms of postoperative pain.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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Serati M, Salvatore S, Cattoni E, Siesto G, Soligo M, Braga A, Sorice P, Cromi A, Ghezzi F, Cardozo L, Bolis P. Female Urinary Incontinence at Orgasm: A Possible Marker of a More Severe Form of Detrusor Overactivity. Can Ultrasound Measurement of Bladder Wall Thickness Explain It? J Sex Med 2011; 8:1710-6. [PMID: 21477016 DOI: 10.1111/j.1743-6109.2011.02245.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Salvatore S, Siesto G, Rizk DEE. Definition of recurrence of pelvic organ prolapse: is it really important? Int Urogynecol J 2011; 22:635-6. [PMID: 21484365 DOI: 10.1007/s00192-011-1424-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 03/22/2011] [Indexed: 11/29/2022]
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Ghezzi F, Cromi A, Siesto G, Giudici S, Serati M, Formenti G, Franchi M. Prognostic significance of preoperative plasma fibrinogen in endometrial cancer. Gynecol Oncol 2010; 119:309-13. [PMID: 20688365 DOI: 10.1016/j.ygyno.2010.07.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Revised: 07/10/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
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Salvatore S, Serati M, Siesto G, Cattoni E, Zanirato M, Torella M. Correlation between anatomical findings and symptoms in women with pelvic organ prolapse using an artificial neural network analysis. Int Urogynecol J 2010; 22:453-9. [PMID: 20972536 DOI: 10.1007/s00192-010-1300-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the present study was to assess the relationship between lower urinary tract symptoms, anatomical findings, and baseline characteristics in women with pelvic organ prolapse (POP). METHODS A cross-sectional observational study was performed, enrolling consecutive women seeking cares for lower urinary tract symptoms (LUTS) with evidence of POP. Data regarding baseline characteristics, LUTS, and physical examination were gathered for each patient. Multivariate analysis (multiple linear regression (MLR)) and artificial neural networks (ANNs) were performed to design predicting models. RESULTS A total of 1,344 women were included. Age, BMI, pelvic organ prolapse quantification (POP-Q) stage I, and previous surgery for urinary incontinence resulted predictors of urgency and stress incontinence. POP-Q stages III-IV were related to voiding dysfunction and POP symptoms. Age, BMI, and menopausal status resulted predictors for sexual dysfunction. Receiver operating characteristic comparison confirmed that ANNs were more accurate than MLRs in identifying predictors of LUTS. CONCLUSIONS LUTS result from a fine interaction between baseline characteristics and anatomical findings. ANNs are valuable instrument for better understanding complex biological models.
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Affiliation(s)
- Stefano Salvatore
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Piazza Biroldi 1, 21100 Varese, Italy.
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Siesto G, Uccella S, Ghezzi F, Cromi A, Zefiro F, Serati M, Bolis P. Surgical and survival outcomes in older women with endometrial cancer treated by laparoscopy. Menopause 2010; 17:539-44. [PMID: 20032796 DOI: 10.1097/gme.0b013e3181c4e9f5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility and safety of laparoscopic surgical management of apparently early-stage endometrial cancer in older women and to compare clinical outcomes between older and younger women. METHODS Our prospective oncological database was retrospectively reviewed to identify all consecutive women who underwent surgery for endometrial cancer from 2002. Data available included information about demography, comorbidities, surgical outcomes, histology, adjuvant therapies, and follow-up. Women were divided in two groups according to age (older, >65 y, and younger, < or =65 y). Univariate and multivariate analyses were performed to identify factors that negatively impact disease-free and overall survival. RESULTS A total of 48 (44.4%) older and 60 (55.6%) younger women were included. Groups were comparable in operative time, blood loss, need for blood transfusions, nodal count, and intraoperative and postoperative complications. Cancer in older women was more frequently upstaged than that in younger women (17 [35.4%] vs 8 [13.3%], respectively; P = 0.01). The 2- and 5-year disease-free survival rates were 82% versus 96% (P = 0.003) and 74% versus 93% (P = 0.0005) and the overall 2- and 5-year survival rates were 87% versus 98% (P = 0.006) and 83% versus 95% (P = 0.01) for older and younger women, respectively. Multivariate analysis showed that advanced surgical stage, unfavorable histology, high-grade tumors (grade 3), and deep myometrial invasion (>50%) are independent risk factors for recurrence. CONCLUSIONS In the absence of absolute anesthesia contraindications, laparoscopy seems to be feasible and safe in older women with endometrial cancer. Comprehensive surgical staging should be offered, regardless of age, to avoid understaging and to optimize treatment strategies.
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Affiliation(s)
- Gabriele Siesto
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, 21100 Varese, Italy.
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Ghezzi F, Uccella S, Cromi A, Siesto G, Serati M, Bogani G, Bolis P. Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial. Am J Obstet Gynecol 2010; 203:118.e1-8. [PMID: 20522410 DOI: 10.1016/j.ajog.2010.04.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 03/09/2010] [Accepted: 04/14/2010] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare postoperative pain after laparoscopic and vaginal hysterectomy for benign disease. STUDY DESIGN A prospective randomized trial was designed to compare laparoscopic hysterectomy and vaginal hysterectomy in patients with uterine volume <or=14 weeks of gestation. Postoperative pain was measured using the visual analog scale (VAS) at 1, 3, 8, and 24 hours postoperatively. Intra- and postoperative outcomes were carefully recorded, including the need for postoperative rescue doses of analgesia. RESULTS A total of 82 patients were enrolled. Patients who underwent vaginal hysterectomy complained of higher postoperative pain at each VAS evaluation (VAS-1 hour, P < .0001; VAS-3 hour, P < .0001; VAS-8 hour, P < .0001; VAS-24 hour, P = .0003) with a higher need for rescue analgesia (P < .0001) and a longer hospitalization (P = .001). The other perioperative characteristics were comparable between the 2 groups. CONCLUSION Laparoscopic hysterectomy provides an advantage over vaginal hysterectomy in terms of postoperative pain, need for rescue analgesia and hospital stay, with similar perioperative outcomes.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.
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Serati M, Salvatore S, Siesto G, Cattoni E, Zanirato M, Khullar V, Cromi A, Ghezzi F, Bolis P. Female Sexual Function during Pregnancy and after Childbirth. J Sex Med 2010; 7:2782-2790. [PMID: 20626601 DOI: 10.1111/j.1743-6109.2010.01893.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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Serati M, Salvatore S, Cattoni E, Zanirato M, Mauri S, Siesto G, Cromi A, Ghezzi F, Bolis P. The Impact of the Loop Electrosurgical Excisional Procedure for Cervical Intraepithelial Lesions on Female Sexual Function. J Sex Med 2010; 7:2267-2272. [PMID: 20412424 DOI: 10.1111/j.1743-6109.2010.01819.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ghezzi F, Cromi A, Siesto G, Serati M, Zaffaroni E, Bolis P. Laparoscopy staging of early ovarian cancer: our experience and review of the literature. Int J Gynecol Cancer 2010; 19 Suppl 2:S7-S13. [PMID: 19955918 DOI: 10.1111/igc.0b013e3181bf82f3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
UNLABELLED We report our experience with laparoscopic staging of apparent early ovarian cancer, and we critically review the current literature on this issue. Potential limits of laparoscopic technique and theoretical concerns of using pneumoperitoneum-based surgery in this setting are addressed. METHODS Surgical, pathological, and oncological outcome data of consecutive patients undergoing comprehensive laparoscopic staging for presumed early ovarian cancer at our institution were prospectively collected. RESULTS The median operative time was 348 minutes (range, 255-450 minutes). The median estimated blood loss was 250 mL (range, 50-3000 mL). The mean number of pelvic and paraaortic lymph nodes harvested was 24.5 (SD, 6.3) and 9.8 (SD, 7.1), respectively. The disease was upstaged in 6 women (23.1%). No conversion to laparotomy and no intraoperative complication occurred. One patient had a retroperitoneal hematoma recognized in the postoperative period, and this required laparotomy and ligature of the hypogastric arteries to achieve hemostasis. The median follow-up period was 26.7 months (range, 2-83 months). Recurrence-free survival was 96.1%. CONCLUSIONS Our results suggest that laparoscopic comprehensive surgical staging is a valuable treatment option for ovarian cancer patients with apparent early disease. Evidence is beginning to accumulate suggesting that minimally invasive surgery is at least equivalent in surgicopathological outcomes and middle-range oncological results to the conventional treatment approach, and early concerns are proving largely unfounded.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Piazza Biroldi 1, Varese, Italy.
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Ghezzi F, Cromi A, Uccella S, Siesto G, Giudici S, Serati M, Franchi M. Laparoscopic versus open surgery for endometrial cancer: a minimum 3-year follow-up study. Ann Surg Oncol 2010; 17:271-278. [PMID: 19826876 DOI: 10.1245/s10434-009-0720-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Indexed: 09/19/2023]
Abstract
BACKGROUND The paucity of long-term oncologic results published in the literature still prevents the scientific community from cementing the place of laparoscopy as the procedure of choice for managing endometrial cancer. We present the outcomes of consecutive patients with endometrial cancer managed laparoscopically with >3-year follow-up. METHODS Data from 117 consecutive women undergoing surgery for treatment of a clinical stage I endometrial cancer and who achieved at least 3-year follow-up were prospectively analyzed. These cases were compared with a historical cohort of 122 consecutive patients with endometrial cancer who had undergone surgery through laparotomy. RESULTS The laparoscopy and laparotomy groups were similar with regard to baseline patient characteristics, surgical stage, proportion of tumors with unfavorable histology and high grade, as well as patterns of adjuvant therapy. The median (range) follow-up of surviving patients was 52 (36-84) months in the laparoscopic cohort and 80 (36-151) months in the laparotomy cohort. Women who underwent laparoscopy and those who underwent laparotomy had similar 3-year recurrence-free survival rates (91.4% vs. 88.5%, P = 0.52), as well as similar 3-year overall survival rates (94.0% vs. 93.4%, P = 1.0). Multivariate analysis showed that advanced surgical stage, unfavorable histology, and patient age >65 years significantly affect survival, regardless of the surgical approach used. CONCLUSIONS Cancer control in women with endometrial cancer does not appear to be worsened by laparoscopic surgery. In the absence of level I evidence to establish long-term recurrence and survival equivalence, analysis of series as they mature is crucial to fully evaluate disease control afforded by laparoscopy.
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MESH Headings
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Aged
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Cohort Studies
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/surgery
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- Follow-Up Studies
- Humans
- Laparoscopy
- Laparotomy
- Middle Aged
- Neoplasm Staging
- Prospective Studies
- Retrospective Studies
- Survival Rate
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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Siesto G, Cromi A, Serati M, Piazza N, Zefiro F, Ghezzi F. Long Term Follow-Up after Laparoscopic Management of Early Stage Endometrial Cancer. J Minim Invasive Gynecol 2009. [DOI: 10.1016/j.jmig.2009.08.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Siesto G, Cromi A, Serati M, Zefiro F, Piazza N, Ghezzi F. Surgical Treatment of Gynecological Malignancies in the Elderly. J Minim Invasive Gynecol 2009. [DOI: 10.1016/j.jmig.2009.08.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Franchi M, Cromi A, Scarperi S, Gaudino F, Siesto G, Ghezzi F. Comparison between lidocaine-prilocaine cream (EMLA) and mepivacaine infiltration for pain relief during perineal repair after childbirth: a randomized trial. Am J Obstet Gynecol 2009; 201:186.e1-5. [PMID: 19560111 DOI: 10.1016/j.ajog.2009.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Revised: 11/23/2008] [Accepted: 04/09/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the effectiveness of topically applied lidocaine-prilocaine (EMLA) cream with local anesthetic infiltration in the reduction of pain during perineal suturing after childbirth. STUDY DESIGN Sixty-one women with either an episiotomy or a perineal laceration after vaginal delivery were assigned randomly to receive either the application of EMLA cream (n = 31) or infiltration with mepivacaine (n = 30) before perineal suturing. Primary outcome was pain during perineal repair. RESULTS Women in the EMLA group had lower pain scores than those in the mepivacaine group (1.7 +/- 2.4 vs 3.9 +/- 2.4; P = .0002). The proportion of women who needed additional anesthesia was similar in the 2 groups (3/30 vs 5/31; P = .71). A significantly higher proportion of women expressed satisfaction with anesthesia method in the EMLA group, compared with the mepivacaine group (83.8% vs 53.3%; P = .01) CONCLUSION EMLA cream appears to be an effective and satisfactory alternative to local anesthetic infiltration for the relief of pain during perineal repair.
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Affiliation(s)
- Massimo Franchi
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
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Ghezzi F, Cromi A, Uccella S, Siesto G, Zefiro F, Bolis P. Incorporating Laparoscopy in the Practice of a Gynecologic Oncology Service: Actual Impact Beyond Clinical Trials Data. Ann Surg Oncol 2009; 16:2305-14. [DOI: 10.1245/s10434-009-0514-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/05/2009] [Accepted: 04/07/2009] [Indexed: 11/18/2022]
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Ghezzi F, Cromi A, Siesto G, Zefiro F, Franchi M, Bolis P. Microlaparoscopy: A further development of minimally invasive surgery for endometrial cancer staging — Initial experience. Gynecol Oncol 2009; 113:170-5. [DOI: 10.1016/j.ygyno.2009.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 01/11/2009] [Accepted: 01/17/2009] [Indexed: 10/21/2022]
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Cromi A, Ghezzi F, Raffaelli R, Bergamini V, Siesto G, Bolis P. Ultrasonographic measurement of thymus size in IUGR fetuses: a marker of the fetal immunoendocrine response to malnutrition. Ultrasound Obstet Gynecol 2009; 33:421-426. [PMID: 19306477 DOI: 10.1002/uog.6320] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To test the hypothesis that intrauterine growth restriction (IUGR) is associated with decreased thymus size in the human fetus. METHODS The thymus perimeter was measured in 60 consecutive IUGR fetuses at prenatal ultrasound examination. IUGR was defined as an abdominal circumference (AC) <5(th) centile. Sixty controls were identified by selection of the next consecutive appropriately grown fetus of similar gestational age (+/-1 week). To exclude fetal size effects, ratios between thymus perimeter and fetal biometry measurements including biparietal diameter (BPD), AC and femur length (FL), as well as estimated fetal weight (EFW) were compared between IUGR fetuses and controls. RESULTS The proportion of fetuses with thymus perimeter <5(th) centile for gestation was significantly higher in IUGR fetuses than in controls (58/60 vs. 7/60, P < 0.0001). The mean thymus perimeter/BPD ratio (0.87 +/- 0.20 vs. 1.13 +/- 0.13, P < 0.0001), thymus perimeter/AC ratio (0.28 +/- 0.06 vs. 0.35 +/- 0.03, P < 0.0001), thymus perimeter/FL ratio (1.18 +/- 0.26 vs. 1.51 +/- 0.19, P < 0.001) and thymus perimeter/EFW ratio (0.05 +/- 0.01 vs. 0.06 +/- 0.01, P = 0.02) were significantly lower in IUGR fetuses than in controls. There was a significant positive correlation between the observed-to-expected mean for gestation thymus perimeter ratio and the enrollment-to-delivery interval (r = 0.44, P < 0.001). CONCLUSION IUGR is associated with a disproportionately small thymus. This supports the hypothesis that thymic involution may be part of the fetal neuroendocrine response to intrauterine starvation.
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Affiliation(s)
- A Cromi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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Ghezzi F, Cromi A, Siesto G, Bergamini V, Zefiro F, Bolis P. Infectious morbidity after total laparoscopic hysterectomy: does concomitant salpingectomy make a difference? BJOG 2009; 116:589-93. [DOI: 10.1111/j.1471-0528.2008.02085.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ghezzi F, Cromi A, Bergamini V, Uccella S, Siesto G, Franchi M, Bolis P. Should adnexal mass size influence surgical approach? A series of 186 laparoscopically managed large adnexal masses. BJOG 2008; 115:1020-7. [PMID: 18651883 DOI: 10.1111/j.1471-0528.2008.01775.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the feasibility and safety of laparoscopic management of adnexal masses > or = 10 cm in size. DESIGN Prospective cohort study. SETTING Two Gynecology Departments of University Hospitals. POPULATION All women presenting with an adnexal mass > or = 10 cm in diameter were candidates for laparoscopic management. Women were excluded from laparoscopic approach if there was evidence of ascites or gross metastatic disease. Neither the sonographic features of the cyst nor elevated serum CA125 level was used to exclude women from having a laparoscopic approach. METHODS A single operative protocol was followed for all women. All removed specimens were sent for immediate pathological evaluation. MAIN OUTCOME MEASURES Rate of conversion to laparotomy, incidence of cancer encountered, and operative complications. RESULTS One hundred and eighty-six women underwent laparoscopic evaluation for an adnexal mass of 10 cm or larger in size. The average preoperative mass size was 12.1 +/- 4.9 cm. A benign pathological condition was found in 86.6% (161/186) of the women, primary ovarian cancer in 16 (8.6%) women, a metastatic tumour of gastrointestinal origin in 1 (0.5%) woman, and a low malignant potential ovarian tumour in 8 (4.3%) women. Laparoscopic management was successful for 174 (93.5%) women. Reasons for conversion to laparotomy included anticipated technical difficulty (n = 7) and malignancy (n = 5). No intraoperative complications occurred in the entire study group. CONCLUSIONS The vast majority of large adnexal masses can be safely resected laparoscopically, provided that there is expertise in laparoscopic surgery, immediate access to frozen section diagnosis, and preparation of patient to receive an adequate cancer surgery where indicated.
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Affiliation(s)
- F Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
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Ghezzi F, Cromi A, Uccella S, Siesto G, Bergamini V, Bolis P. Transumbilical surgical specimen retrieval: a viable refinement of laparoscopic surgery for pelvic masses. BJOG 2008; 115:1316-20. [DOI: 10.1111/j.1471-0528.2008.01802.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cromi A, Ghezzi F, Di Naro E, Siesto G, Loverro G, Bolis P. Blunt expansion of the low transverse uterine incision at cesarean delivery: a randomized comparison of 2 techniques. Am J Obstet Gynecol 2008; 199:292.e1-6. [PMID: 18771988 DOI: 10.1016/j.ajog.2008.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 06/01/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to compare 2 methods of expansion of the uterine incision at the time of cesarean delivery. STUDY DESIGN Women who underwent a low-segment transverse cesarean delivery were assigned randomly to have the blunt expansion of the uterine incision by the physician separating the fingers either in a transversal direction or in a cephalad-caudad direction. The primary outcome measure was the incidence of unintended extensions. RESULTS The transversal (n = 406) and cephalad-caudad (n = 405) expansion groups were similar with regard to patient characteristics, indication to surgery, type of anesthesia, and proportion of emergency procedures. No difference in the need for transfusions (0.7% vs 0.7%; P = 1.0) or estimated blood loss (440 +/- 341 vs 398 +/- 242 mL; P = .09) was noted. The incidence of unintended extension (7.4% vs 3.7%; P = .03) and blood loss of >1500 mL (2.0% vs 0.2%; P = .04) was significantly higher in the transversal expansion group, compared with the cephalad-caudad group. Transversal expansion was an independent contributor to unintended extension and blood loss of >1500 mL. CONCLUSION Because it is associated with less risk of unintended extension and excessive blood loss, expansion of the uterine incision with a cephalad-caudad traction should be preferred to transversal expansion when a cesarean delivery is performed.
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Siesto G, Bergamini V, Ghezzi F, Bellini G, Cromi A, Scarperi S, Kabdebo O. 261: Laparoscopic Versus Laparotomic Myomectomy: Surgical Complications, Fertility and Subjective Outcome. J Minim Invasive Gynecol 2007. [DOI: 10.1016/j.jmig.2007.08.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Siesto G, Bellini G, Festi A, Franchi M, Muñoz J. 370: Ureterovaginal Fistula Following Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2007. [DOI: 10.1016/j.jmig.2007.08.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Siesto G, Bolis P. 259: Changing Trend in the Management of Gynecologic Malignancies. J Minim Invasive Gynecol 2007. [DOI: 10.1016/j.jmig.2007.08.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Siesto G, Ghezzi F, Bergamini V, Uccella S, Cromi A, Zanfra M, Tomera S, Bolis P. 258: Changing the Surgery for Hysterectomy: A Seven-Year Experience on 755 Patients. J Minim Invasive Gynecol 2007. [DOI: 10.1016/j.jmig.2007.08.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cromi A, Ghezzi F, Di Naro E, Siesto G, Bergamini V, Raio L. Large cross-sectional area of the umbilical cord as a predictor of fetal macrosomia. Ultrasound Obstet Gynecol 2007; 30:861-866. [PMID: 17960667 DOI: 10.1002/uog.5183] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine whether a large cross-sectional area of the umbilical cord is a predictor of fetal macrosomia. METHODS Consecutive patients of > 34 weeks' gestation, who presented for sonographic examination and who delivered within 4 weeks of the examination, were included in the study. The sonographic cross-sectional areas of the umbilical cord, the umbilical vessels and the Wharton's jelly were measured in a free loop of the umbilical cord. Logistic regression analysis was used to determine significant predictors of macrosomia (actual birth weight > 4000 g and > 4500 g). Fetal biometric parameters (biparietal diameter, abdominal circumference and femur length), sonographic estimated fetal weight and umbilical cord area > 95(th) centile for gestational age were used as covariates. RESULTS During the study period, 1026 patients were enrolled. Fifty-three (5.2%) newborns had a birth weight > 4000 g, and 22 (2.1%) weighed > 4500 g. The proportion of cases with a large umbilical cord was significantly higher in the group of macrosomic compared with non-macrosomic infants (54.7% vs. 8.7%, P < 0.0001). Multiple regression models demonstrated an independent contribution of the large cord in the prediction of birth weight > 4000 g and > 4500 g (odds ratio (95% CI), 20.6 (9.2-45.9) and 4.2 (1.2-17.7), respectively). The sensitivity, specificity and positive and negative predictive values of a sonographic large umbilical cord were 54.7%, 91.3%, 25.4%, and 97.4%, respectively. The combination of abdominal circumference > 95(th) centile and large cord predicted 100% of macrosomic infants. The proportion of umbilical cords with a Wharton's jelly area > 95(th) centile for gestation was significantly higher in macrosomic fetuses of diabetic compared with non-diabetic mothers. CONCLUSIONS Sonographic assessment of umbilical cord area may improve the prediction of fetal macrosomia.
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Affiliation(s)
- A Cromi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
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Siesto G, Cromi A. 369: Quality of Life Before and After Laparoscopic Partial Cystectomy in Vesical Endometriosis. J Minim Invasive Gynecol 2007. [DOI: 10.1016/j.jmig.2007.08.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Siesto G, Bolis P. 260: Laparoscopic Management of Large Adnexal Masses. J Minim Invasive Gynecol 2007. [DOI: 10.1016/j.jmig.2007.08.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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