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Bizzarri N, Chiantera V, Loverro M, Ercoli A, Vizzielli G, Scambia G. Minimally invasive pelvic exenteration for gynaecological malignancies: the challenge of patients' selection. Facts Views Vis Obgyn 2023; 15:193-196. [PMID: 37742196 PMCID: PMC10643015 DOI: 10.52054/fvvo.15.3.084] [Citation(s) in RCA: 1] [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: 09/26/2023] Open
Abstract
Pelvic exenteration is a radical procedure representing a salvage option in patients with recurrent or persistent gynaecological malignancies. It can be performed with an open or minimally invasive approach. Different studies have demonstrated optimal peri-operative outcomes of minimally invasive pelvic exenteration with no survival difference when compared with an open approach. In this article, we discuss the importance and the challenge of patient selection for pelvic exenteration and more specifically for minimally invasive pelvic exenteration.
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Gullo G, Basile G, Cucinella G, Greco ME, Perino A, Chiantera V, Marinelli S. Fresh vs. frozen embryo transfer in assisted reproductive techniques: a single center retrospective cohort study and ethical-legal implications. Eur Rev Med Pharmacol Sci 2023; 27:6809-6823. [PMID: 37522692 DOI: 10.26355/eurrev_202307_33152] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Several studies have shown higher pregnancy rates and better perinatal outcomes with frozen embryo transfers than with fresh techniques, with better results in patients with polycystic ovary syndrome (PCOS) but with a higher rate of pregnancy complications such as preeclampsia. This retrospective cohort study aims to compare the cumulative live birth rates, maternal and neonatal complications of fresh embryo transfers (ET) and frozen-embryo transfers (FET) in infertile women who underwent assisted reproduction techniques (ART) at the Azienda Ospedaliera Ospedali Riuniti (AOOR) Villa Sofia Cervello, Palermo, Italy. In addition, the authors have focused on the legislative and ethical complexities which such a procedure entails. PATIENTS AND METHODS Out of 475 women undergoing in vitro fertilization programs from January 2017 to January 2021, 128 were enrolled; 70 patients underwent ET, and 58 patients FET. The main outcome measure was live birth rates. Secondary outcomes were clinical pregnancy, ongoing pregnancy, pregnancy loss, low birth weight (LBW), ectopic pregnancy, and obstetrical and perinatal complications. RESULTS The cumulative live birth rates were similar between the fresh transfer (95.7%) and frozen transfer (93.1%). Biochemical pregnancy rates, clinical pregnancy, ongoing pregnancy, and pregnancy loss were similar between the groups. CONCLUSIONS Obstetrical outcomes were not statistically different between the two groups; a higher preterm delivery rate was reported in the FET group. ET birth weights were notably lower for singletons compared to the freeze-all strategy. ET patients also had higher LBW rates, with a 2.5-fold higher rate compared to FET. No significant differences were found in cumulative live birth rates between ET and FET, which is consistent with earlier studies. FET protocols are linked to higher neonatal birth weight and lower risk of LBW than fresh ET. The ethical and legal quandaries inherent in such techniques, as technology moves on and outpaces current legislative frameworks, cannot be discounted.
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Affiliation(s)
- G Gullo
- Department of Obstetrics and Gynecology, IVF UNIT, Villa Sofia Cervello Hospital, University of Palermo, Palermo, Italy.
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Restaino S, Scutiero G, Taliento C, Poli A, Bernardi G, Arcieri M, Santi E, Fanfani F, Chiantera V, Driul L, Scambia G, Greco P, Vizzielli G. Three-dimensional vision versus two-dimensional vision on laparoscopic performance of trainee surgeons: a systematic review and meta-analysis. Updates Surg 2023; 75:455-470. [PMID: 36811183 DOI: 10.1007/s13304-023-01465-z] [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: 11/20/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
Laparoscopic surgery underwent great improvements during the last few years. This review aims to compare the performance of Trainee Surgeons using 2D versus 3D/4 K laparoscopy. A systematic review of the literature was done on Pubmed, Embase, Cochrane's Library and Scopus. The following words and key phrases have been searched: "Two-dimensional vision", "Three-dimensional vision", "2D and 3D laparoscopy", "Trainee surgeons". This systematic review was reported according to the PRISMA statement 2020. PROSPERO registration No. CRD42022328045. Twenty-two randomized controlled trials (RCTs) and two observational studies were included in the systematic review. Two trials were carried out in a clinical setting, and twenty-two trials were performed in a simulated setting. In studies involving the use of a box trainer, the number of errors in the 2D laparoscopic group was significantly higher than in the 3D laparoscopic group during the performance of FLS skill tasks: peg transfer (MD: -0.82; 95% CI - 1.17 to - 0.47; p < 0.00001), cutting (MD: - 1.09; 95% CI - 1.50 to - 0.69 p < 0.00001), suturing (MD: - 0.48; 95% CI - 0.83 to - 0.13 p = 0.007), However, in clinical studies, there was no significant difference in the time taken for laparoscopic total hysterectomy (MD: 8.71; 95% CI - 13.55 to 30.98; p = 0.44) and vaginal cuff closure (MD: 2.00; 95% CI - 0.72 to - 4.72; p = 0.15) between 2D group and 3D group. 3D laparoscopy facilitates learning for novice surgeons and shows improvements in their laparoscopic performance.
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Affiliation(s)
- S Restaino
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Scutiero
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - Cristina Taliento
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy.
| | - A Poli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Bernardi
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - M Arcieri
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, 98122, Messina, Italy
| | - E Santi
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - F Fanfani
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - V Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - L Driul
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - P Greco
- Department of Medical Sciences, Clinic of Obstetrics and Gynecology, University of Ferrara, Via Fossato Di Mortara 64/B, 44124, Ferrara, Italy
| | - G Vizzielli
- Department of Medical Area (DAME), University of Udine, Clinic of Obstetrics and Gynecology, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Gullo G, Etrusco A, Cucinella G, Basile G, Fabio M, Perino A, De Tommasi O, Buzzaccarini G, Morreale C, Marchi L, Laganà AS, Chiantera V, Zaami S. Ovarian tissue cryopreservation and transplantation in menopause: new perspective of therapy in postmenopausal women and the importance of ethical and legal frameworks. Eur Rev Med Pharmacol Sci 2022; 26:9107-9116. [PMID: 36591823 DOI: 10.26355/eurrev_202212_30660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Menopausal transition entails a progressive decrease in hormone production by the ovaries that lead to important physical and psychological changes that could significantly affect quality of life. Hormone replacement therapy (HRT) administered from the onset of menopausal symptoms usually improves quality of life and life expectancy. Nevertheless, it is not risk-free. Ovarian tissue cryopreservation (OTC) has been investigated as a potential new strategy for delaying menopause and/or to avoid HRT. This review analyzes the critical points of HRT to assess whether OTC and subsequent reimplantation can affect postmenopausal management. We assessed available randomized clinical trials in PubMed, Cochrane Library, ISI web of science, and Scopus from August 2021 to November 2022, including studies and trials evaluating the efficacy of OTC in both cancer and menopausal patients, the efficacy of freezing techniques and the possible clinical scenarios that OTC can open, even from the standpoint of legal and ethical issues arising as such innovative techniques become mainstream. Lower duration of the graft and efficacy on estrogen secretions at a physiological and safer concentration of estrogen than conventional HRT based on hormonal supplements. OTC can reportedly trigger estrogen secretions at a lower and safer physiological concentration than conventional HRT. OTC and subsequent reimplantation remain a valid fertility-sparing approach in patients undergoing gonadotoxic treatments. Further studies are needed to better evaluate its safety and efficacy within postmenopausal therapy management and in order to lay out widely shared and evidence-based guidelines and best practices and perform such novel and innovative techniques in a legally and ethically safe fashion, in the best interest of patients and healthcare professionals.
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Affiliation(s)
- G Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, Palermo, Italy.
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Del Mastro L, Poggio F, Blondeaux E, De Placido S, Giuliano M, Forestieri V, De Laurentiis M, Gravina A, Bisagni G, Rimanti A, Turletti A, Nisticò C, Vaccaro A, Cognetti F, Fabi A, Gasparro S, Garrone O, Alicicco MG, Urracci Y, Mansutti M, Poletti P, Correale P, Bighin C, Puglisi F, Montemurro F, Colantuoni G, Lambertini M, Boni L, Venturini M, Abate A, Pastorino S, Canavese G, Vecchio C, Guenzi M, Lambertini M, Levaggi A, Giraudi S, Accortanzo V, Floris C, Aitini E, Fornari G, Miraglia S, Buonfanti G, Cherchi M, Petrelli F, Vaccaro A, Magnolfi E, Contu A, Labianca R, Parisi A, Basurto C, Cappuzzo F, Merlano M, Russo S, Mansutti M, Poletto E, Nardi M, Grasso D, Fontana A, Isa L, Comandè M, Cavanna L, Iacobelli S, Milani S, Mustacchi G, Venturini S, Scinto A, Sarobba M, Pugliese P, Bernardo A, Pavese I, Coccaro M, Massidda B, Ionta M, Nuzzo A, Laudadio L, Chiantera V, Dottori R, Barduagni M, Castiglione F, Ciardiello F, Tinessa V, Ficorella A, Moscetti L, Vallini I, Giardina G, Silva R, Montedoro M, Seles E, Morano F, Cruciani G, Adamo V, Pancotti A, Palmisani V, Ruggeri A, Cammilluzzi E, Carrozza F, D'Aprile M, Brunetti M, Gallotti P, Chiesa E, Testore F, D'Arco A, Ferro A, Jirillo A, Pezzoli M, Scambia G, Iacono C, Masullo P, Tomasello G, Gandini G, Zoboli A, Bottero C, Cazzaniga M, Genua G, Palazzo S, D'Amico M, Perrone D. Fluorouracil and dose-dense adjuvant chemotherapy in patients with early-stage breast cancer (GIM2): end-of-study results from a randomised, phase 3 trial. Lancet Oncol 2022; 23:1571-1582. [DOI: 10.1016/s1470-2045(22)00632-5] [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] [Received: 08/16/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
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Cianci S, Fedele C, Vizzielli G, Pasciuto T, Gueli Alletti S, Cosentino F, Chiantera V, Fagotti A, Scambia G. Surgical outcomes of diaphragmatic resection during cytoreductive surgery for advanced gynecological ovarian neoplasia: A randomized single center clinical trial - DRAGON. Gynecol Oncol 2021; 164:271-277. [PMID: 34844774 DOI: 10.1016/j.ygyno.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/03/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Ovarian cancer (OC) represent nearly 4% of gynecologic malignancies and it is often diagnosed at advanced stage. Diaphragmatic surgery, a fundamental step of advanced stage ovarian cancer (ASOC) debulking surgery, is associated with a high post-operative complication incidence, which is supposedly reduced with thoracostomy tube placement. We assessed the role of intra-operative thoracostomy tube placement, as a prevention measure for post-operative complications, after diaphragmatic resection. METHODS This was a single center prospective randomized trial. Ovarian cancer patients, who underwent mono-lateral diaphragmatic resection, were randomized 1:1 into two arms. Arm A included patients receiving intra-operative thoracostomy tube placement (TP); Arm B patients did not receive thoracostomy tube placement (NTP). After surgery, all patients underwent seriate chest x-ray and ultrasound to record thoracic complications. Statistical analysis included uni- and multivariable logistic regression model (proportional odds model). RESULTS Three hundred seventy-one patients were screened and 88 patients were enrolled: 44 in arm A and B, respectively. No statistically significant differences for intra-operative (p = 0.291) and any grade of post-operative complication (p = 0.072) were detected, while 6.8% of patients in arm A and 22.7% in arm B experienced severe respiratory symptoms (p = 0.035); 18.2% of patients in arm A had a moderate/large pleural effusion versus 65.9% in arm B (p < 0.0001). At multivariable analysis, results confirmed that the NTP-group had a higher risk to receive post-operative thoracostomy tube placement due to pleural effusion than the TP-group (odds ratio [95% Confidence Interval] = 14.5 [3.7-57.4]). CONCLUSIONS Thoracostomy intra-operative tube placement after diaphragmatic resection is effective to prevent post-operative thoracic complications. The extension of resection does not influence outcomes and the risk of post-operative thoracentesis or TP remain elevated.
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Affiliation(s)
- S Cianci
- Department of Human Pathology of Adult and Childhood "G. Barresi", University Hospital "G. Martino", Messina, Italy; Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - C Fedele
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Vizzielli
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - T Pasciuto
- Research Core Facilty Data Collection G-STeP, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Italy
| | - S Gueli Alletti
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Cosentino
- Division of Gynecologic Oncology, Gemelli Molise Hospital, Campobasso, Italy
| | - V Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Palermo, Italy; Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - A Fagotti
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
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Pedone Anchora L, Bizzarri N, Gallotta V, Chiantera V, Fanfani F, Fagotti A, Cosentino F, Vizzielli G, Carbone V, Ferrandina G, Scambia G. Impact of surgeon learning curve in minimally invasive radical hysterectomy on early stage cervical cancer patient survival. Facts Views Vis Obgyn 2021; 13:231-239. [PMID: 34555877 PMCID: PMC8823276 DOI: 10.52054/fvvo.13.3.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Recently, it has been sustained that only surgeons skilled in minimally invasive radical hysterectomy (MI-RH) could provide valuable oncological outcomes in early-stage cervical cancer. Still, literature lacks data correlating surgeon experience with patient survival rate. Objective To investigate the impact of surgeon training patient survival rate following MI-RH for early stage cervical cancer. Methods This was a retrospective study of 243 early-stage cervical cancer treated with MI-RH. Multiple regression analyses were undertaken to investigate the impact of the surgeons learning curve, according to the number of MI-RH, on patients prognosis. Results A steady trend of reduction in disease recurrence risk is associated with increased surgeon experience. The peak of the learning curve was shown at the 19th MI-RH (hazard ratio of disease-free survival: 0.321; 95%CI: 0.140-0.737; p= 0.007). The 3 years disease-free survival that a surgeon could provide to patients is significantly lower at the beginning of his/her learning path comparing to what he/she could guarantee once adequate experience had been achieved (75.4% and 91.6% respectively, p=0.005). Surgeon experience appears to be an independent prognostic factor. Conclusion The experience that a surgeon can achieve practicing in MI-RH significantly influences oncological outcomes of early-stage cervical cancer patients. Future studies comparing minimally invasive and open surgery should take this into account. It would be advisable that the scientific community precisely establishes the minimum training required in the field of MI-RH for early-stage cervical cancer.
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Baessler K, Windemut S, Chiantera V, Köhler C, Sehouli J. Sexual, bladder and bowel function following different minimally invasive techniques of radical hysterectomy in patients with early-stage cervical cancer. Clin Transl Oncol 2021; 23:2335-2343. [PMID: 34003456 PMCID: PMC8455389 DOI: 10.1007/s12094-021-02632-7] [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: 03/11/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022]
Abstract
Purpose Despite the establishment of radical surgery for therapy of cervical cancer, data on quality of life and patient-reported outcomes are scarce. The aim of this retrospective cohort study was to evaluate bladder, bowel and sexual function in women who underwent minimally invasive surgery for early-stage cervical cancer. Methods From 2007–2013, 261 women underwent laparoscopically assisted radical vaginal hysterectomy (LARVH = 45), vaginally assisted laparoscopic or robotic radical hysterectomy (VALRRH = 61) or laparoscopic total mesometrial resection (TMMR = 25) and 131 of them completed the validated German version of the Australian Pelvic Floor Questionnaire (PFQ). Results were compared with controls recruited from gynecological clinics (n = 24) and with urogynecological patients (n = 63). Results Groups were similar regarding age, BMI and parity. The TMMR group had significantly shorter median follow-up (16 months versus 70 and 36 months). Postoperatively, deterioration of bladder function was reported by 70%, 57% and 44% in the LARVH, VARRVH and TMMR groups, respectively (p = 0.734). Bowel function was significantly worse after TMMR with a higher deterioration rate in 72 versus 43% (LARVH) and 47% (VARRVH) with a correspondingly higher bowel dysfunction score of 2.9 versus 1.5 and 1.8, respectively and 1.8 in urogynaecological patients. Sexual dysfunction was common in all surgical groups. 38% considered their vagina too short which was significantly associated with deep dyspareunia. Compared with controls, surgical groups had significantly increased PFQ scores. Conclusion Pelvic floor dysfunction commonly deteriorates and negatively impacts on quality of life after minimally invasive radical hysterectomy, especially bowel function after TMMR. Pelvic floor symptoms should routinely be addressed pre- and postoperatively.
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Affiliation(s)
- K Baessler
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany. .,Pelvic Floor Centre Franziskus and St Joseph Hospital Berlin, Budapester Str. 15-19, 10787, Berlin, Germany.
| | - S Windemut
- Department of Gynecology, Vivantes Hospital Am Urban, Berlin, Germany
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - C Köhler
- Department of Gynecology, Medical Faculty, University of Cologne, Cologne, Germany
| | - J Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Dückelmann AM, Taube E, Abesadze E, Chiantera V, Sehouli J, Mechsner S. When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases. Arch Gynecol Obstet 2021; 304:143-155. [PMID: 33537880 PMCID: PMC8164581 DOI: 10.1007/s00404-021-05971-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
Purpose To analyze the follow-up results of patients suffering from symptomatic early-stage endometriosis after a consistent laparoscopic peritoneal stripping of the altered peritoneum (peritoneal endometriosis and surrounding inflamed tissue) was performed. This type of endometriosis is resistant to medical therapy and/or impairs fertility. Methods Using our prospectively maintained database, we were able to identify all symptomatic women with the suspicion of only peritoneal endometriosis who underwent laparoscopy at our endometriosis center over a period of 5 years. All procedures were carried out in a standardized fashion by one single surgeon, who is highly experienced in minimal invasive surgery, and included a suspended hormonal pretreatment for 2 months. Postoperative outcomes including complications, fertility and recurrence rates were analysed. Results Laparoscopic peritonectomy was performed on 94 women. Follow-up data were available in 87% of these cases. At the time of surgery, almost all patients tested showed signs of stage I or II endometriosis (44.7 and 48.9%, respectively). More than three-quarters of the women reported pain relief, inter alia, due to the post-surgical hormonal therapy. About one-third of the patients wanted to have children after the procedure. 62% of them became pregnant and the majority did so without the need for assisted reproductive therapy. In seven women a re-operation was performed. Conclusion According to our data, a consistent excision of altered peritoneum followed by adjuvant hormonal therapy and multimodal concepts results in better outcomes for the patient, particularly in regards to pregnancy and recurrence rates.
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Affiliation(s)
- A M Dückelmann
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Taube
- Department of Pathology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - E Abesadze
- Department of Gynecology, Vivantes Clinic Berlin Hellersdorf, Myslowitzerstr. 45, 12621, Berlin, Germany
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Piazza Marina, 61, 90133, Palermo, Italy
| | - J Sehouli
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Mechsner
- Department of Gynecology, Charité-Universitätsmedizin BerlinVirchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Ferrandina G, Gallotta V, Federico A, Fanfani F, Ercoli A, Chiantera V, Cosentino F, Turco LC, Legge F, Anchora LP, Bizzarri N, Moroni R, Macchia G, Valentini V, Scambia G. Minimally Invasive Approaches in Locally Advanced Cervical Cancer Patients Undergoing Radical Surgery After Chemoradiotherapy: A Propensity Score Analysis. Ann Surg Oncol 2020; 28:3616-3626. [PMID: 33165720 PMCID: PMC8184543 DOI: 10.1245/s10434-020-09302-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/13/2020] [Indexed: 12/24/2022]
Abstract
Purpose Chemoradiation (CT/RT) followed by radical surgery (RS) may play a role in locally advanced cervical cancer (LACC) patients with suboptimal response to CT/RT or in low-income countries with limited access to radiotherapy. Our aim is to evaluate oncological and surgical outcomes of minimally invasive radical surgery (MI-RS) compared with open radical surgery (O-RS). Patients and Methods Data for stage IB2–IVA cervical cancer patients managed by CT/RT and RS were retrospectively analyzed. Results Beginning with 686 patients, propensity score matching resulted in 462 cases (231 per group), balanced for FIGO stage, lymph node status, histotype, tumor grade, and clinical response to CT/RT. The 5-year disease-free survival (DFS) was 73.7% in the O-RS patients and 73.0% in the MI-RS patients (HR 1.034, 95% CI 0.708–1.512, p = 0.861). The 5-year locoregional recurrence rate was 12.5% (O-RS) versus 15.2% (MI-RS) (HR 1.174, 95% CI 0.656–2.104, p = 0.588). The 5-year disease-specific survival (DSS) was 80.4% in O-RS patients and 85.3% in the MI-RS group (HR 0.731, 95% CI 0.438–1.220, p = 0.228). Estimated blood loss was lower in the MI-RS group (p < 0.001), as was length of hospital stay (p < 0.001). Early postoperative complications occurred in 77 patients (33.3%) in the O-RS group versus 88 patients (38.1%) in the MI-RS group (p = 0.331). Fifty-six (24.2%) patients experienced late postoperative complications in the O-RS group, versus 61 patients (26.4%) in the MI-RS group (p = 0.668). Conclusion MI-RS and O-RS are associated with similar rates of recurrence and death in LACC patients managed by surgery after CT/RT. No difference in early or late complications was reported. Electronic supplementary material The online version of this article (10.1245/s10434-020-09302-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Gallotta
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - A Federico
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - F Fanfani
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Ercoli
- Department of Obstetrics and Gynecology, University of Messina, Messina, Italy
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - F Cosentino
- Gynecologic Oncology, Gemelli Molise, Campobasso, Italy
| | - L C Turco
- Gynecology and Breast Care Unit, Mater Olbia Hospital, Olbia, Italy
| | - F Legge
- Gynecologic Oncology Unit, Department Obstetrics/Gynecology "F. Miulli" General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - L Pedone Anchora
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - N Bizzarri
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - R Moroni
- Direzione Scientifica, Fondazione Policlinico Universitario A.Gemelli, IRCCS, Rome, Italy
| | - G Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - V Valentini
- Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC di Radioterapia, Rome, Italy.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
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11
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Lago V, Fotopoulou C, Chiantera V, Minig L, Gil-Moreno A, Cascales-Campos PA, Jurado M, Tejerizo A, Padilla-Iserte P, Malune ME, Di Donna MC, Marina T, Sanchez-Iglesias JL, Chiva L, Olloqui A, Matute L, García-Granero A, Cárdenas-Rebollo JM, Domingo S. Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction. Gynecol Oncol 2020; 158:603-607. [PMID: 32571682 DOI: 10.1016/j.ygyno.2020.05.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/11/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the factors related with diverting ileostomy performance after colorectal resection and anastomosis, in advanced ovarian cancer cytoreductive surgery. METHODS We have previously demonstrated the risk factors associated with anastomotic leak after colorectal anastomosis: Advanced age at surgery, low serum albumin level, additional bowel resections, manual anastomosis and distance of the anastomosis from the anal verge. However, use of diverting ileostomy is strongly variable and depends on individual surgeon preferences and training. Eight hospitals participated in this retrospective study. Data of 695 patients operated for ovarian cancer with primary colorectal anastomosis were included (January 2010-June 2018). Fourteen pre-/intraoperatively defined variables were identified and analysed as justification factors for use of diverting ileostomy. RESULTS The rate of diverting ileostomy in the entire cohort was 19.13% (133/695; range within individual centers 4.6-24.32%). Previous treatment with bevacizumab [OR 2.8 (1.3-6.1); p=0.01]; additional bowel resections [OR 3.0 (1.8-5.1); p<0.001]; extended operating time [OR 1.005 (1.003-1.006); p<0.001] and intra-operative red blood transfusion [OR 2.7 (1.4-5.3); p<0.001] were found to be independently associated with diverting ileostomy performance. Assuming a 7% AL rate cut-off, up to 51.8% of DI presented an AL risk below 7% and might have been spared. CONCLUSIONS The risk factors that drive the gynecologic oncology surgeons to perform a diverting ileostomy, seem to differ from the actual risk factors that we have identified to be associated with postoperative anastomotic leak. Broader awareness of the risk factors that contribute to a higher perioperative risk profile, will facilitate a better risk stratification process and possibly avoid unnecessary stoma formation in ovarian cancer patients.
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Affiliation(s)
- V Lago
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain.
| | - C Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - L Minig
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | - A Gil-Moreno
- Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - P A Cascales-Campos
- Department of General Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid and Navarre, Spain
| | - A Tejerizo
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - P Padilla-Iserte
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - M E Malune
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - M C Di Donna
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - T Marina
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - J L Sanchez-Iglesias
- Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Chiva
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Madrid and Navarre, Spain
| | - A Olloqui
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - L Matute
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
| | - A García-Granero
- Department of General Surgery, University Hospital Son Espases, Palma de Mallorca, Spain; Department of Human Embryology and Anatomy, University of Valencia, Valencia, Spain
| | - J M Cárdenas-Rebollo
- Department of Applied Mathematics and Statistics, CEU San Pablo University, Madrid, Valencia, Spain
| | - S Domingo
- Department of Gynecologic Oncology, University Hospital La Fe, Valencia, Spain
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12
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Vercellino GF, Erdemoglu E, Lichtenberg P, Muallem MZ, Richter R, Abu-Rustum NR, Plante M, Lécuru F, Greggi S, Monk BJ, Sagae S, Denkert C, Keller M, Alhakeem M, Hellriegel M, Dückelmann AM, Chiantera V, Sehouli J. A GCIG international survey: clinical practice patterns of sentinel lymph node biopsies in cervical cancer. Arch Gynecol Obstet 2019; 300:191-199. [PMID: 31006839 DOI: 10.1007/s00404-019-05164-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/31/2018] [Accepted: 04/12/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the practice patterns among centers and physicians worldwide regarding sentinel lymph node biopsies (SLNB) in cervical cancer (CC) patients. METHOD A validated 35-item questionnaire regarding SLNB in CC supported by the Gynecologic Cancer Intergroup (GCIG), and sponsored by the North-Eastern German Society of Gynaecologic-Oncology (NOGGO) was sent to all major gynecological cancer societies across the globe for further distribution from October 2015 and continued for a period of 7 months. RESULTS One hundred and sixty-one institutions from around the world participated. One hundred and six (66%) of the participants were from university centers and 111 (69%) were gynecologic oncologists. One hundred and fifty-two (97%) performed lymphadenectomy (LNE) and 147 (94%) did so systematically; 97 (60%) used SLNB, due to lower morbidity (73%), reliability (55%) and time-saving (27%). In cases of positive SLNB (pN+), 39% of respondents stopped the operation and sent the patient for chemoradiation (CRT), 45% completed pelvic and paraaortic LNE, whereas 26% went on to perform a radical hysterectomy (RH) and systematic pelvic and paraaortic LNE. In case of negative SLNB (pN0), 39% of institutions still performed a systematic pelvic and paraaortic LNE. CONCLUSION In this survey worldwide, SLNB adoption is an encouraging 60%, yet ample differences exist regarding strategy, and to a lower extent the techniques used. Lack of experience is the most common reason SLNB is not performed. Efforts to increase surgical education on SLNB technique and multicenter prospective trials providing evidence-based guidelines are warranted.
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Affiliation(s)
- G F Vercellino
- Department of Gynecology With Center for Oncological Surgery, Charité Universtitätmedizin, Charité Platz 1, 10117, Berlin, Germany. .,UMG Universität Medizin Göttingen, 37075, Göttingen, Germany.
| | - E Erdemoglu
- Department of Gynecologic Oncology, Suleyman Demirel University, Isparta, Turkey
| | - P Lichtenberg
- Department of Gynecology With Center for Oncological Surgery, Charité Universtitätmedizin, Charité Platz 1, 10117, Berlin, Germany
| | - M Z Muallem
- Department of Gynecology With Center for Oncological Surgery, Charité Universtitätmedizin, Charité Platz 1, 10117, Berlin, Germany
| | - R Richter
- Department of Gynecology With Center for Oncological Surgery, Charité Universtitätmedizin, Charité Platz 1, 10117, Berlin, Germany
| | - N R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Plante
- Division of Gynecologic Oncology, Centre Hospitalier Universitaire de Laval Québec, Quebec, Canada
| | - F Lécuru
- Department of Gynecologic Oncologic and Breast Surgery, Hôpital Européen Georges Pompidou (HEGP), Paris, France.,Université Paris Descartes, Paris, France
| | - S Greggi
- Gynecologic Oncology, Istituto Nazionale per lo Studio e la Cura dei Tumori di Napoli, Naples, Italy
| | - B J Monk
- University of Arizona Cancer Center-Phoenix, Creighton University School of Medicine at St Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - S Sagae
- Department of Gynecologic Oncology, Sapporo West Kojinkai Clinic, Sapporo, Japan
| | - C Denkert
- Department of Pathology, Charité Universtitätmedizin, Berlin, Germany
| | - M Keller
- Department of Gynecology With Center for Oncological Surgery, Charité Universtitätmedizin, Charité Platz 1, 10117, Berlin, Germany
| | - M Alhakeem
- Department of Gynecology With Center for Oncological Surgery, Charité Universtitätmedizin, Charité Platz 1, 10117, Berlin, Germany.,Obstetrics and Gynaecology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - M Hellriegel
- Clinic for Obstetrics and Gynecology, UMG Universitätmedizin, Göttingen, Germany
| | - A M Dückelmann
- Department of Gynecology With Center for Oncological Surgery, Charité Universtitätmedizin, Charité Platz 1, 10117, Berlin, Germany
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Jalid Sehouli
- Department of Gynecology With Center for Oncological Surgery, Charité Universtitätmedizin, Charité Platz 1, 10117, Berlin, Germany. .,ESGO Center of Excellence Ovarian Cancer Surgery, ESGO Accredited European Training Centre in Gynaecological Oncology, Charité Comprehensive Cancer Center (CCCC), Universitätsmedizin Berlin Charité/Medical University of Berlin, Augustenburger Platz 1, Mittelallee 9, 1st Floor, Room No. 1.3073, 13353, Berlin, Germany.
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13
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Lago V, Fotopoulou C, Chiantera V, Minig L, Gil-Moreno A, Cascales-Campos PA, Jurado M, Tejerizo A, Padilla-Iserte P, Malune ME, Di Donna MC, Marina T, Sánchez-Iglesias JL, Olloqui A, García-Granero Á, Matute L, Fornes V, Domingo S. Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study. Gynecol Oncol 2019; 153:549-554. [PMID: 30952369 DOI: 10.1016/j.ygyno.2019.03.241] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 02/22/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. BACKGROUND In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. METHODS Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. RESULTS The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018). CONCLUSIONS Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided.
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Affiliation(s)
- V Lago
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain.
| | - C Fotopoulou
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - V Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - L Minig
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | - A Gil-Moreno
- Department of Obstetrics and Gynecology, Vall d'Hebron, Barcelona, Spain
| | - P A Cascales-Campos
- Department of General Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain
| | - M Jurado
- Department of Obstetrics and Gynecology, University Clinic of Navarra, Navarre, Spain
| | - A Tejerizo
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - P Padilla-Iserte
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - M E Malune
- Department of Gynecologic Oncology, Imperial College London, London, United Kingdom
| | - M C Di Donna
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - T Marina
- Department of Gynecology, Valencian Institute of Oncology, Valencia, Spain
| | | | - A Olloqui
- Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain
| | - Á García-Granero
- Department of General Surgery, University Hospital La Fe, Valencia, Spain
| | - L Matute
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | - V Fornes
- Unit of Biostatistics, Health Research Institute Hospital La Fe, Valencia, Spain
| | - S Domingo
- Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
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14
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Lucidi A, Chiantera V, Gallotta V, Ercoli A, Scambia G, Fagotti A. Role of robotic surgery in ovarian malignancy. Best Pract Res Clin Obstet Gynaecol 2017; 45:74-82. [PMID: 28602522 DOI: 10.1016/j.bpobgyn.2017.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/03/2017] [Indexed: 01/05/2023]
Abstract
As part of minimally invasive surgery, robotic-assisted approach is becoming increasingly popular in gynecologic oncology. It has been shown to be effective and feasible for staging and treating endometrial and cervical cancer, but its role in the context of primary and recurrent ovarian cancers is presently debated. Scanty data are available in the literature, and the level of evidence supporting its use in ovarian cancer is quite low. However, from a retrospective case-control series, robotic surgery seems to be safe and feasible for early-stage ovarian cancer. Its use in treating patients with advanced-stage or relapsed ovarian cancer is still highly controversial, suggesting the choice of robotic approach in a highly selected population.
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Affiliation(s)
- A Lucidi
- Gynecologic Oncology, Armas Civico, University of Palermo, Palermo, Italy
| | - V Chiantera
- Gynecologic Oncology, Armas Civico, University of Palermo, Palermo, Italy
| | - V Gallotta
- Gynecologic Oncology, Fondazione Policlincio A. Gemelli, Catholic University Sacred Heart, Rome, Italy
| | - A Ercoli
- SCDU Obstetrics and Gynecology, Maggiore Hospital, Eastern Piedmont University, Novara, Italy
| | - G Scambia
- Gynecologic Oncology, Fondazione Policlincio A. Gemelli, Catholic University Sacred Heart, Rome, Italy
| | - A Fagotti
- Gynecologic Oncology, Fondazione Policlincio A. Gemelli, Catholic University Sacred Heart, Rome, Italy.
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15
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Vizzielli G, Chiantera V, Tinelli G, Fagotti A, Gallotta V, Di Giorgio A, Gueli Alletti S, Scambia G. Out-of-the-box pelvic surgery including iliopsoas resection for recurrent gynecological malignancies: Does that make sense? A single-institution case-series. Eur J Surg Oncol 2016; 43:710-716. [PMID: 27890348 DOI: 10.1016/j.ejso.2016.10.028] [Citation(s) in RCA: 18] [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: 08/13/2016] [Revised: 10/05/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To report morbidity and oncological outcomes in a consecutive series of lateral isolated recurrent gynecological cancer involving the pelvic side wall (PSW) including the iliopsoas muscle. MATERIAL AND METHODS We retrospectively evaluated a consecutive series between 6/2013 and 12/2015 of lateral isolated recurrent gynecological malignancies treated with a lateral endopelvic resection (LEPR). LEPR was defined as an en-bloc lateral resection of a pelvic tumor with sidewall muscle, and/or bone, and/or major nerve, and/or major vascular structure. Post-surgical complications, quality of life (QoL) and survivals were computed. RESULTS Seventy-four women with pelvic isolated relapse were admitted for surgery during the study period. Among them, 8 cases (10.8%) showed lateral isolated relapse involving the iliopsoas muscle and were treated with LEPR. R0 resection was achieved in 6/8 patients (75.0%), while the pathologic margins were microscopically and macroscopically positive in 1 patient (12.5%), respectively. There were no perioperative mortalities. Major postoperative complications occurred in 3 patients (37.5%) through peripheral neuropathies, thrombosis of the vascular graft and compartment syndrome of the leg. Median follow-up time was 21 months (range, 12-28). The 2-year overall survival (OS) was 88% improving up to 100% if R0 resection was achieved. In patients with positive pathologic margins (n = 2), the 2-year OS was 50%. All women showed an improved QoL after surgery. CONCLUSION LEPR with iliopsoas resection can be safely performed in selected cases with lateral isolated gynecological relapse involving the PSW and was associated with improved QoL and prolonged survival when an R0 resection was achieved.
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Affiliation(s)
- G Vizzielli
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Rome, Italy.
| | - V Chiantera
- Division of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - G Tinelli
- Division of Vascular Surgery, "Agostino Gemelli" Foundation University Hospital, Rome, Italy
| | - A Fagotti
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - V Gallotta
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Rome, Italy
| | - A Di Giorgio
- Division of Surgery, "Agostino Gemelli" Foundation University Hospital, Rome, Italy
| | - S Gueli Alletti
- Department of Women's and Children's Health, "Agostino Gemelli" Foundation University Hospital, Rome, Italy
| | - G Scambia
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
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16
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Borrelli GM, Abrão MS, Taube ET, Darb-Esfahani S, Köhler C, Chiantera V, Mechsner S. (Partial) Loss of BAF250a (ARID1A) in rectovaginal deep-infiltrating endometriosis, endometriomas and involved pelvic sentinel lymph nodes. Mol Hum Reprod 2016; 22:329-37. [PMID: 26832958 DOI: 10.1093/molehr/gaw009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 10/22/2015] [Accepted: 01/18/2016] [Indexed: 01/01/2023] Open
Abstract
STUDY HYPOTHESIS Loss of protein BAF250a (ARID1A) expression is present in women with rectovaginal deep-infiltrating endometriosis (DIE) and endometriosis affecting the pelvic sentinel lymph nodes (PSLN). STUDY FINDING Partial loss of protein BAF250a was found in some of our patient samples, comprising all endometriosis entities, including rectovaginal DIE and endometriosis affecting the PSLN. WHAT IS KNOWN ALREADY Loss of BAF250a (BRG-associated factor 250a)/ARIDIA (AT-rich interactive domain 1A) protein expression was identified among endometriosis-associated ovarian carcinomas and ovarian endometriosis, and this phenomenon was described as a possible early event in the transformation of endometriosis into cancer. DIE affecting the bowel/rectovaginal site is the most aggressive presentation of endometriosis and its 'risk' of malignant transformation has not been studied so far. STUDY DESIGN, SAMPLES/MATERIALS, METHODS We evaluated the immunohistochemical expression of BAF250a protein in 70 samples from patients enrolled in this study who were surgically treated at a tertiary center, university Hospital. The samples submitted to investigation were from rectovaginal DIE (n= 25/30), endometriosis affecting the PSLN (n= 5/7), ovarian endometriosis (n= 20/20) and endometrium from patients without endometriosis used as controls (n= 20/20). MAIN RESULTS AND THE ROLE OF CHANCE Partial loss (i.e. in one tissue section some cells stained positive for BAF250a while other cells, usually an adjacent group, were negative) of BAF250a protein was identified in 36% (9/25) of rectovaginal DIE samples, 40% (2/5) of endometriosis lesions involving the PSLN, 30% (6/20) of endometriomas, and also in 25% (5/20) of endometrium from controls. We found no statistical correlation between occurrence of partial loss of BAF250a protein and the use or not of hormone medications (P = 0.106), cycle phase (P = 0.917) and stage of disease (P = 0.717). LIMITATIONS, REASONS FOR CAUTION We only found partial loss of BAF250a protein expression, and in a small population of women, with relatively high frequency in all benign tissues assessed in the present analysis. Therefore, this finding alone should not be correlated directly with the risk of malignant transformation in these lesions. WIDER IMPLICATIONS OF THE FINDINGS The occurrence of partial loss of BAF250a protein expression in women with rectovaginal DIE and endometriosis affecting the PSLN is described for the first time. The value of this finding as a predictor of malignant transformation in endometriosis must still be clarified and further studied in association with other molecular events, such as PTEN (phosphatase and tensin homolog) deletion and PIK3CA (phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha) mutation. We might then be able to identify in the future which patients with endometriosis are at higher risk of cancer. STUDY FUNDING AND COMPETING INTERESTS This study was supported by an internal Charité grant to the Endometriosis Research Center and the authors declare no conflicts of interest.
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Affiliation(s)
- G M Borrelli
- Clinic for Gynecology - Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - M S Abrão
- Department of Obstetrics and Gynecology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - E T Taube
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - S Darb-Esfahani
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - C Köhler
- Clinic for Gynecology - Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany Department of Gynecology, Asklepios Klinik Harburg, Hamburg, Germany
| | - V Chiantera
- Clinic for Gynecology - Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S Mechsner
- Clinic for Gynecology - Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Germany
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Petrillo M, Vizzielli G, Fanfani F, Gallotta V, Cosentino F, Chiantera V, Legge F, Carbone V, Scambia G, Fagotti A. Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: Proof of a concept. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.07.095] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [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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Ibrahim M, Frangini S, Younes S, Chiantera V, Mechsner S. Welche Rolle spielen die Myofibroblasten und TGFß1 an der Entwicklung der peritonealen Endometriose? Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1558356] [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: 10/23/2022] Open
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Börner C, Buschow R, Chiantera V, Sehouli J, Mechsner S. Erklärt die peritoneale Innervierung die unterschiedliche Schmerzsymptomatik der peritonealen Endometriose und der Peritonealkarzinose des Ovarialkarzinoms? Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1558370] [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: 10/23/2022] Open
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20
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Ibrahim M, Frangini S, Younes S, Chiantera V, Mechsner S. Mikroskopischer und ultra-mikroskopischer Nachweis von Mikrotraumen in der Endometrialen-Myometrialen Übergangzone von Adenomyose-Patientinnen. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1558354] [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: 10/23/2022] Open
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Kabuk B, Mpinou L, Chiantera V, Ebert A, Mechsner S. Cervixstumpfendometriose nach subtotaler Hysterektomie – Wie hoch ist das Risiko? Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1558362] [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: 10/23/2022] Open
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Hagen R, Buschow R, Albrecht N, Chiantera V, Mechsner S. Einfluss der hormonellen Therapie auf die Expression nozizeptiver neuronaler Marker in peritonealen Endometrioseläsionen. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1558383] [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: 10/23/2022] Open
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23
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Arellano C, Neuling P, Albrecht N, Chiantera V, Mechsner S. Die Expression von Semaphorinen in Fibroblasten wird durch Endometriose assoziierte Faktoren reguliert. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1558382] [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: 10/23/2022] Open
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24
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Borrelli GM, Abrão MS, Taube ET, Darb-Esfahani S, Köhler C, Kaufmann AM, Chiantera V, Mechsner S. Immunohistochemical Investigation of Metastasis-Related Chemokines in Deep-Infiltrating Endometriosis and Compromised Pelvic Sentinel Lymph Nodes. Reprod Sci 2015; 22:1632-42. [PMID: 26169037 DOI: 10.1177/1933719115592711] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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
Endometriosis is a prevalent benign disease, despite sharing several similarities with malignancies, such as the possibility of lymphatic spread. In malignancies, chemokines play a sovereign role in the process of metastasis. Metastasis-related chemokine axes have not yet been assessed in deep-infiltrating endometriosis (DIE), and this investigation was the aim of our study. The expression of these chemokines was investigated by immunohistochemistry in rectovaginal DIE lesions and in matched pelvic sentinel lymph nodes (PSLNs) of patients with endometriosis (n = 27), and their expression in the eutopic endometrium (EE) of endometriosis-free women (n = 20) was used as controls. Their staining pattern in rectovaginal DIE, in endometriotic lesions affecting the PSLN as well as in the EE of patients without endometriosis was characterized for the first time. Overall, these chemokines were highly expressed in DIE and endometriosis in PSLN. Chemokines might be involved in the spread of endometriosis and should be further investigated.
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Affiliation(s)
- G M Borrelli
- Clinic for Gynecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - M S Abrão
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - E T Taube
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - S Darb-Esfahani
- Institute of Pathology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - C Köhler
- Clinic for Gynecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany Department of Gynecology, Asklepios Klinik Harburg, Hamburg, Germany
| | - A M Kaufmann
- Clinic for Gynecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - V Chiantera
- Clinic for Gynecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - S Mechsner
- Clinic for Gynecology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Legge F, Chiantera V, Macchia G, Fagotti A, Fanfani F, Ercoli A, Gallotta V, Morganti A, Valentini V, Scambia G, Ferrandina G. Clinical outcome of recurrent locally advanced cervical cancer (LACC) submitted to primary multimodality therapies. Gynecol Oncol 2015; 138:83-8. [DOI: 10.1016/j.ygyno.2015.04.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/27/2015] [Indexed: 01/22/2023]
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Fagotti A, Vizzielli G, Fanfani F, Chiantera V, Margariti P, Gallotta V, Costantini B, Ferrandina G, Tortorella L, Scambia G. Phase III SCORPION trial (ID number: NCT01461850) in epithelial ovarian cancer patients with high tumor load receiving PDS versus NACT: An interim analysis on peri-operative outcome. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Petrillo M, Vizzielli G, Fanfani F, Gallotta V, Cosentino F, Chiantera V, Scambia G, Fagotti A. Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: Proof of concept. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fanfani F, Fagotti A, Gallotta V, Margariti P, Monterossi G, Restaino S, Chiantera V, Shallayeva E, Scambia G. Feasibility of tertiary and quaternary cytoreduction in recurrent epithelial ovarian cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.01.285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fagotti A, Petrillo M, Costantini B, Fanfani F, Gallotta V, Chiantera V, Turco L, Bottoni C, Scambia G. Minimally invasive secondary cytoreduction plus HIPEC for recurrent ovarian cancer: A case series. Gynecol Oncol 2014; 132:303-6. [DOI: 10.1016/j.ygyno.2013.12.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 11/16/2022]
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Ferrandina G, Lucidi A, De Ninno M, Carbone A, Chiantera V, Morganti AG, Macchia G. Successful treatment of a young patient with locally advanced clear cell adenocarcinoma of the uterine cervix undergoing chemoradiation followed by radical surgery. Gynecol Obstet Invest 2013; 77:64-7. [PMID: 24296792 DOI: 10.1159/000356685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/24/2013] [Indexed: 11/19/2022]
Abstract
Clear cell adenocarcinoma (CCAC) of the uterine cervix is a rare variant of cervical adenocarcinoma accounting for approximately 4-9% of this disease. Given the rarity of this pathological entity, the optimal treatment management is far from being defined. Earlier evidence suggested that the prognosis of patients bearing cervical CCAC is worse than with other histotypes, thus making the investigation of multimodal treatment strategies clinically worthwhile. Herein, we report the first case of locally advanced, large size cervical CCAC in a young woman who was triaged to concomitant chemoradiotherapy followed by radical surgery and experienced a pathologically assessed optimal response to this multimodal approach.
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Affiliation(s)
- G Ferrandina
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University, Rome, Italy
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Tan CW, Lee YH, Choolani M, Tan HH, Griffith L, Chan J, Chuang PC, Wu MH, Lin YJ, Tsai SJ, Rahmati M, Petitbarat M, Dubanchet S, Bensussan A, Chaouat G, Ledee N, Bissonnette L, Haouzi D, Monzo C, Traver S, Bringer S, Faidherbe J, Perrochia H, Ait-Ahmed O, Dechaud H, Hamamah S, Ibrahim MG, de Arellano MLB, Sachtleben M, Chiantera V, Frangini S, Younes S, Schneider A, Plendl J, Mechsner S, Ono M, Hamai H, Chikawa A, Teramura S, Takata R, Sugimoto T, Iwahashi K, Ohhama N, Nakahira R, Shigeta M, Park IH, Lee KH, Sun HG, Kim SG, Lee JH, Kim YY, Kim HJ, Jeon GH, Kim CM, Bocca S, Wang H, Anderson S, Yu L, Horcajadas J, Oehninger S, Bastu E, Mutlu MF, Celik C, Yasa C, Dural O, Buyru F, Quintana F, Cobo A, Remohi J, Ferrando M, Matorras R, Bermejo A, Iglesias C, Cerrillo M, Ruiz M, Blesa D, Simon C, Garcia-Velasco JA, Chamie L, Ribeiro DMF, Riboldi M, Pereira R, Rosa MB, Gomes C, de Mello PH, Fettback P, Domingues T, Cambiaghi A, Soares ACP, Kimati C, Motta ELA, Serafini P, Hapangama DK, Valentijn AJ, Al-Lamee H, Palial K, Drury JA, von Zglinicki T, Saretzki G, Gargett CE, Liao CY, Lee KH, Sung YJ, Li HY, Morotti M, Remorgida V, Venturini PL, Ferrero S, Nabeta M, Iki A, Hashimoto H, Koizumi M, Matsubara Y, Hamada K, Fujioka T, Matsubara K, Kusanagi Y, Nawa A, Zanatta A, Riboldi M, da Rocha AM, Guerra JL, Cogliati B, Pereira R, Motta ELA, Serafini P, Bianchi PDM, Zanatta A, Riboldi M, da Rocha AM, Cogliati B, Guerra JL, Pereira R, Motta ELA, Serafini P, Prieto B, Exposito A, Mendoza R, Rabanal A, Matorras R, Bedaiwy M, Yi L, Dahoud W, Liu J, Hurd W, Falcone T, Biscotti C, Mesiano S, Sugiyama R, Nakagawa K, Nishi Y, Kuribayashi Y, Akira S, Germeyer A, Rosner S, Jauckus J, Strowitzki T, von Wolff M, Khan KN, Kitajima M, Fujishita A, Nakashima M, Masuzaki H, Kajihara T, Ishihara O, Brosens J, Ledee N, Petitbarat M, Rahmati M, Vezmar K, Savournin V, Dubanchet S, Chaouat G, Balet R, Bensussan A, Chaouat G, Lee YH, Loh SF, Tannenbaum SR, Chan JKY, Scarella A, Chamy V, Devoto L, Abrao M, Sovino H, Krasnopolskaya K, Popov A, Kabanova D, Beketova A, Ivakhnenko V, Shohayeb A, Wahba A, Abousetta A, al-inany H, Wahba A, El Daly A, Zayed M, Kvaskoff M, Han J, Missmer SA, Navarro P, Meola J, Ribas CP, Paz CP, Ferriani RA, Donabela FC, Tafi E, Maggiore ULR, Scala C, Remorgida V, Venturini PL, Ferrero S, Hackl J, Strehl J, Wachter D, Dittrich R, Cupisti S, Hildebrandt T, Lotz L, Attig M, Hoffmann I, Renner S, Hartmann A, Beckmann MW, Urquiza F, Ferrer C, Incera E, Azpiroz A, Junovich G, Pappalardo C, Guerrero G, Pasqualini S, Gutierrez G, Corti L, Sanchez AM, Bordignon PP, Santambrogio P, Levi S, Persico P, Vigano P, Papaleo E, Ferrari S, Candiani M, van der Houwen LEE, Schreurs AMF, Lambalk CB, Schats R, Hompes PGA, Mijatovic V, Xu SY, Li J, Chen XY, Chen SQ, Guo LY, Mathew D, Nunes Q, Lane B, Fernig D, Hapangama D, Lind T, Hammarstrom M, Golmann D, Rodriguez-Wallberg K, Hestiantoro A, Cakra A, Aulia A, Al-Inany H, Houston B, Farquhar C, Abousetta A, Tagliaferri V, Gagliano D, Immediata V, Tartaglia C, Zumpano A, Campagna G, Lanzone A, Guido M, Matsuzaki S, Darcha C, Botchorishvili R, Pouly JL, Mage G, Canis M, Shivhare SB, Bulmer JN, Innes BA, Hapangama DK, Lash GE, de Graaff AA, Zandstra H, Smits LJ, Van Beek JJ, Dunselman GAJ, Bozdag G, Calis PT, Demiralp DO, Ayhan B, Igci N, Yarali H, Acar N, Er H, Ozmen A, Ustunel I, Korgun ET, Kuroda K, Kuroda M, Arakawa A, Kitade M, Brosens AI, Brosens JJ, Takeda S, Yao T. Endometriosis, endometrium, implantation and fallopian tube. Hum Reprod 2013. [DOI: 10.1093/humrep/det211] [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: 10/26/2022] Open
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Vercellino GF, Chiantera V, Gaßmann J, Erdemoglu E, Drechsler I, Frangini S, Schneider A, Böhmer G. Prospective Comparison of Loop Excision under Colposcopic Guidance versus Vitom Guidance. Geburtshilfe Frauenheilkd 2012; 72:945-948. [PMID: 25258454 DOI: 10.1055/s-0032-1327779] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 04/13/2012] [Revised: 08/19/2012] [Accepted: 08/31/2012] [Indexed: 10/27/2022] Open
Abstract
Background: Aim of the study was to compare the quality of loop excision using a colposcope with results using the VITOM system. Results compared included cervical volume removed, intra- and postoperative complications, and positive resection margins. Methods: A total of 200 patients with histologically confirmed high-grade cervical premalignant lesions, persistent atypical cytological results and/or suspicious colposcopic findings, and cytological and histological discrepancies were included in the study. In transformation zone type 1 (T1) only a superficial cone biopsy was done, in zones type 2 and 3 (T2 and T3) a superficial outside cone biopsy or a deeper inside cone biopsy were done respectively, followed by endocervical curettage. Volume of removed tissue, complications, and positive resection margins were compared for the colposcopy and the VITOM groups. Findings: Demographic and reproductive features were similar between groups. In the VITOM group 49 % of patients had zone T1, 30 % had zone T2, and 21 % had zone T3. In the group of patients managed by colposcopy, 48, 45, and 7 % of patients had zone T1, T2 and T3 zone, respectively (p < 0.01). A "top hat" procedure was done in 65 % of patients in the VITOM group and in 38 % of patients in the colposcopy group (p < 0.05). Mean volume of removed cervical tissue measured was similar, with 1.2 cm3 measured in the VITOM group and 1.14 cm3 in the colposcopy group (p > 0.05). There were no significant differences in the type of procedure or the mean volume of removed tissue. Results were similar for both groups with respect to positive resection margins and complications. Conclusion: VITOM is a safe and reliable system. Results using the VITOM system are comparable to those obtained with conventional colposcopy. The potential advantage of VITOM is the broader availability of endoscopic systems in the operating theatre.
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Affiliation(s)
| | | | - J Gaßmann
- Abteilung für Klinische Psychologie und Psychotherapie, Georg-Elias-Müller Institut für Psychologie, Göttingen
| | - E Erdemoglu
- Department of Gynecology, Suleyman Demirel University, Isparta, Turkey
| | | | | | | | - G Böhmer
- Colposcopy Clinic Wagner Stibbe, Bad Münder
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Nesbitt-Hawes E, Campbell N, Won H, Maley P, Henry A, Abbott J, Potdar N, Mason-Birks S, Elson CJ, Gelbaya TA, Nardo LG, Stavroulis A, Nnoaham K, Hummelshoj L, Zondervan K, Saridogan E, GSWH Consortium WERF, Chamie LP, Soares ACP, Kimati CT, Gomes C, Fettback P, Riboldi M, Serafini P, Lalitkumar S, Menezes J, Evdokia D, Gemzell-Danielsson K, Lalitkumar PGL, Bailey J, Newman TA, Johnston A, Zisimopoulou K, White M, Sadek K, Shreeve N, Macklon N, Cheong Y, Al-Akoum M, Akoum A, Giles J, Garrido N, Vidal C, Mondion M, Gallo C, Ramirez J, Pellicer A, Remohi J, Ghosh S, Chattopadhyay R, Jana S, Goswami SK, Bose G, Chakravarty M, Chowdhuri K, Chakravarty BN, Kendirci Ceviren A, Ozcelik Tanriverdi N, Urfan A, Donmez L, Isikoglu M, Romano A, Schreinemacher MH, Backes WH, Slenter JM, Xanthoulea SA, Delvoux B, van Winden L, Beets-Tan RG, Evers JLH, Dunselman GAJ, Jana SK, Chaudhury K, Chattopadhyay R, Chakravarty BN, Maruyama T, Yamasaki A, Miyazaki K, Arase T, Uchida H, Yoshimura Y, Kaser D, Ginsburg E, Missmer S, Correia K, Racowsky C, Streuli I, Chouzenoux S, de Ziegler D, Chereau C, Weill B, Chapron C, Batteux F, Arianmanesh M, Fowler PA, Al-Gubory KH, Urata Y, Osuga Y, Izumi G, Nagai M, Takamura M, Yamamoto N, Saito A, Hasegawa A, Takemura Y, Harada M, Hirata T, Hirota Y, Yoshino O, Koga K, Taketani Y, Mohebbi A, Janan A, Nasri S, Lakpour MR, Ramazanali F, Moini A, Aflatoonian R, Germeyer A, Novak O, Renke T, Jung M, Jackus J, Toth B, Strowitzki T, Bhattacharya J, Mitra A, Kundu S, Pal M, Kundu A, Gumusel A, Basar M, Yaprak E, Aslan E, Arda O, Ilvan S, Kayisli U, Guzel E, Haouzi D, Monzo C, Lehmann S, Hirtz C, Tiers L, Hamamah S, Choi D, Choi J, Jo M, Lee E, Shen X, Wang BIN, Li X, Tamura I, Maekawa R, Asada H, Tamura H, Sugino N, Tamura H, Tamura I, Maekawa R, Asada H, Sugino N, Liu H, Jiang Y, Chen J, Zhu L, Shen X, Wang B, Yan G, Sun H, Coughlan C, Sinagra M, Ledger W, Li TC, Laird SM, Dafopoulos K, Vrekoussis T, Chalvatzas N, Messini CI, Kalantaridou S, Georgoulias P, Messinis IE, Makrigiannakis A, Xue Q, Xu Y, Zuo WL, Zhang L, Shang J, Zhu SN, Bulun SE, Tomassetti C, Geysenbergh B, Meuleman C, Fieuws S, D'Hooghe T, Suginami K, Sato Y, Horie A, Matsumoto H, Fujiwara H, Konishi I, Jung Y, Cho S, Choi Y, Lee B, Seo S, Urman B, Yakin K, Oktem O, Alper E, Taskiran C, Aksoy S, Takeuchi K, Kurematsu T, Yu-ki Y, Fukumoto Y, Homan Y, Sata Y, Kuroki Y, Takeuchi M, Awata S, Muneyyirci-Delale O, Charles C, Anopa J, Osei-Tutu N, Dalloul M, Weedon J, Muney A, Stratton P, Yilmaz B, Kilic S, Aksakal O, Kelekci S, Aksoy Y, Lordlar N, Sut N, Gungor T, Chan J, Tan CW, Lee YH, Tan HH, Choolani M, Griffith L, Oldeweme J, Barcena de Arellano ML, Reichelt U, Schneider A, Mechsner S, Barcena de Arellano ML, Munch S, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Santoro L, D'Onofrio F, Campo S, Ferraro PM, Tondi P, Gasbarrini A, Santoliquido A, Jung MH, Kim HY, Barcena de Arellano ML, Arnold J, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Arnold J, Barcena de Arellano ML, Buttner A, Vercellino GF, Chiantera V, Schneider A, Mechsner S, Karaer A, Celik O, Bay Karabulut A, Celik E, Kiran TR, Simsek OY, Yilmaz E, Turkcuoglu I, Tanrikut E, Alieva K, Kulakova E, Ipatova M, Smolnikova V, Kalinina E. ENDOMETRIOSIS, ENDOMETRIUM, IMPLANTATION AND FALLOPIAN TUBE. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.78] [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: 11/12/2022] Open
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Fiebitz A, Fritsch M, Reichelt U, Ruester C, Chiantera V, Vercellino GF, Darwish A, Schneider A, Mechsner S. Optimized culture conditions for tissue explants of uterine leiomyoma. Clin Lab 2012; 58:1153-1164. [PMID: 23289184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Uterine leiomyomas are the most common benign tumours in women, which arise from smooth muscle cells of the uterine myometrium and usually are multicentric. In spite of their frequency pathogenesis is widely unknown, mainly due to the absence of a suitable model system. We describe the systematic optimization of culturing leiomyoma tissue explants in an economical and effective ex vivo system. METHODS Different concentrations of oxygen, different media, sera, hormones, and growth factor supplements were tested. Immunohistochemical stainings with antibodies against hormone receptors as well as specifying proliferation and apoptotic indices and real-time PCR were performed. RESULTS Main parameters for culturing myoma tissue explants were tested for finding an optimal protocol. Standard medium D-MEM-F12 in combination with the use of horse serum in a reduced concentration of 1% turned out to be optimal for these tissue cultures as well as the addition of estradiol and epidermal growth factor EGF to media. Reduced oxygen content in the incubator air showed no positive effect. CONCLUSIONS For culturing tissue explants of uterine leiomyoma several conditions were optimized. The established tissue culture model allows examining the effects of known and potential therapeutic substances and the influence of immune competent cells in the process of tumour formation to find new targets for medical treatment.
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Affiliation(s)
- A Fiebitz
- Department of Gynaecology, Charité Hospital Campus Benjamin Franklin, Berlin, Germany
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Dutta M, Joshi M, Srivastava S, Chakravarty B, Chaudhury K, Juan Z, Cui YG, Hou Z, Mao YD, Liu JY, Dogan OE, Soysal D, Posaci C, Saatli HB, Kizildag S, Soysal S, Koyuncuoglu M, Chan RWS, Chan YY, Lee CL, Ng EHY, Yeung WSB, Maruyama T, Yamasaki A, Miyazaki K, Arase T, Uchida H, Yoshimura Y, Novella-Maestre E, Herraiz S, Vila JM, Pellicer A, Arellano Estrada C, Barcena de Arellano ML, Vercellino GF, Chiantera V, Schneider A, Mechsner S. SESSION 74: ENDOMETRIOSIS/ENDOMETRIUM: MOLECULAR AND CELLULAR INSIGHTS 3. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.72] [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: 11/12/2022] Open
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Koehler C, Gottschalk E, Chiantera V, Marnitz S, Hasenbein K, Schneider A. From laparoscopic assisted radical vaginal hysterectomy to vaginal assisted laparoscopic radical hysterectomy. BJOG 2011; 119:254-62. [PMID: 22082331 DOI: 10.1111/j.1471-0528.2011.03202.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Radical hysterectomy with pelvic lymphadenectomy is the standard surgical treatment for patients with early stage cervical cancer. The majority of radical hysterectomies are performed with the open technique. However, laparoscopic, combined laparoscopic and vaginal, and robotic-assisted approaches may also be used. Compared with the abdominal radical hysterectomy (ARH), laparoscopic techniques are associated with less blood loss, shorter hospital stay, better cosmesis, and faster recovery. A further breakthrough in laparoscopic technique can only be made if safety and oncological clearance are comparable with ARH. We describe the technique and results of laparoscopic assisted radical vaginal hysterectomy and the transition to vaginal assisted laparoscopic radical hysterectomy.
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Affiliation(s)
- C Koehler
- Department of Gynaecology, Charité- Universitätsmedizin Berlin, Germany.
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Barcena de Arellano ML, Arnold J, Rüster C, Vercellino GF, Chiantera V, Ebert AD, Schneider A, Mechsner S. Neurotrophic events in peritoneal endometriotic lesions. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1292729] [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: 10/15/2022] Open
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Barcena de Arellano ML, Gericke J, Reichelt U, Okuducu AF, Ebert AD, Chiantera V, Schneider A, Mechsner S. Immunohistochemical characterization of endometriosis-associated smooth muscle cells in human peritoneal endometriotic lesions. Hum Reprod 2011; 26:2721-30. [DOI: 10.1093/humrep/der253] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Münch S, Barcena de Arellano ML, Arnold J, Vercellino GF, Chiantera V, Mechsner S. Die Rolle von Neurotrophinen und Kalzium-bindenden Proteinen in der Endometriose-assoziierten Innervation. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1280484] [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: 10/18/2022] Open
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Barcena de Arellano ML, Arnold J, Vercellino F, Chiantera V, Rüster C, Ebert A, Schneider A, Mechsner S. Spielen Neurotrophine in der Pathogenese von Endometrioseschmerzen eine Rolle? Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1280483] [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: 10/18/2022] Open
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Gericke J, Barcena de Arellano ML, Reichelt U, Ebert AD, Chiantera V, Schneider A, Mechsner S. Muskelmetaplasie in peritonenalen Endometrioseläsionen. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1280485] [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: 10/18/2022] Open
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Favero G, Chiantera V, Oleszczuk A, Galotta V, Hertel H, Herrmann J, Köhler C, Schneider A. New aspects in the treatment of cervical cancer complicated by pregnancy: Laparoscopic nodal evaluation before oncologic treatment delay. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5062] [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: 11/20/2022] Open
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Abstract
OBJECTIVE To investigate the possibility of an association between previous induced abortion and subsequent birth of a small-for-gestational-age (SGA) infant. DESIGN Case-control study. SETTING General and university hospitals. METHODS Cases were 555 women who delivered SGA babies. Controls were 1966 women who gave birth at term (>37 weeks of gestation) to healthy infants of normal weight on randomly selected days at the hospital where cases had been identified. All women in the case and control categories were interviewed on the obstetric wards by one of a team of six interviewers. During the interviews, information was obtained regarding general socio-demographic factors, personal characteristics and habits, gynaecological and obstetric history, general anamnesis, family history of obstetric and gynaecological diseases, and the age of the father of the child. Further information on current pregnancy and delivery was also collected. We used conditional multiple logistic regression (with age as the matching variable), with maximum likelihood fitting, to obtain odds ratios and their corresponding 95% CIs. Included in the regression equations were terms for education, plus terms significantly associated in this data set with the risk of SGA birth (smoking in pregnancy, history of SGA, gestational hypertension and parity). POPULATION Women admitted to a general and a university hospital. RESULTS No significant increase in the risk of SGA birth was observed in women with a previous induced abortion [odds ratio (OR) 1.0; 95% CI 0.6-1.7]. The OR for SGA birth was 1.2 (95% CI 0.7-2.1) for preterm and 1.0 (95% CI 0.7-1.4) for term SGA births. CONCLUSION This study found no association between risk of SGA birth and induced abortion.
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Affiliation(s)
- F Parazzini
- Seconda Clinica Ostetrico Ginecologica, Università di Milano, Fondazione Policlinico, Mangiagalli Regina Elena, Milano, Italy.
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Possover M, Baekelandt J, Flaskamp C, Li D, Chiantera V. Laparoscopic neurolysis of the sacral plexus and the sciatic nerve for extensive endometriosis of the pelvic wall. ACTA ACUST UNITED AC 2007; 50:33-6. [PMID: 17546541 DOI: 10.1055/s-2007-970075] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The aim of this study is to report on the feasibility of laparoscopic neurolysis of the plexus sacralis and the sciatic nerve in deep endometriotic infiltration of the lateral pelvic wall. METHODS A transperitoneal approach to the pelvic nerves combined with the LANN technique for intraoperative assessment of the function of the exposed nerves permit exposure and sparing of all somatic nerves during resection of the endometriotic lesion. RESULTS We report on our short experience with 21 patients who underwent this technique for the treatment of endometriotic infiltration of the sacral plexus at different levels. CONCLUSION In young patients with chronic unilateral sciatica or unilateral pudendal neuralgia - Alcock's canal syndrome - where no neurological/orthopedic etiologies have been found, endometriotic infiltration of the lateral pelvic wall has to be implicated as a potential etiology and an indication for laparoscopy must be discussed. Laparoscopic neurolysis of the pelvic somatic nerves is a feasible procedure for trained laparoscopic surgeons who have a good knowledge of the retroperitoneal pelvic (neuro)anatomy.
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Affiliation(s)
- M Possover
- Department of Obstetrics and Gynecology, St. Elisabeth Hospital, Cologne, Germany.
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Possover M, Baekelandt J, Kaufmann A, Chiantera V. Laparoscopic endopelvic sacral implantation of a Brindley controller for recovery of bladder function in a paralyzed patient. Spinal Cord 2007; 46:70-3. [PMID: 17420771 DOI: 10.1038/sj.sc.3102065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A number of techniques are being investigated to accomplish bladder control recovery in paralyzed patients using the neurostimulation, but currently, all techniques are based on the dorsal implantation of the electrodes using a laminectomy. METHODS On 27 April 2006 we performed a laparoscopic implantation of a Finetech-Brindley bladder controller on the endopelvic sacral roots in a Th8 completely paralyzed woman who had previously undergone the removal of a Brindley controller due to an arachnoiditis after extrathecal implantation with intradural sacral deafferentation. RESULTS We required about 3.5 h for the entire surgical procedure; no complications occurred and the patients went home on 5th postoperative day. The patient is now able to void empty her bladder and her rectum using the controller without further need for self-catheterisation. CONCLUSIONS The presented new technique of laparoscopic implantation of electrodes on the endopelvic portion of the sacral nerve roots is an option to be considered in all paralyzed patients with further wish for electrical induced miction/defecation after previous deafferentation.
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Affiliation(s)
- M Possover
- Department of Gynecology and Obstetrics, St Elisabeth Hospital, Cologne, Germany.
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Possover M, Chiantera V. Isolated infiltrative endometriosis of the sciatic nerve: a report of three patients. Fertil Steril 2007; 87:417.e17-9. [DOI: 10.1016/j.fertnstert.2006.05.084] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 05/12/2006] [Accepted: 05/19/2006] [Indexed: 11/30/2022]
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Abstract
OBJECTIVES We analysed the association between coffee drinking before and during the three trimesters of pregnancy and the risk of preterm birth of babies normal for gestational age (NGA) or small for gestational age (SGA). METHODS Case-control study conducted in University clinics of North Italy. Cases were 502 women who delivered at <37 weeks of gestation. The controls included 1966 women who gave birth at term (>or=37 weeks of gestation) to healthy infants on randomly selected days at the hospitals where cases had been identified. RESULTS There was inverse association for coffee consumption in the third trimester of pregnancy in SGA cases compared to NGA (heterogeneity test between OR: chi1(2)=5.6811 P<0.05). In comparison with not drinkers, all the ORs of overall intake of caffeine were closed near the unity for both SGA and NGA preterm birth. CONCLUSION Compared with no consumption, a low consumption of coffee during pregnancy may not have significant effects on preterm birth.
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Affiliation(s)
- F Chiaffarino
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
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Parazzini F, Chiaffarino F, Chatenoud L, Tozzi L, Cipriani S, Chiantera V, Fedele L. Maternal coffee drinking in pregnancy and risk of small for gestational age birth. Eur J Clin Nutr 2004; 59:299-301. [PMID: 15454971 DOI: 10.1038/sj.ejcn.1602052] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We have analysed the association between coffee drinking before and during the three trimesters of pregnancy and risk of small for gestational age (SGA) birth. METHODS Cases were 555 women who delivered SGA births (ie <10th percentile according Italian standard). The controls included 1966 women who gave birth at term (>/=37 weeks of gestation) to healthy infants of normal weight. RESULTS In comparison with nondrinkers, the ORs for SGA birth were 1.3 (95% confidence interval, CI, 0.9-1.9) for consumption of four or more cups of coffee/day before pregnancy, and 1.2 (95% CI 0.8-1.8), 1.2 (95% CI 0.8-1.8) and 0.9 (95% CI 0.6-1.4) for consumption of three or more cups of coffee/day during the first, second and third trimester of pregnancy, respectively. CONCLUSION These findings were consistent in women who delivered preterm and at term births and were not affected by potential confounding such as smoking.
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Affiliation(s)
- F Parazzini
- I Clinica Ostetrico Ginecologica, Università di Milano, Milano, Italy.
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Abstract
BACKGROUND To offer data on the relationship between diet and risk of pelvic endometriosis, we analysed data collected in the framework of two case-control studies. METHODS Data from two case-control studies conducted in Northern Italy between 1984 and 1999 were combined. Cases were 504 women aged < 65 years (median age 33 years, range 20-65) with a laparoscopically confirmed diagnosis of endometriosis, admitted to a network of obstetrics and gynaecology departments in Milan, Brescia and Pavia. Controls were 504 women (median age 34 years, range 20-61) admitted for acute non-gynaecological, non-hormonal, non-neoplastic conditions. RESULTS Compared to women in the lowest tertile of intake, a significant reduction in risk emerged for higher intake of green vegetables [odds ratio (OR) = 0.3 for the highest tertile of intake] and fresh fruit (OR = 0.6), whereas an increase in risk was associated with high intake of beef and other red meat (OR = 2.0) and ham (OR = 1.8). Consumption of milk, liver, carrots, cheese, fish and whole-grain foods, as well as coffee and alcohol consumption, were not significantly related to endometriosis. CONCLUSIONS This study suggests a link between diet and risk of endometriosis.
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Affiliation(s)
- F Parazzini
- Istituto di Ricerche Farmacologiche 'Mario Negri', 20157 Milano, Clinica Ostetrico Ginecologica, Università di Milano, 20122 Milano and Studi di via Fontana, 20122 Milano, Italy.
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Parazzini F, Di Cintio E, Chiantera V, Guaschino S. Determinants of different Candida species infections of the genital tract in women. Sporachrom Study Geoup. Eur J Obstet Gynecol Reprod Biol 2000; 93:141-5. [PMID: 11074134 DOI: 10.1016/s0301-2115(00)00289-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We have analyzed the differences in the epidemiological characteristics of women with different Candida low female genital tract infection. STUDY DESIGN Eligible for the study were 4228 women aged 18-70 years with symptomatic low gynecological tract infection and clinical findings suggestive for Candida infection consecutively attending during the study period first level outpatients gynecological services in Italy. CHROMagar Candida method was used to identify albicans and non-albicans species and among non-albicans ones Candida glabrata, tropicalis and krusei. RESULTS Out of the 4228 women who entered the study, Candida infection was confirmed by CHROMagar test in 3351 cases (79.3%): Candida albicans was identified in 1431 cases (43%) and non-albicans in 1920. Among the 1920 women with non-albicans infection, Candida glabrata was identified in 1207 women, Candida krusei in 290, Candida tropicalis in 404 (in 19 cases other species or non-specified species were involved). Candida albicans infection was more frequently reported than non-albicans ones in diabetic women (Odds Ratio, OR=1.7, 95%, Confidence Interval, CI 1.1-2.7). Current oral contraceptive users tended more frequently to be infected with Candida albicans than non-albicans, however the estimated OR was only slightly above unity and of borderline statistical significance (OR 1.3, 9.5%, CI 1.1-1.5). Women reporting previous treatment with topic antimicotic reported more frequently non-albicans infection, than Candida albicans ones. However the association was limited and of borderline statistical significance (OR albicans vs. non albicans 0.7, 95% CI 0.5-1.0). Albicans infection was more frequently identified in women whose partner reported symptomatology for Candida infection (OR 1.7, 95% C.I. 1.4-2.0). CONCLUSIONS This study shows that in this Italian population with symptomatic Candida infection of low female genital tract, there are some differences in the epidemiological characteristics of women with albicans and non-albicans infection.
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Affiliation(s)
- F Parazzini
- Istituto di Ricerche Farmacologiche Mario Negri, Via Eritrea 62, 20157 Milano, Italy.
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