Anna Fagotti

Università degli Studi di Perugia, Perugia, Umbria, Italy

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Publications (150)477.11 Total impact

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    ABSTRACT: The goal was to evaluate the safety, feasibility, and reproducibility of total and radical single-site hysterectomy.
    Current opinion in obstetrics & gynecology. 06/2014;
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    ABSTRACT: To analyze in a large series of unresectable advanced ovarian cancer (AOC) patients the prognostic role of pathologic response to neoadjuvant chemotherapy (NACT).
    American journal of obstetrics and gynecology. 06/2014;
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    ABSTRACT: To analyze the impact of secondary cytoreductive surgery (SCS) on survival outcome in a retrospective series of isolated platinum-resistant recurrent ovarian cancer.
    Gynecologic oncology. 06/2014;
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    ABSTRACT: In long-lived organisms, the impacts of environmental changes may become evident after time, possibly in future generations. In this study, we attempt to reveal possible delayed effects of meteorological changes on mixed populations of water frogs living in small water bodies located in the Tiber River basin, by using a time-lagged correlation analysis. The analysis shows that the temperature–precipitation pattern induces definite delayed effects, which suggest two potential, possibly co-occurring, explanatory effects: (I) a cumulative and symmetric effect on mortality and (II) a point and asymmetric effect on recruitment. Our data suggest that the water availability in late summer–early autumn affects the survival of tadpoles and migrating frogs, with no differential effect on the parental species Pelophylax bergeri and the hybrid Pelophylax kl. hispanicus, whereas autumn precipitation has a greater impact on the fecundity and/or reproductive success of the parental species. The best time-lagged regression equations between population data and the annual de Martonne aridity index (I DMa) indicate that I DMa < 20 mm °C−1 is critical for the persistence of the water frogs, and predict that the studied populations will experience a significant decline within the current scenario of climate change.
    Hydrobiologia 06/2014; 730(1). · 1.99 Impact Factor
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    ABSTRACT: The aim of this study was to investigate whether preoperative laparoscopic evaluation of the dissemination of disease may have an independent impact on survival in advanced epithelial ovarian cancer (AEOC).
    Annals of Surgical Oncology 05/2014; · 4.12 Impact Factor
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    ABSTRACT: The aim of this retrospective study was to investigate the incidence of mesenteric lymph node (MLN) involvement, and its prognostic role in advanced ovarian cancer (OC). OC patients undergoing rectosigmoid resection during primary debulking surgery or interval debulking surgery were recorded. Progression-free survival (PFS) and overall survival were calculated from the date of diagnosis to the date of relapse/progression, death of disease, or the date of last follow-up. MLNs were detected in 102/148 cases (68.9 %); the rate of MLN involvement was 47.0 %. The percentage of metastatic MLNs was higher in cases with >5 MLNs removed compared with cases with ≤5 MLNs removed (62.7 % vs. 31.3 %; p = 0.0027). A progressive increase in the rate of metastatic MLNs was documented in association with depth of bowel infiltration (p = 0.026). Cases with metastatic MLNs experienced isolated celiac trunk or aortic lymph node recurrences more frequently than patients without MLN involvement (44.8 % vs. 10.7 %; p = 0.0008). PFS did not differ between cases with positive versus negative MLN involvement (2-year PFS = 31 % vs. 43 %; p = 0.58). OC patients undergoing rectosigmoid resection showed metastatic MLN involvement in 47.0 % of cases. Metastatic MLN status is associated with a high rate of isolated aortic and celiac trunk lymph node recurrences.
    Annals of Surgical Oncology 02/2014; · 4.12 Impact Factor
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    ABSTRACT: Optimally, secondary cytoreduction is acknowledged as a valid option in terms of oncologic outcome for patients with platinum-sensitive recurrent ovarian cancer. In cases of localized relapse, a laparoscopic approach has been attempted at various institutions, but studies on its role for this subset of patients still are limited. This report describes the authors' experience using laparoscopic secondary cytoreduction for patients with localized recurrent ovarian cancer. The results from a retrospective analysis of a prospective case series are reported. Between October 2011 and May 2013, 29 patients with localized recurrent ovarian cancer were selected for a laparoscopic cytoreduction. Two conversions to laparotomy occurred. The analyzed outcome variables included stage and site of disease, type of surgical procedure, operative time, blood loss, length of hospital stay, complications, and oncologic outcome. The median operating time was 188 min. The median estimated blood loss was 150 mL, and the median hospital stay was 4 days. Complete debulking was achieved for 96.2 % of the patients. No intraoperative complications occurred, and postoperative complications were noted in only one patient. The median disease-free survival time was 14 months. For selected patients, laparoscopy is a feasible and safe approach to optimal cytoreduction for patients with localized recurrent ovarian cancer.
    Surgical Endoscopy 01/2014; · 3.43 Impact Factor
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    ABSTRACT: We provided a comprehensive analysis of rate, pattern, and severity of early and late postoperative complications in a very large, single-institution series of locally advanced cervical cancer (LACC) patients administered CT/RT plus radical surgery (RS). A total of 362 consecutive LACC (FIGO stage IB2-IVA) patients were submitted to RS after CT/RT at the Gynecologic Oncology Unit of the Catholic University (Rome/Campobasso). At 4 weeks after CT/RT, patients were evaluated for objective response and triaged to radical hysterectomy and pelvic ± aortic lymphadenectomy. Surgical morbidity was classified according to the Chassagne's grading system. Most cases underwent type III-IV radical hysterectomy (N = 313, 86.5 %); pelvic lymphadenectomy was performed in all patients, while 116 patients (32.1 %) were also submitted to aortic lymphadenectomy. A total of 93 patients (25.7 %) experienced any grade postoperative complications, and 60 (16.6 %) had ≥grade 2 complications; grade 3-4 complications occurred in 21 patients (5.8 %). Of all early postoperative complications (N = 100), 31 (31.0 %) were urinary, 9 (9.0 %) were gastrointestinal, and 45 (45.0 %) were vascular. Of all late complications (N = 31), 20 (64.5 %) were urinary, 7 (22.6 %) gastrointestinal, and 2 (6.4 %) were vascular. Multivariate analysis showed that not complete clinical response to treatment retained an independent, unfavorable association with risk of development of postoperative morbidity, while advanced stage, and aortic lymphadenectomy showed only a borderline value. Failure to achieve clinical complete response to treatment and, to a lesser extent, more advanced stage, and aortic lymphadenectomy, were associated with a higher risk of developing any grade as well as ≥grade 2 complications.
    Annals of Surgical Oncology 01/2014; · 4.12 Impact Factor
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    ABSTRACT: Our study purpose was to evaluate morbidity and postoperative mortality in patients who underwent pelvic exenteration (PE) for primary or recurrent gynecological malignancies. We identified 230 patients who underwent PE, referred to the gynecological oncology units of 4 institutions: Charitè University in Berlin, Friedrich-Schiller University in Jena, S. Orsola-Malpighi University in Bologna, and Catholic University in Rome and in Campobasso. The median age was 55 years. The tumor site was the cervix in 177 patients, the endometrium in 28 patients, the vulva in 16 patients, and the vagina in 9 patients. Sixty-eight anterior, 31 posterior, and 131 total PEs were performed in 116 women together with hysterectomy. A total of 82.6% of the patients required blood transfusion. The mean operative time was 446 (95-970) minutes, and the median hospitalization was 24 (7-210) days. We noted a major complication rate of 21.3% (n = 49). We registered 7 perioperative deaths (3%) calculated within 30 days. The operation was performed within clear margins in 166 patients (72.2%). The overall mortality rate depending on tumor site at the end of the study was 75% for vulvar cancer, 57.6% for cervical cancer, 55.6% for vaginal cancer, and 53.6% for endometrial cancer. Although an important effort for surgeons and for patients, PE remains a therapeutic option with an acceptable complication rate and postoperative mortality. A strict selection of patients is mandatory to reach adequate surgical and oncologic outcomes.
    International Journal of Gynecological Cancer 01/2014; 24(1):156-64. · 1.94 Impact Factor
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    ABSTRACT: Objective the increasing tendency to a tailored treatment in gynecologic oncology has required the extension of the intervention to other non-gynecological structures, as the urinary district. Moreover the role of the urological surgery in gynecologic oncology is still not completely explored. The objective of the study is to evaluate the occurrence of urological procedures in gynecologic oncology surgery. Methods Patients admitted to the Division of Gynecologic Oncology, Catholic University of Sacred Hearth, Rome, Italy, between January 2009 and December 2012, were retrospectively analyzed. Clinical charts identified the occurrence of urological procedures in major gynecological surgery. Results A total of 728 patients were analyzed for the study. A total of 204 urologic procedures were carried out in 83 patients. In all patients, preoperative hydronephrosis appears to be the only statistically significant predisposing factor to urological procedures. At multivariate analysis, stratifying data for different neoplasm, recurrence was the only adjunctive significant variable for ovarian cancer, as well as neo-adjuvant treatment and recurrence for cervical cancer. Conclusions This study has identified preoperative factors influencing the needing of urological procedures in different gynecologic neoplasms, allowing a proper planning of surgical treatment, tailored on each patient.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 01/2014; · 2.56 Impact Factor
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    ABSTRACT: The purpose of this study was to analyze the quality of life in terms of sexual and reproductive outcome in patients suffering from early stage cervical cancer, submitted to an excisional cone as fertility-sparing treatment. A multicenter retrospective analysis about specific dimensions of physical, psychological, reproductive and sexual functions after a cold-knife conization plus pelvic laparoscopic lymphadenectomy was conducted at Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome-Italy and at Division of Gynecology, European Institute of Oncology, Milan-Italy. The aim of this study was twofold. It aimed to analyze the quality of life in patients submitted to minimally invasive surgery and to compare these data with radical trachelectomy. Twenty-three patients with an average age of 30 years decided to participate in this study. After the treatment, all women (100%) had regular menstruation, 7 (30.4%) had increased not invalidating dysmenorrhea; 1 (4.4%) experienced a cervical stenosis; 6 among 10 patients that tried to conceive (60%) obtained one spontaneous pregnancy; 4 more (40%) underwent in vitro fertilization and embryo transfer and only 1 of them (25%) was successful. About sexual assessment, 1 patient (4.4%) had trouble in lubricating, 3 (13%) had anxiety about performance, 6 (26.1%) complained of dyspareunia which was resolved within 3 subsequent months. All patients (100%) obtained a complete psychological and physical recovery. This study demonstrated preliminary encouraging data about sexual and reproductive outcome after excisional conization. A comparison with trachelectomy surely needs longer follow-ups, more cases and prospective analyses.
    Journal of reproduction & infertility. 01/2014; 15(1):29-34.
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    ABSTRACT: Study Objective To compare the perioperative outcome of laparoendoscopic single-site (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH). Design Retrospective multicenter study (Canadian Task Force Classification II-2). Setting Early stage cervical cancer. Patients Forty-six patents with FIGO stage IA2-IB1/IIA1 cervical cancer were included. Nineteen patients (41.3%) received LESS-RH, and 27 cases (58.7%) mLPS-RH. Pelvic lymph node dissection (PLND) was performed in all patients of cases. Interventions In the LESS-RH group all surgical procedures were performed through single umbilical multichannel port. In the mLPS group, RH was completed using a 5-mm umbilical optical trocar, and three additional 3-mm ancillary trocars placed suprapubically, and in the left/right lower abdominal regions. Measurements and Main Results There was no difference in clinic-pathological characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270 (149-380) minutes in LESS-RH and 180 (90-240) minutes in the mLPS-RH group (p value=0.001). No further differences were detected in terms of type of RH, number of lymph nodes removed, or perioperative outcomes between the two groups. Conversion to laparotomy occurred in one patient (5.3%) in the LESS-RH group, following external iliac vein injury. Furthermore, in another woman treated with LESS approach, conversion to standard laparoscopy was required due to truncal obesity. In the mLPS-RH group, no conversions were observed, but reoperation for repair of a ureteral injury occurred. The percentage of patients discharged one day after surgery was significantly higher in the LESS-RH (57.9%), compared to mLPS-RHgroup (25.0%; p value=0.030). After a median follow-up of 27 months (9-73) only one patient, treated with mLPS-RH, experienced pelvic recurrence and died of disease. Conclusions Both LESS-RH and mLPS-RH are feasible ultra minimally invasive approaches for completion of RH plus PLND. Further technical improvements are required to allow a wider diffusion of these techniques for more complex procedures.
    Journal of Minimally Invasive Gynecology 01/2014; · 1.61 Impact Factor
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    ABSTRACT: To analyze the feasibility of laparoscopic/robotic secondary cytoreductive surgery and hyperthermic intraperitoneal intra-operative chemotherapy (SCS+HIPEC) in a retrospective series of isolated platinum sensitive recurrent ovarian cancer. We retrospectively evaluated a consecutive series of ovarian cancer patients with isolated platinum sensitive relapse. Isolated relapse was defined as the presence of a single nodule, in a single anatomic site. In all cases the presence of isolated relapse was assessed at pre-operative FDG-PET/CT scan, and confirmed with staging laparoscopy performed immediately before SCS+HIPEC. 84 women with platinum sensitive relapse received SCS+HIPEC during a 4-years period. Among them, 10 cases (11.9%) showed isolated relapse and were treated with laparoscopic/robotic SCS+HIPEC. In all cases complete debulking was achieved. As HIPEC treatment, 9 women received Cisplatin at 75 mg/m(2), and the remaining patient Oxaliplatin 460 mg/m(2). In 7 patients SCS was performed through the laparoscopic route, and in 3 case with a robotic approach. The median operative time from skin incision to the end of cytoreductive surgery was 122 minutes (95-140), estimated blood loss was 50cc (50-100), and the median length of hospital stay 4 days (3-7). The interval from surgery to adjuvant chemotherapy was 21 days (19-32). No grade 3/4 surgical, metabolic, or hematologic complications occurred. In all cases post-operative FDG-PET/CT scan was negative, and after a median time of 10 months (6-37) from SCS+HIPEC no secondary recurrence were observed. Minimally invasive SCS+HIPEC can be safely performed in selected ovarian cancer patients with platinum sensitive isolated relapse.
    Gynecologic Oncology 12/2013; · 3.93 Impact Factor
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    ABSTRACT: To compare the use of Thunderbeat (TB) with standard electrosurgery (SES), during laparoscopic radical hysterectomy and pelvic lymphadenectomy for gynecological tumors, with respect to operative time DESIGN: Evidence obtained from a properly designed, randomized, controlled trial. classification: Canadian Task Force classification I SETTING: Gynecologic Oncology Unit of the Catholic University of the Sacred Heart in Rome PATIENTS: Fifty patients with early stage cervical cancer (FIGO stages IA2-IB1-IIA<2cm), locally advanced cervical cancer (FIGO stages IB2-IIA>2cm-IIB) submitted to neo-adjuvant treatment (chemotherapy or radio-chemotherapy) showing a complete/partial clinical response and early stage endometrioid endometrial (FIGO stages IB-II) were randomly assigned to undergo TB (arm A) and SES (arm B) INTERVENTION: Laparoscopic radical hysterectomies with bilateral pelvic lymphadenectomy, with an easily reproducible technique were performed. Fifty patients were available for the analysis, with 25 women randomly assigned to TB (arm A) and 25 to SES (arm B). The median operative time was 85 min vs. 115 min for TB and SES, respectively (p=0.001). At multivariate analysis, endometrial cancer (p=0.0001) and TB (p=0.001) were independently associated with less operating time. No differences in terms of peri-operative outcomes and post-operative complications were observed in both arms. Patients undergoing TB reported less post-operative pain, both at rest and after Valsalva' maneuver (p=0.005 and p=0.008, respectively), with less additional analgesics beside standard therapy than in arm B (p=0.02) CONCLUSION: TB is associated with shorter operative time and less post-operative pain than standard technique (SES) in patients with uterine cancer.
    Journal of Minimally Invasive Gynecology 12/2013; · 1.61 Impact Factor
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    ABSTRACT: To describe the feasibility, safety and outcomes of women with stage I cervical cancer treated with laparoendoscopic single-site surgery radical hysterectomy (LESS-RH). A retrospective descriptive study (III). Multiple academic teaching hospitals. Women with FIGO stage IA1-IB1 cervical cancer. LESS-RH as primary therapy for cervical cancer performed by a gynecologic oncologist with expertise in LESS. A multichannel, single-port access device, a flexible-tipped 5-mm laparoscope, and a multifunctional instrument were used in all cases. Clincopathologic, surgical and perioperative outcomes were analyzed. Twenty-two women were identified in whom a LESS-RH was attempted; 20 (91%) successfully underwent the procedure, including 19 wherein pelvic lymphadenectomy (PLND) was completed. Of the two converted procedures, one patient underwent two-port laparoscopy secondary to truncal obesity and one patient underwent conversion to laparotomy secondary to external iliac vein laceration during PLND. Median age and BMI were 46 years and 23.3 kg/m2, respectively. Median number of pelvic lymph nodes removed was 22. One patient experienced an intraoperative complication, and no patient required reoperation. Margins of excision were negative. One patient with two positive pelvic nodes and one patient with microscopic parametrial disease received adjuvant chemosensitized radiation; 3 additional patients received adjuvant radiation therapy secondary to an intermediate risk for recurrence. After a median follow up of 11 months, no recurrences were detected. LESS-RH/PLND is feasible and safe for select patients with stage I cervical cancer. Larger studies are needed to confirm whether the increased technical difficulty of this procedure justifies its use in routine gynecologic oncology practice.
    Journal of Minimally Invasive Gynecology 10/2013; · 1.61 Impact Factor
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    ABSTRACT: To analyze the preliminary experience of three gynecologic oncology services with minilaparoscopic radical hysterectomy (mLRH) for the treatment of cervical cancer and to compare perioperative outcomes with those of conventional laparoscopic surgery (LRH). Prospectively collected data on consecutive cervical cancer patients undergoing radical hysterectomy with a laparoscopic approach were analyzed retrospectively. Perioperative outcomes of women undergoing mLRH were compared to data from control patients who had undergone LRH with 5-mm instruments. Adjustment for potential selection bias in surgical approach was made with propensity score (PS) matching. The study cohort consisted of 257 patients, 35 undergoing mLRH and 222 undergoing LRH. The two groups were comparable in terms of demographic and tumor characteristics. No significant differences were observed between groups in terms of operative time, blood loss, lymph node yield, amount of parametrial or vaginal cuff tissue removed, and percentage of intra- or postoperative complications, both in the entire cohort and in the PS matched group. No conversions were needed from mLRH to standard laparoscopy or from minilaparoscopy to open surgery. Conversion from standard laparoscopy to open surgery was necessary in 2 patients. A shorter hospital stay was observed among women who had mLRH than in those undergoing LRH [2 (1-10) vs 4 (1-14) days, p = 0.005]. This difference remained significant after PS matching. Our preliminary study suggests that in experienced hands minilaparoscopy is a feasible and safe technique for radical hysterectomy and yields results that are equivalent to those of LRH.
    European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 08/2013; · 2.56 Impact Factor
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    ABSTRACT: To evaluate the prognostic impact of routinely use of staging laparoscopy (S-LPS) in patients with primary advanced epithelial ovarian cancer (AEOC) METHODS: All women were submitted to S-LPS before receiving primary debulking surgery (PDS) or neoadjuvant treatment (NACT). The surgical and survival outcome were evaluated by univariate and multivariate analysis. Among 300 consecutive patients submitted to S-LPS no complications related to the surgical procedure were registered. The laparoscopic evaluation showed that almost half of the patients (46.3%) had an high tumor load. One-hundred forty-eight (49.3%) women were considered suitable for PDS and the remaining 152 (50.7%) were submitted to NACT. The percentages of complete (residual tumor, RT=0) and optimal (RT<1cm) cytoreduction of PDS and interval debulking surgery (IDS) were 62.1% and 57.5%, 22.5% and 27.7%, respectively, p=0.07). The post-operative complications of NACT/IDS group were lower than PDS group (p=0.01). The median progression free survival in women with RT=0 at PDS was 25months (95% CI, 15.1 - 34.8), which was statistically significant longer than in all other patients, irrespective of the type of treatment they received (p=0.0001). At multivariate analysis, residual disease (p =0.011) and performance status (p=0.016) maintained an independent association with the PFS. Including S-LPS in a tertiary referral center for the management AEOC does not appear to have a negative impact in terms of survival and it may be helpful to individualize the treatment avoiding unnecessary laparotomies and surgical complications.
    Gynecologic Oncology 08/2013; · 3.93 Impact Factor
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    ABSTRACT: To provide an overview of the available evidence on the role of the different methods in laparoscopic training, and to summarize the results obtained with standardized training programmes in advanced laparoscopic gynaecological surgery. Box trainers as well as virtual reality simulators ensure a benefit in terms of surgical skills development. No data are available showing superiority of one method compared to another. Global Operative Assessment of Laparoscopic Skills (GOALS) remains the most widely used and established scoring system to assess the acquired laparoscopic abilities, also in the field of advanced gynaecological surgery. Standardized training programmes have been recognized as reliable tools able to improve the development of surgical skills, particularly for innovative surgical techniques, such as laparoscopic endoscopic single-site surgery. The traditional approach based on observing and assisting needs to be updated incorporating box trainers and virtual reality simulators. The development of innovative training methods, integrating box trainers and virtual reality simulators, represents the future horizon. All tertiary centres involved in advanced laparoscopic gynaecological surgery should contribute to the development of an integrated network of standardized training programmes, in order to ensure a high-quality laparoscopic training to gynaecologists.
    Current opinion in obstetrics & gynecology 08/2013; 25(4):327-31. · 2.49 Impact Factor
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    ABSTRACT: To prospectively evaluate the accuracy of laparoscopy performed in satellite centres (SCs) to describe intra-abdominal diffusion of advanced ovarian cancer (AOC). Patients with a clinical/radiological suspicion of AOC were included in the protocol. SCs were selected among those surgeons spending a short intensive training period at the Coordinator Center (CC), to learn application of of Staging Laparoscopy (S-LPS) in AOC. All women underwent S-LPS at the SCs and the surgical procedure was recorded and blindly reviewed at the CC. Calculating specificity, positive and negative predictive values and accuracy for each parameter with respect to the CC assessed the diagnostic performance of S-LPS. The Cohen's Kappa was used to test the inter-observer agreement of each parameter. One-hundred sixty-eight cases were considered eligible for the study. A "per protocol analysis" was performed on 120 cases. The worst laparoscopic assessable feature was mesenteric retraction, whereas the remaining variables ranged from 99.2% (peritoneal carcinomatosis) to 90% (bowel infiltration). All but one SCs (SC# 4) reached an accuracy rate ≥ 80% for both single parameters and overall score. The Cohen's K and the p value for overall Predicitive Index Value (PIV) were 0.685 and 0.01 respectively, but improved to 0.773 and 0.388 after removing the SC # 4 from the analysis. S-LPS allows an accurate and reliable assessment of intraperitoneal diffusion of disease in AOC patients in trained gynaecological oncology centers.
    American journal of obstetrics and gynecology 07/2013; · 3.28 Impact Factor
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    ABSTRACT: To compare the timing and pattern of recurrence in patients with advanced ovarian cancer (AOC) receiving primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). We retrospectively evaluated a consecutive series of 175 stage IIIC-IV epithelial ovarian cancer patients, with diffuse peritoneal carcinomatosis documented at initial surgical exploration. Forty patients received complete PDS, and the remaining 135 were treated with NACT followed by IDS with absent residual tumor after surgery. No differences were observed in the distribution of clinical pathological characteristics at the time of diagnosis between the two groups. The median follow-up was 31 months (range 9-150 months). We observed 20 (50.0 %) recurrences in the PDS group compared to 103 (76.3 %) in the IDS group (p = 0.001). Duration of primary platinum-free interval (PFI) was shorter in IDS compared to PDS group (13 vs. 21 months, respectively; p = 0.014). A significantly higher percentage of patients in the IDS group experienced platinum-resistant recurrences (35.9 vs. 5.0 %; p = 0.006) and carcinomatosis at the time of relapse (57.3 vs. 20.0 %; p = 0.0021). Finally, in women with platinum-sensitive recurrence, we observed a shorter secondary PFI in the IDS compared to PDS group (p = 0.006). We documented a better behavior of recurrent disease in AOC patients with diffuse peritoneal carcinomatosis treated with complete PDS compared to women submitted to NACT followed by IDS with no residual tumor after surgery.
    Annals of Surgical Oncology 07/2013; · 4.12 Impact Factor

Publication Stats

1k Citations
477.11 Total Impact Points


  • 1991–2014
    • Università degli Studi di Perugia
      • Department of Cellular and Environmental Biology
      Perugia, Umbria, Italy
  • 2013
    • University of Insubria
      Varese, Lombardy, Italy
  • 1999–2013
    • Catholic University of the Sacred Heart
      • School of Obstetrics and Gynecology
      Roma, Latium, Italy
  • 2012
    • Università Degli Studi Roma Tre
      Roma, Latium, Italy
  • 1995–2012
    • The Catholic University of America
      Washington, Washington, D.C., United States
  • 2009
    • Ospedale Sacro Cuore di Gesù
      Benevento, Campania, Italy
  • 2006
    • Gynecologic Oncology Group
      Buffalo, New York, United States
  • 2001
    • Jackson Memorial Hospital
      Miami, Florida, United States