Anna Fagotti

Università degli Studi di Perugia, Perugia, Umbria, Italy

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Publications (187)624.51 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Nowadays, laparoscopy acquired an increasing role in the management of ovarian cancer. Laparoscopic cytoreduction could represent a new frontier for selected patients after neoadjuvant chemotherapy. Objective: To assess feasibility and early complication's rate of Minimally Invasive Interval Debulking Surgery (MI-IDS) in stage III-IV EOC patients after neoadjuvant chemotherapy STUDY DESIGN: This is a Phase II multicentric study in Advanced Epithelial Ovarian Cancer women with clinical complete response after neoadjuvant chemotherapy, according to GCIG and RECIST criteria. The IRB approval was obtained and all patients signed a written informed consent to be included in the protocol. The study was registered in the with the number NCT02324595 and was named MISSION trial. For patients meeting inclusion criteria, surgical procedures started with diagnostic laparoscopy in order to confirm preoperative findings and assess surgical complexity. MI-IDS included hysterectomy, bilateral salpingo-oophorectomy, appendectomy, omentectomy, peritonectomy and bowel resection. Pelvic and/or aortic lymphadenectomy were not considered as standard procedure in these cases. Intra- and post-operative outcomes, time to restart chemotherapy, survival rate and Quality of Life data were registered. Results: From December 2013 to February 2015, of 184 AEOC patients considered eligible for interval debulking surgery, 52 (28.2%) met inclusion criteria and were enrolled in the study. For twenty-two (12%) of them standard laparotomic approach was preferred because of intra-operatory surgeon's evaluation. Finally 30 (16.3%) patients received the planned treatment of MI-IDS. Median age was 61 years (39 - 81) and median BMI was 24 Kg/m2 (range 20-31). Median numbers of NACT cycles were 4 (range 3-7). Median operative time was 285 minutes (range 124-418) and median EBL was 100 ml (range 50-200). Surgical procedures included 28 (93.3%) hysterectomy and bilateral salpingo-oophorectomy, 29 (96.6%) omentectomy, 2 (6.6 %) appendectomy, 11 (36.6%) regional peritonectomy and 1 (3.4 %) bowel resection. A residual tumor of 0 was reached in 29 patients (96.6%) and 0,5 cm in only one case (3.4%). The vast majority of patients were discharged on post-operative day 2 (range 2 - 3). No early post-operative complications were registered. Median time to restart chemotherapy was 20 days (10 - 30) and all patients successfully completed the cycles. Histological findings showed 3 (10%) complete response, 9 (30%) microscopic residual disease and 18 (60%) evidence of macroscopic residual disease. With a median follow-up of 10.5 month, 5 peritoneal and 2 lymphnodal recurrences were observed. Psychometric test revealed a moderate discomfort in the vast majority of patients (66.7%). All patients still alive. Conclusions: Minimally Invasive-IDS in patients with clinical complete response to neoadjuvant chemotherapy seems to be feasible and safe in terms of perioperative outcomes, psycho-oncological impact and survival rate. The equivalence between MIS and laparotomy needs to be confirmed with a longer follow-up and a larger number of patients.
    American journal of obstetrics and gynecology 11/2015; DOI:10.1016/j.ajog.2015.10.922 · 4.70 Impact Factor
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    ABSTRACT: Study design: To compare the surgical and clinical outcomes of patients affected by early stage endometrial cancer treated using the TELELAP ALF-X platform versus conventional laparoscopic surgery. Design: Single-institutional retrospective cohort study (Canadian Task Force classification II-2). Setting: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy. Patients: The study involved 89 patients affected by early stage endometrial cancer who underwent elective surgical staging between October 2013 to September 2014. Among them, 43 underwent Telelap ALF-X staging (48.3%) (ALF-X group), and 46 underwent conventional laparoscopic staging (51.7%) (Laparoscopic group). Interventions: All selected patients underwent laparoscopic staging with radical hysterectomy (Class A sec Querleu-Morrow), bilateral salpingo-oophorectomy and pelvic lymphadenectomy, if required. Patients in which lymphadenectomy was not required were collected into a subgroup named Group 1; the patients who underwent a pelvic lymphadenectomy were included in Group 2 for each type of surgical approach. Measurements and main results: In Groups 1 and 2 of the ALF-X staging, the median operative times (OTs) were 128 min (range 69-260 min) and 193 min (range 129-290 min) respectively. In Groups 1 and 2 of the Laparoscopic staging, the median operative times (OTs) were 82 min (range 25-180 min) and 104 min (range 36-160 min), respectively. The difference between ALF-X OT and LPS OT was statistically significant for both group (p-value .000). In Group 1 of the ALF-X staging, one conversion to standard laparoscopy occurred (2.3%); instead in Group 2, 2 conversions to laparotomy (4.7%) occurred (p-value .234). No conversion to laparotomy was recorded in the Laparoscopic staging. The post-operative complications recorded included one pelvic hematoma (2.3%) in the ALF-X group (Group 1) and one subocclusion and one pulmonary edema (4.3%) in the Laparoscopic one (Group 1). Conclusion: Basing on operative outcomes and complication rates, our results suggest that the Telelap ALF-X approach is feasible and safe in endometrial cancer staging. However further studies are needed to definitively assess the role of Telelap ALF-X early stage endometrial cancer staging.
    Journal of Minimally Invasive Gynecology 11/2015; DOI:10.1016/j.jmig.2015.11.006 · 1.83 Impact Factor
  • V Gallotta · C Nero · C Callari · C Lodoli · F Fanfani · A Fagotti · G Scambia ·
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    ABSTRACT: Objective: We present a very rare case of focal metastasis of endometrial cancer to the small bowel entirely managed laparoscopically. Methods: A 58 year-old patient with a FIGO I B G2 N0 stage endometrial cancer was found to have a vaginal cuff recurrence and an isolated distant metastasis to the small bowel 13 months after primary treatment. In this video we show a fully laparoscopic management mainly focusing on the small bowel resection with intracorporal anastomosis. A laparoscopic partial colpectomy was also performed. Results: Operative time was 180 min. Intraoperative blood loss was less than 100 cc. The operation was performed successfully with no intra-operative complications. Pathological finding showed recurrent disease in the vaginal cuff and in the resected small bowel segment with free resection margins in both specimens and three mesenteric local nodes negative for metastasis. Patient was discharged on day three and 26 days later started adjuvant chemotherapy. After a 16 months follow-up period, the patient is still disease free and in good general conditions. Conclusion: This case shows a successful laparoscopic management of a case of recurrent endometrial cancer requiring complex surgical procedures.
    Journal of Minimally Invasive Gynecology 09/2015; DOI:10.1016/j.jmig.2015.09.012 · 1.83 Impact Factor
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    ABSTRACT: In human and wildlife populations, the natural microbiota plays an important role in health maintenance and the prevention of emerging infectious diseases. In amphibians, infectious diseases have been closely associated with population decline and extinction worldwide. Skin symbiont communities have been suggested as one of the factors driving the different susceptibilities of amphibians to diseases. The activity of the skin microbiota of amphibians against fungal pathogens, such as Batrachochytrium dendrobatidis, has been examined extensively, whereas its protective role towards the cutaneous infectious diseases caused by Amphibiocystidium parasites has not yet been elucidated in detail.In the present study, we investigated, for the first time, the cutaneous microbiota of the Italian stream frog (Rana italica) and characterized the microbial assemblages of frogs uninfected and infected by Amphibiocystidium using the Illumina next-generation sequencing of 16S rRNA gene fragments. A total of 629 different OTUs belonging to 16 different phyla were detected. Bacterial populations shared by all individuals represented only one fifth of all OTUs and were dominated by a small number of OTUs. Statistical analyses based on Bray-Curtis distances showed that uninfected and infected specimens had distinct cutaneous bacterial community structures. Phylotypes belonging to the genera Janthinobacterium, Pseudomonas, and Flavobacterium were more abundant, and sometimes almost exclusively present, in uninfected than in infected specimens. These bacterial populations, known to exhibit antifungal activity in amphibians, may also play a role in protection against cutaneous infectious diseases caused by Amphibiocystidium parasites.
    Microbes and Environments 09/2015; 30(3). DOI:10.1264/jsme2.ME15041 · 2.23 Impact Factor
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    ABSTRACT: we investigate the prognostic role of pre-treatment ratio between Type 1 (M1) and Type 2 (M2) tumor-associated macrophages (TAMs) in locally advanced cervical cancer (LACC) patients treated with chemoradiation (CT/RT). 84 consecutive LACC patients treated with cisplatin-based CT/RT for a total dose of 50.0 Gy, followed by radical surgery were analysed. Double-staining immunohistochemistry of CD163/p-STAT, CD68/pSTAT1, CD163/c-MAF, and CD68/c-MAF was performed on tumor samples taken at the time of diagnosis. TAMs with CD163+pSTAT1+, or CD68+pSTAT1+ were defined M1; CD163+c-MAF+ or CD68+c-MAF+ defined the M2 phenotype. The number of M1 and M2 cells was counted at low magnification by evaluating for each case the same tumour area. The ratio between M1 and M2 (M1/M2) was finally calculated. At diagnosis, we observed a direct correlation between the number of circulating monocytes and of TAMs (p-value = 0.001). Patients with high M1/M2 experienced more frequently complete pathologic response (no residual tumor) to CT/RT, compared to cases with low M1/M2 (55.0% Vs 29.5%; p-value = 0.029). At multivariate analysis M1/M2 (OR = 2.067; p-value = 0.037) emerged as independent predictor of pathologic response to CT/RT. Women with high M1/M2 showed a longer 5-yrs Disease-free (67.2% Vs. 44.3%; p-value = 0.019), and 5-yrs Overall (69.3% Vs. 46.9%; p-value = 0.037) survival, compared to cases with low M1/M2. The presence of a high M1/M2 ratio was independently associated with an unfavourable survival outcome in multivariate analysis. polarisation of TAMs toward a M2 phenotype, as reflected by a lower M1/M2 ratio, is an independent predictor of poor response to CT/RT, and shorter survival in LACC.
    PLoS ONE 09/2015; 10(9):e0136654. DOI:10.1371/journal.pone.0136654 · 3.23 Impact Factor
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    ABSTRACT: There have been a few studies on the negative effects of pollutants on amphibian skin, the first structural barrier that interacts with the environment and its potential contaminants. In this study an ex vivo skin organ culture from the amphibian Pelophylax bergeri was used to evaluate cell stress responses induced by short-term exposure to cadmium (Cd), a toxic heavy metal known to be an environmental hazard to both humans and wildlife. Histopathological studies were carried out on skin explants using light microscopy and changes in the expression of stress proteins, such as Metallothionein (MT) and Heat shock proteins (HSPs), were investigated by Real-time RT-PCR. Results revealed that amphibian skin reacts to Cd-induced stress by activating biological responses such as morphological alterations and dose- and time-dependent induction of Mt and Hsp70 mRNA expression, suggesting their potential role as biomarkers of exposure to Cd. This work provides a basis for a better understanding of the tissue-specific responses of amphibian skin as a target organ to Cd exposure and its in vitro use for testing potentially harmful substances present in the environment. Copyright © 2015 Elsevier Inc. All rights reserved.
    Ecotoxicology and Environmental Safety 08/2015; 122:EES15669. DOI:10.1016/j.ecoenv.2015.08.001 · 2.76 Impact Factor
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    ABSTRACT: To analyze the feasibility of total mesometrial resection by laparoscopy (L-TMMR) in a multicentric series of early stage cervical cancer. We prospectively evaluated a consecutive series of cervical cancer patients with pre-operative FIGO stage IA2- IB1 at the Catholic University in Rome and in Campobasso and the Charitè University in Berlin. All cases were assessed at pre-operative MRI scan and clinically confirmed by investigation under anesthesia, adhering strictly to the FIGO criteria. The surgical and post-surgical data were collected. 104 women with cervical cancer were admitted between July 2013 and August 2014 and among them 71 patients with pre-operative FIGO stage IA2-IB1 were treated with L-TMMR. One laparotomic conversion was registered. The median operative time was 260min (120 - 670min), estimated blood loss was 100cc (25-900cc), and the median length of hospital stay was 6days (2-26 days). We observed 8 intra-operative complications including a vascular injury of the left internal iliac vein that caused conversion, 6 vesical injuries and 1 uretheral injury managed laparoscopically. Two vescico-vaginal fistula and one hemoperitoenum were observed as major post-operative complications (4.2%). L-TMMR can be safely performed in selected cervical cancer patients. Further larger prospective trials are needed to evaluate the oncological outcome of patients undergoing this surgical procedure. Copyright © 2015. Published by Elsevier Inc.
    Gynecologic Oncology 07/2015; 139(1). DOI:10.1016/j.ygyno.2015.07.010 · 3.77 Impact Factor
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    ABSTRACT: To assess the learning curve associated with tele-assisted surgery. We performed a training box-based study, describing speed and accuracy in volunteers performing basic and complex laparoscopic tasks, to assess performance and in the skill acquisition of inexperienced users, using the Telelap Alf X system. Ten surgeons in gynaecology who had never received formal instruction on this new surgical device, completed four modules during a consecutive 3 day training programme. All the participants completed the training programme with a good learning curve. Use of the TELELAP Alf X advanced surgical robotic system is associated with a rapid learning curve among experienced surgeons. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    International Journal of Medical Robotics and Computer Assisted Surgery 06/2015; DOI:10.1002/rcs.1672 · 1.53 Impact Factor
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    ABSTRACT: The aim of this study was to compare the toxicity, perioperative outcomes of interval debulking surgery (IDS), and duration of progression-free survival (PFS) in women with unresectable high-grade serous advanced ovarian cancer (AOC) receiving neoadjuvant chemotherapy (NACT) with or without bevacizumab. Twenty-five patients with high-grade serous AOC treated with bevacizumab-based NACT (cases) were matched according to initial disease extension assessed by laparoscopy, and age, in a 1:2 ratio, with 50 high-grade serous AOC patients treated with standard NACT without bevacizumab (controls). Both groups received a median of four NACT cycles before IDS (p = 0.867), and the median time interval between NACT and IDS was 27 days in both groups (p = 0.547). Twenty-two cases (88.0 %) showed complete/partial radiologic response compared with 36 controls (72.3 %; p = 0.054). A higher percentage of cases showed complete serological response (48 vs. 35.1 %; p = 0.041). At IDS, complete cytoreduction was achieved in 20 cases (80.0 %) and 36 controls (72.3 %) [p = 0.260]. No differences were observed between groups in terms of surgical complexity score, perioperative outcomes, surgical complications, and chemotherapy-related adverse events. One death due to gastrointestinal perforation was observed among cases. Cases showed a longer median PFS compared with controls (18 months vs. 10 months; p = 0.001), and the administration of bevacizumab (hazard ratio 3.786; p = 0.001) retained a prognostic role for longer PFS at multivariate analysis. The incorporation of bevacizumab in NACT prolongs PFS without affecting the safety of IDS. The risk of gastrointestinal perforation should be considered prior to attempting bevacizumab-based NACT in women with diffuse bowel involvement at initial laparoscopic evaluation.
    Annals of Surgical Oncology 06/2015; DOI:10.1245/s10434-015-4651-8 · 3.93 Impact Factor
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    ABSTRACT: This prospective single-institutional clinical trial sought to assess the safety and feasibility of laparoscopic benign ovarian cyst enucleation with a novel robot-assisted laparoscopic system. In this study, we report a series of 10 cases treated using Telelap ALF-X in the first clinical application on patients at the Division of Gynaecologic Oncology, Catholic University of the Sacred Heart of Rome. The primary inclusion criterion was the presence of monolateral ovarian cyst without a preoperative assessment suspicious for malignancy. Intra-operative data such as docking time, operative time, estimated blood loss, intra and peri-operative complications, and conversion to either standard laparoscopy or laparotomy were collected. The cysts were removed using the ovary sparing technique with respect to conservative surgical principles. The median operative time was 46,3 min, and patients without post-operative complications were discharged either 1 or 2 days after the procedure. Telelap Alf-X laparoscopic enucleation of benign ovarian cysts with ovary sparing techniques is feasible, safe and effective. However, more clinical data are needed to assess whether this approach would offer any other benefits compared to other minimally invasive surgical techniques. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
    Journal of Minimally Invasive Gynecology 05/2015; 22(6). DOI:10.1016/j.jmig.2015.05.007 · 1.83 Impact Factor
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    ABSTRACT: Phase II study on total TELELAP ALF-X hysterectomy. safety, feasibility and perioperative outcomes analysis. Phase II study. Canadian Task Force II-2. Catholic University of the Sacred Heart, Rome, Italy. From October 2013 to May 2014, 80 women underwent total TELELAP ALF X hysterectomy. The study population was divided in two groups according to surgical procedures: total hysterectomy ± bilateral salpingo-oophorectomy (Group 1), and endometrial cancer patients staged also with pelvic lymphadenectomy (Group 2). Total TELELAP ALF-X hysterectomy ± bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy. Median age was 51 years (range 48-79), and median BMI was 24 kg/m2 (range 17.3 - 34.2). Forty-five patients (56.2%) had previous surgery. Median operative time was 140 minutes (range 58-320) in the Group 1 and 197 minutes (range 129-290) in the Group 2 (p < .001). Median docking time was 8 minutes (range 3-25). During the study period, a significant trend in the operative time reduction was observed. Procedures were successfully performed without conversion in 93.7% of cases. We observed 2 (2.5%) intraoperative complications, 3 (3.7%) conversions to standard laparoscopy and 2 (2.5%) to laparotomy. Median time to discharge was 2 days (range 1-5). One patient (1.2%) was readmitted the early post-operative period. As new technology evolves, critical appraisal of patient-related outcomes, utilization, cost, and access to minimally invasive hysterectomy must remain a priority. Despite the relative small number of our series, we showed the feasibility and safety of total TELELAP ALF-X hysterectomy for benig and malignant disease. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
    Journal of Minimally Invasive Gynecology 05/2015; 22(6). DOI:10.1016/j.jmig.2015.05.004 · 1.83 Impact Factor
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    ABSTRACT: Recurrence of disease represents a clinical challenge in cervical cancer patients, especially when all available treatment modalities have been used in the primary setting. The aim of this study was to analyse the patterns of recurrence and their association with clinical outcome in locally advanced cervical cancer (LACC) patients submitted to primary chemoradiation (CTRT) followed by radical surgery (RS). This study was conducted on 364 LACC patients treated with CTRT plus RS since January 1996 to July 2012. For each relapse, information on date of clinical/pathological recurrence, and pattern of disease presentation were retrieved. Post-relapse survival (PRS) was recorded from the date of recurrence to the date of death for disease or last seen. Survival probabilities were compared by the log rank test. Cox's regression model with stepwise variable selection was used for multivariate prognostic analysis for PRS. Within a median follow-up of 42 months, 75 recurrences (20.6%) and 54 disease-associated deaths (14.8%) were recorded. By analysing the pattern of relapse, most of the recurrences were outside the irradiated field (n=43, 57.3%) and the most frequently observed site was visceral (n=16, 21.3%). Among the parameters of the recurrence associated with PRS including the pattern of recurrence, the size of recurrence, SCC-Ag serum levels at recurrence, and secondary radical surgery, only the last one retained an independent predictive role in reducing the risk of death (p=0.037). The feasibility of secondary radical resection positively impacts on PRS of LACC patients submitted to multimodality primary treatments. Copyright © 2015. Published by Elsevier Inc.
    Gynecologic Oncology 05/2015; 138(1). DOI:10.1016/j.ygyno.2015.04.035 · 3.77 Impact Factor

  • Gynecologic Oncology 05/2015; 138:1-2. DOI:10.1016/j.ygyno.2015.04.017 · 3.77 Impact Factor
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    ABSTRACT: To compare prognosis of advanced epithelial ovarian cancer (AEOC) patients based on where the first surgical assessment was performed. Retrospective analysis of primary AEOC patients was performed and three groups were formed based on where the decision of primary treatment was taken: Internal, if the decision was carried out at our Institution (PDS (Primary Debulking Surgery), I-IDS (Internal-Interval Debulking Surgery)) and Referred in case women were referred after neoadjuvant chemotherapy (NACT) from other Centers (R-IDS (Referred-Interval Debulking Surgery)). Among 573 AEOC, 279 (48.7%) were PDS and 294 (51.3%) IDS. In particular, 134 of 294 (45.6%) were R-IDS and 160 (54.4%) were I-IDS. Median progression-free survival (PFS) was 26 months in PDS, 14 months in I-IDS and 17 months in R-IDS. The difference was statistically significant (p<0.05) among all groups. IDS can represent a suitable approach only when the first complete debulking is not achievable in a tertiary referral hospital. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
    Anticancer research 05/2015; 35(5):3027-32. · 1.83 Impact Factor
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    ABSTRACT: To evaluate the safety and feasibility of the new robotic TELELAP ALF-X platform in a heterogeneous series of gynecological procedures. Between September 2013 and May 2014, 146 patients were enrolled in this Phase II study trial. Patients with presumed benign or borderline adnexal disease, and benign and early stage malignant uterine disease were prospectively included. Median age was 52 years (range 19-79 years), and median BMI was 23.7 (range 17.3-34.0 kg/m(2)). Sixty-two patients (32.5 %) underwent mono/bilateral salpingo-oophorectomy or cyst removal (Group A), four patients (2.7 %) myomectomy (Group B), 46 patients (31.5 %) total hysterectomy (Group C), and 34 (23.3 %) endometrial cancer staging (Group D). Median docking time was 7 min (range 3-36). Median OT was 35 min (range 17-145) in the Group A, 40 min (range 10-50) in the Group B, 133 min (range 58-320) in the Group C, and 160 min (range 69-290) in the Group D. Reduction in OT over the study period for hysterectomy (p < 0.001) and adnexal surgery (p < 0.002) was observed. We registered two laparoscopic conversion (3.2 %) in the Group A and two (4.3 %) in the Group C. In the Group D, we showed one (2.9 %) laparoscopic and two (5.8 %) laparotomic conversions. One patient (2.17 %) in the Group C was readmitted in the early postoperative period for severe vaginal bleeding. We report the first series of a novel robotic approach for the treatment of various gynecological conditions. When performed by experienced minimally invasive surgeons, TELELAP ALF-X is feasible and safe. Further studies are mandatory to define the benefits, advantages, and costs of this new robotic approach with respect to others minimally invasive approaches.
    Surgical Endoscopy 04/2015; DOI:10.1007/s00464-015-4187-9 · 3.26 Impact Factor
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    ABSTRACT: To develop an updated laparoscopy-based model to predict incomplete cytoreduction (RT>0) in advanced epithelial ovarian cancer (AEOC), after the introduction of upper abdominal surgery (UAS). Patients and methods The presence of omental cake, peritoneal extensive carcinomatosis, diaphragmatic confluent carcinomatosis, bowel infiltration, stomach and/or spleen and/or lesser omentum infiltration, superficial liver metastases were evaluated by staging laparoscopy (S-LPS) in a consecutive series of 234 women with newly diagnosed AEOC, receiving laparotomic PDS after S-LPS. Parameters showing a specificity ≥75%, PPV ≥50%, and NPV≥50% received 1 point score, with an additional one point in presence of an accuracy ≥60% in predicting incomplete cytoreduction. The overall discriminating performance of the LPS-PI was finally estimated by ROC curve analysis. No-gross residual disease at PDS was achieved in 135 cases (57.5%). Among them, UAS was required in 72 cases (53.3%) for a total of 112 procedures, and around 25% of these patients received bowel resection, excluding recto-sigmoid resection. We observed a very high overall agreement between S-LPS and laparotomic findings, which ranged from 74.7% for omental cake to 94.8% for stomach infiltration. At a LPS-PIV≥10 the chance of achieving complete PDS was 0, and the risk of unnecessary laparotomy was 33.2%. Discriminating performance of LPS-PI was very high (AUC=0.885). S-LPS is confirmed as an accurate tool in the prediction of complete PDS in women with AEOC. The updated LPS-PI showed improved discriminating performance, with a lower rate of inappropriate laparotomic explorations at the established cut-off value of 10. Copyright © 2015. Published by Elsevier Inc.
    Gynecologic Oncology 04/2015; 137(1). DOI:10.1016/j.ygyno.2015.01.006 · 3.77 Impact Factor

  • Gynecologic Oncology 04/2015; 137:115. DOI:10.1016/j.ygyno.2015.01.285 · 3.77 Impact Factor

  • Gynecologic Oncology 04/2015; 137. DOI:10.1016/j.ygyno.2015.01.069 · 3.77 Impact Factor

  • Gynecologic Oncology 04/2015; 137:125. DOI:10.1016/j.ygyno.2015.01.312 · 3.77 Impact Factor

  • Gynecologic Oncology 04/2015; 137:133-134. DOI:10.1016/j.ygyno.2015.01.332 · 3.77 Impact Factor

Publication Stats

3k Citations
624.51 Total Impact Points


  • 1990-2015
    • Università degli Studi di Perugia
      • Department of Cellular and Environmental Biology
      Perugia, Umbria, Italy
  • 1999-2014
    • Catholic University of the Sacred Heart
      • • School of Obstetrics and Gynecology
      • • School of Oncology
      Milano, Lombardy, Italy
  • 2013
    • Columbus-Gemelli University Hospital
      Roma, Latium, Italy
  • 1997-2012
    • The Catholic University of America
      Washington, Washington, D.C., United States
  • 2011
    • Università Cattolica del Sacro Cuore
      Milano, Lombardy, Italy
  • 2006
    • Gynecologic Oncology Group
      Buffalo, New York, United States
  • 2001
    • Policlinico Universitario Agostino Gemelli
      Roma, Latium, Italy