Emanuele Perrone

Policlinico Universitario Agostino Gemelli · Department of Obstetrics and Gynecology

Purpose: The aim of this study is to evaluate the impact of the oestrogen receptor (ER) profile on oncologic outcomes in the new endometrial cancer (EC) risk classification. Methods: Immunohistochemistry (IHC) analyses were performed in a retrospectively reviewed large series of ECs to assess the presence/absence of oestrogen receptors (ER0\1+ o...

This review provides a comprehensive update on recent evidence regarding gynecologic tumors associated with Lynch Syndrome (LS). Endometrial cancer (EC) and ovarian cancer (OC) are the first and second most common gynecologic malignancies in developed countries, respectively, and LS is estimated to be the hereditary cause in 3% of both EC and OC. D...

Objective The primary endpoint of this study was to compare the disease-free survival of patients undergoing open versus minimally invasive pelvic exenteration. The secondary endpoints were cancer-specific survival and peri-operative morbidity. Methods A multi-center, retrospective, observational cohort study was undertaken. Patients undergoing cu...

Abstract Background High-grade serous ovarian cancer (HGSOC) has poor survival rates due to a combination of diagnosis at advanced stage and disease recurrence as a result of chemotherapy resistance. In BRCA1 (Breast Cancer gene 1) - or BRCA2-wild type (BRCAwt) HGSOC patients, resistance and progressive disease occur earlier and more often than in...

Introduction/Background The role of sentinel lymph node mapping in patients with complex atypical hyperplasia (CAH) is a debated topic in literature and needs to be clarified.The aim of this study was to describe the surgical outcomes, intra-postoperative complications of patients with CAH undergoing a radical surgical staging with or without senti...

Introduction/Background The primary endpoint of the present study was to compare the disease-free survival (DFS) of patients undergoing open versus minimally invasive pelvic exenteration (PE). Secondary endpoints cancer-specific survival (CSS) and peri-operative morbidity. Methodology Multi-center, retrospective, observational cohort study. Patien...

Introduction/Background Several studies have explored the prognostic role of hormone receptor status in high grade serous ovarian cancer (HGSOC). However, few reports have investigated their expression according to BRCA mutational status. Notably, there is evidences of a strong interaction between BRCA1/2 proteins and steroid hormones system, inclu...

Introduction/Background The primary endpoint of the present study was to assess the role of systemic inflammatory and molecular markers on DFS in patients with apparent early-stage endometrial cancer. Methodology Retrospective, single-center, observational study. Patients with apparent endometrial cancer undergoing primary surgery between 06/2013–...

Introduction/Background Approximately 40% of complex atypical hyperplasia (CAH) are finally upstaged to invasive endometrial carcinoma (EC).The aim of this study was to identify pre-operative variables that can predict the presence of concomitant EC at final histopathological analysis, so as to identify a population at increased risk of EC and to h...

Introduction/Background The estrogens receptor (ER) expression in endometrial cancer (EC) is known to be associated with prognosis. However, its role was not included in the latest molecular risk classification system. The aim of this study is to assess the impact of ER profile on oncological outcomes in the new EC risk classification. Methodology...

Several studies have explored the prognostic role of hormone receptor status in high-grade serous ovarian cancer (HGSOC) patients. However, few reports have investigated their expression according to BRCA mutational status. The aim of this single-center, observational, retrospective study was to explore the hormone receptor pattern and its potentia...

Introduction The aim of this study is to assess the clinical reproducibility and the potential oncological validity of the molecular information provided by the immunohistochemistry (IHC) to properly stratify the endometrial cancer patients. Methods Retrospective IHC analyses were conducted in a large series of 778 pre-operative uterine-confined E...

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 201...

Objectives The aim of this study is to assess the clinical reproducibility and the oncological validity of the Endometrial cancer (EC) risk stratification based on the molecular information given by the immunohistochemistry (IHC). Methods Retrospective IHC analyses were conducted in a large series of 778 pre-operative uterine-confined ECs, studyin...

Minimally-invasive pelvic exenteration: a survival analysis. Introduction/Background* Pelvic exenteration for recurrent and persistent gynecological malignancies is traditionally performed with open approach (OA). Nevertheless, reports on the use of minimally-invasive surgical (MIS) approach to pelvic exenteration have been published with promisin...

Introduction/Background* Nowadays, after the recent insights about the molecular Endometrial cancer (EC) classification, the usual key histological parameters (i.e histotype and grade) have been shown to have poor reproducibility and adequacy in EC stratification risk. The need to define a more precise guidance of surgical and adjuvant approaches h...

Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This internati...

Objective This prospective randomized trial aimed to assess the impact of the uterine manipulator in terms of lymph vascular space invasion (LVSI) in patients undergoing minimally invasive staging for early-stage endometrial cancer. Methods In this multicentric randomized trial, enrolled patients were randomly allocated in two groups according to...

Objective: The aim of this study is to analyze and draw the potential differences between the robotic-assisted surgery (RS) and the laparoscopy (LPS) in endometrial cancer staging. Methods: In this single-institution retrospective study we enrolled 1,221 consecutive clinical stage I-III endometrial cancer patients undergone minimally invasive su...

Background Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. Methods This international cohort study included adult patients undergoing elective surge...

Background The role of the intrauterine manipulator in minimally invasive hysterectomy for endometrial cancer has been widely debated in terms of impact on the oncological outcomes. To date, definitive conclusions on the possible advantages and oncological safety of its use in endometrial cancer staging are still awaited. Objectives This randomize...

Introduction Minimally invasive surgery (MIS) is the gold standard for endometrial cancer staging. Among MIS approaches, laparoscopy (LPS) and robotic surgery (RS) are the major techniques. The aim of this study is to compare these two approaches in endometrial cancer staging. Methods In this large single-institution retrospective study we enrolle...

Objectives Lymph-vascular space invasion (LVSI) is associated with an increased risk of recurrence. Usually, the interpretation of LVSI is just qualitative, as presence or absence. The aim of this study is to examine the quantitative analysis of LVSI. Methods Retrospective multicentre study. It included 2300 consecutive patients who received a his...

Objective: To evaluate the feasibility of percutaneous approach, we prospectively compared our experience in percutaneous-assisted hysterectomy (PSS-H) with that in a series of laparoscopic hysterectomies (LPS-Hs). Methods: In this multicentric cohort study, from May 2015 to October 2017, 160 patients affected by benign and malignant gynecologic...

To assess the feasibility and the safety of the ultra-minimally invasive (U-MIS) approaches in gynecology, we compared our experience in percutaneous assisted hysterectomy (PSS-H) with a series of 3 mm mini-laparoscopy hysterectomy (m-LPS-H). 126 patients affected by benign and malignant gynecological conditions were considered eligible for minimal...

Background: Treatment of obese female patients represents a real challenge. Indeed, obesity among women has reached epidemic levels not only elevating the cardiovascular and endocrinological risks, but also increasing the incidence of various gynecological pathologies (e.g. endometrial cancer and hyperplasia, uterine fibroids, genital prolapse) wh...

Background: Epithelial ovarian cancer (EOC) is the most lethal gynecologic malignancy. Sacituzumab govitecan (SG) is a novel antibody-drug-conjugate (ADC) targeting trophoblast-antigen-2 (Trop-2), a cell surface glycoprotein highly expressed in many epithelial tumors, to deliver SN-38, the active metabolite of irinotecan. This study aimed to evalua...

Background: Uterine and ovarian carcinosarcomas (CS) are rare cancers with poor prognosis. Sacituzumab-govitecan (SG) is a new class of antibody-drug-conjugate (ADC) targeting the human-trophoblast-cell-surface marker (Trop-2) conjugated with the active metabolite of irinotecan (SN-38). We evaluated the efficacy of SG against biologically aggressi...

Human trophoblast cell-surface marker (Trop-2) is a surface glycoprotein originally identified in human placental tissue and subsequently found to be highly expressed by various types of human epithelial solid tumors. We investigated the efficacy of sacituzumab govitecan, an antibody-drug conjugate (ADC) comprised of a humanized anti- Trop-2 antibo...

Endometrial cancer is the most common gynecologic malignancy in developed countries. The antibody‐drug‐conjugate (ADC) Sacituzumab govitecan (SG) targets trophoblast‐antigen‐2 (Trop‐2) — a cell surface glycoprotein highly expressed in many epithelial tumors — and delivers the active metabolite of irinotecan SN‐38 to Trop‐2‐positive tumor cells. We...

Objective: Uterine serous carcinoma (USC) is an aggressive variant of endometrial cancer with poor prognosis. Sacituzumab govitecan (SG) is a novel antibody-drug-conjugate (ADC) targeting trophoblast cell-surface antigen 2 (Trop-2), a transmembrane-calcium-signal-transducer, to deliver SN-38, the active metabolite of irinotecan. The objective of t...

Study Objective To evaluate the feasibility of percutaneous approach, we prospectively compared our percutaneous hysterectomy (PPS-H) experience with a series of laparoscopic hysterectomies (LPS-H). Design Multicentric comparative prospective study. Setting Fondazione Policlinico Universitario A. Gemelli IRCCS, in Rome, a tertiary health-care cen...

Significance The development of novel, effective treatments for patients with advanced/recurrent cervical cancer remains an unmet medical need. Using whole-exome sequencing, we identified multiple genes with recurrent alterations in cervical cancer, including the ERBB2/PI3K/AKT/mTOR, apoptosis, chromatin remodeling, and cell cycle pathways. Using f...

Objectives Epithelial ovarian cancer (EOC) is the most lethal gynecologic malignancy. Sacituzumab govitecan (SG) is a novel antibody-drug-conjugate (ADC) targeting trophoblast-antigen-2 (Trop-2), a cell surface glycoprotein highly expressed in many epithelial tumors, to deliver SN-38, the active metabolite of irinotecan. This study aimed to evaluat...

Objectives Carcinosarcomas (CS) are highly aggressive gynecologic malignancies containing both carcinomatous and sarcomatous elements. Sacituzumab govitecan (SG) is a novel antibody-drug conjugate (ADC) targeting trophoblast antigen 2 (Trop-2), a cell surface glycoprotein highly expressed in many epithelial tumors, to deliver SN-38, the active meta...

Objectives: Cervical cancer (CC) remains a major health problem worldwide. Poly (adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibitors (PARPi) have emerged as a promising class of chemotherapeutics in ovarian cancer. We explored the preclinical in vitro and in vivo activity of olaparib against multiple primary whole exome sequenced (WES...

Objective: Uterine serous carcinoma (USC) is an aggressive variant of endometrial cancer with poor prognosis. Sacituzumab govitecan (IMMU-132) is a novel antibody-drug conjugate (ADC) targeting trophoblast antigen 2 (Trop-2), a cell surface glycoprotein highly expressed in many epithelial tumors including USC, to deliver SN-38, the active metabolit...

e17028 Background: Recurrent disseminated cervical cancer is a discouraging clinical entity with 1-year survival rates between 10-15%, and development of novel, effective treatments remains an unmet medical need. We investigated the preclinical efficacy of IMMU-132 (sacituzumab govitecan), an antibody-drug conjugate (ADC) comprised of a humanized a...

Objective The effect of the different types of vaginal cuff closures on post-hysterectomy sexual function has not been investigated in depth. We evaluated if there is a difference between transvaginal vs. a laparoscopic closure after total laparoscopic hysterectomy (TLH) on female sexual function, using a validated questionnaire. Design Secondary...

Objective: Aberrant expression of HER2/neu and PIK3CA gene products secondary to amplification/mutations are common in high-grade-serous-endometrial (USC) and ovarian-cancers (HGSOC). Because scant information is currently available in the literature on the potential negative effect of PIK3CA mutations on the activity of afatinib, in this study we...

Objective To investigate the safety, feasibility and oncological adequacy of the Percutaneous Surgical System - PSS in a consecutive series of low-risk endometrial cancer staging. Study Design From May 2015 to April 2017, we prospectively performed 30 consecutive percutaneous staging for low/intermediate risk endometrial cancer (FIGO stage IA G1-G...

This video article demonstrates an inguino-abdominal combined approach for laterally extended pelvic resection, a major surgical procedure for locally advanced primary or recurrent gynecological cancer infiltrating the pelvic sidewall, for which palliative therapy is the only alternative.1 After local institutional review board approval (protocol...

Study objective: The video article describes a laparoscopic anterior pelvic exenteration with radical vaginectomy using the 3-dimensional (3D) vision and multifunction instruments. Methods: This is a step-by-step video presentation of the laparoscopic anterior pelvic exenteration (Canadian Task Force classification III). Although the therapeutic...

This pilot study was aimed to value the feasibility and safety of Senhance Robotic Platform for hysterectomy in obese patients. Ten obese patients (30 < BMI < 40) underwent elective Senhance total extrafascial hysterectomy with bilateral salpingo-oophorectomy at the Division of Gynecologic Oncology of "Policlinico A. Gemelli" Foundation, Rome, Ital...

Objectives: Video endoscopy inguinal lymphadenectomy (VEIL) has emerged as the new frontier for the surgical staging of vulvar cancer (VC) [1, 2]. In this surgical film we show a step-by-step video presentation of a Robotic SLNmapping using ICG (Canadian Task Force classification III). Although the therapeutic benefit of SLN remains controversial...

Background: Vaginal cuff dehiscence following hysterectomy is considered an infrequent but potentially devastating complication. Different possible techniques for cuff closure have been proposed to reduce this threatening adverse event. Objective: Aim of the present randomized study has been to compare laparoscopic and transvaginal suture of the...

Cesarean scar defect (CSD), also known as isthmocele or niche, is the result of incomplete healing of isthmic myometrium after a low transverse uterine incision performed for cesarean section. The prevalence of symptomatic or clinically relevant CSD reported in literature ranges from 19% to 84% and in few cases may be also associated with secondary...

Study objective: To further investigate the psycho-oncologic effect of minimally invasive surgery comparing patients submitted to minimally invasive interval debulking surgery (MI-IDS) with a balanced population treated by standard laparotomy (L-IDS). Design: Single-institution propensity-matched study (Canadian Task Force classification II-2)....

Background Sentinel Lymphonode analysis has become a barely new and innovative way to treat early stages of endometrial cancer (Ballester et al., Lancet Oncol 469–476, 2011; Buda et al., Ann Surg Oncol 2975-81, 2016). Indocyanine green cervical injection is considered gold standard for mapping nodes’ drainage. Blue dye is used as a valid alternativ...

Objectives During the last decade endoscopic surgical procedures have been constantly evolving. The latest innovation in ultra-minimally invasive surgery (MIS) is the percutaneous technology (Percuvance™ Percutaneous Surgical System (PSS), Teleflex Inc., USA). We compared surgical outcome of hysterectomy, in a retrospective cohort study using the m...

Objective: The aim of the study was to evaluate the prognostic value of human epididymis protein 4 (HE4) and cancer antigen 125 markers with pathological prognostic factor to complete the preoperative clinical panel and help the treatment planning. Methods: This prospective multicenter study was conducted in 2 gynecologic oncology centers betwee...

Study objective: to investigate safeness and technical feasibility of needleoscopic fertility sparing staging of borderline ovarian tumor Design: video article and review of the literature SETTING: The patient was a 29 years old women affected by right ovarian cyst suspected for BOT at preoperative MRI and US due to the presence of a right unilocu...

Study objective: In this study we had compared feasibility, and safety, of TELELAP ALF-X system and standard laparoscopy for total hysterectomy for benign and early malignant gynecological disease. Design: Single-institutional retrospective case-control study (Canadian Task Force classification II-2) SETTING: Catholic University of the Sacred He...

Fetal malformations are very frequent in industrialized countries. Although advanced maternal age may affect pregnancy outcome adversely, 80%-90% of fetal malformations occur in the absence of a specific risk factor for parents. The only effective approach for prenatal screening is currently represented by an ultrasound scan. However, ultrasound me...

Cervical cancer remains the leading cause of death by gynecologic cancer worldwide, comprising 15% of all cancers in women younger than 40 years. Standard treatments of invasive cancer in early stages are radical hysterectomy and pelvic radiotherapy, both of which are almost reliable by minimal invasive surgery, so as traditional laparoscopy and ro...

Recently, we have shown advantages of a direct optical entry (DOE) using a bladeless trocar in comparison with the open Hasson technique (OHT) in older reproductive-age women with previous operations, as well as in comparison with Veress needle entry in reproductive-age and postmenopausal women. A prospective multicenter randomized study to determi...

Abstract Authors evaluated the outcome of intracapsular cesarean myomectomy by a prospective case-control study on 68 patients who underwent intracapsular cesarean myomectomy, compared with a control group of 72 patients with myomatosic pregnant uterus who underwent cesarean section without myomectomy. Mostly of removed myomas were subserous or int...

Labor progression is routinely assessed through transvaginal digital inspections, meaning that the clinical decisions taken during the most delicate phase of pregnancy are subjective and scarcely supported by technological devices. In response to such inadequacies, we combined intrapartum echographic acquisitions with advanced tracking algorithms...