Marta Caretto

• Doctor of Medicine
• Medical Doctor at University of Pisa

Introduction The tumor microenvironment (TME) plays an essential role in promoting cancer initiation, progression and metastasis. Cancer-associated fibroblasts (CAFs) are a major constituent of the TME, but universal CAFs’ markers have not yet been identified. We selected several new biomarkers [p16 and α-smooth muscle actin (α-SMA)] to investigate...

Endometriosis is a common estrogen-dependent inflammatory disease with a chronic course and a tendency to recur. The association between endometriosis and cancer has been studied for several years. Numerous reports have demonstrated a strong association between specific ovarian malignancies and endometriotic lesions. Atypical endometriosis has been...

Objective Missing occult para-aortic lymph node metastasis is one of the primary concerns of sentinel lymph node biopsy in endometrial cancer. Our study aimed to evaluate the relationship between intrauterine cancer site and isolated para-aortic lymph node metastasis to tailor treatment and reduce the false negative rate of the sentinel lymph node...

Introduction and hypothesis Lateral suspension is an abdominal prosthetic surgical procedure used to correct apical prolapse. The procedure involves the placement of a T-shaped mesh on the anterior vaginal wall and on the isthmus or uterine cervix that is suspended laterally and posteriorly to the abdominal wall. Since its description in the late 9...

Cancer is an important cause of morbidity and mortality worldwide. At the time of diagnosis, a significant proportion of young women experience unique treatment and survivorship issues centering on treatment-related amenorrhea, including fertility preservation and management of ovarian function as endocrine therapy. Chemotherapy-induced amenorrhea...

Uterine fibroids (also referred to as leiomyomas or myomas) represent the most common pelvic neoplasm in women. Incidence is difficult to determine since there are few longitudinal studies. They are noncancerous monoclonal tumors arising from the smooth muscle cells and fibroblasts of the myometrium. The pathogenesis of leiomyomas is not well under...

Objective: The present study aimed to assess long-term follow-up outcomes in women with in situ/microinvasive adenocarcinoma (AC) of the uterine cervix treated conservatively. Methods: Retrospective multi-institutional study including women with early glandular lesions and 5-year follow-up undergoing fertility-sparing treatment. Independent vari...

Simple Summary The rate of concurrent endometrial cancer (EC) in women with atypical endometrial hyperplasia (AEH) is not negligible. Furthermore, among women with EC, about 12% may have a high-risk disease requiring lymph node status assessment. Given that endometrial sampling cannot exclude EC in women with AEH, knowing variables that increase th...

BACKGROUND: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during th...

Robotic surgery has reached a very high level of advancement, in particular, Da Vinci Xi robotic system allows the execution of surgical tasks of the highest precision. It offers advantages in terms of reduced blood loss, reduced postoperative hospital stay, and less postoperative pain. The disadvantage the surgeon has found is progressive tactile...

Simple Summary The impact of human papillomavirus (HPV) status on cervical glandular lesions is a debated topic. In general, non-HPV-related adenocarcinomas would appear to have a worse prognosis. Assessing this question in early stage or in situ adenocarcinomas may be interesting, as conservative surgery is feasible in these cases. Moreover, this...

Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published i...

Exposure to environmental stressors during pregnancy plays an important role in influencing subsequent susceptibility to certain chronic diseases through the modulation of epigenetic mechanisms, including DNA methylation. Our aim was to explore the connections between environmental exposures during gestation with DNA methylation of placental cells,...

Cancer is an important cause of morbidity and mortality worldwide. At the time of diagnosis, a significant proportion of young patients are concerned about the possible impact of anticancer treatments on their fertility and future chances of conception.Chemotherapy-induced amenorrhea (CIA) is a well-known toxicity after chemotherapy in young cancer...

Background Robotic surgery has gained popularity for the reconstruction of pelvic floor defects. Nonetheless, there is no evidence that robot-assisted reconstructive surgery is either appropriate or superior to standard laparoscopy for the performance of pelvic floor reconstructive procedures or that it is sustainable. The aim of this project was t...

Fertility-sparing surgery (FSS) for women with early stage, low-risk gynecologic cancers can allow patients to have spontaneous or assisted pregnancies without compromising oncologic outcomes. However, candidate patients for these procedures must be carefully selected. The clinical medical ethics framework of nonmaleficence, beneficence, autonomy,...

Healthy women carrying pathogenic germline mutations in BRCA1 or BRCA2 genes have an increased risk of breast and ovarian cancer. Prophylactic gynecological surgery includes risk-reducing bilateral salpingo-oophorectomy, which, in selected cases, can be combined with hysterectomy. Prophylactic gynecological surgery is recommended after completion o...

Background/aim: The aim of the study was to correlate the expression of mismatch repairs proteins (MMR), programmed-death-ligand1 (PDL-1), and estro-progestinic receptors (ER/PgR) in tissue samples from a series of cervical adenocarcinoma (ADC) patients with their clinicopathological features. Materials and methods: Thirty-nine ADC specimens wer...

Background/aim: The majority of patients with endometrial cancer (EC) are diagnosed at an early stage and undergo primary surgery, followed by observation or adjuvant therapy according to risk factors on surgical samples. The objective of this study was to assess the correlation between a risk profile represented by the presence of substantial lym...

Background The aim of this study is to evaluate the initial feasibility, safety, and outcomes of hysterectomy performed by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) at three institutions in Italy.Materials and methodsAll women who underwent vNOTES hysterectomy ± salpingo-oophorectomy for benign indications at three terti...

Depressive disorders and anxiety states represent one of the most frequent psychiatric pathologies occurring transiently in vulnerable women throughout their life, from puberty to menopause. It is now known that sex hormones play a key role on the nervous system, interfering with neuronal plasticity and enhancing the processes of learning, memory,...

Introduction/Background Women carrying a mutation in BRCA 1 or BRCA 2 genes face complex decisions regarding strategies for managing their increased breast and gynecologic cancer risk. Prophylactic mastectomy in high genetic risk of female cancers could severely affect body esteem decreasing sexual satisfaction. Risk-reducing bilateral salpingo-oop...

Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score

Background To evaluate the impact of the Laparoscopic Approach to Cervical Cancer (LACC) Trial on patterns of care and surgery-related morbidity in early-stage cervical cancer. Methods This is a retrospective, a multi-institutional study evaluating 90-day surgery-related outcomes of patients undergoing treatment for early-stage cervical cancer bef...

Introduction and hypothesisSeveral technical alternatives to repair mesh using laparoscopic sacrocolpopexy exist. We aim to describe the outcomes and surgical technique of robotic-assisted colpo-/cervicosacropexy using a standardized suturing scheme to repair the mesh.Methods We retrospectively reported data of 60 consecutive cases of robotic-assis...

Objective: Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of CO...

There is little evidence around the potentially protective role of previous Bacillus Calmette-Guerin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 vaccination. Prior BCG vaccination did not protect SARS-CoV-2 infected patients against postoperative pulmonary complications and 30-day mortality.

The definition of health given by the World Health Organization is that “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Being a man or a woman has a significant impact on health, as a result of both biological and gender-related differences.

Obesity and its related severe consequences have been a major public health problem worldwide. A significant weight gain and intra-abdominal adipose tissue accumulation are observed as women begin the menopausal transition. Nowadays, the change of body weight during menopausal transition represents an important topic of discussion. A number of clin...

Menopause is the permanent cessation of menstrual cycles following the loss of ovarian follicular activity. Quality of life of postmenopausal woman is the result of a series of psychobiological transformations, that see in the reduction of sex hormones and steroids the etiopathogenetic determinant moment. Symptoms of menopause range from somatic si...

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.

Introduction/Background* The effect of BRCA mutational status on biological feature and survival outcome in advanced-stage (IIB-IV stage) High-grade serous ovarian cancer (HGSOC) seems to confer a better prognosis. The aim of our preliminary work is to investigated the stromal p16 expression for HGSOC in advanced-stage (IIB-IV stage), using immunoh...

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...

To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the...

The management of pelvic organ disorders is common and challenging work. Nowadays, midlife women are more active than they were in the past, and the development of pelvic organ prolapse (POP) disrupts quality of life and impairs social and personal activities. The aging process and hormonal changes have a role in influencing the structure and funct...

Objective evaluation of technical skills of the operators during the obstetrical device application for operative vaginal delivery, named kiwi-cup in a simulation training program. Methods Thirty-five residents in obstetrics and gynecology of the University of Pisa, Italy were recruited and evaluated with an assessment scale on technical skills fr...

Introduction: The prevalence of urinary incontinence and of other lower urinary tract symptoms increases after the menopause and affects between 38 % and 55 % of women aged over 60 years. While urinary incontinence has a profound impact on quality of life, few affected women seek care. Aim: The aim of this clinical guide is to provide an evidenc...

Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause (GSM) and has been shown to prevent bone loss and fracture. The risks of HT differ depending on type, dose, combination, duration of use, route of administration, and timing of initiation. Treatment should be individual...

Menopause is associated with a rapid increase in fat mass and a redistribution of body fat from the periphery to the abdomen, resulting in a transition from a gynoid to an android pattern of fat distribution. In postmenopausal women, increase in body mass index and proportion of visceral fat are strongly correlated with the development of hypertens...

Objective: We assessed the effect on lower urinary tract symptoms (LUTS) of a supplement containing cranberry, D-mannose and anti-inflammatory molecules in postmenopausal women undergoing surgery for cystocele. Study design: Forty postmenopausal women were randomized 1:1 to an active group receiving the nutritional supplement twice a day for 2 week...

Background: Simulation in laparoscopic surgery is nowadays recognized as a valid instrument for learning and training surgeons in different procedures. However, its role as evaluation test and self-assessment tool to verify basic surgical skills is still under discussion. Methods: Thirty-three residents in obstetrics and gynecology at University...

Insomnia, vasomotor symptoms (VMS) and depression often co-occur after the menopause, with consequent health problems and reductions in quality of life. The aim of this position statement is to provide evidence-based advice on the management of postmenopausal sleep disorders derived from a systematic review of the literature. The latter yielded res...

Starting from birth, sex hormonal fluctuations mark the various phases of female life leading from puberty to menopause.

Sleep disorders increase in prevalence during the menopausal transition and they constitute a complex phenomenon. Insomnia, the main sleep disorder, can be a primary disorder or it can be secondary to hot flushes (HF), mood disorders, psychosocial factors, medical conditions, and other sleep disturbances, such as obstructive sleep apnoea (OSA) or r...

During menopausal transition, the ovaries are depleted of follicles, oestradiol and inhibin B production falls, and ovulation and menstruation no longer occur. The loss of ovarian sensitivity to follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and the loss of negative feedback of oestradiol and inhibin B on the hypothalamic–pituitary...

The steroidogenic endocrine glands and local synthesis both contribute to the pool of steroids present in the central nervous system and peripheral nervous system. The available clinical and experimental findings support the critical role of neurosteroids during fertile life and reproductive aging and their relationship with endogenous and exogenou...

Uterine fibromatosis is common in women, with an estimated prevalence of up to 15–50% after 35 years. About 80% of women affected by fibromatosis have symptoms and require medical or surgical treatment. Nowadays, the gold standard for the surgical treatment of uterine fibromatosis is the use of minimally invasive surgery. The surgical skills and im...

ß-endorphin is a neuropeptide involved in several brain functions: its plasma levels are higher in obese women and its release increases after oral glucose tolerance test (OGTT) in normal or obese women. The study included 46 healthy women and evaluated the effect of oral dehydroepiandrosterone [DHEA] (50 mg/day) in early postmenopausal women (50–5...

Introduction: Umbilical cord milking is a procedure in which clamped or unclamped umbilical cord is grasped, and blood is pushed ("stripped") two to four times towards the newborn, in a rapid time frame, usually within 20 seconds. The target of umbilical cord milking is to provide infants with their whole potential blood volume-of which they are d...

Pelvic floor dysfunctions are a complex condition in elderly women; pelvic organ prolapse, urinary or fecal incontinence, constipation, pelvic pain, and sexual dysfunction are common problems. The goal of surgical treatment is functional reconstruction with symptom management and repair of anatomic defects. The recent advancements in surgical treat...

Menopause-related symptoms such as hot flushes, night sweats, weight gain, and decreased sexual functioning all have negative impacts on quality of life and affect daily activities such as sleep, work, and leisure activities. During the menopause transition, neurotransmitters, neuropeptides, and neurosteroids undergo important changes as a conseque...

The decline in the reproductive capacity of women in the late fourth to fifth decade of life is accompanied by diverse sequelae, including vasomotor symptoms, an increased risk of osteoporosis, psychogenic disturbance and cardiovascular and cerebrovascular disease. Attempts to ameliorate losses in oestrogen through hormone replacement therapy (HRT)...

Background The learning process of physiological mechanisms of childbirth and its management are important elements in the education of medical students. In this study, we verify how the use of a high-fidelity simulator of childbirth improves competence of students in this regard. Methods A total of 132 medical students were recruited for the stud...

The dehydroepiandrosterone and its metabolite, dehydroepiandrosterone sulfate, have been for a long while at the center of interest for endocrinologists and cardiologists. Consolidated data show that the dehydroepiandrosterone and the dehydroepiandrosterone sulfate present protective actions on the cardiovascular system. These actions are accomplis...

Urinary tract infections (UTIs) are the most common bacterial infections in women, and increase in incidence after the menopause. It is important to uncover underlying abnormalities or modifiable risk factors. Several risk factors for recurrent UTIs have been identified, including the frequency of sexual intercourse, spermicide use and abnormal pel...

A top-down/bottom-up integrated proteomic approach based on LC-MS and 2-DE analysis was applied for comparative characterization of medulloblastoma and pilocytic astrocytoma posterior cranial fossa pediatric brain tumor tissues. Although rare, primary brain tumors are the most frequent solid tumors in the pediatric age. Among them the medulloblasto...