A Fagotti's research while affiliated with Charles University in Prague and other places

Publications (181)

Conference Paper
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Objective Fertility-sparing treatment (FST) has become a treatment option in patients with early stage cervical cancer. This study collected multi-institutional real-world data on treatment and oncological outcome. Methods Patients with cervical cancer (18-40 years) with stages ≥IA1+LVSI who underwent any type of fertility-sparing procedure were in...
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Background: The benefits of minimally invasive surgery are well known in gynaecology. Robotic-assisted surgery has gained widespread acceptance within the surgical community and seems to be the most rapidly developing sector of minimally invasive surgery. Objectives: This video shows the salient steps of total hysterectomy with new robotic techn...
Conference Paper
Objectives Neoadjuvant chemotherapy and interval debulking surgery are widely offered in advanced ovarian cancer patients; the number of NACT cycles to be given is still an issue. Our aim was to compare survival outcomes of patients with advanced ovarian cancer treated with <4 or more NACT cycles. Methods A cohort of patients with stage III-IV epi...
Conference Paper
Introduction Despite the advances in cytoreductive efforts and frontline chemotherapy in advanced ovarian cancer (OC), recurrence is a common event, with >70% of women experiencing relapse within two years of from diagnosis. The standard treatment for recurrent ovarian cancer (ROC) patients has been traditionally represented by systemic chemotherap...
Conference Paper
Introduction This film shows the surgical management of a young BRCA1 mutated women affected by a recurrence of serous endometrial carcinoma (SEC). This aggressive subtype of endometrial cancer recurs in 30–80% of cases and shares most of its molecular features with serous ovarian cancer. The role of BRCA mutations in this setting is still not comp...
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Introduction Ovarian cancer (OC) represent nearly 4% of gynecologic malignancies and it is often diagnosed at advanced stage. Diaphragmatic surgery, a fundamental step of advanced stage ovarian cancer (ASOC) debulking surgery, is associated with a high post-operative complication incidence, which is supposedly reduced with thoracostomy tube placeme...
Conference Paper
Objectives Currently, no clear guidance defining the ideal candidate for minimally invasive interval debulking surgery (MI-IDS) exists. This study aimed to identify predictive factors of minimally invasive approach feasibility in advanced ovarian cancer (AOC) patients who were candidates to IDS after neoadjuvant chemotherapy (NACT). Methods This w...
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Introduction/Background* Pelvic exenteration performed for recurrent cervical cancer has been associated to urological short- and long-term morbidity, due to altered vascularization of tissues for previous radiotherapy. The aim of the present video is to demonstrate the use of intravenous indocyanine green (ICG) to assess vascularity of Bicker ilea...
Conference Paper
Introduction/Background* Investigate the immunohistochemical (IHC) expression of biological markers as potential prognostic/therapeutic factors in vulvar squamous cell carcinoma (VSCC). Methodology A series of 101 patients surgically treated at our Center from 2016 to 2020 were retrospectively enrolled: 53 node negative (Group A) and 48 node posit...
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Introduction/Background* European Society of Gynaecological Oncology (ESGO) and partners are committed to improving the quality of training for gynecological oncology fellows. The aim of this survey was to take a real-life picture of the type and level of the training in cervical cancer surgery, and to investigate whether LACC-trial changes may hav...
Conference Paper
Introduction/Background* Sentinel node biopsy (SNB) is the standard of care for vulvar cancer patients clinically N0 (cN0) at preoperative assessment, with unifocal primary tumor, < 4 cm, not previously excised nor subjected to neoadjuvant treatment. The cN0 patients unsuitable for these strict criteria currently undergo to radical lymphadenectomy,...
Conference Paper
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Introduction/Background* According to current guidelines fertility-sparing treatment (FST) in cervical cancer patients should follow the same principles as in patients without fertility preservation. The literature from the last years, however, show a trend towards less-radical procedures. Although oncological outcomes are reported to be equal or b...
Conference Paper
Introduction/Background* Ovarian cancer is the third most frequent gynecological cancer. In early stage ovarian cancer (ESOC) comprehensive surgical staging is recommended.Surgical staging is traditionally approached by laparotomy, although minimally invasive surgery can be a valid alternative in selected patients. This study aims to analyze the su...
Conference Paper
Introduction/Background* Isolated lymph node recurrence (ILNR) in selected platinum-sensitive recurrent ovarian cancer (psROC) patients is a very infrequent event (12% to 37%) and represent a less aggressive and indolent pattern of ROC. ILNR best treatment is represented by secondary cytoreductive surgery (SCS) with laparotomic or laparoscopic appr...
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Introduction/Background* The purpose of this paper is to analyze data related to infections of patients suffering from gynecological malignancies, particularly after surgical procedures. Furthermore, we performed an economic analysis to provide an overview of HAIs-related costs. Methodology We retrospectively collected data of the culture samples,...
Conference Paper
Introduction/Background* The combination of emerging target therapies and continuous technological advancement in surgical procedures support a trend toward a prolonged survival in advanced ovarian cancer (AOC) patients. Upper abdominal carcinomatosis hides challenging locations for complete gross resection in the hands of expert gynecologic oncolo...
Conference Paper
Introduction/Background* The benefit of surgery and maintenance treatment with parp inhibitors (PARPi) has been recently shown in ovarian cancer (OC) recurrence. Also, the efficacy and safety of stereotactic body radiotherapy (SBRT) is demonstrated in patients with metastatic, persistent, and recurrent OC. The management of oligometastatic progress...
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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...
Conference Paper
Introduction/Background* To investigate the association between the presence of BRCA1/2 mutations and the chemotherapy response score (CRS) in patients with advanced stage high-grade serous ovarian cancer (HGSOC) undergoing neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS). Methodology We retrospectively collected patients with...
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Introduction/Background* The aim of cytoreduction in advanced ovarian cancer is complete removal of gross disease. Retroperitoneal approach is crucial in radical surgery for advanced ovarian cancer. Hudson-Delle Piane is a radical procedure which allows en-bloc removal of uterus, ovaries, pouch of Douglas peritoneum, recto-sigmoid with a retrograde...
Conference Paper
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Indocyanine green to assess vascularity of ileal conduit anastomosis during pelvic exenteration for recurrent/persistent gynecological cancer: a pilot study. Introduction/Background* Pelvic exenteration performed for recurrent/persistent gynecological malignancies has been associated to urological short- and long-term morbidity, due to altered vas...
Conference Paper
Introduction/Background* Despite the advances in cytoreductive efforts and frontline chemotherapy in advanced ovarian cancer (OC), recurrence is a common event, with >70% of women experiencing relapse within two years of from diagnosis. The standard treatment for recurrent ovarian cancer (ROC) patients has been traditionally represented by systemic...
Conference Paper
Introduction/Background* Mutations in BRCA-genes have been identified as predisposing to hereditary breast and ovarian cancers. Little is known about how ovarian cancer risks differs across different BRCA mutation type. The purpose of our study is to identify the correlation between specific type of BRCA mutations and (1) age of onset of high-grade...
Conference Paper
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...
Conference Paper
Introduction/Background* Vulvar cancer (VC) is a lymphotropic disease. The preferred lymphatic pathway involves the inguinofemoral lymph nodes (IFLNs), followed by the pelvic lymph nodes (PLNs). In selected cases, surgical approach to PLNs may be the first choice when histologic confirmation is required for suspicious involvement on imaging or when...
Conference Paper
Introduction/Background* Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust and comprehensive model allowing for individualised surveillance strategy based on risk profile of early-stage cervical cancer patients that were referred...
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Objective This study aimed to evaluate the safety and efficacy of a specified nutritional planning after a pancreatic fistula (PF) diagnosis (1). Methods and procedures Patients with clinical or laboratory diagnosis of PF after cytoreductive surgery (CRS) for ovarian cancer at the Fondazione Policlinico “A. Gemelli” – IRCCS in Rome, were enrolled...
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Objective Neoadjuvant chemotherapy and interval debulking surgery are now widely offered in ovarian cancer patients unsuitable for surgery; the number of preoperative NACT cycles to be given is still an issue. Our aim was to compare survival outcomes of patients with advanced ovarian cancer treated with ≤4 or more NACT cycles. Methods A cohort of...
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Objectives: Fusion imaging is an emerging technique that can fuse real time ultrasound examination with other imaging modalities such as computed tomography (CT), magnetic resonance, and positron emission tomography. The primary aim of the study was to evaluate the Fusion imaging feasibility in patients with advanced ovarian cancer. The secondary...
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Background: The aims of the present study were to assess bilateral sentinel lymph node (SLN) mapping with laparoscopic versus robotic approach, to assess variables affecting bilateral detection rates and to assess survival difference in patients with no/unilateral, compared to bilateral SLN detection. Methods: This is a retrospective, single-cen...
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Ovarian cancer is the most lethal of all gynecologic cancers.1 Primary debulking surgery (PDS) with achievement of no residual tumor (RT, 0) still is the recommended treatment, and the one with the greatest prognostic impact.2,3 Given the usual disease spread, several surgical procedures often are needed, and one of the most frequent is rectosigmoi...
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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...
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Introduction Ovarian cancer (OC) development in BRCA-heterozygotes is due to somatic inactivation of the remaining BRCA-allele. For patients with a long history of systemic treatment, secondary tumor mutations are described in the literature, leading to a possible change in the response to the therapy. The objective of our study was to assess wheth...
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Department of Gynecologic Oncology, ARNAS Ospedali Civico Di Cristina Benfratelli, University of Palermo, Italy Introduction The aim of this study was to assess the prognostic role and the peri-operative outcomes of conization performed before radical hysterectomy in early-stage cervical carcinoma. Methods Multi-center retrospective observational...
Conference Paper
Introduction No consensus has yet been reached on the best strategy for treatment of cervical cancer local recurrence. Vaginectomy could be a salvage treatment in selected patients. Methods The records of vaginal recurrent cervical cancer patients admitted at Fondazione Policlinico ‘Agostino Gemelli’ IRCCS in Rome from January 2010 to June 2019 we...
Conference Paper
Objectives To evaluate feasibility and performance of a radiogenomics model based on ovarian US images predicting germline BRCA1/2 gene status. Methods This retrospective study included 255 patients who were addressed to germline BRCA1/2 testing and pelvic US documenting normal ovaries. Four imaging feature groups were extracted from each normaliz...
Conference Paper
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...
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Introduction ²Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, ItalyComplete disease removal during cytoreductive surgery for AEOC is the main prognostic factor for both PDS and IDS. While a unanimous consensus exists on the RT=0 during PDS, the same is not true for IDS. Many surgeons do not consi...
Conference Paper
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Introduction Neoadjuvant chemotherapy (NACT) and subsequent interval debulking surgery (IDS) has been proposed as an alternative to primary debulking surgery in advanced epithelial ovarian carcinoma. However, no biomarkers of NACT efficacy are reliable in predicting chemo response. This study aimed to identify pre-operative factors of IDS success p...
Conference Paper
Introduction Sentinel lymph node (SLN) mapping with indocyanine green (ICG) is widely utilized in the staging process for apparent uterine-confined endometrial cancer. The aims of the present study were to assess bilateral SLN mapping with laparoscopic versus robotic approach, to assess variables affecting bilateral detection rate and to assess sur...
Conference Paper
Introduction Tumor-free distance (TFD), defined as the minimum distance of uninvolved stroma between the tumor and peri-cervical stromal ring, was recently proposed as predictive marker of recurrence in patients with early-stage cervical cancer treated by primary surgery (particularly if ≤3.5 mm). The aims of the present study were to assess the pr...
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Introduction The therapeutic role of pelvic and para-aortic lymphadenectomy in surgical staging of apparent early-stage epithelial ovarian cancer (aeEOC) is still unclear. Recently, ESGO-ESMO consensus established that re-staging lymphadenectomy is not recommended if patients are already due to receive adjuvant chemotherapy for high-risk eEOC. The...
Conference Paper
Introduction The standard treatment for epithelial early stage ovarian cancer (eEOC) patients includes laparotomic surgical staging, according to FIGO classification. In the last decade, many investigators have assessed the safety, adequacy and feasibility of minimally invasive surgery (MIS) staging of eEOC in properly selected patients, but surviv...
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Objective The aim of this study was to investigate the correlation between BRCA mutational status and response to bevacizumab in a large advanced ovarian cancer (AOC) series. Methods This is a multicenter, retrospective case-control study including upfront AOC treated between January 2015 and June 2019. The main inclusion criteria were: having rec...
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Background. Ovarian cancer (OC) is the most lethal gyne-cological malignancy in developed countries. Beyond surgery , the backbone treatment of advanced OC is platinum-based chemotherapy. The traditional treatments can be improved by the addition of new target therapies and the breast-related cancer antigens (BRCA) genes represents a potential ther...
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A majority of BRCA1/2 (BRCA) pathogenic variants (PVs) are single nucleotide substitutions or small insertions/deletions. Copy number variations (CNVs), also known as large genomic rearrangements (LGRs), have been identified in BRCA genes. LGRs detection is a mandatory analysis in hereditary breast and ovarian cancer families, if no predisposing PV...
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A majority of BRCA1/2 (BRCA) pathogenic variants (PVs) are single nucleotide substitutions or small insertions/deletions. Copy number variations (CNVs), also known as large genomic rearrangements (LGRs), have been identified in BRCA genes. LGRs detection is a mandatory analysis in hereditary breast and ovarian cancer families, if no predisposing PV...
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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...
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Objective: This study is aimed to analyze the clinical outcome of recurrent ovarian cancer patients bearing isolated lymph-node recurrence (ILNR) who underwent salvage lymphadenectomy (SL). The prognostic role of clinicopathological variables and the mutational status of BRCA1/2 have also been investigated. Methods: This retrospective, single-in...
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Objectives: To compare survival outcomes and peri-operative complications in patients with advanced ovarian cancer with 1-10 mm residual disease (RD) at primary debulking surgery (PDS) versus those achieving no gross residual disease (NGR) at interval debulking surgery (IDS). Methods: Patients operated with the intent of complete cytoreduction f...
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Objective: To analyze all published studies comparing minimally invasive surgery (MIS) with laparotomic one in the surgical treatment of high-risk endometrial cancer (EC) in term of operative, peri-operative and oncological outcomes. Data sources: We conducted a systematic literature search in PubMed between January 1995-March 2019. Methods of...
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Background: The aim of this study was to assess the agreement rate between intraoperative evaluation (IOE) and final diagnosis (FD) in a series of surgically resected endometrial carcinoma (EC), with a preoperative ambiguous or inconclusive diagnosis by endometrial biopsies and imaging. Methods: A retrospective study was performed selecting pati...
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Introduction/Background: Minimally invasive surgery (MIS) was adopted as an alternative to laparotomy for radical hysterectomy in patients with early-stage cervical cancer before obtaining solid evidence regarding its effect on survival. We studied what was the outcome of patients that underwent Radical hysterectomy for stage IB1 cervical cancer, d...
Conference Paper
Introduction/Background The aim of the surgical treatment of advanced ovarian cancer is to completely remove all macroscopic disease.To achieve optimal cytoreduction, the use of extensive upper abdominal surgery has become widely accepted.Although the disease doesn’t usually invade the splenic parenchyma, the capsule may commonly be infiltrated. Th...
Conference Paper
Introduction/Background Although the non-inferiority in overall survival (OS) of neoadjuvant chemotherapy (NACT) compared to primary debulking surgery (PDS) has been prospectively demonstrated, complete cytoreduction remains the most powerful determinants of survival among patients with stage III–IV epithelial ovarian carcinoma. In this setting, ou...
Conference Paper
Introduction/Background Several retrospective studies suggested that secondary cytoreductive surgery (SCS) could provide improved clinical outcomes in patients with recurrent ovarian cancer (ROC). The goals of this study were 1) to evaluate the prognostic role of clinico-pathological variables conditioning the post-salvage lymphadenectomy progressi...
Conference Paper
Introduction/Background Ultrasound-guided biopsy is an easy-available technique for obtaining tissue samples, rarely used in suspicious advanced ovarian cancer, in order to plan an early and adequate treatment. Methodology Primary endpoints of the study were feasibility, safety and diagnostic accuracy of TA/TV ultrasound guided biopsy with respect...
Conference Paper
Introduction/Background The present study investigated the role of this novel plasma energy device in gynecological malignancies in the context of a modern personalized approach delivered by a tertiary care referral center. The indication was the resection/ablation of peritoneal and/or serosal carcinomatosis, either in laparotomy or in laparoscopy....
Conference Paper
Introduction/Background Cytoreductive surgery for recurrent abdominal endometrial cancer is typically performed with laparotomy approach. Furthermore, thoracic procedures are usually performed with a thoracotomy approach. Recently, the uni-portal video-assisted thoracoscopic surgery (VATS) has been proposed as the new evolution of VATS, with even l...
Conference Paper
Introduction/Background The number of women diagnosed with ovarian masses during pregnancy has increased in recent years and the management of these women is controversial. Methodology To describe the diagnostic-accuracy of US in the differential diagnosis ovarian masses diagnosed during pregnancy. This is a retrospective single center study, appr...
Conference Paper
Introduction/Background The role of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer (ROC) is controversial after results of randomized trials. The aim of this study is to evaluate SCS in ROC patients with BRCA ½ (BRCAmut) who received platinum-based chemotherapy followed by olaparib maintenance. Methodology This is a case-control...
Conference Paper
Introduction/Background Among all gynaecological neoplasms, ovarian cancer has the highest rate of disease-related malnutrition, representing an important risk factor of postoperative mortality and morbidity. Hence, the importance of finding effective nutritional interventions is crucial to improveovarian cancer patient‘s well-being and survival....
Conference Paper
Introduction/Background Two randomized controlled trials on the role of secondary cytoreductive surgery in platinum-sensitive Recurrent Ovarian Cancer (ROC) patients have shown contrasting results in terms of PFS and OS. Even more debated is the role of surgery in the tertiary setting. This study aims to investigate the current literature on tertia...
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Purpose: Neoadjuvant chemotherapy followed by surgery (NACT + S) has been compared with definitive chemoradiothherapy (CRT) in randomized clinical trials (RCTs) in stage IB2, IIA and IIB cervical cancer (1994 Figo stage). Our aim was to evaluate efficacy and toxicity of NACT + S and CRT and identify differences in clinical outcomes and severe toxi...
Conference Paper
Introduction/Background The OVHIPEC-1 phase III randomized trial has shown a statistically significant improvement in terms of Progression Free and Overall Survival in patients with advanced ovarian cancer, submitted to neoadjuvant chemotherapy (NACT), and receiving HIPEC at time of Interval Debulking Surgery (IDS). Methodology After the publicati...
Conference Paper
Introduction/Background The therapeutic role of systematic pelvic and para-aortic lymphadenectomy in surgical staging of apparent early-stage epithelial ovarian cancer (aeEOC) is still unclear. Recently, ESGO-ESMO consensus conference established that re-staging lymphadenectomy is not recommended if patients are due to receive adjuvant chemotherapy...
Conference Paper
Introduction/Background Evidence in literature supports the accuracy of sentinel lymph node (SLN) in early-stage cervical cancer. SLN is usually analyzed through ultra-staging examination, which cannot be performed intraoperatively as it is too cumbersome and time-consuming. One-step nucleic acid amplification (OSNA) is a rapid assay able to detect...
Conference Paper
Introduction/Background To describe accurately the oncological outcomes after hepatic resection (HR) in recurrent ovarian carcinoma (ROC) evaluating clinic-pathological variables and mutational status of BRCA1/2. Although HR is considered a challenging situation in ROC patients, assessment of BRCA1/2 mutational status seems to have a relevant clini...
Conference Paper
Introduction/Background The benefit of surgical staging with laparoscopy remains controversial and the prognostic significance of peritoneal involvement in locally advanced cervical cancer (LACC) patients has still to be demonstrated. Peritoneal involvement upstages cervical cancer to FIGO stage IVB, which can benefit from addition of bevacizumab t...
Conference Paper
Introduction/Background Study aim was to determine whether sepsis organ failure assessment (SOFA) score is a useful diagnostic tool in patients with an underlying gynecologic malignancy and if other parameters could be used as bloodstream infection predictors. Methodology Between July 2016 and December 2017, 68 patients accessing the Emergency War...
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Objective: The role of secondary cytoreductive surgery (SCS) in platinum-sensitive recurrent ovarian cancer (PSROC) is still controversial. We investigated the role of SCS in PSROC patients with BRCA1/2 mutation (BRCAmut) who received platinum-based chemotherapy followed by olaparib maintenance. Methods: This is a case-control study. Patients wi...
Conference Paper
Objectives Bevacizumab maintenance following platinum-based chemotherapy is an effective treatment for epithelial ovarian cancer (EOC), both in primary and recurrent disease. Our aim was to identify criteria to select elderly patients who can safely benefit from bevacizumab addition. Methods This is a case-control study on patients with primary or...
Conference Paper
Objectives To evaluate the correlation between sarcopenia and operative/peri-operative outcomes in patients receiving primary debulking surgery (PDS) for newly-diagnosed advanced epithelial ovarian cancer (AEOC). Methods All consecutive patiens affected by AEOC and submitted to PDS in our Institution were considered eligible. Total skeletal muscle...
Conference Paper
Objectives To evaluate the adequacy, safety and diagnostic accuracy of transvaginal ultrasound-guided biopsy. Methods This is a retrospective study including patients with suspicious pelvic advanced tumors, primary (excluding cervical and vaginal cancer) or recurrent disease, or uncertain lesions who underwent transvaginal ultrasound guided biopsy...
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Background Robotic platforms have recently acquired progressive importance in different surgical fields, such as urology, gynecology, and general surgery. Through the years, new surgical robots have become available as single-port robotic platform. The study is aimed to value the single-port robotic platform characteristics in different surgical sp...