Mattia Dominoni

Robotic single-site hysterectomy: two institutions' preliminary experience.

To evaluate the feasibility, safety and peri‐ and postoperative outcomes of robotic single‐site hysterectomy for gynaecological diseases.

Effectiveness of aromatase inhibitors in the treatment of advanced endometrial adenocarcinoma

PurposeType I endometrial cancer is a common tumor of the female genital tract. Since in post-menopausal women aromatase enzyme can stimulate the endometrial tissue neoplastic growth, the use of aromatase inhibitors may have a therapeutic effect, especially in patients not eligible for surgery.MethodsA systematic review has been performed, with a very specific scope, i.e., the use of aromatase inhibitors in the treatment of advanced or recurrent endometrial cancer, as a single agent or in combination with others drugs.ResultsOn the basis of the 117 records retrieved from the bibliographic search, the rationale for the use of aromatase inhibitors in endometrial cancer therapy is discussed. Six papers fall within the scope of our systematic review and their results are thoroughly analyzed. Moreover, we report our experience on the clinical effectiveness of anastrozole in the post-chemotherapy treatment of a patient affected by advanced-stage endometrial cancer.ConclusionIn general, aromatase inhibitors seem to have limited clinical benefit in the treatment of advanced and recurrent endometrial cancer, although further clinical trials are necessary to investigate more in depth their role. In our case, we experienced a positive feedback in terms of control of an advanced-stage disease.

Effect of local estrogen therapy (LET) on urinary and sexual symptoms in premenopausal women with interstitial cystitis/bladder pain syndrome (IC/BPS)

The association between vulvodynia and interstitial cystitis/bladder pain syndrome (IC/BPS), a chronic, debilitating disease of unknown etiology, may involve sex hormone-dependent mechanisms regulating vulvo-vaginal health. We aimed to prospectively investigate the effects of 12 weeks of local estrogen therapy (LET) on urinary/bladder and sexual symptoms in premenopausal women with IC/BPS. Thirty-four women (mean age: 36.1 ± 8.4) diagnosed with IC/BPS were treated vulvo-vaginally three-times/week with estriol 0.5 mg cream and tested by validated questionnaires (ICSI/ICPI, pain urgency frequency [PUF], female sexual function index [FSFI]) and by cotton swab testing, vaginal health index (VHI) and maturation index (MI) before and after treatment. Vulvodynia was present in 94.1% of IC/BPS women. A significant positive effect of LET was evident on urinary and sexual function (p < 0.001, for both) following 12 weeks, as well as an improvement of the VHI (p < 0.001) and the MI (p < 0.04). The results of this open study indicate that 12 weeks of local estriol cream at vaginal and vestibular level may ameliorate urinary/bladder pain symptoms, as well as may improve domains of sexual function. The association between vulvar pain and bladder pain could, therefore, be related to a vaginal environment carrying signs of hypoestrogenism, but further studies are needed to clarify this issue.Abstract The association between vulvodynia and interstitial cystitis/bladder pain syndrome (IC/BPS), a chronic, debilitating disease of unknown etiology, may involve sex hormone-dependent mechanisms regulating vulvo-vaginal health. We aimed to prospectively investigate the effects of 12 weeks of local estrogen therapy (LET) on urinary/bladder and sexual symptoms in premenopausal women with IC/BPS. Thirty-four women (mean age: 36.1 ± 8.4) diagnosed with IC/BPS were treated vulvo-vaginally three-times/week with estriol 0.5 mg cream and tested by validated questionnaires (ICSI/ICPI, pain urgency frequency [PUF], female sexual function index [FSFI]) and by cotton swab testing, vaginal health index (VHI) and maturation index (MI) before and after treatment. Vulvodynia was present in 94.1% of IC/BPS women. A significant positive effect of LET was evident on urinary and sexual function (p < 0.001, for both) following 12 weeks, as well as an improvement of the VHI (p < 0.001) and the MI (p < 0.04). The results of this open study indicate that 12 weeks of local estriol cream at vaginal and vestibular level may ameliorate urinary/bladder pain symptoms, as well as may improve domains of sexual function. The association between vulvar pain and bladder pain could, therefore, be related to a vaginal environment carrying signs of hypoestrogenism, but further studies are needed to clarify this issue.

Robotic Single-Site Surgery for Female-to-Male Transsexuals: Preliminary Experience

Hysterectomy with bilateral salpingo-oophorectomy is a part of gender reassignment surgery for the treatment of female-to-male transsexualism. Over the last years many efforts were made in order to reduce invasiveness of laparoscopic and robotic surgery such as the introduction of single-site approach. We report our preliminary experience on single-site robotic hysterectomy for cross-sex reassignment surgery. Our data suggest that single-site robotic hysterectomy is feasible and safe in female-to-male transsexualism with some benefits in terms of postoperative pain and aesthetic results.

The role of fulvestrant in endometrial cancer

ABSTRACT Introduction: Endometrial cancer is the most common malignancy of the female genital tract in industrialized countries. The traditional treatment of endometrial cancer is based on a surgical approach. In recent years, systemic endocrine therapy has demonstrated good efficacy in recurrent or metastatic setting, delaying progression, ameliorating quality of life and palliating symptoms. Areas covered: Phase I and II studies on selective estrogen receptor down-regulators used for the treatment of endometrial cancer treatment have been reviewed. The pharmacokinetic and pharmacodynamic features of selective receptor down-regulators have been also investigated. Expert opinion: Selective estrogen receptor down-regulators may exhibit clinical efficacy in the treatment of gynecological malignancies due to their pure estrogen receptor antagonist properties. However, up to now data are still limited and some unsolved questions remain. Fulvestrant has poor oral bioavailability and low pharmacodynamic characteristics. Further trials are required to examine new selective estrogen receptor down-regulator agents with better pharmacodynamic and pharmacokinetic profiles.

Role of dacarbazine in the treatment of recurrent mullerian adenosarcoma with sarcomatous overgrowth: Our experience

The incidence of uterine sarcoma ranges 1–3% of the female genital tract cancer. Mullerian adenosarcoma (MA) represents the 8–10% of these tumours (Clement and Scully 1974). According to Clement and Scully’s classification, MA is a mixture of epithelial and stromal components (Clement and Scully, 1974). A particular variant of MA is mullerian adenosarcoma with sarcomatous overgrowth (MASO), which is characterised by the presence of high-grade sarcomatous component occupying the inferior quarter of the neoplastic mass (Clement 1989). The presence of heterologous elements, necrosis, vascular invasion, high mitotic index, deep myometrial invasion or extra-uterine localisations leads to a strongly unfavourable prognosis (Clement 1989; Duggal et al. 2010; Tanner et al. 2013). Recently, at our institution, we have started a protocol that includes the chemotherapy use of dacarbazine (DTIC) in MASO recurrence treatment. In this work, we report on the case of a 72-year-old woman treated in the third chemotherapy line who amply benefitted from the cure. To our knowledge, this represents the first report of such a practice.

Veliparib for the treatment of ovarian cancer

ABSTRACT Introduction: Ovarian cancer represents the sixth most commonly diagnosed cancer among women, with an incidence of 6.1 cases per 100.000 women and a cumulative lifetime risk of 0.5%. Treatment is based on debulking surgery and platinum-based chemotherapy, with the potential combination with taxane. However, the recently available data on the genetic basis and aetiology of ovarian cancer has led to the development of new anticancer drugs. Poly(ADP-ribose) polymerase (PARP) inhibitors are one of the most promising new classes of targeted agents currently under investigation for the treatment of ovarian cancer. Veliparib is a small molecule that inhibits both PARP-1 and PARP-2 and was originally shown to be efficacious in BRCA-associated tumors. Areas covered: This manuscript reviews the Phase I and II studies investigating the use of veliparib in ovarian cancer. This article also provides and discusses the pharmacokinetics and pharmacodynamics of veliparib. Expert opinion: It is still being discussed whether PARP inhibitors should be used in a front-line or relapsed setting, alone or in combination with cytotoxic chemotherapy or as maintenance treatment. In terms of veliparib, further investigations are needed to explore its full potential in ovarian cancer. It is hoped that the ongoing phase 3 trials will help to further elucidate it potential as a treatment option.

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

Background: This work analyzes the feasibility and effectiveness of barbed suture during laparoscopic myomectomy. Methods: Eight works have been carefully examined for the meta-analysis from all papers published online until November 2017. Results: Barbed suture proved to be superior to traditional suture technique in blood loss in laparoscopic myomectomy (Standardized Mean Difference [SMD] –0.650, 95% CI –1.420 to –0.119, p = 0.098, test for heterogenity p < 0.0001, I2 = 95.54%), Hb drop (SMD –1.452, 95% CI –3.590 to 0.687, p = 0.183, test for heterogenity p < 0.0001, I2 = 99.08%), suturing difficulty (SMD –0.638, 95% CI –0.935 to –0.342, p ≤ 0.001, test for heterogenity p = 0.25, I2 = 27.84%), suturing time (SMD –1.197, 95% CI –1.848 to –0.549, p ≤0.001, test for heterogenity p = 0.0001, I2 = 83.30%) and total operative time (SMD –0.687, 95% CI –0.804 to –0.569, p ≤ 0.001, test for heterogenity p = 0.292, I2 = 17.44%). Barbed suture demonstrated to be better in comparison with the control group even with regard to the length of hospitalization (SMD –0.278, 95% CI –0.543 to 0.012, p = 0.040, test for heterogenity p = 0.025, I2 = 61.85%), and to perioperative complications (SMD 0.708, 95% CI 0.503–0.996, p = 0.048, test for heterogenity p = 0.79, I2 = 0%). Conclusion: Barbed suture significantly facilitates laparoscopic myomectomy by reducing the total operative/suturing time, estimated blood loss/Hb drop, and reduction of perioperative complications.

Outcome of Persistent Low-grade Cervical Intraepithelial Neoplasia Treated With Loop Electrosurgical Excision Procedure

Objective The aim of the study was to evaluate the outcome of persistent (≥2 years) low-grade cervical intraepithelial neoplasia (CIN 1) treated with loop electrosurgical excision procedure (LEEP). Materials and Methods A study of 252 subjects with persistent biopsy-confirmed CIN 1 diagnosed after low-grade squamous intraepithelial lesions or atypical squamous lesions of undetermined significance on Papanicolaou test and treated with LEEP. Post-LEEP follow-up cytological, colposcopic, and molecular diagnostic examinations were scheduled at 6 months, 1 year, and yearly thereafter. Results The 252 subjects enrolled had a total number of 1,008 visits per colposcopies (median = 3, range = 1–7) during a median post-LEEP follow-up of 25 months (range = 12–121). The cumulative incidence of CIN 2+ at 2 years and at 3 years of follow-up was 2.3% (4/176) and 5.5% (7/128), respectively, or 1.7 cases (95% CI = 1–2.8) per 100 woman-years. Low-grade cervical lesions during post-LEEP follow-up were diagnosed in 70 subjects (27.8%) or 10 cases (95% CI = 7.9–12.6) per 100 woman-years. Overall, persistent and multiple high-risk HPV infections during follow-up were associated with increased rates of CIN persistence or progression. Conclusions Women with persistent CIN 1 after atypical squamous lesions of undetermined significance/low-grade squamous intraepithelial lesion treated with LEEP had a low rate of progression to CIN 2+ but remained at a high risk of low-grade cervical abnormalities during follow-up. This information should be taken into account when deciding on the treatment strategy and counseling women with persistent CIN 1.

Il ruolo della linfoadenectomia nella prognosi del sarcoma uterino

Uterine sarcoma is a rare, but deadly disease. The uterine sarcoma is classified as leiomiosarcoma, endometrial stromal sarcoma, undifferentiated endometrial sarcoma, carcinosarcoma, and adenosarcoma. The most important symptoms are pre- and post-menopausal vaginal bleeding, abdominal pain, and abdominal distension. The best surgical approach is the histerectomy. Salpingo-oophorectomy is not necessary in premenopausal woman with early-stage leiomiosarcoma and endometrial stromal sarcoma. Routine lymphoadenectomy is discussed. Primary surgery with tumor-free resection margins, without residual disease is the main prognostic factor for the survival of the uterine sarcoma patient. It is also important that uterine sarcoma surgery might be centralized to institutions that have the necessary expertise in gynecological oncological surgery. Adjuvant pelvic irradiation can be considered if resection margins in the pelvis are involved. Introduction of irradiation therapy and chemioterapy has not influenced the long-term survival of these patients. Uterine sarcoma patients with extra-uterine disease have a poor prognosis. In our study we arroled 61 patients from 2000 to 2012, to find a correlation between the lymphoadenectomy, prognosis, and survival.