Management of the pelvic floor disfunctions: combined versus single surgical procedure in a multidisciplinary approach: a retrospective study

The objective of this study was to compare the outcome of combined surgical treatment of multicompartmental pelvic floor defects versus single procedures within a multidisciplinary path in order to try to clarify what is the most effective surgical approach

Hysterectomy or not for borderline ovarian tumor in menopause?

Background: The role of hysterectomy for borderline ovarian tumor (BOT) among postmenopausal women is still unclear. Objective(s): To assess the impact of hysterectomy on survival outcomes in postmenopausal women with BOT. Study design: This study was a national, multicenter, observational, retrospective, cohort study including all consecutive eligible postmenopausal patients who underwent primary surgery for BOT in 20 Italian centers from January 2005 to December 2017. Patients were divided into two groups: hysterectomy group vs no-hysterectomy group. Primary outcome was disease-free survival (DFS) at 5 years of follow-up; secondary outcomes were overall survival (OS) and disease-specific survival (DSS) at 5 years of follow-up, hazard ratio (HR) for recurrence, death of any cause and death due to BOT, peri-operative complications rates. Results: 483 patients were included, 144 (29.8 %) women in the no-hysterectomy group and 339 (70.2 %) in the hysterectomy group. Recurrences were significantly more common in the no-hysterectomy group compared to hysterectomy one (8.3 % vs 2.7 %; p = 0.012). The 5-year DFS rate was lower in the no-hysterectomy group than that in the hysterectomy one [92.4 % vs 98.5 %; p = 0.007]. At univariate analyses, women who underwent hysterectomy showed HR of 0.312 (95 %CI:0.131-0.740; p = 0.008) for recurrence. At multivariate analysis, hysterectomy was found to be an independent protective factor for recurrence (HR: 0.253, 95 %CI:0.103-0.618, p < 0.003). Conclusions: In postmenopausal women with BOT, hysterectomy is associated with a decreased risk of recurrence, while it does not affect the risk of death from any cause or death due to the disease. Based on these findings, hysterectomy should be routinely integrated into the surgical staging of BOT in postmenopausal women

Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic

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 COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods: This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results: Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion: Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic

Prolasso degli organi pelvici e sessualità: studio sulla qualità della vita dopo intervento chirurgico di correzione del prolasso

: Introduzione La sfera della sessualità è spesso gravemente inficiata nelle pazienti portatrici di prolasso degli organi pelvici. Scopo dell’articolo è indagare la qualità della vita sessuale delle pazienti prima e dopo l’intervento chirurgico. Materiali e metodi È stato condotto uno studio osservazionale di coorte su pazienti sottoposte a intervento chirurgico di sospensione laterale laparoscopica (LLS) e isterectomia per via vaginale con colpopessi uterosacrale (USLs). È stata indagata l’attività sessuale, la comparsa di dispareunia e il grado di soddisfazione nel rapporto col partner al tempo 0 e a 6-12-24 mesi postoperatori nei 2 gruppi. Risultati Sono state sottoposte a intervento chirurgico 195 pazienti portatrici di prolasso: 145 nel gruppo USLs e 41 nel gruppo LLS. Al tempo 0 erano sessualmente attive il 59% del gruppo LLS e il 32,5% del gruppo USLs. La dispareunia era sperimentata dal 60,9% delle pazienti LLS (I grado: 30,4%, II grado: 21,7%, III grado: 8,7%) e dall’80% delle pazienti USLs (I grado: 44%, II grado: 20%, III grado: 16%). 6 mesi dopo l’intervento chirurgico tra le pazienti sessualmente attive, nel gruppo LLS il 15,8% sperimentava dispareunia (tutte di I grado), che nel 10,5% era persistente mentre nel 5,3% de novo; nel gruppo USLs il 37,5% presentava dispareunia, nel 29% dei casi di I grado, nel l’8,3% dei casi di II grado; la dispareunia era persistente nel 16,7%, de novo nel 20,8%. 12 mesi post-intervento nel gruppo LLS la dispareunia era riscontrata nell’ 11% delle pazienti attive (tutte di I grado e di tipo persistente); nel gruppo USLs la prevalenza di dispareunia era del 18,2% (I grado: 9,1%, II grado: 9,1%), di tipo persistente. Infine a 24 mesi post intervento, nel gruppo LLS nessuna lamentava dispareunia; nel gruppo USLs andate a controllo, 2 ( il 40%) presentavano dispareunia (I grado: 20%, II grado: 20%), in 1 paziente de novo, nell’altra di tipo persistente. In risposta al questionario pre operatorio per l’item Relazione col partner, la mediana dei punteggi era di 25 nel gruppo LLS (35 pazienti) e di 33 nel gruppo USLs (70 pazienti). Ai successivi controlli a 6, 12 e 24 mesi la mediana dei punteggi è stata di 0 in entrambi i gruppi in tutti e tre i controlli temporali. Conclusioni Gli interventi chirurgici di sospensione laterale uterina per via laparoscopica e di isterectomia per via vaginale con colpopessi uterosacrale si sono dimostrati efficaci nel migliorare la sessualità riducendo la dispareunia e aumentando il grado di soddisfazione soggettivo della paziente nel rapporto col partner

Isthmocele: From Risk Factors to Management

 The aim of the present study was to perform a comprehensive review of the literature to provide a complete and clear picture of isthmocele-a hypoechoic area within the myometrium at the site of the uterine scar of a previous cesarean section-by exploring in depth every aspect of this condition

Outcome of endometrial cancer after lymphadenectomy, a single center retrospective analysis of 829 cases with long-lasting follow-up

BACKGROUND: Role of lymphadenectomy in endometrial cancer is unclear. Our objective is to assess the role of lymphadenectomy in endometrial cancer. METHODS: 829 cases of endometrial cancer from a single non-oncological center were reviewed retrospectively from 1981 to 2014. Multivariable Cox regression analyses were performed. Independent variables were: 2009 FIGO stage, histological type of endometrial cancer (non-endometrioid, endometrioid, grading 1, 2 and 3), radicality on parametria, lymphatic dissection (any kind) (yes/no), any kind of chemotherapy, any kind of radiotherapy, brachytherapy, patients' age. Dependent variable was death for endometrial cancer and first relapse. Time variable was the semester of follow-up. P value for significance was set <0.05. RESULTS: Many data about the extension of node dissection were missing. Pelvic node dissection or sampling seem the more common procedure performed. At the 10-semester of follow-up, at the 20-semester of follow-up and at the 30 semester of follow up, lymphadenectomy does not improve overall survival at a p value of less than 0.05. Lymphadenectomy reduces the risk of relapse at the 10 semester and 20-semester of follow-up. CONCLUSIONS: Lymphadenectomy plays a role in preventing relapses but it is not proved that non-aggressive lymphadenectomy in endometrial cancer improves overall survival at p level of 0.05. Therefore, it cannot be excluded that a very small improvement in long lasting survival in few cases of endometrial cancer could be due to node dissections