5 research outputs found
Severe pelvic organ prolapse treated by vaginal native tissue repair: long-term analysis of outcomes in 146 patients
Aims: The aim of this study was to assess the effectiveness and safety of vaginal native tissue repair (VNTR) as a surgical treatment for severe pelvic organ prolapse (POP) and, second, to evaluate the impact on the quality-of-life (QoL) and sexual function. Methods: Women with symptomatic POP (≥III stage according to POP Quantification System) with or without stress urinary incontinence (SUI) underwent VNTR. The clinical stage, 3-day voiding diary, and urodynamic testing were evaluated in the preoperative and postoperative times, respectively. The International Consultation on Incontinence Questionnaire–Urinary Incontinence Questionnaire Short Form (ICIQ–UI SF), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12), and the prolapse quality-of-life questionnaire (P-QoL) were administered. Results: One hundred forty-six patients were recruited. The median follow-up was 48 months (36–63). Fifty-two women (36%) had a previous hysterectomy, and 16 (11%) had a previous prolapse/continence surgery. Preoperatively, 135 (92.5%), 109 (74.7%), and 98 (67.1%) patients had anterior, central, and posterior descent ≥III stage, respectively. Thirty-two patients (22%) had concomitant diagnosis of SUI. Median operative time was 85 min (37–154), and median postoperative hospital stay was 2 days (2–4). No intraoperative severe complications occurred. At the long-term follow-up, the subjective cure rate for prolapse was 97.3% and the objective cure rate was 91.1%. A significant improvement of ICIQ-UI SF, the P-QoL, and the PISQ-12 was recorded at the follow-up (p < 0.001). Conclusion: VNTR is effective, safe, and durable and improves POP-related symptoms and sexual function
Effects of Neoadjuvant Chemotherapy Plus Radical Surgery as Front Line Treatment Strategy in Patients Affected by FIGO Stage III Cervical Cancer
Background. To assess the clinical efficacy and prognostic
outcome of neoadjuvant chemotherapy (NACT) plus
radical surgery (RS) as front line treatment in patients with
FIGO stage III cervical cancer (CC).
Methods. In this retrospective study, 52 FIGO stage III
CC patients treated from 2005 to 2015 were included. All
patients received platinum-based chemotherapy. Patients
reporting clinical response or stable disease after NACT
underwent to RS and bilateral systematic pelvic lymphadenectomy
with or without aortic lymphadenectomy or
anterior exenteration. Patients with progressive disease
underwent palliative management.
Results. After NACT, clinical response was observed in
23 patients (44 %): 4 (7.7 %) complete and 19 (36.5 %)
partial responses, respectively. Also, 15 patients (28.8 %)
had stable disease and 14 (26.9 %) showed disease progression.
RS was performed in 40 cases (76.9 %):
respectively, 28 (70 %) and 7 (17.5 %) underwent type C2
and D radical hysterectomy, while 5 patients (12.5 %)
underwent anterior exenteration. At pathological evaluation,
23 patients (57.5 %) had positive pelvic nodes and 4
(10 %) also had positive aortic nodes. In 6 patients (15 %),
moderate-severe (G3–G5) complications occurred. A total
of 27 patients (67.5 %) received adjuvant therapy: 16
patients (40 %) received chemotherapy, 10 (25 %)
received chemoradiation and 1 (2.5 %) received
radiotherapy. Disease relapse occurred in 24 cases (60 %).
After follow-up period of 60 months, the median OS of the
whole population included was 37 months. Among the 40
surgically treated patients, median OS and DFS were 48
and 23 months, respectively.
Conclusions. NACT plus RS represent a valid alternative
with acceptable morbidity for patients with stage III CC
Type B versus Type C Radical Hysterectomy After Neoadjuvant Chemotherapy in Locally Advanced Cervical Carcinoma: A Propensity-Matched Analysis
The aim of this study was to evaluate the feasibility and safety of type B radical hysterectomy (RH) in the management of patients affected by locally advanced cervical cancer with favorable prognostic factors (tumor diameter <40 mm, negative nodes, or lymphovascular space involvement) and clinical response to neoadjuvant chemotherapy (NACT)