Although endometrial cancer (EC) is the most common gynecologic cancer in developed countries, se... more Although endometrial cancer (EC) is the most common gynecologic cancer in developed countries, several aspects of its management are still controversial. In particular, the need to perform lymphadenectomy represents an important matter of discussion. Because of the discordant results in the literature, it is still not possible to draft any definitive conclusions regarding the therapeutic value of lymph node dissection. The present review discusses the role of lymphadenectomy in the setting of EC, risk factors for lymphatic spread, identification of patients at risk for lymph node dissemination, and the current evidence for adjuvant therapies in patients with positive nodes. Reasons for the difficulty in demonstrating any therapeutic value of pelvic and para-aortic lymphadenectomy are also discussed.
5534Background: NACT followed by radical surgery is considered a valid therapeutic approach in lo... more 5534Background: NACT followed by radical surgery is considered a valid therapeutic approach in locally advanced cervical cancer (LACC). The standard neoadjuvant treatment has not yet been identifie...
PURPOSE OF INVESTIGATION To evaluate the feasibility, safety, and effectiveness of laparoendoscop... more PURPOSE OF INVESTIGATION To evaluate the feasibility, safety, and effectiveness of laparoendoscopic single site surgery (LESS) for the assessment of peritoneal carcinomatosis resectability in patients with advanced stage ovarian cancer (AOC). MATERIALS AND METHODS The authors retrospectively reviewed the medical records of patients affected by advanced stage ovarian cancer who underwent LESS for operative work-up. A standard cytoreductive laparotomy surgery (CRS) was performed. RESULTS Fifty-two women affected by AOC underwent LESS for operative work-up. The peritoneal cancer score was completed in 49 (94%) patients by use of LESS; 34/37 (92%) patients considered with a resectable disease were effectively optimally debulked and 15/52 (28%) patients considered with an unresectable disease received before neoadjuvant chemotherapy (NACT) and then underwent surgery. CONCLUSION LESS is feasible, safe, and is an alternative minimally invasive procedure to assess the resectability of AOC patients.
Clinical and Experimental Obstetrics & Gynecology, 2016
PURPOSE OF INVESTIGATION To evaluate the rate of all postpartum hemorrhages (PPHs) treated with u... more PURPOSE OF INVESTIGATION To evaluate the rate of all postpartum hemorrhages (PPHs) treated with uterine embolization in a third level delivery center. MATERIALS AND METHODS Since January 2008 to March 2014, 29,091 deliveries were registered in the present hospital in Bergamo, Italy. Among these deliveries, 2,002 cases (6.8%) of PPHs occurred. Seventy-three patients with severe obstetric hemorrhage underwent uterine artery embolization (UAE) (47 cases, 1.61/1,000 deliveries) or hysterectomy (26 cases, 0.89/1,000 deliveries). All identified cases were followed up by telephone on January 2015 in order to evaluate long term results. RESULTS Embolization was performed successfully in 45 patients (95.7%). Two women underwent total abdominal hysterectomy: one patient for uterine atony and one for adherent placenta. In the follow up all the women interviewed reported the return of their menstrual cycle and 95.2% of women reported regular cycles. CONCLUSIONS Embolization showed a success rate of 95.7%. For this reason, in the authors' opinion, it is the best choice as second line treatment of PPH, when patient is hemodynamically stable.
Clinical and Experimental Obstetrics & Gynecology, 2016
This review analyzes the changes that occur during normal pregnancy and describes the main odonto... more This review analyzes the changes that occur during normal pregnancy and describes the main odontogenic infections, suggesting the actual best approach in dental management. Several studies support the hypothesis that periodontal disease is associated with preterm labour and other conditions complicating pregnancy, such as pre-eclampsia and fetal growth restriction. Appropriate dental care and prevention during pregnancy may reduce poor prenatal outcomes and eliminating risk factors. Dental examination before pregnancy is strongly suggested in order to act early on dental and periodontal diseases. Prevention means reducing the presence of bacterial plaque through professional hygiene sessions, education, and motivation to proper oral hygiene at home, education in proper nutrition, a balanced diet, and low intake of sugars. For these reasons, it is essential to have a more intense interdisciplinary collaboration between gynecologist and dentist in order to achieve an optimal women's health, during this particular time in their lives.
Ultrasound examination of the foetal cranium can diagnose fetal cranial defects and abnormal skul... more Ultrasound examination of the foetal cranium can diagnose fetal cranial defects and abnormal skull shape and it's aim is to detect in prenatal age most various abnormalities of the skull, brain and foetal face. The changes of each of these components frequently determine the growth of the other two.The abnormalities of the foetal head frequently appear and can associate serious pathological sceneries of high foetal and perinatal morbidity and mortality.Anomalies of the head have been observed using ultrasound study during the early second trimester. To establish diagnosis and long term prognosis is particularly important and helpful correct detection of the nature of the malformation.
The aim of this work is to propose a brief comment about the impact of uterine artery embolizatio... more The aim of this work is to propose a brief comment about the impact of uterine artery embolization on sexual function and psychological well-being of women affected from uterine fibroids.
PURPOSE OF INVESTIGATION To evaluate chemotherapy with concomitant radiotherapy (RT) in "hig... more PURPOSE OF INVESTIGATION To evaluate chemotherapy with concomitant radiotherapy (RT) in "high risk" endometrial cancer (EC) patients. Furthermore to develop a new algorithm for management and treatment. MATERIALS AND METHODS The study included 182 Stage I endometrioid EC patients who underwent definitive surgery after a first treatment. Stage, grade, ploidy DNA index, lymphovascular space involvement (LVSI), tumor diameter (TD), and p53 were considered to identify "high-risk" patients. Twenty-seven women received adjuvant concomitant chemoradiation (CR). Toxicity related to the CR treatment, disease free interval (DFI), and status of the patients were considered. RESULTS Twenty-seven patients according to the present algorithm treatment were considered at "high risk". Median follow up was 43 months (range 16-68). Twenty-five (92%) patients completed CR treatment. Overall, grade 3/4 hematological toxicity was 18% while gastrointestinal toxicity was 15%. ...
Although endometrial cancer (EC) is the most common gynecologic cancer in developed countries, se... more Although endometrial cancer (EC) is the most common gynecologic cancer in developed countries, several aspects of its management are still controversial. In particular, the need to perform lymphadenectomy represents an important matter of discussion. Because of the discordant results in the literature, it is still not possible to draft any definitive conclusions regarding the therapeutic value of lymph node dissection. The present review discusses the role of lymphadenectomy in the setting of EC, risk factors for lymphatic spread, identification of patients at risk for lymph node dissemination, and the current evidence for adjuvant therapies in patients with positive nodes. Reasons for the difficulty in demonstrating any therapeutic value of pelvic and para-aortic lymphadenectomy are also discussed.
5534Background: NACT followed by radical surgery is considered a valid therapeutic approach in lo... more 5534Background: NACT followed by radical surgery is considered a valid therapeutic approach in locally advanced cervical cancer (LACC). The standard neoadjuvant treatment has not yet been identifie...
In the recent years, minimally invasive surgery has emerged as the gold standard for the treatmen... more In the recent years, minimally invasive surgery has emerged as the gold standard for the treatment of both benign and malignant gynecological conditions. Growing evidence suggest that laparoscopic and robotic-assisted treatments allow to archived the same long-term outcomes than conventional open abdominal treatments, minimizing peri-operative morbidity. In the present review we analyzed the advances in the treatment of cervical cancer patients, reporting the advances in both the evolution of concept of radical hysterectomy and of the adoption of minimally invasive surgery. We discussed the advantages related to the introduction of minimally invasive treatment for cervical cancer patients; innovation of conventional laparoscopic surgery as discussed as well. Recent evidence suggested a potential detrimental effect on long-term survival outcomes related to the use of minimally invasive surgery in patients affected by cervical cancer. However, reasons why minimally invasive surgery might have a detrimental effect are still unclear. Further evidence is needed in order to improve quality of treatment for cervical cancer patients.
Although endometrial cancer (EC) is the most common gynecologic cancer in developed countries, se... more Although endometrial cancer (EC) is the most common gynecologic cancer in developed countries, several aspects of its management are still controversial. In particular, the need to perform lymphadenectomy represents an important matter of discussion. Because of the discordant results in the literature, it is still not possible to draft any definitive conclusions regarding the therapeutic value of lymph node dissection. The present review discusses the role of lymphadenectomy in the setting of EC, risk factors for lymphatic spread, identification of patients at risk for lymph node dissemination, and the current evidence for adjuvant therapies in patients with positive nodes. Reasons for the difficulty in demonstrating any therapeutic value of pelvic and para-aortic lymphadenectomy are also discussed.
5534Background: NACT followed by radical surgery is considered a valid therapeutic approach in lo... more 5534Background: NACT followed by radical surgery is considered a valid therapeutic approach in locally advanced cervical cancer (LACC). The standard neoadjuvant treatment has not yet been identifie...
PURPOSE OF INVESTIGATION To evaluate the feasibility, safety, and effectiveness of laparoendoscop... more PURPOSE OF INVESTIGATION To evaluate the feasibility, safety, and effectiveness of laparoendoscopic single site surgery (LESS) for the assessment of peritoneal carcinomatosis resectability in patients with advanced stage ovarian cancer (AOC). MATERIALS AND METHODS The authors retrospectively reviewed the medical records of patients affected by advanced stage ovarian cancer who underwent LESS for operative work-up. A standard cytoreductive laparotomy surgery (CRS) was performed. RESULTS Fifty-two women affected by AOC underwent LESS for operative work-up. The peritoneal cancer score was completed in 49 (94%) patients by use of LESS; 34/37 (92%) patients considered with a resectable disease were effectively optimally debulked and 15/52 (28%) patients considered with an unresectable disease received before neoadjuvant chemotherapy (NACT) and then underwent surgery. CONCLUSION LESS is feasible, safe, and is an alternative minimally invasive procedure to assess the resectability of AOC patients.
Clinical and Experimental Obstetrics & Gynecology, 2016
PURPOSE OF INVESTIGATION To evaluate the rate of all postpartum hemorrhages (PPHs) treated with u... more PURPOSE OF INVESTIGATION To evaluate the rate of all postpartum hemorrhages (PPHs) treated with uterine embolization in a third level delivery center. MATERIALS AND METHODS Since January 2008 to March 2014, 29,091 deliveries were registered in the present hospital in Bergamo, Italy. Among these deliveries, 2,002 cases (6.8%) of PPHs occurred. Seventy-three patients with severe obstetric hemorrhage underwent uterine artery embolization (UAE) (47 cases, 1.61/1,000 deliveries) or hysterectomy (26 cases, 0.89/1,000 deliveries). All identified cases were followed up by telephone on January 2015 in order to evaluate long term results. RESULTS Embolization was performed successfully in 45 patients (95.7%). Two women underwent total abdominal hysterectomy: one patient for uterine atony and one for adherent placenta. In the follow up all the women interviewed reported the return of their menstrual cycle and 95.2% of women reported regular cycles. CONCLUSIONS Embolization showed a success rate of 95.7%. For this reason, in the authors' opinion, it is the best choice as second line treatment of PPH, when patient is hemodynamically stable.
Clinical and Experimental Obstetrics & Gynecology, 2016
This review analyzes the changes that occur during normal pregnancy and describes the main odonto... more This review analyzes the changes that occur during normal pregnancy and describes the main odontogenic infections, suggesting the actual best approach in dental management. Several studies support the hypothesis that periodontal disease is associated with preterm labour and other conditions complicating pregnancy, such as pre-eclampsia and fetal growth restriction. Appropriate dental care and prevention during pregnancy may reduce poor prenatal outcomes and eliminating risk factors. Dental examination before pregnancy is strongly suggested in order to act early on dental and periodontal diseases. Prevention means reducing the presence of bacterial plaque through professional hygiene sessions, education, and motivation to proper oral hygiene at home, education in proper nutrition, a balanced diet, and low intake of sugars. For these reasons, it is essential to have a more intense interdisciplinary collaboration between gynecologist and dentist in order to achieve an optimal women's health, during this particular time in their lives.
Ultrasound examination of the foetal cranium can diagnose fetal cranial defects and abnormal skul... more Ultrasound examination of the foetal cranium can diagnose fetal cranial defects and abnormal skull shape and it's aim is to detect in prenatal age most various abnormalities of the skull, brain and foetal face. The changes of each of these components frequently determine the growth of the other two.The abnormalities of the foetal head frequently appear and can associate serious pathological sceneries of high foetal and perinatal morbidity and mortality.Anomalies of the head have been observed using ultrasound study during the early second trimester. To establish diagnosis and long term prognosis is particularly important and helpful correct detection of the nature of the malformation.
The aim of this work is to propose a brief comment about the impact of uterine artery embolizatio... more The aim of this work is to propose a brief comment about the impact of uterine artery embolization on sexual function and psychological well-being of women affected from uterine fibroids.
PURPOSE OF INVESTIGATION To evaluate chemotherapy with concomitant radiotherapy (RT) in "hig... more PURPOSE OF INVESTIGATION To evaluate chemotherapy with concomitant radiotherapy (RT) in "high risk" endometrial cancer (EC) patients. Furthermore to develop a new algorithm for management and treatment. MATERIALS AND METHODS The study included 182 Stage I endometrioid EC patients who underwent definitive surgery after a first treatment. Stage, grade, ploidy DNA index, lymphovascular space involvement (LVSI), tumor diameter (TD), and p53 were considered to identify "high-risk" patients. Twenty-seven women received adjuvant concomitant chemoradiation (CR). Toxicity related to the CR treatment, disease free interval (DFI), and status of the patients were considered. RESULTS Twenty-seven patients according to the present algorithm treatment were considered at "high risk". Median follow up was 43 months (range 16-68). Twenty-five (92%) patients completed CR treatment. Overall, grade 3/4 hematological toxicity was 18% while gastrointestinal toxicity was 15%. ...
Although endometrial cancer (EC) is the most common gynecologic cancer in developed countries, se... more Although endometrial cancer (EC) is the most common gynecologic cancer in developed countries, several aspects of its management are still controversial. In particular, the need to perform lymphadenectomy represents an important matter of discussion. Because of the discordant results in the literature, it is still not possible to draft any definitive conclusions regarding the therapeutic value of lymph node dissection. The present review discusses the role of lymphadenectomy in the setting of EC, risk factors for lymphatic spread, identification of patients at risk for lymph node dissemination, and the current evidence for adjuvant therapies in patients with positive nodes. Reasons for the difficulty in demonstrating any therapeutic value of pelvic and para-aortic lymphadenectomy are also discussed.
5534Background: NACT followed by radical surgery is considered a valid therapeutic approach in lo... more 5534Background: NACT followed by radical surgery is considered a valid therapeutic approach in locally advanced cervical cancer (LACC). The standard neoadjuvant treatment has not yet been identifie...
In the recent years, minimally invasive surgery has emerged as the gold standard for the treatmen... more In the recent years, minimally invasive surgery has emerged as the gold standard for the treatment of both benign and malignant gynecological conditions. Growing evidence suggest that laparoscopic and robotic-assisted treatments allow to archived the same long-term outcomes than conventional open abdominal treatments, minimizing peri-operative morbidity. In the present review we analyzed the advances in the treatment of cervical cancer patients, reporting the advances in both the evolution of concept of radical hysterectomy and of the adoption of minimally invasive surgery. We discussed the advantages related to the introduction of minimally invasive treatment for cervical cancer patients; innovation of conventional laparoscopic surgery as discussed as well. Recent evidence suggested a potential detrimental effect on long-term survival outcomes related to the use of minimally invasive surgery in patients affected by cervical cancer. However, reasons why minimally invasive surgery might have a detrimental effect are still unclear. Further evidence is needed in order to improve quality of treatment for cervical cancer patients.
Objectives: Previous studies reported an high rates of postoperative pulmonary complications in p... more Objectives: Previous studies reported an high rates of postoperative pulmonary complications in patients undergoing extensive cytoreductive surgery, including diafragmatic resection, for advanced epithelial ovarian cancer (EOC). Methods: This study measured the incidence of postoperative pulmonary complications in a cohort of 21 patients undergoing routine application of Jackson Pratt (JP) drainage as chest tube after diafragmatic resection. Results: The incidence of postoperative pulmonary complications like pleural effusion, pneumothorax and subdiaphragmatic abscess in our group of patients were respectively 33%, 0% and 5%. Conclusions: This study demonstrated a low rate of postoperative pulmonary complications with the routinely application of JP as chest tube with no additional discomfort for patients. Randomized controlled trials are required to test the role of routinely use of chest tube in preventing postoperative pulmonary complications in patients undergoing upper abdominal surgery.
Objective: The aim of this study was to document the presence of severe gastroplegia after radica... more Objective: The aim of this study was to document the presence of severe gastroplegia after radical omentectomy including the perigastric area and lesser omentum in patients with FIGO stage III C serous epithelial ovarian tumors (EOT). Methods: Patients undergoing radical omentectomy in the setting of surgery for FIGO stage IIIC EOT between Jannuary 2014 and Jannuary 2017 were included. Patients with macroscopic involvement of the perigastric area were excluded. The perigastric area was evaluated by an expert pathologist. Nasogastric tube was held for 48 hours. After that it was observed the recovery of gastric function. Results: Fifteen patients were included. All the patients underwent primary debulking surgery. Microscopic involvement of the perigastric omentum area was found in 37% of the cases. Five patients needed to put back the nasogastric tube for severe gastric sintoms. Summary: In this study, evidence is given that radical omentectomy including the perigastric area and lesser omentum is a necessary component of complete cytoreductive surgery in FIGO stage IIIC EOT, whatever great number of severe gastroplegia is reported.
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Papers by Diego Rossetti
Methods: This study measured the incidence of postoperative pulmonary complications in a cohort of 21 patients undergoing routine application of Jackson Pratt (JP) drainage as chest tube after diafragmatic resection.
Results: The incidence of postoperative pulmonary complications like pleural effusion, pneumothorax and subdiaphragmatic abscess in our group of patients were respectively 33%, 0% and 5%.
Conclusions: This study demonstrated a low rate of postoperative pulmonary complications with the routinely application of JP as chest tube with no additional discomfort for patients. Randomized controlled trials are required to test the role of routinely use of chest tube in preventing postoperative pulmonary complications in patients undergoing upper abdominal surgery.
Methods: Patients undergoing radical omentectomy in the setting of surgery for FIGO stage IIIC EOT between Jannuary 2014 and Jannuary 2017 were included. Patients with macroscopic involvement of the perigastric area were excluded. The perigastric area was evaluated by an expert pathologist. Nasogastric tube was held for 48 hours. After that it was observed the recovery of gastric function.
Results: Fifteen patients were included. All the patients underwent primary debulking surgery. Microscopic involvement of the perigastric omentum area was found in 37% of the cases. Five patients needed to put back the nasogastric tube for severe gastric sintoms.
Summary: In this study, evidence is given that radical omentectomy including the perigastric area and lesser omentum is a necessary component of complete cytoreductive surgery in FIGO stage IIIC EOT, whatever great number of severe gastroplegia is reported.