Papers by Mauro Signorelli
Journal of gynecologic oncology, 2015
Endometrial cancer is the most common gynecologic malignancy in the developed countries. Although... more Endometrial cancer is the most common gynecologic malignancy in the developed countries. Although the high incidence of this occurrence no consensus, about the role of retroperitoneal staging, still exists. Growing evidence support the safety and efficacy of sentinel lymph node mapping. This technique is emerging as a new standard for endometrial cancer staging procedures. In the present paper, we discuss the role of sentinel lymph node mapping in endometrial cancer, highlighting the most controversies features.
Journal of gynecologic oncology, 2016
Journal of minimally invasive gynecology, Jan 2, 2016
Since the safety warning from the U.S. Food and Drugs Administration on the use of power morcella... more Since the safety warning from the U.S. Food and Drugs Administration on the use of power morcellators, minimally invasive procedures involving the removal of uterine fibroids and large uteri are under scrutiny. Growing evidence suggests that morcellation of undiagnosed uterine malignancies worse survival outcomes of patients affected by uterine sarcoma. However, to date only limited data regarding morcellation of low-grade uterine neoplasms are available. In the present paper, we reported a case of a (morcellator) port site implantation of smooth muscle tumor occurred six years after laparoscopic morcellation of a uterine smooth muscle tumor of uncertain potential. This case highlights the effects of intra-abdominal morcellation, even in low-grade uterine neoplasms. Caution should be used when determining techniques for tissue extraction; the potential adverse consequences of morcellation should be more fully explored.
Journal of Minimally Invasive Gynecology, 2016
We reviewed the current evidence on the safety, effectiveness, and applicability of extraperitone... more We reviewed the current evidence on the safety, effectiveness, and applicability of extraperitoneal robotic-assisted para-aortic lymphadenectomy (ExtRA-PAL) as the staging procedure of gynecologic malignancies. PubMed (MEDLINE), Scopus, Web of Science databases, and ClinicalTrails.gov were searched for original studies reporting outcomes of ExtRA-PAL. Quality of the included studies and their level of recommendation were assessed using the Grading of Recommendations, Assessment, Development, and Evaluation and the American College of Obstetricians and Gynecologists guidelines, respectively. Overall, 62 studies were identified; after a process of evidence acquisition 5 original investigations were available for this review that included 98 patients undergoing ExtRA-PAL. The main surgical indication was staging for cervical cancer (n = 71, 72%). The mean (SD) number of para-aortic node yielded was 15.4 (±4.7) nodes. Blood transfusion and intraoperative complication rates were 2% and 6%, respectively. ExtRA-PAL was completed in 88 patients (90%). Six (6%) and 4 (4%) patients had conversion to other minimally invasive procedures and open surgery, respectively. Success rate was 99% among patients undergoing ExtRA-PAL without concomitant procedures. Overall, mean (SD) length of hospital stay was 2.8 (±0.5) days. Twenty-four patients (24%) developed postoperative events. According to the Clavien-Dindo grading system, grades IIIa and IIIb morbidity rates were 12% and 2%, respectively. No grades IV and V morbidity occurred. ExtRA-PAL is associated with a high success rate and a relative low morbidity rate. However, because of the limited data on this issue, further studies are warranted to assess the long-term effectiveness of this procedure.
Journal of Gynecologic Oncology, 2016
Journal of gynecologic oncology, 2015
Endometrial cancer is the most common gynecologic malignancy in the developed countries. Although... more Endometrial cancer is the most common gynecologic malignancy in the developed countries. Although the high incidence of this occurrence no consensus, about the role of retroperitoneal staging, still exists. Growing evidence support the safety and efficacy of sentinel lymph node mapping. This technique is emerging as a new standard for endometrial cancer staging procedures. In the present paper, we discuss the role of sentinel lymph node mapping in endometrial cancer, highlighting the most controversies features.
Journal of Gynecologic Oncology, 2015
Evaluation of the impact of sequential chemoradiotherapy in high risk endometrial cancer (EC). Tw... more Evaluation of the impact of sequential chemoradiotherapy in high risk endometrial cancer (EC). Two hundred fifty-four women with stage IB grade 3, II and III EC (2009 FIGO staging), were included in this retrospective study. Stage I, II, and III was 24%, 28.7%, and 47.3%, respectively. Grade 3 tumor was 53.2% and 71.3% had deep myometrial invasion. One hundred sixty-five women (65%) underwent pelvic (+/- aortic) lymphadenectomy and 58 (22.8%) had nodal metastases. Ninety-eight women (38.6%) underwent radiotherapy, 59 (23.2%) chemotherapy, 42 (16.5%) sequential chemoradiotherapy, and 55 (21.7%) were only observed. After a median follow-up of 101 months, 78 women (30.7%) relapsed and 91 women (35.8%) died. Sequential chemoradiotherapy improved survival rates in women who did not undergo nodal evaluation (disease-free survival [DFS], p=0.040; overall survival [OS], p=0.024) or pelvic (+/- aortic) lymphadenectomy (DFS, p=0.008; OS, p=0.021). Sequential chemoradiotherapy improved both DFS (p=0.015) and OS (p=0.014) in stage III, while only a trend was found for DFS (p=0.210) and OS (p=0.102) in stage I-II EC. In the multivariate analysis, only age (≤65 years) and sequential chemoradiotherapy were statistically related to the prognosis. Sequential chemoradiotherapy improves survival rates in high risk EC compared with chemotherapy or radiotherapy alone, in particular in stage III.
International Journal of Gynecological Cancer, 2015
Objective: Neoadjuvant chemotherapy (NACT) is a valid treatment option for women with locally adv... more Objective: Neoadjuvant chemotherapy (NACT) is a valid treatment option for women with locally advanced cervical cancer (LACC). This study aims to evaluate the impact of sociodemographic factors, clinical factors, and NACT regimens on survival endpoints. The role of pathological response to NACT as a surrogate endpoint of survival was also assessed. Materials and Methods: Retrospective analysis of consecutive sample data from women with LACC (stages Ib2-IVa) who underwent NACT followed by radical surgery was performed. Response was classified as optimal response (including complete response and optimal partial response), suboptimal partial response, stable disease, and progressive disease. Results: Four hundred forty-six women who had undergone surgery from 1992 to 2011 were analyzed. The overall optimal response was 35.4%. At a median follow-up of 12.7 years, 165 women (37.0%) experienced recurrence or died. Increase in patient age at surgery, International Federation of Gynecology and Obstetrics stage III/IV versus stage Ib2, and lymphnode positivity versus negativity seemed to impact negatively on survival, whereas neoadjuvant platinum-TaxolYcontaining regimens (compared with platinum-based regimens) improved survival. Response to NACT could be considered a surrogate endpoint of survival. Conclusions: Age, International Federation of Gynecology and Obstetrics stage III/IV, lymph-node involvement, and type of NACT administered have a significant impact on survival. Response to NACT is a good surrogate endpoint of survival in patients with LACC.
Ultrasound in Obstetrics and Gynecology, 2008
Ultrasound in Obstetrics and Gynecology, 2006
Ultrasound in Obstetrics and Gynecology, 2007
Heterotaxy syndrome is a rare congenital disorder that appears in 2 different types: right isomer... more Heterotaxy syndrome is a rare congenital disorder that appears in 2 different types: right isomerism (asplenia syndrome) and left isomerism (polysplenia syndrome). It occurs in approximately 0.8% of patients with congenital heart disease. Characteristics of the disease are an incomplete or inappropriate lateralisation of atria, thoracic organs and abdominal viscera; an associated hydrops can be found. We report a case of a 34-year-old gravida 2, para 1 with sonographic signs of fetal heterotaxy syndrome at the second trimester scan. Ultrasound examination revealed left isomerism with a complex heart anomaly including a ventricular septal defect and atrioventricular block, a hypertrophic cardiomyopathy, a continuing vena azygos and an interrupted inferior vena cava. The fetal liver was located in a central position. The prognosis was even worse due to a generalized hydrops. Because of the diagnosis the woman decided not to continue with the pregnancy. Labor was induced at 24 weeks of gestation after fetocide by intraamniotic instillation of 0.8 mg Digoxin. Postpartal autopsy verified the prenatal diagnosis of ventricular septal defect, left isomerism of the lungs and atrias. It also showed a venoatrial disconnection on the right side with pulmonary venous drainage into the superior vena cava and into the right atrium. In the abdomen an absent retrohepatic vena cava, pancreas in a central position, non-rotation of the intestines and eleven 4 mm-sized spleens on the left side of the body confirmed the prenatal diagnosis of left isomerism. With high resolution ultrasound it is possible to diagnose left isomerism antenatally. Paidopathologic examination is recommended to confirm the diagnosis of this complex congenital anomaly in detail.
Ultrasound in Obstetrics and Gynecology, 2004
Ultrasound in Obstetrics and Gynecology, 2003
The fetal middle cerebral artery (MCA) has been suggested as the vessel of choice for estimating ... more The fetal middle cerebral artery (MCA) has been suggested as the vessel of choice for estimating the fetal risk for anemia by measuring the peak systolic velocity (PSV). It is not clear how different placements of the doppler-gate on the trace of this vessel and correction of the angle of insonation influence the PSV. Although various investigators have constructed reference curves, the patient population has always been described as normal and pregnancies complicated by irregular antibodies, diabetes, hypertensive disorders, fetal malformations, multiple pregnancies and IUGR were excluded. Patients and methods: In a prospective study we measured the MCA-PSV in 67 normal and 79 complicated (high-risk) pregnancies (19-42 weeks). The circle of Willis was identified with color Doppler and the Doppler-gate was placed at the origin of the MCA and in the distal, visualized part of the vessel. Measurements were performed with and without angle-correction and compared. We constructed new reference ranges for the PSV-values of the total population (N = 146) with angle correction. Results: There was a significant difference between the PSV-values at the proximal and the distal part of the MCA with higher velocities proximal. The measurements with angle correction also showed significantly higher velocities as those without. Between the normal and complicated pregnancies we couldn't find a significant difference. Discussion: As we couldn't show significant difference of the PSV-ACM between normal and complicated pregnancies the reference ranges can be applied also in complicated pregnancies. Our data show that placement and angle correction are relevant for a standardisized measurement, especially important because the decision for invasive testing for fetal anaemia depends on it.
Ultrasound in Obstetrics and Gynecology, 2003
Ultrasound in Obstetrics and Gynecology, 2003
We report our findings in a case of pulmonary atresia with intact ventricular septum and ventricu... more We report our findings in a case of pulmonary atresia with intact ventricular septum and ventriculocoronary artery fistula in which power Doppler was used to make the diagnosis.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2008
The aim of the study was to evaluate the adequacy, morbidity, and survival outcome of laparoscopi... more The aim of the study was to evaluate the adequacy, morbidity, and survival outcome of laparoscopic type II radical hysterectomy and pelvic lymphadenectomy in patients with early invasive cervical cancer. Between February 2003 and December 2005, 57 patients underwent total laparoscopic radical hysterectomy (TLRH) with pelvic lymphadenectomy. Eligibility criteria were good general condition, tumor size < 3 cm, no evidence of lymph node metastases in imaging study (magnetic resonance imaging and/or computed tomography and/or positron emission tomography) and body mass index < or = 35. TLRH was completed in 56 patients; in 1 patient, surgery was converted to laparotomy because of positive nodal status at the frozen section. Median age was 43 years and median body mass index was 21.5 kg/m2. The majority of patients (86%) had FIGO stage Ib1 cervical cancer, and the predominant histotype was squamous (59%). Median operating time was 310 minutes and median blood loss 200 mL. No patient required hemotransfusion. Median number of resected lymph nodes was 24, and 6 patients had microscopic node metastasis. Margins were positive in one patient. The only intraoperative complication was a 1-cm cystotomy repaired laparoscopically during the intervention. Four patients required a second surgery, 2 for ureteral stenosis and 2 for the reparation of vaginal cuff diastasis. After a median follow-up of 13 months, 4 patients had a relapse; all 56 patients are alive at present. TLRH with pelvic lymphadenectomy is an adequate and feasible surgical option in treating early invasive cervical cancer; however a longer follow-up is required to evaluate the oncologic outcome of these patients.
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Papers by Mauro Signorelli