Giorgio Bogani

Scopus Publications

The exciting journey of progress: Exploring FIGO 2023 staging for endometrial cancer at a leading ESGO institution
Tommaso Occhiali, Alice Poli, Martina Arcieri, Lorenza Driul, Antonino Ditto, Giorgio Bogani, Andrea Mariani, Giovanni Scambia, Stefano Restaino, and Giuseppe Vizzielli
Elsevier BV

An effective surgical approach to treat obese patients with gynecological disease using a subcutaneous abdominal wall-retraction device to perform low-pressure laparoscopy: A prospective, single-center study
Antonino Ditto, Stefano Fucina, Giulia Chiarello, Giorgio Bogani, Biagio Paolini, Giuditta Fallabrino, Umberto Leone Roberti Maggiore, and Francesco Raspagliesi
Elsevier BV

It is not the surgical approach, but the R0 margins to drive survival after rectal cancer surgery
Luca Sorrentino, Giorgio Bogani, and Gianluca M. Sampietro
Elsevier BV

Automated Measurement of Coronary Artery Calcifications and Routine Perioperative Blood Tests Predict Survival in Resected Stage I Lung Cancer
Federica Sabia, Camilla Valsecchi, Roberta Eufrasia Ledda, Giorgio Bogani, Riccardo Orlandi, Luigi Rolli, Michele Ferrari, Maurizio Balbi, Alfonso Marchianò, and Ugo Pastorino
Elsevier BV

Short- and long-term outcomes of vaginal, laparoscopic, and robotic-assisted surgery in “oldest old” endometrial cancer
Giorgio Bogani, Francesco Raspagliesi, Mario Malzoni, Ilaria Cuccu, Giuseppe Vizzielli, Giovanni Scambia, Fabio Ghezzi, Jvan Casarin, Andrea Giannini, Violante Di Donato,et al.
Elsevier BV

Legal Considerations in Bioidentical Hormone Replacement Therapy: Anticipating Future Challenges in Medical Liability
F. Del Duca, G. Santangelo, G. Bogani, V. Di Donato, G. Perniola, F. Spadazzi, A. Ghamlouch, A. Maiese, P. Frati and C. Trignano

Abstract New pharmaceutical formulations containing multiple active pharmaceutical ingredients have entered the market, combined to form compounded Bioidentical Hormone Replacement Therapy (cBHRT). The rise of alternative therapies is due to a large amount of misinformation about hormone replacement therapy and unexplained fears among the female population. This commentary reviews the impact of cBHRT on the current post-menopausal syndrome. Compounded Bioidentical Hormone Replacement Therapies are formulations of well-known active pharmaceutical ingredients (APIs) derived from plants. In fact, users report that these products seem to be safer and more effective than FDA-approved hormonal replacement therapy. A literature research was performed to address common questions posed by physicians and patients with climacteric syndrome about cBHRT. This study raises several questions about cBHRT. First of all, no safety and security studies of individual cBHRT formulations have been performed. The efficacy of a cBHRT formulation based on personalized treatment appears to be ineffective. The costs of individual galenic preparations do not justify the efficacy and risks of cBHRT. On the medico-legal issue, galenic preparations have two types of possible risks: generic and specific. A generic risk is connected to the preparation, operator-dependent errors, and hygienic precautions. The specific risk of collateral effects is the possible drug-to-drug interactions, which have not been studied yet. The lack of scientific information exposes the prescribing physician to accusations of improper prescription and possible preventable risks. Caution in the prescription of cBHRT is always warranted.

Primary or Interval Debulking Surgery for Advanced Endometrial Cancer with Carcinosis: A Systematic Review and Individual Patient Data Meta-Analysis of Survival Outcomes
Giulia Mantovani, Camelia Alexandra Coada, Stella Di Costanzo, Francesco Mezzapesa, Lucia Genovesi, Giorgio Bogani, Francesco Raspagliesi, Alessio Giuseppe Morganti, Pierandrea De Iaco, and Anna Myriam Perrone
MDPI AG
Objective. To compare the survival outcomes of primary debulking surgery and platinum-based adjuvant chemotherapy versus interval debulking surgery after platinum-based neoadjuvant chemotherapy in patients with stage IVb endometrial cancer and peritoneal carcinosis. Methods. The online search included the following data sources: PubMed, Scopus, WOS, and the Cochrane Library from 1990 to 2024 (PROSPERO registration code: CRD42023438602). A total of 3230 studies were identified, with the inclusion of 16. Individual patient data on survival outcomes, disease distribution, and residual tumors, as well as details of neoadjuvant chemotherapy and adjuvant treatment, were extracted. Results. A total of 285 patients were included: 197 (69%) underwent primary debulking surgery and 88 (31%) underwent interval debulking surgery. The pooled analysis revealed a median progression-free survival in the primary debulking surgery group of 18.0 months compared to 12.0 months in the interval debulking surgery group (p = 0.028; log-rank test), and a median overall survival of 30.92 months versus 28.73 months (p = 0.400; log-rank test). Among the 134 patients with available information on the residual tumor after primary debulking surgery or interval debulking surgery, 110 (82%) had no macroscopic residual tumor (residual tumor = 0). The median progression-free survival was 18.9 months in the residual tumor = 0 group compared to 6.19 months in the residual tumor > 0 group (p < 0.001; log-rank test); the median overall survival was 40.6 months versus 21 months (p = 0.028; log-rank test). Conclusions. These results indicate that primary debulking surgery should be considered the preferred treatment approach for advanced endometrial cancer with carcinosis, especially in carefully selected patients where complete cytoreduction is achievable. Further prospective studies are warranted to confirm these results and to establish standardized criteria for patient selection, incorporating molecular-integrated risk profiles for endometrial cancer.

Role of Pelvic Ultrasound in Predicting the Response to Neoadjuvant Chemotherapy in Locally Advanced Cervical Cancer
Giorgia Perniola, Giulia Paoni Saccone, Noemi Tonti, Federica Tanzi, Innocenza Palaia, Violante Di Donato, Federica Tomao, Ludovico Muzii, Giorgio Bogani, Ilaria Cuccu,et al.
MDPI AG
Background/Objectives: The optimal treatment for locally advanced cervical cancer (LACC) is debated. The proposed treatments are concomitant chemoradiotherapy plus brachytherapy (cCTRT-B) or neoadjuvant chemotherapy (NACT) followed by radical surgery (RS). The prediction NACT response is crucial for identifying responder patients who may benefit from subsequent radical surgery. The aim of this study was to find ultrasound characteristics to predict the response to NACT in patients with LACC. Methods: Consecutive patients with diagnoses of LACC were prospectively enrolled. According to FIGO staging criteria, all IB2-IIIC patients underwent three cycles of platinum-based NACT followed by radical surgery. Patients were evaluated by pelvic ultrasound one week before NACT (T0) and three weeks after the last cycle of chemotherapy (T1). The parameters analysed were volume of the lesion, tumor/uterus volume ratio, parametrial infiltration, color score, resistance (RIUA) and pulsatility (PIUA) indices of uterine arteries (UA). Results: From July 2019 to April 2023, 40 patients were enrolled. A significant decrease in tumor volume (p < 0.01) and a reduced parametrial infiltration after NACT were observed (p < 0.01). The results of the unadjusted and adjusted logistic models showed that age and RIUA positively affect the estimated probability of treatment response (p < 0.01). According to the univariate and multivariate model, RIUA greater than 0.72 ensures 87% sensitivity and 70% specificity with 82.5% accuracy in predicting tumor reduction. Conclusions: Patients over 54 with a RIUA above 0.72 are more likely to respond to NACT. Pelvic ultrasound proved to be a useful tool for predicting NACT response in LACC patients.

Robotic Surgery in Severely Obese Frail Patients for the Treatment of Atypical Endometrial Hyperplasia and Endometrial Cancer: A Propensity-Match Analysis at an ESGO-Accredited Center
Martina Arcieri, Federico Paparcura, Cristina Giorgiutti, Cristina Taliento, Giorgio Bogani, Lorenza Driul, Pantaleo Greco, Alfredo Ercoli, Vito Chiantera, Francesco Fanfani,et al.
MDPI AG
Background and Objectives: Robotic-assisted laparoscopy (RS) has been widely adopted for the management of endometrial cancer (EC) due to favorable perioperative outcomes, especially in the context of obesity, which is an established risk factor for EC. This study retrospectively evaluated the perioperative outcomes of RS versus conventional laparoscopy (LS) in treating EC and atypical endometrial hyperplasia (AH). Methods: Between November 2021 and October 2023, 138 patients with AH or EC underwent surgery at the Clinic of Obstetric and Gynecological—Azienda Sanitaria Universitaria Friuli Centrale, Udine. All patients had total hysterectomy with bilateral salpingo-oophorectomy, with or without lymphadenectomy or sentinel lymph node biopsy. The study included 62 patients treated with LS and 62 with RS. Results: The median BMI was higher in the RS group (35.5 vs. 24 kg/m2, p = 0.001). There was no significant difference in operative time between the laparoscopic group and the robotic console time (median 130 vs. 130 min, p = 0.131). No significant differences were found in terms of blood loss, conversion to laparotomy, intraoperative complications, hospital stay, or early postoperative complications between the two groups. Conclusions: Our data confirm the feasibility of robotic surgery in obese patients, allowing surgical results comparable to those of laparoscopy in normal-weight patients.

Incorporating immune checkpoint inhibitors in epithelial ovarian cancer
Giorgio Bogani, Kathleen N. Moore, Isabelle Ray-Coquard, Domenica Lorusso, Ursula A. Matulonis, Jonathan A. Ledermann, Antonio González-Martín, Jean-Emmanuel Kurtz, Eric Pujade-Lauraine, Giovanni Scambia,et al.
Elsevier BV

Prognostic impact of microscopic residual disease after neoadjuvant chemotherapy in patients undergoing interval debulking surgery for advanced ovarian cancer
Violante Di Donato, Giuseppe Caruso, Tullio Golia D’Augè, Giorgia Perniola, Innocenza Palaia, Federica Tomao, Ludovico Muzii, Angelina Pernazza, Carlo Della Rocca, Giorgio Bogani,et al.
Springer Science and Business Media LLC
Abstract Purpose To determine the prognostic impact of microscopic residual disease after neoadjuvant chemotherapy (NACT) in patients undergoing interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC). Methods Patients affected by FIGO stage IIIC–IV ovarian cancer undergoing IDS between October 2010 and April 2016 were selected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier analysis. Results In total, 98 patients were identified. Four patients (4.1%) were considered inoperable. Overall, 67 patients (out of 94; 71.3%) had macroscopic disease, equating Chemotherapy Response Score (CRS) 1 and 2, 7 (7.4%) had microscopic residuals, equating CRS3, rare CRS2, while 20 (21.3%) had both microscopic and macroscopic disease. Median OS and PFS were, respectively, 44 and 14 months in patients with no macroscopic residual disease (RD = 0) compared to 25 and 6 months, in patients with RD > 0 (OS: p = 0.001; PFS: p = 0.002). The median PFS was 9 months compared to 14 months for patients with more or less than 3 areas of microscopic disease at final pathologic evaluation (p = 0.04). The serum Ca125 dosage after NACT was higher in patients with RD > 0 compared to those without residue (986.31 ± 2240.7 µg/mL vs 215.72 ± 349.5 µg/mL; p = 0.01). Conclusion Even in the absence of macroscopic disease after NACT, the persistence of microscopic residuals predicts a poorer prognosis among AEOC patients undergoing IDS, with a trend towards worse PFS for patients with more than three affected areas. Removing all fibrotic residuals eventually hiding microscopic disease during IDS represents the key to improving the prognosis of these patients.

Chemo-conization in Early-sTage cERvical caNcer >2 cm scheduled for fertilItY-sparing approach: an analysis of the ETERNITY project
Giorgio Bogani, Giovanni Scambia, Mario Malzoni, Jvan Casarin, Giuseppe Vizzielli, Frédéric Amant, Francesco Raspagliesi, Giorgio Bogani, Giovanni Scambia, Anna Fagotti,et al.
Elsevier BV

Performance of molecular classification in predicting oncologic outcomes of fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer
Filippo Alberto Ferrari, Stefano Uccella, Massimo Franchi, Giovanni Scambia, Francesco Fanfani, Anna Fagotti, Matteo Pavone, Francesco Raspagliesi, and Giorgio Bogani
Elsevier BV

Management of Patients with Vulvar Cancers: A Systematic Comparison of International Guidelines (NCCN–ASCO–ESGO–BGCS–IGCS–FIGO–French Guidelines–RCOG)
Stefano Restaino, Giulia Pellecchia, Martina Arcieri, Giorgio Bogani, Cristina Taliento, Pantaleo Greco, Lorenza Driul, Vito Chiantera, Rosa Pasqualina De Vincenzo, Giorgia Garganese,et al.
MDPI AG
Background: Vulvar carcinoma is an uncommon gynecological tumor primarily affecting older women. Its treatment significantly impacts the quality of life and, not least, aesthetics because of the mutilating surgery it requires. Objectives: The management requires a multidisciplinary team of specialists who know how to care for the patient in her entirety, not neglecting psychological aspects and reconstructive surgery. How do the guidelines address multidisciplinarity, team surgical management, passing through preoperative diagnosis, and follow-up in such a challenging rare tumor to treat? Methods: To answer these questions, we compared the main scientific recommendations to identify similarities and differences in diagnostic and therapeutic management to provide an overview of the gaps that there are currently in European and American international recommendations in providing management guidance in a cancer that is both among the rarest and most difficult to manage. In this way, we aim to encourage an update in practices based on the latest scientific evidence. Results: A review of various international guidelines, some dating back to 2014, shows significant variation in approaches, ranging from initial diagnostic procedures to managing relapses. The most recent guidelines also lacked references to the latest literature, indicating that more robust scientific evidence is needed before new treatments, such as electrochemotherapy for palliation and reconstructive surgery post exenteration, can be widely adopted. Conclusions: From the systematic comparison of the main international guidelines, a strong heterogeneity emerged in the diagnostic and therapeutic recommendations as well as for the multidisciplinary approach that today is essential. Our work certainly stimulated an update of the main guidelines.

Human papillomavirus vaccination coverage in Italy
Giorgio Bogani, Giovanni Scambia, Francesco Raspagliesi, and Giovanni Corso
Ovid Technologies (Wolters Kluwer Health)

External validation of the annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer
Luigi A. De Vitis, Gabriella Schivardi, Aurora Gaeta, Giuseppe Caruso, Marina Rosanu, Lucia Ribero, Diletta Fumagalli, Jvan Casarin, Ilaria Betella, Giorgio Bogani,et al.
Elsevier BV

Outcomes of low-risk endometrial cancer with isolated tumor cells in the sentinel lymph nodes: a prospective, multi-center, single-arm, observational study (ENDO-ITC study)
Luigi A. De Vitis, Giorgio Bogani, Francesco Raspagliesi, Octavio Arencibia Sanchez, Beatriz Navarro, Francesco Multinu, Vanna Zanagnolo, Glauco Baiocchi, Louise De Brot, Francesco Fanfani,et al.
Elsevier BV

Editorial: Diagnosis and treatment of vulvar cancer
Violante Di Donato, Tullio Golia D’Augè, Giorgio Bogani, and Andrea Giannini
Frontiers Media SA

Postoperative pain after MiniLap percutaneous versus standard laparoscopic salpingo-oophorectomy: A propensity-matched study
Stefano Restaino, Federico Paparcura, Martina Arcieri, Alice Poli, Giulia Pellecchia, Giorgio Bogani, Cristina Taliento, Luigi Della Corte, Federica Perelli, Jvan Casarin,et al.
Wiley
AbstractObjectiveThe aim of this study was to compare postoperative outcomes in patients undergoing standard laparoscopic salpingo‐oophorectomy versus those using the MiniLap percutaneous surgical system, aiming to demonstrate the non‐inferiority of this ultra‐minimally invasive surgical technique compared to the current gold standard.MethodsThis was a retrospective, single‐center propensity‐matched case–control study. A total of 80 surgical patients undergoing salpingo‐oophorectomy for benign pathology were selected, with 40 in each group (MiniLap in group A and S‐LPS in group B). Postoperative pain was subjectively reported at 2, 4, 12, and 24 h after surgery. The secondary outcomes of this study were to evaluate differences in the duration of surgery, intraoperative blood loss, postoperative complications, and cosmetic results.ResultsThe median operative time was 57.7 min (range, 28–125) in group A and 75.5 min (range, 22–180) in group B (P value 0.005). No statistical differences were recorded in terms of estimated blood loss (P value 0.05), length of hospital stay (P value 0.74), complications (P‐value 0.31), and postoperative pain (P value 0.06 at 2 h postoperatively). Cosmetic outcomes acquired through subjective assessment by the patient and surgeon at discharge and 1 month after surgery demonstrated a statistically significant higher satisfaction rate in the MiniLap compared to the S‐LPS group.ConclusionOur study demonstrates that salpingo‐oophorectomy performed with the MiniLap system is feasible, safe, and well‐tolerated by patients. Furthermore, this technique has proven to be non‐inferior to standard LPS in terms of postoperative pain, blood loss, hospital stay duration, and complications.

Uterine smooth muscle tumours with uncertain malignant potential: reproductive and clinical outcomes in patients undergoing fertility-sparing management
Umberto Leone Roberti Maggiore, Francesco Fanfani, Giovanni Scambia, Ilaria Capasso, Emanuele Perrone, Giuseppe Parisi, Gian Franco Zannoni, Francesca Falcone, Alessandra Di Giovanni, Mario Malzoni,et al.
Oxford University Press (OUP)
Abstract STUDY QUESTION Can patients with uterine smooth muscle tumours of uncertain malignant potential (STUMP) be effectively and safely managed with fertility-sparing treatment? SUMMARY ANSWER This multicentre retrospective study demonstrates that fertility-sparing management for patients diagnosed with STUMP is both feasible and safe. WHAT IS KNOWN ALREADY Few studies, involving a limited number of patients, have investigated fertility-sparing management for STUMP in women with future pregnancy aspirations. STUDY DESIGN, SIZE, DURATION This multicentre retrospective study was conducted in collaboration with 13 Italian institutions specializing in gynaecologic oncology. The primary objective was to evaluate the reproductive outcomes of the included patients, while the secondary objective was to analyse their clinical outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 106 patients with a histological diagnosis of STUMP who underwent fertility-sparing treatment for uterine tumours were included. Patient data were collected from 13 referral centres across Italy, and reproductive and clinical outcomes were documented during follow-up. The median (range) length of follow-up was 48 (7–191) months. MAIN RESULTS AND THE ROLE OF CHANCE Of the 106 patients, 47 (44.3%) patients actively tried to conceive after fertility-sparing surgery, and 27 of them (57.4%) achieved a pregnancy. Among the patients trying to conceive, 12 (25.5%) women had more than one pregnancy after surgery for STUMP. At follow-up, 23 (21.7%) out of the 106 women had a recurrence of uterine disease. Furthermore, a higher rate of recurrence was observed among patients who became pregnant (17 out of 27 women (63.0%)) compared with those who did not (6 out of 79 women (7.6%); P &lt; 0.001). Only two cases (1.9%) of malignant relapse were recorded, and one patient with a leiomyosarcoma recurrence died. LIMITATIONS, REASONS FOR CAUTION The primary limitation of this study is the inherent biases associated with its retrospective design. WIDER IMPLICATIONS OF THE FINDINGS This multicentre retrospective study represents the largest case series to date examining the reproductive and clinical outcomes of patients undergoing conservative treatment for STUMP. The findings suggest that patients can be counselled on the feasibility and safety of fertility-sparing management, which should be considered by clinicians as both safe and effective. STUDY FUNDING/COMPETING INTEREST(S) No funding was received, and there are no competing interests. TRIAL REGISTRATION NUMBER N/A.

Laparoscopic prediction of primary cytoreducibility of epithelial ovarian cancer
Tullio GOLIA D’AUGÈ, Ilaria CUCCU, Emanuele DE ANGELIS, Violante DI DONATO, Ludovico MUZII, Ottavia D’ORIA, Vito CHIANTERA, Sandro GERLI, Donatella CASERTA, Aris R. BESHARAT,et al.
Edizioni Minerva Medica
Ovarian cancer affects thousands of women every year and represents the female cancer with the highest mortality rate. Effectively, it is a severe disease that requires a multidisciplinary approach for optimal treatment. Surgery currently is the cornerstone of its treatment and numerous methods have been analyzed and developed to predict the possibility of obtaining a residual tumor of 0 (RT=0). This review aimed to analyze the available data in the literature about minimally invasive surgical methods to predict an RT=0 in patients with advanced epithelial ovarian carcinoma undergoing primary debulking surgery. An accurate review of the literature has been performed on the available data about the surgical criteria of cytoreducibility during primary debulking surgery. An accurate assessment of the extent of intra- and extra-abdominal pathology is essential to guide the surgeon in the most appropriate therapeutic choice for patients with ovarian cancer and multidisciplinary approaches that combine different methodologies such as radiological methods (magnetic resonance imaging, positron emission tomography and computed tomography), surgical (mini-laparotomy, laparoscopy) and serological (CA-125, HE4) data provide a complete picture in determining the extent of the tumor and an enormous aid in personalizing the therapeutic approach.

Update on Genitourinary Syndrome of Menopause: A Scoping Review of a Tailored Treatment-Based Approach
Ilaria Cuccu, Tullio Golia D’Augè, Ilaria Firulli, Emanuele De Angelis, Giovanni Buzzaccarini, Ottavia D’Oria, Aris Raad Besharat, Donatella Caserta, Giorgio Bogani, Ludovico Muzii,et al.
MDPI AG
This scoping review explores the therapeutic strategies available for managing genitourinary syndrome of menopause (GSM), a condition often underdiagnosed and undertreated despite significantly affecting women’s quality of life. GSM results from decreased estrogen levels during menopause, leading to a range of symptoms including vulvovaginal atrophy and urinary tract issues. Material and Methods: we screened the literature for original studies with “menopause”, “hormonal therapy”, “vulvovaginal atrophy”, “urinary incontinence”, “urinary infections”, “genitourinary syndrome”. Results: A total of 451 relevant articles were retrieved. After screening, 19 articles were included in this scoping review. Discussion: First-line treatments typically include lubricants and moisturizers for short-term symptom relief, while unresolved or severe cases may warrant hormonal treatment. Topical hormonal treatments often have fewer side effects than systemic alternatives. Special attention is given to selective estrogen receptor modulators like ospemifene and steroid hormones like dehydroepiandrosterone (DHEA), which have shown beneficial effects on GSM symptoms. Moreover, innovative therapeutic approaches, such as laser treatment, are discussed in the context of their efficacy and accessibility. The safety of GSM hormonal therapy in women with a history or risk of cancer is also addressed, noting the need for more definitive research in this area. While there is a growing demand for tailored therapy, this scoping review emphasizes the importance of effective communication and counseling to allow women to make informed decisions about their treatment. Overall, this review underscores the need for increased awareness and further research into effective treatment options for GSM.

Relapse Patterns in Early-Stage Endometrial Cancer Based on Molecular Classification
Giorgio Bogani and Francesco Raspagliesi
American Medical Association (AMA)

Fertility-sparing treatment with conization versus radical hysterectomy in patients with early-stage cervical cancer: Inverse propensity score weighted analysis
Antonino Ditto, Fabio Martinelli, Marco Dri, Umberto Leone Roberti Maggiore, Giorgio Bogani, Shigeky Kusamura, Biagio Paolini, Edgardo Somigliana, and Francesco Raspagliesi
BMJ
Objective To report 20 years of experience with fertility-sparing surgery for patients with early-stage cervical cancer, comparing the oncological outcomes with outcomes for those who underwent a radical hysterectomy. Methods Patients with pre-operative stage IA1 with lymphovascular space invasion, IA2 and IB1 cervical cancer (any grade) were included (2018 International Federation of Gynecology and Obstetrics staging system). Inclusion criteria comprised age (18–44 years), histology (squamous, adenocarcinoma, or adenosquamous) and absence of previous/concomitant cancer. A thorough counseling about oncological and obstetrical potential risks was mandatory for patients asking for fertility sparing. Results for consecutive patients who underwent fertility-sparing surgery (cervical conization and nodal evaluation) were analyzed and compared with results for patients treated with radical surgery. Oncological outcomes were assessed with a propensity score adjustment with inverse probability of treatment weighting. Results Overall, 109 patients were included in the study. Ten patients abandoned the fertility-sparing route because of nodal involvement (n=5), margin positive (n=2), or because patients requested radical treatment (n=3). Sentinel node mapping was performed in 19 of 49 (38.8%) patients in the fertility-sparing surgery group. Among the patients in the fertility-sparing group, 6 (12.2%) patients relapsed. 34 (69.4%) patients attempted to conceive. Pre-operative covariates selected to define the probability of having either fertility-sparing or radical surgery were well balanced using inverse probability of treatment weighting. Pathological features were similar between the groups, including grading, histotype, stage, and lymphovascular space invasion. After a median follow-up of 38.8 (range 5–186) months there were no differences in progression-free survival (p=0.32) and overall survival (p=0.74) between the fertility-sparing and radical hysterectomy groups. The results after inverse probability of treatment weighting adjustment did not show significant differences in progression-free survival (p=0.72) and overall survival (p=0.71) between the groups. Conclusion Fertility-sparing surgery based on conization plus laparoscopic lymph node evaluation, may be considered safe and effective for patients with early-stage cervical cancer.

Response to: Correspondence on 'Predicting the risk of nodal disease with histological and molecular features in endometrial cancer: the prospective PROME trial' by Aznar et al
Giorgio Bogani, Luca Lalli, Jvan Casarin, Fabio Ghezzi, Valentina Chiappa, Francesco Fanfani, Giovanni Scambia, and Francesco Raspagliesi
BMJ

Giorgio Bogani

RESEARCH INTERESTS

Scopus Publications