Maria Luisa Gasparri
@hsr.it
IRCCS Ospedale San Raffaele
Scopus Publications
Scopus Publications
Stefania Rizzo, Maria Luisa Gasparri, Lucia Manganaro, Filippo Del Grande, Andrea Papadia, and Francesco Petrella
MDPI AG
Ovarian cancer typically presents at advanced stages, with prognosis heavily influenced by the presence of residual disease following cytoreductive surgery. The role of resecting enlarged extra-abdominal lymph nodes during cytoreductive procedures remains contentious. These enlarged lymph nodes are commonly identified through high-resolution imaging techniques such as ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography–computed tomography (PET-CT). A comprehensive understanding of the relevant anatomy, imaging modalities, and surgical techniques for addressing lymphadenopathy in regions such as the supraclavicular fossa, axillae, mediastinum, and pericardiophrenic fat is crucial in determining the feasibility of surgical intervention. An appropriate evaluation of these factors is essential to optimize debulking, which is recognized as the most significant prognostic determinant in patients with ovarian cancer. This review underscores the importance of multidisciplinary approaches in managing advanced ovarian cancer with extra-abdominal lymph node involvement to enhance patient outcomes.
Rahel Felicia Mirjam Schmidt, Yves Harder, Lorenzo Rossi, Paola Canino, Simone Schiaffino, Arianna Calcinotto, Ulrike Perriard, Rossella Graffeo, Roberta Decio, Claudia Canonica,et al.
MDPI AG
Background and Objectives: The Albumin-to-Alkaline Phosphatase ratio (AAPR) is an easily applicable and cost-effective marker investigated as an outcome predictor in solid cancers. Preliminary evidence in breast cancer suggests that a low AAPR correlates with a poor response to neoadjuvant chemotherapy (NAC) in primary tumors. However, data regarding the axillary response are lacking. This study aims to evaluate whether the AAPR can predict the axillary response in initially nodal-positive (cN+) breast cancer patients undergoing NAC. Materials and Methods: Clinical and biochemical variables of cN+ breast cancer patients undergoing NAC were collected. Pre-NAC albumin and alkaline phosphatase serum values were utilized in the AAPR calculation. Fisher’s exact test was performed to identify differences between the two groups of patients (high and low AAPR according to the cut-off reported in the literature). The primary outcome was the nodal pathologic complete response (pCR) rate in the two groups of patients. Results: Nodal pCR was achieved in 20/45 (44.4%) patients. A total of 36/45 (80%) patients had an AAPR > 0.583. Among patient and tumor characteristics, the only statistically significant difference between the two groups was the axillary pCR between the low and high AAPR groups (p-value = 0.03, OR = 0.129, 95% CI = 0.00–0.835). Conclusions: This pilot study suggests that the pre-treatment AAPR might be an early predictor of axillary response in cN+ breast cancer patients undergoing NAC. This result justifies further investigation in larger prospective trials to validate this finding.
Natalia Krawczyk, Thorsten Kühn, Nina Ditsch, Steffi Hartmann, Oreste Davide Gentilini, Annette Lebeau, Jana de Boniface, Markus Hahn, Güldeniz Karadeniz Çakmak, Sadaf Alipour,et al.
MDPI AG
Background: Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory breast condition often mistaken for inflammatory breast cancer and, therefore, requires a biopsy for accurate diagnosis. Although not cancerous, IGM can cause emotional distress because of severe pain and ensuing breast deformity. Differentiating IGM from other breast inflammations caused by infections is essential. IGM mostly affects premenopausal women and is potentially associated with recent pregnancies and breastfeeding. The risk factors, including smoking and contraceptive use, have inconsistent associations. Steroid responses suggest an autoimmune component, though specific markers are lacking. Methods: We performed a narrative review on potential risk factors, diagnostics, and therapy of IGM. Results: Diagnostics and clinical management of IGM are challenging. The treatment options include NSAIDs, steroids, surgery, antibiotics, immunosuppressants, prolactin suppressants, and observation, each with varying effectiveness and side effects. Conclusions: Current IGM treatment evidence is limited, based on case reports and small series. There is no consensus on the optimal management strategy for this disease. The GRAMAREG study by the EUBREAST Study Group aims to collect comprehensive data on IGM to improve diagnostic and treatment guidelines. By enrolling patients with confirmed IGM, the study seeks to develop evidence-based recommendations, enhancing patient care and understanding of this condition.
SummaryBackgroundMultimorbidity poses a global challenge to healthcare delivery. This study aimed to describe the prevalence of multimorbidity, common disease combinations and outcomes in a contemporary cohort of patients undergoing major abdominal surgery.MethodsThis was a pre‐planned analysis of a prospective, multicentre, international study investigating cardiovascular complications after major abdominal surgery conducted in 446 hospitals in 29 countries across Europe. The primary outcome was 30‐day postoperative mortality. The secondary outcome measure was the incidence of complications within 30 days of surgery.ResultsOf 24,227 patients, 7006 (28.9%) had one long‐term condition and 10,486 (43.9%) had multimorbidity (two or more long‐term health conditions). The most common conditions were primary cancer (39.6%); hypertension (37.9%); chronic kidney disease (17.4%); and diabetes (15.4%). Patients with multimorbidity had a higher incidence of frailty compared with patients ≤ 1 long‐term health condition. Mortality was higher in patients with one long‐term health condition (adjusted odds ratio 1.93 (95%CI 1.16–3.23)) and multimorbidity (adjusted odds ratio 2.22 (95%CI 1.35–3.64)). Frailty and ASA physical status 3–5 mediated an estimated 31.7% of the 30‐day mortality in patients with one long‐term health condition (adjusted odds ratio 1.30 (95%CI 1.12–1.51)) and an estimated 36.9% of the 30‐day mortality in patients with multimorbidity (adjusted odds ratio 1.61 (95%CI 1.36–1.91)). There was no improvement in 30‐day mortality in patients with multimorbidity who received pre‐operative medical assessment.ConclusionsMultimorbidity is common and outcomes are poor among surgical patients across Europe. Addressing multimorbidity in elective and emergency patients requires innovative strategies to account for frailty and disease control. The development of such strategies, that integrate care targeting whole surgical pathways to strengthen current systems, is urgently needed for multimorbid patients. Interventional trials are warranted to determine the effectiveness of targeted management for surgical patients with multimorbidity.
SummaryCardiovascular complications after major surgery are associated with increases in morbidity and mortality. There is confusion over definitions of cardiac injury or complications, and variability in the assessment and management of patients. This international prospective cohort study aimed to define the incidence and timing of these complications and to investigate their impact on 30‐day all‐cause mortality. We performed a prospective, international cohort study between January 2022 and May 2022. Data were collected on consecutive patients undergoing major abdominal surgery in 446 hospitals from 28 countries across Europe. The primary outcome measure was cardiovascular complications as defined by the Standardised Endpoints for Perioperative Medicine‐Core Outcome Measures for Perioperative and Anaesthetic Care initiative up to 30 days after surgery. The secondary outcome was 30‐day postoperative mortality. This study included 24,203 patients, of whom 611 (2.5%) developed cardiovascular complications. In total, 458 (1.9%) patients died within 30 days of surgery, of which 123 (26.9%) deaths were judged to be cardiac‐related. Mortality rates were higher in patients who developed postoperative cardiovascular complications than in those who did not (19.8% vs. 1.4%), which persisted after risk adjustment (hazard ratio (95%CI) 4.15 (3.14–5.48)). We estimated an absolute risk reduction (95%CI) of 0.4 (0.3–0.5) in mortality in the absence of all cardiovascular complications. This would confer a relative risk reduction in mortality of 21.1% if all cardiovascular complications were prevented. Postoperative cardiovascular complications are relatively common and occur early after major abdominal surgery. However, over 1 in 5 postoperative deaths were attributable to these complications, highlighting an important area for future randomised trials.
Jessica Mauro, Diego Raimondo, Giampaolo Di Martino, Maria Luisa Gasparri, Stefano Restaino, Daniele Neola, Luca Clivio, Carmelo Calidona, Robert Fruscio, Giuseppe Vizzielli,et al.
BMJ
ObjectiveTo evaluate the impact of different volumes of indocyanine green (ICG) on the detection rate and bilateral mapping of sentinel lymph nodes in patients with apparent uterine-confined endometrial cancer.MethodsAll patients who underwent surgical staging with sentinel node mapping in six reference centers were included. Two different protocols of ICG intracervical injection were used: (1) 2 mL group: total volume of 2 mL injected superficially; (2) 4 mL group: total volume of 4 mL, 2 mL deeply and 2 mL superficially. Logistic regression was used to analyze factors that could influence dye migration and detection rates. A sensitivity analysis was carried out to determine how independent variables could affect the sentinel node detection rate.ResultsOf 442 eligible patients, 352 were analyzed (172 in the 2 mL group and 180 in the 4 mL group). The bilateral detection rates of the 2 mL and 4 mL groups were 84.9% and 86.1%, respectively (p=0.76). The overall detection rate was higher with a volume of 4 mL than with 2 mL (92.4% vs 97.8%, respectively; p=0.024). In the univariate analysis the rate of bilateral mapping fell from 87.5% to 73.5% when the International Federation of Gynecology and Obstetrics (FIGO) 2009 tumor stage was >IB (p=0.018). In the multivariate analysis, for both overall and bilateral detection rates a statistically significant difference emerged for the volume of ICG injected and FIGO 2009 stage >IB. Increasing body mass index was associated with worse overall detection rates on univariate analysis (p=0.0006), and significantly decreased from 97% to 91% when the body mass index exceeded 30 kg/m2(p=0.05).ConclusionsIn patients with early-stage endometrial cancer, a volume of 2 mL ICG does not seem to compromise the bilateral detection of sentinel lymph nodes. In women with obesity and FIGO 2009 stage >IB, a 4 mL injection should be preferred.
Michalis Kontos, Prodromos Kanavidis, Thorsten Kühn, Yazan Masannat, Bahadir Gulluoglu, , Eduardo Gonzalez, Melanie Walker, A. J. Collins, M. T. Nano,et al.
Springer Science and Business Media LLC
Maggie Banys-Paluchowski, Laura Brus, Natalia Krawczyk, Sophie Valeria Kopperschmidt, Maria Luisa Gasparri, Nana Bündgen, Achim Rody, Lars Hanker, Franziska Hemptenmacher, and Peter Paluchowski
Springer Science and Business Media LLC
Abstract Purpose The use of autologous tissues is considered gold standard for patients undergoing breast reconstruction and is the preferred method in the post-radiation setting. Although the latissimus dorsi flap (LDF) has been replaced by abdominal flaps as technique of choice, it remains a valuable option in several specific clinical situations and its use has been regaining popularity in recent years. In this work, we present an 18-year retrospective analysis of a single-institution single-surgeon experience with LDF-based reconstruction with focus on early complications and reconstructive failures. Methods Hospital records of all patients undergoing breast surgery for any reason in the Certified Breast Cancer Center, Regio Klinikum Pinneberg, Germany between April, 1st 2005 and October, 31st 2022 were reviewed. 142 consecutive LDF-based reconstructive procedures were identified. Detailed information was gathered on patient characteristics, treatment-related factors, and complications. Results One hundred forty patients (139 female, 1 male) received 142 LDF-based surgeries. The flap was used mainly for immediate breast reconstruction with or without implant (83% of patients), followed by defect coverage after removal of a large tumor (7%), implant-to-flap conversion with or without placement of a new implant (6%), and delayed post-mastectomy reconstruction (4%). The use of LDF decreased between 2005 and 2020 (2005: 17, 2006: 13, 2007: 14, 2008: 16, 2009: 5, 2010: 9, 2011: 8, 2012: 3, 2013: 10, 2014: 8, 2015: 8, 2016: 7, 2017: 7, 2018: 4, 2019: 4, 2020: 2, 2021: 6, 2022: 4). Surgery was performed for invasive breast cancer in 78%, ductal carcinoma in situ in 20% and other reasons such as genetic mutation in 1% of patients. Ipsilateral radiation therapy was received by 12% of patients prior to LDF surgery and by 37% after the surgery. 25% of patients were smokers. The median duration of surgery, including all procedures conducted simultaneously such as e.g., mastectomy, axillary surgery, or implant placement, was 117 min (range 56–205). Patients stayed in the hospital for a median of 7 days (range 2–23 days). The most common complication was seroma (26%), followed by wound dehiscence (8%), surgical site infection (7%), partial skin and/or nipple necrosis of any size (7%) and hematoma requiring surgical evacuation (2%). 19% of all patients required seroma aspiration or drainage, mostly at the donor site and performed under ultrasound guidance in the ambulatory setting. Flap loss due to necrosis occurred in 2% of patients. Conclusions Latissimus dorsi flap is a well-established surgical technique commonly used for immediate breast reconstruction as well as defect coverage in locally advanced breast cancer. To the best of our knowledge, this is one of the largest single-surgeon analyses of early complications in patients receiving LDF. As expected, seroma was the most common complication observed in nearly one third of patients and requiring a therapeutic intervention in every fifth patient. Serious adverse events occurred rarely, and flap loss rate was very low.
Giorgio Raia, Maria Del Grande, Ilaria Colombo, Marta Nerone, Lucia Manganaro, Maria Luisa Gasparri, Andrea Papadia, Filippo Del Grande, and Stefania Rizzo
MDPI AG
Background: The primary objective of this study was to assess the associations of computed tomography (CT)-based whole-body composition values with overall survival (OS) and progression-free survival (PFS) in epithelial ovarian cancer (EOC) patients. The secondary objective was the association of body composition with chemotherapy-related toxicity. Methods: Thirty-four patients (median age 64.9 years; interquartile range 55.4–75.4) with EOC and thorax and abdomen CT scans were included. Clinical data recorded: age; weight; height; stage; chemotherapy-related toxicity; and date of last contact, progression and death. Automatic extraction of body composition values was performed by dedicated software. Sarcopenia was defined according to predefined cutoffs. Statistical analysis included univariate tests to investigate associations of sarcopenia and body composition with chemotoxicity. Association of body composition parameters and OS/PFS was evaluated by log-rank test and Cox proportional hazard model. Multivariate models were adjusted for FIGO stage and/or age at diagnosis. Results: We found significant associations of skeletal muscle volume with OS (p = 0.04) and PFS (p = 0.04); intramuscular fat volume with PFS (p = 0.03); and visceral adipose tissue, epicardial and paracardial fat with PFS (p = 0.04, 0.01 and 0.02, respectively). We found no significant associations between body composition parameters and chemotherapy-related toxicity. Conclusions: In this exploratory study, we found significant associations of whole-body composition parameters with OS and PFS. These results open a window to the possibility to perform body composition profiling without approximate estimations.
Giorgio Bogani, Violante Di Donato, Andrea Papadia, Alessandro Buda, Jvan Casarin, Francesco Multinu, Francesco Plotti, Maria Luisa Gasparri, Ciro Pinelli, Anna Myriam Perrone,et al.
Elsevier BV
Guillaume Favre, Eva Gerbier, Emeline Maisonneuve, Léo Pomar, Ursula Winterfeld, Karine Lepigeon, Kitty W. M. Bloemenkamp, Odette de Bruin, Eimir Hurley, Hedvig Nordeng,et al.
Wiley
The objective of this study was to describe the use of COVID‐19‐related medicines during pregnancy and their evolution between the early/late periods of the pandemic.
Maggie Banys-Paluchowski, Michael Untch, Natalia Krawczyk, Maria Thurmann, Thorsten Kühn, Jalid Sehouli, Maria Luisa Gasparri, Jana de Boniface, Oreste Davide Gentilini, Elmar Stickeler,et al.
Springer Science and Business Media LLC
Abstract Purpose In the last 2 decades, the optimal management of the axilla in breast cancer patients receiving neoadjuvant chemotherapy (NACT) has been one of the most frequently discussed topics. Little is known about the attitudes of surgeons/radiologists towards new developments such as targeted axillary dissection. Therefore, the NOGGO conducted a survey to evaluate the current approach to axillary management. Methods A standardized digital questionnaire was sent out to > 200 departments in Germany between 7/2021 and 5/2022. The survey was supported by EUBREAST. Results In total, 116 physicians completed the survey. In cN0 patients scheduled to receive NACT, 89% of respondents recommended sentinel lymph node biopsy (SLNB) after NACT. In case of ypN1mi(sn), 44% advised no further therapy, while 31% proposed ALND and 25% axillary irradiation. 64% of respondents recommended a minimally invasive axillary biopsy to cN + patients. TAD was used at the departments of 82% of respondents and was offered to all cN + patients converting to ycN0 by 57% and only to selected patients, usually based on the number of suspicious nodes at time of presentation, by 43%. The most common marking technique was a clip/coil. 67% estimated that the detection rate of their marker was very good or good. Conclusion This survey shows a heterogenous approach towards axillary management in the neoadjuvant setting in Germany. Most respondents follow current guidelines. Since only two-thirds of respondents experienced the detection rate of the marker used at their department as (very) good, future studies should focus on the comparative evaluation of different marking techniques.
Guillaume Favre, Emeline Maisonneuve, Léo Pomar, Charlotte Daire, Christophe Poncelet, Thibaud Quibel, Cécile Monod, Begoña Martinez de Tejada, Leonhard Schäffer, Andrea Papadia,et al.
Elsevier BV
Maggie Banys-Paluchowski, Thorsten Kühn, Yazan Masannat, Isabel Rubio, Jana de Boniface, Nina Ditsch, Güldeniz Karadeniz Cakmak, Andreas Karakatsanis, Rajiv Dave, Markus Hahn,et al.
MDPI AG
Background: Surgical excision of a non-palpable breast lesion requires a localization step. Among available techniques, wire-guided localization (WGL) is most commonly used. Other techniques (radioactive, magnetic, radar or radiofrequency-based, and intraoperative ultrasound) have been developed in the last two decades with the aim of improving outcomes and logistics. Methods: We performed a systematic review on localization techniques for non-palpable breast cancer. Results: For most techniques, oncological outcomes such as lesion identification and clear margin rate seem either comparable with or better than for WGL, but evidence is limited to small cohort studies for some of the devices. Intraoperative ultrasound is associated with significantly higher negative margin rates in meta-analyses of randomized clinical trials (RCTs). Radioactive techniques were studied in several RCTs and are non-inferior to WGL. Smaller studies show higher patient preference towards wire-free localization, but little is known about surgeons’ and radiologists’ attitudes towards these techniques. Conclusions: Large studies with an additional focus on patient, surgeon, and radiologist preference are necessary. This review aims to present the rationale for the MELODY (NCT05559411) study and to enable standardization of outcome measures for future studies.
Roghieh Nooripour, Simin Hosseinian, Nikzad Ghanbari, Shahpar Haghighat, Joshua J. Matacotta, and Maria Luisa Gasparri
Springer Science and Business Media LLC
Maria Luisa Gasparri, Sara Albasini, Marta Truffi, Karin Favilla, Barbara Tagliaferri, Francesca Piccotti, Daniela Bossi, Giulia Armatura, Arianna Calcinotto, Corrado Chiappa,et al.
SAGE Publications
Background: Systemic inflammatory markers draw great interest as potential blood-based prognostic factors in several oncological settings. Objectives: The aim of this study is to evaluate whether neutrophil-to-lymphocyte ratio (NLR) and pan-immune-inflammation value (PIV) predict nodal pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) in node-positive (cN+) breast cancer (BC) patients. Design: Clinically, cN+ BC patients undergoing NAC followed by breast and axillary surgery were enrolled in a multicentric study from 11 Breast Units. Methods: Pretreatment blood counts were collected for the analysis and used to calculate NLR and PIV. Logistic regression analyses were performed to evaluate independent predictors of nodal pCR. Results: A total of 1274 cN+ BC patients were included. Nodal pCR was achieved in 586 (46%) patients. At multivariate analysis, low NLR [odds ratio (OR) = 0.71; 95% CI, 0.51–0.98; p = 0.04] and low PIV (OR = 0.63; 95% CI, 0.44–0.90; p = 0.01) were independently predictive of increased likelihood of nodal pCR. A sub-analysis on cN1 patients ( n = 1075) confirmed the statistical significance of these variables. PIV was significantly associated with axillary pCR in estrogen receptor (ER)−/human epidermal growth factor receptor 2 (HER2)+ (OR = 0.31; 95% CI, 0.12–0.83; p = 0.02) and ER−/HER2− (OR = 0.41; 95% CI, 0.17–0.97; p = 0.04) BC patients. Conclusion: This study found that low NLR and PIV levels predict axillary pCR in patients with BC undergoing NAC. Registration: Eudract number NCT05798806.
James C Glasbey, Tom EF Abbott, Adesoji Ademuyiwa, Adewale Adisa, Ehab AlAmeer, Sattar Alshryda, Alexis P Arnaud, Brittany Bankhead-Kendall, M K Abou Chaar, Daoud Chaudhry,et al.
Elsevier BV
Stefania Rizzo, Giorgio Raia, Maria Del Grande, Maria Luisa Gasparri, Ilaria Colombo, Lucia Manganaro, Andrea Papadia, and Filippo Del Grande
Frontiers Media SA
ObjectivesThe main objective of this systematic review was to examine the literature evaluating association of image-based body composition with chemotherapy-related toxicity in ovarian cancer patients. A secondary objective was to evaluate the different definitions of sarcopenia across studies.MethodsThis systematic review was conducted according to the PRISMA-DTA statement and the protocol was registered on Prospero. A comprehensive literature search of 3 electronic databases was performed by two authors. For each eligible article, information was collected concerning the clinical setting; basic study data; population characteristics; technical aspects; body composition features; chemotherapy drugs administered; association of body composition values and toxicities. The overall quality of the included studies was critically evaluated.ResultsAfter the initial retrieval of 812 articles, the systematic review included 6 articles (5/6 studies were retrospective; one was prospective). The number of patients ranged between 69 and 239; mean/median age ranged between 55 and 65 years; the percentage of sarcopenic patients ranged between 25% and 54%. The cut-off values to define sarcopenia and the vertebral levels for evaluation of body composition were different. Five studies included chemotherapy based on carboplatin and paclitaxel, 1 included chemotherapy based on pegylated liposomal doxorubicin. Among the studies including carboplatin and paclitaxel, 3/5 demonstrated an association with toxicity, whereas 2/5 did not. Altogether, 4/6 papers demonstrated an association between the body composition values and the development of chemotherapy-related toxicities.ConclusionsThere is a wide variability of results about the association of body composition and chemotherapy-related toxicity in ovarian cancer patients. Therefore further studies, possibly including a comprehensive assessment of body compartments and where the definition of body composition cut-offs is constant, are warranted to better understand this association.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022337753, identifier (CRD42022337753).
Marta BONOLLO, Serena BELLAMINUTTI, Maria L. GASPARRI, and Andrea PAPADIA
Edizioni Minerva Medica
INTRODUCTION
Conventionally, laparoscopic surgery in gynecology requires multiple accesses in the abdominal cavity. Laparo-Endoscopic Single-Site surgery (LESS) is a more recent technique consisting in a laparoscopy in which the abdominal cavity is reached by a single umbilical incision. The aim of this systematic review is to summarize and comment the benefits and drawbacks in benign gynecological surgeries, including hysterectomy, myomectomy, and adnexal surgery, by LESS and conventional Multi-Port Laparoscopy (MPL), respectively.
EVIDENCE ACQUISITION
A systematic review following the Preferred Reporting Items for Systematic reviews and Randomized Control Trials (PRISMA) was performed by researching articles in PubMed, Medline, Web of Science, and Cochrane library. The terms searched were "single port laparoscopy" or "laparo-endoscopic single site surgery" or "single site laparoscopy" or "single-incision laparoscopic surgery" and "hysterectomy", or "myomectomy", or "adnexal surgery". Only randomized-controlled trials (RCTs) comparing LESS and MPL in benign gynecology were included.
EVIDENCE SYNTHESIS
Thirteen RCTs including 1088 women undergoing gynecological surgery for benign disease through LESS versus MPL were included in the analysis of which 620 underwent hysterectomy, 154 myomectomy, 314 adnexal surgery. LESS approach was performed in 531/1088 (48.8%) procedures. All studies compared the surgical outcomes for length of operative time, hemoglobin drop, length of hospitalization, rate of conversion, post-operative pain, intra and post-operative complications. For hysterectomy, a longer operating time and a higher conversion rate were shown in the LESS group, but no significant differences were found for the other outcomes. For myomectomy, the only significant difference was found for a higher conversion rate in the LESS group. For adnexal surgery, no significant differences were found. Globally there was no difference in pain based on the Visual Analog Scale score. Cosmetic outcome was reported in 6/13 of the studies included, 4/6 demonstrated a superior cosmetic satisfaction in the LESS group.
CONCLUSIONS
Despite cosmetic result is intuitively the main advantage for LESS technique, current evidence does not seem to demonstrate a clear superiority of LESS compared to MPL in benign gynecological surgery.
Maria Luisa Gasparri, Jana de Boniface, Philip Poortmans, Oreste D Gentilini, Orit Kaidar-Person, Maggie Banys-Paluchowski, Rosa Di Micco, Laura Niinikoski, David Murawa, Eduard Alexandru Bonci,et al.
Oxford University Press (OUP)
Abstract Background There is no consensus on axillary management after neoadjuvant therapy (NAT) in patients with clinically node-positive (cN+) breast cancer. To investigate current clinical practice, an international survey was conducted among breast surgeons and radiation oncologists. The aim of the first part of the survey was to provide a snapshot of international discrepancies regarding axillary surgery in this context. Methods The European Breast Cancer Research Association of Surgical Trialists (EUBREAST) developed a web-based survey containing 39 questions describing clinical scenarios in the setting of axillary management in patients with cN1 disease converting to ycN0 after NAT. The survey was then distributed to breast surgeons and radiation oncologists via 14 breast cancer societies between April and October 2021. Results Responses from 349 physicians in 45 countries were recorded. The most common post-NAT axillary surgery in patients with cN1 disease converting to ycN0 was targeted axillary dissection (54.2 per cent), followed by sentinel lymph node biopsy (SLNB) alone (20.9 per cent), level 1–2 axillary lymph node dissection (ALND) (18.4 per cent), level 1–3 ALND (4 per cent), and targeted lymph node biopsy (2.5 per cent). For SLNB alone, dual tracers were most commonly used (62.3 per cent). Management varied widely in patients with ambiguous axillary status before initiation of treatment or a residual metastatic burden in the axilla after NAT. In patients with ycN+ tumours, ALND was the preferred surgical approach for 66.8 per cent of respondents. Conclusion These results highlight the wide heterogeneity in surgical approaches to the axilla after NAT. To standardize the guidelines, further data from clinical research are urgently needed, which underlines the importance of the ongoing AXSANA (EUBREAST-3) study.
Giorgio Bogani, Violante Di Donato, Andrea Papadia, Alessandro Buda, Jvan Casarin, Francesco Multinu, Francesco Plotti, Ilaria Cuccu, Tullio Golia D'Auge, Maria Luisa Gasparri,et al.
Elsevier BV
Maria Luisa Gasparri, Serena Bellaminutti, Ammad Ahmad Farooqi, Ilaria Cuccu, Violante Di Donato, and Andrea Papadia
MDPI AG
This systematic review identifies, evaluates, and summarises the findings of all relevant individual studies on the prevalence of BRCA mutation (BRCAm) in endometrial cancer patients and the incidence of endometrial cancer in BRCAm women patients. Consequently, the benefits and limits of a prophylactic hysterectomy at the time of the risk-reducing salpingo-oophorectomy are analysed and discussed. A systematic literature search was performed in the databases of PubMed, Cochrane, and Web of Science until May 2022; 13 studies met the eligibility criteria. Overall, 1613 endometrial cancer patients from 11 cohorts were tested for BRCA1/2 mutation. BRCA1/2m were identified in 4.3% of women with endometrial cancer (70/1613). BRCA1m was the most represented (71.4%) pathogenic variant. Alongside, a total of 209 BRCAm carriers from 14 studies were diagnosed with endometrial cancer. Only 5 out of 14 studies found a correlation between BRCAm and an increased risk of endometrial cancer. Nevertheless, two studies found a statistical difference only for BRCA1m women. The present systematic review does not provide strong evidence in favour of performing routine hysterectomy at the time of risk-reducing salpingo-oophorectomy; however, it provides epidemiological data that can be useful for counselling patients in order to offer a tailored approach.
Maria Luisa Gasparri, Rosa Di Micco, Arianna Siconolfi, Ammad Ahmad Farooqi, Gabrielle Di Bartolomeo, Veronica Zuber, Donatella Caserta, Filippo Bellati, Ilary Ruscito, Andrea Papadia,et al.
Elsevier
Maria Luisa Gasparri, Rosa Di Micco, Veronica Zuber, Katayoun Taghavi, Giampaolo Bianchini, Serena Bellaminutti, Francesco Meani, Rossella Graffeo, Massimo Candiani, Michael D. Mueller,et al.
Elsevier BV
Introduction Preliminary clinical evidence suggests a detrimental effect of pathogenic variants of BRCA1 and 2 genes on fertility outcome. This meta-analysis evaluates whether women carrying BRCA mutations (BRCAm) have decreased ovarian reserve, in terms of Anti-Muellerian Hormone (AMH), compared to women without BRCAm (wild-type). Material and methods Systematic searches of PubMed, Medline, Scopus, Embase, Science Direct and the Cochrane Library from inception until July 2020 were conducted. All studies comparing AMH level in fertile age women, with and without BRCA pathogenic variants were considered. Sub-analyses were performed according to age, presence of breast cancer, and type of mutation. Results Among 64 studies, 10 series were included. For the entire cohort, a trend of reduced AMH level were found between BRCAm carriers and women without pathogenic variants. BRCAm carriers aged 41-years or younger had lower AMH levels compared to 41-years or younger wild type women (OR: 0.73 [95%CI-1.12;-0.35]; p = 0.0002). This finding was confirmed for BRCA1m carriers (OR: 1 [95%CI-1.96;-0.05]; p = 0.004) whereas no difference was observed between BRCA2m carriers and wild type women. The same analysis on breast cancer patients with and without BRCAm achieved the same results. Conclusion Young BRCA1m carriers seem to have lower AMH level compared with wild type women and therefore a potential decreased ovarian reserve.
Fabio Corsi, Sara Albasini, Luca Sorrentino, Giulia Armatura, Claudia Carolla, Corrado Chiappa, Francesca Combi, Annalisa Curcio, Angelica Della Valle, Guglielmo Ferrari,et al.
Elsevier BV
BACKGROUND
Type of axillary surgery in breast cancer (BC) patients who convert from cN + to ycN0 after neoadjuvant chemotherapy (NAC) is still debated. The aim of the present study was to develop and validate a preoperative predictive nomogram to select those patients with a low risk of residual axillary disease after NAC, in whom axillary surgery could be minimized.
PATIENTS AND METHODS
1950 clinically node-positive BC patients from 11 Breast Units, treated by NAC and subsequent surgery, were included from 2005 to 2020. Patients were divided in two groups: those who achieved nodal pCR vs. those with residual nodal disease after NAC. The cohort was divided into training and validation set with a geographic separation criterion. The outcome was to identify independent predictors of axillary pathologic complete response (pCR).
RESULTS
Independent predictive factors associated to nodal pCR were axillary clinical complete response (cCR) after NAC (OR 3.11, p < 0.0001), ER-/HER2+ (OR 3.26, p < 0.0001) or ER+/HER2+ (OR 2.26, p = 0.0002) or ER-/HER2- (OR 1.89, p = 0.009) BC, breast cCR (OR 2.48, p < 0.0001), Ki67 > 14% (OR 0.52, p = 0.0005), and tumor grading G2 (OR 0.35, p = 0.002) or G3 (OR 0.29, p = 0.0003). The nomogram showed a sensitivity of 71% and a specificity of 73% (AUC 0.77, 95%CI 0.75-0.80). After external validation the accuracy of the nomogram was confirmed.
CONCLUSION
The accuracy makes this freely-available, nomogram-based online tool useful to predict nodal pCR after NAC, translating the concept of tailored axillary surgery also in this setting of patients.