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Article ; Online: Lymphatic Spread of Ovarian Cancer: Can the Anatomical and Pathological Knowledge Help a Personalized Treatment?

Aletti, Giovanni D

2018 Volume 25, Issue 7, Page(s) 1791–1793

MeSH term(s)	Female ; Humans ; Lymphatic Metastasis ; Lymphatic Vessels/pathology ; Ovarian Neoplasms/pathology ; Ovarian Neoplasms/therapy ; Precision Medicine
Language	English
Publishing date	2018-04-25
Publishing country	United States
Document type	Editorial
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-018-6475-9
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Article ; Online: Time for centralizing patients with ovarian cancer: what are we waiting for?

Aletti, Giovanni D / Cliby, William A

Gynecologic oncology

2016 Volume 142, Issue 2, Page(s) 209–210

Language	English
Publishing date	2016
Publishing country	United States
Document type	Editorial
ZDB-ID	801461-9
ISSN	1095-6859 ; 0090-8258
ISSN (online)	1095-6859
ISSN	0090-8258
DOI	10.1016/j.ygyno.2016.07.004
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Article ; Online: Quality control in ovarian cancer surgery.

Aletti, Giovanni D / Peiretti, Michele

Best practice & research. Clinical obstetrics & gynaecology

2017 Volume 41, Page(s) 96–107

Abstract: The optimal surgical management of patients with ovarian cancer includes a thorough staging with peritoneal and retroperitoneal assessment for early disease stages and a complete debulking with the removal of all macroscopic tumor for advanced disease ... ...

Abstract	The optimal surgical management of patients with ovarian cancer includes a thorough staging with peritoneal and retroperitoneal assessment for early disease stages and a complete debulking with the removal of all macroscopic tumor for advanced disease stages. Disparities across different institutions in terms of optimal surgical management have been described. Surgical quality control programs constitute a real possibility to ensure and improve the quality of the surgery performed. Guidelines for surgery in early and advanced disease stages have been recently reviewed by the National Comprehensive Cancer Network (NCCN), and several quality indicators (QIs) have been proposed. These QIs can be used as a powerful tool to monitor, compare, and improve the quality of surgery across different centers and institutions. Furthermore, a transparent report of surgical outcomes through the creation of National and International Networks, adherence to the NCCN guidelines, and the establishment of quality control programs with a strong training and education component are key factors in enhancing the quality of surgery for patients with ovarian cancer.
Language	English
Publishing date	2017-05
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2050090-7
ISSN	1532-1932 ; 1521-6934
ISSN (online)	1532-1932
ISSN	1521-6934
DOI	10.1016/j.bpobgyn.2016.08.008
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Article ; Online: Evaluation of perioperative management of advanced ovarian (tubal/peritoneal) cancer patients: a survey from MITO-MaNGO Groups.

Greggi, Stefano / Falcone, Francesca / Aletti, Giovanni D / Cascella, Marco / Bifulco, Francesca / Colombo, Nicoletta / Pignata, Sandro

Journal of gynecologic oncology

2022 Volume 33, Issue 5, Page(s) e60

Abstract: Objective: The European Society of Gynaecological Oncology (ESGO)-quality indicators (QIs) for advanced ovarian cancer (AOC) have been assessed only by few Italian centers, and data are not available on the proportion of centers reaching the score ... ...

Abstract	Objective: The European Society of Gynaecological Oncology (ESGO)-quality indicators (QIs) for advanced ovarian cancer (AOC) have been assessed only by few Italian centers, and data are not available on the proportion of centers reaching the score considered for a satisfactory surgical management. There is great consensus that the Enhanced Recovery After Surgery (ERAS) approach is beneficial, but there is paucity of data concerning its application in AOC. This survey was aimed at gathering detailed information on perioperative management of AOC patients within MITO-MaNGO Groups. Methods: A 66-item questionnaire, covering ESGO-QIs for AOC and ERAS items, was sent to MITO/MaNGO centers reporting to operate >20 AOC/year. Results: Thirty/34 questionnaires were analyzed. The median ESGO-QIs score was 31.5, with 50% of centers resulting with a score ≥32 which provides satisfactory surgical management. The rates of concordance with ERAS guidelines were 46.6%, 74.1%, and 60.7%, respectively, for pre-operative, intra-operative, and post-operative items. The proportion of overall agreement was 61.3%, and with strong recommendations was 63.1%. Pre-operative diet, fasting/bowel preparation, correction of anaemia, post-operative feeding and early mobilization were the most controversial. A significant positive correlation was found between ESGO-QIs score and adherence to ERAS recommendations. Conclusion: This survey reveals a satisfactory surgical management in only half of the centers, and an at least sufficient adherence to ERAS recommendations. Higher the ESGO-QIs score stronger the adherence to ERAS recommendations, underlining the correlations between case volume, appropriate peri-operative management and quality of surgery. The present study is a first step to build a structured platform for harmonization within MITO-MaNGO networks.
MeSH term(s)	Carcinoma, Ovarian Epithelial ; Female ; Genital Neoplasms, Female ; Humans ; Mangifera ; Ovarian Neoplasms ; Surveys and Questionnaires
Language	English
Publishing date	2022-06-03
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2478405-9
ISSN	2005-0399 ; 2005-0380
ISSN (online)	2005-0399
ISSN	2005-0380
DOI	10.3802/jgo.2022.33.e60
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Article ; Online: Practice patterns and complications of hysterectomy for invasive cervical cancer after the Laparoscopic Approach to Cervical Cancer trial.

Schivardi, Gabriella / Casarin, Jvan / Habermann, Elizabeth B / Bews, Katherine A / Langstraat, Carrie L / Cliby, William / Cucinella, Giuseppe / De Vitis, Luigi A / Ramirez, Pedro T / Aletti, Giovanni D / Mariani, Andrea / Multinu, Francesco

American journal of obstetrics and gynecology

2023 Volume 230, Issue 1, Page(s) 69.e1–69.e10

Abstract: Background: After the publication of the Laparoscopic Approach to Cervical Cancer trial, the standard surgical approach for early-stage cervical cancer is open radical hysterectomy. Only limited data were available regarding whether the change to open ... ...

Abstract	Background: After the publication of the Laparoscopic Approach to Cervical Cancer trial, the standard surgical approach for early-stage cervical cancer is open radical hysterectomy. Only limited data were available regarding whether the change to open abdominal hysterectomy observed after the Laparoscopic Approach to Cervical Cancer trial led to an increase in postoperative complication rates as a consequence of the decrease in the use of the minimally invasive approach. Objective: This study aimed to analyze whether there was a correlation between the publication of the Laparoscopic Approach to Cervical Cancer trial and an increase in the 30-day complications associated with surgical treatment of invasive cervical cancer. Study design: Data from the American College of Surgeons National Surgical Quality Improvement Program were used to compare the results in the pre-Laparoscopic Approach to Cervical Cancer period (January 2016 to December 2017) vs the results in the post-Laparoscopic Approach to Cervical Cancer period (January 2019 to December 2020). The rates of each surgical approach (open abdominal or minimally invasive) hysterectomy for invasive cervical cancer during the 2 periods were assessed. Subsequently, 30-day major complication, minor complication, unplanned hospital readmission, and intra- or postoperative transfusion rates before and after the publication of the Laparoscopic Approach to Cervical Cancer trial were compared. Results: Overall, 3024 patients undergoing either open abdominal hysterectomy or minimally invasive hysterectomy for invasive cervical cancer were included in the study. Of the patients, 1515 (50.1%) were treated in the pre-Laparoscopic Approach to Cervical Cancer period, and 1509 (49.9%) were treated in the post-Laparoscopic Approach to Cervical Cancer period. The rate of minimally invasive approaches decreased significantly from 75.6% (1145/1515) in the pre-Laparoscopic Approach to Cervical Cancer period to 41.1% (620/1509) in the post-Laparoscopic Approach to Cervical Cancer period, whereas the rate of open abdominal approach increased from 24.4% (370/1515) in the pre-Laparoscopic Approach to Cervical Cancer period to 58.9% (889/1509) in the post-Laparoscopic Approach to Cervical Cancer period (P<.001). The overall 30-day major complications remained stable between the pre-Laparoscopic Approach to Cervical Cancer period (85/1515 [5.6%]) and the post-Laparoscopic Approach to Cervical Cancer period (74/1509 [4.9%]) (adjusted odds ratio, 0.85; 95% confidence interval, 0.61-1.17). The overall 30-day minor complications were similar in the pre-Laparoscopic Approach to Cervical Cancer period (103/1515 [6.8%]) vs the post-Laparoscopic Approach to Cervical Cancer period (120/1509 [8.0%]) (adjusted odds ratio, 1.17; 95% confidence interval, 0.89-1.55). The unplanned hospital readmission rate remained stable during the pre-Laparoscopic Approach to Cervical Cancer period (7.9% per 30 person-days) and during the post-Laparoscopic Approach to Cervical Cancer period (6.3% per 30 person-days) (adjusted hazard ratio, 0.78; 95% confidence interval, 0.58-1.04)]. The intra- and postoperative transfusion rates increased significantly from 3.8% (58/1515) in the pre-Laparoscopic Approach to Cervical Cancer period to 6.7% (101/1509) in the post-Laparoscopic Approach to Cervical Cancer period (adjusted odds ratio, 1.79; 95% confidence interval, 1.27-2.53). Conclusion: This study observed a significant shift in the surgical approach for invasive cervical cancer after the publication of the Laparoscopic Approach to Cervical Cancer trial, with a reduction in the minimally invasive abdominal approach and an increase in the open abdominal approach. The change in surgical approach was not associated with an increase in the rate of 30-day major or minor complications and unplanned hospital readmission, although it was associated with an increase in the transfusion rate.
MeSH term(s)	Female ; Humans ; Uterine Cervical Neoplasms/surgery ; Uterine Cervical Neoplasms/complications ; Hysterectomy/methods ; Postoperative Complications/etiology ; Patient Readmission ; Laparoscopy/methods ; Retrospective Studies
Language	English
Publishing date	2023-09-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2023.09.002
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Article ; Online: Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: a systematic review and meta-analysis.

Bogani, Giorgio / Cliby, William A / Aletti, Giovanni D

Gynecologic oncology

2015 Volume 137, Issue 1, Page(s) 167–172

Abstract: Objective: To review the current evidence on the effects of intra-abdominal morcellation on survival outcomes of patients affected by unexpected uterine leiomyosarcoma (ULMS) and to estimate the risk of recurrence in those patients.: Methods: PubMed ( ...

Abstract	Objective: To review the current evidence on the effects of intra-abdominal morcellation on survival outcomes of patients affected by unexpected uterine leiomyosarcoma (ULMS) and to estimate the risk of recurrence in those patients. Methods: PubMed (MEDLINE), Scopus, Embase, Web of Science databases as well as ClinicalTrials.gov, were searched for data evaluating the effects of intra-abdominal morcellation on survival outcomes of patients with undiagnosed ULMS. Studies were evaluated per the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and the American College of Obstetricians and Gynecologists (ACOG) guidelines. Results: Sixty manuscripts were screened, 11 (18%) were selected and four (7%) were included. Overall, 202 patients were included: 75 (37%) patients had morcellation of ULMS, while 127 (63%) patients had not. A meta-analysis of these studies showed that morcellation increased the overall (62% vs. 39%; OR: 3.16 (95% CI: 1.38, 7.26)) and intra-abdominal (39% vs. 9%; OR: 4.11 (95% CI: 1.92, 8.81)) recurrence rates as well as death rate (48% vs. 29%; OR: 2.42 (95% CI: 1.19, 4.92)). No between-group difference in cumulative extra-abdominal recurrence (OR: 0.34 (95% CI: 0.07, 1.59)) rate was observed. Conclusions: Our data support a significant correlation between uterine morcellation and an increased risk of intra-abdominal recurrence in patients affected by unexpected ULMS. However, the limited data on this issue and the absence of high level of evidence suggest the need of further studies designed to estimate the risk to benefit ratio of morcellation in patients with uterine fibroids and undiagnosed ULMS.
MeSH term(s)	Female ; Humans ; Leiomyosarcoma/pathology ; Leiomyosarcoma/surgery ; Minimally Invasive Surgical Procedures/adverse effects ; Minimally Invasive Surgical Procedures/methods ; Neoplasm Recurrence, Local/pathology ; Neoplasm Seeding ; Survival Rate ; Treatment Outcome ; Uterine Neoplasms/pathology ; Uterine Neoplasms/surgery
Language	English
Publishing date	2015-04
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	801461-9
ISSN	1095-6859 ; 0090-8258
ISSN (online)	1095-6859
ISSN	0090-8258
DOI	10.1016/j.ygyno.2014.11.011
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Article ; Online: There Is Nothing New Under the Sun.

Aletti, Giovanni D / Bristow, Robert E / Chi, Dennis / Cliby, William A

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

2015 Volume 33, Issue 30, Page(s) 3520

MeSH term(s)	Female ; Gynecologic Surgical Procedures ; Humans ; Ovarian Neoplasms/surgery ; Peritoneal Neoplasms/surgery
Language	English
Publishing date	2015-10-20
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	604914-x
ISSN	1527-7755 ; 0732-183X
ISSN (online)	1527-7755
ISSN	0732-183X
DOI	10.1200/JCO.2015.61.9536
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Article ; Online: Management of ovarian cancer: guidelines of the Italian Medical Oncology Association (AIOM).

Gadducci, Angiolo / Aletti, Giovanni D / Landoni, Fabio / Lazzari, Roberta / Mangili, Giorgia / Olivas, Paola / Pignata, Sandro / Salutari, Vanda / Sartori, Enrico / Scambia, Giovanni / Zannoni, Gian Franco / Sabbatini, Roberto / Lorusso, Domenica

Tumori

2020 Volume 107, Issue 2, Page(s) 100–109

Abstract: Introduction: Ovarian cancer is the most lethal gynecologic malignancy. Over 5200 new cases of this tumor are diagnosed yearly in Italy, resulting in more than 3600 deaths. In terms of molecular biology, five different ovarian cancer subtypes should be ... ...

Abstract	Introduction: Ovarian cancer is the most lethal gynecologic malignancy. Over 5200 new cases of this tumor are diagnosed yearly in Italy, resulting in more than 3600 deaths. In terms of molecular biology, five different ovarian cancer subtypes should be distinguished. Method: This article summarizes the evidence-based guidelines that the Italian Medical Oncology Association (AIOM) has developed with a multidisciplinary panel of experts, including pathologists, gynecologic oncologists, medical oncologists, and radiotherapists, with the support of methodologists, to help clinicians involved in the management of patients with ovarian cancer in their daily clinical practice. Results: The most relevant randomized clinical trials regarding surgery, chemotherapy, and molecularly targeted agents (bevacizumab and PARP inhibitors) in early, advanced, and recurrent disease have been critically analyzed. The levels of evidence and strength of recommendation have been reported for any issue. Conclusion: Women with a clinical suspicion of ovarian cancer should be centralized in referral centers. The
MeSH term(s)	Antineoplastic Agents, Immunological/therapeutic use ; BRCA1 Protein/genetics ; BRCA2 Protein/genetics ; Bevacizumab/therapeutic use ; Female ; Genetic Testing/methods ; Humans ; Italy/epidemiology ; Medical Oncology/methods ; Molecular Targeted Therapy/methods ; Mutation ; Neoplasm Recurrence, Local ; Ovarian Neoplasms/diagnosis ; Ovarian Neoplasms/epidemiology ; Ovarian Neoplasms/therapy ; Poly(ADP-ribose) Polymerase Inhibitors/therapeutic use ; Practice Guidelines as Topic ; Survival Analysis
Chemical Substances	Antineoplastic Agents, Immunological ; BRCA1 Protein ; BRCA2 Protein ; Poly(ADP-ribose) Polymerase Inhibitors ; Bevacizumab (2S9ZZM9Q9V)
Language	English
Publishing date	2020-10-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	280962-x
ISSN	2038-2529 ; 0300-8916
ISSN (online)	2038-2529
ISSN	0300-8916
DOI	10.1177/0300891620966382
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Article: Ovarian cancer care: it's time for "personalized" approaches.

Aletti, Giovanni D / Hartmann, Lynn C

Oncology (Williston Park, N.Y.)

2010 Volume 24, Issue 8, Page(s) 728, 736

MeSH term(s)	Administration, Oral ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biomarkers/blood ; CA-125 Antigen/blood ; Carboplatin/administration & dosage ; Doxorubicin/administration & dosage ; Early Detection of Cancer ; Female ; Humans ; Infusions, Parenteral ; Membrane Proteins/blood ; Neoplasms, Glandular and Epithelial/diagnosis ; Neoplasms, Glandular and Epithelial/drug therapy ; Ovarian Neoplasms/diagnosis ; Ovarian Neoplasms/drug therapy ; Paclitaxel/administration & dosage ; Patient Selection
Chemical Substances	Biomarkers ; CA-125 Antigen ; MUC16 protein, human ; Membrane Proteins ; Doxorubicin (80168379AG) ; Carboplatin (BG3F62OND5) ; Paclitaxel (P88XT4IS4D)
Language	English
Publishing date	2010-07
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	1067950-9
ISSN	0890-9091
ISSN	0890-9091
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Article ; Online: Incidence of sentinel lymph node metastases in apparent early-stage endometrial cancer: a multicenter observational study.

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2024

Abstract: Objective: Ultrastaging is accurate in detecting nodal metastases, but increases costs and may not be necessary in certain low-risk subgroups. In this study we examined the risk of nodal involvement detected by sentinel lymph node (SLN) biopsy in a ... ...

Abstract	Objective: Ultrastaging is accurate in detecting nodal metastases, but increases costs and may not be necessary in certain low-risk subgroups. In this study we examined the risk of nodal involvement detected by sentinel lymph node (SLN) biopsy in a large population of apparent early-stage endometrial cancer and stratified by histopathologic characteristics. Furthermore, we aimed to identify a subgroup in which ultrastaging may be omitted. Methods: We retrospectively included patients who underwent SLN (with bilateral mapping and no empty nodal packets on final pathology) ± systematic lymphadenectomy for apparent early-stage endometrial cancer at two referral cancer centers. Lymph node status was determined by SLN only, regardless of non-SLN findings. The incidence of macrometastasis, micrometastasis, and isolated tumor cells (ITC) was measured in the overall population and after stratification by histotype (endometrioid vs serous), myometrial invasion (none, <50%, ≥50%), and grade (G1, G2, G3). Results: Bilateral SLN mapping was accomplished in 1570 patients: 1359 endometrioid and 211 non-endometrioid, of which 117 were serous. The incidence of macrometastasis, micrometastasis, and ITC was 3.8%, 3.4%, and 4.8%, respectively. In patients with endometrioid histology (n=1359) there were 2.9% macrometastases, 3.2% micrometastases, and 5.3% ITC. No macro/micrometastases and only one ITC were found in a subset of 274 patients with low-grade (G1-G2) endometrioid endometrial cancer without myometrial invasion (all <1%). The incidence of micro/macrometastasis was higher, 2.8%, in 708 patients with low-grade endometrioid endometrial cancer invading <50% of the myometrium. In patients with serous histology (n=117), the incidence of macrometastases, micrometastasis, and ITC was 11.1%, 6.0%, and 1.7%, respectively. For serous carcinoma without myometrial invasion (n=36), two patients had micrometastases for an incidence of 5.6%. Conclusions: Ultrastaging may be safely omitted in patients with low-grade endometrioid endometrial cancer without myometrial invasion. No other subgroups with a risk of nodal metastasis of less than 1% have been identified.
Language	English
Publishing date	2024-03-21
Publishing country	England
Document type	Journal Article
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2023-005173
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