Debora Pirillo

Azienda Sanitaria Unità Locale di Reggio Emilia

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Vincenzo Dario Mandato

Azienda Sanitaria Unità Locale di Reggio Emilia

Gino Ciarlini

Azienda Sanitaria Unità Locale di Reggio Emilia

Federica Torricelli

Azienda Sanitaria Unità Locale di Reggio Emilia

Giovanni Battista La Sala

Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini"

Lorenzo Aguzzoli

Azienda Sanitaria Unità Locale di Reggio Emilia

M Abrate

Azienda Sanitaria Unità Locale di Reggio Emilia

Gianluca Annunziata

Azienda Sanitaria Unità Locale di Reggio Emilia

Valentina Mastrofilippo

Istituti di Ricovero e Cura a Carattere Scientifico

Angelo Cagnacci

Ospedale Policlinico San Martino

Matteo Generali

Istituti di Ricovero e Cura a Carattere Scientifico

Cooperative Institutions

Istituti di Ricovero e Cura a Carattere Scientifico

Azienda Sanitaria Unità Locale di Reggio Emilia

University of Modena and Reggio Emilia

Ospedale Santa Maria

University of Bologna

Azienda Ospedaliera S.Maria

Policlinico di Modena

Policlinico S.Orsola-Malpighi

Santa Maria Nuova Hospital

Regione Emilia-Romagna

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The role of minimally invasive surgery in epithelial ovarian cancer treatment: a narrative review

Frontiers in Medicine (2023)

Matteo Generali Gianluca Annunziata Debora Pirillo Giovanni D’Ippolito Gino Ciarlini

Objectives The aim of this narrative review is to summarize the available evidence on the use of minimal invasive surgery (MIS) in the management of epithelial ovarian cancer (EOC). Background MIS is currently performed to stage and treat EOC at different stage of presentation. We will evaluate risks and benefits of minimally invasive surgery for early stage EOC treatment, then potential advantages provided by staging laparoscopy in identifying patients suitable for primary cytoreductive surgery (PDS) will be discussed. Finally we will investigate the growing role of MIS in the treatment of advanced EOC after neoadjuvant chemotherapy (NACT) and in the treatment of EOC recurrence. Methods An electronic database search was performed on PubMed, Medline, and Google Scholar for relevant studies up to December 2022. Conclusion LPS represents a feasible surgical procedure for the staging and treatment in early, advanced and EOC relapse in selected patients treated in high-volume oncological centers by surgeons with adequate experience in advanced surgical procedures. Despite the increasing use of MIS over the last few years, randomized clinical trials are still needed to prove its effectiveness.

Invasive surgery

Narrative review

10.3389/fmed.2023.1196496

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Citations (3)

Gastric cancer in a pregnant woman presenting with low back pain and bilateral erythematous breast hypertrophy mimicking primary inflammatory breast carcinoma.

Anticancer Research (2011)

Vincenzo Dario Mandato Debora Pirillo Maria Carolina Gelli M. Cavina Giovanni Battista La Sala

This report describes the first case of a pregnant woman presenting low-back pain and breast pain associated with bilateral erythematous breast hypertrophy, proving to be the result of metastatic disease from a gastric carcinoma. A 30-year-old pregnant woman was admitted complaining of persistent severe low back pain, breast pain and concomitant bilateral erythematous breast hypertrophy, mimicking primary inflammatory breast carcinoma. During the caesarean section, widespread disease was found and finally metastatic gastric cancer was detected. Pregnant women with gastric cancer may present symptoms that are considered common during pregnancy. Common symptoms that present warning characteristics, such as the persistent severe pain observed in the presented case, should be carefully investigated as they may be the only warning signs and symptoms of rare ominous conditions such as gastric cancer.

Breast carcinoma

Back Pain

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Postcoital haemperitoneum without vaginal injury, a clinical challenge

Australian and New Zealand Journal of Obstetrics and Gynaecology (2010)

Vincenzo Dario Mandato Debora Pirillo Gino Ciarlini Giuseppina Comitini Giovanni Battista La Sala

10.1111/j.1479-828x.2010.01231.x

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Uterine Papillary Serous Carcinoma Arising in a Polyp

American Journal of Clinical Oncology (2019)

Vincenzo Dario Mandato Federica Torricelli Stefano Palomba Stefano Uccella Debora Pirillo

Objectives: The objectives of this study were to evaluate whether the international recommendations on the management of uterine papillary serous carcinoma arising in a polyp are uniformly followed in Italian Oncologic Centers and whether the strategy adopted is effective. Materials and Methods: Patients with uterine papillary serous carcinoma arising in a polyp and who had undergone a hysterectomy were identified in the 2003-2013 database of 7 Italian Gynecologic Oncology Centers. Clinical and pathologic characteristics and outcomes were compared between staging procedure types. Survival curves of the women were plotted using the Kaplan-Meier method and analyzed using Cox regression hazard model and the log-rank test. Associations between clinical parameters and the incidence of recurrence were assessed by generalized linear models and the Fisher test. Results: A total of 75 patients met the inclusion criteria. Recurrence-free survival was affected positively by type of surgical staging and negatively by preoperative diagnosis of hypertension. The association between surgical staging and recurrence-free survival resulted significant at univariate survival analysis ( P =0.048 and 0.045) and maintained a trend of significance ( P =0.070) in multivariate analysis, whereas hypertension was demonstrated to be the principal influencing factor. Conclusions: The international recommendations on the management of uterine papillary serous carcinoma are not uniformly followed in daily practice, although the extension of the surgery seems to be associated with lower recurrence rates also when uterine papillary serous carcinoma is confined to a polyp or endometrial surface.

Serous carcinoma

Univariate analysis

10.1097/coc.0000000000000541

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ABO/Rh Blood Group and Cervical Cancer Survival: Results from Our Own and Other Studies

Journal of Cancer (2024)

Vincenzo Dario Mandato Federica Torricelli Valentina Mastrofilippo Ilaria Vacca Beatrice Melli

Cervical cancer is the most common genital cancer worldwide and is mainly caused by a persistent human papillomavirus infection. Well-known prognostic factors are age, histology, stage, stromal invasion, tumor size, and tumor grade. The relationship between the ABO and Rh system with cervical cancer has been studied since the 1950s, though without obtaining clear results. Here we investigated the association between the ABO blood group and Rh system and consecutively treated cervical cancer patients in our department.

Histology

10.7150/jca.95245

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Impact of 2 years of COVID‐19 pandemic on ovarian cancer treatment in IRCCS‐AUSL of Reggio Emilia

International Journal of Gynecology & Obstetrics (2023)

Vincenzo Dario Mandato Federica Torricelli Valentina Mastrofilippo Carlotta Pellegri Loredana Cerullo

Pandemic

2019-20 coronavirus outbreak

10.1002/ijgo.14937

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Polymorphisms in cyclooxygenase-2 gene in endometrial cancer patients

Tumor Biology (2015)

Federica Torricelli Vincenzo Dario Mandato Enrico Farnetti M Abrate Bruno Casali

The enzyme cyclooxygenase 2 is an inducible enzyme expressed at sites of inflammation and in a variety of malignant solid tumors such as endometrial cancer (EC). In EC patients, its over-expression is correlated with progressive disease and poor prognosis. The expression is encoded by a polymorphic gene, called PTGS2. The aim of the current study was to test the hypothesis that rs5275 polymorphism of PTGS2 influence the prognosis of EC patients. This paper is a retrospective cohort study. Clinical and pathological data were extrapolated and genotypes were assessed on formalin-fixed and paraffin-embedded non-tumor tissues. A total of 159 type I EC patients were included in the final analysis. Univariate analysis indicated that patients with rs5275 genotype CC have a lower risk to develop a grade (G) 2-3 endometrial cancer. rs5275 effect on EC grading was confirmed by multivariate analysis also after data adjusting for age, BMI, parity, hypertension, and diabetes. Adjusted odds ratio (OR) confirmed that patients with rs5275 genotype CC have a risk 80 % lower (OR = 0.20, P = 0.009) to develop a G2 and/or G3 EC in comparison with patients with TT or TC genotype. Differentiation of the type 1 EC is significantly and independently influenced by rs5275 polymorphism. rs5275 CC patients have a lower risk to present a G2-G3 EC.

Univariate analysis

10.1007/s13277-015-3424-0

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Province Wide Clinical Governance Network for Clinical Audit for Quality Improvement in Endometrial Cancer Management

International Journal of Gynecological Cancer (2011)

Vincenzo Dario Mandato Debora Formisano Debora Pirillo Gino Ciarlini Lillo Bruno Cerami

Background According to the hub-and-spoke model introduced in the Provincial Healthcare System of Reggio Emilia, early endometrial cancer is treated in peripheral low-volume hospitals (spokes) by general gynecologist, whereas more complex cancers are treated by gynecological oncologists at the main hospital (hub). Objective To guarantee a uniformly high standard of care to all patients with endometrial cancer treated in hub and spoke hospitals of Reggio Emilia Province. Methods The specialists of the 5 hospitals of Reggio Emilia Province instituted an inter hospital and multidisciplinary oncology group to write common and shared guidelines based on evidence-based medicine through the use of clinical audit. They valued the process indicators before and after guidelines introduction identifying the site of improvement and verifying the standard achievement. Results Diagnostic hysteroscopy use increased significantly from preguideline period, 53%, to postguideline period, 74%. Magnetic resonance use and accuracy increased significantly from preguideline to postguideline periods: 8.1% to 35.3% and 37.3% to 74.7%, respectively. Laparoscopy use increased from 1.6% (preguideline) to 18.6 (postguideline). Early surgical complications decreased from 16% (preguideline) to 9% (postguideline). Radiotherapy use increased from 14.% (preguideline) to 32.3% (postguideline). Conclusion It is possible for a provincial oncology group to build an oncology network providing an improvement in the assistance of patients with endometrial cancer through the use of clinical audit. Clinical audit made it possible to obtain the full attendance of specialists of various disciplines involved in the treatment of endometrial cancer to optimize response time schematizing process.

Clinical audit

Clinical Governance

Attendance

10.1097/igc.0b013e318232cab5

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Effects of low- or high-dose hormone therapy on fasting and post-methionine homocysteine levels in postmenopausal women

Climacteric (2006)

Angelo Cagnacci Matteo Generali Debora Pirillo Francesco Vincenzo M. Baldassari Annibale Volpe

Objective To evaluate the effect of two different hormone therapy (HT) doses on fasting and post-methionine homocysteine levels, an independent risk factor for cardiovascular and thromboembolic diseases.Methods Forty-eight women in natural postmenopause randomly received calcium 1 mg/day (control group; n = 12) or calcium plus low dose (1 mg estradiol plus 0.5 mg norethisterone; n = 18) or high dose (2 mg estradiol plus 1 mg norethisterone; n = 18) HT in a 6-month randomized, controlled, prospective study.Results Folate levels did not vary in any group, while levels of vitamin B12 significantly decreased after low- (−12.2 ± 6.6%; p < 0.04) or high-dose HT (−13.9 ± 6.1%; p < 0.01). Fasting homocysteine was reduced by either HT dose in a way that was inversely related to pretreatment homocysteine levels (−0.675x; r = 0.644; p < 0.0001). Modification of post-load homocysteine increase was influenced by the HT dose and inversely related to the homocysteine response to methionine observed at baseline. The regression slope observed with the low-dose HT (−1.637x; r = 0.57; p < 0.02) was significantly steeper (p < 0.001) than that observed with the high-dose HT (−0.304x; r = 0.554; p < 0.03) dose.Conclusions Low- or high-dose HT similarly influences fasting homocysteine levels. Low-dose HT seems to be more effective than high-dose HT in reducing the post-methionine homocysteine increase.

Hormone Therapy

10.1080/13697130600870352

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Clinical governance network for clinical audit to improve quality in epithelial ovarian cancer management

Journal of Ovarian Research (2013)

Vincenzo Dario Mandato M Abrate Pierandrea De Iaco Debora Pirillo Gino Ciarlini

Epithelial ovarian cancer (EOC) is the most lethal gynecological cancer. Several hospitals throughout the region provide primary treatment for these patients and it is well know that treatment quality is correlated to the hospital that delivers. The aim of this study was to investigate the management and treatment of EOC in a Region of the North Italy (Emilia-Romagna, Italy). A multidisciplinary group made up of 11 physicians and 3 biostatisticians was formed in 2009 to perform clinical audits in order to identify quality indicators and to develop Region-wide workup in accordance with the principles of evidence-based medicine (EBM). The rationale was that, by setting up an oncogynecology network so as to achieve the best clinical practice, critical points would decrease or even be eliminated. Analysis of cases was based on the review of the medical records. 614 EOC patients treated between 2007 and 2008 were identified. We found only 2 high-volume hospitals (≥ 21 patients/year), 3 medium-volume hospitals (11–20 operated patients/year), and 7 low-volume hospitals (≤ 10 operated patients /year). Only 222 patients (76.3%) had a histological diagnosis, FIGO surgical staging was reported only in 206 patients (70.9%) but not all standard surgical procedures were always performed, residual disease were not reported in all patients. No standard number of neoadjuvant chemotherapy cycles was observed. The differences in terms of treatments provided led the multidisciplinary group to identify reference centers, to promote centralization, to ensure uniform and adequate treatment to patients treated in regional centers and to promote a new audit involving all regional hospitals to a complete review of the all the EOC patients.

Clinical Governance

Clinical audit

Clinical Practice

10.1186/1757-2215-6-19

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Citations (15)