Biomedical subjects

Pierluigi Benedetti Panici

Publications and source records attributed to Pierluigi Benedetti Panici.

At least 19 recordsLinked to original sources

PubMed2006

Secondary cytoreductive surgery in patients with platinum-sensitive recurrent ovarian cancer.

BACKGROUND: Secondary surgical cytoreduction (SCR) represents a promising therapeutic strategy for patients affected by ovarian cancer disease recurrence. The aim of this prospective observational trial was to analyze the role of SCR in patients with platinum-sensitive ovarian cancer. METHODS: Patients with platinum-sensitive ovarian cancer underwent SCR by a single surgical team. Clinical and oncologic data were prospectively recorded. A total of 47 patients underwent SCR from 1999 to 2003. RESULTS: The mean operating time was 210 minutes, and mean blood loss was 500 mL. The most frequent surgical procedures carried out were splenectomy, lymphadenectomy, bowel resection, and extensive peritonectomy. Optimal cytoreduction was achieved in 41 patients. Thirty-seven patients had no visible tumor at the end of SCR. Overall median survival was 49 months. Patients who achieved optimal residual disease had a median survival of 61 months, whereas patients who had residual disease >1 cm had a median survival of 19 months. CONCLUSIONS: Positive CA-125 (cancer antigen 125) was identified as a negative prognostic factor at multivariate analysis. After careful selection, optimal cytoreduction can be achieved in most patients who are subjected to SCR with acceptable morbidity. Residual tumor and CA-125 represent the most important prognostic factors.

Adenocarcinoma, Clear Cell↗

PubMed2006

Histologic analysis of endometriomas: what the surgeon needs to know.

OBJECTIVE: To evaluate by thorough pathologic analysis the histologic features of the endometrioma wall excised at laparoscopy. DESIGN: Prospective series of consecutive patients. SETTING: Tertiary care, university hospital. PATIENT(S): Fifty-nine patients with ovarian endometriomas. A total of 70 cysts were examined. INTERVENTION(S): Patients underwent operative laparoscopy with the stripping technique for excision of the ovarian endometrioma. MAIN OUTCOME MEASURE(S): A thorough histologic examination was performed on the entire cyst wall specimen. RESULT(S): Histologic examination confirmed the endometriotic nature of the cyst in 100% of the cases. The inner wall of the endometrioma was covered by endometriotic tissue on 60% of the surface. The mean cyst wall thickness was 1.4 mm. The mean value of maximal depth of endometriosis penetration in the endometrioma wall was 0.6 mm. In 99% of the cases the maximal penetration of the endometriotic tissue was <1.5 mm. CONCLUSION(S): In the present study, we demonstrate that the endometrioma wall contains endometriotic tissue in 100% of the cases. However, the endometriotic tissue may cover the inner cyst wall for a surface that varies between 10% and 98% of the entire wall (median value 60%). This tissue may reach a depth of 2 mm, but for most of the surface it does not penetrate >1.5 mm. These histologic data may help the gynecologic laparoscopist select the surgical approach that maximally preserves healthy ovarian tissue.

Adult↗

PubMed2006

One-year follow-up of tension-free vaginal tape (TVT) and trans-obturator suburethral tape from inside to outside (TVT-O) for surgical treatment of female stress urinary incontinence: a prospective randomised trial.

OBJECTIVES: To compare tension-free vaginal tape (TVT) and trans-obturator suburethral tape from inside to outside (TVT-O) for surgical treatment of stress urinary incontinence (SUI) for complications (primary end point) and success rate (secondary end point). METHODS: Seventy-two consecutive patients, with a mean age of 53.2 yr (range: 38-69 yr) and affected by SUI, were included in this randomised controlled trial. After preoperative assessment, patients were randomly allocated to the TVT or TVT-O procedure. Operative time, perioperative complications, and hospital stay were prospectively recorded. Cure of SUI was defined as no leakage of urine during the stress test at urodynamic testing at the 12-mo evaluation. The Wilcoxon signed rank sum test, Mann-Whitney U test, McNemar test, and Fisher exact test were used to verify statistical significance, set at p<0.05. RESULTS: All patients were evaluable at the 12-mo follow-up. The characteristics of patients were well balanced between groups after randomisation. The mean operative time was significantly shorter in the TVT-O group. Perioperative complications were significantly more common after the retropubic approach (5% and 27% in TVT-O and TVT groups, respectively, p<0.04). The groups did not differ significantly in intraoperative blood loss, hospital stays, and time to return to normal activities. Sixty-five patients (90%) were successfully treated for SUI 12 mo after the operation (89% and 91% for TVT-O and TVT groups, respectively). CONCLUSIONS: Both techniques appear to be equally effective in the surgical treatment of SUI. However, TVT-O had a shorter operative time and lower overall perioperative complication rate.

Female↗

PubMed2006

An unusual case of secondary fibrosarcoma after treatment for breast cancer.

BACKGROUND: Post-irradiation breast sarcoma is a rare and highly aggressive tumor, associated with poor prognosis. However, the mean latent periods reported for postradiation sarcomas after treatment of breast cancer ranges from 5 to 10 years. CASE: We present a rare case of fibrosarcoma of the axilla, diagnosed 23 months after breast surgery and irradiation for medullary poorly differentiated carcinoma, treated with wide local excision with resection of the serratus anterior muscle until pleural wall. CONCLUSION: This case confirm a possible early appearance of sarcoma in the irradiation field after radiotherapy. Thus, when a nodule appears in the irradiation field even if within 2 years after radiotherapy, physician should be alert for a possible sarcoma and wide biopsy with histologic confirmation is auspicable.

Adult↗

PubMed2006

Distal phalange necrosis: a severe manifestation of palmar plantar erythrodysesthesia.

Palmar plantar erythrodysesthesia is a cutaneous drug reaction induced by chemotherapy. We present a case of a patient with neurosensorial deficit affected by ovarian cancer who experienced a painless necrosis of a distal phalange of the hand during treatment with pegylated liposomal doxorubicin. Palmar plantar erythrodysesthesia may be underestimated by physicians in paucisymptomatic patients.

Antibiotics, Antineoplastic↗

PubMed2006

Pelvic lymphadenectomy for cervical carcinoma: laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study.

OBJECTIVE: To compare transperitoneal, extraperitoneal and laparoscopic pelvic lymphadenectomy in terms of feasibility and morbidity in patients affected by cervical cancer undergoing radical hysterectomy. METHODS: Consecutive patients affected by stage IB-IIB cervical carcinoma scheduled for radical surgery entered the study. Patients were randomly assigned to transperitoneal (TPL), extraperitoneal (EPL) or laparoscopic pelvic lymphadenectomy (LPL). All patients underwent classical radical hysterectomy. Perioperative data were recorded. Follow up examinations were performed at the 15th, 30th and 60th day after surgery. RESULTS: 168 patients entered the study. The mean operative times were: 63+/-7.6, 54+/-6.7 and 75+/-8.4 min (TPL vs EPL P<0.001; EPL vs LPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. The feasibility of the procedures, analyzed on an intention-to-treat basis, was 96%, 93% and 95% for TPL, EPL and LPL group respectively (P=ns). The average hospitalizations were: 5.6+/-0.9, 3.2+/-0.4 and 3.1+/-0.3 days (TPL vs EPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. CONCLUSIONS: EPL and LPL are as feasible and effective as TPL and can be adequately performed with a reasonable complication rate. LPL showed a statistically significant longer operative time. However, both EPL and LPL can minimize some postoperative complications reducing length of stay.

Female↗

PubMed2006

Minilaparotomy versus laparoscopy in the treatment of benign adnexal cysts: a randomized clinical study.

OBJECTIVE: To determine advantages and disadvantages of minilaparotomy and laparoscopy in managing patients affected by benign adnexal masses. STUDY DESIGN: Prospective, randomized, clinical trial on 127 patients affected by adnexal cysts. Patients were submitted to adnexal surgery through a laparoscopic or minilaparotomy approach on a random basis. RESULTS: Hundred and twenty-seven patients were enrolled in the study and randomly assigned to laparoscopy (63 patients) or minilaparotomy (64 patients). Characteristics of the patients and of the cysts were homogeneous between the two groups. No significant differences between the two groups were recorded in terms of operative time, intraoperative complications, ileus, length of stay and recovery time. The intraoperative rupture rate of the cyst was significantly higher in the laparoscopy group only in a subgroup of patients affected by cysts greater than 7 cm in diameter (p=0.01). Three patients randomized to laparoscopy required conversion to laparotomy. Concerning postoperative outcomes, postoperative pain and minor complications were significantly less in patients undergoing laparoscopy (p=0.001 and 0.04). CONCLUSIONS: Operative laparoscopy appears to be the preferable approach for the management of adnexal cysts. Minilaparotomy can be considered a mini-invasive approach as well, with acceptable operative and postoperative outcomes, and is a suitable alternative in case of contraindications to laparoscopy.

Adnexal Diseases↗

PubMed2006

Mechanical bowel preparation before gynecologic laparoscopy: a randomized, single-blind, controlled trial.

OBJECTIVE: To evaluate the use of mechanical bowel preparation (MBP) before gynecologic laparoscopy, using as the primary endpoint the appropriateness of the surgical field as judged by the surgeon. DESIGN: Prospective, randomized, single-blind clinical trial. SETTING: Academic department specializing in gynecologic surgery. PATIENT(S): One-hundred sixty-two patients scheduled for laparoscopy. INTERVENTION(S): The evening before laparoscopy, patients were randomized to either MBP with 90 mL of oral sodium phosphate (NaP) or no bowel preparation. MAIN OUTCOME MEASURE(S): Patient discomfort was evaluated with a visual analogue scale. Bowel preparation was evaluated by a surgeon (blind to bowel-preparation status) using a 5-point scale. Surgical difficulty, operating times, and postoperative complications were recorded. RESULT(S): Preoperative discomfort was significantly greater in the MBP group. No significant difference in the evaluation of the surgical field, operative difficulty, operative time, and postoperative complications was present between the two groups. CONCLUSION(S): Bowel preparation with oral NaP does not offer any significant advantage in patients undergoing laparoscopy for benign gynecologic conditions. In addition, MBP significantly increases preoperative discomfort.

Adult↗

PubMed2005

Diagnostic open laparoscopy in the management of advanced ovarian cancer.

OBJECTIVE: Optimal primary cytoreductive surgery (OPCS) plus adjuvant chemotherapy (AC) represents the standard management for patients with advanced ovarian cancer (AOC). Recently, some authors have suggested the use of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in patients with unresectable AOC. This study has been started to evaluate the role of diagnostic open laparoscopy (DOL) in predicting who are the best candidates to OPCS. METHODS: All patients newly diagnosed as affected by AOC were submitted to DOL in order to establish the possibility of OPCS considered as no residual tumor left after operation. Patients considered not susceptible of OPCS were submitted to three cycles of NACT, administered every 3 weeks (Carboplatin, targeted AUC = 6, plus paclitaxel 175 mg/mq), followed by IDS and adjuvant chemotherapy. RESULTS: From January 2000 to March 2004, 87 patients with AOC underwent DOL. Fifty-three patients (61%) were judged operable and therefore submitted to primary cytoreductive surgery (Group A). Optimal debulking rate in this group of patients was 96%. Thirty-four patients were judged affected by disease not cytoriducible to absent residual tumor and therefore scheduled for NACT-IDS-AC (Group B). Twenty-five patients were judged with partial clinical response and were therefore scheduled for IDS and AC. Optimal debulking rate (no residual tumor ) in Group B patients was 80%. No major perioperative complications, due to laparoscopy, occurred. All Group B patients received the first cycle of chemotherapy the day after DOL. In 34 patients (39%), an explorative laparotomy was avoided. With a median follow-up of 22 months (range 2-49 months), the proportions surviving were 87% and 60% in Group A and Group B patients, respectively. CONCLUSION: DOL could be considered a valid diagnostic tool in evaluating the extent of disease in AOC. Our data suggest that the use of DOL leads to decrease the rate of primary cytoreductive surgery for AOC; on the other hand, a higher optimal debulking rate (no residual tumor) at primary surgery is achieved.

Adult↗

PubMed2005

Successful pregnancy after conservative surgery for stage IC ovarian cancer with serous borderline tumor on controlateral ovary: a case report.

BACKGROUND: In invasive ovarian cancer, fertility saving surgery is confined to early-stage and low-grade disease, and only few study reported sparing fertility up to FIGO stage IC ovarian cancer. CASE: We present a rare case of a 30-year-old woman affected by IC ovarian cancer with borderline tumor on controlateral ovary who underwent "conservative" debulking surgery followed by adjuvant chemotherapy. A spontaneous planned pregnancy occurred 5 years postsurgery. At 60-month follow-up, patients have no evidence of disease. CONCLUSIONS: Nowadays, preservation of ovarian function in women with tumors in early stage should be evaluated for conservative surgery. It is important to emphasize that patients selected for conservative surgery should have complete surgical staging. Careful follow-up is mandatory to ensure safety of this procedure.

Adult↗

PubMed2005

Ovarian cancer, diagnosed with PET, with bilateral inguinal lymphadenopathy as primary presenting sign.

BACKGROUND: Ovarian cancer groin lymph nodes metastases are rare. Only one case of disease spread isolated to the groins has been reported in the English literature. We report the case of a patient with bilateral inguinal lymphadenopathy due to tumor metastases and in which tumor origin was diagnosed using [(18)F]fluorodeoxyglucose positron emission tomography (PET). CASE REPORT: This is the first case of bilateral groin lymph nodes as sole site of metastases from ovarian cancer. Primary origin was identified using PET. CONCLUSIONS: In rare cases, the ovaries can directly metastasis to the groin even in a relatively initial tumor growth phase. PET may play a role in the diagnosis of occult ovarian tumors.

Female↗

PubMed2005

Vaginal estrogen therapy and overactive bladder symptoms in postmenopausal patients after a tension-free vaginal tape procedure: a randomized clinical trial.

OBJECTIVE: To evaluate whether the frequency of overactive bladder (OAB) symptoms increases in menopause patients after a tension-free vaginal tape (TVT) procedure, and to determine if topical estrogen therapy can help prevent these symptoms. DESIGN: After undergoing a preoperative assessment, enrolled patients were randomly allocated to receive TVT plus postoperative vaginal estrogen therapy (ET group) or TVT without adjunctive medical treatment (No ET group). The pre- and postoperative assessments included: acquisition of a urogynecologic history with standardized questions regarding urinary function (including a 10-grade visual analogue scale score), urogynecologic clinical examination, and urodynamic assessment. Follow-up assessments were performed at 1, 3, and 6 months after surgery. RESULTS: Fifty-six of 59 patients were evaluable; 28 received topic vaginal estrogen after surgery (ET group) and 28 did not receive adjunctive medical treatment (No ET group). The overall OAB syndrome rate in menopause patients (No ET group) was 7% (2 of 28 patients) at baseline and 32% (9 of 28 patients) 6 months after surgery (P = 0.04). At the 6-month follow-up assessment, the incidence of urinary urgency was 4% (1 of 28 patients) and 29% (8 of 28 patients) in the ET and No ET groups, respectively (P = 0.01). Differences in frequency and nocturia were not statistically significant. Analysis of the visual analogue scale scores revealed that at the 6-month follow-up assessment, urgency significantly improved in the ET group compared with the No ET group (0.23 +/- 1.0 vs 2.30 +/- 3.7, respectively; P = 0.02). CONCLUSIONS: The TVT procedure seems to increase the frequency of OAB syndrome in menopause patients. Vaginal estriol therapy significantly reduces symptoms of urinary urgency, has a high rate of patient satisfaction, and can be used to treat postmenopausal women for at least 6 months after a TVT procedure.

Administration, Intravaginal↗

PubMed2005

Laparoscopic stripping of endometriomas: a randomized trial on different surgical techniques. Part II: pathological results.

BACKGROUND: The stripping technique for endometriomas excision has been reported to be associated with follicular loss. The objective of this trial was to evaluate the presence and nature of ovarian tissue adjacent to the endometrioma cyst wall obtained by stripping with different techniques. METHODS: Forty-eight patients with ovarian endometrioma were enrolled in two consecutive independent randomized trials. Two different techniques were analysed at the initial adhesion site (circular excision and subsequent stripping versus immediate stripping). Two different techniques were analysed at the ovarian hilus (stripping versus coagulation and cutting). Histology analysis was performed in three portions of the cyst wall (initial adhesion site, intermediate part of the specimen, ovarian hilus). RESULTS: Recognizable ovarian tissue was inadvertently excised together with the endometrioma cyst wall in most cases. At initial adhesion sites more ovarian tissue was removed with the circular excision technique (< 0.001). No significant difference in quality of ovarian tissue (number and type of follicles) was found between specimens obtained with different surgical techniques at the initial or at the final part of the procedure. At the initial adhesion site and at the intermediate part of the cyst wall, the ovarian tissue removed along with the endometrioma wall was mainly constituted by tissue with no follicles or only primordial follicles (60% and 48% of the specimens from the initial part with both techniques, and from the intermediate part, respectively, had no follicles or only primordial follicles). Close to the ovarian hilus the ovarian tissue removed along with the endometrioma wall mostly consisted of tissue which contained primary and secondary follicles (69% of the cases, combining the two groups). CONCLUSIONS: Ovarian tissue is inadvertently excised together with the endometrioma wall in most cases. The excised tissue is at normal functional development stages only near the ovarian hilus. The different techniques used do not influence significantly the quality of the resected tissue.

Adult↗

PubMed2005

Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial.

BACKGROUND: The role of systematic aortic and pelvic lymphadenectomy in patients with optimally debulked advanced ovarian cancer is unclear and has not been addressed by randomized studies. We conducted a randomized clinical trial to determine whether systematic aortic and pelvic lymphadenectomy improves progression-free and overall survival compared with resection of bulky nodes only. METHODS: From January 1991 through May 2003, 427 eligible patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIB-C and IV epithelial ovarian carcinoma were randomly assigned to undergo systematic pelvic and para-aortic lymphadenectomy (n = 216) or resection of bulky nodes only (n = 211). Progression-free survival and overall survival were analyzed using a log-rank statistic and a Cox multivariable regression analysis. All statistical tests were two-sided. RESULTS: After a median follow-up of 68.4 months, 292 events (i.e., recurrences or deaths) were observed, and 202 patients had died. Sites of first recurrences were similar in both arms. The adjusted risk for first event was statistically significantly lower in the systematic lymphadenectomy arm (hazard ratio [HR] = .75, 95% confidence interval [CI] = 0.59 to 0.94; P = .01) than in the no-lymphadenectomy arm, corresponding to 5-year progression-free survival rates of 31.2 and 21.6% in the systematic lymphadenectomy and control arms, respectively (difference = 9.6%, 95% CI = 1.5% to 21.6%), and to median progression-free survival of 29.4 and 22.4 months, respectively (difference = 7 months, 95% CI = 1.0 to 14.4 months). The risk of death was similar in both arms (HR = 0.97, 95% CI = 0.74 to 1.29; P = .85), corresponding to 5-year overall survival rates of 48.5 and 47%, respectively (difference = 1.5%, 95% CI = -8.4% to 10.6%), and to median overall survival of 58.7 and 56.3 months, respectively (difference = 2.4 months, 95% CI = -11.8 to 21.0 months). Median operating time was longer, and the percentage of patients requiring blood transfusions was higher in the systematic lymphadenectomy arm than in the no-lymphadenectomy arm (300 versus 210 minutes, P<.001, and 72% versus 59%; P = .006, respectively). CONCLUSION: Systematic lymphadenectomy improves progression-free but not overall survival in women with optimally debulked advanced ovarian carcinoma.

Adult↗

PubMed2005

Minilaparotomy hysterectomy: a valid option for the treatment of benign uterine pathologies.

OBJECTIVE: To evaluate feasibility and outcome of minilaparotomy hysterectomy in a consecutive series of patients. STUDY DESIGN: Cohort analytic study. From October 1995 to March 2001, 148 out of 228 (65%) consecutive hysterectomies for benign gynecologic disease were performed by an abdominal route. Minilaparotomy hysterectomy (transversal cutaneous incision < 10 cm, within the pubic hair) was attempted in all patients with benign uterine disease and contraindications for vaginal surgery. Surgical parameters were prospectively assessed in terms of length of incision, operative time, estimated blood loss, duration of ileus, perioperative complications and length of postoperative stay. RESULTS: A minilaparotomic approach was performed in 118 patients (80%). Conversion to Pfannenstiel was necessary in three cases. The minilaparotomy incision, 8 cm (range 6-10) of median length, was performed below the pubic hair line. The median operating time was 50 min (range 34-88). No intraoperative complications or perioperative blood transfusions were reported, while minor postoperative complications occurred in 16 patients (14%). The median postoperative stay was three days (range 2-5). CONCLUSIONS: The minilaparotomy hysterectomy is feasible in the majority of women undergoing hysterectomy for benign disease. Because of the excellent outcome achieved, it should be considered a valid alternative to the classic abdominal hysterectomy.

Adult↗

PubMed2005

Laparoscopic stripping of endometriomas: a randomized trial on different surgical techniques. Part I: clinical results.

BACKGROUND: Laparoscopic surgery has become the gold-standard treatment for ovarian endometriomas. The objective of this trial was to evaluate different procedures for the laparoscopic excision of ovarian endometriomas with the stripping technique. METHODS: Forty-eight patients with ovarian endometrioma were enrolled in two consecutive independent randomized trials. Two different techniques were analysed at the initial adhesion site (circular excision and subsequent stripping versus immediate stripping). Two different techniques were analysed at the ovarian hilus (stripping versus coagulation and cutting). Operative time and technical difficulties were prospectively evaluated. Histological analysis was performed in three portions of the cyst wall and the results of the histologic study are reported separately. RESULTS: At the initial part of the stripping procedure, the technique of circular excision and subsequent stripping appeared to be more easily performed than the technique of direct stripping (P < 0.01), although operative times were comparable between the two techniques. At the hilus, the two techniques utilized appeared to be comparable both for easiness of procedure and operating times. CONCLUSIONS: In this prospective, randomized study, different techniques used during the stripping procedure appeared to be comparable in terms of operative times and complications. One technique used at the beginning of the procedure (circular excision followed by stripping) was easier to perform.

Adult↗

PubMed2005

Ringer's lactate solution remains in the peritoneal cavity after laparoscopy longer than expected.

OBJECTIVE: To evaluate by serial ultrasound scans how long a Ringer's lactate instillation remains in the peritoneal cavity after laparoscopy. DESIGN: Prospective, randomized, double blind, clinical trial. SETTING: Tertiary care, university hospital. PATIENT(S): Thirty-six patients undergoing diagnostic or minor operative laparoscopy. INTERVENTION(S): At the end of laparoscopy, the patients were tilted to an anti-Trendelenburg position and all fluid was aspirated. The patients were then randomized to receive an instillation of 300 mL of Ringer's lactate or no fluid instillation. Serial transvaginal ultrasound scans were performed at the end of surgery and at 24, 48, and 96 hours after the surgery. MAIN OUTCOME MEASURE(S): Through direct measurements of scalar fluid volumes instilled in the operating room and real-time ultrasound comparisons, an empiric formula was calculated to correlate actual intraperitoneal volumes to ultrasonically derived measurements of fluid pockets. With this formula, the volume of intraperitoneal fluid at 24, 48, and 96 hours after surgery was calculated. RESULT(S): Twenty-four hours after surgery, a mean volume of 184 mL was present in the Ringer's lactate group versus 46 mL in the control group. At 48 hours after surgery, the mean volumes were 78 mL versus 30 mL, respectively. No statistically significant differences were found after 96 hours. CONCLUSION(S): Peritoneal absorption of instilled crystalloids is traditionally reported to be 30 to 60 mL/hour. We report detecting statistically significant amounts of fluid at 24 and 48 hours after surgery, after infusion of 300 mL of Ringer's lactate. This suggests that fluid remains in the peritoneal cavity longer than traditionally believed.

Adult↗

PubMed2005

Single agent cisplatin chemotherapy in surgically resected vulvar cancer patients with multiple inguinal lymph node metastases.

OBJECTIVE: The aim of this study was to evaluate acute and long-term morbidity, recurrence rate, and overall survival in patients with multiple groin lymph node metastases treated with postoperative chemotherapy. METHODS: Patients affected by FIGO stages III, IVA, and IVB (pelvic lymph nodes only) submitted to surgery were then treated with four cycles of cisplatin 100 mg/m(2) given 21 days apart. Toxicity, overall, and disease-free survival were evaluated. RESULTS: Fourteen patients were evaluated. Median patients age was 58 (range 48-82). Median performance status was 0 (0-2). All patients completed the treatment. No treatment-related deaths occurred. Only two patients suffered from grade 4 neutropenia during chemotherapy. Three patients suffered from long-term severe lymphedema. Four patients suffered a disease recurrence. Three of these patients were subjected to surgery with no severe postoperative complications. Two of the latter patients are still alive. At a median follow-up of 57.5 months (range 23-79 months) actuarial 3-year overall survival and progression-free survival are 86% and 71%, respectively. CONCLUSIONS: In patients affected by vulvar cancer with multiple lymph node metastases, radical surgery followed by chemotherapy is a feasible strategy, with an acceptable short- and long-term complication rate. Results in terms of overall survival and disease-free survival are promising. Furthermore, due to absence of local long-term tissue toxicity, this strategy allows physicians to surgically treat regional lymph node recurrence safely.

Aged↗