Giacomo Corrado

The Female Reproductive Tract Microbiota and Endometrial Cancer: A Systematic Review

This systematic review aimed to summarize the available evidence on the associations between the female reproductive tract microbiota and endometrial cancer (EC). While gut microbiota has been studied extensively, microbial communities within the endometrium, cervix, and vagina remain relatively understudied. A systematic literature search was conducted in PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library for studies published up to January 2025. Predefined PECO-based criteria included studies on women or human cell models assessing genital tract microbiota in EC versus non-EC controls, focusing on composition, diversity, or function; reviews and non-microbiota studies were excluded. A total of 21 studies were included. Overall, there was a consistent depletion of protective Lactobacillus species and enrichment of anaerobic, pro-inflammatory bacteria like Prevotella, Atopobium, and Porphyromonas in EC tissues. Beta-diversity was significantly different between EC and controls across studies, indicating distinct microbial profiles. Some studies also identified fungal and viral taxa associated with EC, and functional assays demonstrated that certain species could modulate host immune responses or promote tumor growth. Despite methodological heterogeneity and the lack of evidence supporting causality due to the observational design, the findings support an association between altered genital tract microbiota and EC.

Feasibility, safety, and efficacy of robotic single-port hysterectomy (R-SPH) using the da Vinci SP system in low-risk endometrial cancer: a pilot study

The purpose of this study was to evaluate the feasibility, safety, and efficacy of robotic single-port hysterectomy (R-SPH) with the da Vinci SP in low-risk endometrial cancer. Patients with clinically confirmed endometrioid endometrial cancer, FIGO stages IA-IB, were enrolled for R-SPH. All surgical procedures were performed through a single 2.5 cm umbilical incision. An Intuitive Access Port of small size was placed into the incision, and pneumoperitoneum was established. Robotic instruments were inserted as described below through the Intuitive Access Port, which has four different channel ports: in the superior channel, a three-dimensional 8.5 mm optics; in channel 1, Cadiere Forceps; in channel 2, a Maryland Bipolar; and in channel 3, monopolar scissors. From June 24 to November 13, 2024, a total of 25 patients were included in the study. The median age was 61 years, and median BMI was 25.9 kg/m R-SPH seems safe and feasible in endometrial cancer. The true benefit of the technique should be sought in larger comparative studies. ClinicalTrials.gov Protocol Record: NCT06681831.

Comparison between single‐site and multiport robot‐assisted hysterectomy in obese patients with endometrial cancer: An Italian multi‐institutional study

AbstractBackgroundThe aim of this study is to compare robotic single‐site hysterectomy (RSSH) and robotic multiport hysterectomy (RMPH) for endometrial cancer (EC) in obese patients in terms of surgical outcomes.MethodsThis retrospective study compares RSSH with RMPH in obese patients with EC and FIGO stages I to II divided in three classes according to their body mass index (BMI): class A (30‐34.9 kg/m2), class B (35‐39.9 kg/m2), and class C (>40 kg/m2).ResultsWe included 225 patients (RSSH: 76; RMPH: 149). The operative time and estimated blood loss (EBL) were lower in the A class of the RSSH group. The EBL and the conversion rate increased when the BMI increased in the RSSH group. The hospital stay was higher in the A class of the RMPH group.ConclusionsThe advantages of RSSH in terms of reduced invasiveness remain true only in the first BMI class, whereas they are lost when the BMI increased.

Chemotherapy resistance in epithelial ovarian cancer: Mechanisms and emerging treatments

Ovarian cancer (OC) remains a fatal malignancy because most patients experience recurrent disease, which is resistant to chemotherapy. The outcomes for patients with platinum-resistant OC are poor, response rates to further chemotherapy are low and median survival is lower than 12 months. The complexity of platinum-resistant OC, which comprises a heterogeneous spectrum of diseases, is indeed far from being completely understood. Therefore, comprehending tumors' biological behaviour to identify reliable biomarkers, which may predict responses to therapies, is a demanding challenge to improve OC management. In the age of precision medicine, efforts to overcome platinum resistance in OC represent a dynamic and vast field in which innovative drugs and clinical trials rapidly develop. This review will present the exceptional biochemical environment implicated in OC and highlights mechanisms of chemoresistance. Furthermore, innovative molecules and new therapeutic opportunities are presented, along with currently available therapies and ongoing clinical trials.

Fertility preservation in patients with BRCA mutations or Lynch syndrome

Guidelines and expert consensus are lacking on fertility preservation in BRCA mutation carriers and in patients with Lynch syndrome. The safety of fertility preservation in this setting is still a topic of debate and multiple factors need to be carefully considered. The aim of this review was to analyze the reproductive potential of women harboring a genetic mutation affecting the DNA repair system and explore the efficacy and safety of existing fertility preservation strategies in these patients.

Cisplatin? Why not?

The role of HER2 pathway in vulvar paget’s disease

Vulvar Paget's disease (VPD) is an orphan neoaplasm accounting 1-2 % of vulvar malignancies. Advanced VPD is currently laking effective treatment options. Since HER2 is overexpressed in 30-40 % of VPD cases, this scoping review explores its prognostic significance and the effectiveness of HER2-targeted therapies. A literature review was conducted using the PubMed and Scopus databases. The search was restricted to articles in English and human studies, incorporating the terms "extramammary Paget disease", "vulva", "HER2", "anti-Her2 therapy" and "trastuzumab". Two reviewers screened abstracts and full-text article while recording relevant data. Seventeen small retrospective studies on HER2 expression in VPD were evaluated. All studies assessed HER2 using IHC, while only 9 studies also employed FISH to detect gene amplification. A total of 270 patients are reported, of which 121 patients (45 %) had a 3 + or 2 + score. HER2/neu amplification was reported in 40 % of invasive tumours vs 17.5 % of non-invasive tumor. Eleven case-reports and series suggested a possible benefit of HER2-targeted therapies. To be mentioned, 4 articles reported trastuzumab combined with chemotherapy as the first-line treatment option, while trastuzumab monotherapy resulted in excellent objective response in two case reports. Although HER2 expression in VPD represents a potential therapeutic target, current evidence is largely derived from case reports and lacks substantial clinical trial data. There is an urgent need for targeted clinical trials and expanded genomic profiling to enhance understanding of the underlying molecular mechanisms and optimize treatment strategies.

New Advances in Cervical Cancer: From Bench to Bedside

Cervical cancer is the most common gynecologic malignancy and the fourth most common cancer in women worldwide. Over the last two decades, minimally invasive surgery (MIS) has emerged as the mainstay in the surgical management of early-stage cervical cancer, bringing advantages such as a lower operative morbidity and shorter hospital stay compared to open surgery, while maintaining comparable oncologic outcomes in numerous retrospective studies. Considering oncological patients, it is mandatory to assess the oncological outcomes and safety of this type of surgery. Moreover, there are different future outlooks on cervical cancer therapy, based on immunotherapy, target therapy, and poly-ADP-ribose polymerases (PARP) inhibitors in combination with each other, and in combination with standard chemotherapy and radiotherapy. The goal is to find an approach that is as personalized as possible.

Physicians’ Controversies Towards Fertility Preservation in Young Patients with Gynecological Cancer: An MITO Survey

Guidelines on fertility preservation (FP) have been developed to help young women preserve their fertility, which may have been impaired due to cancer. Nevertheless, the correct management of oncological patients of childbearing age remains controversial, especially regarding gynecological malignancies. For this reason, we explored the current knowledge, attitudes, and clinical practices of physicians towards the challenges of FP in this population. A specially developed questionnaire on fertility-related issues in patients with gynecological cancer was administered via email to 167 people, representing 167 centers of the Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies (MITO) group. A total of 56 physicians, who represented 56 out of these 167 centers, responded to our survey (response rate: 33.5%). Approximately half of these physicians stated that they had adequate knowledge about the use of gonadotropin-releasing analog (GnRHa) injections (n = 30; 53.6%), the cryopreservation of oocytes (n = 25; 44.6%), and the cryopreservation of ovarian tissue (n = 27; 48.2%) in patients with gynecological tumors. Meanwhile, regarding (borderline) ovarian tumors, endometrial or cervical cancer, and genetic mutation carriers, attitudes varied substantially. In conclusion, the results of our survey highlight the different perspectives on controversial topics among physicians directly involved in the treatment of these tumors. These findings also demonstrate the lack of evidence on these issues to adequately counsel this specific patient population.

Patterns of recurrence in FIGO stage IB1-IB2 cervical cancer: Comparison between minimally invasive and abdominal radical hysterectomy

Aim of our study was to evaluate whether the different laparotomic (ARH) or minimally invasive (laparoscopic and robotic) approaches (MIS) in FIGO stage IB1-IB2 cervical cancer, present different patterns of recurrence of the disease. The secondary endpoint of the study was the evaluation of the variables most involved with the risk of relapse and therefore lower DFS and OS. The study enrolled patients with definitive histological diagnosis of squamous or adenocarcinoma stage IB1-IB2 cervical cancer who underwent minimally invasive or abdominal radical hysterectomy from 2001 to 2018. The study enrolled 360 patients and 59 patients (16.4 %) reported a disease relapse. The data showed that ARH group was not associated with different recurrence patterns than MIS group (p = 0.14). Moreover, there was no statistically significant difference regarding DFS (p = 0.52) and OS (p = 0.29) between the ARH group and the MIS group. MIS, in FIGO stage IB1-IB2 cervical cancer, is not associated with different relapse patterns compared to ARH, nor with a higher risk of distance metastasis and finally, without significant difference in term of DFS and OS. More studies are needed to determine the factors that modify the site of relapse.

Single-Port Hysterectomy (R-SPH) Using the Da Vinci SP System in Low-Risk Endometrial Cancer

Patients with clinically confirmed endometrioid endometrial cancer at FIGO stage IA-IB were eligible for robotic single-port hysterectomy (R-SPH). Criteria included: well or moderately differentiated tumor grade (G1 or G2), sufficient vaginal access, uterine size under 12 weeks' gestation, adequate bone marrow, kidney, liver, and heart function, and an ECOG performance status of 2 or below. Exclusions applied to patients with significant cardiopulmonary disease, previous pelvic or abdominal radiation, or severe hip disease affecting positioning. Prior abdominal surgeries did not exclude patients from robotic surgery. Surgeries were performed using the Vinci Single-Site® system by a specialized team. Clinical data collected included age, BMI, FIGO stage, tumor grade, surgical margin status, and hospital stay duration. Operation times were divided into docking, console (surgical), and total operation times. Intraoperative assessments included complications, blood loss, hemoglobin changes, and transfusions if hemoglobin was ≤7 g/L. Postoperative complications were evaluated short- and long-term, including surgical, cardiac, and respiratory events.