Background and Objectives: Ectopic pregnancy (EP) is a potentially life-threatening condition and the leading cause of maternal mortality in the first trimester. Although both surgical and medical approaches are effective, selection criteria for Methotrexate (MTX) treatment remain inconsistent across international guidelines. Additionally, limited data on long-term reproductive outcomes are available. Materials and Methods: We conducted a single-center retrospective cohort study of 107 patients diagnosed with tubal EP and treated at the Obstetrics and Gynecology Unit of the University Hospital of Parma between 2019 and 2023. MTX (50 mg/m²) was offered to patients with β-hCG < 5000 mIU/mL, sac diameter < 40 mm, and no embryonic cardiac activity or hemoperitoneum; others underwent salpingectomy. Treatment outcomes, predictors of MTX success, and fertility outcomes were analyzed. Results: Medical treatment was offered to 36 patients (33.6%), with an overall success rate of 72%: in total, 20 resolved after a single dose and 6 after a second dose. Surgical conversion was necessary in 10 patients. The remaining 71 patients (66.4%) underwent primary salpingectomy. Initial β-hCG levels and gestational age did not significantly predict MTX failure (p 0.14 and 0.73, respectively), whereas gestational sac diameter was identified as a reliable predictor of treatment success (p = 0.01). In particular, a gestational sac maximum diameter of <2 cm emerged as a positive factor for MTX success (OR 1.13, 95% CI: 1.1–1.3, p = 0.04). Among the 50 patients with follow-up data, 68% achieved a term live birth, with no significant difference between the MTX (52.9%) and surgical (75.8%) groups (p 0.12). Most of the pregnancies (90%) occurred spontaneously, while only 10% required assisted reproductive technologies. Conclusions: MTX is a safe and effective treatment for tubal EP when patients are appropriately selected. Gestational sac diameter appears to be a reliable predictor of success. Both medical and surgical treatments yielded comparable reproductive outcomes, supporting individualized care models that prioritize fertility preservation.

Background/Objective: Women with Class III obesity (BMI ≥ 40 kg/m²) have a lifetime risk of endometrial cancer (EC) as high as 10–15%. However, evidence focused specifically on Class III obese patients remains limited. This study evaluated the surgical feasibility and safety of robotic surgery in Class III obese women with EC. Methods: A single-center retrospective study was conducted at the ESGO-accredited University Hospital of Parma (Italy) from October 2021 to February 2025. All women had apparent early-stage EC and underwent robotic hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node (SLN) mapping with Indocyanine Green. Patients were categorized into three BMI groups: Group A (BMI ≥ 40 kg/m²), Group B (BMI 30–39 kg/m²), and Group C (BMI < 30 kg/m²). Perioperative variables—including operative time, estimated blood loss, conversion to laparotomy, intra- and postoperative complications, hospital and Intensive Care Unit (ICU) stay, and SLN mapping failure—were compared across groups. Results: A total of 109 women were included: 26 (23.9%) in Group A, 45 (41.3%) in Group B, and 38 (34.9%) in Group C. Class III obesity was not associated with higher intraoperative (p = 0.390) or postoperative (p = 0.805) complication rates. Conversion to laparotomy (p = 0.720), estimated blood loss (p = 0.123), ICU stay (p = 0.156), and hospital stay (p = 0.491) were superimposable across groups. Operative time was significantly longer in Group A (p = 0.003) compared to the other groups. Successful bilateral SLN mapping differed significantly across groups (p = 0.026), being lower in Group A (73.1%) compared to Group B (95.6%) and Group C (81.6%). Conclusions: Robotic surgery is safe and feasible in Class III obese EC patients, with perioperative morbidity comparable to that of lower BMI groups. Nevertheless, longer operative times and a lower rate of successful bilateral SLN mapping highlight the need for tailored strategies and further research to optimize nodal staging in severely obese women.

Background/Objectives: Patients with advanced ovarian cancer face a high risk of venous thromboembolism (VTE). This study evaluates the incidence and risk factors for pulmonary thromboembolism (PE) in patients with advanced high-grade serous ovarian carcinoma (HGSOC) undergoing primary treatment, with a focus on personalized risk stratification. Methods: A retrospective analysis was conducted on women with FIGO stage IIIA-IVB HGSOC treated at the University Hospital of Parma between January 2012 and May 2023. All patients underwent CT-based staging prior to primary treatment. When resectability was uncertain, diagnostic laparoscopy and the Fagotti score were performed. Based on cytoreductive potential, patients received either primary debulking surgery (PDS) followed by adjuvant chemotherapy (AC) or neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) and AC. The Khorana score, a thromboembolic risk model, was calculated prior to chemotherapy. Logistic regression was used to assess the association between baseline characteristics and PE. Results: Among 167 HGSOC patients analyzed, 13 (7.8%) experienced PE. Among the 115 patients undergoing diagnostic laparoscopy, each 2-point increase in the Fagotti score above 8 raised PE risk by 76% (OR 1.76, p = 0.006, 95% CI: 1.17–2.63). Patients undergoing NACT-IDS had a significantly higher risk of PE (OR 4.04, 95% CI: 1.19–13.74, p = 0.02) than patients who underwent PDS. A Khorana score of 3 was an independent predictor of PE (OR 37.66, 95% CI: 2.43–582.36, p = 0.009). Conclusions: Based on our results, NACT followed by IDS or a Fagotti score greater than 8 were associated with increased PE risk in HGSOC patients. Khorana score was the strongest predictor of PE in HGSOC patients.