Chirurgia最新文献

Introduction: we report the case of a recurrent giant pseudopolyp occurring in a patient without a history of inflammatory bowel disease (IBD), with an asymptomatic interval of nine years. Case Presentation: a 51-year-old Caucasian male with no relevant medical history was hospitalized for a subocclusive mass in the right colon, suspected to be neoplastic. He underwent a right hemicolectomy, and the histopathology revealed a giant pseudopolyp without malignancy. Follow-up for IBD was recommended but not completed. Nine years later, the patient presented with a similar clinical picture, and another mass was found at the site of the prior anastomosis. Surgical excision confirmed another giant pseudopolyp with no evidence of neoplasia. Conclusion: giant pseudopolyps, while often associated with IBD, can occur in patients without a prior inflammatory history. This case underscores the need to include pseudopolyps in the differential diagnosis of colonic masses, even in the absence of IBD, to avoid unnecessary surgical morbidity.

Objective: this retrospective study aimed to evaluate the impact of BRCA mutational status on the outcomes of patients with advanced ovarian cancer treated with either primary debulking surgery (PDS) or neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Material and Methods: a total of 79 patients with stage III-IV ovarian cancer treated at Elias Emergency University Hospital between January 2014 and March 2024 were included. Patients received either PDS followed by chemotherapy or NACT-IDS. Clinical and pathological characteristics, progression-free survival (PFS), and overall survival (OS) were analyzed and stratified by BRCA mutational status. Kaplan-Meier analysis and Cox proportional hazard models were used to compare survival outcomes between BRCA-mutated (BRCAmut) and BRCA wild-type (BRCAwt) patients across treatment groups. Results: the BRCAwt group showed a slight trend favoring PDS in terms of OS (48 months vs. 38 months, p = 0.03) and PFS (22 months vs. 19 months, p = 0.552), though the difference in PFS was not statistically significant. In contrast, BRCAmut patients treated with NACT-IDS demonstrated significantly improved OS compared to those undergoing PDS (71 months vs. 50 months, p = 0.043), while PFS was similar between groups (25 months vs. 23 months, p = 0.345). Complete cytoreduction (R0) was achieved in a higher proportion of BRCAmut patients (80.8% vs. 56.6% in BRCAwt).

Conclusion: BRCA mutational status is a critical factor influencing survival outcomes in advanced ovarian cancer. While BRCAwt patients may slightly benefit from PDS, BRCAmut patients exhibit significantly improved OS with NACT-IDS. These findings support the need for individualized treatment strategies based on BRCA status to optimize outcomes in ovarian cancer.

Introduction: tumour specific surgery in colon cancer is gaining popularity among colorectal surgeons. Many advocate adapting surgical technique based on preoperative CT staging as not all patients require complete mesocolic excision (CME) and D3 lymphadenectomy. We aimed to assess the sensitivity and specificity of preoperative CT scans in nodal staging and analyse whether inadequate CT staging could have influenced local recurrences. Material and Methods: a retrospective cohort study was conducted on patients with stage I-III colon cancer who were followed up at our hospital between 2011 and 2019. The clinical and pathological variables and data on locoregional recurrence (LRR) were extracted from the electronic patient file, including imaging data performed as part of the standard oncological follow-up protocol. Results: the overall CT scan accuracy to identify the nodal status was 56.9% with sensitivity and specificity of 60.6% and 52.5%. Overstaging occurred in 95 patients (22%) and understaging in 92 (21%). Among understaged patients, 8 (8.7%) developed nodal LRR. Conclusion: considering that roughly one in three patients with nodal LRR, were underdiagnosed in terms of nodal status, by the preoperative CT assessment, the therapeutic decisions regarding the surgical approach should not be guided by this and CME with central vascular ligation (CVL) should be applied to all patients as a standardized surgical technique.

Background: the axillary reverse mapping (ARM) procedure aims to preserve the lymphatic drainage structures of the upper extremity during axillary surgery for breast cancer, thereby reducing the risk of lymphedema in the upper limb. Material and Methods: this prospective study included 57 patients with breast cancer who underwent SLNB and ARM. The sentinel lymph node (SLN) was identified using a radioactive tracer. The ARM nodes were identified using indocyanine green with a near-infrared imaging system. All SLNs were examined intraoperatively. If the SLN was metastatic, further surgery was considered. The identified ARM nodes were preserved unless they coincided with the SLN. Results: ARM nodes were visualized in 53 patients (92.94%). Crossover between SLN and ARM nodes was observed in 19 patients, 5 untreated and 14 who received neoadjuvant systemic treatment (NST), resulting in an overall crossover rate of 33.33%. Patients who received NST were more likely to show SLN-ARM crossover (p = 0.015) compared to those who underwent upfront surgery. Of the 20 patients with positive SLNs, 13 had crossover, 5 untreated and 8 received NST. In patients with positive SLN-ARM nodes, additional invaded ARM nodes were identified 7 patients, all of whom received NST. Conclusions: using ARM in patients undergoing SLNB allows a supraselective approach to axillary surgery, aiming to reduce morbidity. In cases where patients underwent upfront surgery all SLN-ARM nodes were found to be metastatic and none of the other fluorescent nodes that were removed showed signs of invasion. The crossover rates are higher in patients with neoadjuvant treatment.

Introduction: surgery for rectal cancer often presents multiple tactical and technical challenges due to factors such as the tumor's extent, limited anatomical space, proximity to the anal sphincter complex, and the use of neoadjuvant radiotherapy. These factors can significantly increase the complexity of surgery and the risk of both immediate and delayed complications, which can occur intraoperatively or postoperatively. Objective: the aim of this study was to retrospectively analyze the causes, diagnostic methods, and management of complications in patients who underwent surgery for rectal cancer. Additionally, the study sought to evaluate the impact of these complications on patients' therapeutic outcomes. Materials and Methods: we conducted a single-center, non-experimental, descriptive retrospective study over a five-year period at a single surgical clinic. The cohort consisted of 157 patients with rectal cancer, with various tumor locations, who underwent either radical or palliative surgical interventions. We analyzed demographic data, clinical and imaging factors, and statistically assessed intraoperative incidents, accidents, and postoperative complications. Results: complications were not isolated events; many patients experienced multiple associated complications. The overall complication rate was 16.56%, with 15.38% of complications being hemorrhagic incidents, 7.69% involving vascular or nervous plexus injuries, and 13 patients experiencing anastomotic dehiscence. Additionally, 26.9% of patients had complications related to the stoma, and 15.38% developed anastomotic stenosis. The overall mortality rate was 3.82%. Conclusions: surgeons performing rectal cancer surgeries must undergo extensive training to ensure accurate early diagnosis, effective surgical technique, and the proper management of postoperative complications. This approach is crucial in preventing negative outcomes, including diminished quality of life for patients and higher mortality rates.

Background: laparoscopy has emerged as a pivotal tool for the management of acute abdominal pathologies. It provides diagnostic and therapeutic advantages, enabling surgeons to evaluate and address diverse acute abdominal conditions using minimally invasive techniques. The aim of this consensus was to obtain evidence-based guidance for surgeons regarding the utilization of laparoscopy in emergency medical settings, and has been divided into trauma and non-trauma emergencies. This is the part dedicated for trauma. Material and Methods: the task forces of the RAES Research Committee and a panel of experts were established. The development of consensus statements started with an extensive literature review of available medical databases (PubMed, Cochrane, and EMBASE). A set of questions addressing major issues related to the use of laparoscopy in trauma and non-trauma emergencies was defined. The validation of the questions set was performed by the expert group through the first Delphi round. Consensus statements and recommendations were also obtained. The quality of evidence and recommendation strength were rated using the GRADE system. The recommendations were formulated in a directive manner and then assessed by an expert panel using the Delphi technique for agreement. Results: the two main types of emergencies were trauma and non-trauma. There were seven recommendations for the trauma section. For each statement, agreement from the expert panel was obtained. The statements included training for surgeons involved in trauma care, indications and contraindications for laparoscopy in trauma cases, and conversions and complications of laparoscopy for trauma. Conclusions: the RAES consensus offers a set of guidelines for surgeons managing acute abdominal conditions using laparoscopic techniques.

Introduction: minimally invasive surgery is the surgery of the present and has become the "gold standard" for the most pathologies. The training of surgeons in minimally invasive techniques is mandatory required to be carried out during the residency program. In Romania, there is no national minimally invasive surgical training program, only universities and certain university hospitals are concerned with this aspect. The aim of this study was to assess the level of minimally invasive surgical training at the national level and to identify the concerns of residents and young specialists in surgical specialties. Material and Method: the Young-RAES team designed a confidential 25-question online questionnaire that explores the individual minimally invasive surgical training and needs of young medical surgeons. The online questionnaire was sent to young surgeons from Romania, RAES members and non-members, and was distributed on social networks. All young surgeons, regardless of specialty (age 40 years), were invited to participate in the period December 2023 " January 2024 on the survey. Results: a total of 197 respondents from 9 University Centers participated in the survey. The majority of respondents (55.3%) described their current position as a resident doctor, 94.4% working in a public hospital. Only 20.3% have the benefit of having a laparoscopic simulation center in the institution where they work, and 63.5% have followed some form of individual training in minimally invasive techniques. Most respondents performed their first surgical intervention after the 3rd year of residency, the most common procedure being laparoscopic cholecystectomy. Regardless of gender distribution, most respondents wanted more than 1 year of minimally invasive training during their residency program. Conclusions: this national survey emphasizes the need for a training program in minimally invasive surgery at the national level, with a common structure and program and with the possibility of periodic individual evaluation, the importance of promoting surgical training being mandatory for improving postoperative results.

Background: the evolution of axillary management in breast cancer has witnessed significant changes in recent decades, leading to an overall reduction in surgical interventions. There have been notable shifts in practice, aiming to minimize morbidity while maintaining oncologic outcomes and accurate staging for newly diagnosed breast cancer patients. These advancements have been facilitated by the improved efficacy of adjuvant therapies. Objective: To compare the outcomes of axillary lymph node dissection (ALND) and loco-regional axillary radiotherapy (ART) on lymphedema and disease recurrence in locally advanced breast cancer (LABC) cases that have shown a downstaging of their axillary status after neoadjuvant chemotherapy (NACT). Material and Methods: sixty patients with LABC with an initial cN1-2 disease showed a downstaging of their axillary status to cN0 after NACT. They were randomized into two groups. The first group (the control group) underwent ALND, while the second group (the study group) had a sentinel lymph node biopsy (SLNB) and post-operative ART. Patients with failed SLNB or positive SLNB were excluded. All patients were followed up for loco-regional recurrence and lymphedema for at least one year. Results: no statistical significance was found between both groups regarding loco-regional recurrence. There was a higher rate of arm lymphedema in the control group. Lymphedema was found in 46.7% of patients who underwent ALND, compared to 13.4% in the study group (patients with SLNB and radiotherapy). Conclusion: axillary radiation after SNLB has shown no difference regarding axillary recurrence when compared to ALND. However, our results were in favor of radiation concerning lymphedema. With all the ongoing research aiming at reducing axillary surgery, this study could be an initiative for a new strategy in LABC.

Background: cutaneous melanoma has often unpredictable lymphatic drainage patterns, especially at the level of the trunk, head and neck regions. Sentinel lymph node biopsy (SLNB) is an important prognostic tool that accurately assesses regional lymph node involvement and guides therapeutic decisions. Material and Methods: this prospective study involved 104 patients diagnosed with cutaneous melanoma who underwent SLNB using a radioactive tracer. Sentinel lymph nodes (SLN) were identified via lymphoscintigraphy and gamma camera guidance, followed by histopathological and immunohistochemical evaluation. Results: the SLNB identification rate was 100%. Multiple lymphatic drainage basins (LDB) were identified in 27% of cases, predominantly in trunk, head, and neck regions. The mean number of SLN identified was 2.11 by lymphoscintigraphy and 3.35 by histopathology. SLN metastases were present in 22.11% of patients. Conclusions: SLNB with a radioactive tracer is particularly useful for cutaneous melanomas of the trunk, head or neck. This technique also has less false negative results for melanomas located at the lever of the limbs.

Background: colorectal cancer is a common and serious condition, with surgical resection being the primary treatment for localized cases. Anastomotic dehiscence (AD) remains a significant postoperative complication, and anastomoses are typically created using either manual suturing or mechanical stapling, each with specific benefits and challenge. Material and Methods: this retrospective study analyzed outcomes in 100 rectal cancer patients who underwent surgical resection, with anastomoses performed via manual suturing (n=50) or mechanical stapling (n=50). Primary outcomes included fistula rates, postoperative complications, and recovery metrics. Secondary outcomes focused on operative time, hospital stay and quality of life. Results: mechanical anastomosis reduced procedure time (15 +- 5 minutes vs. 30 +- 5 minutes; p 0.01) and improved quality of life at 12 months (HQI: 87 vs. 75; p 0.01). The incidence of fistulas was higher in patients with manual suturing compared to mechanical suturing, but without significant differences (12% vs. 22%; p = 0.29). Mechanical anastomosis shortened the hospitalization period (12.66 vs. 13.58 days; but manual suturing allowed for faster recovery of intestinal transit (82% vs. 76%). Conclusions: mechanical anastomosis is more efficient, but manual anastomosis remains valuable in complex cases. Technique selection should be tailored to individual patient needs and surgical conditions.