Chirurgia最新文献

The study aimed to evaluate the effect of inflammatory blood markers on the postoperative outcomes of gastric cancer patients. We sought to assess the prognostic value of biomarkers and prognostic scores concerning short-term postoperative results. Material and methods: A non-randomized retrospective study was conducted, including gastric cancer patients proposed for curative-intent gastrectomy between 2012-2024 in the general surgery department of Mures County Hospital. We measured systemic inflammation by determining the neutrophile-to-lymphocyte ratio, neutrophile-toplatelet ratio, and platelet-to-lymphocyte ratio, prognostic nutritional index (PNI), modified Glasgow score (mGS), and Systemic Inflammatory Index (SII). Results: the white blood cell count (p 0.0001), the neutrophile count (p 0.0001), the lymphocyte count (p=0.001), the platelet count (p=0,01), the C-reactive protein levels (p 0.0001), the albumin levels (p 0.0001), the neutrophilto- platelet ratio (p=0.01), the prognostic nutritional index (p 0.0001), the modified Glasgow score (p 0.0001) and the Systemic inflammatory index (p 0.0001) were strongly associated with the postoperative outcome. In the multivariate analysis, CRP levels and modified Glasgow score were significantly associated with postoperative outcome. Conclusion: Systemic inflammatory markers play a significant role in predicting postoperative complications in gastric cancer. The interplay between inflammatory markers, surgical techniques, nutritional support, and complication management forms a multifaceted approach to predict postoperative outcomes.

Background: Polytrauma is a major cause of morbidity and mortality, yet formal training in its management is often absent from undergraduate medical curricula. This study aimed to assess the knowledge and perceptions of Romanian medical students regarding polytrauma management and evaluate the need for dedicated curricular courses.

Methods: A cross-sectional survey was conducted among medical students from seven major universities in Romania. The questionnaire included demographic data, knowledge about polytrauma, skills related to first aid, and perceptions on introducing polytrauma courses. The study took place at several prominent medical universities across Romania, including Bucharest, Craiova, Timisoara, Iasi, Cluj-Napoca, Targu Mures, and Sibiu. Overall, 413 students participated in the survey and were recruited through online platforms and direct interaction. All participants completed the survey voluntarily.

Results: Of all the participants, 78.7% had heard about polytrauma primarily through clinical rotations in General Surgery, Emergency Medicine, and Orthopedics. However, only 31% of the participants who heard about polytrauma accurately defined it. No correlation was found between confidence in providing first aid and actual knowledge (p=0.097). Almost 80% believed that polytrauma management should be a mandatory subject in the curriculum.

Conclusion: The study highlights a significant gap in Romanian medical education regarding polytrauma management skills among students. It supports the introduction of mandatory courses on trauma care to enhance practical skills and knowledge retention among future healthcare professionals.

Hydatid disease is a parasitic infection caused by Echinococcus granulosus, most commonly affecting the liver and lungs. Musculoskeletal localization accounts for only 1-4% of cases, and primary muscular hydatidosis without thoracic or abdominal organ involvement is extremely rare. We report the case of a 65-year-old man who presented in an emergency setting with acute respiratory distress and an irreducible left inguinal hernia. Computed tomography revealed an extensive multiloculated cystic lesion involving the left iliopsoas and proximal thigh muscles, associated with pelvic bone destruction and a secondary right testicular cyst, in the absence of hepatic or pulmonary hydatid disease. Emergency surgery included hernia repair and excisional biopsy of the thigh masses, which intraoperatively showed the typical appearance of hydatid cysts. Histopathology confirmed Echinococcus granulosus infection, and postoperative albendazole therapy was initiated. The postoperative course was complicated by severe chronic obstructive pulmonary disease, and, despite initial recovery, the patient later developed a hip abscess and repeatedly refused further surgery, ultimately being lost to follow-up. An institutional 10-year review and a focused literature review underline the rarity and diagnostic difficulty of primary musculoskeletal hydatid disease. Primary musculoskeletal and retroperitoneal hydatid disease should be considered in the differential diagnosis of cystic soft-tissue lesions, even in the absence of hepatic or pulmonary involvement, particularly in patients from endemic areas.

Introduction: breast cancer continues to dominate as the most frequently diagnosed malignancy among women globally, with surgery playing a key role in treatment. Despite advances in disease management and improved survival, the impact on patients quality of life (QoL) remains an important issue. This review aims to synthesize evidence on QoL outcomes, focusing on patient-reported outcomes following different types of breast cancer surgery. Methods: A systematic search was performed in PubMed, Scopus, and Web of Science from January 2022 until May 2025 to identify English-language publications on breast cancer QoL using validated PROMS. Seventeen studies met the inclusion criteria and were reviewed independently by two authors. Results: The EORTC QLQ-C30 and BR23 instruments demonstrated superior body image and emotional functioning following breast-conserving surgery. However, 40 to 60% of patients undergoing mastectomy without reconstruction reported persistent sexual dysfunction. SF-36 and FACT-B indicated improvements in physical and mental health postreconstruction, although 31% of mastectomy patients remained below functional thresholds. BREAST-Q revealed higher satisfaction and better psychosocial well-being in autologous reconstruction compared to implant-based reconstruction. Oncoplastic breast surgery was associated with significantly higher mean BREAST-Q breast-conserving treatment (BCT) scores compared to conventional wide local excision, with patients in the oncoplastic group reporting approximately 90% mean satisfaction with breast appearance versus 75% in the conventional group. Conclusions: Breast-conserving surgery or reconstruction after mastectomy improves quality of life compared to mastectomy alone. Oncoplastic breast surgery significantly enhances body image relative to conventional wide local excision (BCT). Autologous breast reconstruction is associated with greater patient satisfaction but carries a higher risk of complications compared to implant-based reconstruction.

Unstable pelvic ring fractures pose significant clinical challenges due to their intricate anatomy, substantial bleeding risk and frequent involvement of multiple organ systems. In the prehospital setting, early haemorrhage control with pre-peritoneal pelvic packing (PPP) and angioembolisation (AE) is critical: PPP rapidly controls venous bleeding, while AE targets arterial sources. Following initial resuscitation, timely bone repair with temporary external fixation (ExFix) and definitive bone repair, with open reduction and internal fixation (ORIF), is vital in minimising long-term complications. Hence, to coordinate these approaches from prehospital care to surgical intervention, a multidisciplinary approach is required along the trauma pathway. Advancements in trauma network systems may also offer improvements in survival and functional recovery. Therefore, this literature review critically evaluates the indications, timing and synergistic use of PPP, AE, ExFix and ORIF to optimise outcomes for patients with unstable pelvic ring fractures.

Background: Gastric cancer remains a major global health burden. Beyond oncologic outcomes, health-related quality of life (HRQoL) is increasingly recognized as a critical endpoint influenced by the reconstruction method after gastrectomy.

Methods: A prospective observational study was conducted between December 2021 and December 2024 at the Emergency County Hospital of Targu Mures, Romania, including 150 patients undergoing curative-intent gastrectomy. Patients were divided into two groups: gastroduodenal anastomosis (Billroth I, n=72) and gastrojejunal anastomosis (Billroth II/Roux-en-Y, n = 78). HRQoL was assessed using the EORTC QLQ-STO22 preoperatively and at 3 and 6 months postoperatively. Scores were linearly transformed to a 0 - 100 scale. Statistical analysis was performed with EasyMedStat

Results: The mean age was 61 years, with similar baseline characteristics. Postoperative complications occurred in 32.0% of patients, mostly grade I - II. Both groups showed deterioration in dysphagia, pain, reflux, and anxiety at 3 months, followed by partial recovery at 6 months. Reflux scores were consistently higher in the gastrojejunal group at all timepoints (baseline 26.1 vs. 17.6; 3 months 36.5 vs. 24.5; 6 months 27.2 vs. 14.7; p 0.001). Eating restrictions were also greater at 3 and 6 months.

Conclusions: Both reconstruction methods impair short-term HRQoL, with partial recovery by 6 months. Gastrojejunal reconstruction is associated with higher reflux and eating restrictions, whereas gastroduodenal reconstruction shows more favorable functional outcomes.

Pelvic organ prolapse (POP) and rectal prolapse (RP) frequently co-occur as manifestations of global pelvic floor dysfunction. This narrative review (January 1, 2015, to August 1, 2025) synthesizes research on the evaluation and surgical management of concurrent disease, emphasizing symptom mapping, standardized examination, and dynamic magnetic resonance defecography (DMRD) - guided phenotyping. Across retrospective series and small prospective studies, single-session, minimally invasive repair - most commonly sacrocolpopexy (Ã+- hysteropexy) with ventral rectopexy - appears feasible in well-selected patients, with perioperative morbidity similar to that in isolated procedures and consistent improvements in bulge symptoms, obstructed defecation, and quality of life. Key principles include multidisciplinary planning, nerve-sparing ventral dissection, non-overlapping meshes with complete peritonealization, and enhanced-recovery pathways. Mesh complications after rectopexy are uncommon. Across recent series, 30-day readmission rates are approximately 2-3%, and early recurrence rates are about 10% for rectal prolapse and 5-8% for apical prolapse at roughly 1-2 years; moreover, a meta-analysis of 16,471 patients found no increase in short-term complications with concomitant repair. Overall, despite encouraging outcomes, heterogeneity, selection bias, and limited follow-up constrain certainty. Higher-quality comparative and long-term studies are needed to refine indications and establish long-term effectiveness.

Background: The role of lymphadenectomy in endometrial cancer has long been debated. Once considered to have prognostic and therapeutic value, it is now evident that balancing accurate staging with procedure-related morbidity remains a challenge. Objective: This review aims to clarify the current indications for systematic lymphadenectomy in endometrial carcinoma, integrating the updated FIGO 2023 staging system, the ESGOESTRO- ESP 2025 guidelines, and the emerging role of molecular classification. Methods: We analyzed landmark randomized controlled trials, updated guideline recommendations, and the evolving paradigm of sentinel lymph node (SLN) mapping, with emphasis on risk stratification based on histology, grade, lymphovascular space invasion (LVSI), and molecular features. Results: High-level evidence demonstrated that systematic lymphadenectomy does not improve survival in early-stage disease, while significantly increasing morbidity. Current guidelines remain complex, but consistently emphasize SLN mapping as the preferred method of nodal assessment. Systematic lymphadenectomy is no longer justified as routine; it is reserved for high-intermediate and high-risk patients when SLN mapping fails, performed as side-specific dissection. In advanced disease, the surgical goal is complete cytoreduction, with selective removal of bulky or suspicious nodes; systematic lymphadenectomy must not be performed in stages III-IV. Conclusion: The paradigm has shifted from universal lymphadenectomy to a tailored, risk-adapted approach. SLN biopsy represents the new standard, reducing morbidity without compromising oncologic outcomes. Expanding access to molecular profiling, still limited in Romania, is crucial for better oncological results and alignment with European standards.

Background: Nodal status is one of the most important prognostic factors in endometrial cancer (EC), but systematic lymphadenectomy is associated with significant morbidity. Sentinel lymph node (SLN) mapping offers a less invasive alternative. However, data are limited where indocyanine green is unavailable. Methods: Between November 2019 and March 2025, 29 women with FIGO stage Iâ?"III EC were prospectively enrolled in this study. Cervical injection of methylene blue, with or without technetium-99m, was used for SLN mapping. Ultrastaging was performed routinely. In patients with high-risk disease, full pelvic and para-aortic lymphadenectomy was also performed. Detection rates, sensitivity, and negative predictive value (NPV) were calculated. Results: Overall and bilateral detection rates were 75% and 48%, respectively (methylene blue: 72% / 44%; dual tracer: 100% / 75%). Nodal metastases were identified in 9 of 29 patients (31%). Patient-level sensitivity was 71%, with an NPV of 88%. Application of the side-specific completion algorithm increased sensitivity to 86%. Side-specific sensitivity and NPV reached 100%. Lymphovascular space invasion and 50% myometrial invasion were significantly associated with nodal metastasis (p 0.05). No mapping-related complications were observed. Conclusions: SLN mapping with methylene blue, with or without technetium, combined with a side-specific completion algorithm, enables reliable nodal staging even without fluorescence imaging.

Introduction: The Gleason score plays a key role in risk stratification and surgical treatment selection for prostate cancer. This study evaluates the correlation between Gleason score, patient age, and tumor aggressiveness, with implications for medical practice. Methods: This retrospective study included 215 patients from Sf. Apostol Andrei Clinical Emergency Hospital of Constanta County (2023-2024) with histopathologically confirmed prostate lesions. Demographic variables (age), Gleason score (classified according to ISUP 2019), and histological grade were analyzed. Data were statistically analyzed using t tests, ANOVA, and logistic regression. While international guidelines provide a standardized framework for management, local and regional variations in healthcare access, diagnostic pathways, and patient preferences significantly influence real-world clinical practice. This study aims to describe the histopathological spectrum of prostatic lesions and evaluate the prognostic relevance of the Gleason score in surgical decision-making within the specific context of a Romanian tertiary care center. By highlighting regional particularities, such as the high burden of aggressive disease and the challenges in implementing active surveillance, our findings contribute to a more nuanced understanding of global prostate cancer care. Results: Benign prostatic hyperplasia (BPH) accounted for 42.8% of cases, PCa for 44.7%, and urothelial carcinoma for 8.4%. Among prostate cancers, 87.5% had clinically significant disease (Gleason >=7), with 29.2% high-risk (Gleason 8-10). Gleason 7 was most frequent (58.3%), predominantly 3+4. A significant correlation was observed between advanced age ( >70 years) and tumor aggressiveness (OR = 2.3; 95% CI: 1.4-3.8). Radical prostatectomy was primarily chosen for Gleason scores >=7, with higher complication rates in older patients. Conclusions: Advanced age and a high Gleason score are independent factors of tumor aggressiveness. Early surgical intervention in patients with Gleason >=7 improves oncological outcomes. Integrating histopathology with multiparametric MRI and molecular biomarkers could optimize management of these patients.