Chirurgia最新文献

Background: Intestinal ischaemia is an abdominal emergency characterized by a drastic reduction in blood flow in the mesenteric vessels with the possible onset of necrosis of the small intestine and/or colon. Its incidence is rather rare and the diagnosis is very difficult as the clinical presentation is not specific and there are no pathognomonic laboratory tests. Methods: A retrospective study was carried out on 28 patients with intestinal infarction, including analysis of the risk factors, comorbidities, symptoms, laboratory tests and instrumental investigations, to determine the presence of eventual signs of mesenteric ischaemia secondary to vascular insufficiency. Results: Twenty-four patients (85%) underwent surgery and intestinal necrosis was found in all. Among these, a quite high mortality rate (64%) was observed. Conclusion: The retrospective study confirmed the low frequency, high mortality and diagnostic difficulty of mesenteric ischaemia in its various clinical forms. Currently, there are neither laboratory tests nor instrumental techniques that can give a certain diagnosis of acute mesenteric ischaemia in an early phase. However, strong clinical suspicion, a rapid diagnosis and an aggressive therapeutic approach could improve the clinical results and reduce its high mortality.

Background: Gastric cancer surgery requires not only oncological radicality but also functional reconstruction. Billroth I remains the most physiological method of restoring continuity, whereas Billroth II and Roux-en-Y are most frequently adopted in the oncological treatment. Nutritional and immune competence strongly influence postoperative outcomes, and the Controlling Nutritional Status (CONUT) score has emerged as a validated biomarker integrating albumin, lymphocyte count, and cholesterol in predicting complications in surgically treated patients. Methods: We conducted a prospective observational single-center study including 150 patients undergoing curative distal gastrectomy between October 2021 and December 2024. Reconstruction was performed using Billroth I (n=72) or Billroth II/Roux-en-Y (n=78). The CONUT score was assessed preoperatively (T0), early postoperatively (T1), and at three months (T2). Outcomes included CONUT evolution, postoperative complications (Clavien Dindo), length of stay, readmission, and mortality. Results: Both reconstruction groups demonstrated a significant postoperative increase in CONUT score (median 2 [1-3] at T0 to 3 [2-4] at T1, p 0.001), followed by partial recovery at three months. No differences were observed between Billroth I and Billroth II/Roux-en-Y at any timepoint. Higher CONUT values at T0, T1, and T2 independently predicted overall and major complications (OR range 1.15 1.25, p 0.05). Postoperative morbidity, mortality (3.3%), and hospital stay were similar across groups. Conclusions: The CONUT score is an independent predictor of perioperative morbidity in gastric cancer, while the choice of reconstruction method does not significantly alter immunonutritional trajectories. Serial CONUT monitoring may enhance perioperative risk stratification.

Background: Hepatic resection is a key curative option for hepatocellular carcinoma (HCC), but postoperative morbidity and early mortality remain significant concerns, especially in patients with impaired liver function. Accurate preoperative risk stratification is essential to improve outcomes. This study compares the predictive value of three liver function scores - MELD, ALBI, and Child-Pugh - for postoperative morbidity and 30-day mortality. Methods: A retrospective study was conducted on 55 patients who underwent hepatic resection for HCC between 2013 and 2024 at a single tertiary center. Preoperative MELD, ALBI, and Child-Pugh scores were calculated and analyzed in relation to postoperative complications and mortality. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROC curves. Results: Postoperative morbidity occurred in 23.6% of patients, with a 30-day mortality rate of 9.1%. The ALBI score showed the highest specificity (73.8%) and NPV (81.6%) for morbidity prediction. It also demonstrated perfect sensitivity (100%) and NPV (100%) for post-hepatectomy liver failure (PHLF), with an AUC of 0.85. Patients with ALBI Grade 1 had fewer complications and shorter hospital stays. MELD showed moderate predictive value, particularly in ruling out mortality. The Child-Pugh score had the weakest performance, primarily due to low sensitivity. Conclusion: ALBI is the most accurate and objective score for identifying high-risk patients undergoing liver resection for HCC. MELD provides additional value in mortality exclusion. The limited sensitivity of Child-Pugh suggests it should be used with caution. Incorporating ALBI into preoperative assessment may enhance surgical decision-making and risk stratification.

Background: Intrahepatic anatomy remains a challenge in mini-invasive liver surgery. Augmented Reality (AR), which integrates digital information with the user's environment, can benefit liver surgery by improving tumor and vessel positioning, resection planning, and surgical training. This review highlights AR's applications in liver surgery.

Methods: Articles published from 2010-2024 on PubMed using keywords ("Augmented Reality" AND "Liver Surgery") OR ("Navigation" AND "Liver Surgery") were analyzed. 32 articles assessing AR's accuracy, safety, operative time, and training impact were included.

Results: AR in Image-Guided Surgery (IGS) combines 3D reconstructions (e.g., CT scans) with laparoscopic images, enhancing the understanding of the surgical site. AR aids in margin planning, lesion boundary setting, and accurate hemostasis. It improves oncological outcomes, reduces errors, increases accuracy, and sometimes shortens surgery time. AR also enhances surgical training by accelerating skill acquisition and reducing the learning curve. However, more data is needed to standardize AR techniques.

Conclusion: AR can significantly enhance mini-invasive liver surgery by improving precision, safety, efficiency, and training. While further research is necessary to standardize techniques, AR holds great potential for improving surgical outcomes and training quality.

Introduction: Various techniques for intraoperative measurement of resection margins have been explored to prevent positive margins in breast-conserving surgery. Although multiple methods exist, none is perfect, and most are costly and not easily accessible. Material and Methods: This prospective study was conducted at the Surgical Clinic of Mures County Clinical Hospital, utilizing data from breast cancer patients who underwent conservative treatment between 2014 and 2019. Resection margins were measured using ultrasound and mammography, and these values were compared with histopathological reports. Results: A total of 166 patients were enrolled, with 10 patients (6.02%) having positive resection margins. For ultrasound, at a 2 mm cut-off, sensitivity was 63.86% and specificity was 93.98%; at a 5 mm cut-off, sensitivity increased to 95.78% with the same specificity of 93.98%. For mammography, at a 2 mm cut-off, sensitivity was 6.627% and specificity was 93.98%; at a 5 mm cut-off, sensitivity was 37.35% with the specificity remaining at 93.98%. Conclusions: Ultrasound at a 5 mm cut-off showed higher sensitivity compared to a 2 mm cut-off, while mammography showed low sensitivity at both cut-offs. These results indicate that, while both methods have high specificity, their accuracy and sensitivity vary, necessitating cautious interpretation for clinical use.

Background: Colon cancer is a common malignancy with significant complications, particularly gastrointestinal bleeding and anemia, requiring emergent transfusions. The aim of the study is to explore the complex relationship between emergent transfusions in colon cancer patients and their concurrent cardiac pathology. Methods: A retrospective case-control study conducted between January 2020 - February 2024 in South-Eastern Romania focused on adult patients with colon cancer and moderate/severe anemia. The study included patients with advanced-stage colon adenocarcinoma, complicated tumors requiring blood transfusions, and excluded those with mild anemia, cancer history, or previously transfusions for the same condition. Patients were analyzed based on their anemia severity, demographic and clinical characteristics, and perioperative outcomes, with a specific focus on the impact of concurrent cardiac pathology. Results: The study included 153 patients, divided into two groups based on anemia severity: moderate anemia (MA, n=124) and severe anemia (SA, n=29). No significant differences were found in tumor histopathology or stage between the two groups, though significant differences were observed in blood loss, invasions, and transfusion needs. Postoperative outcomes showed a higher rate of complications, longer hospital stays, and increased mortality in the SA group compared to the MA group. Additionally, cardiac comorbidities were associated with more severe anemia, increased intraoperative blood loss, longer surgery duration, and a higher need for transfusions, as well as more frequent postoperative complications. Conclusions: Severe anemia and pre-existing cardiac conditions are linked to poorer surgical outcomes, greater transfusion requirements, and higher complication rates.

Background: Intestinal ischaemia is an abdominal emergency characterized by a drastic reduction in blood flow in the mesenteric vessels with the possible onset of necrosis of the small intestine and/or colon. Its incidence is rather rare and the diagnosis is very difficult as the clinical presentation is not specific and there are no pathognomonic laboratory tests. Methods: A retrospective study was carried out on 28 patients with intestinal infarction, including analysis of the risk factors, comorbidities, symptoms, laboratory tests and instrumental investigations, to determine the presence of eventual signs of mesenteric ischaemia secondary to vascular insufficiency. Results: Twenty-four patients (85%) underwent surgery and intestinal necrosis was found in all. Among these, a quite high mortality rate (64%) was observed. Conclusion: The retrospective study confirmed the low frequency, high mortality and diagnostic difficulty of mesenteric ischaemia in its various clinical forms. Currently, there are neither laboratory tests nor instrumental techniques that can give a certain diagnosis of acute mesenteric ischaemia in an early phase. However, strong clinical suspicion, a rapid diagnosis and an aggressive therapeutic approach could improve the clinical results and reduce its high mortality.

Rhino-orbital mucormycosis is an uncommon invasive fungal infection caused by a fungus belonging to the order Mucorales. It is a lifethreatening, fulminant disease with high rates of morbidity and mortality despite treatment. Immunocompromised patients are primarily affected, and it almost always occurs in patients with uncontrolled diabetes mellitus, especially those in diabetic ketoacidosis. The second wave of the COVID-19 pandemic emerged with increased reports of rhino-orbital mucormycosis, especially in India. It has been widely suggested that prolonged steroid therapy coupled with dysglycemia resulting from diabetes provides an excellent opportunity for fungal invasion. We report the case of a 64-year-old male admitted to our clinic in September 2024 with the presumptive diagnosis of right orbital cellulitis. The patient's history revealed recent COVID-19-related pneumonia, hospitalized in a different hospital, and type 2 diabetes mellitus with insulin treatment. After extensive paraclinical investigations, and given the rapid evolution of the clinical signs, despite intensive and complex therapy, we concluded the diagnosis of Rhino-orbital mucormycosis. Our case supports the hypothesis that the ominous triad of diabetes, corticosteroid use, and the background of COVID-19 determines the increased risk of mucormycosis, and that extensive research must be conducted to find the optimal treatment for these cases.

Introduction: Technological advances in the field of radiation therapy have established modern techniques like Volumetric Modulated Arc Therapy (VMAT) as the radiation treatment of choice for nearly all malignancies. Unfortunately, due to many reasons that are not in the scope of this paper, even nowadays not all patients have access to these modern techniques and are managed with the "older" Three-Dimensional Conformal Radiation Therapy (3DCRT). Methods: In this retrospective study, we performed a comparison of VMAT to 3DCRT by terms of five (5) year overall survival (OS), disease-free survival (DFS), and toxicity in patients treated for endometrial and cervical cancer. A total of 173 gynecological cancer patients treated with either VMAT or 3D-CRT technique were included in this study: 73 patients (Group A) were treated with VMAT, and 100 patients (Group B) were managed with 3D-CRT technique. The endpoints of this trial were: disease free survival (DFS), overall survival (OS), and toxicity of treatment. Results: Our results showed significant 5-year DFS advantage for the patients in group A, while OS had no significant difference between the two groups. Conclusion: Reduced toxicity was demonstrated in group A compared to group B, regarding mostly gastrointestinal (GI) toxicity.

Advanced ovarian cancer is frequently diagnosed at late stages, necessitating precise and individualized treatment strategies. Surgical cytoreduction remains the cornerstone of treatment, with complete macroscopic tumor resection offering the best survival outcomes. However, accurately assessing resectability remains a major challenge. This review aims to evaluate the role of staging laparoscopy in triaging patients with advanced epithelial ovarian cancer, with a focus on its utility in determining surgical resectability and guiding treatment pathways. Emphasis was placed on predictive scoring systems: clinical scores (Suidan score), operative scores (Fagotti, PCI, Eisenkop) and postoperative scores (Aletti). Laparoscopic triage has shown greater predictive accuracy than traditional imaging in evaluating tumor resectability. Scoring systems such as the Fagotti and the Peritoneal Cancer Index provide validated intraoperative frameworks. International guidelines, such as ESMO, ESGO, NCCN, and ASCO, support laparoscopy for preoperative assessment, although its implementation remains limited in some countries, including Romania. Challenges include the lack of standardization, restricted access to advanced laparoscopic infrastructure, and the risk of port-site metastases. Staging laparoscopy is a valuable tool in the management of advanced ovarian cancer, aiding in the selection of optimal treatment strategies. Future integration of radiomics, artificial intelligence, and molecular profiling holds promise for fully personalized patient care.