Chirurgia最新文献

Background: Prostate cancer is a major global health concern, and current diagnostic methods, including prostate-specific antigen testing, have significant limitations. SelectMDx is a urinary biomarker test used for risk stratification of clinically significant prostate cancer, with the potential to reduce unnecessary biopsies. Methods: This retrospective study included 126 patients evaluated in a Romanian university hospital between January 2022 and December 2023. All patients had PSA 3 ng/mL and/or abnormal digital rectal examination findings and underwent the SelectMDx test followed by transrectal ultrasound-guided biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and diagnostic performance was assessed using ROC curves. Results: SelectMDx demonstrated a sensitivity of 90.6%, specificity of 70.4%, and NPV of 94.3% in the cohort with PSA 10 ng/mL. The test performed optimally in patients with negative DRE or PI-RADS 3 scores, reducing unnecessary biopsies. Conclusions: SelectMDx has proven to be a valuable tool in the risk stratification of clinically significant prostate cancer, contributing to improved clinical decision-making and reducing unnecessary biopsies. However, further studies are needed to validate its performance across different populations.

Background: In rectal cancer surgery, maintaining a balance between oncologic control and postoperative quality of life is critical. Sphincter-preserving procedures may offer better functional outcomes, but results vary depending on the technique used. Methods: This retrospective, observational, single-center study included 62 patients with adenocarcinoma of the rectum 5 cm from the anal verge, operated between August 2022 and August 2024. All received standard neoadjuvant therapy. Patients underwent one of three procedures: abdominoperineal resection, standard coloanal anastomosis, or delayed coloanal anastomosis (Turnbull-Cutait). Functional outcomes were assessed using LARS and St Marks scores at 1, 6, and 12 months postoperatively. Satisfaction was evaluated via telephone interviews. Results: Seventeen patients underwent abdominoperineal resection, 10 received standard coloanal anastomosis, and 35 underwent the delayed technique. Standard anastomosis yielded significantly better continence scores than the Turnbull-Cutait group. Patients with abdominoperineal resection had higher rates of pulmonary complications and prolonged inflammation. At one year, 80% of patients reported satisfaction with the procedure. Conclusion: All techniques can provide high satisfaction, but standard coloanal anastomosis appears to offer superior functional outcomes. Surgical decision-making should be individualized and based on thorough informed consent.

Background: Early anastomotic bleeding is a relatively understated complication of colorectal surgery. Despite intraoperative preventing protocols aiming to limit postoperative anastomotic hemorrhage, in some cases it can be dramatic. Therefore, we have decided to find out if our protocol of prompt emergency endoscopic management (Stop-the-Bleeding Protocol) is feasible, effective and safe. Methods: Between January, 1st 2017 and July 1st 2024, we run a prospective single-center study including all the patients who underwent colorectal resection with stapled anastomosis and experienced significant per rectum bleeding within the first 30 postoperative days. Primary outcomes were feasibility and efficacy of the endoscopic approach, related complications and mortality. Results: 599 patients underwent colorectal resections with mechanical anastomosis in our Center, of whom 48 patients (8%) experienced per rectum bleeding. Bleeding was encountered after all types of stapled anastomosis: recto-colic anastomoses (28 patients, 10.1%), side-to-side colo-colic anastomoses (5 patients, 3.7%) and side-to-side ileocolic anastomoses (15 patients, 8%). Hemostasis was obtained endoscopically in all the cases, mostly by only one session. No anastomotic dehiscence/leakage or fatality related to the hemorrhagic complication, or the endoscopic procedure were encountered in these series. Conclusions: Emergency endoscopic hemostasis for postoperative bleeding after colorectal stapled anastomosis is feasible, effective and safe.

Dear Editor, In 2021, we published an article titled "The Art of Medical Photography in Breast Surgery": Clinical, Intra-operative and Specimen Photography- Standards and Recommendations in Chirurgia (1). The main objective of this article was to define medical visual documentation, which is now an indispensable part of breast surgery, with its purposes and justifications for use, and to set standards by putting specific suggestions to reach good medical visual documentation defined as high quality and academically effective in breast surgery. hrough the Medical Visual Documentation Unit, which started to work on the subject in 2013 and was established within Kocaeli University Faculty of Medicine of Kocaeli Turkiye in 2015, we brought an academic perspective to the subject and tried to add standards to the literature to reach better medical visual documentation with the support of the Faculty of Fine Arts Photography Department. In line with the studies carried out until 2021 and the technologies of that period, we determined and published the recommendations that will enable us to reach the highest quality and academic effective medical visual documentation in breast surgery (1). As a result of the technology and experience at that time, we recommended the use of a professional camera with a changeable lens and with an exposure control system as a best choice for high-level facilities for medical visual documentation in breast surgery to obtain good medical visual documentation (1).

Introduction: Non-muscle-invasive bladder cancer (NMIBC) is common and heterogeneous, requiring risk-adapted therapeutic strategies. BCG remains standard for intermediate- and high-risk forms, but its effectiveness is influenced by limited access, variable tolerance, treatment resistance, and healthcare system disruptions. Material and Methods: This retrospective study aimed to identify prognostic factors for survival with an additional assessment of the influence of the COVID-19 pandemic. Although we could not directly evaluate the effect of COVID- 19 pandemic due to lack of recorded variables,we hypothesize it may have contributed to the limited impact of BCG therapy in our real-world setting. A total of 100 patients were selected from an initial group of 297 diagnosed in the Urology Clinic of Tg.Mures between 2006 - 2008, followed up until 2024. Prognostic analysis included clinical variables, RecScore and ProgScore were calculated using the EORTC risk calculator. No specific cut-offs were applied; the scores were analyzed as continuous variables. Results: Age over 70 and tumor multiplicity were significantly associated with increased mortality. RecScore was significantly correlated with the risk of relapse (p=0.0464). ProgScore showed a marginal association with mortality in univariate analysis (p=0.0561), but was not significant in multivariate models (p=0,9159). BCG therapy had a marginal protective effect, but did not significantly influence survival. Although we could not directly evaluate the effect of COVID-19 pandemic due to lack of recorded variables,we hypothesize that it may have contributed to treatment discontinuities in this real-life cohort. Conclusions: The results support the need for personalized, risk-based strategies and underline the importance of integrating real-world data into NMIBC management, especially in the context of systemic disruptions.

Background: Incisional hernias are a frequent complication after abdominal surgery, affecting a significant number of patients worldwide. When complicated by bowel obstruction, these hernias require urgent surgical intervention, which can lead to increased perioperative risks and prolonged recovery. This study aims to evaluate and compare the clinical outcomes and quality of life between open and laparoscopic surgery for incisional hernias complicated by bowel obstruction. Methods: AA 6-year prospective cohort study was conducted between January 2019 and 2024. A total of 117 patients who presented with incisional hernias complicated by bowel obstruction were included. Patients were divided into two groups: open surgery (n=91) and laparoscopic surgery (n=26). Pain and quality of life were assessed using the Visual Analog Scale and the questionnaire of the European Hernia Society. Results: Complication rates were significantly lower in the laparoscopic group (23.1% vs. 38.5%), although no significant differences were found in Clavien-Dindo complication grades. Patients who underwent laparoscopic surgery reported significantly lower postoperative pain scores on day 1 and discharge, and they showed superior quality of life scores, especially regarding pain during physical activity and cosmetic concerns, as measured by the EuraHS-QoL questionnaire. Conclusions: Laparoscopic surgery for incisional hernias complicated by bowel obstruction results in fewer complications, reduced postoperative pain, and improved quality of life compared to open surgery.

Background: Radical resection remains the most important factor that influences long term survival for patients with colon cancer. In order to achieve R0 resections in cases of locally advanced colon cancer a multivisceral resection is required. The aim of this study is to give insights regarding tumour characteristics, surgical treatment, early results and final evaluation of surgical specimen. Methods: This retrospective study includes all consecutive patients positively diagnosed with colon cancer between January 2018 and January 2025 in whom multivisceral resection was performed. We evaluated the clinical characteristics of the patients, the type of surgery, postoperative complications and the final pathological staging. We grouped the patients based on pathological evaluation and TNM staging system in pT3, pT4a and pT4b. Results: During this period there were 968 patients diagnosed with colon cancer in whom surgery was performed, of those multivisceral resection was performed in 82 cases (8.47%). Based on final pathological evaluation 21 patients (25.6%) presented pT3 tumours and the rest, 74.4% were pT4 tumours, the vast majority were patients with pT4b tumours (43 cases, 52.4%). Most common organs resected were small bowel 26 patients (31.7%), bladder 29 cases (34.1%), genital organs in 24 cases (28.2%) and abdominal wall in 22 cases (25.9%). Based on pathological evaluation pT4b tumours were more frequent moderate (55.8%) and poorly (7%) differentiated with lymphatic (67.4%), vascular (39.5%) and perineural invasion (27.9%) by comparison with pT3 or pT4a tumours. Severe complication occurred in 7.31%. Conclusions: Multivisceral resection represents a relatively safe procedure in the radical treatment of patients with advanced colonic cancer. Our study demonstrates that if this procedure is done in a tertiary centre by a surgical team with high expertise and experience in treatment of advanced abdominal malignancies it can provide a safe solution for these patients.

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.

Ischemia time is a well-established determinant of liver transplant outcomes. Patient survival is substantially affected by prolonged warm (WIT) and cold ischemia time (CIT) of the graft during liver transplant. One component that may be a contributing factor to both WIT and CIT is back bench time (BBT). We have identified BBT as a potentially significant underlying cause of post transplant complications. A literature search was performed using the major available databases. Articles comparing grafts using normothermic machine perfusion and static cold storage with measured WIT and CIT, and post-transplant outcomes, were included. A total of 18 studies were selected; however, we were only able to identify two studies that refer to BBT. In this systematic review, we conclude BBT is a modifiable factor of ischemia that may be impacted by the surgeon experience and requires more in depth studies to fully understand a safe threshold and its effect on post transplant outcomes such as EAD, IC, and graft survival.

Background: Cholelithiasis is a common gastrointestinal condition that significantly burdens healthcare systems worldwide. The primary cause of gallstone production is cholesterol hypersaturation. Age and female sex are considered more potent risk factors than other factors, but recent studies presented strong associations between cholesterol gallstones and obesity. Case report: We present a case of a 49-year-old male patient with acute onset intensive abdominal pain in the right upper quadrant. Physical examination, abdominal ultrasound, and laboratory analyses confirmed the diagnosis of acute cholecystitis. The cholecystectomy was done and was found a thickened gall bladder wall with gangrenous mucosa and over 300 gallstones sizes ranging from 2 mm to 5 mm inside it. Conclusions: Clinical examination of the patient, laboratory analyses, and abdominal ultrasound diagnoses are gold-standard diagnostic tools. The mainstay of treatment of symptomatic and asymptotic gallstone diseases is surgery, cholecystectomy.