Chirurgia最新文献

Introduction: We report our experience of six patients admitted to our hospital during January - July 2023 with complex aortic conditions treated with a two-stage hybrid procedure, consisting of surgical debranching - bypass grafting - of the supra-aortic branches off-pump and stent graft placement for Thoracic Endovascular Aortic Repair (TEVAR). Clinical features: The clinical cases we present highlight the use of TEVAR in both chronic (Type B aortic dissections, pseudoaneurysms, and penetrating aortic ulcers) and acute conditions (traumatic aortic transections and ruptured aortic aneurysms). TEVAR is a less invasive surgical approach for management of these critical patients, having as benefits: smaller incisions, avoiding operative risks associated with the classical procedure, shorter recovery time after the intervention and lower hospitalization costs. Conclusions: TEVAR offers an alternative to open surgery, showing better immediate and mid-term results, as well as providing the chance to solve a variety of both chronic and acute cases that would be otherwise classified as too high risk for classic open surgery.

Acute pancreatitis is a serious inflammatory condition of the pancreas that can be life-threatening, with the approach to treatment depending on the severity of the disease. Diagnosing acute pancreatitis, predicting its severity, and assessing prognosis generally involve imaging techniques like computed tomography, magnetic resonance imaging and ultrasound, along with scoring systems such as Ranson, Acute Physiology and Chronic Health Evaluation II (APACHE II), and the Bedside Index for Severity in Acute Pancreatitis (BISAP). Computed tomography is regarded as the gold standard due to its high sensitivity and specificity, while magnetic resonance imaging and ultrasound offer valuable insights into biliary obstruction and vascular issues. These scoring systems help categorize patients based on clinical and laboratory data into mild, moderate, or severe levels, influencing treatment decisions like intensive care unit admission, early enteral feeding, and the use of antibiotics. However, despite the importance of these imaging and scoring methods in managing acute pancreatitis, they face challenges in terms of accuracy, consistency, practicality, and cost-effectiveness. In this review we aimed at discussing the clinical usefulness of the most important scoring systems for prediction of severity in this complex disease.

Background: Advanced prostate cancer is a biologically heterogeneous disease often marked by multiple genetic and epigenetic alterations that influence tumor progression, treatment resistance, and prognosis. Among the most frequently altered genes are PTEN, AR-V7, TP53, TMPRSS2-ERG, and ERBB2, each with potential relevance for stratifying risk and guiding targeted therapy. Methods: This retrospective study included 43 patients with advanced prostate cancer who underwent radical prostatectomy. Tumor specimens were analyzed using fluorescence in situ hybridization (FISH) to assess the mutational status of the five markers. Clinicopathological parameters, including PSA levels, Gleason score, tumor stage, and invasion status, were correlated with molecular alterations using multinomial logistic regression. Results: The most common isolated alteration was PTEN loss (20.9%), followed by TP53 amplification (16.3%), TMPRSS2-ERG fusion (13.9%), AR-V7 expression (11.6%), and ERBB2 amplification (7%). Combined alterations were also observed, with dual or triple marker expression in select aggressive cases. PTEN- and AR-V7+ were associated with low PSA values despite aggressive pathology, while ERBB2+ correlated with high PSA levels and high Gleason scores. TP53+ and ERBB2+ were also significantly associated with high-grade tumors (Gleason 7). AR-V7+ was the only marker significantly associated with seminal vesicle invasion. Younger age was weakly correlated with AR-V7+ and TP53+ status. Conclusions: The molecular profile defined by PTEN, AR-V7, TP53, and ERBB2 identifies distinct biological subtypes in advanced prostate cancer, each with specific prognostic and therapeutic implications. Integration of these biomarkers into routine clinical assessment may improve treatment personalization and risk stratification. Validation in larger, prospective cohorts is warranted.

Background/aims: This study aimed to assess and compare the severity of acute pancreatitis (AP) in patients with and without underlying chronic pancreatitis (CP). Methods: We included patients diagnosed with AP and categorized them into those with CP and those without CP. Disease severity was defined by the presence of organ failure, intensive care unit (ICU) admission, or mortality. Results: ACP accounted for 25.85% of all AP cases in the study. Patients with ACP were more commonly male smokers with low BMI, lower albumin levels, and higher Balthazar scores. In contrast, patients with AP (without CP) had significantly higher heart rates (HR), Balthazar, and CTSI scores. Length of hospitalization and mortality rate were higher in those patients with AP, who were associated with a high rate of organ dysfunction. Prognostic factors influencing survival at 72 hours were respiratory failure, creatinine/albumin ratio, BISAP, albumin levels, and AKI. Meanwhile, survival at 30 days was influenced by respiratory failure, the creatinine/albumin ratio, and blood urea nitrogen. Conclusions: Compared to AP without CP, ACP is associated with a less severe disease course, lower mortality, reduced organ failure, and shorter ICU stays. However, ACP is more frequently observed in male smokers with lower BMI and albumin and higher CTSI and Balthazar scores.

Introduction: The Preoperative Aspects and Dimensions Used for Anatomical Classification (PADUA) score was developed based on an algorithm incorporating anatomical characteristics and renal tumor size to predict surgical risk and perioperative complications in patients undergoing open nephrectomy. For the current study, we extended the application of the PADUA score to laparoscopic partial nephrectomy and analyzed the outcomes. Materials and Methods: Our study was based on a retrospective analysis of 94 patients who underwent partial nephrectomy at the Urology Department of Prof. Th. Burghele Clinical Hospital between 2020 and 2024. Two groups were analyzed: the first included 44 cases (54.5% male) treated laparoscopically (38 via transperitoneal and 6 via retroperitoneal approach), and the second included 50 cases (54% male) treated with open surgery via a lumbar approach. Results: The mean age of patients in the open (OPN) and laparoscopic (LPN) groups was 64 and 61.2 years, respectively. We analyzed three variables in relation to the PADUA score: ischemia time, operative time, and body mass index (BMI). In the laparoscopic group, no correlation was found between ischemia time and operative time (p=0.655 and p=0.686, respectively). Similarly, no correlation was observed in the open group (p=0.882 and p=0.787, respectively). The PADUA score was significantly correlated with BMI in the laparoscopic group (p=0.023), but not in the open group (p=0.202). Regarding complications, the PADUA score was significantly associated with postoperative complications in the laparoscopic group (p=0.013), but not in the open group (p=0.287). Conclusion: The PADUA score was used to assess the complexity of renal tumor resection using both open and laparoscopic approaches. Our study demonstrated that a higher BMI is associated with a higher PADUA score, suggesting that obesity may increase the complexity of the laparoscopic approach in partial nephrectomy. Furthermore, in the laparoscopic group, a high PADUA score was significantly correlated with the occurrence of postoperative complications.

This article presents the first robotic-assisted DIEP flap breast reconstruction in Eastern Europe, performed at the Regional Institute of Oncology Iasi, Romania. A 48-year-old female, three years post-Madden mastectomy, underwent autologous breast reconstruction with a bi-pedicled DIEP flap. The procedure utilized the da Vinci Xiî robotic system for precise dissection of the vascular pedicles via a transabdominal preperitoneal approach. Robotic dissection was completed safely, with minimal fascial incisions, and totaling 104 minutes (out of total operative time of 11 hours). The uneventful post-operative course allowed patient discharge on postoperative day 4. This case marks a technological milestone for Romania and demonstrates the feasibility of robotic surgery in autologous breast reconstruction. The successful implementation of this technique opens the door for wider adoption in Eastern Europe, offering the potential for reduced donor site morbidity and improved recovery.

Introduction: Colorectal cancer remains one of the major issues in modern healthcare, being one of the most common neoplasms and the second leading cause of cancer-related deaths. Despite significant recent advances, treatment modalities and the popularization of screening programs, treatment course and outcomes still vary among patients. This study aimed to observe the differences in staging, course of treatment, and survival between patients 70 and 70 years old with rectal cancer. Material and Methods: The study was a retrospective analysis of data collected prospectively in nine centers located in Poland, Romania, and Germany. Consecutive patients operated on for rectal cancer between 2013-2019 were included and divided into groups 70 and â?¥70. Results: A total of 2443 patients were included with a median age of 66 years and a predominance of male (63.16%). There were no significant differences in terms of sex, tumor localization or staging between the younger and the older group. A significantly higher number of procedures with stoma creation was observed and a lower number of lymph nodes yielded in older patients. There were no significant differences in the rate of R0 resections. The use of preoperative radiotherapy was also higher in the younger group. The rate of complete response did not differ significantly, and the overall survival was significantly lower in older patients. Conclusions: Despite similar staging, older and younger patients receive different treatment course, including less radical surgery and less frequent use of radiotherapy. Overall survival is poorer in older patients in stages I-IV.

Introduction: Gallbladder cancer is the most common biliary malignancy frequently diagnosed incidentally on cholecystectomy specimens for presumed benign disease. Once the diagnosis is confirmed on histopathologically, the treatment must be completed by resecting the gallbladder liver bed and regional lymph nodes. The laparoscopic approach seems to be efficient and oncologically safe. The aim of our study was to present the 9-year experience in treating gallbladder cancer in our surgery clinic by both open and laparoscopic approach completed by a literature review with the latest updates regarding the state of the laparoscopic approach in treating this type of cancer. Materials and Methods: Fifty-seven patients underwent radical surgery and 26 resections had a palliative purpose. Among radical resections, 52 were performed by using the open approach and 5 by using the laparoscopic approach. 14 cases out of 57 were completion procedures performed after a malignant histopathological finding was confirmed on a simple cholecystectomy specimen. In the majority of cases, the primary simple cholecystectomy was performed by laparoscopic approach. The laparoscopic approach was used in 3 cases of re-resection and 2 per-primam resections. Results: The median age of the patients was 64.21 years in the open group and 67.2 years in the laparoscopic group. Most patients were females. All patients had one or more comorbidities with an ASA score of 3 or 4 in 52 patients out of 57. ASA score had lower values in the laparoscopic group. The average surgery time for the laparoscopic group was 308 minutes, similar to the one for the open group that was 294 minutes. The complication rate was higher in the open group. The number of harvested lymph nodes was similar between the groups. The laparoscopic group benefited of lower postoperative pain, faster recovery and shorter hospital stay (6.2 days versus 13 days). Gallbladder cancer evolves asymptomatic in early stages and the diagnosis in advanced stages limits the therapeutic options. Still, in cases incidentally diagnosed on cholecystectomy specimens for presumed benign disease (stages T1-T3), the re-resection might be performed by laparoscopic approach. Also, in per-primam diagnosed selected cases, the laparoscopic resection might be performed by experimented teams. Conclusions: The laparoscopic approach is an ideal alternative to the open approach in treating early-stage gallbladder cancer. This surgical approach provides oncological safety, similar R0 resection rates and number of harvested lymph-nodes. The maximum benefit of this surgical approach is achieved in high-volume centers with experimented teams.

Delay graft function (DGF) is a condition that is frequently associated with kidney transplantation and could complicate subsequent evolution of the renal graft. There are multiple factors implicated in the development of DGF, some avoidable through careful management, others without the possibility of correction. Gordon syndrome or type II pseudo-hypoaldosteronism and nephrotoxicity induced by calcineurin inhibitors are complications that can precipitate the development of DGF. These unfavorable manifestations can occur after high levels of Tacrolimus secondary starting calcineurin inhibitors treatment and can be prevented with careful monitorization of its levels. We reported a case of a 58-year-old patient who was admitted as receptor for cadaveric kidney transplantation (KT) and developed all the complications associated with Gordon-like syndrome and nephrotoxicity including DGF in the context of high Tacrolimus levels after starting calcineurin inhibitors treatment.

Introduction: Electrolyte imbalances are common following minimally invasive rectal resections, particularly in patients with protective ileostomies. Such imbalances can severely hinder postoperative recovery, resulting in dehydration, renal dysfunction, and various metabolic abnormalities. Objectives: This study aims to evaluate the incidence and ramifications of electrolyte imbalances in rectal cancer patients undergoing minimally invasive surgical procedures, irrespective of ileostomy status. Methods: A retrospective analysis was performed on 117 rectal adenocarcinoma patients who underwent minimally invasive resections between 2016 and 2023. Patient categorization was based on ileostomy status, with rigorous assessment of preoperative and postoperative electrolyte levels and comprehensive documentation of complications. Results: Of 117 patients, 91 (77.8%) had a protective ileostomy. Hypokalemia and hyponatremia were significantly prevalent in the ileostomy cohort; hypokalemia affected 16.2% of patients by postoperative day two, declining to 7.7% by day four (p=0.03). Dehydration-related complications were recorded in 3.4% of cases, while acute renal insufficiency was observed in 0.9%. Readmission rates were significantly increased in the ileostomy group (32.5%) due to fluid and electrolyte disorders (p 0.01). Conclusions: The presence of a protective ileostomy during rectal cancer surgery is associated with an increased risk of postoperative electrolyte imbalances and subsequent complications, highlighting the need for diligent monitoring and management strategies.