Chirurgia最新文献

Introduction: Pancreatic metastases are rare tumors representing about 2-5% of pancreatic malignant conditions. The most common origin is renal cell carcinoma, while metastases with other (non-renal) origins are much rarer. Patients and Method: Fifteen patients with non-renal pancreatic metastases were resected in our center. The postoperative immunohistochemical examination demonstrated their primary non-pancreatic origin. The patients were radiologically assessed and diagnosed with isolated metastatic or oligometastatic disease, which allowed pancreatic resection. Results: Fifteen patients with various types of cancer (3 - colorectal, 3 - bile duct, 2 - uterine, 2 - retroperitoneal, 2 - melanomas, 2 - ovarian, 1 - pheochromocytoma) were included. Five metastases were synchronous and 10 were metachronous. Their location was cephalic â?" 9 patients and distal â?" 6. Standard pancreatic resections (9 pancreaticoduodenectomies and 4 distal splenopancreatectomies) were performed, as well as limited (2 central pancreatectomies). Twelve patients survived postoperatively; death occurred in 3 patients. Neoplastic recurrence occurred in 9 patients â?" resection was possible in two of them. Currently, only three patients are alive, without relapse. Conclusions: Pancreatic resection for non-renal pancreatic metastases is indicated in certain selected cases, in the context of the multidisciplinary oncological approach.

Background: Acute right-sided colonic ischemia is a life-threatening condition often necessitating emergent surgical intervention. However, postoperative results are uncertain, especially in the absence of the possibility of revascularization. This study aimed to evaluate clinical characteristics and surgical outcomes in patients undergoing surgical intervention without vascular reconstruction. Methods: A retrospective cohort study was conducted on 73 patients presenting with acute right-sided colon ischemia without feasible vascular intervention. Patients were categorized into three groups: extended rightsided colectomy with primary anastomosis, colectomy with ostomy, and exploration only. Demographic, clinical, and perioperative data were analyzed and compared. Results: From the 73 patients with acute right-sided colonic ischemia without vascular repair, 47 undergoing colectomy and 26 exploratory surgery. Colectomy patients had lower comorbidity (ACCI 4.11 vs. 5.59, p=0.017) and better outcomes, with 30-day mortality of 7.7â?"11.8% compared to 80.8% in the exploration-only group. Among resection patients, ostomy was more common (34 vs. 13 anastomoses), and complications were slightly higher (41.2% vs. 30.8%). One-year mortality was highest in the ostomy group (26.5%) and lowest in the anastomosis group (15.4%). Conclusions: In acute right-sided colonic ischemia patients without vascular repair, extended right-sided colectomy is associated with improved outcomes when performed in appropriately selected individuals. Surgical intervention should be prioritized in patients with acceptable comorbidity profiles.

video width="640" height="480" controls controlsList="nodownload" poster="https://www.revistachirurgia.ro/pdfs/video/alexandru_martiniuc_robotic_hepatectomy.jpg" style="margin-top: -20px;" source src="https://www.revistachirurgia.ro/pdfs/video/alexandru_martiniuc_robotic_hepatectomy.mp4" type="video/mp4" Your browser does not support the video tag. /video We present the case of a 41-year-old female patient diagnosed with a liver hemangioma located in the left lobe - segments 2-3. We performed an atypical liver resection of the segments 2-3 using the Versius robotic system. To the best of our knowledge, the majority of centers perform liver surgery using the DaVinci system, while data regarding liver surgery with other robotic platforms are scarce. We demonstrate the safety and feasibility of the Versius system in performing a crush-clamping technique for liver transection using the Maryland bipolar forceps and the monopolar curved scissors.

Introduction: Nationally, colon cancer is the most common malignancy, followed by breast cancer with an incidence in a slight increase in recent years. This increase in incidence has led to the necessity of development of more effective screening programs, which possess the advantages of being reproducible and easily accessible, destined for the population at risk, with the purpose of establishing, as soon as possible, a positive diagnosis, allowing adequate treatment. Tumoral invasion of the peritumoral ganglia represents one of the most important negative prognostic factors, alongside perineural invasion. The 8th edition of the TNM classification imposes the histopathological examination of at least 12 lymph nodes from the resected piece to facilitate precise staging and avoid downgrading. Perineural invasion in colorectal malignancies is associated with an unfavorable evolution unlinked to the other ways of dissemination, due to the multiple molecular mechanisms. Bellis D. et al. reported an increased rate of locoregional recurrence associated with a negative 5 years prognosis, in the presence of perineural invasion, documented in 33% of the studied cases. Case report: We present the case of a 68-year-old patient with moderately differentiated stage III B sigmoid adenocarcinoma, operated on in the General Surgery Clinic of Coltea Clinical Hospital with histopathological staging T3N1M0 with lymphovascular and perineural invasion present on the surgical specimen, who underwent an R0 resection with end-to-end colorectal anastomosis, with loco-regional recurrence at 1 year after the intervention. Conclusions: Early postoperative malignant recurrence was favored by the perineural and lymphovascular invasion, although a resection with oncologic safety margins was practiced, in the presence of adjuvant chemotherapy, in concordance with actual guidelines.

Background/aim: This study aims to identify resistance phenotypes within the Plastic Surgery Department of a tertiary hospital in Romania. The goal is to guide the appropriate administration of antimicrobial therapy to optimize patient outcomes while minimizing the risk of multidrug-resistant bacterial strain development. Methods: A prospective clinical study was conducted on 78 patients admitted to the Plastic Surgery Department. Pus samples were collected by attending physicians. Bacterial culture and identification using API cards were conducted. Antibiotic susceptibility testing was performed through the Kirby-Bauer disk diffusion method. Results: A total of 100 bacterial strains were isolated from 78 clinical samples. The most frequently identified strains were: Staphylococcus aureus (32%), Klebsiella pneumoniae (21%), Escherichia coli (10%), Proteus mirabilis (10%), and Pseudomonas aeruginosa (10%). Among these, 20% of Escherichia coli and 28.5% of Klebsiella pneumoniae strains exhibited an extended-spectrum betalactamase (ESBL) phenotype. Resistance to fluoroquinolones was observed in 23.8% of Klebsiella pneumoniae and 10% of Escherichia coli strains. Aminoglycoside resistance was detected in 30% of Escherichia coli and 71.5% of Klebsiella pneumoniae strains. Analysis of Pseudomonas aeruginosa isolates revealed resistance to carbapenems â?" namely imipenem (40%), cephalosporins (50%), and fluoroquinolones (20%). Staphylococcus aureus strains were classified into different phenotypes, including methicillinresistant Staphylococcus aureus (62.5%), beta-lactamase producers (37.5%), aminoglycoside-resistant (78.1%), and fluoroquinolone-resistant strains (18.8%).

Conclusion: The findings highlight that the bacterial strains identified in this study demonstrated a high level of susceptibility to fluoroquinolones, suggesting their potential efficacy in antimicrobial therapy.

Introduction: Mixed neoplasms represent a big family of complex tumors that consist of more than one neoplastic tissue. Mixed tumors are categorized into collision, composite, carcinosarcomas, and amphicrine tumors. Case Report: Hereinafter, we describe a case of a collision tumor composed of mantle cell lymphoma and mucinous adenocarcinoma located in the ascending colon in a 63-year-old man. A patient was admitted to the hospital due to sideropenic anemia, central abdominal pain spreading into the right lumbal area, and occasional loose stools. Results: Laboratory tests revealed sideropenic anemia, thrombo-cytosis, and inflammatory syndrome. A colonoscopy detected an ulcer-proliferative mass located at the hepatic flexure. Endoscopic biopsy from the mass confirmed poorly differentiated adenocarcinoma. A computed tomographic scan demonstrated a circumferential thickening of the hepatic flexure that narrows the colon lumen to the length of 10 cm. Multiple regional lymph nodes were enlarged. Consequently, the patient underwent a right hemicolectomy with ileotransverse colon anastomosis. Pathologic findings showed an ulcer-exophytic mass in ascedens. Microscopic examination of the lesion detected a poorly differentiated mucinous adenocarcinoma colliding with mantle cell lymphoma that was confirmed by immunohistochemistry. Regional lymph nodes were enlarged, involved by lymphoma. Following the surgery, the patient received R-CHOP chemotherapy. To the best of our knowledge, only four such cases have been reported in the literature so far. Unfortunately, long-term follow-up was not available. Conclusions: The diagnosis of collision tumors can be very challenging, and prognosis and therapy are still not investigated enough. More reports of collision tumors should be documented to establish standard protocols for treatment.

Background: Muscle-invasive bladder tumors (MIBT) usually require radical cystectomy (RC) followed by urinary diversion to maintain urinary flow. The two main methods used are simple direct cutaneous ureterostomy (SDCU) and Bricker ileal conduit diversion (BICD), each with distinct advantages and disadvantages. This study compares the outcomes of these two techniques across two university centers in Romania, with each center employing a different surgical approach Material and Methods: A retrospective study was conducted on 64 patients with MIBT, divided into two equal groups.One center performed the SDCU technique with a classical approach and the other used BICD via a laparoscopic approach. Glomerular filtration rates (GFR), blood loss, operative time, length of hospitalization and postoperative complications were assessed. Results: Both techniques provided similar postoperative renal function outcomes. The BICD group exhibited a more pronounced decrease in hemoglobin levels (median decrease of 2.1 g/dL compared to 1.8 g/dL in the SDCU group, p=0.007) and a significantly shorter hospital stay (median of 11 days for BICD versus 15 days for SDCU, p 0.001). Moreover, the incidence of urinary tract infections was significantly lower in the BICD group (p=0.016) Conclusions: The BICD technique is preferable for patients at increased risk of infections due to a shorter hospital stay and a lower incidence of urinary tract infections. Conversely, the SDCU technique remains a viable option for elderly patients. The significant difference in hospital stay duration (11 vs. 15 days) underscores the necessity for a rigorous and individualized selection of the urinary diversion type, tailored to the patientâ??s specific needs and the surgical approach of each center.

Introduction: Acute appendicitis remains one of the most common surgical emergencies worldwide. Complicated acute appendicitis may present as perforated or gangrenous appendicitis with a compromised appendiceal base. This is a challenging scenario for surgeons that may require, in some cases, an ileocolic resection. This study aims to demonstrate the advantages and efficacy of a minimally invasive approach to complicated appendicitis requiring ileocolic resection. Materials and Methods: We reviewed patients who underwent extended resection for complicated acute appendicitis at our hospital from January 2022 to May 2024. Baseline, preoperative, intraoperative and postoperative features were analyzed. Results: During the study period, 15 patients with acute appendicitis required laparoscopic extended resection. Nine (56.2 %) underwent ileocecal resection, and 6 (43.8%) underwent right colectomy. All patients had an intracorporeal side to side, isoperistaltic 60 mm mechanical anastomosis. Mean length of stay was 7 Ã+- 1.3 days with no CD III and IV complications. No postoperative abdominal abscesses or anastomotic leaks occurred. Conclusions: Totally laparoscopic approach is a safe procedure for patients with complicated appendicitis requiring ileocolic resection.

Resection or bypass surgery for benign or malignant esophageal pathologies presents multiple challenges, which is why it is addressed to centers of digestiveexcellence. One such challenge is the restoration of the continuity of the digestive tract, the colon being an important option for esophageal substitution. Lon-term follow up of patients with colon reconstruction is essentially related to digestive-nutritional problems. An exceptional situation, by its particularity and evolution, is the appearance of pre-malignant lesions (polyps) or frankly malignant lesions of the colon graft. The aim of the article was to draw attention to the risk of such a long-term complication, unforeseen, difficult to manage diagnostically and therapeutically. At the same time, the limited data in the literature, usually case reports, leave a series of unanswered questions for the attending physician, both in terms of etiology and case management. That is why we wanted to review the literature, identify common elements with other authors, so as to seek working hypotheses and identify mechanisms or, at least, to signal such a possible complication.

Breast cancer (BC) is recognized as one of the leading malignancies affecting women worldwide. Its remarkable heterogeneity is a defining characteristic, contributing to both diverse patterns of disease progression and varied therapeutic responses. This review explores the evolution of breast cancer classifications, focusing on key prognostic and predictive factors. It examines traditional systems, such as the TNM staging and histological differentiation, while also incorporating modern elements like molecular subtypes, genomic alterations, and advanced diagnostic assays. By combining classical clinicopathological insights with cutting-edge molecular genetic technologies, the goal is to refine the precision of treatment strategies, ultimately advancing both our understanding and management of this complex disease. The review also emphasizes the importance of a global perspective, as achieving the primary treatment goals - prolonged survival and enhanced quality of life - requires addressing the disease in a broader, more comprehensive context. Breast cancer's complexity, driven by significant variability both across and within tumors, presents major challenges to conventional diagnostic and therapeutic approaches. However, breakthroughs in genomic research, such as molecular profiling and genetic testing, have deepened our understanding of this cancer's intricate nature. These advances have led to the identification of critical genetic alterations - including mutations in BRCA1/2, TP53, PALB2, PTEN, and PIK3CA - that profoundly impact tumor behavior, treatment efficacy, and patient prognosis. Genomic assays like Oncotype DX, MammaPrint, PROSIGNA, and EndoPredict offer valuable insights into recurrence risks and treatment choices, underscoring the growing importance of precision medicine. Moreover, the implementation of Molecular Tumor Boards further enhances personalized treatment strategies, contributing to improved patient outcomes and survival rates. This review underscores the significance of tailored therapeutic approaches and highlights the dynamic evolution of breast cancer in clinical practice.