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Introduction: Minimally invasive esophagectomy (MIE) has gained popularity in the surgical treatment of esophageal cancer over the past three decades. By introducing minimally invasive techniques, esophageal oncological surgery has advanced in terms of safety, radicality, functional preservation and quality of life post-esophagectomy of the patients. Material and Method: We present the experience of the Center of Excellence in Esophageal Surgery at Sf. Maria Clinical Hospital regarding total (MIE) through total 3D HD thoraco-laparoscopic modified McKeown triple approach. In between January 2015 - December 2021, 24 patients (M) were treated for thoracic esophageal cancer. The average age of patients was 57 years. Most of the esophageal tumors were midthoracic (62.5%), 83.3% were squamous carcinomas and half were moderately differentiated. Most of the esophageal tumors were locally advanced tumors (cT3N1 – 58.3%), 18 patients were staged III. 70.8% of patients received neoadjuvant chemo radiotherapy. Results: Thoracoscopic esophageal mobilizations were successful in all 24 patients, no conversion to thoracotomy. Laparoscopic gastric mobilizations were successful in all 24 patients, conversion to open technique was performed in 7 patients for creation extracoporeally of the gastric conduit through an epigastric minilaparotomy. The esophageal substitute was represented by the gastric conduit. The intraoperative blood loss was minimal. The average duration of surgical interventions was 360 minutes. All the surgical interventions were considered with curative intention (R0). The rate of intraoperative complications was 20.8%. The rate of early postoperative complications was 66%. Distribution of postoperative complications according to the Clavien-Dindo Classification (0-33.3%, 1-16.6%, 2-4.1%, 3a-12.5%, 3b-8.3%, 4a-0%, 4b-8.3%, 5-16.6%) highlighted a rate of 33.3% of major complications. The advantages of MIE observed in the studied group in the postoperative period were: reduced postoperative pain, improved comfort and early mobilization of the patients. Conclusions: The early outcomes of using the minimally invasive approach in the treatment of esophageal cancer in our clinic include the reduction of perioperative morbidity, the duration of hospitalization and a faster recovery.

Background: Non-alcoholic fatty liver disease (NAFLD) has increased exponentially in recent years in Western European countries, where the number of hepatitis of viral etiology has been declining, and it is thought to be the most common cause of chronic liver disease in the near future (1). Currently, NAFLD is both the second most common cause of hepatocellular carcinoma (HCC) and the second most common indication for liver transplantation (2-4). This problem is very serious, as cases of NAFLDs are increasingly in children, a population with a long life ahead, and in whom the disease has all the time to progress to cirrhosis and HCC (5, 6). Objectives: The goal of this prospective study is to determine the effect of an original formula consisting in silymarin, organic selenium and alpha lipoic acid, in reducing liver damage in patients with chronic liver disease. Material and methods: The study started in March 2018, initially with a group of patients from Bucharest, integrated in the study at St. Mary’s Hospital. In October 2018 it was expanded at the national level to 1 718 patients, monitored by 145 investigating physicians from 134 centers, with an average of 11.8 patients per investigating physician. Outcomes: Taking each stage of fatty liver disease (FLD) at T0 moment (the beginning of the study), we observed that 25% of patients with grade I FLD had no sign of disease at the end of the study, 74% of those with grade II FLD recovered or improved their health, and 83% of patients with grade III FLD recovered or improved their health. There were 149 patients with no FLD detected at the end of the study (recovered). Conclusion: Based on triple antioxidant therapy, the original formula improved the evolution and prognosis of patients with chronic liver disease.

Introduction: We present our department experience in pancreatic surgery over the last 6 years. From its inception the number of pancreatic resections has been continuously growing each year. Method: We performed a retrospective analysis of a prospectively maintained database where we included all the patients with pancreatic resections over the last 6 years. We present the main indication and the different types of pancreatic resections, postoperative morbidity, intrahospital and 90-day mortality and an analysis of survival for the patients with pancreatic ductal adenocarcinoma. Results: We analyzed 198 patients, 193 with pancreatic resections and 5 patients with open surgery microwave ablation. There were 145 pancreaticoduodenectomies, 37 distal pancreatectomies, one total pancreatectomy, 3 distal pancreatectomies with celiac axis resection and 7 surgical interventions for chronic pancreatitis. Conclusion: We presented our center's experience in pancreatic surgery with good overall results, however, there is still room for continuous improvement and refinements to achieve better shortterm outcomes, regarding postoperative morbidity and mortality.

Introduction. The target pathway programmed cell death‑1 (PD‑1)/ programmed death‑ligand 1 (PD‑L1) shows clinical efficacy in solid tumors, but also in Hodgkin’s and non‑Hodgkin’s lymphoma. PD‑L1 expression most often correlates with a poor prognosis and a PD‑1 regulatory factor that mediates immunosuppression. The presence of an increased number of tumor‑infiltrating lymphocytes (TILs) PD‑1 + is a favorable prognostic factor in patients with diffuse large B cell lymphomas (DLBCLs) and follicular lymphomas, while the low number of TILs PD‑1 + is associated with an increased risk of histological transformation. In DLBCLs, TILs PD‑1 + may not reflect the depletion of T‑mediated tumor cells but may be an indicator of lymphoid cell origin. Objectives. The objective of this study was to describe the correlation between PD‑1 and PDL‑1 with survival in patients with the diagnosis of diffuse large B cell lymphoma. Material and methods. We have studied 80 patients and we have analyzed DLBCLs according to the Hans algorithm; in addition, we analyzed PD‑1 and PD‑L1 in tumor cells and in immune cells and we correlated this data with patient’s survival. Results. We found that there is a tendency of decreased survival and therapeutic response in DLBCL patients, with both an intense and weak PD‑L1 positivity in tumor cells. PD‑1 low positivity was associated in higher percentage with relapse and treatment unresponsiveness. Conclusions: Our data suggested that PD‑L1 expression correlates with a poor clinical response although it is not an independent prognostic marker and PD‑1 represents a favorable prediction factor for survival.

Introduction. Focal liver lesions represent one of the main indications of ultrasound-guided liver biopsy. The purpose of the study was to evaluate the advantages and risks of liver biopsy, and to highlight the importance of a close follow-up in the prevention of postprocedural complications. Methods. We have retrospectively analyzed a number of 52 patients, who underwent liver biopsies in the Clinical Emergency Hospital of Bucharest, Romania, after being diagnosed with various types of focal liver lesions through ultrasound scanning. Results. Regarding the quality of the bioptic samples obtained: 98% of them were diagnostic, only 2% being nondiagnostic, mainly due to the tissue necrosis found within the tumor. The majority of the cases selected for the study had multiple liver lesions (70%), the rest of 30% had single lesions identified by ultrasound scanning. After histopathological analysis, in 89 % of the cases the lesion proved to be malignant (of which 70% were hepatic metastases and 30% were liver carcinomas), the rest of 11% were benign. This last category included hepatic adenomas and focal nodular hyperplasia, identified in young female population. Our study did not reveal any relation between the location of the lesion within the liver and the number of needle passes needed in order to obtain viable biopsy specimens (P = 0.16). Of all the cases that underwent liver biopsy, only 4% had complications, mainly minor bleeding and only 1% major bleeding and transitory hypotension. There was no case of death registered. Conclusions. Ultrasound guided percutaneous liver biopsy is a fast, economical and user-friendly procedure, frequently used in the diagnosis of focal liver lesions. The success rate of the biopsy in obtaining viable samples is high and it depends more on the structure of the lesion and the materials used, rather than on the anatomical localization of the lesion within the liver. Severe complications can be avoided if a close follow-up of the patients is performed.

Introduction. Ingestion of corrosive substances often causes serious damage to the upper gastrointestinal mucosa, occasionally perforation and, in rare cases, death. Most of these events are accidental, especially in children and the elderly, and voluntary (for suicidal purposes) in adults. If the patient survives the acute episode, the long-term complications are mainly esophageal and/or gastric stenosis and esophageal cancer after 1-2 decades of evolution. Endoscopic treatment of benign esophageal stenosis consists of dilation with Savary bougies and dilation balloon, esophageal stent assembly, with the purpose of restoring esophageal luminal patency. Superior digestive endoscopy plays an important role in the evaluation of benign esophageal stenosis in terms of the severity and the extent of stenosis. Case presentation. We present the case of a 47-yearold patient admitted to our clinic for dysphagia for solid and semi-solid foods. Endoscopy revealed an esophageal stricture due to the voluntary ingestion of caustic substance with suicidal purpose, 9 months before presentation. After multiple sessions of endoscopic dilatation with Savary bougies, an esophageal stent was placed, that solved patient’s dysphagia. Conclusions. Post-caustic esophageal stenosis is a common cause of dysphagia in patients with ingestion of corrosive substances. Patients can benefit from endoscopic esophageal stent placement treatment.

Introduction. C-MYC is one of the essential transcription factors that play a role in various cellular functions. The MYC rearrangement is associated with low overall survival and low progression-free survival, increased risk of central nervous system disease relapse in patients diagnosed with diffuse large B cell lymphoma (DLBCL) and treated with R-CHOP. Also, c-MYC amplification is an unfavorable prognostic factor, amplified by BCL2 and BCL6 rearrangements, respectively, designating lymphomas as high grade according to the WHO 2016 revision. Objectives. We search the correlations of the double or triple expression of C-MYC and BCL2 and/or BCL6 markers, with clinical survival data. Methods. A cohort of 80 patients with DLBCL was examined for MYC, BCL2 and BCL6 immunohistochemical expression. Results. Six, respectively four, patients of the total cohort were MYC/BCL2 and MYC/BCL6 positive and only 3 were MYC/BCL2/BCL6 triple positive. The median overall survival was 6 months, 95% confidence interval (CI)) for triple expression and 13 months (CI 95%) for MYC/BCL2, respectively MYC/BCL6 dual expression. Complete therapeutical response was registered in 2 patients with triple expression and 4, respectively 2 patients, with MYC/BCL2 and BCL6 dual expression. Relapse was registered in 1 patient, either MYC/BCl2 dual positivity respectively triple positivity, and in 2 patients with MYC/BCL6 positivity. Conclusions. Our study has showed that the double and triple positivity expression in DLBCL have a low incidence (15%) and are correlated with poor survival, the prognosis being unfavorable.

Background and aims Postoperative esophageal leaks are one of the major causes of postoperative mortality and morbidity. The purpose of this study was to review current knowledge of current methods of diagnosis and management of postoperative esophageal leaks. Methods: A systematic literature search was performed in the PubMed/Medline database using the terms "postoperative esophageal leaks" and "postesophagectomy complications" to identify articles relevant to the current diagnostic and prophylactic and curative treatment of post-oesophagectomy anastomotic fistulas. Results: Several papers have shown that the incidence of fistulas varies and is dependent on several factors: the location of the anastomosis, the type of suture used, the biological condition of the patient. Due to the severity of the mediastinal anastomotic fistula, great importance is being given to the methods of preventing its occurrence by intraoperative testing or improving the gastric tube vascularity. The most recent articles present endoscopic methods of treating this complication by using coated esophageal stents and endoluminal vacuum therapy. Conclusion In patients with mediastinal postoperative esophageal fistulas, diagnosis and management represent a real challenge for the surgeon-endoscopist-therapist team. The early diagnosis and the establishment of an optimal therapy to address the parietal defect and the biological status of the patient are mandatory conditions for resolving this postoperative complication.