71 results on '"Iulian BREZEAN"'
Search Results
2. Pancreatic adenocarcinoma with synchronous liver metastases – is there a role for surgery?
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Alexandru Filipescu, Pharmacy, Bucharest, Romania, Cornel Savu, Carmen Savu, Mihaela Vilcu, Camelia Cristina Diaconu, Gabriel Gorecki, Nicolae Bacalbasa, Irina Balescu, Mihai Dimitriu, Cristian Balalau, Iulian Brezean, Laura Iliescu, Lucian Pop, and Emil Belu
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Medicine (General) ,medicine.medical_specialty ,business.industry ,General Medicine ,medicine.disease ,Gastroenterology ,R5-920 ,Internal medicine ,pancreatic adenocarcinoma ,medicine ,Medicine ,Adenocarcinoma ,resection ,business ,liver metastases - Abstract
Pancreatic cancer remains one of the most aggressive neoplasms affecting people worldwide, with lower than one year rates of survival, especially if metastatic disease is encountered. In such cases palliative chemotherapy has been proposed, but the overall prognostic remains extremely poor. Meanwhile, in certain cases, spectacular response to chemotherapy has been observed, with significant reduction and even disappearance of the liver lesions. In this respect, attention was focused on establishing whether surgery might improve the outcomes in such cases. This is a literature review of the largest studies conducted on this issue.
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- 2020
3. Etiopathogenesis of inflammatory pseudotumors of the liver
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Mihai Dimitriu, Carmen Savu, Cristian Balalau, Nicolae Bacalbasa, Camelia Cristina Diaconu, Lucian Pop, Pharmacy, Bucharest, Romania, Laura Iliescu, Iulian Brezean, Mihaela Vilcu, Irina Balescu, Alexandru Filipescu, Pharmacy, Bucharest, Roman, Cornel Savu, and Emil Belu
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Medicine (General) ,Pathology ,medicine.medical_specialty ,business.industry ,liver ,stomatognathic diseases ,R5-920 ,Materials Chemistry ,Medicine ,etiopathogenesis ,business ,inflammatory pseudotumors ,Inflammatory pseudotumors - Abstract
Inflammatory pseudotumors of the liver are rare entities, only few cases being reported so far, pathogenesis of these lesions being scarcely understood. However since now multiple mechanisms have been proposed in order to explain the development of these lesions, the knowledge of their pathogenesis being mandatory in order to further orientate the therapeutic strategy. The current paper is a literature review of the largest studies which aimed to discuss the etiopathogenesis of the inflammatory pseudotumors of the liver.
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- 2020
4. The role of quaternary cytoreduction in relapsed ovarian cancer – a systematic review
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Nicolae BACALBASA, Irina BALESCU, Mihaela VILCU, Ioana HALMACIU, Camelia C. DIACONU, Simona DIMA, and Iulian BREZEAN
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lcsh:R5-920 ,quaternary ,ovarian cancer ,debulking ,lcsh:R ,lcsh:Medicine ,lcsh:Medicine (General) ,survival - Abstract
Introduction. Ovarian cancer is characterized by a high capacity of relapse, even in cases in whom cytoreductive surgery with curative intent followed by platinum and taxanes-based chemotherapy were performed. In such cases, attention was focused on determining if iterative cytoreduction might improve the long-term outcomes and how far these boundaries can be pushed. While for secondary cytoreduction multiple studies have been conducted, for tertiary and quaternary cytoreduction data are significantly scarcer. The objective of the study. This paper aims to realize a systematic review of the studies published so far on the theme of quaternary cytoreduction. Methodology. We searched medical journals in English language published from January 2010 to December 2019. Results. Six studies involving 110 patients submitted to quaternary cytoreduction met the inclusion criteria. Data reported in the above mentioned studies demonstrate that quaternary cytoreduction can be safely performed both at the level of the lower and the upper abdomen, in order to maximize the debulking effort. However, a significantly lower number of cases will be considered candidates for this type of procedure, when compared to secondary or even tertiary cytoreduction, an adequate selection process being mandatory in order to minimize the postoperative risks. Conclusions. Although it is less frequently feasible when compared to secondary or tertiary cytoreduction, quaternary cytoreduction might be beneficial in selected cases.
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- 2020
5. Krukenberg tumors from breast cancer – literature review
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Nicolae BACALBASA, Irina BALESCU, Mihaela VILCU, Camelia C. DIACONU, Simona DIMA, and Iulian BREZEAN
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lcsh:R5-920 ,breast cancer ,krukenberg tumors ,lcsh:R ,lcsh:Medicine ,prognosis ,lcsh:Medicine (General) - Abstract
Krukenberg tumors are ovarian metastases from different malignancies, most often originating from the gastrointestinal tract. However, in rare cases, other primary tumors, even with extra-abdominal location, might lead to the development of such lesions. Neither the mechanism of development, prognostic significance or therapeutic strategy are not clearly defined so far. It seems that these lesions are more frequently encountered in patients with BRCA1/2 mutations. Most often, Krukenberg tumors are bilateral lesions associated with ascites and with firm areas at the level of the ovarian surface. This paper aims to review existing data regarding Krukenberg tumors from breast cancer.
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- 2020
6. Uterine neuroendocrine tumors – literature review
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Iulian Brezean, Nicolae Bacalbasa, Irina Balescu, Mihaela Vilcu, Pharmacy, Bucharest, Romania, and Simona Dima
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Medicine (General) ,Pathology ,medicine.medical_specialty ,business.industry ,Neuroendocrine tumors ,uterine neuroendocrine tumors ,medicine.disease ,surgery ,R5-920 ,Materials Chemistry ,Medicine ,business ,prognostic ,radiotherapy - Abstract
Uterine neuroendocrine tumors are extremely rare malignancies which are usually diagnosed in advanced stages of the disease and are associated with poor prognostic. Due to their rarity a standard therapeutic strategy as well as a standard diagnostic protocol is still missing, these patients being rather diagnosed and treated by extrapolation of the present guidelines for other types of neuroendocrine tumors. This is a literature review of the most relevant studies conducted on the issue of diagnostic and management of uterine neuroendocrine tumors.
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- 2020
7. The correlation between the extent of left upper abdominal resections and perioperative outcomes in advanced stage and relapsed ovarian cancer
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Irina Balescu, Pharmacy, Bucharest, Roman, Iulian Brezean, Dragos Cretoiu, Ioana Halmaciu, Laura Iliescu, Nicolae Bacalbasa, Mihai Dimitriu, Alexandru Filipescu, Pharmacy, Bucharest, Romania, Camelia Cristina Diaconu, Mihaela Vilcu, and Simona Dima
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Medicine (General) ,medicine.medical_specialty ,business.industry ,Advanced stage ,Perioperative ,advanced stage or relapsed ovarian cancer ,medicine.disease ,Surgery ,left upper abdominal resections ,R5-920 ,debulking surgery ,Materials Chemistry ,medicine ,Medicine ,business ,Ovarian cancer - Abstract
The aim of this study is to analyze the feasibility and safety of left upper abdominal resections as part of debulking surgery. Case series presentation. Between January 2015 and August 2019, 32 patients were submitted to left upper abdominal resections. Left upper abdominal resections were performed as part of primary cytoreduction in 22 cases, as part of secondary cytoreduction in eight cases, and respectively as part of tertiary cytoreduction in two cases. The complexity of the resection increased from primary to secondary and tertiary cytoreduction; in the meantime, the rates of postoperative complications also increased with the attempt of cytoreduction. Therefore the postoperative morbidity rate was of 27% at the time of primary cytoreduction, 37.5% at the time of secondary cytoreduction and 50% at the time of tertiary cytoreduction. However, association of left upper abdominal resections leaded to a complete resection rate of 77% at the time of primary cytoreduction, 62.5% at the time of secondary cytoreduction and 50% at the time of tertiary cytoreduction. Conclusions. Left upper abdominal resections might increase the rates of complete debulking in the setting of advanced stage or relapsed ovarian cancer. However the complexity of procedures and the risk of postoperative complications increase with the number of attempts of debulking.
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- 2020
8. Right Upper Abdominal Resections in Advanced Stage Ovarian Cancer
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Nicolae Bacalbasa, Irina Balescu, Iulian Brezean, Cora Pop, Alexandru Filipescu, Mihaela Vilcu, Camelia Cristina Diaconu, Simona Dima, and Laura Iliescu
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Adult ,Cancer Research ,medicine.medical_specialty ,Operative Time ,Blood Loss, Surgical ,General Biochemistry, Genetics and Molecular Biology ,Resection ,Abdomen ,medicine ,Humans ,In patient ,Neoplasm Metastasis ,Aged ,Neoplasm Staging ,Retrospective Studies ,Ovarian Neoplasms ,Pharmacology ,Porta hepatis ,business.industry ,Advanced stage ,Cytoreduction Surgical Procedures ,Perioperative ,Middle Aged ,medicine.disease ,Debulking ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Female ,Full thickness ,business ,Ovarian cancer ,Research Article - Abstract
Background/aim The right upper abdominal involvement is frequently encountered in patients with advanced stage ovarian cancer. The aim of this paper is to study the safety and efficacy of extended resections at this level as well as to determine the sites of residual disease. Patients and methods Between January 2016 and December 2019, 26 patients submitted to right upper abdominal resections were identified. Results Peritoneal stripping and full thickness resections were the most commonly performed resections (in 57% and 19% of cases, respectively), followed by capsular liver resection and atypical liver resection (in 30% and 23% of cases, respectively) while the most common sites where resection was incomplete were the liver pedicle and porta hepatis. Exceptionally, one case necessitated performing a pancreatoduodenectomy as part of debulking surgery. Postoperatively, two cases developed serious complications and required reintervention; however, the overall mortality was null. Conclusion Right upper abdominal resections seem to be feasible and effective in order to maximize the debulking effort with acceptable risks arising from perioperative complications.
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- 2020
9. Superior Mesenteric and Portal Vein Reconstruction With Cadaveric Allograft During Pancreatoduodenectomy – A Case Report and Literature Review
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Irinel Popescu, Vladislav Brasoveanu, Mihaela Vilcu, Nicolae Bacalbasa, Simona Dima, Irina Balescu, Laura Iliescu, and Iulian Brezean
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Cancer Research ,medicine.medical_specialty ,Portal vein ,General Biochemistry, Genetics and Molecular Biology ,Mesenteric Vein ,Pancreaticoduodenectomy ,Resection ,Mesenteric Veins ,Pancreatic cancer ,Cadaver ,Humans ,Medicine ,Postoperative outcome ,Neoplasm Invasiveness ,External iliac vein ,Superior mesenteric vein ,Aged ,Neoplasm Staging ,Pharmacology ,Portal Vein ,business.industry ,Plastic Surgery Procedures ,Allografts ,medicine.disease ,Tumor Burden ,Pancreatic Neoplasms ,Treatment Outcome ,Radiology ,business ,Cadaveric spasm ,Vascular Surgical Procedures ,Research Article - Abstract
Background/aim During the last decade it has been widely demonstrated that venous involvement in pancreatic head cancer is not a sign of poor prognostic, while surgery with curative intent is feasible and with encouraging results. However, the location and extent of venous invasion can occasionally pose serious problems in terms of reconstruction. The aim of the paper is to describe a case in which total superior mesenteric and portal vein resection followed by reconstruction were successfully performed. Case report We present the case of a 74-year-old patient submitted to surgery for locally advanced pancreatic cancer invading the portal and superior mesenteric veins. Surgery consisting of pancreatoduodenectomy en bloc with portal vein and superior mesenteric vein resection was performed. The venous axis was reconstructed by using a venous cadaveric allograft originating from the external iliac vein. The postoperative outcome was favorable and the histopathological studies confirmed the local invasion of the resected venous structures. Conclusion The cadaveric venous allograft can be safely used in order to reconstruct the venous axis following extended vascular resections for pancreatic cancer.
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- 2020
10. Extended Pelvic Resections as Part of Secondary Cytoreduction for Relapsed Ovarian Adenocarcinoma
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Nicolae Bacalbasa, Irina Balescu, Simona Dima, Iulian Brezean, and Mihaela Vilcu
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Adult ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Disease ,General Biochemistry, Genetics and Molecular Biology ,Cystectomy ,Recurrent disease ,medicine ,Humans ,Ovarian adenocarcinoma ,Aged ,Pelvic Neoplasms ,Retrospective Studies ,Ovarian Neoplasms ,Pharmacology ,Tumor biology ,business.industry ,Mortality rate ,Cytoreduction Surgical Procedures ,Middle Aged ,Prognosis ,medicine.disease ,Debulking ,Adenocarcinoma, Mucinous ,Cystadenocarcinoma, Serous ,Endometrial Neoplasms ,Surgery ,Female ,Neoplasm Recurrence, Local ,Ovarian cancer ,business ,Adenocarcinoma, Clear Cell ,Follow-Up Studies ,Research Article - Abstract
Background/aim Ovarian cancer presents an aggressive tumor biology, a significant number of patients experiencing recurrent disease. The aim of this study was to examine the feasibility and effectiveness of secondary debulking surgery for relapsed ovarian cancer. Patients and methods Between 2014 and 2018, debulking surgery for relapsed ovarian cancer was performed in 40 cases. Results Debulking surgery to no residual disease was achieved in 31 cases; among the remaining cases, an R1 resection was feasible in six cases, while in the remaining three cases an R2 resection was performed. The most commonly performed visceral resections were represented by rectosigmoidian resection, right colon resection, total or partial cystectomy and unilateral or bilateral ureteral resection. The early postoperative morbidity rate was 32.5% while the postoperative mortality rate was 2.5%. Conclusion Extended pelvic resections are feasible in patients with relapsed ovarian cancer and might be performed with acceptable rates of postoperative complications.
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- 2019
11. Laparoscopic management of ureteral endometriosis
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Irina Balescu, Nicolae Bacalbasa, Iulian Brezean, and Mihaela Vilcu
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lcsh:R5-920 ,medicine.medical_specialty ,Ureteral endometriosis ,business.industry ,lcsh:R ,laparoscopy ,Urology ,lcsh:Medicine ,General Medicine ,medicine ,resection ,lcsh:Medicine (General) ,business ,ureteral endometriosis - Abstract
Ureteral endometriosis is characterized by the development of deep infiltrating islets of endometrial tissue affecting the ureter, the optimal management in such cases being still poorly defined. Once the techniques of laparoscopic surgery improved, this minimally invasive approach has been proposed with encouraging results in treating such cases. When it comes to the types of surgical procedure which are needed in such cases, they are chosen accordingly to the degree, extent and localization of the endometrial tissue. This is a literature review of the largest studies which were conducted on the theme of the laparoscopic management of ureteral endometriosis; the main analyzed parameters refer to the efficacy and safety of the procedure.
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- 2019
12. Laparoscopic management of deep infiltrating colorectal endometriosis
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Irina Balescu, Iulian Brezean, Nicolae Bacalbasa, and Mihaela Vilcu
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endometriosis ,Colorectal endometriosis ,lcsh:R5-920 ,medicine.medical_specialty ,business.industry ,lcsh:R ,lcsh:Medicine ,General Medicine ,shaving ,full thickness resection ,Gastroenterology ,Internal medicine ,Medicine ,lcsh:Medicine (General) ,business ,colorectal resection - Abstract
Deep infiltrating endometriosis is a debilitating disease which usually affects young women and significantly impacts on the quality of life. Due to the fact that it remains a benign condition which usually affects patients at the reproductive age, an aggressive, radical surgical procedure might be considered as a too mutilating one by certain cases. In consequence, attention was focused on treating these patients in a less invasive manner, procedures like rectal shaving or full thickness local excision being proposed. In the meantime, once the minimally invasive techniques evolved, laparoscopic surgery has been widely proposed in the last decade in order to treat this pathology. The current paper is a literature review of the largest studies which investigated and compared the outcomes after minimally invasive approach for deep infiltrating colorectal endometriosis.
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- 2019
13. Intraductal papillary mucinous neoplasm of the pancreas – when and how to operate?
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Emil Belu, Cristian Balalau, Camelia Cristina Diaconu, Gabriel Gorecki, Pharmacy, Bucharest, Romania, Alexandru Filipescu, Nicolae Bacalbasa, Mihaela Vilcu, Lucian Pop, Irina Balescu, Iulian Brezean, Mihai Dimitriu, Laura Iliescu, Carmen Savu, and Cornel Savu
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Medicine (General) ,Pathology ,medicine.medical_specialty ,Intraductal papillary mucinous neoplasm ,business.industry ,General Medicine ,medicine.disease ,branch duct ,R5-920 ,medicine.anatomical_structure ,medicine ,Medicine ,resection ,Pancreas ,business ,main duct ,ntraductal papillary mucinous neoplasm - Abstract
Described for the first time in 1982, intraductal papillary mucinous neoplasms have been widely studied so far. According to the site of origin and location, it seems that these tumors have a specific risk of malignisation and therefore their type of treatment as well as the moment in which it should be applied should be carefully tailored. In this respect, multiple therapeutic strategies have been proposed, ranging from follow up and limited excision to total pancreatectomy. The current paper is a literature review of the largest studies conducted on the theme of the therapeutic strategies in intraductal papillary mucinous neoplasms.
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- 2020
14. Indocyanine green guided surgery for pancreatic surgery
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Mihaela Vilcu, Emil Belu, Cornel Savu, Carmen Savu, Pharmacy, Bucharest, Romania, Mihai Dimitriu, Nicolae Bacalbasa, Camelia Cristina Diaconu, Laura Iliescu, Lucian Pop, Alexandru Filipescu, Iulian Brezean, Cristian Balalau, and Irina Balescu
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Medicine (General) ,medicine.medical_specialty ,indocyanine green ,business.industry ,pancreatic tumors ,infrared guided surgery ,Pancreatic surgery ,Surgery ,chemistry.chemical_compound ,R5-920 ,chemistry ,Materials Chemistry ,medicine ,Medicine ,business ,Indocyanine green - Abstract
Indocyanine green guided surgery has gained significant popularity in the last decade in different areas including colorectal, gynecological or even hepatic surgery. Moreover, recently published papers came to demonstrate the utility of the method in pancreatic surgery, providing a better identification of pancreatic lesions and bringing significant information regarding the local anatomy. The current paper represents a literature review of the most relevant studies published so far on this issue.
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- 2020
15. Indocyanine green guided liver resection for hepatocellular carcinoma – literature review
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Laura Iliescu, Mihai Dimitriu, Pharmacy, Bucharest, Romania, Cornel Savu, Iulian Brezean, Carmen Savu, Nicolae Bacalbasa, Mihaela Vilcu, Emil Belu, Camelia Cristina Diaconu, Lucian Pop, Cristian Balalau, Irina Balescu, and Alexandru Filipescu
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Medicine (General) ,medicine.medical_specialty ,indocyanine green ,business.industry ,anatomical liver resection ,General Medicine ,medicine.disease ,Resection ,chemistry.chemical_compound ,R5-920 ,chemistry ,Hepatocellular carcinoma ,infrared ,medicine ,Medicine ,Radiology ,business ,Indocyanine green - Abstract
Anatomical liver resection guided by segmental portal inflow compression proved to be an efficient tool in order to maximize the curative surgical treatment in hepatocellular carcinoma. In this respect, in the last decades, once the concept of indocyanine guided surgery gained more field, the method has been also implemented in hepatic surgery. Therefore it seems that intravenous injection followed by portal pedicle clamping and liver inspection in infrared light inspection might delimitate the segments of the liver and might successfully guide the gesture of anatomical liver resection. The current paper is a literature review of the studies which analyzed the efficacy and safety of indocyanine green guided liver surgery.
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- 2020
16. The correlation between endometriosis and metabolic syndrome
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Simona Dima, Irina Balescu, Pharmacy, Bucharest, Romania, Nicolae Bacalbasa, Iulian Brezean, and Mihaela Vilcu
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endometriosis ,obesity ,Medicine (General) ,medicine.medical_specialty ,business.industry ,Endometriosis ,General Medicine ,medicine.disease ,Gastroenterology ,metabolic syndrome ,Correlation ,R5-920 ,Internal medicine ,estrogen ,medicine ,Medicine ,Metabolic syndrome ,business - Abstract
Although it represents a benign condition, endometriosis is an important and sometimes debilitating health problem affecting women worldwide, associated with a high capacity of relapse. While the correlation between different endometrial pathologies, obesity and metabolic syndrome has been clearly demonstrated lately, the relationship between endometriosis and metabolic syndrome is far to be understood. The aim of this paper is to review the most relevant studies conducted on this issue.
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- 2020
17. ACUTE URINARY RETENTION DUE TO A LARGE ISTHMIC LEIOMYOMA – A CASE REPORT AND LITERATURE REVIEW
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Mihaela Vilcu, Iulian Brezean, Nicolae Bacalbasa, Simona Dima, Irina Balescu, and Pharmacy, Bucharest, Romania
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medicine.medical_specialty ,Medicine (General) ,intra-isthmic development ,uterine leiomyoma ,business.industry ,Urinary retention ,Urology ,medicine.disease ,urologic and male genital diseases ,female genital diseases and pregnancy complications ,Leiomyoma ,R5-920 ,Materials Chemistry ,medicine ,Medicine ,medicine.symptom ,acute urinary retention ,business - Abstract
Uterine leiomyoma represent a common finding in women at fertile age, being usually responsible for the apparition of metrorhagia and pelvic pain; in certain cases presenting large uterine fibroids, tumoral masses can be encountered at the clinical abdominal exam. However, in certain cases they can be responsible for the apparition of urinary signs such dysuria and pollakiuria due to their compression on the urinary bladder. The aim of this paper is to report the case of a 56-year-old patient who presented for oligo-anuria and bilateral ureteral hydronephrosis and who was diagnosed with a large intra-istmic leiomyoma with vaginal development which induced the development of acute urinary retention. The patient was submitted to surgery, a total hysterectomy with bilateral adnexectomy being performed.
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- 2019
18. Indocyanine green utility in sentinel node detection for cervical cancer patients
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Iulian Brezean, Cristian Balalau, Mihaela Vilcu, Nicolae Bacalbașa, and Irina Balescu
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sentinel lymph node detection ,Cervical cancer ,lcsh:R5-920 ,medicine.medical_specialty ,indocyanine green ,cervical cancer ,business.industry ,Sentinel node ,medicine.disease ,chemistry.chemical_compound ,chemistry ,medicine ,Radiology ,lcsh:Medicine (General) ,business ,Indocyanine green - Abstract
With wide implementation of screening tests for the Human Papilloma Virus, the number of diagnosed cases of premalignant or early stages of cervical cancer has increased considerably. As a consequence, surgeons’ attention has focused on determining how best to limit the surgical procedure so the benefits of the procedure will not be surpassed by postoperative morbidity. In this respect, extended lymph node dissection, routinely associated so far with cervical cancer patients, has in the last decades been replaced with sentinel node detection and biopsy. Initially performed through radiocolloid injection, this method has undergone permanent changes in order to maximize its efficacy and safety. Although the laparoscopic approach had been widely used in the past, a new method has been proposed, i.e., the use of indocyanine green injection, which has yielded promising results for sentinel node detection in the early stages of cervical carcinoma. This paper reviews the literature of the most relevant studies conducted on this topic.
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- 2019
19. Benefits and ethical issues in domino liver transplant
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Irina Balescu, Mihaela Vilcu, Adina Croitoru, Iulian Brezean, Nicolae Bacalbasa, Pharmacy, Bucharest, Romania, and Simona Dima
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Medicine (General) ,Ethical issues ,General Medicine ,survival ,Domino ,surgical procedures, operative ,R5-920 ,Political science ,metabolic disorders ,Medicine ,ethical issues ,Engineering ethics ,domino liver transplant - Abstract
Due to the permanent discordance between the number of available liver grafts and the number of cases on the waiting lists, attention was focused on developing different solutions in order to increase the number of grafts. Once the technique of living donor has been proposed, the number of grafts increased but the gap between the number of available grafts and the cases on the waiting list is still significant. Therefore attention was focused on finding out other solutions such as splitting the graft or performing a domino liver transplant. The procedure of domino transplant consists of harvesting a graft from a young patient with metabolic disorders in which a healthy graft will be used and implants it to a marginal receiver. The method seems to associate minimal risks for the marginal donor to develop the metabolic disorder especially if the donor suffers from familial amyloid polyneuropathy; however, ethical issues in such cases are obvious. The aim of this paper is to analyse both the benefits of domino liver transplant and the ethical issues of the procedure.
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- 2019
20. EX VIVO LIVER RESECTION FOR TUMORAL PATHOLOGY – BENEFITS, RISKS AND OUTCOMES
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Ana Maria Bianca Mitricof, Pharmacy, Bucharest, Romania, Iulian Brezean, Irina Balescu, Nicolae Bacalbasa, Mihaela Vilcu, Adina Croitoru, and Simona Dima
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Pathology ,medicine.medical_specialty ,Medicine (General) ,autotransplantation ,business.industry ,liver tumors ,General Medicine ,Resection ,ex vivo resection ,R5-920 ,Medicine ,business ,Ex vivo - Abstract
Ex vivo liver surgery techniques have been proposed almost two decades ago in order to extend the indications and feasibility of liver resections for large, but not absolutely unresectable liver lesions. However, the procedure remains a demanding one, being associated with high risks of postoperative complications; therefore it should be performed only in specialized centers. This is a literature review of the largest studies conducted on the theme of ex vivo liver resection for tumoral pathology.
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- 2019
21. Value of sentinel node biopsy in anal cancer patients
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Nicolae Bacalbasa, Iulian Brezean, Pharmacy, Bucharest, Romania, Mihaela Vilcu, Irina Balescu, and Cristian Balalau
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Biopsy ,medicine ,Anal cancer ,General Medicine ,Radiology ,Sentinel node ,medicine.disease ,business ,Value (mathematics) - Published
- 2019
22. IS HIPEC BENEFICIAL IN PLATINUM RESISTANT RELAPSED OVARIAN CANCER?
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Irina Balescu, Iulian Brezean, Adina Croitoru, Mihaela Vilcu, Nicolae Bacalbasa, Pharmacy, Bucharest, Romania, and Simona Dima
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Medicine (General) ,business.industry ,intraperitoneal heated chemotherapy (hipec) ,medicine.disease ,platinum resistance ,ovarian cancer ,R5-920 ,Materials Chemistry ,Cancer research ,Medicine ,business ,Ovarian cancer ,Platinum resistant - Abstract
Ovarian cancer remains one of the most aggressive biological malignancies which is characterised by a high capacity of relapse even in cases in which a curative intent treatment is performed. In such cases the therapeutic options are rather limited, especially in platinum resistant lesions. The aim of this paper is to analyse the reported results after performing intraperitoneal heated chemotherapy in such cases.
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- 2019
23. Value of sentinel node biopsy in anal cancer patients
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Nicolae BACALBASA, Irina BALESCU, Cristian BALALAU, Mihaela VILCU, and Iulian BREZEAN
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lcsh:R5-920 ,irradiation ,anal cancer ,lcsh:R ,metastasis ,lcsh:Medicine ,lcsh:Medicine (General) ,sentinel node biopsy - Abstract
Anal cancer is a rare digestive malignancy with high propensity to spread via lymphatic route, leading to the apparition of metastases at the level of superficial inguinal and perirectal stations. However, prophylactic irradiation of all these fields is not recommended due to the inacceptable high risks of complications when compared to the rates of metastases. Therefore, sentinel lymph node biopsy has been routinely associated in order to determine which cases present lymphatic metastases and could benefit most after irradiation. This is a literature review of the largest studies conducted on the subject of sentinel lymph node biopsy in anal cancer patients.
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- 2019
24. DUODENAL RESECTIONS AS PART OF THE THERAPEUTIC STRATEGY FOR DUODENAL MALIGNANT TUMORS
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Adina Croitoru, Iulian Brezean, Mihaela Vilcu, Simona Dima, Irina Balescu, Nicolae Bacalbasa, and Pharmacy, Bucharest, Romania
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medicine.medical_specialty ,duodenal resection ,Medicine (General) ,complications ,business.industry ,Gastroenterology ,survival ,R5-920 ,duodenal malignancies ,Internal medicine ,Materials Chemistry ,medicine ,Medicine ,business ,Therapeutic strategy - Abstract
Duodenal carcinoma remains a very rare pathology, the most efficient therapeutic strategy remaining intensively debatable. However, it seems that the most appropriate therapeutic approach for each case can be established depending on the dimensions and stage of the tumor and according to the tumoral localization. Although initially it has been proposed that in all cases in which resection is feasible a duodenopancreatectomy should be performed, nowadays the therapeutic strategy has been submitted to permanent changes, more conservative approaches such as endoscopic full thickness resection or pancreas preserving duodenal resection being proposed with encouraging results. This is a literature review of the largest studies which investigated the feasibility of duodenal resections for duodenal malignant tumors.
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- 2019
25. The role of sentinel lymph node detection in early gastric cancer – literature review
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Cristian Balalau, Iulian Brezean, Nicolae Bacalbasa, Pharmacy, Bucharest, Romania, Mihaela Vilcu, and Irina Balescu
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Oncology ,lcsh:R5-920 ,medicine.medical_specialty ,business.industry ,gastric cancer ,lcsh:R ,Sentinel lymph node ,lcsh:Medicine ,sentinel lymph node dissection ,General Medicine ,Early Gastric Cancer ,Internal medicine ,lymphadenectomy ,medicine ,lcsh:Medicine (General) ,business - Abstract
Gastric cancer has been for a long period of time one of the most aggressive malignancies due to the fact that it was usually diagnosed in advanced stages of the disease. However, in the last decades, introduction of upper digestive endoscopy on a wider scale led to a higher detection of this malignancy in earlier stages. Therefore, surgery with curative intent and, in consequence, better long-term outcomes, has been reported. In order to maximize the effect of surgery and to minimize the postoperative complication rates, in the Eastern studies the concept of sentinel lymph node biopsy has been implemented with satisfactory results. This is a literature review of the studies conducted so far on the theme of sentinel lymph node detection in gastric cancer patients.
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- 2019
26. Does sentinel node biopsy play a role in pancreatic adenocarcinoma?
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Nicolae Bacalbasa, Iulian Brezean, Mihaela Vilcu, Pharmacy, Bucharest, Romania, Irina Balescu, and Cristian Balalau
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lcsh:R5-920 ,Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,lcsh:R ,lcsh:Medicine ,General Medicine ,Sentinel node ,medicine.disease ,sentinel node biopsy ,Biopsy ,pancreatic adenocarcinoma ,Medicine ,Adenocarcinoma ,lcsh:Medicine (General) ,business ,lymph node metastases - Abstract
Pancreatic adenocarcinoma remains one of the most aggressive malignancies worldwide which is unfortunately associated with very poor long-term survival. However, it seems that the only option in order to improve the outcomes of these patients remains radical surgery consisting of in block resection of the tumor and the surrounding tissues. When it comes to the extent of the lymph node dissection, a permanent debate still exists between the eastern and the western countries; while the Western countries consider that an extended lymph node dissection increases the postoperative complication worthwhile, the Eastern countries consider that this should be the treatment of choice as long as these tumors usually disseminate on the lymphatic route. In order to establish what patients could benefit most from an extended lymph node dissection, certain authors proposed performing the sentinel lymph node biopsy technique. This is a literature review of the largest studies conducted on this theme.
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- 2019
27. Liver transplantation for unresectable hepatic metastases from colorectal cancer: literature review
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Irina Balescu, Nicolae Bacalbasa, Pharmacy, Bucharest, Romania, Mihaela Vilcu, and Iulian Brezean
- Subjects
medicine.medical_specialty ,lcsh:R5-920 ,Colorectal cancer ,business.industry ,medicine.medical_treatment ,lcsh:R ,lcsh:Medicine ,colorectal cancer ,General Medicine ,Liver transplantation ,medicine.disease ,Gastroenterology ,extrahepatic disease ,liver transplant ,Internal medicine ,medicine ,hepatic metastases ,business ,lcsh:Medicine (General) - Abstract
Colorectal cancer represents one of the most common malignancies reported worldwide, associated with an increased risk of hepatic metastases development. Historically, the development of liver metastases from colorectal cancer has been associated with extremely poor rates in terms of survival. Improvement of the surgical techniques, as well as of the perioperative outcomes, in association with the development of new chemotherapeutic agents lead to a better survival; however, in certain cases with unresectable liver metastases, association of chemotherapy and resection can be no longer feasible due to the extent of the disease. In such cases liver transplantation has been proposed with promising results. However, this therapeutic strategy is only indicated when the absence of extrahepatic disease is documented. This is a literature review of the largest studies which focused on the topic of liver transplantation for unresectable liver metastases from colorectal cancer.
- Published
- 2019
28. Does sentinel lymph node detection play a role in patients with vaginal cancer?
- Author
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Cristian Balalau, Pharmacy, Bucharest, Romania, Iulian Brezean, Mihai Dimitriu, Mihaela Vilcu, Nicolae Bacalbasa, and Irina Balescu
- Subjects
Oncology ,Vaginal cancer ,medicine.medical_specialty ,business.industry ,Sentinel lymph node ,lcsh:R ,lcsh:Medicine ,vaginal cancer ,medicine.disease ,Internal medicine ,lymphadenectomy ,medicine ,In patient ,business ,sentinel lymph node biopsy - Abstract
The role of sentinel lymph node detection was clearly demonstrated in patients diagnosed with gynecologic malignancies such as breast, endometrial, cervical or vulvar cancer. Therefore, the method provides an adequate staging of the disease with minimal postoperative complications when compared to classical extended lymphadenectomy. Recently, the method has been successfully reported in vaginal cancer patients. This is a literature review of the current papers published so far on the issue of sentinel lymph node detection in vaginal cancer patients. Although only few cases have been reported so far, it seems that sentinel lymph node biopsy in vaginal cancer patients represents a safe, effective and feasible method to diminish the rates of unnecessary extended lymph node dissection in vaginal cancer patients. However, due to the rarity of the disease in association with the low number of cases reported so far, the method is not part of the therapeutic standard protocol for this disease, larger studies still being needed.
- Published
- 2019
29. Gracilis myocutaneous flap for perineal defect reconstruction after left hemivulvectomy for locally invasive vulvar cancer – A case report and a literature review
- Author
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Adriana Ghelmene, Andreea Mereuta, Nicolae Bacalbasa, Iulian Brezean, Irina Balescu, Mihaela Vilcu, and Alina Tanase
- Subjects
perineal defect ,lcsh:R5-920 ,medicine.medical_specialty ,business.industry ,Defect reconstruction ,radical total vulvectomy ,Vulvar cancer ,medicine.disease ,Surgery ,Gracilis myocutaneous flap ,gracilis myocutaneous flap ,medicine ,Hemivulvectomy ,lcsh:Medicine (General) ,business - Abstract
Performing radical surgery for locally advanced vulvar cancer is usually associated with the occurrence of large perineal defects. In order to provide a better healing process of the perineal wound, different reconstructive techniques have been proposed. We present the case of a 63-year-old female patient diagnosed with locally advanced vulvar cancer for which a left hemivulvectomy with bilateral inguinal lymph node dissection was performed. After completion of the resection phase, the reconstruction with gracilis myocutaneous flap was performed. The patient developed a non-union of the flap. However, it slowly healed without any surgical re-intervention. Gracilis myocutaneous flap seems to be an effective and feasible method of perineal reconstruction after extended perineal resection for gynecological malignancies, including vulvar cancer. The method appears effective even in pre-irradiated patients with larger perineal wounds resulting after total pelvic exenteration for locally advanced gynecological malignancies.
- Published
- 2019
30. The influence of lymph node status on the overall survival in surgically treated hilar cholangiocarcinoma
- Author
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Mihaela Vilcu, Iulian Brezean, Nicolae Bacalbasa, Irina Balescu, and Pharmacy, Bucharest, Romania
- Subjects
Medicine (General) ,medicine.medical_specialty ,business.industry ,lymph node dissection ,R5-920 ,medicine.anatomical_structure ,Materials Chemistry ,Overall survival ,Medicine ,hilar cholangiocarcinoma ,resection ,Radiology ,business ,Lymph node - Abstract
Cholangiocarcinoma represents an extremely aggressive digestive malignancy associated with very poor survival rates in the absence of a treatment with curative intent. Moreover, an important per cent of patients are diagnosed in advanced stages of the disease, when resection with curative intent is no longer feasible. When it comes to cases which can be submitted to surgery, radical resection, including lymph node dissection, seems to be one of the most important therapeutic strategies in order to improve survival. This is a literature review of the most relevant studies which were focused on analyzing the impact of lymph node status on the overall survival of surgically treated hilar cholangiocarcinomas
- Published
- 2019
31. Merkel cell carcinoma – pro and cons aspects for sentinel lymph node biopsy
- Author
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Mihaela Vilcu, Irina Balescu, Iulian Brezean, Nicolae Bacalbasa, Mihai Dimitriu, and Pharmacy, Bucharest, Romania
- Subjects
Medicine (General) ,Pathology ,medicine.medical_specialty ,integumentary system ,medicine.diagnostic_test ,business.industry ,Merkel cell carcinoma ,Sentinel lymph node ,cons ,General Medicine ,medicine.disease ,sentinel node biopsy ,merkel cell carcinoma ,R5-920 ,Biopsy ,Medicine ,business ,prognostic - Abstract
Merkel cell carcinoma represents an aggressive histopathological subtype of skin cancer with a high propensity to spread via lymphatic route. Once the benefits of the sentinel lymph node detection have been proven in malignant melanoma, the effectiveness of the method was investigated further on in Merkel cell carcinoma, as long as the two tumoral subtypes seem to have a common embryological origin. Surprisingly, the results reported so far in Merkel cell carcinoma are rather confusing, the method not being so far associated as part of the standard therapeutic protocol. However, it seems that the method plays a certain role in identifying the high risk patients and further tailoring the therapeutic strategy. This is a literature review of the most eloquent studies conducted on this theme.
- Published
- 2019
32. Sentinel lymph node biopsy in thyroid cancer – literature review
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Pharmacy, Bucharest, Romania, Mihaela Vilcu, Nicolae Bacalbasa, Irina Balescu, and Iulian Brezean
- Subjects
Medicine (General) ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Sentinel lymph node ,medicine.disease ,sentinel node biopsy ,R5-920 ,cervical lymph node dissection ,Biopsy ,thyroid cancer ,Materials Chemistry ,medicine ,Medicine ,Radiology ,business ,Thyroid cancer - Abstract
Thyroid cancer has been usually treated by total or near total thyroidectomy in association with cervical lymph node dissection and followed by adjuvant oncological and endocrinological treatment. In order to maximize the effect of the surgical approach and to minimize the perioperative rates of complications, certain authors proposed the introduction of the sentinel node detection; however, the method has certain particularities due to the complex lymphatic anatomy of the cervical region. This is a literature review of the more significant studies conducted so far on this theme.
- Published
- 2019
33. SENTINEL LYMPH NODE IN COLORECTAL CANCER
- Author
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Nicolae Bacalbasa, Pharmacy, Bucharest, Romania, Iulian Brezean, Mihai Dimitriu, Irina Balescu, and Mihaela Vilcu
- Subjects
Oncology ,medicine.medical_specialty ,Medicine (General) ,Colorectal cancer ,business.industry ,Sentinel lymph node ,recurence ,colorectal cancer ,General Medicine ,medicine.disease ,sentinel node biopsy ,neoadjuvant radiotherapy ,R5-920 ,Internal medicine ,lymphadenectomy ,medicine ,Medicine ,business - Abstract
Colorectal cancer represents one of the most encountered malignancies worldwide, with a high capacity of lymphatic spread. Therefore, the lymph node status plays a crucial role in order to tailor the adjuvant treatment and to decrease the recurrence rates. In consequence, performing the sentinel lymph node detection in colorectal cancer patients should orientate the surgeon’s attention on the lymphatic basins of drainage and, furthermore to orientate the lymph node dissection. However, the method has certain particularities in colorectal patients depending on the location of tumor, on the size and on the type of associated neoadjuvant therapy. This is a literature review of the most relevant studies conducted on this theme.
- Published
- 2019
34. Anterior Pelvic Exenteration for Chemo-irradiated Non-diethylstilbestrol Exposed Clear Cell Vaginal Cancer
- Author
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Nicolae Bacalbasa, Iulian Brezean, Simona Dima, Mihaela Vilcu, and Irina Balescu
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Adult ,Cancer Research ,medicine.medical_specialty ,Vaginal Neoplasms ,medicine.medical_treatment ,Locally advanced ,Diethylstilbestrol ,General Biochemistry, Genetics and Molecular Biology ,Lesion ,medicine ,Humans ,Stage (cooking) ,Pharmacology ,Vaginal cancer ,Pelvic exenteration ,business.industry ,Chemoradiotherapy ,medicine.disease ,Pelvic Exenteration ,Surgery ,Anterior pelvic exenteration ,Treatment Outcome ,Carcinogens ,Female ,medicine.symptom ,business ,Clear cell ,Adenocarcinoma, Clear Cell ,Research Article ,medicine.drug - Abstract
Background/Aim: Clear cell vaginal adenocarcinomas are rare tumors occurring in women which are usually treated by chemo radiotherapy with good outcomes. However, in certain cases, this treatment is not associated with complete response and a further surgery is needed. Case Report: We present the case of a 38-year-old patient diagnosed with stage IVA clear cell vaginal cancer who had been previously submitted to radio chemotherapy and in whom the lesion persisted after the oncological treatment; therefore, the patient was proposed for surgery with curative intent. The tumor was resected by performing an anterior pelvic exenteration with good outcomes, the patient being discharged in the seventh postoperative day. At one-year follow-up the patient remains free of recurrent disease. Conclusion: Pelvic exenteration with curative intent might be the option of choice for persistent locally advanced clear cell vaginal cancer.
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- 2019
35. Pelvic Exenteration for Locally Advanced and Relapsed Pelvic Malignancies – An Analysis of 100 Cases
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Iulian Brezean, Simona Dima, Adrian Neacsu, Nicolae Bacalbasa, Irina Balescu, Adina Croitoru, and Mihaela Vilcu
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Aged ,Neoplasm Staging ,Pelvic Neoplasms ,Pharmacology ,Cervical cancer ,Pelvic exenteration ,business.industry ,Endometrial cancer ,Mortality rate ,Disease Management ,Cancer ,Middle Aged ,Prognosis ,medicine.disease ,Primary tumor ,Pelvic Exenteration ,Tumor Burden ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Neoplasm Grading ,Neoplasm Recurrence, Local ,Ovarian cancer ,business ,Research Article - Abstract
Background/aim Although pelvic exenteration is an aggressive surgical procedure, it remains almost the only curative solution for patients diagnosed with large pelvic malignancies. Patients and methods We present a series of 100 patients submitted to pelvic exenteration with curative intent. Results The origin of the primary tumor was most commonly represented by cervical cancer, followed by, endometrial cancer, rectal cancer, ovarian cancer and vulvo-vaginal cancer. An R0 resection was confirmed in 68 cases, while the remaining 32 cases presented lateral positive resection margins or perineal positive margins. The postoperative morbidity rate was 37% while the mortality rate was 3%. As for the-long term outcomes, the median overall survival time was 38.7 months, being most significantly influenced by the origin of the primary tumor. Conclusion Although pelvic exenteration is still associated with an increased morbidity, an important improvement in the long-term survival can be achieved, especially if radical resection is feasible.
- Published
- 2019
36. Pancreatoduodenectomy En Bloc With Vascular Resections in Borderline Resectable Pancreatic Cancer
- Author
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Irina Balescu, Mihaela Vilcu, Adina Croitoru, Iulian Brezean, Vladislav Brasoveanu, Nicolae Bacalbasa, and Simona Dima
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,Asymptomatic ,General Biochemistry, Genetics and Molecular Biology ,Pancreaticoduodenectomy ,Resection ,Postoperative Complications ,Borderline resectable ,Long period ,medicine.artery ,Pancreatic cancer ,medicine ,Humans ,Superior mesenteric artery ,Vascular resection ,Neoplasm Staging ,Pharmacology ,Chemotherapy ,Portal Vein ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Treatment Outcome ,Female ,Neoplasm Grading ,medicine.symptom ,business ,Vascular Surgical Procedures ,Research Article - Abstract
Background/aim Pancreatic cancer remains asymptomatic for a long period of time, being frequently diagnosed when vascular invasion is already present. Such cases are widely known as borderline lesions. The aim of this study was to identify the effectiveness of vascular resection in this subgroup of patients. Patients and methods Fifteen such cases were submitted to surgery with curative intent. Results Eight cases were diagnosed with borderline resectable lesions with portal vein invasion and were submitted to per primam resection and seven cases were initially diagnosed with arterial invasion and had been initially submitted to neoadjuvant chemotherapy followed by resection. In all cases portal vein resection was needed while in other four cases association of superior mesenteric artery resection was performed. Postoperatively, five patients developed complications requiring reoperation, three of whom died at the end of the first postoperative month. The histopathological studies confirmed the completeness of resection in all cases. Conclusion Vascular resections in pancreatic cancer resections remain demanding procedures, and are reserved for cases in which a radical resection is feasible.
- Published
- 2019
37. Management of cervical cancer during pregnancy– literature review
- Author
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Pharmacy, Bucharest, Romania, Alin Bodog, Iulian Brezean, Nicolae Bacalbasa, Mihaela Vilcu, Ioan Dumitru Suciu, and Irina Balescu
- Subjects
Cervical cancer ,Pregnancy ,medicine.medical_specialty ,business.industry ,Obstetrics ,medicine ,General Medicine ,medicine.disease ,business - Published
- 2018
38. Diagnostic and therapeutic strategies in peritoneal carcinomatosis from breast cancer – literature minireview
- Author
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Irina Balescu, Pharmacy, Bucharest, Romania, Ioan Dumitru Suciu, Mihaela Vilcu, Nicolae Bacalbasa, Iulian Brezean, and Alin Bodog
- Subjects
Oncology ,medicine.medical_specialty ,Breast cancer ,business.industry ,Internal medicine ,Medicine ,General Medicine ,business ,medicine.disease ,Peritoneal carcinomatosis - Published
- 2018
39. Sentinel lymph node biopsy in vulvar cancer – literature minireview
- Author
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Mihaela Vilcu, Nicolae Bacalbasa, Pharmacy, Bucharest, Romania, Ioan Dumitru Suciu, Iulian Brezean, Irina Balescu, and Alin Bodog
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Biopsy ,Sentinel lymph node ,medicine ,General Medicine ,Radiology ,Vulvar cancer ,medicine.disease ,business - Published
- 2018
40. Management of cervical cancer during pregnancy– literature review
- Author
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Alin BODOG, Nicolae BACALBASA, Irina BALESCU, Mihaela VILCU, Iulian BREZEAN, and Nicolae SUCIU
- Subjects
lcsh:R5-920 ,cervical cancer ,lcsh:R ,lcsh:Medicine ,pregnancy ,management ,lcsh:Medicine (General) - Abstract
Although the exact incidence of cervical cancer cases in pregnant women is not known, undoubtedly is the most common gynecological malignancy diagnosed during pregnancy. Association between the two entities does not seem to influence the oncological outcomes. However, the management of these cases remains a real challenge for the obstetrician and for the onco-gynecologist, fighting for two lives being necessary. Moreover, due to the rarity of cases, there are no standard guidelines, the therapeutic strategy being influenced only by small case series and observational studies. This is a literature review of the current therapeutic options available for the management of such cases.
- Published
- 2018
41. Diagnostic and therapeutic strategies in peritoneal carcinomatosis from breast cancer – literature minireview
- Author
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Nicolae BACALBASA, Irina BALESCU, Ioan SUCIU, Mihaela VILCU, Iulian BREZEAN, and Alin BODOG
- Subjects
lcsh:R5-920 ,breast cancer ,lcsh:R ,peritoneal carcinomatosis ,lcsh:Medicine ,lcsh:Medicine (General) ,hyperthermic intraperitoneal chemotherapy - Abstract
Peritoneal carcinomatosis with breast cancer origin is an uncommon situation, which usually develops late during the evolution of the disease. The development of such lesions is commonly associated with an aggressive histology (such as lobular carcinoma) and advanced stage at diagnostic and is usually associated with a poor outcome. The positive diagnostic of peritoneal carcinomatosis with breast cancer origin can be sustained only if a biopsy from the tumoral nodules demonstrates the mammary origin of the lesions. In order to improve the outcome of these patients cytoreductive surgery alone or in association with hyperthermic intraperitoneal chemotherapy has been proposed. However, more studies are still needed in order to include the method as part of the therapeutic strategy of these patients.
- Published
- 2018
42. Is there a place for liver transplantation in cases with unresectable central cholangiocarcinoma?
- Author
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Irina Balescu, Iulian Brezean, Alin Bodog, Nicolae Bacalbașa, and Mihaela Vilcu
- Subjects
medicine.medical_specialty ,liver transplantation ,business.industry , unresectable ,medicine.medical_treatment ,lcsh:R ,central cholangiocarcinoma ,medicine ,lcsh:Medicine ,Liver transplantation ,business ,Surgery - Abstract
Central cholangiocarcinoma represents a very aggressive malignancy associated with poor survival rats especially due to the fact that most patients are diagnosed in advanced stages of the disease when curative resection is no longer feasible. In order to try improving the long-term outcomes of these patients, especially in unresectable cases liver transplantation has been proposed with promising results. This is a literature review of the largest studies focused on this subject. Cholangiocarcinomas remain aggressive tumors with poor outcomes whenever surgery with curative intent is not feasible. Currently, the largest experience accumulated consists of neoadjuvant external beam radiotherapy in association with beam radiation, 5 fluorouracil and capecitabine followed by orthotopic liver transplantation. Following this therapeutic protocol excellent long-term outcomes have been reported even if vascular involvement is present.
- Published
- 2018
43. A SPECIFIC CASE OF APPENDICITIS IN THE ELDERLY – AN EXPERIENCE FOR THE YOUNG CLINICIAN
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Iulian Brezean, Mihaela Vâlcu, I. R. Toader, C. A. Vișan, and S.A. A. Shadaloey
- Subjects
03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,General surgery ,Medicine ,030208 emergency & critical care medicine ,030211 gastroenterology & hepatology ,business ,medicine.disease ,Appendicitis - Abstract
Appendicitis is an inflammatory disease caused by obstruction of the appendiceal lumen. It represents one of the most common abdominal pathologies in clinical practice. Appendicitis has a well-defined range of signs and symptoms but is harder to diagnose in elderly patients because of less specific symptomatology, a wide differential diagnosis, and communication problems. The perforation rate in the elderly is 50–70%, rising with age (particularly above age 80), compared with a perforation rate of 20–30% in the general population, suggesting that symptoms may appear mild while the case may actually be severe. With rising life expectancy and thus an increase in elderly patients presenting with appendicitis symptoms, and to further the experience of the young clinician, we report the case of an 88-year old woman who was admitted to the hospital’s emergency ward, with acute hypogastric pain that radiated to the back and to the entire abdomen. Appendicitis was diagnosed, followed by surgical procedure and the patient recovered well.
- Published
- 2018
44. Hepatic artery reconstruction after extended resection for borderline resectable pancreatic head cancer: A case report
- Author
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Emil Belu, Cornel Savu, Carmen Savu, Vladislav Brasoveanu, Nicolae Bacalbasa, Lucian Pop, Gabriel Gorecki, Ovidiu Stiru, Laura Iliescu, Ovidiu Gabriel Bratu, Camelia Cristina Diaconu, Iulian Brezean, Irina Balescu, and Dragos Romanescu
- Subjects
0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Left gastric artery ,business.industry ,Cancer ,General Medicine ,Articles ,Splenic artery ,Vascular surgery ,medicine.disease ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,medicine.anatomical_structure ,Immunology and Microbiology (miscellaneous) ,030220 oncology & carcinogenesis ,Pancreatic cancer ,medicine.artery ,medicine ,Medical history ,Radiology ,Radical surgery ,business ,Artery - Abstract
Pancreatic head cancer is frequently associated with invasion of the surrounding vascular structures, such cases being considered for a long period of time as unresectable. Improvement of the vascular surgery techniques allowed association of extended vascular resections and reconstructions, increasing in this way the percentage of patients benefiting from radical surgery. We present the case of a 47-year-old male patient with no significant medical history diagnosed with a large pancreatic head tumor invading the common and proper hepatic artery as well as the portal vein. The venous reconstruction was performed using a synthetic prosthesis while the left hepatic artery was sutured to the left gastric artery; meanwhile the right hepatic artery was reconstructed using the splenic artery. In conclusion, extended hepatic artery resection followed by arterial reconstruction in association with portal vein resection and prosthetic replacement might be needed in cases presenting large pancreatic head tumors with vascular invasion.
- Published
- 2020
45. Utility of indocyanine green injection in patients with cervical cancer besides the identification of sentinel lymph node (Review)
- Author
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Emil Belu, Dragos Cretoiu, Irina Balescu, Camelia Cristina Diaconu, Mihaela Vilcu, Cristian Balalau, Adrian Neacsu, Iulian Brezean, Carmen Savu, Ovidiu Gabriel Bratu, Alexandru Filipescu, Nicolae Bacalbasa, Laura Iliescu, Cornel Savu, and Ioana Halmaciu
- Subjects
0301 basic medicine ,Cervical cancer ,Cancer Research ,medicine.medical_specialty ,business.industry ,Sentinel lymph node ,Cancer ,Trachelectomy ,Review ,General Medicine ,Disease ,medicine.disease ,03 medical and health sciences ,Dissection ,chemistry.chemical_compound ,030104 developmental biology ,0302 clinical medicine ,Lower limb lymphedema ,Immunology and Microbiology (miscellaneous) ,chemistry ,030220 oncology & carcinogenesis ,Medicine ,Radiology ,business ,Indocyanine green - Abstract
Due to the wide introduction of screening tests, patients with neoplastic diseases of the uterine cervix trend to be diagnosed in early stages of the disease, and less invasive surgical procedures are needed in certain cases. In this respect, the technique of sentinel lymph node dissection has been widely implemented as part of the therapeutic strategy, indocyanine green (ICG) being one of the most reliable markers for sentinel lymph node detection. However, it seems that this agent is extremely useful in order to achieve better short-term and long-term results after cervical cancer surgery, due to its capacity to determine the uterine vascular perfusion in cases in which conservative treatment, such as trachelectomy, is performed, as well as to prevent and treat lower limb lymphedema. A literature review was conducted of the studies which focused on the role of ICG utility in cervical cancer patients besides sentinel lymph node detection, special focus was given to vascularization preservation and lower limb lymphedema prevention and treatment.
- Published
- 2020
46. Cytoreductive surgery for advanced stage ovarian cancer in the second trimester of pregnancy-a case report and literature review
- Author
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Iulian Brezean, Irina Balescu, Nicolae Bacalbasa, Laura Iliescu, Simona Dima, and Mihaela Vilcu
- Subjects
Adult ,medicine.medical_specialty ,endocrine system diseases ,medicine.medical_treatment ,Ovariectomy ,Hysterectomy ,advanced stage ovarian cancer ,cytoreduction ,03 medical and health sciences ,0302 clinical medicine ,Peritonectomy ,Pregnancy ,medicine ,Humans ,030212 general & internal medicine ,Clinical Case Report ,Lymph node ,Ovarian Neoplasms ,Chemotherapy ,business.industry ,Romania ,General surgery ,Ovary ,General Medicine ,Cytoreduction Surgical Procedures ,medicine.disease ,Dissection ,Omentectomy ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Pregnancy Trimester, Second ,Female ,Lymph Nodes ,Ovarian cancer ,business ,Research Article - Abstract
Rationale: Advanced stage ovarian cancer is rarely encountered in pregnant women, due to the high number of ultrasound imagistic studies performed during this period. The clinical course of patients diagnosed with advanced stage ovarian cancer is similar in pregnant and nonpregnant women. Patient concerns: We present the case of a 27-year-old woman initially submitted to emergency surgery for ovarian cyst torsion in the ninth week of gestation, at that moment ovarian cystectomy being performed. Diagnoses: The histopathological studies demonstrated the presence of a moderately differentiated epithelial ovarian cancer. Interventions: Although the interdisciplinary team decided for staging surgery followed by platinum-based chemotherapy beginning from the second trimester of pregnancy, both the patient and her family refused this strategy and opined for total hysterectomy en bloc with bilateral adnexectomy. Surprisingly, intraoperatively both ovaries had a tumoral aspect, whereas peritoneal carcinomatosis nodules were found in the Douglas pouch. Therefore, the neoplastic process was staged as a IIIC epithelial ovarian cancer, a total hysterectomy with bilateral adnexectomy, Douglas pouch peritonectomy, omentectomy, pelvic and para-aortic lymph node dissection being performed. Outcomes: The patient was discharged in the sixth postoperative day and was confined to the oncology service in order to be submitted to the standard taxanes and platinum based chemotherapy. Lessons: Although ovarian cancer has been rarely reported during pregnancy, this diagnostic should be taken in consideration whenever persistent adnexal masses are encountered.
- Published
- 2020
47. The Risk of Para-Aortic Lymph Node Metastases in Apparent Early Stage Ovarian Cancer
- Author
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Irina Balescu, Alexandru Filipescu, Mihai Dimitriu, Nicolae Bacalbasa, Mihaela Vilcu, Laura Iliescu, Iulian Brezean, Camelia Cristina Diaconu, and Simona Dima
- Subjects
Adult ,medicine.medical_specialty ,Medicine (General) ,para-aortic lymph node metastases ,Disease ,early stage ,ovarian cancer ,Article ,03 medical and health sciences ,0302 clinical medicine ,R5-920 ,Risk Factors ,Medicine ,Humans ,030212 general & internal medicine ,Stage (cooking) ,Lymph node ,Aorta ,Neoplasm Staging ,Retrospective Studies ,Ovarian Neoplasms ,business.industry ,Histology ,General Medicine ,Middle Aged ,medicine.disease ,Cystadenocarcinoma, Serous ,Dissection ,Serous fluid ,medicine.anatomical_structure ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Lymph Node Excision ,Female ,Lymph ,Radiology ,Lymph Nodes ,Menopause ,business ,Ovarian cancer - Abstract
Background and objectives: To identify the risk factors for para-aortic lymph node metastases in cases with presumed early stage ovarian cancer. Materials and methods: Between 2014 and 2019, 48 patients with apparent early stage ovarian cancer were submitted to surgery. In all cases, pelvic and para-aortic lymph node dissection was performed for staging purposes. Results: Among the 48 cases we identified nine cases with positive pelvic lymph nodes and 11 cases with positive para-aortic lymph nodes. The positivity of the retrieved lymph nodes was significantly correlated with the histopathological subtype represented by serous histology (p = 0.02), as well as with the degree of differentiation (p = 0.004). Conclusion: Patients with serous ovarian carcinomas in association with a poorer degree of differentiation are at risk of associated lymph node metastases even in presumed early stages of the disease. Therefore, lymph node dissection should be performed in such cases in order to provide adequate staging and tailoring of further treatment.
- Published
- 2020
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48. Upper Abdominal Resections as Part of Tertiary Cytoreduction for Relapsed Ovarian Cancer
- Author
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Mihaela Vilcu, Simona Dima, Irina Balescu, Nicolae Bacalbasa, and Iulian Brezean
- Subjects
Cancer Research ,medicine.medical_specialty ,Optimal Debulking ,medicine.medical_treatment ,Splenectomy ,Diaphragmatic breathing ,General Biochemistry, Genetics and Molecular Biology ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Aged ,Retrospective Studies ,Pharmacology ,Ovarian Neoplasms ,business.industry ,Pancreatic tail ,Cytoreduction Surgical Procedures ,Middle Aged ,medicine.disease ,Debulking ,Prognosis ,Adenocarcinoma, Mucinous ,Surgery ,Cystadenocarcinoma, Serous ,Endometrial Neoplasms ,030220 oncology & carcinogenesis ,Gastrectomy ,Female ,Neoplasm Recurrence, Local ,business ,Ovarian cancer ,Research Article ,Adenocarcinoma, Clear Cell ,Follow-Up Studies - Abstract
Background/aim The role of upper abdominal resection as part of debulking surgery for advanced-stage or relapsed ovarian cancer has been widely debated. The aim of this study was to investigate the safety and efficacy of upper abdominal resection as part of tertiary cytoreduction. Patients and methods Between 2005 and 2019, 11 cases presenting upper abdominal recurrences after surgically treated ovarian cancer were submitted to surgery with radical intent. Results Complete debulking surgery was feasible in eight cases, optimal debulking was performed in two cases, while in one case a suboptimal resection was performed. The most commonly performed upper abdominal resections consisted of liver resection in seven cases, splenectomy in four cases, diaphragmatic resection in three cases, pancreatic tail resection in two cases and partial gastrectomy in another two cases. Postoperative complications were encountered in two cases, while postoperative mortality was null. Conclusion Extended upper abdominal resection can be safely performed in order to increase the chances of optimal debulking surgery at the time of tertiary cytoreduction.
- Published
- 2020
49. Total Exenteration En Bloc with a Nephrectomy for Locally Advanced Cervical Cancer Invading a Pelvic Kidney—A Case Report and Literature Review
- Author
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Nicolae Bacalbasa, Alexandru Filipescu, Iulian Brezean, Laura Iliescu, Irina Balescu, Mihaela Vilcu, Camelia Cristina Diaconu, and Simona Dima
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Medicine (General) ,medicine.medical_treatment ,Rectum ,Uterine Cervical Neoplasms ,Case Report ,030230 surgery ,Choristoma ,Kidney ,Pelvis ,03 medical and health sciences ,0302 clinical medicine ,R5-920 ,ectopic kidney ,medicine ,nephrectomy ,Humans ,locally advanced cervical cancer ,Neoplasm Invasiveness ,Cervical cancer ,Pelvic kidney ,Urinary bladder ,Pelvic exenteration ,business.industry ,General Medicine ,Middle Aged ,Ectopic kidney ,medicine.disease ,Nephrectomy ,Female Urogenital Diseases ,Surgery ,Pelvic Exenteration ,body regions ,medicine.anatomical_structure ,Female ,030101 anatomy & morphology ,business - Abstract
Introduction: Extended pelvic resection might be the option of choice in patients presenting locally advanced cervical cancer. However, the possibility of a co-existence of an ectopic, pelvic kidney that is invaded by such a tumor is extremely rare. Case Presentation: A 54-year-old female patient, diagnosed with locally advanced cervical cancer in the presence of a pelvic kidney, was submitted to surgery with curative intent. A large, abscessed cervical tumor invading the urinary bladder and the rectum was found, so a total exenteration was planned. Intraoperatively, tumor invasion of the left kidney, which was found in an ectopic, pelvic position was also encountered; therefore, total pelvic exenteration in association with a left nephrectomy was successfully performed. Conclusions: The presence of an ectopic, pelvic disposition of the kidney makes it susceptible to be invaded by locally advanced pelvic tumors; in such cases, a nephrectomy might also be needed.
- Published
- 2020
50. Sentinel lymph node in early stage ovarian cancer; a literature review
- Author
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Vladislav Brasoveanu, Irina Balescu, Iulian Brezean, Nicolae Bacalbasa, and Mihaela Vilcu
- Subjects
Oncology ,medicine.medical_specialty ,lcsh:R5-920 ,business.industry ,Sentinel lymph node ,medicine.disease ,early stage ovarian cancer ,sentinel lymph node ,standard therapeutic protocol ,Internal medicine ,medicine ,Stage (cooking) ,mapping ,Ovarian cancer ,business ,lcsh:Medicine (General) - Abstract
Although sentinel lymph node mapping has been widely implemented in gynecological malignancies in order to minimize the number of unnecessary lymph node dissections and to diminish postoperative morbidity rate, little is known about ovarian cancer sentinel lymph node mapping. This article presents a literature review regarding the effectiveness, safety and benefits of this method. Sentinel lymph node detection in early stage ovarian cancer seems to be a safe and effective method, able to minimize the rate of patients submitted to unnecessary lymph node dissection. The second goal of the procedure, to minimize the risk of missing involved lymph nodes, seems also to have been achieved, most studies reporting a very small number of cases diagnosed with positive non-sentinel lymph nodes. Considering all these data we can note that this procedure is not yet included as part of the standard therapeutic protocol, so that further studies would be necessary to include it as a common therapeutic approach in the case of patients with early stage ovarian cancer.
- Published
- 2018
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