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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.

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.

Diabetes mellitus (DM) and heart failure (HF) are often associated and each disease independently increases the risk for the other. It is well recognized that diabetes is a risk factor for mortality among individuals with heart failure. The risk of incident HF among patients with DM increases with older age, obesity, retinopathy, hypertension, coronary artery disease, peripheral arterial disease, nephropathy, longer duration of DM and higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) value. The treatment of each pathology in the presence of the other raise difficulties in the clinical practice. First-line treatment of DM in patients with HF should include metformin and SGLT2 inhibitors; conversely, saxagliptin, pioglitazone and rosiglitazone are not recommended in patients with DM and HF.

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.

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.

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.

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.

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.

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.

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.

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.

Nowadays, the surgical success rate for stress urinary incontinence (SUI) is approximately 90 % the mid-urethral synthetic slings being currently the most effective surgical options in women with SUI. The initial treatment should consist of conservatory measures such as pelvic floor exercises, hormonal medication or vaginal pessary, the failure or refusal of these methods will then guide the surgeon towards a surgical decision with the use of a mid-urethral sling either of retropubic or transobturator type. The choice between the two slings should be done after a complete evaluation of the urinary function taking into consideration the coexistence of a mixed incontinence, a dysfunction of the intrinsic sphincter, a rigid urethra but also the age and the weight of the patient as well as the possible previous surgical interventions for SUI. The advantages of each type of mid urethral sling and their associated complications should be preoperatively explained to the patient, the decision to opt for one or another sling depending also on the professional experience of the surgeon. The aim of this review is to present the advantages and the disadvantages of two types of mid-urethral slings – the retropubic and the transobturator sling- as well as the possible intra-and postoperative complications and their management