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img src="/images/viorel_scripcariu.jpg" alt="Viorel Scripcariu" style="float: right;max-width: 30%;"/ Assuming the leadership of the Romanian Society of Surgery for the next four years is for me a moment of deep significance and responsibility. With a tradition of almost 130 years, this organization is at the foundation of the Romanian surgeon community, and my role is to continue this legacy and open new paths for the future of Romanian surgery. I would like to share the priorities I have set for this mandate, given our shared commitment to promote excellence in surgical practice and to respond to contemporary challenges. An essential aspect of my mandate is to respect the rich tradition and history of Romanian surgery. The Romanian Society of Surgery was founded at the end of the 19th century in Bucharest, with the surgeon Constantin Severeanu at its head. At the meeting on January 27, 1899, the society constituted its first board, with Thoma Ionescu as president, together with other founding members such as Dr. Leonte, Dr. Racoviceanu-Pitesti, Dr. Duma and Dr. Staicovici. Over the years, numerous meetings were organized at the Institute of Topographic Anatomy in Bucharest, where clinical cases, new surgical methods and lectures by medical personalities from abroad were presented. Over the years, the society has continued to promote international collaboration, organizing congresses and inviting renowned surgeons from abroad to lecture and perform innovative surgery in Romania. This rich history and respect for traditional values are fundamental to preserving and enhancing the standards of excellence we have inherited. We will continue our efforts to honor our mentors and their achievements, ensuring that their legacy will continue to inspire and guide new generations of Romanian surgeons. [ a href="https://revistachirurgia.ro/pdfs/2024-4-357.pdf" read more /a ]., (Celsius.)

Introduction: This article reports the authors' experience with their first 50 consecutive robotic pelvic procedures, aiming to determine the feasibility and safety of adopting robotic pelvic surgery. Robotic surgery offers several benefits for minimally invasive surgery, but its applicability is hindered by cost and limited regional experience. This study aimed to evaluate the feasibility and safety of robotic pelvic surgery. Material and Methods: This is a retrospective review of our initial experience with robotic surgery for colorectal, prostate, and gynaecologic neoplasia, between June and December 2022. The surgical outcomes were evaluated in terms of perioperative data, such as operative time, estimated blood loss, and length of hospital stay. Intraoperative complications were recorded, and postoperative complications were evaluated at 30 days and 60 days after surgery. The feasibility of the roboticassisted surgery was assessed by measuring the conversion rate to laparotomy. The safety of the surgery was evaluated by recording the incidence of intraoperative and postoperative complications. Results: Fifty robotic surgeries were performed over 6 months, including 21 interventions for digestive neoplasia, 14 gynaecologic cases, and 15 prostatic cancers. Operative time ranged from 90 to 420 minutes, with two minor complications and two grade II Clavien-Dindo complications. One patient required prolonged hospitalization and an end-colostomy, deriving from an anastomotic leakage requiring reintervention. No thirty-day mortality or readmissions were reported. Conclusion: The study found that robotic-assisted pelvic surgery is safe and has a low rate of transfer to open surgery, making it a suitable addition to conventional laparoscopy., (Celsius.)

Background: Pancreatic cancer represents one of the most frequent cancers with an increased incidence. Most cases on initial diagnosis are considered to be locally advanced and surgery remains the most important therapeutic option. The aim of this study was to evaluate postoperative morbidity that can impair the association of adjuvant therapy. Methods: We performed a retrospective study on a prospective database that includes all the patients diagnosed with pancreatic cancer in which surgery was performed between 2012 and 2021. We divided the patients in advanced tumours and localized tumours and we compared the outcomes after surgery. Results: On 58 patients with pancreatic tumours surgery was performed: 28(48.3%) pancreaticoduodenectomies and 30 (51.7%) distal pancreatectomies. Localized tumours (T1 and T2) were encountered in 32 patients (55.2%) and more advanced tumours (T3 and T4) were present in 26 cases (44.8%). Although there was no significant difference either for major complications, we observed a tendency for patients with advanced tumours to develop a major complication (15.6% vs 34.6%, p=0.09). The occurrence of major complication, such as pancreatic fistula and postoperative hemorrhage, there was no significant difference (6.25% vs 7.69% and 6.25% vs. 23.1%). On multivariate analysis of preoperative factors associated with the occurrence of a severe complication only the CA19-9 levels were associated with an increased risk (odds ratio 0.666, 95% CI 0.5-1.01; p= 0.04) Conclusions: This study showed no significant differences in terms of postoperative complications between the two subgroups. CA 19-9 is an accurate biomarker for the prediction of postoperative complications., (Celsius.)

Introduction: There is an immune response after major surgery and inflammatory complications following complex surgery have a direct impact on morbidity and mortality. Currently, we do not have clinical tools to predict in which subset of patients a major complication will occur. The aim of this study was to evaluate the immediate dynamics of C-reactive protein (CRP), presepsin and procalcitonin in patients in which esophagectomy was performed either through video assisted thoracic surgery (VATS) or open approach. Methods: We conducted a prospective study on 27 patients with a mean age of 61.48 +-6.80 years, 13 patients with VATS and 14 with open approach, most of the patients were on stage III esophageal cancer (81%) and in all cases neoadjuvant treatment was performed. Results: There were increased levels of CRP, presepsin and procalcitonin after both arms of the study with significantly higher values for the open approach and with the same dynamic curves. In 3 cases there were extremely elevated levels of procalcitonin in the absence of a septic complication, in all cases a major complication occurred. Conclusion: Video assisted thoracoscopic esophageal mobilization induces a less immune response, even with the association of laparotomy. An elevated postoperative procalcitonin level can be an early indicator of a major postoperative complication., (Celsius.)

As the COVID-19 pandemic extends, its negative consequences on the effectiveness of therapeutic programs - previously assumed by the medical community and imperatively suspended for a difficult-to-predict period of time - are becoming increasingly worrying. In this context, as the evidence-based recommendations are not possible, most of the national and international scientific societies tried to develop balanced recommendations (1-4). The Romanian Society of Coloproctology (SRCP) and the Romanian Association for Endoscopic Surgery (ARCE) have created a working group that, taking into account recent publications, the statements of international academic societies, the national legislative context and the unique experience of countries severely affected by this pandemic (China, Italy, Spain, USA, etc.) proposes for Romania, the following recommendations for medical practice in colorectal surgery during the COVID-19 pandemic. These recommendations are subjected to continuous review, depending on the global and national situation of the pandemic, the particular needs of each hospital, the recommendations of the competent authorities and the evolution of the literature that publishes the conclusions of ongoing clinical trials., (Celsius.)

Introduction: Neuroendocrine tumors of the gastro-entero-pancreatic system have a variety of components, clinical manifestations and prognostic indices according to their anatomical site. Therefore, their diagnostic and management strategies differ a great deal. Prognosis concerning NETs can be poor due to the degree of differentiation, early metastasizing and the high degree of invasiveness. Material and Methods: For the present study, the patient files were evaluated and the parameters of interest were followed. Results: Over the course of 6 years there were 37 patients diagnosed with and treated for NETs, regardless of primary tumor site. There were 9 patients with NETs of the primite mid- and hindgut thusly: 5 cases with colorectal NETs and 4 cases of small bowel NETs. 6 patients benefited from radical surgical treatment, 2 cases with palliative procedures and only one patient with tumor biopsy. The tumors were evaluated according to the 2010 WHO classification based on the number of mitoses and the Ki67 proliferation index. Adjuvant treatment was adapted according to staging and histopathological parameters. Conclusions: Despite recent progress in managing NETs, there are still many controversial aspects regarding the management of these cases, mainly about timing the right sequence of therapy., (Celsius.)

In the fine balance between tumor invasion and our defensive systems, the role played by the adaptive immune response at the tumor site is critical. Beyond the fact that all the immune components of the innate and adaptive response can be observed to varying degrees in the tumor microenvironment, it appears that a high density of T cytotoxic and memory lymphocytes, in a context of Th1 immune orientation in the tumor and its invasion front, provides a prognostic marker of paramount importance for colorectal cancer and more generally all solid tumors. The understanding of the role of immunity in cancer, tailored during one century of intensive research, has led to a complete paradigm shift.based on a sharp dissection In order to show the major impact of this conceptual revolution, we herein retrace through the example of colorectal cancer, how an effective immune test, namely the "Immunoscore", has been developed. We also provide up to date data demonstrating the capacity of the Immunoscore to prognosticate with a better accuracy than the TME classification clinical outcomes and to guide therapeutic strategies., (Celsius.)

Introduction: In this study, we aim to identify the impact of neoadjuvant radiation treatment upon the number of harvested and positive lymph nodes in the surgical specimen; in addition, we tried to identify the impact of chemotherapy in association with radiotherapy on said structures. Patients and methods: In the study we included patients treated for rectal cancer within a single oncologic surgical Unit serving the north-eastern part of Romania, over a period of 5 and a half years, between May 2013 and April 2018. Firstly, we compared pathologic lymph node status to pretherapeutic staging. Secondly, we compared lymph node values in relation to the treatment scheme. Results: There was a total of 498 patients treated radically through open surgery for low and mid rectal cancer. We saw a decrease in N staging in 218 cases, 65 remaining stationary and 10 increasing their lymph node staging on the surgical specimen. We identified significant differences between the total number of lymph nodes (17.4 vs 24.2, p 0.001), the number of positive lymph nodes (1.4 vs 3.4, p 0.001) and the ratio between positive and total lymph nodes (0.08 vs 0.14, p 0.001) in patients with and without neoadjuvant treatment respectively. However, there was no statistical difference between patients with and without chemotherapy associated to radiotherapy in the neoadjuvant treatment plan (p=0.539, p=0.58, p=0.575). Conclusion: This study shows there are significant variations according to the application of neoadjuvant treatment, between the numbers of positive and total lymph nodes, as well as the positive/total lymph node ratio., (Celsius.)

It is important for surgeons to keep up with improvements both in and outside their field. As medicine evolves, new techniques appear, and oncology is one of the main beneficiaries. "Liquid biopsy" is one of the most recent domains of interest in oncology, as it may provide important details regarding the characteristics of the main tumor and its metastases. Malignant cells are in a continuous dynamic, which makes the initial diagnostic biopsy and the pathological specimen evaluation insufficient in the late evolution of the disease, when relapse or metastases may appear. The fact that the healthcare provider is able to find out additional information about the tumor at a given time, by evaluating a blood sample to obtain a "liquid biopsy" is of utmost importance and gives multiple potentially usable data. There are three means of obtaining biological material that may be used as "liquid biopsy": evaluation of circulating tumor cells, circulating tumor DNA and exosomes. The most intensely studied entity is that of circulating tumor cells, with different applications, amongst which the most important, at present time, is the prognostic value that has important demonstrated implications, not only in breast and prostate cancer, but also in colorectal cancer. Although surgery will, most certainly, not be replaced by other treatments when aiming for a curative approach to rectal cancer, it is important for the surgeon to know information about complementary fields, one of which is comprised by "liquid biopsy"., (Celsius.)

Background: Both anemia and blood transfusion are now considered independent risk factors for poor outcome in colorectal cancer patients. Severe anemia can increase tumor aggressiveness and blood transfusion may induce immunosuppression and promote cancer recurrence. Specific Patient Blood Management (PBM) strategies for oncological surgical patients are insufficiently defined and recommended. Primary objectives: Evaluation of the perioperative anemia prevalence and transfusion rate in colorectal cancer patients. Secondary objectives: Sub-group analysis of anemic versus non-anemic patients and colon versus rectal cancer patients. Methods: We retrospectively reviewed records from all consecutive surgical oncological patients admitted between January and June 2017. We selected major lower abdominal surgical patients and then colorectal surgical patients. We evaluated the perioperative hemoglobin values dynamics (preoperative=Hb1, postoperative= Hb2, at discharge= Hb3), anemia prevalence and severity and transfusion rate. Statistical analysis used Student t test, Wilcoxon signed-rank and Chi-square tests from SPSS 17. Results: Of the 1284 patients screened, 546 patients were submitted to major lower abdominal surgery and 260 patients to colorectal cancer surgery. The mean age was 65.6 +- 11.1 years, 57.7% males. The perioperative dynamics of hemoglobin was Hb1/Hb2/Hb3 =12/10.6/10.4 g/dL. Anemia prevalence was 52.3/82.3/82.6% preoperatively/postoperatively/at hospital discharge. Global transfusion rate was 23.8%, with pre/intra/postoperative distribution of 2.3/11.9/10.8%. Anemic patients were older (p=0.005), with a higher transfusion rate (p 0.001) and a longer hospital LOS (p=0.04). Colon cancer patients had lower Hb values (p=0.001) and higher prevalence of preoperative anemia (p=0.001) comparing with rectal cancer patients. Conclusions: The analysis of this cohort of colorectal cancer patients identified an increased prevalence of anemia in all perioperative phases. There is an urgent need of PBM program implementation in this selected group of surgical patients., (Celsius.)

According to evidence accumulated in the last years, many cancer centers recommend a treatment plan based solely on chemo-radiotherapy and exclude surgery from the treatment options in locally advanced cervical cancer (LACC). In Romania, surgery was at the forefront of therapeutic options. Nevertheless, current data shows that in fact, a large number of patients are still referred to surgery in various stages of diagnosis and treatment. It was noted that recommendations may differ, in spite of the wide dissemination of the literature data.Works published so far, discussing the role of surgery in LACC treatment shows a lack of consensus. A group of experts in oncology (SURCECAN research group - Surgery of Cervical Cancer) met for a session of the Romanian Surgical Society (Bucharest) on April 18, 2018. They found that LACC therapeutic strategy in Romania may differ somewhat from the European recommendations.On top of that, late enrolement to RT and low acces to specialized centers are the problem. Performing surgery not only allows the evaluation of the pathological response to chemo-radiotherapy, but also achieves a better local control. In conclusion, there is still a place for surgery within locally advanced cervical cancer treatment options. More trials need to be carried out in order to confirm the findings and establish high levels of confidence for each piece of information provided., (Celsius.)

Background: Gastrointestinal stromal tumors are some of the most common mesenchymal tumors of the gut. The aim of this study is to asses the clinical manifestation and treatment of gastric GISTs. Methodology: We performed a retrospective 5-year multicenter study conducted on a prospective collected database, which includes all the patients diagnosed with GIST in which surgery was performed. We selected all the pateients with gastric GISTs and we analyzed the clinical manifestation, treatment and prognostic factors. Results: There were 42 patients with GISTs of which the gastric GISTs were encountered in 23 cases (54.76%). There were 7 laparoscopic resections and 16 open surgery resections. Pathological examination showed that many of the patients were in group 6a and 6b (30.43%). CD117 was positive in 91.3% of cases. Regarding postoperative morbidity, there were 4 cases of pulmonary complications, 3 cases of surgical site infection and one postoperative hemorrhage. Conclusions: In our experience surgery for gastric GIST must be performed by a highly trained team, the keyset for a improved survival is the multidisciplinary approach that includes an accurate diagnosis, prognostic risk stratification and accurate treatment., (Celsius.)

Background: Surgery remains one of the most important part of the multimodal treatment of patients diagnosed with gastric cancer. Due to the fact that the consequences in terms of postoperative morbidity can delay the onset of postoperative chemotherapy or even can make the patient unfitted for adjuvant treatment, a thorough clinical evaluation of patient prior to surgery is mandatory. Methods: We performed a retrospective study, which included all the patients diagnosed with gastric cancer in which radical surgery was performed during a 5-year period in a single center. All the patients, tumour and surgery characteristics were used for a risk analysis for the occurrence of overall, medical and surgical complications. Results: There were 189 patients in whom radical surgery was performed, 100 (52.9%) total gastrectomies and 89 (47.1%) subtotal gastrectomies, without difference in term of postoperative morbidity. There were 25 (13.2%) cases of duodenal stump fistula, 15 (15%) cases of esojejunal fistula. On multivariate analysis albumin levels (OR 1.9, p=0.035), hypertension (OR 4.22, p=0.0311) and splenectomy (OR 3.91, p=0.048) were independent factors for overall complications, albumin levels (OR 1.91, p=0.0405), hypertension (OR 3.54, p=0.0444), neoadjuvant treatment (OR 3.97, p=0.01657) and splenectomy (Or 1.66 p=0.05) for medical complications; age (OR 1.71,p=0.044), hypertension (OR 2.22, p=0.045) and albumin levels (OR 1.92, p=0.041) for surgical type complications. Conclusions: Postoperative morbidity after gastrectomy remains one of the most important factors that can impair the effectuation of a multimodal treatment protocol. Comorbidity factors, nutritional status and surgical technique are the key factors that can influence the amount and the consequence of a surgical complication., (Celsius.)

Background: Pylorus preserving (PP) pancreaticoduodenectomy (PD) has several advantages in terms of shorter operation time and improved nutritional status but with an increased risk for delayed gastric emptying. Methods: We performed a retrospective study on all patients in which PD was performed from May 2012 to May 2018. It was analyzed early postoperative outcomes and the incidence of delayed gastric emptying (DGE) syndrome for patients with pylorus PP PD technique and pancreaticogastrostomy (PG). Results: There were 47 PD, in which PP technique was performed in 42 cases. The tumour location was in the pancreatic head (n=21, 44.68%), periampullary (ampulla of Vater) (n=14,29.78%), distal bile duct (n=7,14.89%), duodenum (n=2, 4.25%) and advanced right colon cancer (n=3, 6.38%). There were 10 cases (21.2%) of grade III-V complications, grade A pancreatic fistula (PF)8 cases (17%), grade B in 3 cases (6.4%) and grade C in 1 case (2.12%). DGE was encountered in 17 cases (36.17%), grade A 2 cases (4.25%), grade B in 4 cases (8.5%) and grade C in 2 cases (4.25%). Biliary fistula occurred in 3 cases (6.4%) and in 4 cases relaparotomy was needed. Conclusions: The results of our study are concluding with the previous studies, the addition of PG to PP PD does not increase the risk of DGE., (Celsius.)

Certain combinations of the hematological components, specifically, neutrophils and lymphocytes, named neutrophil to lymphocyte ratio (NLR) or multiplication of neutrophil and monocyte (MNM) have been shown to have prognostic value in a variety of cancers., Material and Methods: Retrospective study which included 133 patients with uterine cervical cancer with or without neoadjuvant therapy based on prognostic factors and correlations between NLR and MNM values, markers that were analyzed as continuous variables. This study aimed to establish the critical value of hematological markers. Results: NLR is significantly lower for preoperative stages I and II (p = 0.0004). There is a significant association between NLR and lymph node metastasis (p = 0.016), parametrial invasion (p = 0.035), lymphovascular space invasion (p = 0.0151) and tumor size (p = 0.0017). Correlational analysis showed that there is a significant association between MNM and lymph node metastasis (p = 0.020), parametrial invasion (p = 0.00010), lymphovascular space invasion materially affecting the value MNM (p = 0.0018), tumor size more than 4 cm (p = 0.0314). NLR and MNM were significantly lower in patients with complete response to neoadjuvant treatment. Discussion: The results of this study outlines the importance of hematological panel and parameters that can be easily used at no extra cost to establish further evolution of patients to treatment., (Celsius.)