Search

Urogenital fistulas are abnormal communications between the female genital and urinary tract; while such fistulas, which are the most commonly encountered, are located between the vagina and urinary bladder and are caused by the local extension of a tumoral process. Another frequently encountered cause is represented by the obstetric one, leading to the development of uterovesical fistulas. However, many questions regarding the diagnosis and management of uterovesical fistulas remain unanswered. Therefore, the aim of this article was to review the existent data so far, with special attention being focused on the pathogenic mechanisms leading to this complication, on the modalities of diagnosis, and on the possible therapeutic strategies. Therefore, according to the time of diagnosis, uterovesical fistulas can be classified as early fistulas, diagnosed in the first months postoperatively and late fistulas, diagnosed within several years from the initial surgical procedure. For early fistulas, a conservative therapeutic strategy can be taken in consideration, while in cases diagnosed after a longer period of time, a surgical approach should be taken into consideration. Meanwhile, although a surgical approach can cure most of the cases, attention should be given towards preventive strategies such as provision of quality obstetric care with improvements of surgical skills.

Peritoneal carcinomatosis colorectal cancer unfortunately represents a frequently encountered condition during the natural history of this malignancy which has been considered for a long period of time as a terminal event. However, once new surgical and oncological therapies have been reported significant changes have been reported in the management of these cases. Therefore, cytoreductive surgery to no residual disease as a stand-alone procedure or in association with intraperitoneal hyperthermic chemotherapy has been proposed and significant benefits in terms of survival have been reported; unfortunately not all patients with peritoneal carcinomatosis are candidates for this combined approach, especially if extended, nonresectable lesions are present. In such cases pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proposed with promising results. The aim of the current paper is to review the most important studies conducted on this issue.

Locally advanced and relapsed rectal cancer represent one of the most commonly reported indications for total pelvic exenteration especially in men, while in women the surgical procedure might be limited to a posterior exenteration. This procedure is still associated with high risks of postoperative complications and high rates of perioperative mortality, therefore careful selection of the cases is mandatory. However, in the last decades improvement in the field of oncology treatment leaded to the increase of the lifespan of patients diagnosed with rectal cancer; in this respect, it is easy to be understood the fact that an increased number of cases will develop at a certain moment of their evolution pelvic recurrences which need more extended surgical procedures at a more advanced age. Therefore, extended procedures such as pelvic exenterations are needed in these cases; the aim of this paper is to study whether pelvic exenteration is suitable for elderly patients and which cases could benefit most from this aggressive surgical approach.

Introduction. Pelvic recurrence is not a rare event after resection with curative intent for rectal cancer originating from different segments of the rectum (lower, intermediary and superior part). Material and methods. This retrospective observational study included 106 patients; among these cases there were 79 patients who accepted surgical treatment of rectal cancer (treated in a governmental hospital between 2014 and 2017) and who were submitted to anterior resection with Hartmann’s procedure (6.5% of patients), anterior resection of rectosigmoid with colorectal anastomosis (78% of cases) and abdominoperineal resection (15% of cases). Results. After a 2 year follow-up, pelvic recurrence was reported in 11patients ~ 14% of cases: 33% rate of recurrence after Hartmann procedure, 9% rate of recurrence after abdominoperineal resection, and 10% rate of recurrence after anterior resection of rectosigmoid with colorectal anastomosis. 39 patients (49% of cases) had been submitted to preoperative radiotherapy: the pelvic recurrence rate among these cases was of 11% (9 patients). The rate of recurrence (RR) was also significantly influenced by the stage at diagnostic: stage III had RR = 52% of cases, stage II had RR = 41% of cases and stage I had RR = 0% of cases). The survival rate among surgically treated patients after 1 one year was 86%, and 80% in the first 2 years after treatment. Conclusions. Rectal cancer diagnosed in advanced stages has a high recurrence rate. A low recurrence rate indicates successful curative surgical treatment. The highest recurrence rate was reported after Hartmann procedure (which was usually performed as an emergency operation for locally advanced lesions).

Background/Aim: Locally advanced pancreatic cancer has been considered for a long period of time as an unresectable lesion and therefore, all patients have been traditionally addressed to the oncological services for palliative purposes. However, due to the wide usage of newer oncological agents in association with improved surgical techniques, radical surgical procedures became feasible. The aim of this study was to present the different surgical procedures that were performed in locally advanced pancreatic cancer patients in order to achieve radical resections. Patients and Methods: Between 2019 and 2020, six cases were submitted to pancreatic and vascular resections in Fundeni Clinical Hospital. Results: In all cases, surgery with curative intent was attempted; portal vein resection was performed in five cases, whereas arterial resection was performed in three cases. Reconstruction was performed by direct re-anastomosis, by placing cadaveric or synthetic grafts. The postoperative outcomes were favourable in all cases. Conclusion: Vascular resections can be safely associated with pancreatic resections in cases presenting locally advanced pancreatic lesions, with acceptable morbidity rates.

Local recurrence (LR) of rectal cancer (RC) has a disease-free survival rate of up to 50% if diagnosed early. Endorectal ultrasound (ERUS) is an outpatient procedure that can be used together with rectal digital examination for patient follow-up. This is the first study to determine the diagnostic test accuracy of ERUS in the detection of LR after RC and whether it is a good follow-up method. Three authors independently searched MEDLINE and ClinicalTrials.gov databases and included relevant original studies based on strict inclusion/ exclusion criteria. 3220 articles were identified. After reading the abstracts, 50 articles were selected, out of which 22 were deemed suitable for study inclusion, comprising 3737 patients, which were followed for 59,72 -16,4 months. Based on the available data, sensitivity of ERUS was 88,3% (CI 84,6 - 91,3%), specificity was 94,3 % (CI 92,7 - 95,5%) and diagnostic odds ratio of ERUS was 271,88 (CI 76,998 - 960,04), with ERUS being the only diagnosis method to detect LR in 40 - 12%. Area under the curve for ERUS was 0,9723 - 0,0131. LR after curative treatment of RC in our study was 15 - 2,99%. Concluding, ERUS seems to be a good and efficient follow-up method for diagnosing RC LR.

Background/Aim: Locally advanced liver tumours with vascular invasion have been considered for a long period of time as unresectable lesions, so the patient was further deferred to oncology services for palliation. However, improvement of the surgical techniques and the results reported so far came to demonstrate that extended hepatic and vascular resections might be safely performed in such cases and might significantly improve the long-term outcomes. Materials and Methods: A 61-year-old patient was diagnosed with a caudate lobe tumour invading the inferior cava vein and the right hepatic pedicle. Results: The patient was successfully submitted to surgery, and an extended right hepatectomy en bloc with cava vein resection was performed; the continuity of the cava vein was re-established by the placement of a synthetic graft. The postoperative outcome was uneventful. Conclusions: Although initially considered as a formal contraindication for resection, vascular invasion of the greater vessels should not preclude surgery if complete resection is achievable.

Chondroid lipoma is a rare benign lesion affecting the breast, in which the diagnosis of malignancy is difficult to be excluded during preoperative studies. In this respect, a correct histopathological diagnosis is mandatory in order to avoid overdiagnosis and subsequently overtreatment. In the present study, the case of a 61-year-old patient who self-referred for the development of a large tumor at the level of the left breast is reported. Biopsy raised the suspicion of a chondroid lipoma; thus, the patient was submitted to conservative surgery. The lesion was completely excised by performing a total mastectomy. The histopathological studies confirmed the presence of chondroid lipoma, with no signs of malignant transformation. At the 24-month follow-up interval no signs of recurrence were detected. In conclusion, although it may reach significant dimensions, giant chondroid lipoma of the breast is a benign lesion that may benefit from conservative treatment and does not recur.