Search

Many recent scores based on the inflammatory response, such as Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), Lymphocyte Monocyte Ratio (LMR) have been demonstrated to have a prognostic value in cancer patients. The ratio between neutrophils and lymphocytes is a very useful tool, most studies admitting its role as a prognostic marker in cancer. We made a retrospective study on 391 patients hospitalized and operated in emergency for complicated colorectal cancer in the Surgery II clinic of the "St. Ap. Andrei" from Galati, Romania, between 2008-2017. We demonstrated that the increased preoperative value of NLR was a negative prognostic factor for long-term survival in patients with complicated colorectal cancer (HR = 7.581, 95% CI = (6.358,9.039) (p = 0.000000)). The cut-off point is > 2.61, with sensitivity of 73.61 and specificity of 100.00. The mean survival time in patients with NLR < = 2.61 was 39,676, 95% CI = (37,189, 42,163) and in those with NLR > 2.61 it was 12,504, 95% CI = (11,747, 13,261), the difference between the survival time of patients with values ​​above the cutoff and below the cutoff being statistically significant (p = 0.000000, Log-Rank).

Background Anastomotic leak (AL) is a common but severe complication after oesophagectomy. It is unknown how to determine the severity of AL objectively at diagnosis. Determining leak severity may guide treatment decisions and improve future research. This study aimed to identify leak-related prognostic factors for mortality, and to develop a Severity of oEsophageal Anastomotic Leak (SEAL) score. Methods This international, retrospective cohort study in 71 centres worldwide included patients with AL after oesophagectomy between 2011 and 2019. The primary endpoint was 90-day mortality. Leak-related prognostic factors were identified after adjusting for confounders and were included in multivariable logistic regression to develop the SEAL score. Four classes of leak severity (mild, moderate, severe, and critical) were defined based on the risk of 90-day mortality, and the score was validated internally. Results Some 1509 patients with AL were included and the 90-day mortality rate was 11.7 per cent. Twelve leak-related prognostic factors were included in the SEAL score. The score showed good calibration and discrimination (c-index 0.77, 95 per cent c.i. 0.73 to 0.81). Higher classes of leak severity graded by the SEAL score were associated with a significant increase in duration of ICU stay, healing time, Comprehensive Complication Index score, and Esophagectomy Complications Consensus Group classification. Conclusion The SEAL score grades leak severity into four classes by combining 12 leak-related predictors and can be used to the assess severity of AL after oesophagectomy.

Background: The increased rates of postoperative mortality after emergency surgery for obstructive colon cancer (OCC) require the use of risk-stratification scores. The study purpose is to external validate the surgical risk calculator (SRC) and the AFC/OCC score and to create a score for risk stratification. Patients and methods: Overall, 435 patients with emergency surgery for OCC were included in this retrospective study. We used statistical methods suitable for the aimed purpose. Results: Postoperative mortality was 11.72%. SRC performance: strong discrimination (AUC = 0.864) and excellent calibration (11.80% predicted versus 11.72% observed); AFC/OCC score performance: adequate discrimination (AUC = 0.787) and underestimated mortality (6.93% predicted versus 11.72% observed). We identified nine predictors of postoperative mortality: age > 70 years, CHF, ECOG > 2, sepsis, obesity or cachexia, creatinine (aN) or platelets (aN), and proximal tumors (AUC = 0.947). Based on the score, we obtained four risk groups of mortality rate: low risk (0.7%)—0–2 factors, medium risk (12.5%)—3 factors, high risk (40.0%)—4 factors, very high risk (84.4%)—5–6 factors. Conclusions: The two scores were externally validated. The easy identification of predictors and its performance recommend the mortality score of the Clinic County Emergency Hospital of Galați/OCC for clinical use.

Reflux disease continues to be one of the most common pathologies in the world. There is much discussion regarding the mechanism of developing and the variety of possible symptoms. In recent years, the use of new technologies, like high-resolution manometry and pH impedance, brought new insights into this disease. Also, there are emerging therapies that are covering the gap between the patients treated with proton-pump inhibitor (PPI) therapy and those who benefit the most from laparoscopic treatment (hiatal hernia, complications of gastroesophageal reflux disease (GERD). Also, most of them are less invasive than a laparoscopic fundoplication. We present a short review of the treatment options in patients who need more than lifestyle changes and PPI therapy.

Ovarian cancer is the most lethal gynecological oncological condition. He responds to primary surgical treatment, although the vast majority of patients are diagnosed in advanced stages of the disease, in which the rate of recurrences is increased and the chance of survival at 5 years is below 45%.

Caustic ingestion is a major health concern in both developed and developing countries, that may lead to serious esophageal and gastric injury.Initially, the ingestion of a caustic substance produces post-caustic esophagitis, this being the acute phase, which in time by chronicization and by the methods of tissue remodeling, by fibrosis determines the post-caustic esophageal stenosis.

Ovarian neoplasm responds to primary surgical treatment, although the vast majority of patients are diagnosed in advanced stages of the disease, in which the rate of relapses is increased and the chance of survival at 5 years is below 45%. It represents the most lethal gynecological oncological conditio

This study aimed to compare the postoperative and pathological outcomes between CROSS and FLOT in esophageal adenocarcinoma (EAC) patients from an international, multicenter cohort.Ongoing debate exists around optimum approach to locally advanced esophageal adenocarcinoma (EAC), with proponents for perioperative chemotherapy, such as FLOT, or multimodal therapy, in particular the CROSS regimen.Patients undergoing CROSS (n = 350) and FLOT (n = 368), followed by curative esophagectomy for EAC were identified from the Oesophagogastric Anastomosis Audit (OGAA).The 90-day mortality was higher after CROSS than FLOT (5% vs 1%, p = 0.005), even on adjusted analyses (odds ratio (OR): 3.97, CI95%: 1.34 - 13.67). Postoperative mortality in CROSS were related to higher pulmonary (74% vs 60%) and cardiac complications (42% vs 20%) compared to FLOT. CROSS was associated with higher pCR rates (18% vs 10%, p = 0.004) and margin-negative resections (93% vs 76%, p0.001) compared with FLOT. On adjusted analyses, CROSS was associated with higher pCR rates (OR: 2.05, CI95%: 1.26 - 3.34) and margin-negative resections (OR: 4.55, CI95%: 2.70 - 7.69) compared to FLOT.This study provides real-world data CROSS was associated with higher 90-day mortality than FLOT, related to cardio-pulmonary complications with CROSS. These warrant a further review into causes and mechanisms in selected patients, and at minimum suggest the need for strict radiation therapy quality assurance. Research into impact of higher pCR rates and R0 resections with CROSS compared to FLOT on long-term survival is needed.

OBJECTIVE This study aimed to characterize rates and management of anastomotic leak (AL) and conduit necrosis (CN) after esophagectomy in an international cohort. BACKGROUND Outcomes in patients with anastomotic complications of esophagectomy are currently uncertain. Optimum strategies to manage AL/CN are unknown, and have not been assessed in an international cohort. METHODS This prospective multicenter cohort study included patients undergoing esophagectomy for esophageal cancer between April 2018 and December 2018 (with 90 days of follow-up). The primary outcomes were AL and CN, as defined by the Esophageal Complications Consensus Group. The secondary outcomes included 90 day mortality and successful AL/CN management, defined as patients being alive at 90 day post-operatively, and requiring no further AL/CN treatment. RESULTS This study included 2247 esophagectomies across 137 hospitals in 41 countries. The AL rate was 14.2% (n = 319) and CN rate was 2.7% (n = 60). The overall 90-day mortality rate for patients with AL was 11.3%, and increased significantly with severity of AL (Type 1: 3.2% vs. Type 2: 13.2% vs. Type 3: 24.7%, p < 0.001); a similar trend was observed for CN. Of the 329 patients with AL/CN, primary management was successful in 69.6% of cases. Subsequent rounds of management lead to an increase in the rate of successful treatment, with cumulative success rates of 85.4% and 88.1% after secondary and tertiary management, respectively. CONCLUSION Patient outcomes worsen significantly with increasing AL and CN severity. Re-intervention after failed primary anastomotic complication management can be successful, hence surgeons should not be deterred from trying alternative management strategies.

In 1826, Lisfranc practiced a perineal circular incision, without opening the peritoneum. 50 years later, Verneuil and then Dolbeau and Denonvilliers practiced more extensive resections. In 1907, Lockart-Mummery described the operation that bears his name. In 1875, Kocher and Volkmann used the sacral approach that has been popularized by Kraske. Later, it became well known in the whole world and, with some little changes, it has been used in Europe by Bardenhaver, Hochenegg, Billroth, Rehn, Heinike and Rygidier and in the USA by Harrison Cripps, Edwards, Bevan and Grey Turner. Almost all of them resected the rectum and reestablished the continuity with a primary anastomosis. It seems that Volkmann practiced the combined abdominal and perineal approach for the first time in 1877, followed by Czerny and Köenning. Between 1896-1899, Quenu popularized this technique. In 1908, Ernest Miles began to use the technique and in 1914 he published the results. The resection of the posterior wall of the vagina in a rectum cancer has first been made by Hildebrant in 1879. The abdominal approach has been used by Hartmann in 1923. In 1930, Dixon together with Mayo, Waugh, Black and Judd described the “Mayo clinic operation”, meaning the resection of the rectal tumor with extraperitoneal anastomosis. They called that “anterior resection” and in 1948 they published their 20 years’ experience results and they definitely popularized the technique.

Esophageal stenosis is one of the most common sequels of caustic injury. After the ingestion, in the acute phase, the life support is sometimes critical, and the treatment varies from observation to esophagectomy. During the first 6 months, endoscopic dilation can be necessary in order to maintain the patency of the esophageal lumen. Usually, endoscopic dilation is the treatment of choice for caustic stenosis of the esophagus. Sometimes this procedure is not possible or too risky and then reconstruction surgery is needed, but no earlier than 6 months. We present the case of a 57 years old male who was referred to our clinic for the treatment of a mid-esophageal caustic stenosis, after the accidental ingestion of a concentrated alkaline substance 6 months before. After an initial successful endoscopic dilation, in the second attempt, due to the asymmetric position of the stenosis and the high risk of perforation, we decided to perform an esophageal by-pass. We chose to use the left colon for interposition, with the left branch of middle colic artery as the feeding source and the sigmoid trunk as the second arcade. The surgical procedure went uneventful, with restoration of normal oral feeding.

Introduction: Tumors of ileo-caecal valve are most clinically manifested either through transit disorders or anemic syndrome. The 88-year-old patient is admitted for abdominal pain in the left flank, vomiting, asthenia and lack of intestinal transit for faeces, with a progressive onset of one week. Clinical examination: generalized affected state, wide abdomen, painful left flank and hypochondrium, lack of intestinal transit and pallor. Paraclinic: severe hypochromic microchrome anemia (hemoglobin: 5.8 g / dl). Plain radiography: hydro-aeric levels in the left hypochondrium. Abdominal CT: ileo-colic intussusception that completely occupies the ascending colon to the hepatic flexure, with no visible tumoral lesions. After hydroelectrolytic and hemodynamic balancing with restoration of intestinal transit, colonoscopy is performed: 5 cm ulcer-vegetative tumor formation at the ileo-caecal valve level - biopsy with histopathological examination: moderately differentiated adenocarcinoma. Patient refuses surgery. After 3 weeks, the patient returns to the clinic for the recurrence of digestive symptoms and emergency surgery is performed: laparotomy by median suprasubombilical incision, finding: ileo-ceco-appendico-colic invagination up to the middle third of the transverse colon, defective attachment of ascending colon, ileum dilated with thick wall. The invagination is reduced, the tumor formation is discovered. Right hemicolectomy with ileotransversoanastomosis is performed. Postoperatively, the patient shows a simple evolution with discharge of the 9th postoperative day. Conclusions: The ileocolic invagination in adults is most often the appearance of a tumor located on mobile segments of the intestine. The right colon invagination is possible when there is a defect of acolation, anatomical peculiarity encountered in the presented case.

After caustic ingestion, patients may be either asymptomatic or may exhibit a variety of initial signs and symptoms, depending on the digestive segment predominantly affected. The DROOL system is a noninvasive scoring method used for the evaluation of esophageal lesions and has a good correlation with the development of esophageal stenosis. Management of these patients depends on several factors, including the presence of the symptomatology, in addition to the nature of the caustic substance. Upper endoscopy is indicated in the first 48 hours or after the first two weeks, when it is recommended to start endoscopic dilation sessions. If endoscopic treatment is inefficient, surgical treatment is required.

Globally, the colo-rectal cancer is the 4th in frequency of all neoplasia and in Romania is the 2nd, with a yearly tendency of increasing the number of new cases. The poor symptomatology in the inchoate stages and also the deficiency of effective screening programs lead to frequently late presentation of patients, with tumors in complicated stages, when the surgical operations, very often can no longer have a curative intention. We will present the results of a retrospective study during 10 years (2007-2016) that included 431 patients with complicated colo-rectal cancers, admitted and operated in the 2nd Surgery Clinic of the Clinical Emergency County Hospital “Sf. Ap. Andrei” from Galati, Romania. In 133 cases (30,9%), most of them occlusive, it was practiced in emergency a left iliac anus, leaving the tumor in its place. The Hartmann operation was practiced in 97 cases (22,5%). Anytime it was possible, we practiced operations with radical intentions, like: right hemicolectomy, in 46 cases (10,7%), left hemicolectomy, in 13 cases (3%), segmentary colectomy with anastomosis, in 30 cases (6,9%). Regarding the surgical operations in emergency, many of them don’t have a radical intention, taking into account the local invasion of the tumors and the metastasis. In these situations, a first surgical gesture is required, as an intervention that is meant to save the patient’s life, solving only the complication.

Cutaneous metastases from endometrial cancer are rare and unusual. This is the case of a 72 years old female patient, diagnosed in 2018 with G3 endometrial serous carcinoma (ESC). At 18 months from the surgical intervention, the patient developed bilateral inguinal lymph nodes metastases and skin secondary lesions; histological and immunohistochemical tests were performed. Computed tomography scan did not indicate visceral secondary lesions, local or regional relapses. We present the treatment practiced, the case's evolution and we discuss about epidemiology, molecular biology, treatment options and management of advanced and local lesions. The appearance of skin metastases in theses cases is associated with poor prognosis and treatment options are limited to palliative chemotherapy and radiotherapy.

The emergency surgery for colorectal cancer is associated with high rates of morbidity and mortality due to factors related to the characteristics of the patients but also the therapeutic attitude. This study aims to identify the surgical interventions associated with the postoperative complications, with the main causes of morbidity, with the reinterventions and with the postoperative deaths. We included in this retrospective study 431 patients hospitalized and operated in an emergency for complicated colorectal malignant tumors in the Surgery II Clinic of the Clinical Emergency County Hospital "Sf. Ap. Andrei from Galati, in the period 2008-2017. The patients data were collected from observation sheets, operative protocols, pathological, imaging and laboratory bulletins, at the time of the emergency intervention, as well as from those of subsequent admissions in patients who benefited from serial interventions. The postoperative morbidity was 10.44%. The resections with anastomosis were associated with the presence of postoperative complications (p 0.01): pseudomembranous colitis, (p 0.01) and postoperative intestinal occlusion (p 0.01). The practice of lymph node dissection was associated with postoperative complications (p 0.01): pseudomembranous colitis (p 0.01) and intestinal occlusion (p 0.01). The reinterventions were associated with resections with anastomosis (p 0.01), lymph node dissection (p 0.01) or patients with open /semi-open abdomen (p 0.04). The postoperative mortality was 9.28%. It was associated with the practice of lymph node dissection (p 0.01), of the ileostomy (p 0.01), with the open /semi-open abdomen (p 0.04). Patients with colostomy had the lowest number of hospitalization days (p 0.01). The resections with anastomosis per primam and the lymph node dissection were associated with morbidity. The type of main surgery did not influence the postoperative mortality, this being associated with the concomitant surgery: the lymph node dissection, the ileostomy, and the abdomen closure type. The reinterventions were associated with resections with anastomosis per primam, with lymph node dissection and with the open /semi-open abdomen. The duration of hospitalization was significantly shorter in patients with a colostomy.

Introduction: The inflammatory response plays a critical role in carcinogenesis. There are recent scores based on the systemic inflammatory response, such as neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), which have been shown to have prognostic value in cancer patients. These scores allow the identification of patients who will have poor response to treatment and poor survival. The aim of this study is to evaluate the prognostic role of NLR, PLR, LMR and PNI in terms of long-term survival in patients with colorectal cancer, operated in emergency. Material and Methods: We included 391 patients admitted and operated for complicated colorectal cancer in the Surgery II clinic of the Clinical Emergency County Hospital Sf. Ap. Andrei - from Galati, between 2008-2017. We analyzed the paraclinical factors of systemic inflammation NLR, PLR, MRL and PNI. As prognostic factors, survival curves were analyzed. Results: The high values of NLR and PLR increased the risk of death (HR = 7.581, 95% CI = (6.358,9.039), p value = 0.000000, respectively HR = 1.043, 95% CI = (1.039, 1.047), p value = 0.000000), and the increased values of LMR and PNI led to the decrease of this risk (HR = 0.069, 95% CI = (0.054.0.090), p value = 0.000000, respectively HR = 0.758, 95 % CI = (0.730.0.788), p value = 0.000000). In the multivariate regression analysis, the increase of PLR resulted in an increase in the risk of death (HR = 1.024, 95% CI = (1.019.1.029), p value = 0.000000), and for the LMR and PNI, a reduction of the risk of death (HR = 0.353, 95% CI = (0.248.0.504), p value = 0.000000, respectively HR = 0.852, 95% CI = (0.822.0.883), p value = 0.000000). Conclusions: The univariate analysis showed that NLR and PLR are risk factors, and LMR and PNI are protective factors in terms of survival. The multivariate analysis revealed that PLR is an independent risk factor, and LMR and PNI were independent protection factors.

Introduction: Ovarian cancer is one of most fatal gynecological condition. The number of patients diagnosed in advanced stages is very high, hence the recurrence rate is high, and the chance of survival at 5 years is less than 45%. Purpose: To evaluate correspondance between overall survival with clinical, paraclinical, tumor or treatment characteristics and to identify prognostic factors in patients with advanced ovarian cancer - stage III and IV FIGO. Material and Method: We performed a retrospective study in 65 patients with advanced ovarian cancer - stages III and IV FIGO operated during 2010-2018, with a follow-up period of at least one year. There were correlations with clinical and paraclinical charateristics, tumor or treatment characteristics and with overall survival. Results: In the univariate statistical analysis of survival, a significant statistical association is obtained by the presence of pelvic pain at presentation (p_value = 0.033744), with the stage III (p_value = 0.007595, respectively p_value = 0.022090), with the type of citoreduction (p_value = 0.035) , with postoperative complications (p_value = 0.000685) within the pathological subtypes (p_value = 0.046266), with adjuvant treatment (p_value = 0.000083). Cox multivariate regression analysis showed that adjuvant chemotherapy (HR = 0.046, 95% CI = (0.008, 0.261), (p_value = 0.000492), suboptimal cytoreduction (HR = 0.346, 95% CI = (0.140, 0.853), (p_value) = 0.021219) and postoperative complications (HR = 53,751, 95% CI = (4,672, 618,365), (p_value = 0.001389) are independent prognostic factors. Conclusions: Absence of pelvic pain at diagnosis, FIGO IIIC stage, suboptimal cytoreduction, presence of postoperative complications, inadequate adjuvant treatment and pathological type of clear cell cancer have been shown to be prognostic factors for overall survival. In patients with advanced ovarian cancer, the type of optimal citoreduction and adjuvant treatment are independent protective factors for overall survival, and the presence of postoperative complications has been shown to be an independent risk factor.

In the last decades, by improving the oncological treatment, the life expectancy of the adolescent patients with ovarian cancer has been increased and more than that they have succeeded by a real chance of obtaining a future pregnancy. Thus, the problem of preserving fertility becomes paramount both for patients who have suffered from an oncological disease and for those up to the age of 40 who have fertility problems.

Ovarian neoplasm is extremely aggressive and has a high mortality rate among affected women; therefore, the crucial role of screening tests is easy to understand. Prevention and early diagnosis should be essential priorities in the management of this malignancy. Since a complete and correct clinical examination can select the cases that require specialized investigations, we can consider it a first screening test.

Introduction: The predilection of lobular invasive breast cancer metastasis for the stomach is a topic that has succumbed to various assumptions over the time. Background and Aims: Gastric metastasis of lobular breast cancer is unusual and it can be diagnosed after a long period of time from primary tumor diagnosis. The aim of this study was to review current knowledge regarding the current methods of diagnosis and treatment of gastric metastasis of breast cancer. Methods: A systematic literature search was performed in the Pub-Med Medline database using the terms "gastric metastasis of lobular breast cancer" and "gastric metastasis features" to identify articles relevant to gastric metastasis of lobular breast cancer. Results: Several papers have shown that the topic is rarely presented in the form of case presentations or miniseries by summing up sporadic cases. Due to its rarity and metastasis specificity as host type and appearance after latency of lobular breast cancer makes its gastric metastasis considered atypical and occasionally confused with a primary stomach malignancy. The most recent articles present the immunohistochemical diagnostic criteria of this clinical entity and a new therapeutic approach. Conclusion: At patients with gastric metastasis of lobular breast cancer, obtaining pathologic material and biopsies interpretation can be a real challenge for getting a correct pathologic diagnosis, immunohistochemistry gives us definite diagnosis. The introduction of an endoscopic surveillance protocol for patients with lobular breast cancer could be a proposal for the detection of early gastric metastases allowing for appropriate therapy.

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

Introduction: Choosing the optimal treatment for patients with complicated colon cancer operated in an emergency remains a challenge. The study aims to identify the factors that influence the therapeutic decision in these patients. Patients and Methods: We included in this retrospective study 449 patients operated in emergency for complicated colon cancer, in the Clinical Emergency County Hospital "St. Ap. Andrei" Galati between 2008-2017. The patients data were collected from the observation sheets, the surgical, imaging and laboratory protocols. Results: The operations performed were: resections with a stoma in 37.63% of cases, resections with anastomosis in 36.97%, stomas in 16.26% and internal derivations in 9.13% of patients. Elderly age was correlated with stomas with or without tumour resection (p 0.05). Preoperative diagnosis of IDH was associated with resections with anastomosis, those with occlusion were associated with internal derivations and those with digestive perforations with resections with a stoma (p 0.05). The stomas were associated with the presence of intraoperatively detected complications (p 0.05). Conclusions: Complicated colon tumours operated on in an emergency require surgical treatment tailored to each patient. It is important to choose the type of treatment taking into account the patient's condition at admission, clinical-paraclinical data, tumour location, tumour complication and the presence of other complications detected intraoperatively.

Introduction: The GIST tumors are very rare entities ( 1% of all tumors). They originate in the Cajal interstitial cells, which are part of the autonomic nervous system of the intestine. Their most common location is the stomach, followed by the small intestine. The aim of this paper is to present a very rare case of perforated ileal GIST, associated with Meckel diverticulum. Case report: A 71 years old patient with comorbidities is admitted in emergency for symptoms and signs of acute surgical abdomen. The exploratory laparotomy reveals generalized acute peritonitis due to perforated ileal tumor and Meckel's diverticulum. A segmental enterectomy is performed, with favorable postoperative evolution. The histological examination of the resection piece shows the appearance of GIST, confirmed immunohistochemically. Conclusions: The GIST tumors of the small intestine are unusual tumors and the spontaneous perforation and life-threatening hemorrhage are a rarity. The main treatment for this form of GIST is the resection, with a favorable clinical outcome.

Introduction: In 2018, the colon cancer was the 5th type of neoplasia regarding the cancer mortality and the rectal cancer was the 10th. The survival of patients with colorectal cancer operated in emergency still remains unsatisfactory, the death being due to local recurrences and to metastases. The aim of this study is to evaluate some correlations of overall survival with clinic and paraclinic features, tumor or treatment characteristics in order to identify prognostic factors, for cases with colorectal tumors that underwent emergency surgery. Material and Methods: We performed a retrospective analysis on 431 patients with colorectal cancer operated in emergency between 2008-2017, excluding 40 patients with postoperative deaths, with a follow-up period of at least one year. There were correlations of some clinic and paraclinic features, tumor or treatment characteristics with the overall survival. Results: In the univariate statistical survival analysis, a statistically significant association was obtained with: the age 61 years (p_value = 0.000049), abdominal surgical history (p_value = 0.031725), heart disease (p_value = 0.000007), atrial fibrillation (p_value = 0.007496), preoperative diagnosis (p_value = 0.034352), cachexia (p_value = 0.000000), oliguria (p_value = 0.000000), anemia (p_value = 0.000006) hydro-electrolytic disorders (p_value = 0.000001), tumor localization (p_value = 0.000030), invasion into other organs (p_value = 0.000000), appearance of "frozen pelvis" (p_value = 0.000000), peritoneal carcinomatosis (p_value = 0.000000), liver metastases (p_value = 0.000000), type of surgery (p_value = 0.000000), lymph node dissection (p_value = 0.000001), liver biopsy (p_value = 0.043483), stoma reversal (p_value = 0.000000 ), serial interventions (p_value = 0.000000), pTNM (p_value = 0.000000), tumor grading (p_value = 0.007069). The Cox multivariate regression analysis revealed that: the age 61 years - HR = 1,026, 95% CI (1,012, 1,039) (p value = 0.000139), cachexia - HR = 1,358, 95% CI (1,046, 1,764) (p value = 0.021617), peritoneal carcinomatosis - HR = 2.346, 95% CI (1.163, 4.732) (p_value = 0.017253), disease stage - HR = 36.745, 95% CI (14.778, 91.366) (p_ value = 0.000000), intervention type - HR = 0.187, 95% CI (0.045, 0.779) (p_ value = 0.021281) and serial interventions - HR = 0.282, 95% CI (0.144.0.551) (p_ value = 000213) are independent prognostic factors. Conclusions: The prognostic factors for patients with colorectal cancers operated in emergency are: the age 61, the presence of abdominal surgical history and associated cardiac conditions, especially atrial fibrillation, diagnosis of diastatic perforation imminence, cachexia, oliguria, hydro-electrolytic disorders at admission, rectal tumors, tumor invasion in other organs, the appearance of "frozen pelvis", the presence of liver metastases or peritoneal carcinomatosis, undifferentiated tumors, stage IV, practicing an internal derivation or not performing lymph node dissection. The age over 61, cachexia, as well as peritoneal carcinomatosis, stage III or IV are independent risk factors the Hartmann procedure and the serial interventions are independent protective factors.

Background: Numerous procedures for reconstruction after total gastrectomy have been proposed in order to achieve the lowest postoperative morbidity. Roux-en-Y esojejunostomy is widely accepted as a standard reconstruction technique due to its simplicity and its satisfactory nutritional outcomes. The construction of a gastric pouch and the maintenance of the duodenal transit have been proposed to ameliorate the quality of life of patients with gastric cancer. The aim of this study is to assess the quality of life of patients with different types of reconstruction after total gastrectomy. Material and Method: A systematic literature search was performed in PubMed, Science Direct, Wiley Online, Springer Link, up to December 1, 2019. Only original articles published in English were included. Quality of life was measured using different instruments. Postoperative aspects of reflux oesophagitis, dumping syndrome, food intake and weight status were evaluated. Results: 15 studies were included in this research. Three techniques for restoring the digestive tract continuity were compared: Roux-en-Y eso-jejunostomy, jejunal interposition and gastric pouch construction. The statistical results of the included studies were evaluated in terms of quality of life or weight status. Conclusions: The length of the alimentary limb for prophylaxis of eso-jejunal reflux should be at least 50 cm, but not more than 60 cm for the prevention of malabsorption. The quality of life was significantly better in patients with gastric pouch. Maintaining the duodenal transit does not seem to bring any benefit in quality of life or weight status, even if this is a physiological way.

Introduction: Achalasia is the most common esophageal motility disorder. So far, the treatment, which can be medical, endoscopic or surgical, provides only symptomatic relief. However, this can grant a normal life to the patients. We focused our study on the value of pre- and intraoperative endoscopy and manometry for improving outcome of surgical treatment. Material and method This is a retrospective chart review of a cohort of patients diagnosed with achalasia at St Mary Clinical Hospital, Bucharest between 2013 and 2017. The objective of this study was the assessment of the immediate and long term efficacy of laparoscopic Heller myotomy associated with Dor anterior fundoplication, intraoperative endoscopy and intraoperative manometry, as well as the assessment of late post-operative complications. The diagnosis of achalasia was based on symptoms, barium esophagogram, upper endoscopy and esophageal manometry. The immediate efficacy was assessed by comparing Eckhart score, LES pressure and LES vector volume before and after surgery. Results: In total, 47 patients, had surgical treatment for achalasia between 2013 and 2017. For 7 patients who failed prior endoscopic or surgical, this was the second therapeutic intervention. 39 patients underwent laparoscopic surgery, 30 patients had associated intraoperative endoscopy and, 22 patients had associated intraoperative manometry. There was a significant improvement in mean Eckardt score (from 6,5 to 1,26, p 0,001), mean LES pressure (from 18,5 mmHg to 7 mmHg, p 0,001). Morbidity was 2,12 % and we have had 1 recurrence and 2 postoperative esophagitis. Conclusions: At present, laparoscopic Heller myotomy with an anterior Dor fundoplication, is a standard indication in achalasia, proving its efficiency and safety. Intraoperative use of endoscopy is recommended and intraoperative manometry may provide additional information on the effectiveness of myotomy. Surgical treatment of achalasia should be performed in specialized, experienced centers.

Scope neoadjuvant RCT influence on early and long term postoperative outcomes in patients with locally advanced esophagogastric junction adenocarcinomas. Materials and method Sixty two patients with locally advanced esophagogastric junction adenocarcinomas were treated at the Center of Excellence in Esophageal Surgery at St. Mary Hospital between 2010-2017. According to the Siewert classification, the group comprised of type I - 11 patients, type II - 18 patients and type III - 33 patients. Only 17 patients received preoperative RCT. The surgical treatment for the 62 resected patients was: abdominal extended gastrectomy - 40 patients, Ivor-Lewis - 13 patients, McKeown esophagogastrectomy (3 incisions) - 5 patients and transhiatal esophagectomy - 4 patients. Results: Postoperative morbidity was 46.77% and was mainly represented by fistulas in 17 patients and pulmonary complications such as pleurisy,pneumonia and ARDS in 12 patients. Fistula occurred in 15 cases: grade 1 - 2 patients, grade 2 - 10 patients, grade 3 - 5 patients. Postoperative mortality was 4.8% (p_value = 0.017980 Fisher's Exact Test). Downstaging was observed in 7 patients. I did not encounter statistically significant differences in long term survival. Conclusions: Neoadjuvant RCT had no impact on postoperative morbidity, but statistically influenced postoperative mortality.

Introduction: The Zenker Diverticulum is a rare pathology, the selection of patients for invasive treatments is questionable, as well as the applied therapeutic method. The aim of the study is to evaluate the main methods of classical and endoscopic surgical treatment in this pathology and to correlate pathophysiological aspects with clinical consequences. MATERIAL AND METHOD We included 36 patients with Zenker hypopharyngeal diverticulum treated in 2010/2017 in two university clinics: 7 patients by classical surgical approach at the General and Esophageal Surgery Clinic of St. Mary's Hospital Bucharest and 29 patients with endoscopic approach at Department of Diagnostic and Interventional Digestive Endoscopy of the Regional Institute of Hepatology and Gastroenterology Prof Dr Octavian Fodor, Cluj-Napoca. The age of the patients ranged from 42 to 84 years and in the 7th to 15th decade. Results: Cricopharyngeal myotomy was performed in all patients. Diverticullectomy was performed in 7 patients treated surgically. The average hospitalization duration was 4 days. Intra-procedural complications showed 3 patients treated endoscopically and consisted of laminar haemorrhage. Two patients were treated with endoscopic endoscopic hemostasis and hot pens and one patient had endoscopic hemostasis with clips. The post-procedural complications were: local pain, leukocytosis, melena, fever, cervical hematoma. These post-treatment events were seen in 6 patients. The posttreatment morbidity was 16.66%. Conclusions: In patients included in the batch, the endoscopic treatment efficiency was 80%. Peristent postinterventional symptomatology was mainly represented by dysphagia, post-procedural syndrome was associated with dysphagia persistence. Patients with persistent post-surgical symptoms were required to reintervention.

Esophageal diverticulum has an incidence of less than 1% in the population, 70% occur in the cervical esophagus and are known as Zenker diverticulum. The treatment is indicated in symptomatic patients - dysphagia being a constant symptom. Current treatment includes minimally invasive transoral tehnics for septum dividing between diverticulum and esophagus, either with stapler or via interventional endoscopy, as well as the open technique: diverticullectomy with cervical crycopharyngiomyotomy - for large diverticulums. We present the case of a 74-yo patient, with dysphagia, regurgitation, and weight loss with progressive 2-year evolution. After an ambulatory thyroid ultrasonography that raised suspicion of a Zenker diverticulum, was reffered to gastroenterology service, where UGI endoscopy have not revealed esophageal pathology and recommends cervical CT: a voluminous diverticulous pouch in contact with the left sternocleidomastoid muscle with food remnants. (Fig.A) She is admitted to hospital for further investigations. Barium swallow: an oval round image in the cervical region, approximately the size of 3 cervical vertebrae, retentive (fig. B) EDS: broad diverticular communication with cervical esophagus, voluminous diverticulum with food and barium remnants(Fig. C) A cervical approach was decided: diverticulumlectomy with a TA 55mm stapler (Fig. D), the stapling line was reinforced by another polyglicolic 3-0 serumuscular running suture and cricopharyngeal myotomy (Fig. E) The postoperative evolution was unremarkable. The low incidence of this disease and the actual management controversy are recommendations for the treatment of patients in clinics with experience in esophageal surgery.

The purpose of this paper is to present the advantages and disadvantages of neoadjuvant RCT in multimodal therapyof ESC.Between 1998-2014 221 patients were treated with ESC, 85 of whom received neoadjuvant RCT. For these we have made imaging and pathologic assessment of response using RECIST and MANDARD criteria and statistical data were interpreted in terms of the factors that influence the response. Also, they were evaluated statistical correlations between RCT and resectability, postoperative morbidity, mortality and long-term survival.45 patients were imagistic responders and 34 underwent surgery, 40 non-responders of which 14 underwent surgery. Of the 48 surgical patients with preoperative RCT, histopathological evaluation showed that 32 were pathological responders and 16 non responders. There were performed statistical analyzes of correlations between RCT and resectability, stage, location of ESC, morbidity, mortality and survival.RCT increase resectability, improves survival and maximum duration of survival, more in responders than in nonresponders and does not affect postoperative complications and postoperative mortality, nor among the responders or nonresponders. Imaging evaluation result of the response to RCT overestimate responders.

Adenocarcinoma of the gastroesophageal junction is more common in the West. Preoperative chemotherapy or chemoradiotherapy is performed for locally advanced disease. Recent studies are suggesting higher rates of curative resection and reduced rates of local recurrence in patients with neoadjuvant combination of chemotherapy and radiation therapy. The role of targeted agents in neoadjuvant therapy is under investigation.

The 8th edition of TNM cancer staging is based on data from large patient cohorts, data collected from the Worldwide Collaboration Cancer Esophageal (WECC) group, or the International Association for Gastric Cancer (IGCA), including treated patients surgically per primate or after neoadjuvant treatment. This edition redefines the esophago-gastric junction tumors and recommends different TNMs staging: Siewert type I and II should be classified according to TNM recommendations for esophageal adenocarcinoma, while for Siewert type III the TNM classification for gastric cancer should be considered. Anatomical characteristics feature type T (tumor invasion), type N (regional lymph node invasion) and type M (distant metastasis). Non-anatomic characteristics include tumor differentiation (G) and tumor localization (L). Category descriptors are currently evaluated by endoscopy with biopsy, fine needle aspiration (EUS-FNA), thoraco-abdomino-pelvic computer tomography (CT) and positron emission tomography (CT-PET). The new TNM staging edition presents separate classifications applicable for therapeutic strategy: clinical staging cTNM (prior to any treatment), pathological staging pTNM (after surgery first) and neoadjuvant pathologic staging ypTNM (after neoadjuvant treatment followed by surgery). The refinement of each category and subcategory of T, N, M makes the 8th edition more accurate and adaptable to current practice, including for therapeutic strategy. The purpose of this study is to evaluate the clinical and therapeutical implications of the 8th edition of the TNM staging for esophago gastric junction adenocarcinoma.

Aim: The goal of this study is to evaluate the open packing of the lesser sac (OPLS) in treatment of infected severe acute pancreatitis Methodology: The study was based on 98 cases in which this technique was applied during the period between 19942007, in two departments of surgery (Clinical Hospital CF 2 and Clinical Hospital ?Sf. Maria” Bucharest). The technique was applied based on the therapeutically protocol previously established beginning with 2000. The OPLS technique was analyzed relatively to: timing of surgery, the localization of the infected necrosis or abscesses, growing germs on the cultures, antibiotics received, executed primarily or at reintervention, the number of debridement, hospitalization, morbidity and mortality. The information was statistically processed using SPSS test version 17 for Windows. Results: The OPLS technique improved the control of the local sepsis, in the retrospective/prospective study in 83.7%. Mortality was 16.3% (16/98), with a global mortality of 26.3% (75/285) and a postoperative mortality of 29.5% (66/224). Conclusions: Considering the fact that the intensive care techniques are approximately the same in the last 15 years, we thought that this improvement in the survival rate may be due to the application of OPLS in cases with indication and optimal timing for surgery.

Colonic cancer is the most common malignancy of the digestive tract, representing 13% of all malignancies. The aim of the study is to evaluate the current therapeutic strategy in patients with CC. Mortality from the disease is declining in many Western countries; this may be the result of screening for CC, resection of adenomas, early detection of tumoral lesions and the use of individualized therapeutic strategies. The multimodal treatment of the disease includes different sequences such as: surgery, chemotherapy, radiotherapy,immunotherapy. Current advances in the research of mechanisms of carcinogenesis in CC make it possible to use genetic information in order to establish the prognostic and predictive factors for selecting the patients for individualized therapy. The current methods of CC evaluation allow the planning of individualized therapeutic strategies, which would lead to optimal results.

Carcinosarcoma is a rare form of ovarian cancer with mixed origin, and its association with mature teratoma is extremely rare. We present the case of patient T. M. aged 67, admitted into our clinic on the 15/05/2016, F.O. 4877 for the increase of the abdominal volume. On admission, the patient was afebrile, conscious, cooperative, cardio-respiratory balanced, having the abdomen distended in volume, sharp dullness in the flanks, positive wave sign bioumoral within normal limits except: uric acid = 6.64 mg / dL, serum glucose = 113.7 mg / dl, serum total proteins = 8.65 g / dl, the albumin / globulin subunit, CRP 33.63 mg / l, sideremia 51 ug / dl, CA 125 = 588.4 IU. Abdominal ultrasound: high volume fluid and multiple perihepatic formations and multiple formations with cystic transformation in the abdomen and pelvis. CT exam describes multiple tissular masses localized intraperitoneal in the abdominal-pelvic region, sheath fluid effusion, infiltrative, with mass effect on the digestive lumens, without visible CT obstruction. Surgical treatment consisted in evacuation of the ascites fluid, excision of the tumoral lumps situated in the great omentum, omentectomy, excision of the lumps of the gastrocolic ligament, bilateral ovariectomy and hysterectomy. Postoperative simple evolution. Histopathology confirmed the diagnosis of bilateral ovarian carcinosarcoma associated with tridermic mature teratoma (presence of brain tissue areas associated with cartilage, transitional type epithelium, tubal type epithelium, endometrial stroma type and fatty tissue). IHC confirms the compatibility with the diagnosis of ovarian carcinosarcoma (mixed malignant Mullerian tumor). The patient followed adjuvant polichemotherapy. The association of teratoma with carcinosarcomatoase elements confers a poor prognosis case.

The management in severe acute pancreatitis evolved in the last two decades. Consulting the literature and the accumulated clinical experience manage to the release of this study based on the comparison of the treatment in PAS between two distinct periods: 1994-1999 (retrospective) and 2000-2007 (prospective). Among the 285 patients whit PAS admitted and treated in the two departments, 224 (78.6%) was submitted to the surgical intervention with various surgical indications. There is an obvious difference between the retrospective and prospective studies concerning the indication of surgery and mostly the timing for surgery. The lots were analyzed concerning the etiology, management of treatments and specific treatments, and the timing of the surgical intervention was analyzed based on the specific etiologic treatment and the period of time between the admission and the first surgical intervention, the mark being the 21 day according with the recommendations of the International Association of Pancreatology. There were analyzed: the period of time between the onset of the disease and the surgical intervention, the status of the patients at the surgical moment, the global mortality based on the timing of surgery, the evolution of the management of PAS along the period of the research, comparisons whit the literature. The registered data were statistically processed using the SPSS test version 17 for Windows.

The reflux of the gastric juice in the esophagus can determine the injury of the esophageal epithelium. When the healing of the lesion is done by replacing the normal squamous epithelium with columnar epithelium, the entity is called Barrett’s esophagus (BE). Although controversial, some studies showed 0,5% per year the incidence of the esophageal adenocarcinoma in patients with BE, 30 times more often than general population. Taking into consideration the possible development of an adenocarcinoma, the patients with Barrett’s esophagus require endoscopic surveillance after a standardized protocol. There is still much controversy about the treatment of patients with Barrett’s esophagus, especially in the presence of dysplasia. The aims of the treatment are gastro-esophageal reflux symptoms control, healing of associated esophagitis and prevention of development of adenocarcinoma.

Primary retroperitoneal tumors are relatively rare and the histological characters vary. We present the case of a retroperitoneal lipoma in a 51-year-old male patient, whose main complain was enlarging of the abdomen in the last 2 months. The CT of the abdomen and pelvis revealed a giant retroperitoneal tumor. The patient suffered a surgical intervention that revealed a giant retroperitoneal tumor, 40/35 cm, weighting 14 Kg. The pathology exam established the diagnosis: retroperitoneal lipoma with areas of necrosis and lipogranulomatosis. The postoperative evolution was simple.