Introducere: Cancerul colorectal este unul dintre cele mai frecvent întâlnite tumori maligne ale sistemului digestiv, incidenţa acestei boli crude crescând constant. Materiale şi Metode: 236 de pacienţi diagnosticaţi cu cancer de colon drept au fost revizuiţi retrospectiv. Pentru toţi pacienţii incluşi în acest studiu, hemicolectomie dreaptă sau hemicolectomie dreaptă extinsă cu anastomoză ileo-colonică a fost efectuată. Pacienţii au fost împărţiţi în două grupuri: grupul de studiu incluzând pacienţi care au dezvoltat fistulă de anastomoză şi grupul de control, incluzând pacienţi fără fistulă. Date clinice, chirurgicale, postoperatorii şi împrejurările apariţiei fistulelor anastomotice (AL) au fost evaluate. Studiul investighează posibilii factori de risc şi de protecţie pentru dezvoltarea fistulelor anastomotice şi nu în ultimul rând studiează relaţia dintre fistulă de anastomoză şi mortalitatea. Rezultate: factori de risc cum ar fi vârstă înaintată, tumorile 1/3 drepte ale colonului transvers, intervenţiile chirurgicale de urgenţă, sutură mecanică, anastomoza L-T, reluarea tardivă a motilităţii intestinale au fost identificate în timpul cercetării. Anastomoza L-L a fost identificată ca factor protector în dezvoltarea fistulei de anastomoză. Concluzii: Conform rezultatelor cercetării, în cazul tumorilor colonului drept, anastomoza ileo-transversă L-L ar trebui adaptată, având ceea mai scăzută rată în ceea ce priveşte dezvoltarea fistulei de anastomoză.

Introducere: Cancerul colorectal (CRC) se numără printre principalele cauze de deces cauzate de cancer în întreaga lume. Pacienţii vârstnici sunt adesea consideraţi ca fiind o categorie cu risc crescut, predispuşi la complicaţii postoperatorii. Materiale şi metode: 138 pacienţi cu vârsta de peste 75 de ani şi diagnosticaţi cu cancer colorectal au fost revizuiţi retrospectiv. Pacienţii au fost împărţiţi în două grupuri: Grupul de studiupacienţii care au dezvoltat complicaţii postoperatorii, şi Grupul de control-pacienţii fără probleme în perioada postoperatorie. Au fost comparate date clinice, preoperatorii, chirurgicale, postoperatorii şi oncologice. Scopul studiului a fost de a determina posibili factori de risc în apariţia complicaţiilor postoperatorii şi de a analiza influenţa acestora asupra mortalităţii. Rezultate: Factori de risc cum ar fi sexul bărbătesc, obezitate, insuficienţa cardiacă, diabet zaharat tip II, anemie severă, hipoproteinemie, clasificare ASA III-IV, intervenţiile chirurgicale efectuate în urgenţă, timp operator îndelungat, sângerări semnificative intra-operatorie, internare prelungită, localizare distală a formaţiunilor tumorale, stadiile TNM III-IV, antecedente de cancer digestiv operat sau alte operaţii abdominale majore necanceroase efectuate au fost identificaţi. Concluzii: Tratamentul chirurgical al cancerului colorectal în cazul populaţiei cu vârstă înaintată rămâne o provocare, această categorie de pacienţi trebuie să beneficieze de o atenţie deosebită pentru a asigura o şansă de a minimaliza sau evita aceste complicaţii.

This study was designed with an aim to share our experience of primary pelvic exenterations. The study included 23 patients with different types of pelvic cancer enrolled at a single institution between November 2011 and July 2020. The patient mean age was 55 years (range, 43-72 years) and the oncological indications included: Stage IVa cervical cancer (11 cases, 48.9%), stage IVa endometrial cancer (1 case, 4.3%), stage IVa vaginal cancer (6 cases, 26%), stage IIIb bladder cancer (3 cases, 13%), stage IIIc rectal cancer (1 case, 4.3%) and undifferentiated pelvic sarcoma (1 case, 4.3%). Total, anterior, and posterior pelvic exenterations were performed on 34.4, 56.5 and 13% of cases, respectively. Related to levator ani muscle, 13 (56.5%) pelvic exenterations were supralevatorian, 10 (43.5%) infralevatorian, and 5 (21.7%) were infralevatorian with vulvectomy. No major intraoperative complications occurred. Seven patients (30.5%) developed early complications, 4 of them (17.4%) required reoperation and 1 (4.3%) perioperative death caused by a pulmonary embolism was recorded. Only 1 patient experienced a late complication, a urostomy stenosis. Over a median follow-up period of 35 months, 8 (34.8%) patients died. The median overall survival (OS) was 33 months (range, 1-96 months). The 2-year and 5-year survival rates were 72 and 66%, respectively. Primary pelvic exenteration may be related with various postoperative complications, without high perioperative morality and with long-term survival.

Objective To describe the laterally extended parametrectomy (LEP) surgical technique, emphasizing the main challenges of the procedure.Methods LEP was designed as a more radical surgical procedure aiming to remove the entire parametrial tissue from the pelvic sidewall. Its initial indications were for lymph node positive Stage Ib (current International Federation of Gynecology and Obstetrics 2018 Stage IIIc) and Stage IIb cervical cancer. Currently, with most guidelines recommending definitive radiochemotherapy for these cases, initial LEP indications have become debatable. LEP is now mainly indicated for removing tumors involving the soft structures of the pelvic sidewall during a pelvic exenteration, aiming to obtain lateral free margins. This expands the lateral borders of the dissection to not only the medial surface of internal iliac vessels, but also to the true limits of the pelvic sidewall.Results During LEP, the parietal and visceral branches of the hypogastric vessels are divided at the entry and exit level of the pelvis. Consequently, the entire internal iliac system is excised, and no connective or lymphatic tissue remain on the pelvic sidewall. The main technical challenges of LEP are caused by the difficulty in ligating large caliber vessels (internal iliac artery and vein) and the variable anatomic distribution of pelvic sidewall veins.Conclusion LEP is a feasible technique for removing pelvic sidewall recurrences, aiming to obtain surgical free margins.

Objective: The aim of the study was to assess the factors associated with increased mortality in patients with acute mesenteric ischemia, emphasizing the importance of an early diagnosis and a prompt surgical intervention in order to avoid lesion progression. Materials and method: A retrospective analytical study was conducted on a study population of 50 male and female patients with acute ischemia of the mesenteric arteries, aged between 36-92 years. Demographic and pathological history characteristics were assessed, together with presented symptoms, laboratory and CT findings, as well as surgical outcome and time-related aspects between presentation in the emergency department and time of surgery, as well as the hospitalization period until discharge or death. Results: Muscular defense (OR = 23.05) and shock (OR = 13.24) as symptoms were strongly associated with a poor prognosis, while elevated values of lactate dehydrogenase (p = 0.0440) and creatine kinase (p = 0.0025) were associated with higher death rates. The time elapsed during investigations in the emergency room was significantly higher in patients who deceased (p = 0.0023), similarly to the total time from the onset of symptoms to the beginning of surgery (p = 0.0032). Surgical outcomes showed that patients with segmental ischemia of the small bowel had significantly higher chances of survival (p <0.0001). Conclusion: Increased mortality rates in patients presenting in the emergency department for acute mesenteric ischemia were observed in patients with occlusion of the superior mesenteric artery, with higher levels of CK and LDH, as well as with longer periods of stay in the emergency department for diagnostic procedures until the commencement of the surgical intervention. Therefore, proper investigations in a timely manner followed by a specific and prompt surgical intervention may avoid unfavorable evolution of patients towards death.